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Phase 2a > GI > Flashcards

GI Flashcards

1
Q

What is Crohn’s disease?

A

A chronic disease that causes bowel inflammation

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2
Q

What environmental factor increases risk of developing inflammatory bowel disease?

A

Smoking

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3
Q

What drugs exacerbate Crohn’s disease?

A

NSAIDs

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4
Q

Pathology/histology of Crohn’s disease

A

o Granulomas
o All Layers and levels
o Skip lesions
o Deep ulcers and fissures -> cobblestone appearance

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5
Q

Symptoms of Crohn’s disease

A

o Diarrhoea
o Abdominal pain
o Weight loss
o Fatigue

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6
Q

Signs of Crohn’s disease

A

o Bowel ulceration
o Abdominal tenderness
o Perianal abscess/fistulae/skin tags
o Clubbing, skin, joint and eye problems

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7
Q

Investigations for suspected inflammatory bowel disease

A

o Bloods – cultures, anaemia, B12, folate, ESR, CPR
o Stool sample
o Colonoscopy and biopsy
o AXR

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8
Q

Pharmacological management of Crohn’s disease

A 
o   Mild – prednisolone 
o   Severe – IV hydrocortisone 
o   Additional – AZA, monoclonal 
     antibodies 
o   Surgery
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9
Q

Lifestyle management of Crohn’s

A

Stop smoking, try different diets

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10
Q

Complications of Crohn’s disease

A

Bowel obstructions, malabsorption

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11
Q

What is ulcerative colitis?

A

A chronic disease that causes bowel inflammation

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12
Q

Pathology of ulcerative colitis

A 
o   Colon only 
o   No granulomas 
o   Mucosal inflammation only 
o   Continuous involvement  
o   Goblet cell depletion and crypt abscesses
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13
Q

Symptoms of ulcerative colitis

A

o Episodic or chronic diarrhoea (± blood and mucus)
o Crampy abdominal discomfort
o Urgency
o Fatigue, weight loss

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14
Q

Signs of ulcerative colitis

A

o Fever, tachycardia
o Tender distended abdomen if acute
o Extraintestinal features – clubbing, oral ulcers, conjunctivitis, arthritis, spondylitis, nutritional defects

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15
Q

Management of ulcerative colitis

A 
o   Mild – 5-ASA, steroids
o   Moderate – prednisolone then 5-ASA
o   Severe – fluids and electrolytes, IV hydrocortisone, 
     ciclosporin 
o   Maintenance – 5-ASAs
o   Surgery
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16
Q

Complications of ulcerative colitis

A

Psychosocial and sexual problems, colorectal cancer risk doubled

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17
Q

What is irritable bowel syndrome?

A

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

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18
Q

Epidemiology of IBS

A

Usually <40yrs old, twice as common in women

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19
Q

Symptoms of IBS

A 
o   Chronic > 6 months: 
o   Urgency
o   Incomplete evacuation 
o   Constipation 
o   Diarrhoea 
o   Abdominal bloating/distension 
o   Worsening of symptoms after food
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20
Q

What can exacerbate IBS symptoms?

A

Stress, menstruation, gastroenteritis

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21
Q

Signs of IBS

A

Abdominal distension

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22
Q

What is the tool used to diagnose IBS?

A

The Rome diagnostic tool

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23
Q

What is the criteria for diagnosis of IBS?

A 
• Recurrent abdominal pain (or discomfort) associated 
  with at least 2 of:
       o   Relief by defecation 
       o   Altered stool form 
       o   Altered bowel frequency
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24
Q

When do you think differential diagnosis for IBS?

A

o >60yrs
o Anorexia/weight loss
o Waking at night with pain diarrhoea
o Mouth ulcers

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25
Q

Investigations for suspected IBS

A

• Bloods – FBC, ESR, CRP and coeliac serology
• Stool sample
• Low threshold for referring if family history of ovarian
or bowel cancer

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26
Q

Management of IBS

A

• Constipation – adequate water and fibre intake,
physical activity, laxatives
• Diarrhoea – avoid sorbitol, alcohol, caffeine, ‘trigger
foods’, reduce fibre, try bulking agent and loperamide
after loose stool
• Colic/bloating – oral antispasmodics
• Psychological symptoms – CBT

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27
Q

What is coeliac disease?

