GI Flashcards
What is often the main cause of gastritis?
H. pylori
What does it suggest if neutrophils are present in oesophagitis?
It is acute
What are the key features that coeliac disease presents with?
Anaemia
Weight loss
Diarhoea
What are the complications of coeliac disease?
Anaemia
Oesteoporosis
Dermatitis herpetiformis
What are the key histological features of coeliac disease?
Villous atrophy
Crypt hyperplasia
Intra epithelial lymphocytosis
Lamina propria rich in plasma cells
What are the complications associated with diverticulitis?
Fistula
Obstruction
Haemorrhage
Perforation
Super infection with CMV/ C.diff
What diseases is Ulcerative colitis associated with?
Primary biliary cirhosis
Ankylosing spondolytis
What are the key histological features of UC?
Punctate ulcers Psuedopolyps Haemorrhagic colonic mucosa Basal plasmocytosis Crypt abscesses Mucin depletion Inflammation (diffuse)
What is microscopic colitis?
A condition which typically affects middle aged women, with profuse longstanding diarrhoea, with a normal colonoscopy.
There is thickened collagen between the epithelium, with lymphocytic inflammation, associated with autoimmune conditions and NSAID use.
What are the two main types of oesophageal cancer?
- Squamous cell carcinoma- increased risk in smoking, alcohol, low protein diet, HPV infection
- Adenocarcinoma- develops from Barretts metaplasia, chronic GORD, increased risk in alcohol, smoking, obesity, NSAIDs
What are the main causes of dysphagia?
- Mechanical block eg. malignancy, stricture, extrinsic pressure eg. lung cancer, mediastinal mass, AAA, retrosternal goitre, or pharyngeal pouch
- Motility disorders eg. achalasia, oesphahgeal spasm, or bulbar palsy
- Oesophagitis
Give examples of anti-emetics.
D2 receptors- Metoclopramide, Deompeidone
H1 receptors- Cyclizine
What is the triple therapy for H.pylori infection?
- PPI eg. omeprazole
- Clarithromycin
- Amoxicillin/ Metronidazole
What are the symptoms of a duodenal ulcer?
Can be asymptomatic, or can have epigastric pain (after eating) and weight loss.
Which drugs can be used in GORD?
Antacids eg. Magnesium trisilicate
Alginates eg. Gaviscon
What are the commonest causes of upper GI bleeding?
Oesophageal varices Mallory-Weiss tears Peptic ulcers Malignancy Oesophagitis Duodenitis Drugs- NSAIDs, steroids, anticoagulants
What are the causes of gastric/ oesophageal varices?
Portal hypertension Thrombosis Cirrhosis Schistosomiasis Right sided heart failure
What are wet and dry beriberi?
Beriberi is a severe form of Vitamin B1 (thiamine) deficiency. It involves heart failure with…
Oedema (wet) or
Neuropathy (Dry)
What are the usual symptoms of acute pancreatitis?
Epigastric pain which radiates to the back.
Pain is relieved on sitting forward, or a hot water bottle on the back.
Vomitting
Jaundice
Bruising (grey turners/ cullens signs)
What can be the complications of acute pancreatitis?
Pseudocyst Chronic pancreatitis Sepsis Bleeding Pulmonary oedema/ effusion Necrosis Cholecystitis DIC
What is the Modified Glasgow Score?
To calculate the severity of Acute Pancreatitis: P- PaO2 LOW A- Age HIGH N- WCC HIGH C- Calcium LOW R- Urea HIGH E- LDH HIGH A- Albumin LOW S- Glucose HIGH
What are gallstones composed of
- Bilirubin- large, often solitary. Increased risk with age and obesity.
- Pigment- small, irregular.
- Mixed stones- salt, pigment and cholesterol.
What are the main presentations of gallstones?
- Biliary colic- intermittent RUQ pain
- Acute cholecystitis- RUQ/ epigastric pain, fever, vomitting, gallbladder mass. Stone in the gallbladder neck. Murphy’s sign positive.
- Chronic cholecystitis- vague abdominal pain, flatulence, fat intolerance. chronic inflammation
- Ascending cholangitis- RUQ pain, fever and jaundice = Charcot’s Triad. Infection
- Gallstone ileus
- Pancreatitis
- Empyema
- Gallbladder necrosis
What is Courvoisier’s Law?
Painless jaundice and a palpable gallbladder= unlikely to be gallstones, likely to be pancreatic or cholangiocarcinoma.
What are examples of the causes of epigastric pain?
MI Pneumonia GORD Duodenal/ gastric ulcer Gastritis Acute pancreatitis Acute cholecystitis Biliary colic Cancer Visceral perforation Trauma
What is Primary Biliary Cholangitis?
