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GI and Liver Flashcards

1
Q

What are the upper GI tract red flags (5)

A
  • Anaemia
  • Loss of weight
  • Anorexia
  • Recent onset/progressive
  • M (haemetamesis)
  • Swallowing difficulty
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2
Q

What is the epidemiology of GORD (2)

A
  • Common

- Prolonged reflux can cause stricture/Barretts (squamous - columnar)

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3
Q

What can cause/are risk factors for GORD (8)

A
  • Hiatus hernia (sliding or rolling)
  • Smoking
  • Alcohol
  • Obesity
  • Loss of peristalsis/sphincter function loss
  • Overeating
  • Pregnancy
  • Increased acid secretion
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4
Q

How might GORD present (6)

A
  • Heartburn (worse on alcohol/hot drinks, stooping/bending, relieved by antacids)
  • Belching
  • Acid/food brash (reflux of acid and food into mouth)
  • Water brash (excess salivation)
  • Pain on swallowing
  • Cough
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5
Q

How do you diagnose GORD (3)

A
  • Clinical unless ALARMS or over 55
  • Endoscopy
  • Barium swallow
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6
Q

How do you treat GORD (6)

A
  • Lifestyle change
  • Antacids (Mg trisilicate)
  • Gaviscon
  • PPI (lansoprazole)
  • H2 receptor antagonists (cimetidine)
  • Fundoplication
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7
Q

What is a peptic ulcer

A
  • A break in the superficial epithelial lining penetrating down to muscularis mucosa of stomach or duodenum. Have a fibrous base and increased inflammatory cells
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8
Q

What is the epidemiology of peptic ulcer disease (4)

A
  • Increases with age
  • Most commonly caused by H.pylori or NSAIDs
  • Duodenal ulcers more common than gastric
  • Duodenal cap and Lesser curvature of stomach are most common areas
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9
Q

What is the pathophysiology of peptic ulcer disease

A
  • NSAIDs or H.pylori disrupt the mucosal layer covering the gastric mucosa
  • This leads to acid destroying the epithelial layer and infiltrating to the muscularis mucosa layer
  • This leads to ulceration and also gastritis
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10
Q

How might peptic ulcer disease present (4)

A
  • Very localised burning epigastric pain
  • Weight loss
  • Nausea
  • Ulcers can get deeper until they cause haemorrhage or peritonitis
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11
Q

How do you diagnose peptic ulcer disease (3)

A
  • Stool antigen test
  • C-urea breath test (for H.pylori)
  • Endoscopy (ALARMS/over 55)
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12
Q

How do you treat peptic ulcer disease (3)

A
  • PPI/H2 receptor antagonist (cimetidine)
  • Stop NSAIDs
  • H.pylori (clarithromycin + amoxicillin)
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13
Q

What is a varice

A
  • A dilated vein at risk of bleeding
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14
Q

What is the epidemiology of oesophago-gastric varices (2)

A
  • 90% with cirrhosis will develop varices

- Usually develop in the lower oesophagus/gastric cardia

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15
Q

What are the causes of oesophago-gastric varices (3)

A
  • Pre-hepatic portal hypertension (thrombus)
  • Intra-hepatic portal hypertension (cirrhosis)
  • Post-hepatic portal hypertension (heart failure/budd chiari syndrome)
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16
Q

How might oesophago-gastric varices present (5)

A
  • Rupture
  • Abdominal pain
  • Haematemesis
  • Pallor
  • Tachycardia/hypotension
  • Shock
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17
Q

How do you diagnose oesophago-gastric varices

A
  • Endoscopy
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18
Q

How do you treat oesophago-gastric varices (4)

A
  • Acute (rupture)
  • Blood transfusion
  • Variceal banding
  • iv terlipressin (vasoconstriction)
  • Prevention
  • Beta-blockers
  • Variceal banding
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19
Q

What is gastritis

A
  • Stomach inflammation associated with mucosal damage
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20
Q

What can cause gastritis (5)

A
  • NSAIDs
  • H.pylori
  • Ischaemia
  • Increased acid secretion
  • Autoimmune gastritis
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21
Q

How might gastritis present (5)

A
  • Epigastric pain
  • Abdominal swelling
  • Vomiting/haemetamesis
  • Indigestion
  • Nausea/stomach upset
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22
Q

How do you diagnose gastritis (2)

