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Phase 2a hockey teaching > GI > Flashcards

GI Flashcards

1
Q

Mean age of onset for Chron’s?

A

26

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2
Q

Mean age of onset for UC?

A

34

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3
Q

Where does Chron’s affect?

A

Any part of gut, commonly terminal ileum

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4
Q

Where does UC affect?

A

Below the ileo caecal valve, if it goes above the caecum it’s called backwash ileitis

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5
Q

What antibody does UC test positive for?

A

pANCA (Perinuclear Anti-Neutrophil Cytoplasmic Antibodies), Chron’s tests negative

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6
Q

Which disease is smoking protective for and which is it a RF for?

A

UC - protective

Chron’s - RF

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7
Q

What is a distinguishing common symtom of Chron’s?

A

Mouth ulcers

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8
Q

Chron’s symptoms?

A 
Right iliac fossa (LQ) mass/pain
Diarrhoea
Blood in stool
Malabsorption- B12, iron def anaemia
(sign - acutely can sound like appendicitis)
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9
Q

UC symtoms?

A

Diarrhoea due to excess mucus
Bloating
If it says finger up the bum with blood on it think UC
May have weight loss and malaise

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10
Q

Extraintestinal symptoms of UC and Chron’s?

A 
Large joint arthritis
Irisitis, Episcleritis
erythema nodosum (on shins most common in UC)
mouth ulcers (mouth and vagina?
Pyoderma gangrenosum

PRIMARY SCLEROSING CHOLANGITIS AND UVEITIS = MORE COMMON IN UC

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11
Q

What would a barium swallow for Chron’s and UC show?

A

Chron’s - cobblestone appearance

UC - loss of haustrations, drain pipe colon

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12
Q

What is diagnostic for UC and Chron’s?

A

Chron’s - colonoscopy
UC- sigmoidoscopy
(+biopsy)

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13
Q

Histology of Chron’s?

A
  • Skip lesions
  • Transmural inflammation
  • Non caseating Granulomas
  • Increase in goblet cells
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14
Q

Histology of UC?

A
  • Superficial inflam - mucosal
  • Continous
  • Crypt abscesses
  • Goblet cell depletion
  • Ulcers
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15
Q

Complications of Chron’s

A

Obstruction (due to fibrosis)
Fistulas
Adenocarcinoma of the distal ileum
Osteoporosis

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16
Q

Complications of UC

A

Perforation, Toxic Megacolon

COMPLICATIONS RARE WITH UC – more common in crohns

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17
Q

What is the severity staging criteria for UC called?

A

True Love and Witts severity index

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18
Q

What investigations will you do for UC and Chron’s?

A
  • Colonoscopy and biopsy
  • Barium swallow
  • FBC - anaemia of chronic disease, iron deficient anaemia (B12 often ileum), ESR and CRP raised, low albumin (severe)
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19
Q

Chron’s drug treatment?

A
  • initiate remission 1. oral prednisolone
  • maintenance - azathioprine/ mercaptopurine
  • 2nd line methotrexate
  • unresponsive - influximab (anti TNF)
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20
Q

UC drug treatment?

A

Initiate remission

  • 1st line- Mild: Mesalazine/alamine (5-aminosalicylic acid)
  • Moderate: steroids (pred) then 5ASA
  • Severe: IV hydrocortisone
  • 2nd line: azathioprine, methotrexate (immunosuppressants)

Maintenance

  • 1st line: 5-ASA
  • 2nd Line: immunosuppressant e.g. azathioprine, methotrexate.
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21
Q

UC and Chron’s non drug treatment

A

Chron’s stop smoking
B12 and iron supplementation
80% will require surgery – the two surgical options – Ileocaecal resection, Stricturoplasty

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22
Q

Define Coeliac’s?

A

T Cell mediated Autoimmune disease caused by an abnormal reaction to GLUTEN resulting in damage and inflammation of intestinal tract

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23
Q

Symptoms of coeliac’s?

