GI Flashcards
1
Q
Mean age of onset for Chron’s?
A
26
2
Q
Mean age of onset for UC?
A
34
3
Q
Where does Chron’s affect?
A
Any part of gut, commonly terminal ileum
4
Q
Where does UC affect?
A
Below the ileo caecal valve, if it goes above the caecum it’s called backwash ileitis
5
Q
What antibody does UC test positive for?
A
pANCA (Perinuclear Anti-Neutrophil Cytoplasmic Antibodies), Chron’s tests negative
6
Q
Which disease is smoking protective for and which is it a RF for?
A
UC - protective
Chron’s - RF
7
Q
What is a distinguishing common symtom of Chron’s?
A
Mouth ulcers
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)
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
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
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
12
Q
What is diagnostic for UC and Chron’s?
A
Chron’s - colonoscopy
UC- sigmoidoscopy
(+biopsy)
13
Q
Histology of Chron’s?
A
- Skip lesions
- Transmural inflammation
- Non caseating Granulomas
- Increase in goblet cells
14
Q
Histology of UC?
A
- Superficial inflam - mucosal
- Continous
- Crypt abscesses
- Goblet cell depletion
- Ulcers
15
Q
Complications of Chron’s
A
Obstruction (due to fibrosis)
Fistulas
Adenocarcinoma of the distal ileum
Osteoporosis
16
Q
Complications of UC
A
Perforation, Toxic Megacolon
COMPLICATIONS RARE WITH UC – more common in crohns
17
Q
What is the severity staging criteria for UC called?
A
True Love and Witts severity index
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)
19
Q
Chron’s drug treatment?
A
- initiate remission 1. oral prednisolone
- maintenance - azathioprine/ mercaptopurine
- 2nd line methotrexate
- unresponsive - influximab (anti TNF)
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.
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
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
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)
24
Q
Coeliac antibodies
A
Anti-gliadin
Anti-transglutaminase
Anti-endomysial
25
Ix for coeliac's
Blood tests
Small bowel biopsy (4-6 diagnostic)
Antibodies
26
Tx for coeliac's
Gluten free diet (lactose free if necessary)
Supplementation
Pneumococcal vaccine (Due to decreased spleen function in some)
Manage Anaemia
27
Histology of coeliac's
Villous atrophy
Crypt hyperplasia
Increased lymphocytic infiltration
28
Complications of coeliac's
- Malabsorptive problems e.g. osteopenia, iron deficiency anaemia
And
- Increases risk of Colon cancer
29
Appendicitis symptoms
```
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
```
30
Appendicitis signs
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
31
Complications of appendicitis
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.
32
Dx appendicitis
Generic inflammatory/infection markers (CRP, ESR, WCC)
US and CT
laparatomy
33
Mx appendicitis
Metronidazole
IV abx
Appendectomy
34
What do you use to know the likelihood of surgery in appendicitis?
Alvarado score
> 7 operate
< 4 unlikely
35
Cause of acute peritonitis?
Infection or irritation due to:
Perforation
Appendicitis
Cholecystitis
36
Symptoms of acute peritonitis?
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
Signs of acute peritonitis?
Washboard rigidity - pain worse by movement
No bowel signs
low bp, tachycardia, tachypnoea
38
Dx acute peritionitis?
Erect CXR - air under diaphragm
| Serum amylase- pancreatitis?
39
Tx acute peritonitis?
Resusc with fluids, Abx, Possible surgical intervention
40
Peptic ulcer definition?
Caused by break in the normal mucosal layer exposing the underlying tissue to the corrosive action of the GI tract.
41
Three most common causes of peptic ulcers?
H.PYLORI!
Smoking
NSAID USE
42
Sx of peptic ulcers?
(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
Syndrome causing peptic ulcers?
Zollinger- Ellison syndrome - recurrent peptic ulcers, gastrinoma secreting gastrin
44
Ix for peptic ulcers?
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
Tx for peptic ulcers?
TRIPLE THERAPY
Omeprazole, Metronidazole (amoxicillin) and Clarithromycin (1PPI and 2ABx)
Also change lifestyle (NSAIDS stop, alcohol, smoking)
46
Complications for peptic ulcers?