A
  • Endoscopy/biopsy

- H.pylori stool antigen/C urea breath test

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23
Q

How do you treat gastritis (3)

A
  • Stop NSAIDs
  • PPI/H2 receptor agonists (cimeditine)
  • H.pylori (clarithromycin + amoxicillin)
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24
Q

What are the main causes of malabsorption (4)

A
  • Pancreatic insufficiency
  • Decreased bile secretion
  • Decreased absorptive surface area (coeliac/crohns/surgery)
  • Non-pancreatic enzyme insufficiency (lactose intolerance)
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25
What is coeliac disease
- A T-cell mediated autoimmune disorder leading to small bowel inflammation, damage and malabsorption in response to prolamin
26
What is the epidemiology of coeliac (3)
- 1% population affected - Associated with family - Peaks in infancy and 50-60
27
Describe the pathophysiology of coeliac
- Gluten sensitive T-cells cause inflammatory response to prolamin - This causes villous atrophy, crypt hyperplasia and wc in the epithelium - Affects proximal small bowel most leading to Fe, vitamin D and folate deficiency (anaemia)
28
How might coeliac present (6)
- Abdominal pain - Bloating - Nausea and vomiting - Weight loss - Diarrhoea - Anaemia
29
How do you diagnose coeliac (2)
- Duodenal biopsy (villous atrophy etc.) | - Serum antigen testing (tissue transglutimase antibody)
30
How do you treat coeliac (2)
- Gluten free diet | - Replace Vit. D, Fe and folate
31
What is the epidemiology of ulcerative colitis (UC) (3)
- More common than Crohns - More common in non-smokers - Usually presents at 15-30
32
Describe the pathophysiology of UC
- Non-granulatomous inflammation of superficial mucosal layer - Starts at rectum spreads out to ileocaecal valve - No skip lesions (continous) - 50% rectum, 30% rectum and distal colon, 20% rectum and colon - Crypt abscesses and goblet cell depletion
33
How might UC present (6)
- Remission/exacerbation (depression, stress, NSAIDs) - Diarrhoea (blood + mucus) - Left lower quadrant pain - Weight loss/malaise - Cramps - Oral ulcers/erythema nodosum
34
How do you diagnose UC (3)
- Bloods (raised CRP/ESR/WCC) - Stool sample to exclude infection - Colonoscopy and biopsy
35
How do you treat UC (6)
- Mild/moderate - Oral 5 aminosalicylic acid (sulfasalazine) - Oral prednisolone - Severe - iv hydrocortisone - Infliximab - Remission - Azathioprine - Surgery
36
What is the epidemiology of crohns (3)
- More common in females - More common in smokers - Usually presents at 20-40
37
Describe the pathophysiology of crohns
- Transmural granulatomous inflammation of mouth to gut - Skip lesions (non-continous) - Cobblestone appearance
38
How might crohns present (4)
- Diarrhoea - Abdominal pain (less localised) - Anal tags - Weight loss/malaise
39
How do you diagnose crohns (3)
- Bloods (raised ESR/CRP/WCC) - Stool sample to exclude infection - Colonsocopy with biopsy
40
How do you treat crohns (6)
- Smoking cessation - Mild/moderate - Slow releasing steroid - Prednisolone - Severe - IV hydrocortisone - Infliximab - Remission - Azathioprine - Surgery
41
What is intestinal obstruction
- Arrest/blockage of the forward propulsion of intestinal contents
42
What are the 3 types of intestinal obstruction
- Obstruction of lumen - Disease of wall - Disease outside wall
43
What can cause obstruction of bowel lumen (2)
- Tumour | - Bile stone (ileum)
44
What can cause Disease of bowel wall (4)
- Tumour - Crohns - Diverticulitis - Neural
45
What can cause disease outside bowel wall (2)
- Adhesion (most common cause) | - Volvulus
46
What are the main causes of small bowel obstruction (SBO) (4)
- Adhesion (most common) - Tumour - Hernia - Crohns
47
Describe the pathophysiology of SBO
- Obstruction leads to proximal dilation and distention of bowel - This causes malabsorption and ischaemia - Ischaemia can lead to necrosis and perforation
48
How might SBO present (5)
- Abdominal pain (initially colicky) - Abdominal distension (less than LBO) - Vomiting - Late constipation - Increased bowel sounds
