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Phase 2a > GI > Flashcards

GI Flashcards

1
Q

what are the causes of intraluminal obstruction

A

tumour
diaphragm disease
meconium ileus

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2
Q

what are the causes of intramural obstruction

A

inflammatory disease - Crohns, diverticulitis
tumours
hirschsprungs disease = no nerves in part of intestine

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3
Q

what are the causes of extraluminal obstruction

A

adhesions
volvulus
intussusception

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4
Q

what are adhesions

A

fibrous bands stick 2 bits of bowel together post-surgery

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5
Q

what is volvulus

A

complete twisting of a loop of intestine around its mesenteric attachment site

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6
Q

what is intussesception

A

one part of intestine telescopes inside another

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7
Q

describe how H.pylori virulence factors cause ulcer formation

A

increased stomach acid production
acute inflammatory reaction = neutrophils
urease production = ammonia = mucosal layer damage

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8
Q

what is paralytic ileus

A 
failure of peristalsis causing painless distention
ususally caused by:
drugs
surgery
trauma
intraabdominal sepsis
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9
Q

what is pseudo obstruction

A

syndrome caused by severe impairment in ability of intestines to push food through
characterised by signs and symptoms of intestinal obstruction but no lesions in intestinal lumen are present

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10
Q

describe the tumour staging in TNM staging for GI cancers

A 
T1 = invades submucosa
T2 = invades muscularis propria
T3 = invades bowel wall
T4 = reach peritoneum
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11
Q

describe the node staging in TNM staging of GI cancers

A 
N1 = spread to lymph nodes
N2 = spread to lymph nodes above diaphragm
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12
Q

what is the M staging in TNM

A

metastases
M0 = no mets
M1 = surrounding structure involvement e.g. liver

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13
Q

describe Duke’s staging of cancer

A

Duke A = confined to muscularis propria
Duke B = invasion through muscularis propria but not reached lymph nodes
Duke C = involvement of lymph nodes
Duke D = widespread metastases

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14
Q

what is Hirschprung’s disease

A

birth defect in which nerves are missing from part of the intestine = causes lack of movement in distal end of bowel which causes mechanical obstruction and dilated loops of bowel

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15
Q

define gastroenteritis

A

diarrhoea +/- vomiting due to an enteric infection

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16
Q

define acute diarrhoea

A

acute = 3+ episodes of partially formed/watery stools under 14 days

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17
Q

define dysentery

A

infectious diarrhoea and blood

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18
Q

define travellers diarrhoea

A

GE occuring under 2 weeks after entering new country

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19
Q

define food poisoning

A

disease (infection or toxin) caused by food/drink consumption

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20
Q

what does nosocomial mean

A

originating in hospital

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21
Q

define malabsorption

A

inadequate absorption of nutrients from the intestines

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22
Q

what are the signs of malabsorption

A

floating stools/stearrhoea = high fat content
anaemia = B12/iron deficient
diorrhoea

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23
Q

what causes poor weight gain

A 
insufficient calories
insufficient protein
insufficient fluid
insufficient sodium
intra-uterine growth retardation
weaning onto expressed breast milk
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24
Q

what are the 4 types of lactose intolerance

A
  1. primary = lactase production declines over time
  2. secondary = due to small intestine injury
  3. developmental lactase deficiency = may occur in premature infants, only transient
  4. congenital lactase deficiency = genetic lack
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25
Q

what does FTT mean

A

failure to thrive

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26
Q

how is coeliac disease staged

A

= Marsh grading 0-3

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27
Q

describe the Marsh grading of coeliacs disease

A

0 = normal, no villus atrophy
1 = changes consistent with coeliac but not diagnostic
2 = normal villi but increased crypt hyperplasia
3 a,b,c = confirm coeliac disease, significant villus atrophy

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28
Q

what are the 2 main types of inflammatory bowel disease

A

Crohn’s

ulcerative colitis

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29
Q

what part of the gut is mostly affected in Crohn’s

A

terminal ileum and colon

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30
Q

what is erythema nodosum

A

type of skin inflammation that is located in a part of the fatty layer of skin
tender erythmatous lesions on shink
associated with IBD, sarcoidosis, pregnancy

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31
Q

what is ankylosing spondylitis

A

chronic inflammation of spinal joints

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32
Q

what investigation distinguishes between Crohns and UC

A

biopsy
crohn’s = granulomas
UC = no granulomas, crypt destruction

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33
Q

what is coeliac disease

A

autoimmune condition primarily affecting small intestine where body has inflammatory reaction to gluten

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34
Q

what is crohns disease

A

type of inflammatory bowel disease characterised by cobblestone mucosa

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35
Q

what is ulcerative colitis

A

type of inflammatory bowel disease that affects the mucosa of the colon

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36
Q

how does aspirin cause ulcers

A

sit on mucosa of stomach

release salicyclic acid = inhibits prostaglandin synthetase = cause ulceration

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37
Q

how can aspirin be adapted to prevent ulceration

A

enteric coating = doesnt dissolve in acidic environment

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38
Q

what to think about/look out for if patient has heamodynamic shock

A

gastritis/peptic ulcers

may need to treat with PPI

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39
Q

what are the complications of peptic ulcers

A

can erode through gastroduodenal artery = haemorrhage
can erode through muscle wall = peritonitis
can erode through muscle wall and reach pancreas = pancreatitis

