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Phase 2a > GI > Flashcards

GI Flashcards

1
Q

What is IBD

A

Umbrella term for chronic systemic diseases involving inflammation of intestine
- Immune respose against gut/colonic flora

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2
Q

What is Crhons’s disease

A

Inflammation of GI tract anywhere from mouth to anus

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3
Q

Macroscopic changes in Crohns (4)

A
  • Inflamm of GI tract
  • Skip lesions
  • Cobblestone apperance
  • Deep uclers in mucosa
  • oral and perianal disease
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4
Q

Microscopic changes (4)

A
  • Transmural inflamm
  • Granuloma
  • Increase chronic inflamm cells
  • Increase goblet cells
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5
Q

Crohns presentation

A

sx

  • Diarrhoea - bleeding + pain
  • abdo pain
  • weight loss
  • fatigue
  • fever
  • Malasie

signs

  • abdo tenderness
  • anal strictures
  • fistulae
  • clubbing
  • perianal abscess
  • skin, eye + joint issues
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6
Q

Crohns investigations

A
  • FBC:
    Normochromic, normocytic anaemia - malabsorption
    Fe/B12/folate deficiency
  • Stool sample
  • C.diff/campylobacter
  • faecal calprotectin
  • Barium swallow
    cobblestone apperance
  • GOLD
    colonoscopy + biopsy
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7
Q

Crohns - advice and assessments prior to tx

A
  • stop smoking

- assess risk of osteoperosis

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8
Q

Crohns tx

A
  1. Induce remission
    - Oral corticosteroids - Prednisolone
  2. If no impovement add Anti-TNF antibodies
    - Influximab
  3. Maintain remission
    - Azathioprine
    - Methotrexate
  4. surgery
    - at worst affected areas
    - tx complications
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9
Q

Crohns severe flare ups tx

A

IV hydrocortisone

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10
Q

Crohns complications

A
  • Stricture
  • Colorectal cancer
  • Fistulae
  • Aneamia
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11
Q

Ulcerative colitis defenition

A

inflamm disorder of colonic mucosa - never affects proximal to ileocecal valve

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12
Q

UC macroscopic

A
  • continuous inflamm
  • ulcers
  • pseudo-polyps
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13
Q

UC microscopic

A
  • mucosal inflamm
  • no granuloma
  • depleted goblet cells
  • crypt abscesses
  • backwash ileutis –> villous atrophy
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14
Q

UC presentation

A

sx

  • Pain in LLQ
  • Diarrhoea - blood + mucous
  • Abdo discomfort
  • Tenesmus
signs 
acute:
fever/tachy/tender
- extra intestinal signs 
- clubbing 
- erythema nodosum
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15
Q

UC investigations

A
  • stool sample
    R/O infectious causes
- Bloods
FBC:
*anaemia
* raised ESR/CRP
*pANCA +ve
*faecal calprotectin
  • Barium swallow
  • GOLD
    colonsocopy + mucosal biopsy
    loss of haustrations
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16
Q

UC severity index

A

Truelove and Witt’s

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17
Q

UC tx

A 
Induce remission 
1. mild - Aminosalicylate 
    1st - Mesalazine/Sulfasalazine 
if no response:
- prednisolone

Maintain remission

  • Mesalazine
  • azathioprine
Sever disease:
infliximab 
PR steroids 
surgery 
IV hydrocortisone
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18
Q

UC surgery

A

Panproctocolectomy - remove colon and rectum

  • Permanent iliostomy
  • Ileo-anal anastamosis (j-pouch)
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19
Q

UC complications

A

Toxic dilatation
perforation
CRC
PSC

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20
Q

Extraintestinal signs of IBD

  • eyes
  • Joints
  • skin
  • liver
  • renal
A
  • uveitis/ conjunctivitis
  • Arthralgia
    Ankolysing spondy
    small joint arthiritis
  • Eryhtema nodosum
    Pyoderma gangrenosum
  • Fatty liver
    PSC
    Chronic hepatitis + Cirrhosis
  • Oxalate stones (small bowel)
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21
Q

Fludrocortisone

A

Increase mineralocorticoid

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22
Q

Hydrocortisone

A

Mineral and glucocorticoid

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23
Q

Prednisolone

A

Increase glucocorticoid

Decrease Mineralocorticoid

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24
Q

Glucocorticoid S/E

A 
weight gain
impaired glucose regualtion
galucoma 
neutrophilia 
cushings
osteoperosis 
immunosuppression
depression
insomnia
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25
Q