49
How do you diagnose SBO (3)
- X-Ray (distended bowel) - FBC - CT (gold standard)
50
How do you treat SBO (4)
- Fluids - Analgesia and anti-emetics - Bowel decompression - Surgery
51
What are the main causes of large bowel obstruction (LBO) (2)
- Malignancy | - Volvulus
52
Describe the pathophysiology of LBO
- Bowel proximal to obstruction dilates/distends - This leads to ischaemia, which causes mucosal oedema - This leads to necrosis and perforation
53
How might LBO present (5)
- Abdominal pain (less colicky than SBO) - Abdominal distension (more than SBO) - Constipation - May be faecal vomiting - Palpable mass
54
How do you diagnose LBO (3)
- X-Ray (bowel distension) - FBC - CT
55
How do you treat LBO (4)
- Fluids - Analgesia and anti-emetics - Bowel decompression - Surgery
56
What is the epidemiology of acute mesenteric ischaemia (2)
- Usually seen in older patients | - Nearly always affects small bowel
57
What are the causes of acute mesenteric ischaemia (4)
- Superior mesenteric artery thrombosis (Most common) - SMA embolus (eg. in A.F) - Mesenteric vein thrombosis - Decreased flow/C.O
58
How might acute mesenteric ischaemia present (3)
- Triad of - Acute severe abdominal pain - Absence of abdominal findings - Hypovolaemia (shock)
59
How do you diagnose acute mesenteric ischaemia (3)
- X-Ray (to exclude other causes) - Laparotomy - CT/MRI angiography
60
How do you treat acute mesenteric ischaemia (4)
- Fluids - IV gentamicin - IV heparin - Surgery to remove necrosed bowel
61
What is the epidemiology of ischaemic colitis (2)
- More common in older | - Related to underlying CVS disease
62
What are the causes of ischaemic colitis (4)
- Thrombus - Embolus - Low flow/C.O - Drugs
63
How might ischaemic colitis present (3)
- Sudden onset LLQ abdominal pain - Bright red blood in stools +/- diarrhoea - May be hypovolaemic/shock
64
How do you diagnose ischaemic colitis (2)
- Urgent CT to exclude perforation | - Colonoscopy and biopsy
65
How do you treat ischaemic colitis (3)
- Antibiotics - Fluids - Gangrenous (peritonitis + shock) - Urgent surgery
66
What is irritable bowel syndrome (IBS)
- A mixed group of abdominal symptom with no organic cause found
67
What is the epidemiology of IBS (3)
- Onset before 40 - Common - More common in females
68
What are the main causes of IBS (5)
- Depression/anxiety - Stress - Abuse - GI infection - Eating disorders
69
What are the types of IBS (3)
- IBS-D - IBS-C - IBS-M
70
How might IBS present (8)
- ABC - Abdominal pain/discomfort - Bloating - Change in bowel habit - 2+ of: - Urgency - Incomplete emptying - Bloating - Mucus in stool - Symptoms worse after food
71
What is the epidemiology of acute pancreatitis
- Inflammation of pancreatic gland initiated by any acute injury - Reoccurs if untreated - Can be difficult to distinguish from chronic
72
What are the causes of acute pancreatitis
- IGETSMASHED - Idiopathic - Gallstones (most common) - Ethanol (alcohol) - Trauma - Steroids - Mumps - Autoimmune - Scorpion venom - Hyperlipidaemia - E - Drugs
73
Describe the pathophysiology of acute pancreatitis
- Premature activation of pancreatic enzymes leads to autodigestion of the pancreas by its own enzymes - This leads to acute inflammation of the pancreas - Destruction of Beta cells on islets of langerhans leads to hyperglycaemia - Blood vessel damage leads to haemorrhage
74
How might acute pancreatitis present (6)
- Sudden/subacute onset severe epigastric/middle abdominal pain, radiating to back (may be relieved by sitting forward) - Nausea and vomiting - Fever - Jaundice - Tachycardia/hypotension - Bruising on stomach/flank (greys/cullens signs)
75
How do you diagnose acute pancreatitis (4)
- Bloods (raised serum amylase and lipase) - Erect CXR (exclude gastro-duodenal perforation) - MRI - Ultrasound (gallstones)
76
How do you treat acute pancreatitis (6)
- Remove stones - Analgesia (morphine) - Nasogastric tube - Catheter - Drain build up - ANtibiotics
77
What is chronic pancreatitis
