GI Flashcards
1
Q
what is GORD?
A
Exposure of squamous mucosa to refluxed acid leads to cell injury and accelerated desquamation- compensated for by basal cell hyperplasia
2
Q
what is the aetiology of GORD?
A
- Oesophageal sphincter hypotension
- Hiatus hernia
- Systemic sclerosis
- Obesity
- Smoking
- Alcohol
- Pregnancy
- Slow gastric emptying
3
Q
how does GORD present clinically?
A
heartburn, chronic cough, laryngitis
4
Q
what are some differential diagnoses of GORD?
A
- oesophagitis
- duodenal cancer
- sphincter of Oddi malfunction
5
Q
how is GORD treated?
A
- lifestyle mod- weight loss, reduce alcohol intake, smoking cessation
- antacids
- proton-pump inhibitors
- H2 receptor antagonists
6
Q
what is Barrets oesophagus?
A
- long term consequence of reflux
- metaplasia from squamous to columnar epithelium
- increased risk of oesophageal carcinoma
7
Q
what is a Mallory-Weiss tear?
A
rupture of the oesophageal mucosa due to repeated retching and vomiting
8
Q
how long does a Mallory-Weiss tear take to heal?
A
bleeding stops after 1-2 days, tear takes 10 days to heal
9
Q
what are peptic ulcers?
A
Peptic ulcers are a breach in the mucosa lining the alimentary tract as a result of acid and pepsin attack.
10
Q
what can cause peptic ulcers?
A
- Hyperacidity
- Helicobacter gastritis
- Duodena-gastric reflux
- NSAIDS
- Smoking
- Genetic
11
Q
how do peptic ulcers present clinically?
A
- Epigastric pain
- Bloating
- Fullness
- Heartburn
- Tender epigastrium
12
Q
how can a suspected diagnosis of a peptic ulcer.be confirmed?
A
- endoscopy
- barium meal
13
Q
what are some differential diagnoses of peptic ulcers?
A
Non-ulcer dyspepsia GORD Gastric malignancy Duodenitis Gastritis
14
Q
how are peptic ulcers treated?
A
depends upon H. pylori test- if positive= omeprazole, metronidazole and clarithromycin
if negative= stop NSAIDs, treat with PPI
15
Q
what is the difference between acute and chronic peptic ulcers?
A
A.Acute- develop as part of acute gastritis, a complication of severe stress or a result of extreme hyperacidity
B.Chronic ulcers- occur most frequently at mucosal junctions- where acid and pepsin come into contact with mucosa, caused by failure of mucosal defence
16
Q
what can cause gastritis?
A
- H.pylori infection
- Autoimmune gastritis
- Viruses
- Duodena-gastric reflux
- Alcohol
- NSAIDS
17
Q
how does gastritis present clinically?
A
- can be asymptomatic
- epigastric pain, vomiting and haematemesis
18
Q
how is gastritis treated?
A
- h, pylori eradication and H2 blocker
- alcohol and smoking cessation
19
Q
what is coeliac disease?
A
- glucose-sensitive enteropathy
* It is a state of heightened immunological responsiveness to ingested gluten
20
Q
what is the result of coeliac disease?
A
villous atrophy, crypt hyperplasia and intraepithelial lymphocytosis
21
Q
what is the pathogenesis behind coeliac disease?
A
gliadin protein taken in, broken down by transglutaminase, binds to antigen presenting toxic T cells- cause injury to epithelial cells
22
Q
how does coeliac disease present clinically?
A
- Steatorrhoea
- Diarrhoea
- Weight loss
- Pernicious anaemia
- Osteoarthritis
- Amenorrhoea
23
Q
what are some differential diagnoses of coeliac disease?
A
IBS, lactose intolerance, ulcerative colitis
24
Q
where can inflammation in Crohn’s disease occur?
A
anywhere along the gut from the mouth to the anus
25
what is the appearance of Crohn's disease?
- skip lesions- not continuous
| - cobblestone mucosa
26
how would a patient with Crohn's disease present clinically?