A

A disease in which the small intestine is hypersensitive to gluten, leading to difficulty in digesting food.

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28
Q

What is the pathology of coeliac disease?

A

T-cell response to gluten in small bowel -> villous atrophy and crypt hyperplasia -> malabsorption

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29
Q

What gene is coeliac disease associated with?

A

HLA DQ2

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30
Q

What skin condiiton is associated with coeliac disease?

A

Dermatitis herpetiformis

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31
Q

Symptoms of coeliac disease

A 
o   Stinking stools/steatorrhoea 
o   Diarrhoea 
o   Abdominal pain, bloating
o   Nausea and vomiting 
o   Weight loss 
o   Fatigue and weakness
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32
Q

Investigations for suspected coeliac disease

A

o Bloods – anaemia
o Antibodies – anti-transglutaminase test
o Duodenal biopsy while on gluten-containing diet
o Genotyping

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33
Q

Management of coeliac disease

A

Life-long gluten free diet

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34
Q

Complications of coeliac disease

A

Anaemia, dermatitis herpetiformis, osteopenia/osteoporosis, risk of malignancy

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35
Q

List 4 causes of malabsorption

A

Coeliacs disease, Crohn’s disease, starvation/poor diet, biliary obstruction

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36
Q

What is GORD?

A

Prolonged or recurrent reflux of gastric contents (acid +/- bile) into oesophagus

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37
Q

Epidemiology of GORD

A
  • 25% of adults experience it (heartburn)

* 2-3x more common in men

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38
Q

Causes of GORD

A 
o   Lower oesophageal sphincter hypotension 
o   Hiatus hernia 
o   Oesophageal dysmotility 
o   Gastric acid hypersecretion 
o   Delayed gastric emptying
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39
Q

Risk factors for GORD

A

o Obesity
o Pregnancy
o Smoking
o Alcohol

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40
Q

What is a hiatus hernia?

A

Part of the stomach protrudes through the oesophageal opening in the diaphragm

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41
Q

What is the pathology of GORD?

A

Tone of the LOS is reduced, as well as frequent transient relaxations of the LOS -> stomach acid enters oesophagus -> increased mucosal sensitivity to gastric acids

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42
Q

Symptoms of GORD

A

o Heartburn – burning retrosternal discomfort after
meals, lying or straining, relieved by antacids
o Belching
o Acid brash (acid or bile regurgitation)
o Increased salivation
o Painful swallowing
o Nocturnal asthma, cough

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43
Q

Investigations for suspected GORD

A

• Endoscopy
• 24 hr oesophageal pH monitoring if endoscopy
normal

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44
Q

Management of GORD

A 
o   Lifestyle: 
         -  Weight loss
         -  Smoking cessation 
         -  Reduce hot drinks, alcohol, citrus fruits, fizzy 
            drinks, spicy food
         -  Raise bed head 
o   Drugs:
         -  Antacids – Gaviscon 
         -  PPI – lansoprazole 
o   Surgery if severe - laparoscopic Nissen fundoplication
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45
Q

What is Barrett’s oesophagus?

A

Metaplasia of oesopahgeal cells = squamous -> columnar -> can progress to cancer, IRREVERSIBLE

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46
Q

Why does Barrett’s oesophagus increase risk of oesophageal cancer?

A

The new glandular epithelial cells are predisposed to becoming malignant, since they are not genetically stable in the oesophagus

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47
Q

Signs and symptoms of oesopahgeal cancer?

A

o Dysphagia
o Weight loss
o Retrosternal chest pain
o Hoarseness, cough

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48
Q

What is gold standard investigation for diagnosing oesophageal cancer?