Which carcinogen increases risk of oespohageal + gastric cancers

A

Nitrosamines

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26
Q

Irritable bowel syndrome defenition + RF

A

-Functional bowel disorder - mixed group of abdo sx with no organic cause

Female 
stress 
hamily hx of IBS
young 
mental health issues
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27
Q

3 types of IBS

A

IBS - C
IBS - D
IBS - M

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28
Q

IBS triggers

A

stress
hormones
GI infections
Food - wheat/milk/beans/citrus fruits

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29
Q

When should you consider IBS

A
  • abdo pain/discomfort
  • bloating
  • change in bowel habit
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30
Q

IBS presentation

A
  • C/D/M
  • urgency
  • incomplete evacuation
  • Mucous PR
  • nausea
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31
Q

what makes IBS worse

A

stress
gastroentirits
menstruation

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32
Q

IBS investigations

A 
diagnosis of exculsion
- Bloods
FBC
Coelaic- Anti-TTG
IBD markers
- Stool sample 
- conoscopy
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33
Q

IBS differential

A

IBS-D –> lactose intolerant
coeliac
IBD
CRC

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34
Q

cireria for IBS diagnosis

A

Abdo pain:

  • relieved by defication
  • assosc w/ change in bowel habit or frequency

2 or more of:

  • mucous PR
  • worsening of sx after eating
  • bloating
  • emergency evacuation
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35
Q

IBS tx

- diet and lifestyle

A 
Avoid trigger foods 
high fibre foods
fluids
avoid caffine + fizzy drinks 
small frequent meals
enough sleep 
low FODMAP diet 
- apple/ cows milk/baked beans
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36
Q

IBS tx

  • pain
  • diarrhoea
  • constipation
  • 2nd line
  • 3rd line
A
  • Pain - Buscapan (antispasmodic)
  • Diarrhoea - Loperamide
  • Constipation - Linaclotide
  • avoid lactulose - bloating
  • Amitryptaline
  • DROWSY
  • SSRI antidepressants
    Citalopram
  • CBT
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37
Q

What is coeliac disease

A

systemic AI disease triggered by exposure to gluten

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38
Q

Risk factors for coeliac

A

HLA-DQ2/8 assosc
FHx
Other AI diseases
Irish

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39
Q

Coeliac causative molecule

A

Gliadin

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40
Q

Coeliac presentation

A 
sx- 
abdo pain 
bloating 
diarrhoea
mouth ulcers
fatigue 
weight loss

signs

  • steattorhea
  • anaemia
  • dermatitis hepatiformis
  • failure to thrive
  • osteomalacia
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41
Q

Coeliac macroscopic signs

A
  • reduced duodenal folding

- scalloping

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42
Q

What other disease should you test when a new diagnosis of coeliac is found

A

T1DM

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43
Q

Coeliac endocopy and intestinal biopsy results

A

Villous atrophy
crypt hyerplasia
intraepithelial lymphocytes

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44
Q

When is serology only accurate in coeliacs

A

If a gluten containing diet is followed >6weeks before testing

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45
Q

Coeliac investigations

A
  • Check total IgA Ab levels to exclude IgA deficeincy

Serology
- IgA tissue transglutaminase Ab
(first choice)
- IgA endomysial Ab

Endoscopy and biopsy

DEXA

Bloods: FBC/B12/Folate

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46
Q

Complications of coeliac

A 
Vitmain deficiency 
Anaemia
Osteoperosis 
Ulcerative jejunitits
Non-Hodking lymphoma
malignancy risk - small bowel/oesophageal 
- 2x increase risk 
subfertility 
Dermatitis hepatiformis
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47
Q

Coeliac tx

A

Lifelong gluten free diet

DEXA scan

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48
Q

Differential dx of GORD

A

CAD
biliary colic
PUD
Malignancy

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49
Q

GORD pathophysiology

A

LOS tone decreases with increase in transient LOS relaxations

Increased mucosal sensitivity to gastric acis and decreased oesophageal clearnance of acid

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50
Q

GORD predisposing factors

A 
Hiatus hernia 
Pregnancy 
large meals 
chronic coughing 
alcohol 
smoking 
Gastric acid hypersecretion 
slow gastric emptying 
Drugs - nitrates/tricyclics
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51
Q