* Diarrhoea
* Abdo pain
* Weight loss/ failure to thrive
* Fatigue
* Fever
* Malaise
* Anorexia
27
what are some differential diagnoses of Crohn's disease?
ulcerative colitis, TB, amyloidosis, bowel carcinoma
28
which areas of the GI tract does ulcerative colitis affect?
only affects colon
| starts distally and is continuous
29
how would a patent with ulcerative colitis present?
Symptoms- diarrhoea, abdominal discomfort, bowel frequency relates to severity
Signs- fever, tachycardia, tender, distended abdo
30
how would you diagnose ulcerative colitis?
- AXR- no faecal shadows, colonic dilatation
- stool sampling to exclude bacterial cause of symptoms
- colonoscopy- see ulcers and take a biopsy
- barium enema
31
what treatment would you offer a patient with ulcerative colitis?
- mild- prednisolone
- moderate- prednisolone and steroid enemas
- severe- admit, hydrocortisone IV
32
what is a volvulus?
a twist of segment of bowel adhesions- sticking together abdominal structures
33
what can cause small bowel obstruction?
adhesions or hernias
34
what can cause large bowel obstruction?
colonic carcinoma, constipation, diverticular stricture, volvulus
35
how does a mechanical obstruction appear on clinical examination and what symptoms will the patient have?
examination- distension, tinkling bowel sounds
symptoms- colicky abdo pain, vomiting, absolute constipation
36
what is a paralytic ileus?
adynamic bowel due to absence of normal peristaltic contractions
37
what can cause acute mesenteric ischaemia?
trauma, vasculitis, radiotherapy, strangulation
38
what clinical triad is seen in acute mesenteric ischaemia?
- acute severe abdo pain
- no abdo signs
- rapid hypovolaemia
39
how is acute mesenteric ischaemia diagnosed?
raised Hb, raised WCC, persistent metabolic acidosis
40
how can a patent with acute mesenteric ischaemia treated?
fluid resuscitation, heparin, local thrombolysis
| remove dead bowel via surgery
41
what clinical triad of symptoms is seen in chronic mesenteric ischaemia?
- severe, colicky post-prandial abdo pain
- weight loss
- upper abdo bruit
42
how would you treat chronic mesenteric ischaemia?
surgery, percutaneous transluminal angioplasty and stent insertion
43
how does chronic colonic ischemia present (ischaemic colitis)?
lower left-sided abdo pain and bloody diarrhoea
44
how would you treat a patient who presents with chronic colonic ischaemia (ischaemic colitis)?
fluid replacement and antibiotics
45
what can cause haemorrhoids?
* Constipation with prolonged straining
* Bowel habit may be normal
* Minor causes: Congestion from pelvic tumour, pregnancy, CCF, portal hypertension
46
what is the pathophysiology of haemorrhoids?
Vascular cushions protrude through a tight anus
Become more congested and hypertrophy
Protrude again more readily
Protusions may then strangulate
47
how do haemorrhoids present clinically?
- bright red rectal bleeding
- mucous discharge
- severe anaemia
- weight loss
48
how would you treat haemorrhoids?
- medical- topi analgesics
- non-operative- rubber band ligation, infra-red coagulation
- surgery- excisional haemorrhoidectomy
49
what can cause anal fistulae?
blockage of deep intramuscular gland ducts predisposes to formation of abscesses, these discharge to form fistulae.
blockage due to perianal sepsis, abscesses, Crohn's, TB
50
How would you treat anal fistulae?
fistulotomy and excision
51
what is an anal fissure?
painful tear in squamous lining of the lower anal canal
52
what is the aetiology of anal fissures?
hard faeces and parturition
53
how would you treat anal fissures?
lidocaine and GTN ointment
54
how would you treat a perianal abscess?
incise and drain under general anaesthetic
55
what is pilonidal sinus?
obstruction of natal cleft hair follicles 6cm above the anus.
ingrowing of hair excites a foreign body reaction and may causes secondary tracts to open laterally and also cause abscesses
56
what is IBS?
a mixed group of abdominal symptoms for which no organic cause can be found
57
what are the 3 subtypes of IBS?
