GI Flashcards
1
Q
what are the causes of intraluminal obstruction
A
tumour
diaphragm disease
meconium ileus
2
Q
what are the causes of intramural obstruction
A
inflammatory disease - Crohns, diverticulitis
tumours
hirschsprungs disease = no nerves in part of intestine
3
Q
what are the causes of extraluminal obstruction
A
adhesions
volvulus
intussusception
4
Q
what are adhesions
A
fibrous bands stick 2 bits of bowel together post-surgery
5
Q
what is volvulus
A
complete twisting of a loop of intestine around its mesenteric attachment site
6
Q
what is intussesception
A
one part of intestine telescopes inside another
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
8
Q
what is paralytic ileus
A
failure of peristalsis causing painless distention ususally caused by: drugs surgery trauma intraabdominal sepsis
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
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
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
12
Q
what is the M staging in TNM
A
metastases
M0 = no mets
M1 = surrounding structure involvement e.g. liver
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
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
15
Q
define gastroenteritis
A
diarrhoea +/- vomiting due to an enteric infection
16
Q
define acute diarrhoea
A
acute = 3+ episodes of partially formed/watery stools under 14 days
17
Q
define dysentery
A
infectious diarrhoea and blood
18
Q
define travellers diarrhoea
A
GE occuring under 2 weeks after entering new country
19
Q
define food poisoning
A
disease (infection or toxin) caused by food/drink consumption
20
Q
what does nosocomial mean
A
originating in hospital
21
Q
define malabsorption
A
inadequate absorption of nutrients from the intestines
22
Q
what are the signs of malabsorption
A
floating stools/stearrhoea = high fat content
anaemia = B12/iron deficient
diorrhoea
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
24
Q
what are the 4 types of lactose intolerance
A
- primary = lactase production declines over time
- secondary = due to small intestine injury
- developmental lactase deficiency = may occur in premature infants, only transient
- congenital lactase deficiency = genetic lack
25
what does FTT mean
failure to thrive
26
how is coeliac disease staged
= Marsh grading 0-3
27
describe the Marsh grading of coeliacs disease
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
28
what are the 2 main types of inflammatory bowel disease
Crohn's
| ulcerative colitis
29
what part of the gut is mostly affected in Crohn's
terminal ileum and colon
30
what is erythema nodosum
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
31
what is ankylosing spondylitis
chronic inflammation of spinal joints
32
what investigation distinguishes between Crohns and UC
biopsy
crohn's = granulomas
UC = no granulomas, crypt destruction
33
what is coeliac disease
autoimmune condition primarily affecting small intestine where body has inflammatory reaction to gluten
34
what is crohns disease
type of inflammatory bowel disease characterised by cobblestone mucosa
35
what is ulcerative colitis
type of inflammatory bowel disease that affects the mucosa of the colon
36
how does aspirin cause ulcers
sit on mucosa of stomach
| release salicyclic acid = inhibits prostaglandin synthetase = cause ulceration
37
how can aspirin be adapted to prevent ulceration
enteric coating = doesnt dissolve in acidic environment
38
what to think about/look out for if patient has heamodynamic shock
gastritis/peptic ulcers
| may need to treat with PPI
39
what are the complications of peptic ulcers
can erode through gastroduodenal artery = haemorrhage
can erode through muscle wall = peritonitis
can erode through muscle wall and reach pancreas = pancreatitis
40
what are curling's ulcers
microulcers due to mucosal ischaemia caused by severe burns as burns on body cause severe plasma volume loss and therefore ischaemia
41
where are ulcers more commonly found (including NSAIDS)
in the duodenum rather than in the stomach
42
what type of epithelium is the oesophagus
stratified squamous
43
what type of epithelium is the stomach
simple columnar
44
what is metaplasia
change in differentiation of a cell from one fully differentiated type to a different fully differentiated type
45
what is barrett's oesophagus
columnar glandular epithelium growth in oesophagus instead of squamous epithelium
caused by GORD = results in metaplasia = premalignant lesions
46
why is barretts oesophagus significant
lining = genetically unstable = mutations highly likely = increased risk of neoplasm
47
what type of cancer occurs in the oesophagus and stomach
adenocarcinoma
48
what are the risk factors for oesophageal cancer
smoking
| drinking
49
what are the risk factors for gastric cancer
smoked/pickled food
H.pylori
pernicious anaemia
male
50
how does a gastric tumour appear
shallow gastric carcinoma
tumour
thickened wall = leather like
51
what is GORD
prolonged/recurrent reflux of gastric contents into oesophagus
52
what is the mean age for appendicitis
10-20
53
what is the most common form of pancreatic cancer
pancreatic adenocarcinoma = 85%
54
how does pancreatic cancer present
jaundice
weight loss
light stools dark urine
55
why is pancreatic cancer so deadly
presentation indicating pancreatic cancer is so late cancer has usually spread to other organs by the time its found
56
what age for pancreatic cancer
over 70 usually
57
what is a mallory-weiss tear
mucosal lacerations in the upper GI tract caused by sudden increase in pressure = cause bleeding = bloody vomit
58
what are the RF for mallory-weiss tears
excessive alcohol consumption
bulimia
frequent cough
59
how are mallory-weiss tears treated
resuscitation
maintain airway + oxygen
replace lost fluids
tears heal rapidly
60
what is gastropathy
injury to gastric mucosa with epithelial cell damage and regeneration but little to no inflammation
61
what most commonly causes gastropathy
NSAID usage = reduce protective prostaglandins = stomach acid break down mucosa
62
how are gastropathies treated