A

Malabsorption – Weight loss (buttock wasting in children)
Diarrhoea and steatorrhea
Bloating and Indigestion
Iron deficiency Anaemia (Often initial diagnosis)

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24
Q

Coeliac antibodies

A

Anti-gliadin
Anti-transglutaminase
Anti-endomysial

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25
Q

Ix for coeliac’s

A

Blood tests
Small bowel biopsy (4-6 diagnostic)
Antibodies

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26
Q

Tx for coeliac’s

A

Gluten free diet (lactose free if necessary)
Supplementation
Pneumococcal vaccine (Due to decreased spleen function in some)
Manage Anaemia

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27
Q

Histology of coeliac’s

A

Villous atrophy
Crypt hyperplasia
Increased lymphocytic infiltration

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28
Q

Complications of coeliac’s

A
  • Malabsorptive problems e.g. osteopenia, iron deficiency anaemia
    And
  • Increases risk of Colon cancer
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29
Q

Appendicitis symptoms

A 
Starts central pain (visceral all over) then moves to lower R quadrant when peritoneum involved
Pain radiate to shoulder
Pyrexia
Pain on Walking
Nausea
Loss of appetite
Testicular pain in men
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30
Q

Appendicitis signs

A

Rovsing’s sign - press on the left lower quadrant and pain is felt in the right lower quadrant
Dunphy’s sign - coughing causes pain in mcburney’s point
Mcburney’s sign (do on both sides) - rebound tenderness, press in, when take away - pain

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31
Q

Complications of appendicitis

A

Ischaemia as a result of exudate build up and toxic damage to the blood vessels
This leads to Gangrene – And eventually perforation causing peritonitis, septicaemia and ultimately a gruesome death.

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32
Q

Dx appendicitis

A

Generic inflammatory/infection markers (CRP, ESR, WCC)
US and CT
laparatomy

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33
Q

Mx appendicitis

A

Metronidazole
IV abx
Appendectomy

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34
Q

What do you use to know the likelihood of surgery in appendicitis?

A

Alvarado score
> 7 operate
< 4 unlikely

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35
Q

Cause of acute peritonitis?

A

Infection or irritation due to:
Perforation
Appendicitis
Cholecystitis

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36
Q

Symptoms of acute peritonitis?

A

Sudden onset acute abdo pain exacerbated by movement (eg coughing)
Often the pain may be generalised then localised (due to the poorly locating visceral fibres affected first, then the better locating parietals get involved)
Collapse, Shock

37
Q

Signs of acute peritonitis?

A

Washboard rigidity - pain worse by movement
No bowel signs
low bp, tachycardia, tachypnoea

38
Q

Dx acute peritionitis?

A

Erect CXR - air under diaphragm

Serum amylase- pancreatitis?

39
Q

Tx acute peritonitis?

A

Resusc with fluids, Abx, Possible surgical intervention

40
Q

Peptic ulcer definition?

A

Caused by break in the normal mucosal layer exposing the underlying tissue to the corrosive action of the GI tract.

41
Q

Three most common causes of peptic ulcers?

A

H.PYLORI!
Smoking
NSAID USE

42
Q

Sx of peptic ulcers?

A

(50% asymptomatic)
Epigastric burning pain - *GNAWING pain
Weight loss (might not eat due to the pain), Vomiting (rare)
Tiredness (anaemia ??)
Duodenal = WORSE AT NIGHT/HUNGRY (pain may radiate to the back in these ones)
Gastric = WORSE ON EATING

43
Q

Syndrome causing peptic ulcers?

A

Zollinger- Ellison syndrome - recurrent peptic ulcers, gastrinoma secreting gastrin

44
Q

Ix for peptic ulcers?

A

1st line = Stool test
Urea breath test (H. Pylori gives off ammonia)
Endoscopy – done in anyone over 55 with red flag symptoms
Serum IgG antibodies (although cannot see if treatment has worked as levels remain high)
FBC - anaemia

45
Q

Tx for peptic ulcers?