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40
Q

what are curling’s ulcers

A

microulcers due to mucosal ischaemia caused by severe burns as burns on body cause severe plasma volume loss and therefore ischaemia

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41
Q

where are ulcers more commonly found (including NSAIDS)

A

in the duodenum rather than in the stomach

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42
Q

what type of epithelium is the oesophagus

A

stratified squamous

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43
Q

what type of epithelium is the stomach

A

simple columnar

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44
Q

what is metaplasia

A

change in differentiation of a cell from one fully differentiated type to a different fully differentiated type

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45
Q

what is barrett’s oesophagus

A

columnar glandular epithelium growth in oesophagus instead of squamous epithelium
caused by GORD = results in metaplasia = premalignant lesions

46
Q

why is barretts oesophagus significant

A

lining = genetically unstable = mutations highly likely = increased risk of neoplasm

47
Q

what type of cancer occurs in the oesophagus and stomach

A

adenocarcinoma

48
Q

what are the risk factors for oesophageal cancer

A

smoking

drinking

49
Q

what are the risk factors for gastric cancer

A

smoked/pickled food
H.pylori
pernicious anaemia
male

50
Q

how does a gastric tumour appear

A

shallow gastric carcinoma
tumour
thickened wall = leather like

51
Q

what is GORD

A

prolonged/recurrent reflux of gastric contents into oesophagus

52
Q

what is the mean age for appendicitis

A

10-20

53
Q

what is the most common form of pancreatic cancer

A

pancreatic adenocarcinoma = 85%

54
Q

how does pancreatic cancer present

A

jaundice
weight loss
light stools dark urine

55
Q

why is pancreatic cancer so deadly

A

presentation indicating pancreatic cancer is so late cancer has usually spread to other organs by the time its found

56
Q

what age for pancreatic cancer

A

over 70 usually

57
Q

what is a mallory-weiss tear

A

mucosal lacerations in the upper GI tract caused by sudden increase in pressure = cause bleeding = bloody vomit

58
Q

what are the RF for mallory-weiss tears

A

excessive alcohol consumption
bulimia
frequent cough

59
Q

how are mallory-weiss tears treated

A

resuscitation
maintain airway + oxygen
replace lost fluids
tears heal rapidly

60
Q

what is gastropathy

A

injury to gastric mucosa with epithelial cell damage and regeneration but little to no inflammation

61
Q

what most commonly causes gastropathy

A

NSAID usage = reduce protective prostaglandins = stomach acid break down mucosa

62
Q

how are gastropathies treated

A

proton pump inhibitors = omeprazole

removal of causative agent

63
Q

name a proton pump inhibitor

A

omeprazole

64
Q

name a H2 receptor antagonist

A

cimetidine

65
Q

what is achalasia

A

decrease in ganglionic cells in the nerve plexus of oesophageal wall = aperistalsis and failure of LOS to relax = impairs oesophageal emptying

66
Q

what is systemic sclerosis

A

multisystem autoimmune disease

increased fibroblast activity = abnormal growth of connective tissue

67
Q

what is ischaemic colitis

A

transient lack of blood supply to colon causes inflammation and injury
usually caused by atherosclerosis/vessel occlusion
most likely to occur at splenic flexure (superior and inferior mesenteric artery)
abdominal XR shows thumbprinting

68
Q

what is mesenteric ischaemia

A

lack of blood supply to colon = causes pain
usually caused by atherosclerosis
requires surgical intervention and anticoagulants
chronic can cause colitis

69
Q

what are haemorrhoids

A

enlarged vascular mucosal cushions in the anal canal
can cause bleeding, pain, itch
RFs = constipation, straining, increased abdominal pressure
internal skin tags can cause ischaemia = gangrene

70
Q

how are haemorrhoids treated

A

increase fluid and fibre
rubber band ligation
haemorrhoidectomy

71
Q

what is an anorectal abcess

A

infection of anal sinus = inflammation = formation of pus filled abcess

72
Q

what is a fissure-in-ano

A

tear in mucosa of anal canal

73
Q

what is a pilonidal sinus

A

obstruction of natural hair follicles above the anus = can get infected = pain, pus, swelling
cause = congenital

74
Q

what is a midgut malrotation

A

twisting of entire midgut around axis of superior mesenteric artery
cause = congenital
need surgical correction to prevent volvulus