- Debilitating continuous inflammation of the pancreas leading to progressive fibrosis of exocrine pancreatic tissue
78
What is the epidemiology of chronic pancreatitis (2)
- More common in males | - Usually presents around 50
79
What are the causes of chronic pancreatitis (5)
- Alcohol (most common) - Recurrent acute pancreatitis - Cystic fibrosis - CKD - Autoimmune pancreatitis
80
How might chronic pancreatitis present (5)
- Epigastric pain radiates to back, relived by sitting forward and worse on alcohol - Nausea and vomiting - Weight loss/decreased appetite - Diabetes - Diarrhoea
81
How do you diagnose chronic pancreatitis (3)
- Serum amylase and lipase - Enhanced contrast CT - Abdominal ultrasound
82
How do you treat chronic pancreatitis (3)
- Alcohol cessation - Pain relief (NSAIDs/opiates) - Duct drainage
83
What is the epidemiology of appendicitis (3)
- Most common surgical emergency - More common in males - Most common 10-20
84
How might appendicitis present (5)
- Right iliac fossa pain - Anorexia - Nausea and vomiting - Guarding/tenderness - Diarrhoea
85
How do you diagnose appendicitis (3)
- Bloods (raised WWC, ESR, CRP) - Ultrasound - CT
86
How do you treat appendicitis (2)
- Appendicectomy | - Post-op antibiotics
87
Describe the process of bilirubin catabolism
- Old/damaged erythrocytes broken down by the liver and spleen producing biliverdin - Biliverdin is then converted into unconjugated bilirubin - Unconjugated bilirubin travels to the liver bound to albumin where it is converted to conjugated bilirubin - This is then released into bile, where it enters the small intestine and is converted to urobilinogen - 10% of urobilinogen converted to urobilin whioch is excreted in urine - 90% of urobilinogen is converted to stercobilin where it is excreted in faeces
88
What is jaundice
- A yellow discolouration of the skin caused by raised serum bilirubin
89
What are the two types of jaundice
- Pre hepatic (raised unconjugated) (haemolysis and Gilberts) - Cholestatic (raised conjugated) (Liver and Biliary obstruction)
90
What questions might you ask to distinguish between cholestatic and Pre-hepatic jaundice (3)
- Itching? (Yes in cholestatic) - Stools? (pale in cholestatic) - Urine? (dark in cholestatic) - All normal in pre-hepatic
91
What is biliary colic
- Pain associated with temporary obstruction of the cystic/bile duct caused by a stone
92
What is cholangitis
- Inflammation of the bile duct
93
What is cholecystits
- Inflammation of the gallbaldder
94
What is the epidemiology of gallstones (3)
- More common in females - Increases with age - Most are formed in the gallbladder
95
What are the risk factors for gallstones (5)
- Obesity - Increasing age - Smoking - Diabetes - Female
96
How might gallstones present (3)
- Biliary colic (severe sudden onset epigastric/RUQ pain that radiates over shoulder, associated with nausea and vomiting) - Tenderness and guarding - Jaundice
97
Where might gallstones get stuck
- Bile duct (cholangitis) | - Cystic duct (cholecystitis)
98
How do you diagnose Cholangitis (4)
- Ultrasound - Abnormal Liver biochem. (raised AST, ALP, ALT) - Raised WCC, CRP, ESR - Raised serum bilirubin
99
How do you diagnose Cholecystitis (3)
- Ultrasound - Raised WCC, CRP, ESR - May be abnormal Liver biochem./raised bilirubin
100
How do you treat gallstones (6)
- Iv fluids - Nasogastric tube - Opiates - IV antibiotics - Shockwave lithotripsy - Surgery eg. cholecystectomy
101
How do you define acute and chronic hepatitis
- Acute <6 months | - Chronic >6 months
102
What can cause acute hepatitis (4)
- Virus (hep. A to E and EBV) - Alcohol - Autoimmune - Drugs/toxins
103
How might acute hepatitis present (6)
- RUQ pain - Malaise and myalgia - Cholestatic jaundice - GI upset - Tender hepatomegaly - Raised serum ALP/AST and bilirubin
104
What can cause chronic hepatitis (4)
- Viral (hep. B, C, D) - Alcohol - Drugs - Autoimmune
105
How might chronic hepatitis present (4)
- Cholestatic jaundice - Ascites/oedema (albumin def.) - Bleeding/bruising (clotting factor def.) - Liver biochem and LFTs may be raised or normal