A

TRIPLE THERAPY
Omeprazole, Metronidazole (amoxicillin) and Clarithromycin (1PPI and 2ABx)
Also change lifestyle (NSAIDS stop, alcohol, smoking)

46
Q

Complications for peptic ulcers?

A

Perforation

Haemorrhage if overlies a blood vessel

47
Q

Define diverticulosis

A

The presence of diverticulae in the large intestine

48
Q

Define diverticular disease

A

The presence of symptoms resulting from the existence of diverticulae in the large intestine

49
Q

Define (acute) diverticulitis

A

Ongoing inflammation of one or more diverticulae

50
Q

Cause diverticular disease

A

Thickening of the muscle layer and because of high intraluminal pressure, pouches of mucosa go through the wall at weak points

51
Q

Symptoms of diverticular disease

A

95% asymptomatic, LIF pain intermittently, erratic bowel habit

52
Q

Investigations of diverticular disease

A

Flexible sigmoidoscopy, Barium enema

53
Q

Complications of diverticular disease

A

Perforations, Fistula formation (possible bladder obstruction)

54
Q

Treatment of diverticular disease

A

Diet more fibre, Smooth muscle relaxants

55
Q

Sx of diverticulitis

A

LIF pain, Fever, abdo guarding, tachycardia (similar to appendicitis but on the left)

56
Q

Ix of diverticulitis

A

US, Bloods (ESR, CRP), possible sigmoidoscopy

57
Q

Tx of diverticulitis

A

Cephalosporin and Metronidazole

58
Q

What drugs can cause acute pancreatitis?

A

Azathioprine

59
Q

Ix and dx for acute pancreatitis

A

(Dx ) SERUM AMYLASE and LIPASE, ERCP/MRCP, Upper abdo CXR – flecks of calcification

60
Q

Sx of acute pancreatitis

A

Central abdo pain RADIATING TO BACK, better when sitting forward accompanied by nausea/vomiting

Steatorrhea
Oliguria

61
Q

Sx of chronic pancreatitis

A

Upper abdo pain intermittently, tachycardia, hypotension

Steatorrhea
Oliguria

62
Q

Examination signs of pancreatitis

A 
Guarding
Reduced/absent bowel sounds
Periumbilical bruising (Cullen’s sign) 
Flank bruising (Grey Turners)
Released lipases causes fat necrosis within abdomen = GREY TURNERS SIGN
63
Q

Cx of pancreatitis

A

Cysts
Abscesses
Destruction of the Islets of Langerhans = DIABETES
ARDS = Pulmonary failure in acute pancreatitis (circulating digestive enzymes (eg trypsin, phospholipase A2) = lose of surfactant = ARDS and pleural effusion)
Fluid shift

64
Q

Assessing severity of pancreatitis

A 
Glasgow scoring system (PANCREAS)
PO2Oxygen< 60mmHg or 7.9kPa
Age > 55
NeutrophiliaWhite blood cells> 15
Calcium< 2mmol/L
RenalUrea> 16mmol/L
EnzymesLactate dehydrogenase(LDH) > 600iu/LAspartate transaminase(AST) > 200iu/L
Albumin< 32g/L
SugarGlucose> 10mmol/L
65
Q

Tx of acute pancreatitis

A

Resusc with fluids, Cefuroxime

66
Q

Tx of chronic pancreatitis

A

Pancreatic enzyme supplements, NSAIDS and opiates for the pain, fat soluble vits (ADEK)

67
Q

Causes of small bowel obstruction (80% of all intestinal obstructions)

A 
Adhesions
Hernias
Tumour
Crohn’s 
Volvulus
Gallstone Ileus
68
Q

Px of small bowel obstruction

A

Colicky abdominal pain
Loops of bowel may be palpable
Vomiting
Abdominal Distension

69
Q

What so you find on an abdo radiograph of gallstone ileus?