IBS w/ constipation
IBS w/ diarrhoea
mixed IBS
58
how does IBS present clinically?
symptoms- nausea, bladder symptoms, backache, abdominal bloating, urgency, incomplete evacuation
59
what are some differential diagnsoses of IBS?
coeliac cancer, IBD, coeliac disease, gastroenteritis, diverticular disease
60
how can IBS be diagnosed?
pain relieved by defection OR 2 of:
| Urgency, incomplete evacuation, abdominal bloating, mucous PR, worsening of symptoms after food
61
what is diverticulitis?
inflammation of the diverticula- an out pouching of the gut wall, usually at sites of entry of perforating arteries
62
what is the aetiology of diverticulitis?
* Faeces obstruct the neck of the diverticulum- usually sigmoid colon
* Low fibre diet
* Lack of dietary fibre leads to the intraluminal increased pressures- this forces the mucosa to herniate through the muscle layers of the gut adjacent to penetrating vessels
63
how does diverticulitis present clinically?
* Left iliac fossa pain
* Fever
* Nausea
* Fistula formation
* Can be asymptomatic
64
how would you treat diverticulitis?
analgesia, high fibre diet and IV fluids
65
what is the aetiology of appendicitis?
* Inflammation precipitated by obstruction due to lymphoid hyperplasia/ tumour
* Faecoliths- hard pellets of faeces arising from dehydration and compaction
* Inflammation occurs due to breach of epithelial mucosa, infection leads to mucosal ulceration and a polymorph response
66
how would a patient with appendicitis present clinically?
* Perilumbilical pain
* Anorexia
* Constipation
* Tachycardia
* Fever
* Furred tongue
67
what 3 clinical signs can be used to diagnose appendicitis?
* Rovsings sign- pain greater in RIF than LIF when LIF is pressed
* Psoas sign- pain on extending hip
* Cope sign- pain on flexion and internal rotation of right hip
68
how would you treat appendicitis?
- appendicetomy
- laparoscopy
ABX- metronidazole and cefurozime
69
what can cause peritonitis?
Primary:
- Rare
- Risk groups- spontaneous bacterial peritonitis, females, immunocompromised, peritoneal dialysis patient, ascites
Secondary:
- Perforation of hollow viscus- contamination of cavity with secretions
- Inflammation of abdominal organs
- Peritoneal dialysis
- TB
- Ischaemia of hollow viscus
- Chemical
70
how does peritonitis present clinically?
pain, tenderness and systemic symptoms (nausea, chills, rigorous, dizziness)
71
how is peritonitis diagnosed?
abdo examination- guarding, rebound, rigidity
72
where does oesophageal carcinoma most commonly occur?
middle of the oesophagus
73
how does oesophageal carcinoma present clinically?
dysphagia
weight loss
retrosternal chest pain
74
how is oesophageal carcinoma staged?
```
T1 – invading lamina propria/submucosa
T2 – invading muscularis propria
T3 – invading adventitia
T4 – invasion of adjacent structures
N0 – no nodal spread
N1 – regional node mets
M0 – no distant spread
M1 – distal metastases
```
75
what are the signs and symptoms of an adenocarcinoma of the stomach?
```
Symptoms:
•Often non-specific
•Dyspepsia
•Weight loss
•Vomiting
•Dysphagia
•Anaemia
```
```
Signs suggesting incurable disease
•Epigastric mass
•Hepatomegaly
•Jaundice
•Ascites
•Large left supraclavicular (Virchow’s) node
•Acanthosis nigricans
```
76
what is a polyp?
abnormal growth of tissue projecting into the intestinal lumen from the normally flat mucosal surface
77
what are the 2 types of hiatus hernia?
- Sliding- where the gastro-oesophageal junction slides up into the chest
- Rolling- where the gastro-oesophageal junction remains in the abdomen but a bulge of stomach herniates up into the chest alongside the oesophagus
78
what is an inguinal hernia?
- Indirect hernias pass through internal inguinal ring and out the external inguinal ring
- Direct hernias push their way directly forward through the posterior wall of the inguinal canal, into a defect in the abdominal wall
79
what is hereditary nonpoylposis colorectal cancer?
DNA mismatch repeat genes are mutated- so there is accelerated progression from polyps to colorectal cancer
80
what is familial adenomatous polyposis?
APC gene is mutated- so lots of polyps develop in teenage years- this increases the risk of extracolonic malignancies
81
what is a femoral hernia?