106
What are the methods of blood borne transmission (5)
- Needlestick - IV drug use - Tattoo - Sex - Blood products
107
What is the major risk of chronic hepatitis
- Chronic hepatitis leads to cirrhosis which leads to hepatocellular carcinoma
108
What type of virus is hepatitis A and is it acute or chronic
- RNA virus | - Acute
109
How is hepatitis A spread
- Faeco-oral transmission
110
How do you treat hepatitis A (3)
- Monitor liver function - Supportive treatment - Vaccinate + human normal immunoglobulin for close contacts
111
What type of virus is hepatitis B and is it acute or chronic
- DNA virus | - Acute and chronic
112
How is hepatitis B spread
- Blood-borne transmission
113
How do you treat hepatitis B (3)
- Acute - Monitor liver function + vaccinate close contacts - Follow up blood test after 6 months to see if antibody is still there - Chronic - Alpha interferon
114
What type of virus is hepatitis C and is it acute or chronic
- RNA virus | - Acute and chronic
115
How is hepatitis B spread
- Blood borne transmission
116
How do you treat hepatitis C (3)
- Acute - Monitor liver function + vaccinate close contacts - Follow up blood test after 6 months to see if antibody is still there - Chronic - Alpha interferon + Ribavirin
117
What type of virus is hepatitis D and is it acute or chronic
- RNA virus | - Acute and chronic
118
How is hepatitis D spread
- Blood borne transmission
119
How do you treat hepatitis D (3)
- Acute - Monitor liver function + vaccinate close contacts - Follow up blood test after 6 months to see if antibody is still there - Chronic - Alpha interferon
120
What type of virus is hepatitis E and is it acute or chronic
- RNA virus | - Acute
121
How is hepatitis E spread
- Faeco-oral transmission
122
How do you treat hepatitis E (3)
- Monitor liver function - Supportive treatment - Vaccinate + human normal immunoglobulin for close contacts
123
What is Cirrhosis
- End stage of all progressive liver diseases, which is irreversible and associated with portal hypertension and liver failure
124
What are the main causes of cirrhosis (3)
- Alcohol - Hepatitis B, C, D - Non alcoholic fatty liver disease
125
What is the pathophysiology of cirrhosis
- Chronic liver injury results in inflammation necrosis and hence progressive fibrosis of liver parenchyma - If cause of fibrosis is treated early then can be reversed - Later stage can improve/regress but will not reverse
126
How might cirrhosis present (6)
- Oedema/ascites - Hepatomegaly - Jaundice - Bleeding/bruising - Hair loss - White nails/clubbing
127
How do you diagnose cirrhosis (4)
- Liver biopsy (gold standard) - LFTs (low albumin/prothrombin time) - Liver biochem. (raised AST/ALT) - Imaging (ultrasound/CT)
128
How do you treat cirrhosis (5)
- Alcohol abstinence - Good nutrition - Transplant - Avoid NSAIDs - Hepatocellular carcinoma screening
129
What are the causes of portal hypertension (3)
- Pre-hepatic (portal vein thrombus) - Intra-hepatic (cirrhosis) - Post-hepatic (RH failure)
130
What is the epidemiology of primary biliary cirrhosis (3)
- More common in females - Usually presents around 50 - Autoimmune, unknown cause
131
What are the risk factors for primary biliary cirrhosis (4)
- Smoking - Recurrent UTI - Family history - Other autoimmune disease
132
Describe the pathophysiology of primary biliary cirrhosis
- Autoimmune granulatomous inflammatory damage of interlobar bile ducts, leading to Liver fibrosis and cirrhosis
133
How might primary biliary cirrhosis present (4)
- Itching - Hepatomegaly - Jaundice - Lethargy/fatigue
134
How do you diagnose primary biliary cirrhosis (4)
- Liver biochem. (raised ALP) - LFTs (raised cholsterol/bilirubin) - Ultrasound - Liver biopsy
135
What is the treatment for primary biliary cirrhosis (3)
- Ursodeoxycholic acid (improves bilirubin levels) - Vitamin ADEK - Liver transplant
136
Describe the pathophysiology of alcoholic liver disease
