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Finals > GI > Flashcards

GI Flashcards

1
Q

what causes GORD?

A

reflux of gastric contents back into oesophagus/prolonged contact with mucosa. Due to;

  • reduced tone in LOS and transient relaxations
  • increased mucosal sensitivity to gastric acid
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2
Q

Predisposing factors to GORD?

A

obesity, pregnancy, systemic sclerosis

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3
Q

Features of GORD?

A

heart burn, regurgitation, cough and nocturnal asthma, hoarse voice

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4
Q

Red flags of GORD?

A

weight loss, dysphagia, haematemesis, anaemia

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5
Q

Ix for GORD?

A

OGD, 24hr pH monitoring

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6
Q

Mx of GORD? + name 2 medications and their classes

A
  1. lifestyle - lose weight, avoid alcohol, avoid aggravating foods, stop smoking
    PPI e.g. omeprazole
    H2 receptor antagonist e.g. Ranitidine
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7
Q

Complications of GORD - name 2

A

strictures, barrret’s oesophagus

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8
Q

what is the histological change in barretts oesophagus?

A

squamous –> columnar epithelium

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9
Q

what is alchalasia?

A

oesophageal peristalisis - failure of the LOS to relax which impairs oesophageal emptying

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10
Q

name some Ix for oesophageal issues?

A

Barium swallow - shows the dilation of the oesophagus and the peristalisis
oesophageal manometry
OGD
CXR

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11
Q

what is a hiatus hernia?

A

when part of the stomach herniates through the oesophageal hiatus of the diaphragm

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12
Q

Main RF for malignancy in the lower 1/3 of the oesophagus?

A

Barrett’s oesophagus - adenocarcenoma (lower 1/3)

SCC occurs in the middle 1/3 - RF = smoking/alcohol

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13
Q

what is H.Pylori?

A

gram -ve urease producing bacteria found in the gastric antrum

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14
Q

which diseases is H.Pylori associated with?

A

chronic gastritis, peptic ulcer disease, gastric cancer, gastric B cell lymphoma

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15
Q

name 2 methods of non-invasive and invasive testing for H.Pylori?

A

NON INVASIVE - urea breath test, stool antigen test, serology
INVASIVE - endoscopic gastric mucosal biopsy (test for urease and then test histology)

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16
Q

Which Abx are given to eradicate H.Pylori?

A

omeprazole + metronidazole + clarithromycin

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17
Q

Name some causes of peptic ulcers

A

H.Pylori, NSAIDS, crohns

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18
Q

How do duodenal ulcers and gastric ulcer features differ?

A

DU - pain when pt is hungry

GU - pain when pt is eating

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19
Q

Name some complications of gastric ulcers?

A

Perforation –> painless haemorrhage

gastric outlet obstruction

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20
Q

Red flags with gastric ulcer symptoms?

A

pain similar to peptic ulcer
+ nausea, anorexia, weight loss
mets –> ascites and hepatomegaly

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21
Q

Name the two presentations of upper GI bleeding?

A 
haematemesis = vomit blood
malaena = passage of black tar stools
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22
Q

Mx for an upper GI bleed?

A

IMMEDIATE - FBC/UE/LFT/clotting. group and save, cross match 4 units, start IV fluids

  • stop NSAIDS/warfarin/aspirin
  • give PPI to high risk patients
  • consider ABX
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23
Q

Name some causes of upper GI bleeding

A

mallory weiss tear, previous ulcer, varices, gastric carcinoma

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24
Q

Causes of lower GI bleeding (small intestine/colon)

A

SI - cancer, UC, meckels diverticulum

Colon - haemmerhoids, fissure, neoplasm, UC/CD, diverticular disease

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25
Q

How do you investigate a lower GI bleed?

A

resuscitate - fluids/blood
Hx and exam
protoscopy for anorectal disease
sigmoidoscopy

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26
Q

What is coeliac disease?

A

autoimmune condition whcih reacts to the a gliadin portion on the gluten molecule causing an inflammatory cascade

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27
Q

What is shown on histology on a patient with coeliac disease?

A

villous atrophy
crypt hyperplasia
increased intraepithelial cells

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28
Q

Features of coeliac disease?

A

tired, malaise, steatorrhea, deficiency in B12/folate/iron

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29
Q

What Ix do you do for coeliac disease?

