Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

My GI > GI Clinical > Flashcards

GI Clinical Flashcards

1
Q

What are common symptoms of functional disorders?

A

Nausea
Vomiting
Diarrhoea
Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Stomatitis

A

Inflammation in the mouth due to any cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is angular stomatitis?

A

Type of inflammation in the mouth but it occurs in the corners.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Halitosis?

A

Bad Breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes of Halitosis?

A
  1. Poor oral hygiene
  2. Anxiety
  3. Oseophageal stricture
  4. Pulmonary sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the causes of Indigestion?

A

Constipation

or blockage in the stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Red flags which are related to dyspepsia which suggest cancer?

ii. What age group have a higher risk of significant GI pathology related to this?

A
  1. Dysphagia
  2. Weight loss
  3. Vomiting
  4. Anorexia
  5. Haemetesis
  6. Melena.

ii. 55 and above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the difference between Nausea an Retching?

A

Nausea is the feeling of wanting to vomit

Retching- Strong involuntary but unproductive attempt to vomit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give examples of causes for vomiting.

A
  1. Any GI disease
  2. Infections: Viral- influenza or norovirus
    Bacteria: Pertussis or Urinary infection
  3. CNS disease: Raise intracranial pressure, vesitibular disturbance or migraine.
  4. Metabolic : Uraemia or Hypercalcaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does faeculent vomiting suggest?

A

Low intestinal obstruction or presence of gastrocolic fistula.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is faeculent vomiting?

A

Vomiting of faeces.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Haematemesis?

A

Vomiting of blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are early morning nausea and vomiting both caused by?

A

Pregnancy, Alcohol dependence and some metabolic disorders such as Uraemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the main cause of persistent nausea when it is by itself and no other complaints are present?

A

Stress related.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is flatulence?

Causes?

A

Loads of farting. Big wind.

ii. high intake of carbonated drinks and high-fibre diet.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is organic abdominal pain caused mainly by?

A

Stretching of smooth muscle or organ capsules.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does bloody diarrhoea suggest?

A

Colonic and/or rectal disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does acute diarrhoea which lasts 2-3 days suggest?

A

Infective cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is epigastric pain most likely caused by?

A
  1. Food intake pain
  2. Dyspepsia
  3. Peptic ulcer disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a common symptom of gastro-oesophageal reflux.

A

Heart burn.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the two main places of origin for right hypochondrial pain?

A
  1. Gall bladder and bilary tract.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What two main diseases can present with pain in the right hypochondrium?

A
  1. Hepatic congestion

2. Peptic ulcer disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pain in the left iliac fossa mainly associates with what area?

A

if acute then mainly colonic origin e.g. acute diverculitis

If chronic mainly functional bowel disorders.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the main causes for pain in the right iliac fossa?

A
  1. Acute appendicitis
  2. ileocaecal disease
  3. Functional bowel disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is proctalgia fugax?

A

Severe deep pain deep in the rectum that comes on suddenly but lasts only for a short time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are causes of abdominal wall pain which has localised tenderness ?

A
  1. Muscle pain
    If not relieved by tensing then probably from wall itself
  2. Nerve entrapment
  3. external hernias
  4. Entrapment of internal viscera

due to traumatic or surgical alterations of abdominal wall musculature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Anorexia is usually a late symptom of cancer true or false

A

true.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the main cause of weight loss in malabsorption?

A

anorexia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the main cause of weight loss with normal or increased dietary intake?

A

Hyperthyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the five fs related to abdominal distention?

A 
Flatus
Fat
Fetus
Fluid
Faeces
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is intermittent distention a common feature of ?

A

Functional bowel disorders.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the 9 regions of the abdomen?

A
  1. Epigastrium
  2. Right/left hypochondrium
  3. umbilical
  4. Right and left lumbar
  5. Hypogastrium
  6. Right/left iliac fossa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is Ascites?

A

Excess fluid in the peritoneal cavity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How can you prove Ascites is present?