What is GORD

A

reflux of gastric acid through LOS irritating lining of the oesophagus

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52
Q

Epithelial lining of

  • stomach
  • oesophagus
A
  • columnar epithelium

- squamous epithelium

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53
Q

GORD presentation

A
  • Heartburn
  • worse when bending/lying
  • worse w/ alcohol/hot drinks
  • Belching
  • bloating
  • regurgitation
  • odynophagia
  • retrosternal pain
  • hoarse voice
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54
Q

GORD extra-oesophageal

A

Laryngitis
sinusitis
Nocturnal asthma
chronic cough

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55
Q

GORD what remits an endoscopy

A 
GI bleed
- hamatemisis 
- melena 
Weight loss
Dysphagia 
Anaemia
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56
Q

GORD lifestyle management

A

Weight loss
avoid alcohol + smoking
small regular meals
raise bed head

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57
Q

GORD Tx

A

Acid neutralising meds - PRN
- Gaviscon

Antacids
- Mg trisiclate mixture

PPI
- Lansoprazole

H2 receptor antagonists
- Ranitidine

Surgery
- Nissen’s fundoplication
Increases LOS pressure

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58
Q

GORD complications

A 
- Oesophageal stricture 
worsening of dysphagia 
tx:
endoscopic dilatation 
long term PPI 
-Barret's oesophagus 
squamous-->columnar
Metaplasia 
Increased goblet cells 
Pre-malignant for adenocarcinoma 
tx:
PPI
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59
Q

What is an ulcer

A

Breach in the mucosa of the stomach or duodenum

Duodenal ulcers more common

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60
Q

What arteries cause haemorrorahge after ulcers

  • Lesser curvature
  • Duodenal cap posterior wall
A

L.Gastric artery

Gastroduodenal artery

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61
Q

Differences between IBD and IBS

A

Stool:
IBS- mucus
IBD - bloody

IBD:
Joint/skin/eye issues
Lack of appetite
weight loss

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62
Q

PUD aetiology

A 
H.pylori 
NSAIDs
SSRI's
steroids 
Increased acid:
- Alcohol 
- smoking 
- caffine
- stress
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63
Q

PUD - NSAIDs MOA

A

Inhibit COX-1

  • decrease prostaglandin synthesis
  • decreases mucous secretion
  • mucosa vulnerable
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64
Q

PUD presentation

A 
Epigastric pain 
bloating/belching 
weight loss
loss of appetite
vomitting 
melena 
haematemesis
65
Q

Who do you tell the difference between a gastric and duodenal ulcer

A

Gastric - increase pain when eating

Duodenal - improves on eating

  • nocturnal pain
  • weight gain
66
Q

H- Pylori PUD

A 
Gram -ve bacteria 
Secreates urease - 
- Breaksdown urea into NH3 + CO2 
- NH3 neutralises acid and protect H.pylori 
- damage to stomach tissue
67
Q

Which 3 chemicals does H.Pylori increase inorder to damage mucous

A

Gastrin
Histamine
SST

68
Q

PUD investigations

A

Pt <55y/o

  • Stool Ag testing
  • C13 breath test
  • serology testing

Endoscopy to:
All ALARM pts
Pt>55y/o

69
Q

Cancer red flag sx

A 
ALARMS
A - Anaemia 
L - Loss of weight 
A Anorexia 
R - Recurrent onset/progressive sx
M - Melena/haematemesis 
S - swallowing issues
     Dysphagia
70
Q

PUD DD

A 
A.cholangitis
Cholecystitis
Gallstones
GORD
IBD
71
Q

PUD tx

A

Lifestyle:

  • Decrease smoking + alcohol
  • Loose weight
  • Reduce stress
Pharma:
- Stop NSAIDs
- H pylori eradication:
Triple therapy
Lansoprazole
Metronidazole 
Amoxicillin
  • H2 receptor antagnosit
    Ranitidine
    Cimetidine
72
Q

PUD complications

A 
Haemorrhage --> shock
Peritonitis
Malignancy 
Strictures
Pyloric stenosis
73
Q

Where is Mcburneys point

A

2/3 of the way between umbilicus and ASIS

74
Q

Appendicitis aetiology

A

Faecolith obstruction

undigested seed

75
Q

Why does onset of central pain become localised in appendicitis

A

Visceral nerves irritated then localisation to RIF as parietal nerves become irritated