A

Abs - TTG, EMA
FBC - anaemia?
DXA scan
Distal duodenal biopsy

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30
Q

Mx for coeliac disease?

A

gluten free diet, pneumococcal vaccine

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31
Q

What is the effect of a resected terminal ileum?

A

B12 malabsorption –> megaloblastic anaemia

Bile salt malabsorption –> renal oxalate stones

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32
Q

what is meckels diverticulum??

A

diverticulum which is left over from the umbilical cord (60cm from the ileocaecal valve)

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33
Q

how can a meckel’s diverticulum present?

A

lower GI bleeding, perforation, inflammation, obstruction

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34
Q

causes of intestinal ischaemia?

A

reduced blood flow

  • atheroma
  • embolism
  • vasculitis
  • shock
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35
Q

how does bowel ischaemia present?

A

severe abdo pain but with limited findings on examination

36
Q

how do small bowel tumours present?

A

abdo pain, diarrhoea, anorexia, anaemia, carcinoid features

37
Q

which conditions increase the risk of small bowel tumours?

A

crohns, coeliac

38
Q

which cells do carcinoid tumours develop from?

A

enterochromaffin cells (produce serotonin)

39
Q

how does carcinoid syndrome (increased serotonin present)

A

flushing, wheezing, diarrhoea, abdo pain

40
Q

name a serotonin antagonist?

A

cyroheptadine

41
Q

what does high 5HIAA in urine make a potential diagnosis?

A

carcinoid small bowel tumour

42
Q

What causes IBD?

A

inflammatory condition affecting the bowel.
Genetics - stronger for CD, familial aggregation, links with HLAB27
Environment - reduced Rx of UC with smoking, smoking precipitates relapses

43
Q

Features of CD presentation?

A 
commonly affects ileocaecal bowel
abdo pain and weight loss
diarrhoea
bleeding/pain on defacation
anal tags/fissures/abscesses
oral ulcers
44
Q

Features of UC presentation?

A

diarrhoea and blood/mucus
urgency
tenesmus
L lower quadrant pain

45
Q

Histological features of CD?

A 
affects oral --> perianal parts of bowel
discontinuous lesions
deep ulcers/fissure (cobblestone appearance)
transmural inflammation
granulomas
46
Q

Histological features of UC?

A 
Colon only affected (begins in rectum then extends up)
continuous lesions
red mucosa/bleeds easily
mucosal inflammation only
no granulomata, crypt abscessees
47
Q

How do you investigate IBD?

A

BLOODS - FBC (anaemia, platelets), ESR, CRP, albumin, LFTs

IMAGING - rigid flexible sigmoidoscopy, rectal biopsy, colonoscopy, small bowel imaging, plain XR

48
Q

IBD DD?

A

infection, ischaemia, radiation, bacteria overgrowth

49
Q

Name some extra-gastrointestinal features of IBD?

A

EYES - uveitis, episcleritis
JOINTS - arthralgia, ankylosing spondylitis, inflammatory back pain
SKIN - erythema nodosum
LIVER - fatty liver, sclerosing cholangitis, cirrhosis, hepatitis
RENAL - oxalate stones

50
Q

How do you induce and maintain remission in UC?

A

Induce remission - Aminosalicylate/IV steroids

maintain remission - topical aminosalicylate (azathioprine if severe.)

51
Q

How do you induce and maintain remission in CD?

A

STOP SMOKING
induce remission - steroids, enteral feed, infliximab
maintain remission - azathioprine/surgery

52
Q

Name some complications of IBD

A

perforated bowel, strictures, abscesses, fistulae/fissures, colon cancer

53
Q

What is the definition of constipation?

A

consistent difficulty in defacation. Infrequent passage of stools <3 days/weeks + straining and passage of hard stools with a sensation of incomplete emptying

54
Q

Name some causes of pregnancy

A 
GENERAL - pregnancy, low fibre, immobile
METABOLIC - DM, hypothyroid
FUNCTIONAL - IBS
DRUGS - opiates
NEURO - SC lesion, PD
GI - hirschprung, obstruction
55
Q

Constipation red flags?

A

rectal bleeding, anaemia, resent onset, >50, tenesmus

56
Q

What are diverticula?

A

pouches of mucosa through colonic muscular wall, they form due to increased intracolonic pressure and areas of weakness in the bowel wall

57
Q

RF for formation of diverticula?