A

Asking patient to move on their sides. Causes shifting dullness. Dullness from flanks will move. This suggests 1-2 L of fluid present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What does a succussion splash suggest?

A

Gastric outlet obstruction if patient has not drunk in 2-3 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is a proctoscopy used for?

A

To look for anorectal pathology such as haemorrhoids.

Patients with a history of bright red rectal bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a sigmoidoscopy used for?

A

routine examination when patient presents with diarrhoea and lower abdominal symptoms e.g. rectal bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the two types of idiopathic aphthous ulcerations?

A

Minor and Major.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are characteristics of minor aphthous ulcerations?

A

the common type. Grey/white centre less than 10 mm. Heals within 14 days usually without scarring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the characteristics of major aphtous ulcerations?

A

Bigger than 10 mm persistent for weeks/months. Heal with scarring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the potential causes of mouth ulcers?

A
  1. GI diseases ( e.g. Inflammatory bowel disease)
  2. Infection : viral- HSV and HIV
    Fungal- canidaisis
    Bacterial- TB and syphilis
  3. Systemic disease: reactive arthritis
    Behcet syndrome
  4. Trauma e.g. dentures
  5. Neoplasia e.g. squamous cell carcinoma
  6. Drugs e.g. ereythma multiforme major.
  7. skin disease e.g. pemphigoid and pemphigus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Describe the characteristics of squamous cell carcinoma of the mouth.

A

Majority develop at floor of the mouth or lateral borders of the tongue.

Advanced tumours are hard, indurated ulcers with raised and rolled edges.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are the aetiological agents of squamous cell carcinoma of the mouth?

A
  1. Tobacco
  2. heavy alcohol consumption
  3. areca nut
  4. HPV 16
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the treatment of squamous cell carcinoma?

A

Surgical excision

neck dissection to potentially remove lymph nodes and/or radiotherapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What causes transient white patches?

A

Candida infection or due to systemic lupus erythematosus.

Local causes are trauma from drugs e.g. ill fitting dentures or aspirin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are persistent white patches caused by?

A

Leukoplakia - premalignant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the causes for oral pigment lesions?

A

Peutz-Jeghers syndrome and Addison disease.

Heavy metals e.g. lead and drugs e.g. phenothiazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is glossitis?

A

Red,smooth sore tongue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the cause of glossitis

A

iron,folate and Vitamin B12 deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is geographic tongue?

A

It is harmless migratory glossitis where ulcer like lesion forms changing colour and size.

Not related to cancer at all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is gingivitis?

A

Inflammation of the gums

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the causes of gingivitis?

A

Chronic

Bacterial plaque

Acute
spirochaete and fusiform bacteria ( poor hygiene and smoking)

gingival inflammation- pregnancy, scurvy and drug induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How do you treat gingivitis ?

A

bacterial plaque- plaque removal

acute- oral metronidazole and chlorhexidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the main bacteria which causes tooth decay?

A

Streptoccous mutans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is xerostomia?

A

dry mouth.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the cause of xerostomia?

A
  1. Sjogren syndrome and mikulicz
  2. Drugs - antimuscarinic.
  3. radiotherapy
  4. dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What do tertiary contraction of peristalsis in the oesophagus suggest?

A

Pathogenic non propulsive contractions. Caused by local reflexes within the myenteric plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is dysphagia?

A

Difficulty swallowing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is odynophagia?

A

Pain in swallowing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What does odynophagia suggest?

A

Oesophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the characteristics of heartburn?

A

retrosternal burning pain that can spread to the neck and across the chest.

Can be difficult to distinguish from the pain of ischaemic heart disease.

Worst lying down at night- when gravity promotes reflux.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What does regurgitation suggest?

A

Gastro-oesophageal reflux disease or organic stenosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the main sign of oesophageal disorder?

A

Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What are ways of investigating oesophageal disorders?

A
  1. Barium swallow meal
  2. Gastroscopy
  3. Manometry
  4. Ambulatory pH monitoring
  5. Impedance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Why does acid reflux increase with Gastro-oesophageal reflux disease (GORD)?