Perforation
| Haemorrhage if overlies a blood vessel
47
Define diverticulosis
The presence of diverticulae in the large intestine
48
Define diverticular disease
The presence of symptoms resulting from the existence of diverticulae in the large intestine
49
Define (acute) diverticulitis
Ongoing inflammation of one or more diverticulae
50
Cause diverticular disease
Thickening of the muscle layer and because of high intraluminal pressure, pouches of mucosa go through the wall at weak points
51
Symptoms of diverticular disease
95% asymptomatic, LIF pain intermittently, erratic bowel habit
52
Investigations of diverticular disease
Flexible sigmoidoscopy, Barium enema
53
Complications of diverticular disease
Perforations, Fistula formation (possible bladder obstruction)
54
Treatment of diverticular disease
Diet more fibre, Smooth muscle relaxants
55
Sx of diverticulitis
LIF pain, Fever, abdo guarding, tachycardia (similar to appendicitis but on the left)
56
Ix of diverticulitis
US, Bloods (ESR, CRP), possible sigmoidoscopy
57
Tx of diverticulitis
Cephalosporin and Metronidazole
58
What drugs can cause acute pancreatitis?
Azathioprine
59
Ix and dx for acute pancreatitis
(Dx ) SERUM AMYLASE and LIPASE, ERCP/MRCP, Upper abdo CXR – flecks of calcification
60
Sx of acute pancreatitis
Central abdo pain RADIATING TO BACK, better when sitting forward accompanied by nausea/vomiting
Steatorrhea
Oliguria
61
Sx of chronic pancreatitis
Upper abdo pain intermittently, tachycardia, hypotension
Steatorrhea
Oliguria
62
Examination signs of pancreatitis
```
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
Cx of pancreatitis
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
Assessing severity of pancreatitis
```
Glasgow scoring system (PANCREAS)
PO2 Oxygen < 60mmHg or 7.9kPa
Age > 55
Neutrophilia White blood cells > 15
Calcium < 2 mmol/L
Renal Urea > 16 mmol/L
Enzymes Lactate dehydrogenase (LDH) > 600iu/L Aspartate transaminase (AST) > 200iu/L
Albumin < 32g/L
Sugar Glucose > 10 mmol/L
```
65
Tx of acute pancreatitis
Resusc with fluids, Cefuroxime
66
Tx of chronic pancreatitis
Pancreatic enzyme supplements, NSAIDS and opiates for the pain, fat soluble vits (ADEK)
67
Causes of small bowel obstruction (80% of all intestinal obstructions)
```
Adhesions
Hernias
Tumour
Crohn’s
Volvulus
Gallstone Ileus
```
68
Px of small bowel obstruction
Colicky abdominal pain
Loops of bowel may be palpable
Vomiting
Abdominal Distension
69
What so you find on an abdo radiograph of gallstone ileus?
Rigler's triad:
- small bowel obstruction
- a gallstone outside the gallbladder
- air in the bile ducts.
70
Cx of small bowel obstruction
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
Ix for small bowel obstruction
AXR
Bloods (look for anaemia and electrolyte imbalance)
Laparotomy is diagnostic but not undertaken lightly
72
Mx of small bowel obstruction
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
Define GORD
Reflux of the acidic stomach contents into the oesophagus.
74
RF for GORD
Can be caused by Smoking, Obesity, Hiatus hernia, Certain food/drink and sphincter dysfunction, higher risk in pregnancy
75
Px of GORD
Heartburn
| Can present similarly to an MI
76
Ix of GORD
Endoscopy
| Barium swallow to asses hiatus hernia or strictures
77
Cx of GORD
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
Mx of GORD
```
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
What is a hernia?
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
What is an irreducible hernia?
Hernia cannot be pushed back where it should be
81
What is an incarcerated hernia?
Contents of the hernia are stuck inside it
82
What is an obstructed hernia?
Bowel is obstructed by the hernia
83
What is a strangulated hernia?
Ischaemia of the tissue inside the hernia
84
What is a direct inguinal hernia?
- 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
What is an indirect inguinal hernia?
- 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
Mx of hernias
May require surgical repair
Reducing the hernia can prevent strangulation from occurring
Dx: clinical and examination
87
LFT's quick summary
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
How would you differentiate between an inguinal hernia and a tumour in the testes?
Can't get above an inguinal hernia
89
Mallory Weiss tear
A tear in the mucosa of the oesophagus, common in alcoholics and bulemics