- Fatty liver is caused by excess alcohol as fat is produced by livers metabolism of alcohol - Hepatitis/cirrhosis occurs due to lymphocytic infiltration and fat deposition
137
How might alcoholic liver disease present (6)
- Hepatomegaly - Jaundice - Bleeding/bruising - Ascites/oedema - Malaise/fever - Clubbing/white nail discolourations
138
How do you diagnose alcoholic liver disease (4)
- Liver biochem. (raised AST/ALT) - LFTs (raised bilirubin/prothrombin time) - Liver biopsy (fatty liver/cirrhosis) - Ultrasound/CT
139
How do you treat alcoholic liver disease (4)
- Alcohol cessation - Iv thiamine (avoid wernicke-korsakoff encelopathy which is caused by alcohol withdrawal) - Avoid NSAIDs/good diet - Liver transplant
140
What is liver failure
- Liver loses the ability to repair/regenerate leading to decompensation
141
What are the two types of liver failure
- Acute liver failure - When acute liver injury leads to hepatic encephalopathy and coagulation issues in a patient with a previously healthy liver - Acute on chronic - When liver fails as a result of decompensation of chronic liver disease
142
What are the main causes of liver failure (3)
- Viral (hepatitis and EBV) - Drugs (most commonly paracetamol) - Hepatocellular carcinoma
143
How might liver failure present (5)
- Jaundice - Nausea/vomiting/fever - Hepatic encephalopathy (confusion, dec. consciousness) - Fetor hepaticus (smell like pear drops) - If acute on chronic signs of chronic liver disease (Clubbing/oedema/ascites/bleeding/bruising)
144
How do you diagnose liver failure (4)
- Liver biochem. (raised AST/ALT) - LFTs (raised bilirubin/prothrombin time) - CT/Ultrasound - Raised NH3
145
How do you treat liver failure (4)
- Iv mannitol if raised ICP - Iv glucose if hypoglycaemia - Platelets and electrolytes - Liver transplant
146
What may cause a raised ALT
- Specific to liver injury
147
What may cause a raised ALP
- Liver injury or cholestatic disease (not just liver specific)
148
What is ascites
- Accumulation of free fluid in the peritoneal cavity
149
What is the epidemiology of ascites (2)
- Poor prognosis (20% 5 year survival) | - Common post-op and in cirrhosis
150
What are the main causes of ascites (3)
- Low albumin - Low flow (portal hypertension - cirrhosis and HF) - Local inflammation (peritonitis)
151
How might ascites present (4)
- Abdominal swelling/distention - Dull shifting - Discomfort/mild pain - Severe suggests peritonitis - May be peripheral oedema
152
How do you diagnose ascites (2)
- Dull shifting | - Ascitic tap (protein - transudate or exudate)
153
How do you treat ascites (3)
- Treat underlying cause - Diuretics/sodium restriction - Fluid drain/shunt
154
What are the causes of peritonitis (2)
- Bacterial - primary (perforation) | - Chemical - secondary (bile)
155
How might peritonitis present (6)
- Sudden onset severe abdominal pain - Initially diffuse and then localises - Shock and collapse - Fever/sweats - Patient wants to lie still - Pain relieved by resting hands on abdomen
156
How do you diagnose peritonitis (2)
- Bloods (raised WCC/ESR/CRP) | - Erect CXR to look for bowel perforation
157
How do you treat peritonitis (4)
- Iv fluids - Iv antibiotics - Nasogastric tube - Surgery
158
What is the epidemiology of oesophageal cancer (3)
- More common in males - Upper 2/3 = SSC, lower 1/3 = Adenocarcinoma - 6th most common cancer
159
What are the risk factors for oesophageal cancer (5)
- Smoking - Alcohol - Obesity - GORD/barretts - Achalasia (dysmotility)
160
How might oesophageal cancer present (4)
- Usually late and advanced - Progressive dysphagia (initially solids then liquids) - Weight loss/malaise - Cough/hoarseness
161
How do you diagnose oesophageal cancer (3)
- Endoscopy and biopsy - Barium swallow - PET/MRI/CT (staging)
162
How do you treat oesophageal cancer (2)
- Surgical excision + chemo. +/- radiotherapy | - Palliative stent/laser treatment for dysphagia
163
What is the epidemiology of gastric cancer (4)
- 4th most common cancer - More common in males - Increases with age - Adenocarcinoma
164
What are the risk factors for gastric cancer (4)