A

Due to increased transient lower oseophageal sphincter relaxations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are the two main forms of IBD?

A

Crohns disease

Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the epidemiology of IBD?

A

Highest incidence rates are in Northern Europe and North America. With Jewish population having highest ethnic rate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the main cause of IBD?

A

Unknown. However it is associated with many co factors.

  1. Genes
  2. Environment
  3. Intestinal micobiota
  4. Host immune response.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are the major genetic factors associated with IBD?

A
  1. NOD2 gene- found on chromosome 16 also present in bacterial cell wall. Expressed in epithelial and macrophages. Increases risk of developing CD
  2. Autophagy genes
  3. Th17 pathway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are the major enviromental factors of IBD?

A
  1. Smoking
  2. NSAIDS
  3. Hygiene
  4. nutritional factors
  5. Psychological factors e.g. chronic stress and depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What are the mechanisms of intestinal microbiota which may relate to IBD?

A
  1. Intestinal dysbiosis - less diviersity of bacteria in guy e.g. more E.coli
  2. Specific pathogenic organisms- increased E.Coli found in ileal epithelial cells in Crohn’s disease.
  3. Bacterial antigens
  4. defective chemical barrier
  5. Impaired mucosal barrier function.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What part of the GI tract is Crohn’s disease most prominent?

A

The Terminal ileum and ascending colon. (ileocolonic disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Does Crohn’s disease only cover one area?

A

It can however it can also display two other patterns

  1. Skip lesions- effect certain areas of Gut with healthy bowel inbetween
  2. Total colitis- can effect whole of colon.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the name given when IBD affects the rectum alone?

A

Proctitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is the name given when IBD affects rectum and extends proximally to involve sigmoid and descending colon.

A

left-sided colitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is the name given when IBD affect the whole colon?

A

Extensive colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What are the three main sites of UC?

ii. what is the most common site of UC

A
  1. Extensive colitis
  2. Distal colitis ( left sided colitis)
  3. Proctitis
    ii. Rectum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are the macroscopic changes of Crohns disease?

A
  1. The involved bowel is thickened and narrowed.
  2. Deep ulcers and fissures in the mucosa produce a cobblestone appearance.
  3. Potential intra-abdominal fistulae and absecesses may be seen.
  4. Early feature -aphtoid ulceration in the colon.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are macroscopic features of ulcerative colitis?

A
  1. Mucosa is reddened and thickened and bleeds easily

2. Severe cases - extensive ulcerations with adjacent mucosa appearing as post-inflammatory polups.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are macroscopic features of fulminant colonic disease of either UC or CD?

A

Most of mucosa is lost.

Formation of mucosal islands (oedematous mucosa)

toxic dilation occurs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What are the microscopic features of CD?

A

Inflammation extends through all layers (transmural) patchy

Increase in chronic inflammatory cells and lymphoid hyperlplasia

Glanulomas present in roughly half of patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What are the microscopic features of UC?

A

Inflammation is limited to the mucosa. Continuos

chronic inflammatory cells infiltrate lamina propria.

crypt abscesses and goblet cell depletion seen

Rare for granulomas to be seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What are the two types of peripheral athropathies?

A
  1. Type 1 ( pauciarticular)- Acute and self-limiting

2. Type 2 (polyarticular)- chronic. usually associated with uvetitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Give examples of extragastrointestinal manifestations of IBD?

A
  1. Eyes e.g. uvetis and conjunctivitis
  2. Joints- type 1 and 2 arthropathy
  3. Skin e..g erytherma nodosum
  4. Liver and biliary tree e.g. scelrosing cholangitis, fatty liver,chronic hepatitis,cirrhosis and gallstones
  5. Nephrolithiasis
  6. Venous thrombosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Give the main infective and non-infective causes of diarrhoea?

A

Non infective

  1. IBD
  2. Colitis
  3. Behcet isease
  4. Diverticular disease
  5. malabsoprtion
  6. Drugs e.g. laxatives, statins, metforming

Infective.