76
Q

Why referred shoulder pain

A

Diaphragm irritation

C345

77
Q

Appendicitis presentation

A 
Abdo pain 
Loss of appetite
Nausea
Diarrhoea
Vomitting 
Signs:
- Tender at Mcburneys 
- Guarding to RIF
- Fever 
- Rovsing's sign 
  palpation on LIF causes pain in RIF
78
Q

Appendicitis - signs of peritonitis

A
  • Rebound tenderness

- Percussion tenderness

79
Q

Appendicits investigations

A 
- Bloods 
  CRP/ESR - raised
  WCC - raised 
- CT (GOLD)
- USS
  Inflammed appendix mass
- Pregnancy test 
  Serum bHCG
- Urinalysis (Exclude UTI)
80
Q

Appendictis DD

A
  • Ectopic pregnancy
  • Ovarian cysts (rupture)
  • Meckels diverticulum
  • Ulcer perforation
81
Q

Appendictis tx

A

Laproscopic appendectomy
- Pre op Abx
Metronidaole + Cefuroxime

82
Q

Meckels diverticulum complications

A
  • Ulcer

- Acute inflamm

83
Q

Bowel obstruction - mechanical causes (4)

A
  • Hernia
  • Intususception
  • Tumour
  • Adhesions
  • Volvus
84
Q

Small bowel obstrucion causes

A

Post - op adhesions
Strangulated hernia
Volvulus - kids

85
Q

Large bowel obstruction causes

A

Malignancy
Volvulus
Hirschsprung disease
Diverticular disease

86
Q

Obstrucion presentation

A 
Sx- 
vomitting 
absolute constipation 
colicky --> diffuse abdo pain 
anorexia 
signs- 
Abdo distension 
tinkling bowel sounds 
tympanic percussion 
lack of flatulence
87
Q

Distension - small or large bowel obstruction

A

Less distension in small bowel obstruction

88
Q

Obstruction investigations

A
  • Abdo CT - GOLD
    excludes perforation
    bowel dilatation
    bowel wall thickening
  • AXR
    dilated bowel loops
    kidney bean - volvus
  • Bloods
    WCC raised
89
Q

Obstruction tx

A 
NG tube 
IV fluids 
Analgesics
Abx 
Surgery
90
Q

What is an adhesion

A

sticking together of abdo structures through fibrous adhesions
- bowel loops
- omentum
common post-op

91
Q

What is a volvus

A 
occurs at part of bowel with mesentery
- sigmoid colon 
- caecum 
cuts off blood supply 
coffe bean sign
92
Q

What is an intussusception

A 
telescopping of bowel causing obstruction 
- ileocecal valve into caecum 
can cause:
perforation 
strangulation
93
Q

Bowel obstruction abdo X-ray bowel measurements warning

A

SB > 3cm wide
LB > 6cm wide
Caecum/sigmoid >9cm

94
Q

What is diverticular disease

A

Asymptomatic diverticula - outpouchings of bowel wall

95
Q

Site for diverticula

A

Sigmoid

  • narrowes part so highest pressure
  • site where B.V penetrates colon wall - weakest point
96
Q

Types of diverticula

A

True - CONGENITAL
ALL layers involved in outpouching

Flase - ACQUIRED
Only mucosa and submucosa involved in outpouching
- muscle layer remains

97
Q

Diverticula patho

A

Low fibre diet
increases intra-colonic pressure
herniation at weak site

98
Q

Acute diverticulisis cause and complications

A
  • faecolith obstruction leading to stagnation + bacterial multiplication
- complications:
perforation 
abscess formation 
fistulae 
haemorrhage 
acute perotinitis - generalised
99
Q

Acute diverticulitus presentation

A 
sx- 
LIF pain 
Altered bowel habits - erratic
Nausea 
flatulence 
Fever 
Signs- 
Tenderness 
guarding 
Ferbile 
tachycardic 
palpable tender mass
100
Q