proton pump inhibitors = omeprazole
| removal of causative agent
63
name a proton pump inhibitor
omeprazole
64
name a H2 receptor antagonist
cimetidine
65
what is achalasia
decrease in ganglionic cells in the nerve plexus of oesophageal wall = aperistalsis and failure of LOS to relax = impairs oesophageal emptying
66
what is systemic sclerosis
multisystem autoimmune disease
| increased fibroblast activity = abnormal growth of connective tissue
67
what is ischaemic colitis
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
what is mesenteric ischaemia
lack of blood supply to colon = causes pain
usually caused by atherosclerosis
requires surgical intervention and anticoagulants
chronic can cause colitis
69
what are haemorrhoids
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
how are haemorrhoids treated
increase fluid and fibre
rubber band ligation
haemorrhoidectomy
71
what is an anorectal abcess
infection of anal sinus = inflammation = formation of pus filled abcess
72
what is a fissure-in-ano
tear in mucosa of anal canal
73
what is a pilonidal sinus
obstruction of natural hair follicles above the anus = can get infected = pain, pus, swelling
cause = congenital
74
what is a midgut malrotation
twisting of entire midgut around axis of superior mesenteric artery
cause = congenital
need surgical correction to prevent volvulus
75
what is a hernia
abnormal protrusion of viscus through normal or abnormal defect in body cavity
76
what are the most common hernias
1. inguinal
2. femoral
3. umbilical
4. hiatal
77
how do hernias present
painless lump
| can cause obstructions and bowel strangulation
78
what is an inguinal hernia
herniation through inguinal canal directly or indirectly
79
describe a direct inguinal hernia
originate medial to inferior epigastric artery
| herniate through inguinal canal
80
describe an indirect inguinal hernia
originate lateral to inferior epigastric arter
| herniate through deep inguinal ring
81
describe a femoral hernia
occur just below inguinal ligament
abdominal viscera pass through femoral ring and into potential space of femoral canal
most commonly in children
82
describe umbilical hernias
sections of small bowel herniate out through umbilicus
| common in women with multiple pregnancies
83
describe hiatal hernias
abdominal organs (usually stomach) slip through diaphragm into the chest
associated with GORD
can be rolling or sliding
84
how are hernias treated
surgical reduction and mesh implantation
85
what is anorexia nervosa
restriction of energy intake leading to low body weight
BMI below 17.5
fear of gaining weight
86
what are the 2 subtypes of anorexia nervosa
restricting
| binge-eating/purging
87
what is bulimia nervosa
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
what are episodes of binge eating characterised by
```
rapid eating
eating until uncomfortably full
eating large amounts of food when not hungry
eating alone (embarrassment)
feeling guilty afterwards
```
89
how long does binge eating or bulimia nervosa have to be going on for to diagnose
at least once a week for 3 months
90
name and describe 4 other specified feeding and eating disorders OFSED
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
describe the Core Model (slade 1982) explanation of cause of ED
combination of low self-esteem and perfectionism leading to a need for control
use food to self control
92
describe the progression of an eating disorder
initially positive comments and reinforcements about weight loss
then terror at losing control = forced to eat and emotional instability
93
what are the important things to look out for in a risk assessment of ED
severe restriction of food/fluids
electrolyte imbalance
bone deterioration
94
what is needs to be monitored in the management of someone with an ED
breathing problems
cardiac problems
rapid weight loss
suicidal
95
what is the treatment for bulimia nervosa/binge eating disorder
CBT
96
what is the treatment for anorexia nervosa
CBT
Maudsley AN treatment model (MANTRA)
specialist supportive clinical management
97
what antibodies are associated with IBD (crohns/UC)
ANCA
| ASCA
98
what drugs are used to treat crohns and UC
```
crohns = prednisolone to induce remission + azathioprine to maintain
UC = prednisolone to induce remission + mesalazine to maintain
```
99
what feature of UC will you find on XR
lead pipe appearance of bowel
100
what is loperamide
aka immodium
| used to stop diarrhoea frequency
101
what are the 2 types of colorectal cancer
familial adenomatous polyposis (FAP) = polyps form
hereditary non-polyposis colorectal cancer (HNPCC) = cant sue DNA damaging chemo
= MORE COMMON
102
describe the triple therapy used to treat H.pylori infections
= PPI + 2 Abx
amoxicillin
omeprazole
clarithromycin/metronidazole
103
what symptom do you get if the ileo-caecal valve is non-functioning
foecal vomiting
104
what symptoms differentiate left and right colorectal cancer
```
LEFT
= blood in stool
= rectal bleeding
= colicky pain
= changes in bowel habit
RIGHT
= iron deficient anaemia
= R iliac fossa mass
= weight loss
```
105
what symptoms differentiate a small bowel obstruction and a large bowel obstruction
```
SMALL
= early faecal vomiting
= late constipation
LARGE
= late vomiting
= obstipation = complete constipation
= blood in stool
```
106
what is diverticulitis
gaps in mucosal layer of large intestine = pouches of mucosa extrude through to form diverticula = rupture and cause foecal matter to spill out
107
what test can help differentiate IBD and IBS
faecal calprotectin
raised in IBD (crohns/UC)
normal in IBS
108
most common site for colorectal cancer?
sigmoid colon or rectum
109
scoring system for upper GI bleed
glasgow-blatchford score
110
name some causes of an upper gi bleed
mallory weiss tear
oesophageal varices
gastric cancer
gastritis
peptic ulcer
duodenal ulcer
111
what investigations and management for rectal cancer (and what cancer is it)
rectal adenocarcinoma
sigmoidoscopy + biopsy
anterior resection
112
difference between ileostomy and colostomy
ileostomy:
RIF
spouted
liquid