  1. Bacteria
    e. g. Campylobacter jejuni, salmonella,shigella, E.Coli, Staphylococcal enterocolitis
  2. Virus e.g. rotavirus
  3. Fungal e.g. histoplasmosis
  4. Parasitic e.g. Amoebic dysentery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

when should Crohns disease be considered with patients that have diarrhoea ?

A
  1. Symptoms persisting beyond 5 days
  2. Vitamin malabsorption
  3. malnourishment
  4. children with reduced growth velocity.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What are the symptoms of Crohns disease?

A
  1. Diarrhoea
  2. Abdominal pain
  3. Weight loss
  4. Malaise
  5. Lethargy
  6. Anorexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What are the main presenting features with children who have CD?

A

Reduced growth velocity

delayed puberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What is steatorrhea ?

A

Faeces containing fat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Describe the stool of a patient with CD?

A

Diarrhoea. usually contains blood

Steatorrhoea is present in small bowel disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What are the physical signs of CD?

A

Weight loss

signs of malnutrition

Apthous ulcerations

tender abdomen with /or right iliac fossa mass occassional found

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What blood test results would you find with someone with CD?

A

Anaemia is common- >100g/L of haemoglobin

Raised ESR-An erythrocyte sedimentation rate (ESR) is a type of blood test that measures how quickly erythrocytes (red blood cells) settle at the bottom of a test tube that contains a blood sample. Normally, red blood cells settle relatively slowly. A faster-than-normal rate may indicate inflammation in the body

Raised CRP-C-reactive protein (CRP) is a blood test marker for inflammation in the body. CRP is produced in the liver and its level is measured by testing the blood. CRP is classified as an acute phase reactant, which means that its levels will rise in response to inflammation

Hypoalbuminaemia

Serological test- negative perinuclear ANCA but positive ASCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What imaging and endoscopy should be carried out with CD?

A
  1. Colonoscopy- if colonic involvement suspected. Except if presenting with severe disease.
  2. Upper gastrointesitinal endoscopy- exclude oesophageal and gastroduodenal disease.
  3. Small bowel imaging - mandatory
  4. Ultrasound- radiation free imaging for assessing disease activity in the ileum and colon.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is the main treatment for CD?

A

Glucocorticosteroids. Used to induce remission.

(oral prednisolone 30-60 mg/day).

Exclusive enteral nutrition- mainly used for paediatric practice.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What are the symptoms of Hepatitis A?

A
  1. Lethargy
  2. Headaches,
  3. Fever
  4. Nausea
  5. Abdominal pain
  6. Jaundice

Incubation- 2-6weeks typically 28 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What are the type of treatments used to induce remission of crohns disease?

A
  1. Steroids
  2. enteral nutrition
  3. Anti -TNF treatment e.g. infliximab and adalimumab
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What are the type of treatments used to maintain remission?

A
  1. immunosuppresive e.g. azathioprine.

2. Anti- TNF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Smoking cessation will dramatically decrease risk of CD true or false?

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What are the indications of surgery with CD?

A
  1. Failure of medical therapy
  2. Complications e.g. enterocutaneous fistula, toxic dilation
  3. Presence of perianal sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Describe the procedures that can be carried out for crohns disease.

A
  1. Strocturoplasty- strictures can be widened in small bowel disease
  2. Resection and anastomosis. Need an ileocolonoscopy to access the anastomosis for disease recurrence
  3. If Colonic CD involves whole colon and the rectum is spared, a subtotal colectomy and ileorectal anastomosis may be performed.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is anastomosis surgery?

A

Surgical joining of two hollow organs,such as different part of intestine or blood vessels,in order to bypass disease or resected tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What are the complications of crohns disease?

A
  1. stricture formation
  2. fistula formation
  3. obstruction
  4. pyoderma gangrenosum
  5. anaemia
  6. osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is the terminology given when examination of colectomy specimen des not lead to a diagnosis of CD or UC?