Divertivular disease investigations

A

colonscopy

  • colonic wall thickening
  • divertiula
101
Q

A. diverticulits investigations

A

CT abdo - GOLD
Barium enema
Abdo X-ray

  • No colnocoscopy due to perforation risk
102
Q

Diverticular disease tx

A

High fibre diet
Mebeverine - ant-spasmodic
Relaxes SM

103
Q

A.diverticulitis tx

A 
fluids 
SM relaxants - diazepam 
Abx:
Ciprofloxacin
Metronidazole

Surgery -
degree of infective complications indicates requirements

104
Q

Chronic inflammation cell infiltrates

A

Mononuclear cells - monocytes
Lymphocytes
Plasma cells
Macrophages

105
Q

Causes of gastritis

A 
H- pylori 
chronic alcohol 
NSAIDs
AI gastritis
Herpes simplex 
CMV
106
Q

What is AI gastritis

A

Ab against parietal cells

  • Atrophic gastritis
  • IF deficiency –> Prenicious anaemia
  • 3x risk adenocarcinoma
107
Q

Gastritis presentation

A 
N + V
Abdo bloating 
Haematemsis 
Melena 
Indigestion 
Epigastric pain
108
Q

Gastritis DD

A

PUD
GORD
Gastric lymphoma
Non ulcer dyspepsia

109
Q

Gastritis investigations

A
  • Upper GI endoscopy + biopsy
    Red,irritated + inflammed mucosa

If H-pylori suspected:

  • C-urea breath test
  • Stool Ag test
110
Q

Gastritis tx

A

Avoid:
alcohol
NSAIDs
Citrus fruits

  • Educate Pts
  • H-pylori eradication
111
Q

Oesophageal cancer location

A

Upper 2/3 = Squamous cell

Lower 1/3 = Adenocarcinoma

112
Q

How does H-pylor infection lead to cancer

A
  • Persistent infection
  • Chronic gastritis
  • Atrophic gastrits
  • Pre malignant intestinal metaplasia
  • Dysplasia
  • advanced gastric cancer
113
Q

Peritonitis causes

A 
A - Appendicitis 
E - ectopic pregnancy 
I - TB infection 
O - Obstruction 
U - ulcer

Peritoneal dialysis

114
Q

4 types of gastric cancers

A 
Adenocarcinoma 
- Diffuse 
- Intestinal 
Lymphoma 
Carcinoid tumour - G cells 
Leiomyosarcoma - SM
115
Q

Gastric cancer epidemiology

A

Japan/China

Male

116
Q

3 types of bowel ischaemia

A

Acute mesenteric
Chronic mesenteric
Ischaemic colitis - chronic colonic ischaemia

117
Q

Watershed areas of colon

A

Spenic fexure

Caecum

118
Q

When should you suspect mesenteric ischaemia

A

Atrial fibrillation + Abdo pain

119
Q

Foregut blood supply

A

Coelaic artery

120
Q

Midgut blood supply

A

S. mesenteric artery

121
Q

Hindgut blood supply

A

Inferior mesenteric artery

122
Q

Acute mesenteric ischaemia causes

A

Thrombosis - common

Thromboembolism - from AF

SMV - Thrombosis

Non occlusive - LOW BP
- low CO after MI

123
Q

Bowel ischaemia presentation

A
  • Acute severe abdo pain
  • No abdo signs
  • Diarrhoea
  • Vomitting
  • Weight loss
  • Hypovolaemia
  • Melaena
124
Q

Bowel ischaemia investigations

A

Bloods:
- High lactate (Metabolic acidosis)

X-ray - GOLD
- Gass less abdo

Laparotomy
- find necrotic bowel

125
Q

Bowel ischaemia tx

A 
Fluids 
Abx 
- IV gentamicin + metronidazole 
Heparin/anticoag 
Surgery
126
Q

Bowel ischaemia complications

A

Perforation –> Septic peritonitis

Gangrene

Systemic inflamm response syndrome –> Multi organ failure

Scarring and narrowing of intestines

127
Q

Bowel ischaemia RF

A 
Atherosclerosis 
>50y/o
smoking 
COPD 
Arrhythmia 
Clotting disorder
128
Q

Ischaemic colitis RF

A 
Contraceptive pill 
Thrombophilia 
- Hypercoagulability 
Vasculitis 
- BF restriciton
129
Q