A

age, low fibre diet, obesity, sedentary lifestyle, smoking and NSAIDS

58
Q

Features of diverticular disease?

A

Lower left quadrant intermittant abdo pain, bloating, constipation and diarrhoea

59
Q

Features of acute diverticulitis?

A

severe LLQ pain, N&V, constipation or diarrhoea, urinary symptoms, fever

60
Q

Signs of acute diverticulitis on examination?

A

increased HR, tender LIF, reduced bowel sounds, guarding, rigidity, tenderness

61
Q

Ix for acute diverticulitis?

A

CXR - perforated and pneumoperitoneum?
AXR - dilated bowel loops
CT abdo - abscess

AVOID COLONOSCOPY - PERFORATION RISK

62
Q

How do you manage acute diverticulitis?

A

ABx, liquids, analgesia

63
Q

Name two genetic conditions which increase the risk of bowel cancer

A

FAP, HNPCC

64
Q

What screening would you do for someone with FAP/HNPCC?

A

FAP - annual colonoscopy to identify polyps and resect

HNPCC - colonoscopy every 1-2 years and extracolonic surveillance

65
Q

Name some risk factors for colon cancer

A

age, family history, HNPCC, FAP, high animal protein and low fibre diet

66
Q

Features of L and R sided colon cancer?

A

LEFT - rectal bleeding, stenosis, altered bowel habit, colicky bowel pain
RIGHT - anaemia, RIF mass

67
Q

Ix for CRC?

A

IMAGING - colonoscopy, CT, barium enema
BLOODS - FBC, UE, LFT, CEA tumour marker
CXR, PET
Faecal occult blood test

68
Q

How are the general public screened for CRC?

A

age 60-74
Faecal occult blood/FIT every 2 years
one off flexible sigmoidoscopy

69
Q

How do you investigate IBS?

A

stool culture, baseline bloods (FBC, ESR, B12, folate, coeliac, TFT)

70
Q

How do you manage IBS?

A

low FODMAP diet
amitryptilline
manage any depression/anxiety which is underlying

71
Q

what are some non-GI causes of the acute abdomen presentation?

A

DKA, MI, pneumonia, IBS

72
Q

what do you want in the history of the acute abdomen?

A

Abdo/urinary/gynae Hx

  • ONSET - sudden e.g. perforation/torsion/AAA/ectopic
  • SITE - e.g. RIF = appendicitis, LLQ = diverticulitis
  • COLICKY - mechanical flow obstructed (e.g. ureteric calculi, bowel obstruction)
73
Q

what are you looking at on initial examination of an acute abdomen presentation?

A

shock - ruptured organ?
fever
peritonitis - tenderness, buarding, ridgidity
obstruction - “tinkling bowel sounds”

74
Q

Ix of the acute abdomen?

A 
rectal and pelvic exam
Bloods - FBC/UE/LFT/amylase
urinalysis
CXR
AXR
laparoscopy
pregnancy test
75
Q

What causes appendicitis?

A

lumen of the appendix is obstructed by faecocolith

76
Q

Features of acute appendicitis?

A

central abdo pain which localises to the RIF
anorexia, N&V, diarrhoea
pyrexial
guarding and tenderness

77
Q

Ix for acute appendicitis?

A

Bloods - WCC, CRP, ESR

US and CT of the abdomen

78
Q

name 2 causes for localised peritonitis

A

acute appendicitis, cholecystitis

79
Q

What causes generalised peritonitis?

A

rupture of abdominal viscus, e.g. ulcer

80
Q

Main causes of a small intestine obstruction

A

adhesions, hernias, crohns, intussuption, extrinsic cancer involvement

81
Q

Main causes of colonic obstruction?

A

carcinoma of the colon, sigmoid volvulus, diverticular disease

82
Q

Features of a bowel obstrucrion?

A

bowel above obstruction is dilated
colicky abdo pain
vomiting (soon in SBO + bilious)
Constipation (earlier with LBO)

83
Q

Findings on abdo exam of a bowel obstruction?

A

distension and tinkling bowel sounds

84
Q

Mx of a SBO and LBO

A

SBO - NG suction and IV fluids

LBO - surgery

85
Q

Name a cause of functional bowel obstruction and when does it occur?

A

paralytic ileus - occurs after abdo surgery/opiate use

Finals (21 decks)

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