- Smoking - Family history - H.pylori - Diet
165
What are the two types gastric cancer
- Intestinal (type 1) - Well formed, differentiated - Better prognosis - Diffuse (type 2) - Poorly formed, undifferentiated - Poor prognosis
166
How might gastric cancer present (5)
- Severe, constant epigastric pain - Weight loss/malaise - Nausea and vomiting - Dysphagia if in fundus - Anaemia
167
How do you diagnose gastric cancer (2)
- Endoscopy and biopsy | - PET/MRI/CT
168
How do you treat gastric cancer (2)
- Surgery + combo. chemo. + radiotherapy | - Nutritional support
169
What is the epidemiology of small intestine cancer (2)
- Rare | - Mostly adenocarcinoma, some lymphomas
170
How might small intestine cancer present (4)
- Abdominal pain - Diarrhoea - Weight loss - Mass
171
How do you diagnose small intestine cancer
- Endoscopy and biopsy
172
How do you treat small intestine cancer
- Surgery and radio/chemotherapy
173
What are colorectal polyps
- An abnormal growth of tissue projecting from the colonic mucosa
174
Why are colorectal polyps significant
- They are adenomas, which are precursors for adenocarcinomas - So they are removed at colonoscopy
175
What is the epidemiology of colorectal cancer (4)
- 3rd most common cancer - More common in males - Usually in older people - Usually adenocarcinomas
176
What are the risk factors for colorectal cancer (6)
- Smoking - Polyps - Ulcerative colitis - Family history - Obesity - Alcohol
177
How might right sided colorectal cancer present (4)
- Mass - Abdominal pain - Anaemia - Weight loss
178
How might left sided/sigmoid colorectal cancer present (3)
- Change in stool habit - Blood and Mucus in stool - Weight loss/malaise
179
How might rectal colorectal cancer present
- Rectal bleeding/mucus
180
How do you diagnose colorectal cancer (3)
- Colonoscopy and biopsy (gold standard) - Double contrast barium enema - CT colonoscopy
181
How do you treat colorectal cancer (3)
- Surgery (colectomy) - Radiotherapy (palliative/rectal) - Chemotherapy (post-op)
182
What is the epidemiology of hepatocellular carcinoma (3)
- 5th most common cancer - 90% of liver tumours - More common in males
183
What is the main risk factor for hepatocellular carcinoma
- Cirrhosis (especially chronic hepatitis B and C)
184
How might hepatocellular carcinoma present (6)
- Jaundice - RUQ pain - Hepatomegaly - Bleeding/bruising - Ascites/oedema - Weight loss/malaise
185
How do you diagnose hepatocellular carcinoma (2)
- Liver biopsy | - Enhanced contrast CT
186
What is the treatment for hepatocellular carcinoma (2)
- Surgical resection | - Liver transplant
187
What is the epidemiology of pancreatic cancer (4)
- 99% in exocrine pancreas - More common in males - More common in older people - Most are adenocarcinomas
188
What are the risk factors for pancreatic cancer (4)
- Smoking - Diabetes - Chronic pancreatitis - Family history
189
How might pancreatic cancer present (5)
- Diabetes - Weight loss - Acute pancreatitis - Head - painless obstructive jaundice - Tail - epigastric pain radiates to back
190
How do you diagnose pancreatic cancer
- Ultrasound guided biopsy
191
How do you treat pancreatic cancer (2)
- 5 year survival 3% - Surgery + post-op chemo. - Palliative care
192
What is the definition of diarrhoea
- Abnormal passage of loose or liquid stools more than 3 times a day - Chronic >2 weeks, acute <2 weeks
193
What factors suggest infective diarrhoea
- Sudden onset associated with crampy abdominal pains
194
What factor suggests bacterial infection
- Blood in the stools
195
What are the risk factors for infective diarrhoea (4)
- Foreign travel - Crowding - Poor hygiene - PPI and H2 antagonists
196
What are the causes of infective diarrhoea (5)
- Mostly caused by virus - Rotavirus (children) - Norovirus (adults) - Campylobacter (adults) - E. coli, shigella, salmonella (children) - C. diff
197
How do you treat infective diarrhoea (4)
- Anti-emetics - Anti-motility agents - Fluids/k+ - Antibiotics

Finals (11 decks)

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