A

Rigler’s triad:

  • small bowel obstruction
  • a gallstone outside the gallbladder
  • air in the bile ducts.
70
Q

Cx of small bowel obstruction

A

Dilation of proximal bowel, and the collapse of distal bowel. The normal secretory and digestive functions of the mucosa become impaired.

Strangulated Obstruction occurs when bloody supply cut. Leads to ischaemia and gangrene, sometimes within 6 hours.

71
Q

Ix for small bowel obstruction

A

AXR
Bloods (look for anaemia and electrolyte imbalance)
Laparotomy is diagnostic but not undertaken lightly

72
Q

Mx of small bowel obstruction

A

Catheter
Analgesia
TED Stockings
NG tube to decompress small bowel, nil by mouth
Rehydrate Patient with potassium crystalloid
SURGERY – In cases of ischaemia this must be performed immediately, also performed in cases of closed loop obstruction

73
Q

Define GORD

A

Reflux of the acidic stomach contents into the oesophagus.

74
Q

RF for GORD

A

Can be caused by Smoking, Obesity, Hiatus hernia, Certain food/drink and sphincter dysfunction, higher risk in pregnancy

75
Q

Px of GORD

A

Heartburn

Can present similarly to an MI

76
Q

Ix of GORD

A

Endoscopy

Barium swallow to asses hiatus hernia or strictures

77
Q

Cx of GORD

A

GORD can lead to metaplasia = Barrett’s oesophagus (considered a premalignant conditions – oesophageal adenocarcinoma)
Anaemia – due to blood loss
Lower Oesophageal Sphincter Stricture caused by fibrosis due to damage from stomach contents

78
Q

Mx of GORD

A 
Antacids - 1st line
H2 blocker/antagonist - rinitidine 
PPIs 
Lose weight
Smoking cessation
Alcohol intake reduction
Avoid eating late at night
Sleep with more pillows
79
Q

What is a hernia?

A

It is when an organ pushes through and opening in the muscle or tissue that holds it in place
E.g. Intestines through a weakened abdominal wall.
Essentially when a structure escapes from where
it should be and ends up somewhere else

80
Q

What is an irreducible hernia?

A

Hernia cannot be pushed back where it should be

81
Q

What is an incarcerated hernia?

A

Contents of the hernia are stuck inside it

82
Q

What is an obstructed hernia?

A

Bowel is obstructed by the hernia

83
Q

What is a strangulated hernia?

A

Ischaemia of the tissue inside the hernia

84
Q

What is a direct inguinal hernia?

A
  • medial to inferior epigastric artery (slides into DM- Direct Medial)
  • weakness in the posterior wall of the inguinal canal forcing intestine through into the IC
  • Direct come through the muscle into the inguinal canal
85
Q

What is an indirect inguinal hernia?

A
  • lateral to inferior epigastric artery
  • The abdominal contents pass through the deep inguinal ring, passing through the inguinal canal and can exit via superficial ring. Ring not closed up in birth.
  • Indirect come through the deep inguinal ring into the inguinal canal and can be strangulated by the deep ring
86
Q

Mx of hernias

A

May require surgical repair
Reducing the hernia can prevent strangulation from occurring

Dx: clinical and examination

87
Q

LFT’s quick summary

A

AST and ALT are your transaminases – these are raised in PARENCHYMAL LIVER PROBLEMS e.g. hepatitis, NAFLD, Cirrhosis

GGT – raised in ALCOHOL!

If ALP and GGT are raised this indicates an OBSTRUCTIVE PICTURE e.g. gallstones, cholangitis, primary biliary sclerosis

88
Q

How would you differentiate between an inguinal hernia and a tumour in the testes?

A

Can’t get above an inguinal hernia

89
Q

Mallory Weiss tear

A

A tear in the mucosa of the oesophagus, common in alcoholics and bulemics

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