A

Oesophagoscopy with biopsy

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49
Q

Management of oesophageal cancer

A

o Lifestyle changes
o Oesophagectomy with perioperative chemo
o Combine with chemo/radiotherapy if necessary

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50
Q

Causes of gastric cancer (adenocarcinoma)

A

o Helicobacter pylori
o Genetic predisposition
o Unknown

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51
Q

Symptoms of gastric cancer

A

o Dyspepsia
o Weight loss
o Vomiting
o Dysphagia

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52
Q

Signs of gastric cancer

A 
o   Anaemia 
o   Troisier’s sign – enlarged supraclavicular node 
     (Virchow’s node)
o   Epigastric mass
o   Hepatomegaly 
o   Jaundice 
o   Ascites
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53
Q

What investigations are used to stage cancer?

A

CT/MRI - to indentify metastases

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54
Q

Investigations for suspected gastric cancer

A

o Gastroscopy and multiple ulcer edge biopsies
o Endoscopic ultrasound (EUS) – evaluate depth of
invasion

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55
Q

Management of gastric cancer

A

o Endoscopic resection in early stages
o Partial gastrectomy if distal, total if proximal
o Combination chemotherapy
o Targeted therapy – monoclonal antibodies

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56
Q

What factors predispose an individual to colorectal cancer?

A

Neoplastic polyps, IBD, genetic predisposition (FAP and HNPCC), alcohol, smoking

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57
Q

What genes predispose an individual to colorectal cancer?

A

FAP and HNPCC

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58
Q

What drug can prevent colorectal cancer?

A

Aspirin

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59
Q

Signs and symptoms of a left-sided colorectal cancer

A

Bleeding/mucus PR, altered bowel habits or obstruction, tenesmus, mass PR, fistula

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60
Q

Signs and symptoms of right-sided colorectal cancer

A

Weight loss, anaemia, abdominal pain, obstruction

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61
Q

What is the UK colorectal screening programme?

A

Faecal occult blood from stool sample, 60-69yrs old

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62
Q

Investigations for suspected colorectal cancer

A

o FBC – microcytic anaemia
o Sigmoidoscopy or colonoscopy or virtually by CT
o Rectal examination

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63
Q

Management of colorectal cancer

A

o Surgery – laparoscopic resection, colostomy bag
o Radiotherapy
o Chemotherapy – FOLFOX
o Targeted – monoclonal antibodies

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64
Q

What are the main causes of peptic ulcers?

A

o H. pylori
o Drugs - NSAIDs, steroids
o Stress – H. pylori and stress
o Lack of blood supply (mucosal ischaemia)– low BP, stomach cells stop making mucin, decreased defence against stomach acid

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65
Q

By what mechanism does H. pylori cause peptic ulcers?

A

Lives in gastric mucosa – secretes urease -> splits urea into CO2 and ammonia -> damages gastric mucosa -> peptic ulcer

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66
Q

How do NSAIDs cause peptic ulcers?

A

NSAIDs inhibit prostaglandins -> decreased mucous secretion -> decreased defence against stomach acid

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67
Q

How can low BP causes peptic ulcers?

A

Low BP -> stomach cells stop making mucin -> decreased defence against stomach acid

68
Q

List 3 risk factors for peptic ulcers

A

Alcohol, smoking, stress

69
Q

Symptoms of peptic ulcers

A

o Epigastric pain often related to hunger, specific
foods, or time of day
o Fullness after meals
o Heartburn

70
Q

What the ALARMs symptoms in GI conditions?

A

Anaemia, loss of weight, anorexia, recent onset, melaena/haematemesis, swallowing difficulty

71
Q

Investigations for suspected peptic ulcers?

A

o Test for H. pylori – stool antigen test
o Endoscopy – biopsy ulcer to check for H. pylori,
exclude malignancy

72
Q

Management of peptic ulcers

A

o Lifestyle – reduce alcohol and smoking
o H. pylori eradication – triple therapy (PPI + 2 ABX)
o Drugs to reduce acid – PPI’s , H2 blockers (ranitine)
o Surgery if drugs not effective

73
Q

Name a PPI

A

Lanzoprazole

74
Q

Complications of peptic ulcers

A

o Bleeding
o Perforation
o Malignancy
o Decreased gastric outflow

75
Q

What is gastritis?