75
Q

what is a hernia

A

abnormal protrusion of viscus through normal or abnormal defect in body cavity

76
Q

what are the most common hernias

A
  1. inguinal
  2. femoral
  3. umbilical
  4. hiatal
77
Q

how do hernias present

A

painless lump

can cause obstructions and bowel strangulation

78
Q

what is an inguinal hernia

A

herniation through inguinal canal directly or indirectly

79
Q

describe a direct inguinal hernia

A

originate medial to inferior epigastric artery

herniate through inguinal canal

80
Q

describe an indirect inguinal hernia

A

originate lateral to inferior epigastric arter

herniate through deep inguinal ring

81
Q

describe a femoral hernia

A

occur just below inguinal ligament
abdominal viscera pass through femoral ring and into potential space of femoral canal
most commonly in children

82
Q

describe umbilical hernias

A

sections of small bowel herniate out through umbilicus

common in women with multiple pregnancies

83
Q

describe hiatal hernias

A

abdominal organs (usually stomach) slip through diaphragm into the chest
associated with GORD
can be rolling or sliding

84
Q

how are hernias treated

A

surgical reduction and mesh implantation

85
Q

what is anorexia nervosa

A

restriction of energy intake leading to low body weight
BMI below 17.5
fear of gaining weight

86
Q

what are the 2 subtypes of anorexia nervosa

A

restricting

binge-eating/purging

87
Q

what is bulimia nervosa

A

episodes of binge eating = large amounts of food in small amount of time AND lack of control over eating during episode
then compensatory behaviour to prevent weight gain

88
Q

what are episodes of binge eating characterised by

A 
rapid eating
eating until uncomfortably full
eating large amounts of food when not hungry
eating alone (embarrassment)
feeling guilty afterwards
89
Q

how long does binge eating or bulimia nervosa have to be going on for to diagnose

A

at least once a week for 3 months

90
Q

name and describe 4 other specified feeding and eating disorders OFSED

A
  1. atypical anorexia nervosa = weight still in normal range
  2. bulimia nervosa/binge eating = low frequency or duration
  3. purging
  4. night eating syndrome
91
Q

describe the Core Model (slade 1982) explanation of cause of ED

A

combination of low self-esteem and perfectionism leading to a need for control
use food to self control

92
Q

describe the progression of an eating disorder

A

initially positive comments and reinforcements about weight loss
then terror at losing control = forced to eat and emotional instability

93
Q

what are the important things to look out for in a risk assessment of ED

A

severe restriction of food/fluids
electrolyte imbalance
bone deterioration

94
Q

what is needs to be monitored in the management of someone with an ED

A

breathing problems
cardiac problems
rapid weight loss
suicidal

95
Q

what is the treatment for bulimia nervosa/binge eating disorder

A

CBT

96
Q

what is the treatment for anorexia nervosa

A

CBT
Maudsley AN treatment model (MANTRA)
specialist supportive clinical management

97
Q

what antibodies are associated with IBD (crohns/UC)

A

ANCA

ASCA

98
Q

what drugs are used to treat crohns and UC

A 
crohns = prednisolone to induce remission + azathioprine to maintain
UC = prednisolone to induce remission + mesalazine to maintain
99
Q

what feature of UC will you find on XR

A

lead pipe appearance of bowel

100
Q

what is loperamide

A

aka immodium

used to stop diarrhoea frequency

101
Q

what are the 2 types of colorectal cancer

A

familial adenomatous polyposis (FAP) = polyps form

hereditary non-polyposis colorectal cancer (HNPCC) = cant sue DNA damaging chemo
= MORE COMMON

102
Q

describe the triple therapy used to treat H.pylori infections

A

= PPI + 2 Abx
amoxicillin
omeprazole
clarithromycin/metronidazole

103
Q

what symptom do you get if the ileo-caecal valve is non-functioning

A

foecal vomiting

104
Q

what symptoms differentiate left and right colorectal cancer

A 
LEFT
= blood in stool
= rectal bleeding
= colicky pain
= changes in bowel habit
RIGHT
= iron deficient anaemia
= R iliac fossa mass
= weight loss
105
Q

what symptoms differentiate a small bowel obstruction and a large bowel obstruction

A 
SMALL
= early faecal vomiting
= late constipation
LARGE 
= late vomiting
= obstipation = complete constipation
= blood in stool
106
Q

what is diverticulitis

A

gaps in mucosal layer of large intestine = pouches of mucosa extrude through to form diverticula = rupture and cause foecal matter to spill out

107
Q

what test can help differentiate IBD and IBS

A

faecal calprotectin
raised in IBD (crohns/UC)
normal in IBS

108
Q

most common site for colorectal cancer?

A

sigmoid colon or rectum

109
Q

scoring system for upper GI bleed

A

glasgow-blatchford score

110
Q

name some causes of an upper gi bleed

A

mallory weiss tear
oesophageal varices
gastric cancer
gastritis
peptic ulcer
duodenal ulcer

111
Q

what investigations and management for rectal cancer (and what cancer is it)

A

rectal adenocarcinoma
sigmoidoscopy + biopsy
anterior resection

112
Q

difference between ileostomy and colostomy

A

ileostomy:
RIF
spouted
liquid

Phase 2a (15 decks)

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