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nicks phase 2a flaschards > GI > Flashcards

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

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2
Q

what is the aetiology of GORD?

A
  • Oesophageal sphincter hypotension
  • Hiatus hernia
  • Systemic sclerosis
  • Obesity
  • Smoking
  • Alcohol
  • Pregnancy
  • Slow gastric emptying
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3
Q

how does GORD present clinically?

A

heartburn, chronic cough, laryngitis

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4
Q

what are some differential diagnoses of GORD?

A
  • oesophagitis
  • duodenal cancer
  • sphincter of Oddi malfunction
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5
Q

how is GORD treated?

A
  • lifestyle mod- weight loss, reduce alcohol intake, smoking cessation
  • antacids
  • proton-pump inhibitors
  • H2 receptor antagonists
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6
Q

what is Barrets oesophagus?

A
  • long term consequence of reflux
  • metaplasia from squamous to columnar epithelium
  • increased risk of oesophageal carcinoma
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7
Q

what is a Mallory-Weiss tear?

A

rupture of the oesophageal mucosa due to repeated retching and vomiting

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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

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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.

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10
Q

what can cause peptic ulcers?

A
  • Hyperacidity
  • Helicobacter gastritis
  • Duodena-gastric reflux
  • NSAIDS
  • Smoking
  • Genetic
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11
Q

how do peptic ulcers present clinically?

A
  • Epigastric pain
  • Bloating
  • Fullness
  • Heartburn
  • Tender epigastrium
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12
Q

how can a suspected diagnosis of a peptic ulcer.be confirmed?

A
  • endoscopy

- barium meal

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13
Q

what are some differential diagnoses of peptic ulcers?

A 
Non-ulcer dyspepsia
GORD
Gastric malignancy
Duodenitis
Gastritis
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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

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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

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16
Q

what can cause gastritis?

A
  • H.pylori infection
  • Autoimmune gastritis
  • Viruses
  • Duodena-gastric reflux
  • Alcohol
  • NSAIDS
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17
Q

how does gastritis present clinically?

A
  • can be asymptomatic

- epigastric pain, vomiting and haematemesis

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18
Q

how is gastritis treated?

A
  • h, pylori eradication and H2 blocker

- alcohol and smoking cessation

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19
Q

what is coeliac disease?

A
  • glucose-sensitive enteropathy

* It is a state of heightened immunological responsiveness to ingested gluten

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20
Q

what is the result of coeliac disease?

A

villous atrophy, crypt hyperplasia and intraepithelial lymphocytosis

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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

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22
Q

how does coeliac disease present clinically?

A
  • Steatorrhoea
  • Diarrhoea
  • Weight loss
  • Pernicious anaemia
  • Osteoarthritis
  • Amenorrhoea
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23
Q

what are some differential diagnoses of coeliac disease?

A

IBS, lactose intolerance, ulcerative colitis

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24
Q

where can inflammation in Crohn’s disease occur?

A

anywhere along the gut from the mouth to the anus

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25
Q

what is the appearance of Crohn’s disease?

A
  • skip lesions- not continuous

- cobblestone mucosa

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26
Q

how would a patient with Crohn’s disease present clinically?

A
  • Diarrhoea
  • Abdo pain
  • Weight loss/ failure to thrive
  • Fatigue
  • Fever
  • Malaise
  • Anorexia
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27
Q

what are some differential diagnoses of Crohn’s disease?

A

ulcerative colitis, TB, amyloidosis, bowel carcinoma

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28
Q

which areas of the GI tract does ulcerative colitis affect?

A

only affects colon

starts distally and is continuous

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29
Q

how would a patent with ulcerative colitis present?

A

Symptoms- diarrhoea, abdominal discomfort, bowel frequency relates to severity

Signs- fever, tachycardia, tender, distended abdo

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30
Q

how would you diagnose ulcerative colitis?

A
  • AXR- no faecal shadows, colonic dilatation
  • stool sampling to exclude bacterial cause of symptoms
  • colonoscopy- see ulcers and take a biopsy
  • barium enema
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31
Q

what treatment would you offer a patient with ulcerative colitis?

A
  • mild- prednisolone
  • moderate- prednisolone and steroid enemas
  • severe- admit, hydrocortisone IV
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32
Q

what is a volvulus?

A

a twist of segment of bowel adhesions- sticking together abdominal structures

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33
Q

what can cause small bowel obstruction?

A

adhesions or hernias

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34
Q

what can cause large bowel obstruction?

A

colonic carcinoma, constipation, diverticular stricture, volvulus

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35
Q

how does a mechanical obstruction appear on clinical examination and what symptoms will the patient have?

A

examination- distension, tinkling bowel sounds

symptoms- colicky abdo pain, vomiting, absolute constipation

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36
Q

what is a paralytic ileus?

A

adynamic bowel due to absence of normal peristaltic contractions

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37
Q

what can cause acute mesenteric ischaemia?