A

Indeterminate colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What is the main difference between CD and UC?

A

CD can be found anywhere along the GI tract

UC never spreads proximal to the ileocaecal valve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What are the main symptoms and signs of UC?

A

5Ps

  1. Pyrexia (fever)
  2. pseudopolyps
  3. lead pipe radiological appearance
  4. Poo (bloody diarrhoea)
  5. proctitis- frequent passage of blood and mucus, urgency and tenesmus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

List symptoms of UC.

A
  1. diarrhoea with mucus and blood (MAJOR symptom)
  2. Lower abdominal discomfort
  3. malaise
  4. Lethargy
  5. Anorexia
  6. Weight loss
  7. apthous ulcerations

note symptoms 3-6 not as severe as with CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What is the relationship of smoking with UC?

A

UC is 3 fold as common in non smokers than smokers. Opposite for CD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What defines a sever attack of ulcerative colitis?

A
  1. Stool frequency : >6 stools/day with a lot of blood
  2. Fever: >37.8
  3. Tachycardia ( >90b.p.m)
  4. ESR: >30mm/h
  5. Anaemia: <100 g/L of haemoglobin
  6. Albumin <30g/L
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What are the complications of UC?

A

Acute: Toxic megacolon- Gas filled and contains mucosal islands. Xray shows colon is thin-walled and a diameter >6cm.

chronic: colonic cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What tests are used for UC

A

white cell count and platelet count- commonly raised

moderate to severe attacks- iron deficiency anaemia and hypoalbyminaemia

ESR and CRP often raised

pANCA- positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

How should you exclude infectious colitis?

A

stool tests.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

WHat imaging shoud be used for UC?

A

Plain x-ray

ultrasound- inflammation of colonic wall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

How to differentiate betwen mild,moderate and severe UC?

A

Predominantly based on stool motion per
day

Mild - less or equal to 4

moderate 5

severe- 6 or more.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What is the main treatment of UC?

A
  1. 5-ASA e.g. mesalazine - causes agranulocytosis
  2. Steroids- prednisolone
  3. Anti TNF agent
  4. immunosupressants.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

How do you treat mild UC?

A

5- ASA-mainstay for induction and maintenance of remission

topical steroid foams per rectum or prednisolone 20mg retention enemas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

How do you treat moderate UC?

A
  1. Oral prednisolone for induction 40mg/day for 1 weeks then taper by 5mg/week over following 7 weeks
  2. Maintain with 5-ASA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

How to treat severe UC?

A
  1. IV hydration/electrolyte replacement , IV steroids e.g. hydrocortisone and heparain to prevent thromboembolism
  2. daily testing
  3. If worsen use anti TNF then if fails urgent colectomy
  4. IF improving transfer to Prednisolone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What is salvage therapy?

what are the requirements?

A

Medication to try and avoid colectomy.

CRP >45mg/L and 8 or more bowel motions after 3 days of IV Hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What happens in salvage therapy?

A

Occurs with use of ciclosporin as a continuos infusion or anti TNF induction and maintenance therapy.

More ulcerations= more TNF induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What are the indications of surgery for UC?

A 
acute: 
failure of medical treatment
Toxic dilation
haemorrhage
imminent peforation

chronic
Incomplete response to treatment/steroid dependent

dypslasia on surveillance colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What surgical operations are used in UC?

A

Subtotal colectomy and terminal
ileostomy

At a later date two options:

  1. Proctectomy with a permanent ileostomy -

to avoid permanent ileostomy use ileo-anal pouch. Risk of pouchitis though.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What are the causes of Gastro-oesophageal reflux disease? (GORD)

A
  1. Low Lower oesophageal sphincter pressure
  2. Increased abdominal pressure
  3. More tranient lower oesophageal sphincter relaxations
  4. Sliding hiatus hernia
  5. Rolling hiatus hernia
  6. Oesophageal dysmotility (systemic sclerosis)
  7. gastric acid hypersecretion
  8. smoking and alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What is the difference between sliding and rolling hiatus hernias?