A

Inflammation of the gastric mucosa

76
Q

Causes of gastritis

A

NSAIDS, alcohol, H. pylori, reflux/hiatus hernia, autoimmune, Zollinger-Ellison syndrome, Menetrier’s disease

77
Q

Symptoms of gastritis

A

Epigastric pain, vomiting

78
Q

Investigations for suspected gastritis

A

o Blood and stool tests

o Upper GI endoscopy

79
Q

Management of gastritis

A

o Triple therapy if H. pylori
o Lifestyle – stop smoking and alcohol
o PPI’s

80
Q

Complications of gastritis

A

Peptic ulcers

81
Q

Pathology of appendicitis

A

Gut organisms invade appendix wall after lumen obstruction -> oedema, ischaemic necrosis and perforation

82
Q

Symptoms of appendicitis

A

o Periumbilical pain that move to RIF
o Anorexia
o Constipation

83
Q

Signs of appendicitis

A

o Tachycardia
o Fever
o Peritonism with guarding and rebound
o Percussion tenderness in RIF

84
Q

Investigations for suspected appendicitis

A
  • Bloods – rasied neutrophils and CRP
  • Ultrasound
  • CT
85
Q

Management of appendicitis

A

• Appendicectomy
• Antibiotics preop
• Laparoscopy – not if suspected gangrenous
perforation (risk of abscess)

86
Q

Complications of appendicitis

A
  • Perforation
  • Appendix mass
  • Appendix abscess
87
Q

Causes of small bowel obstruction

A

Adhesions, hernias, gallstones

88
Q

Pathophysiology of bowel obstruction

A

Physical factor prevents movement of intestinal contents through tract -> backing up of GI and inability to empty -> vomiting and constipation

89
Q

What is an adhesion?

A

Two bits of bowel stick together by fibrous band (usually had previous surgery)

90
Q

What is a volvulus?

A

Affects sigmoid colon -> twists and cuts off blood supply

91
Q

What is intussusception?

A

Folding of the intestines on itself

92
Q

Signs and symptoms of bowel obstruction

A 
o   Vomiting, nausea and anorexia 
o   Early colic 
o   Constipation 
o   Abdominal distension – active ‘tinkling’ bowel 
     sounds 
o  Abdominal pain
93
Q

What is an ileus?

A

Ileus – functional obstruction from low bowel motility -> bowel sounds absent, less pain

94
Q

Investigations for suspected bowel obstruction

A
  • Abdominal x-ray – gas shadows
  • CT – establish cause of obstruction
  • Blood tests – amylase, FBC, U&E
  • Consider colonoscopy if large bowel
95
Q

Management of bowel obstruction

A

• Immediate action:
o Nasogastric intubation and IV fluids
o Analgesia
o Catheterise to monitor fluid status
• Surgery if:
o Strangulation
o Closed loop obstruction
• Endoscopic stenting – palliation or bridge to surgery

96
Q

What us diverticular disease?

A

High intraluminal pressures force mucosa to herniate through the muscle layers of the gut at weak points adjacent to penetrating vessels

97
Q

In which part of the colon is diverticulitis most common?

A

Sigmoid colon

98
Q

Investigations for suspected diverticular disease

A
  • Colonoscopy - common incidental finding

* CT abdomen - diagnostic

99
Q

What is diverticulitis?

A

When the mucosal outpounchings in diverticular disease get infected or inflammed

100
Q

Signs and symptoms of diverticular disease

A

Altered bowel habit ± left-sided colic relieved by defecation, nausea and flatulence

101
Q

Signs and symptoms of diverticulitis

A

Features of diverticular disease + pyrexia, raised WCC, raised CRP/ESR, tender colon ± peritonism

102
Q

Management of diverticular disease

A

o Antispasmodics – mebeverine

o Surgical resection if severe

103
Q

Management of diverticulitis

A

o Mild - bowel rest (fluids only) ± antibiotics

o Severe - analgesia, NBM, IV fluids and IV antibiotics

104
Q

Complications of diverticular disease

A
  • Perforation
  • Haemorrhage
  • Fistulae
  • Abscesses
105
Q

What are the causes of acute mesenteric ischaemia?