A

trauma, vasculitis, radiotherapy, strangulation

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38
Q

what clinical triad is seen in acute mesenteric ischaemia?

A
  • acute severe abdo pain
  • no abdo signs
  • rapid hypovolaemia
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39
Q

how is acute mesenteric ischaemia diagnosed?

A

raised Hb, raised WCC, persistent metabolic acidosis

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40
Q

how can a patent with acute mesenteric ischaemia treated?

A

fluid resuscitation, heparin, local thrombolysis

remove dead bowel via surgery

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41
Q

what clinical triad of symptoms is seen in chronic mesenteric ischaemia?

A
  • severe, colicky post-prandial abdo pain
  • weight loss
  • upper abdo bruit
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42
Q

how would you treat chronic mesenteric ischaemia?

A

surgery, percutaneous transluminal angioplasty and stent insertion

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43
Q

how does chronic colonic ischemia present (ischaemic colitis)?

A

lower left-sided abdo pain and bloody diarrhoea

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44
Q

how would you treat a patient who presents with chronic colonic ischaemia (ischaemic colitis)?

A

fluid replacement and antibiotics

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45
Q

what can cause haemorrhoids?

A
  • Constipation with prolonged straining
  • Bowel habit may be normal
  • Minor causes: Congestion from pelvic tumour, pregnancy, CCF, portal hypertension
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46
Q

what is the pathophysiology of haemorrhoids?

A

Vascular cushions protrude through a tight anus
Become more congested and hypertrophy
Protrude again more readily
Protusions may then strangulate

47
Q

how do haemorrhoids present clinically?

A
  • bright red rectal bleeding
  • mucous discharge
  • severe anaemia
  • weight loss
48
Q

how would you treat haemorrhoids?

A
  • medical- topi analgesics
  • non-operative- rubber band ligation, infra-red coagulation
  • surgery- excisional haemorrhoidectomy
49
Q

what can cause anal fistulae?

A

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
Q

How would you treat anal fistulae?

A

fistulotomy and excision

51
Q

what is an anal fissure?

A

painful tear in squamous lining of the lower anal canal

52
Q

what is the aetiology of anal fissures?

A

hard faeces and parturition

53
Q

how would you treat anal fissures?

A

lidocaine and GTN ointment

54
Q

how would you treat a perianal abscess?

A

incise and drain under general anaesthetic

55
Q

what is pilonidal sinus?

A

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
Q

what is IBS?

A

a mixed group of abdominal symptoms for which no organic cause can be found

57
Q

what are the 3 subtypes of IBS?

A

IBS w/ constipation
IBS w/ diarrhoea
mixed IBS

58
Q

how does IBS present clinically?

A

symptoms- nausea, bladder symptoms, backache, abdominal bloating, urgency, incomplete evacuation

59
Q

what are some differential diagnsoses of IBS?

A

coeliac cancer, IBD, coeliac disease, gastroenteritis, diverticular disease

60
Q

how can IBS be diagnosed?

A

pain relieved by defection OR 2 of:

Urgency, incomplete evacuation, abdominal bloating, mucous PR, worsening of symptoms after food

61
Q

what is diverticulitis?

A

inflammation of the diverticula- an out pouching of the gut wall, usually at sites of entry of perforating arteries

62
Q

what is the aetiology of diverticulitis?

A
  • 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
Q

how does diverticulitis present clinically?

A
  • Left iliac fossa pain
  • Fever
  • Nausea
  • Fistula formation
  • Can be asymptomatic
64
Q

how would you treat diverticulitis?

A

analgesia, high fibre diet and IV fluids

65
Q

what is the aetiology of appendicitis?

A
  • 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
Q

how would a patient with appendicitis present clinically?

A
  • Perilumbilical pain
  • Anorexia
  • Constipation
  • Tachycardia
  • Fever
  • Furred tongue
67
Q

what 3 clinical signs can be used to diagnose appendicitis?

A
  • 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
Q

how would you treat appendicitis?

A
  • appendicetomy
  • laparoscopy
    ABX- metronidazole and cefurozime
69
Q

what can cause peritonitis?

A

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
Q

how does peritonitis present clinically?

A

pain, tenderness and systemic symptoms (nausea, chills, rigorous, dizziness)

71
Q

how is peritonitis diagnosed?

A

abdo examination- guarding, rebound, rigidity

72
Q

where does oesophageal carcinoma most commonly occur?

A

middle of the oesophagus

73
Q

how does oesophageal carcinoma present clinically?

A

dysphagia
weight loss
retrosternal chest pain

74
Q

how is oesophageal carcinoma staged?

A 
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
Q

what are the signs and symptoms of an adenocarcinoma of the stomach?

A 
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
Q

what is a polyp?

A

abnormal growth of tissue projecting into the intestinal lumen from the normally flat mucosal surface

77
Q

what are the 2 types of hiatus hernia?