Ischaemic colitis presentation

A

Abdo pain
Rectal bleeding
diarrhoea
Shock

130
Q

Shock signs

A 
Pale 
Sweaty
Rapid pulse 
Decreased urine 
confusion
131
Q

Ischaemic colitis investigations

A

Colonoscopy + Biopsy
- Exclure stricture formation at site

Flexible sigmoidoscopy

CT
- excludes perforation

132
Q

Ischaemic colitis tx

A

Fluids

Abx

133
Q

Oesophageal cancer aetiology

A 
Alcohol 
Achalasia 
Smoking 
Obesity 
Barret's oesophagus
134
Q

Oesophageal cancer protective factors

A

Fibre
Caretnoids
Folate
Vit C

135
Q

Oesophageal cancer presentation

A 
Dysphagia 
Weight loss
Vomiting 
Loss of appetite
Pain

Squamous cell

  • hoarse voice
  • cough
136
Q

Oesophageal cancer investigations

A

Endoscopy and biopsy

Barium swallow - strictures

CT - Staging

137
Q

Oesophageal cancer + dysphagia tx

A

Surgical resection
Neoadjuvant chemo

Dyshpagia tx
- Endoscopic stent insertion to restore patency

138
Q

RF for SI tumours

A

Chrons

Coeliac disease

139
Q

SI tumour types

A

Adenocarcinoma - common

Non - Hodgkin’s lymphoma

140
Q

Small intestine tumour presentation

A 
Pain 
Diarrhoea
Anorexia 
Weight loss
Anaemia 
Palpable mass
141
Q

Chronic mesenteric ischaemia causes

A

Atherosclerosis

142
Q

Most common colorectal cancer

A

Adenocarcinoma

- Cells lining colonic crypts

143
Q

2 inherited causes of colon cancer

A

FAP - Familial adenomatous polyposis

HNPCC - Heriditary nonpolyposis colon cancer
Lynch syndrome

144
Q

What is Familial adenomatous polyposis

A
  • AD condition
  • Genetic variability in APC gene
  • Abonrmailty in APC causes beta catenin to build up
    beta catenin causes upregualtion of proliferation in the epithelium
  • > 100 polyps develp
  • 100% lifetime risk of CRC
145
Q

Process of polyps becoming cancerous

A
  • Cells divide faster than usual
  • Polyps
    TSG mutations
    -Adenocarcinoma
    Malignant evolution of polyps
146
Q

CRC risk factors

A 
Age 
Low fibre diet
Smoking 
Red meat high diet 
Alcohol 
Family hx
obesity 
Male 
Ulcerative colitis
147
Q

What is a polyp

A

Abnormal growth of tissue projecting into intestinal lumen from normally flat muscosal surface

Most polyps are adenomas
(precursors for most colorectal lesions)

148
Q

CRC presentation - general

A 
Change in bowel habit 
- More loose and frequent stools
Weight loss
PR bleeding 
Tenesmus 
Iron deficiency anaemia
149
Q

CRC specific presentation

A 
Asceding bowel 
Grow outwards 
- pain RIF
- No bowel obstruction 
- Ulceration and bleeding 
Desceding bowel
Ring shaped infiltratign mass 
- Bowel obstruction 
- Colicky abdo pain 
- Bloody stools 
- Altered bowel habits
150
Q

CRC differential diagnosis

A

Haemorrhoids
Diverticular disease
IBD
Ischaemic colitis

151
Q

CRC investigations

A

Colonoscopy + Biopsy

  • GOLD
  • risk of perforation

CT Colonography

Barium enema

  • No sedation required
  • avoid perforation risk
  • Apple core sign

Bloods
- FBC - microcytic anaemia

Staging CT

152
Q

What test is used in population screening tests for CRC

A

Faecal occult blood test

153
Q

Tumour marker for CRC

A

CEA - Carcinomembryonic Ag

- Only useful for CRC recurrence

154
Q

What classification system is used for CRC staging

A

Dukes classification

155
Q

Descibe the Dukes classification

A

A - Limited to muscularis mucosa

B - Extension through muscularis mucosa
(muscle of bowel wall)

C - LN involvement

D - metastatic

156
Q

CRC management

A

Surgery

  • End to end anastamosis of bowel
  • only indicated if no mets
  • post op chemo

Endoscopic stenting
- palliation in malignant obstruction

Chemo

Radio

157
Q

What is an anterior resection surgery removing

A

Tumours of low sigmoid colon or higher rectum

158
Q

3 cancer screening programmes in UK

A

Breast
Bowel
Cervical

Phase 2a (11 decks)

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