A

Low CO, trauma, vasculitis, radiotherapy, strangulation

106
Q

Signs and symptoms of acute mesenteric ischaemia

A 
o   Acute severe abdominal pain
o   No/minimal abdominal signs 
o   Rapid hypovolaemia -> shock
o   Degree of illness often far out of proportion with 
     clinical signs
107
Q

Investigations for suspected acute mesenteric ischaemia

A

o Bloods – high Hb, high WCC, persistent metabolic
acidosis
o X-ray – gasless abdomen
o CT/MR contrast angiography

108
Q

Management of acute mesenteric ischaemia

A

o Resuscitation with fluid, antibiotics and heparin

o Surgery to remove dead bowel

109
Q

Complications of acute mesenteric ischaemia

A

Septic peritonitis, multiple organ failure

110
Q

What causes chronic mesenteric ischaemia?

A

Combination of low-flow state with atheroma

111
Q

Signs and symptoms of chronic mesenteric ischaemia

A

o Severe, colicky post-prandial abdominal pain (‘gut
claudication’)
o Malabsorption, N&V, weight loss
o Upper abdominal bruit

112
Q

Investigations for suspected chronic mesenteric ischaemia

A

CT angiography and contrast-enhanced MR angiography

113
Q

Management of chronic mesenteric ischaemia

A

o Surgery - reduce risk of acute ischaemia
o Percutaneous transluminal angioplasty and stent
insertion

114
Q

What is the main cause of ischaemic colitis?

A

Low flow in inferior mesenteric artery territory

115
Q

Symptoms of ischaemic colitis

A

Lower left-sided abdominal pain ± bloody diarrhoea

116
Q

What is the ‘gold standard’ investigation for suspected ischaemic colitis?

A

Lower GI endoscopy

117
Q

Management of ischaemic colitis

A

Fluid replacement and antibiotics

118
Q

Complications of ischaemic colitis

A

Ischaemic strictures, gangrenous ischaemic colitis

119
Q

What is a Mallory-Weiss tear?

A

Persistent vomiting/retching causes haematemesis via an oesophageal mucosal tear

120
Q

Risk factors for Mallory-Weiss tear?

A

Vomiting, retching, frequent alcohol consumption, chronic cough, bulimia, hiccuping

121
Q

Signs and symptoms of a Mallory-Weiss tear?

A
  • Bouts of retching/vomiting -> haematemesis

* Shock, syncope, light-headedness, dizziness

122
Q

Investigation for suspected Mallory-Weiss tear

A

Endoscopy

123
Q

Management of a Mallory-Weiss tear

A

Conservative - resuscitation, maintain airway, oxygen, fluids

124
Q

Complications of a Mallory-Weiss tear

A
  • Hypovolaemic shock -> death
  • Re-bleeding
  • MI
125
Q

What is a pilonidal sinus?

A

Obstruction of natal cleft hair follicles approx. 6cm above anus

126
Q

Epidemiology of pilonidal sinus

A

M>F, 10:1, obese

127
Q

Management of pilonidal sinus

A

o Excision of sinus tract ± primary closure

o Offer hygiene and hair removal advice

128
Q

What causes an anorectal abscess?

A

Gut organisms, TB, staphs

129
Q

Which sex has the higher risk of anorectal abscess?

A

Females, 8:1

130
Q

Management of anorectal abscess

A

Incise and drain under GA

131
Q

What conditions are associated with anorectal abscesses?

A

DM, Crohn’s, malignancy

132
Q

What is a fissure-in-ano?

A

Painful tear in squamous lining of lower anal canal

133
Q

Which sex has the higher risk of developing a fissure-in-ano?

A

Male

134
Q

Causes of fissure-in-ano

A

Hard faeces, parturition (anterior)

135
Q

Management of fissure-in-ano

A

Lidocaine ointment + GTN ointment, fibre, fluids, stool softener, Botulinum toxin injection (2nd line), surgery

136
Q

What is a fistula-in-ano?

A

A chronic abnormal communication between the epithelialised surface of the anal canal and perianal skin

137
Q

What causes a fistula-in-ano?