Bowel enters femoral canal, presenting as mass in upper medial thigh or above the inguinal ligament (points down leg, not into groin – this distinguishes it from inguinal)
82
what is an incisional hernia?
this follows the breakdown of muscle closure after surgery
83
what can cause bloody diarrhoea?
oCampylobacter
oShigella/salmonella
oE coli
oAmoebiasis
84
what can cause explosive diarrhoea?
cholera, giardia, Yersinia, rotavirus
85
what can cause travellers diarrhoea?
```
Shigella
Salmonella
Campylobacter
Aeromonas and Plesimonas
Vibrio cholera
Norovirus – cruise ships
Rotavirus
E coli
```
86
how does shigella present?
abdo pain
blood diarrhoea
sudden fever and headache
87
how is shigella treated?
ciprofloxacin
88
what are the key clinical signs of cholera?
Profuse (1L/h), rice water stools, fever, vomiting, rapid dehydration
89
how would you treat cholera?
- oral rehydration
| - oral erythromycin or ciprofloxacin
90
what is the aetiology of Crohn's disease?
- smoking increases risk
- family history
- stress/ depression can precipitate relapse
91
how is Crohn's disease treated?
- optimise nutrition
- oral prednisolone
- surgery to remove affected areas of the bowel
92
How is IBS treated?
- healthy diet
- if constipated- reduce fibre intake, laxatives
- diarrhoea- loperamide
93
how is coeliac disease diagnosed?
- gastroscopy w/ biopsies
| - bloods- test for anti-gliadin, anti-transglutaminase and anti-endomysial antibodies
94
how is coeliac disease treated?
life long gluten-free diet
95
what are some complications of coeliac disease?
- anaemia
- secondary lactose intolerance
- osteoporosis
- risk of malignancy
96
how is GORD diagnosed?
- good history
- investigations only warranted if PPI fails- endoscopy, barium swallow
- 24h ambulatory pH monitoring
97
what are some complications of GORD?
- oesophagitis
- metaplasia- Barrett's oesophagus
- adenoma
- stricture formation
- ulcers
- iron-deficiency from bleeding
98
what are some risk factors of oesophageal carcinoma?
* Diet
* Alcohol excess
* Smoking
* Achalasia
* Plummer-Vinson syndrome
* Obesity
* Diet low in vitamins A and C
* Nitrosamine exposure
* Reflux oesophagitis ± Barrett’s oesophagus
99
how are stomach carcinomas treated?
- partial gastrectomy for distal tumors
| - total if more proximal
100
how do tumours of the small intestine present clinically?
- abdominal pain
- diarrhoea
- anorexia
- anaemia
101
how is colorectal cancer staged?
Dukes’ criteria, and 5yr treated survival rate
- A – limited to muscularis mucosae
- B – extension through muscularis mucosae
- C – involvement of regional lymph nodes
- D – distant metastases
102
how are both acute and chronic gastritis diagnosed ?
histologically:
- acute- neutrophil infiltration
- chronic- mononuclear cells- macrophages, plasma cells and lymphocytes
103
what are the alarm symptoms of peptic ulcers?
```
Anaemia- iron deficiency
Loss of weight
Anorexia
Recent onset of symptoms
Meleana/ haematemesis (vomiting fresh blood)
```
104
what is diverticulosis?
presence of diverticula
105
what are diverticula?
outpouchings of the gut wall, usually at sites of entry of perforating arteries
106
What are the 5 causes of mechanical obstruction of the bowel?
adhesion, tumour, intussusception, hernia, volvulus
107
what can cause pseudo-obstruction of the bowel?
myopathy
| neuropathy
108
how is pseudo-obstruction of the bowel treated?
- neostigmine
| - colonoscopic decompression
109
what are the complications of bowel obstruction?
- bowel ischaemia
- perforation
- sepsis
110
what is Hirschsprung's disease?
nerves at the distal end of the colon are not present, resulting in obstruction of the bowel
111
what is the gold standard of tests for diagnosing ischaemic colitis?
colonoscopy and biopsy
112
what does gangrenous ischaemic colitis present with?
peritonitis and hypovolaemic shock
113
how is pilonidal sinus treated?
pre-op Abx then excision of sinus tract