Autoimmune liver disease
90% are WOMEN aged over 50 years
It is a chronic autoimmune granulomatous inflammation, which leads to cholestasis
May lead to fibrosis, cirrhosis and portal hypertension.
What are the features of PBC?
Often asymptomatic RAISED ANTI-MITOCHONDRIAL ANTIBODY Raised ALP levels, mildly raised AST/ALT Finger clubbing Pruritis Lethargy Jaundice Xanthelasma, xanthomata Hepatosplenomegaly Malabsorption of fat soluble vitamins
How does acute cholecystitis present?
RUQ/epigastric pain Fever Vomitting GB mass Murphy's sign positive
How does CHRONIC cholecystitis present?
Vague abdo pain
Flatulence
Fat intolerance
Chronic inflammation
How does ascending cholangitis present?
CHARCOT’S TRIAD:
- Fever
- RUQ pain
- Jaundice
How does obstructive jaundice present?
Epigastric pain
What are the most common causes of SMALL bowel obstruction?
- Adhesions
- Hernias
- Crohn’s disease
- Malignancy
What are the most common causes of LARGE bowel obstruction?
- Malignancy
- Diverticular disease
- Colonic volvulus
What is colonic volvulus?
When the mesentery of the sigmoid colon twists so that the segment of bowel twists
This loop can become ischemic due to compromised blood supply
Which triad may present in haemochromatosis?
- Tanned skin
- Cirrhosis
- Diabetes
Which diabetes medication is associated with weight gain?
Glicazide (sulfonylurea)
_______________ may present with chronic central abdominal pain, steatorhoea and weight loss.
Chronic pancreatitis
Which antibiotic can be given for cholecystitis?
Co-amoxiclav
What are the symptoms of chronic pancreatitis?
Steatorrhoea
Weight loss
Bloating
How can C. diff infection be treated?
Vancomycin
Metronidazole
Which skin complaints may be seen in IBD?
Erythema nodosum
Pyoderma gangrenosum
Which type of GI cancer has a signet ring appearance histologically?
Gastric adenocarcinoma
If a patient finds it difficult to initiate swallowing, what does this suggest?
Bulbar palsy- LMN lesion of CN 9-12
If a patient is suffering with intermittent dysphagia, what does this suggest?
Oesophageal spasm
If a patient with dysphagia has a neck bulge/ gurgle on drinking, what does this suggest?
Pharyngeal pouch
What is achalasia?
Failure of the lower oesophageal sphincter to relax
Due to degeneration of myenteric plexus
Causes dysphagia
What can cause a benign oesophageal stricture?
GORD
Surgery
What is dyspepsia?
Indigestion
Which type of ulcer is more common: gastric or duodenal?
Duodenal
4X more common
What can cause a duodenal ulcer?
H. Pylori infection NSAIDs Steroids Smoking Excess acid secretion
The Rockall Score is used for predicting mortality from_____________________
Upper GI bleeding
What are the likely causes of bloody diarrhoea?
- Infection- Campylobacter, Shigella, Salmonella, E.coli
- Ulcerative collitis
- Crohn’s
- Colonic cancer
- Polyps
What can cause steatorrhoea?
Chronic pancreatitis
Biliary obstruction
Abscorbic acid (Vitamin C) is used to treat ________
Scurvy
How may gallstone ileus appear on Xray?
- Air in the common bile duct
- Small bowel dilated and fluid filled loops
- Gallstone
Which patients is PBC most common in?
Females
Aged 50 years
Which patients is PSC most common in?
Males
Aged 20-40 years
Which autoimmune liver disease is most associated with UC?
PSC
What are the signs/ symptoms of PBC?
Often asymptomatic Finger clubbing Pruritis Lethargy Jaundice Xanthelasma, xanthomata Hepatosplenomegaly
What are the signs/ symptoms of PSC?
Pruritis
Lethargy
Cirrhosis
What are the 2 types of hiatus hernia?
- Sliding hiatus hernia (80%) - gastro-oesophageal junction slides up into chest
- Rolling hiatus hernia (20%) - gastro-oesophageal junction remains in abdomen
What are the commonest causes of small bowel obstruction?
Adhesion
Hernias
What are the commonest causes of large bowel obstruction?
Colon cancer Diverticular strictures Volvulus Sigmoid volvulus Constipation
How does small bowel obstruction present?
Vomitting earlier than large bowel obstruction
Less distension than large bowel obstruction
How does large bowel obstruction present?
Vomitting later than small bowel obstruction
More distended than small bowel obstruction