A

Perianal sepsis, abscesses, Crohn’s, TB

138
Q

Investigations for suspected fistula-in-ano

A

MRI, endoanal US scan

139
Q

Management of fistula-in-ano

A

Fistulotomy and excision

140
Q

UK epidemiology of diarrhoea

A

o Viral most commmon
o Rotavirus - children
o Rota virus childhood vaccination -> reduction

141
Q

Causes of diarrhoea

A
  • Gastroenteritis
  • Traveller’s diarrhoea
  • C. diff
  • IBS
  • Colorectal cancer
  • Crohn’s, UC, coeliac
142
Q

Diagnostic criteria for travellers diarrhoea

A 
3 or more unformed stool per day plus one of the following:
o	Abdo pain
o	Cramps 
o	Nausea
o	Vomiting
o	Dysentery
143
Q

Risk factors for diarrhoea

A

Travel, diet change, D&V contact, fever/pain, HIV, medication

144
Q

What does chronic diarrhoea suggest?

A

IBS/Crohn’s/UC/Coeliac

145
Q

What does bloody diarrhoea suggest?

A

Salmonella, E. coli, UC, Crohn’s, cancer

146
Q

What does mucus diarrhoea suggest?

A

IBS, cancer, polyps

147
Q

What is the most likely cause of explosive diarrhoea?

A

Cholera, Rotavirus

148
Q

What does steatorrhoea suggest?

A

Pancreatic insufficiency, biliary obstruction

149
Q

Investigations for diarrhoea

A
  • Stool test - microscopy, culture, parasites
  • Bloods - culture, inflammatory markers (FBC/CRP)
  • Lower GI endoscopy
150
Q

What are the main red flag symptoms in a patient with diarrhoea?

A
  • Dehydration
  • Electrolyte imbalance
  • Renal failure
  • Immunocompromise
  • Severe abdominal pain
151
Q

What are the red flag symptoms/RFs for bowel cancer?

A

Over 50, chronic diarrhoea, weight loss, blood in stool, FH

152
Q

Management of diarrhoea

A
  • Treat cause
  • Food handlers – no work until stool samples -ve
  • Rehydration - oral/IV
  • Codeine phosphate after loose stool
  • Avoid antibiotics unless infective and systemic upset
153
Q

What is peritonitis?

A

Inflammation of the peritoneum

154
Q

What is peritonism?

A

Tensing of muscles to prevent movement of peritoneum

155
Q

Causes of peritonitis

A
  • Cholecystitis
  • Pancreatitis
  • Appendicitis
  • Diverticulitis
156
Q

Symptoms of peritonitis

A
  • Pain, vomiting

* Systemic symptoms – nausea, chills, rigor, fever

157
Q

Signs of peritonitis

A
  • Silent abdomen
  • Rebound tenderness
  • Patient doesn’t want to move
158
Q

Investigations for suspected peritonitis

A

CT abdomen

159
Q

Management of peritonitis

A
  • Fluid resuscitation
  • Surgery - laparotomy (open), laparoscopy (key-hole)
  • ITU
160
Q

Complications of peritonitis

A

o Bowel obstruction

o Sepsis

161
Q

What is a hernia?

A

Protrusion of a viscus or part of a viscus through a defect of the walls of its containing cavity into an abnormal position

162
Q

What causes Crohn’s disease?

A

Inappropriate immune response against gut flora in a genetically susceptible individual

163
Q

What causes ulcerative colitis?

A

Inappropriate immune response against colonic flora in genetically susceptible individuals

164
Q

What do tympanic bowel sounds indicate about the bowel contents?

A

Air/gas

165
Q

Give 3 roles of the stomach other than digestion

A

Secrete and activate proteases
Regulate emptying into the duodenum
Produce stomach acid

166
Q

What medication would you give to treat H. pylori?

A

Triple therapy - omeprazole, amoxacillin and clarithromycin

167
Q

What antibodies can be tested for to confirm Coeliac’s?

A

IgA tussye transglutaminase

IgA anti-endomysial (EMA)

Phase 2a (9 decks)

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