A
  • 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
Q

what is an inguinal hernia?

A
  • 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
Q

what is hereditary nonpoylposis colorectal cancer?

A

DNA mismatch repeat genes are mutated- so there is accelerated progression from polyps to colorectal cancer

80
Q

what is familial adenomatous polyposis?

A

APC gene is mutated- so lots of polyps develop in teenage years- this increases the risk of extracolonic malignancies

81
Q

what is a femoral hernia?

A

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
Q

what is an incisional hernia?

A

this follows the breakdown of muscle closure after surgery

83
Q

what can cause bloody diarrhoea?

A

oCampylobacter
oShigella/salmonella
oE coli
oAmoebiasis

84
Q

what can cause explosive diarrhoea?

A

cholera, giardia, Yersinia, rotavirus

85
Q

what can cause travellers diarrhoea?

A 
Shigella
Salmonella
Campylobacter
Aeromonas and Plesimonas
Vibrio cholera
Norovirus – cruise ships
Rotavirus
E coli
86
Q

how does shigella present?

A

abdo pain
blood diarrhoea
sudden fever and headache

87
Q

how is shigella treated?

A

ciprofloxacin

88
Q

what are the key clinical signs of cholera?

A

Profuse (1L/h), rice water stools, fever, vomiting, rapid dehydration

89
Q

how would you treat cholera?

A
  • oral rehydration

- oral erythromycin or ciprofloxacin

90
Q

what is the aetiology of Crohn’s disease?

A
  • smoking increases risk
  • family history
  • stress/ depression can precipitate relapse
91
Q

how is Crohn’s disease treated?

A
  • optimise nutrition
  • oral prednisolone
  • surgery to remove affected areas of the bowel
92
Q

How is IBS treated?

A
  • healthy diet
  • if constipated- reduce fibre intake, laxatives
  • diarrhoea- loperamide
93
Q

how is coeliac disease diagnosed?

A
  • gastroscopy w/ biopsies

- bloods- test for anti-gliadin, anti-transglutaminase and anti-endomysial antibodies

94
Q

how is coeliac disease treated?

A

life long gluten-free diet

95
Q

what are some complications of coeliac disease?

A
  • anaemia
  • secondary lactose intolerance
  • osteoporosis
  • risk of malignancy
96
Q

how is GORD diagnosed?

A
  • good history
  • investigations only warranted if PPI fails- endoscopy, barium swallow
  • 24h ambulatory pH monitoring
97
Q

what are some complications of GORD?

A
  • oesophagitis
  • metaplasia- Barrett’s oesophagus
  • adenoma
  • stricture formation
  • ulcers
  • iron-deficiency from bleeding
98
Q

what are some risk factors of oesophageal carcinoma?

A
  • Diet
  • Alcohol excess
  • Smoking
  • Achalasia
  • Plummer-Vinson syndrome
  • Obesity
  • Diet low in vitamins A and C
  • Nitrosamine exposure
  • Reflux oesophagitis ± Barrett’s oesophagus
99
Q

how are stomach carcinomas treated?

A
  • partial gastrectomy for distal tumors

- total if more proximal

100
Q

how do tumours of the small intestine present clinically?

A
  • abdominal pain
  • diarrhoea
  • anorexia
  • anaemia
101
Q

how is colorectal cancer staged?

A

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
Q

how are both acute and chronic gastritis diagnosed ?

A

histologically:

  • acute- neutrophil infiltration
  • chronic- mononuclear cells- macrophages, plasma cells and lymphocytes
103
Q

what are the alarm symptoms of peptic ulcers?

A 
Anaemia- iron deficiency
Loss of weight
Anorexia
Recent onset of symptoms
Meleana/ haematemesis (vomiting fresh blood)
104
Q

what is diverticulosis?

A

presence of diverticula

105
Q

what are diverticula?

A

outpouchings of the gut wall, usually at sites of entry of perforating arteries

106
Q

What are the 5 causes of mechanical obstruction of the bowel?

A

adhesion, tumour, intussusception, hernia, volvulus

107
Q

what can cause pseudo-obstruction of the bowel?

A

myopathy

neuropathy

108
Q

how is pseudo-obstruction of the bowel treated?

A
  • neostigmine

- colonoscopic decompression

109
Q

what are the complications of bowel obstruction?

A
  • bowel ischaemia
  • perforation
  • sepsis
110
Q

what is Hirschsprung’s disease?

A

nerves at the distal end of the colon are not present, resulting in obstruction of the bowel

111
Q

what is the gold standard of tests for diagnosing ischaemic colitis?

A

colonoscopy and biopsy

112
Q

what does gangrenous ischaemic colitis present with?

A

peritonitis and hypovolaemic shock

113
Q

how is pilonidal sinus treated?

A

pre-op Abx then excision of sinus tract

nicks phase 2a flaschards (15 decks)

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