A

Sliding- gastro-oesophageal junction slides up into chest. Acid reflux able to occur due to incompetence of LOS.

rolling- Gastro-oesophageal junction remains in the abdomen but of a bulge of the stomach herniates up into chest alongside the oeophagus. GORD is less common with this as junction remains intact.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What are the symptoms of GORD?

A
  1. Heartburn- sensation made worse by lying down, stooping , drinking alcohol , hot drinks or after a heavy meal
  2. Regurgitation of food and acid
  3. waterbrash- extra salivation
  4. odynophagia
  5. Nocturnal asthma - cough
  6. Laryngitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

How can you differentiate between GORD and cardiac ischaemia?

A
  1. GORD pain very rarely radiates to arm while it happens with ischaemia
  2. GORD is relived by antaacids while cardiac ischaemia isn’t
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What are the complications of GORD?

A
  1. Oesophagitis
  2. Ulcers
  3. Benign strictures
  4. Barrett’s oesophagus.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What are the four grades of oesophagitis?

A

A- mucosal breaks confined to the mucosal folds,each no longer 5 mm

B- at least one mucosal break longer than 5 mm confined to the mucosal fold but not continuous between two folds.

C- Mucosal breaks that are continuous between the tops of mucosal folds but not circumferential

D- Extensive mucosal breaks engaging at leats 75% of oesophageal circumference.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is Barrett’s oesophageous?

A

When squamous epithelium in the oesophageous is replaced with metaplastic columnar mucosa to form ‘columnar-lined oesophagus’ CLO.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What are the clinical features of barrett’s oesophageous?

A

Can be seen as a continual circumferential sheet

can be seen as finger like projections extending upwards from the squamocolumnar junction

can be seen as islands of columnar mucosa intersperse with areas of squamous mucosa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

obesity is a major risk factor for Barret’s oesophageous true or false?

A

true.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

What is the likelihood of Barrett’s oesophageous causing oeophageal adenocarcinoma?

A

While B.O is premalignant, it shows a 1% risk in a typical patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

How do you differentiate between high grade and low grade dysphagia with B.o?

A

HGD is usually associated with endoscopically visible nodule or ulcerations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

How do you investigate Barrett’s oesophageous?

A

Endoscopy with biopsy in all four quadrants of CLO.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

How do you treat Barrett’s oesophageous?

A
  1. Endoscopic mucosal resection
  2. endscopic submucosal dissection
  3. Surgical oesophagectomy

first 2 treatments used to prevent third.

Following removal of all known nodular or lesions.

  1. RADIOFREQUENCY ABLATION IS USED this is the endoscopic treatment for dysplasia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

How do you investigate GORD?

A
  1. If there is dysphagia and the patient is younger than 55, use endoscopy to assess oesophagitis and hiatus hernia.
  2. 24 hour intraluminal pH monitoring or with manometry help.

ph <4 or >14.72 indicates reflux.

If patient older than 55 and doesn’t have dysphagia just treat with drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What is the treatment for GORD?

A

Lifestyle: Weightloss, stop smoking, raising bed head at night.

Drugs

Antacids- form a gel with gastric contents to reduce reflux e.g. magnesium trisilicate, aluminum hydroxide

H2-receptor antagonists- acid supression e.g. cimetidine and ranitidine

PPI-inhibit gastric hydrogen. Main choice for mild cases by doctors. e.g. omeprazole and rabeprazole

patients who do not respond to PPI and still have symtpoms are described as having non-erosive reflux disease (NERD)

surgery

  1. laparoscopic Nissen fundoplication
  2. lapararoscopic insertion of a magnentic bead band.

These are used to increase LOS sphincter pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What can potentially happen if carbohydrate, protein and liver metabolism is disrupted?

A
  1. Fatigue
  2. weight loss
  3. muscle atrophy
  4. Hypoalbuminaemia
  5. Hypoglycaemia
  6. Reduced coagulation factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

How does hypoalbuminaemia cause oedema?

A

Reduction in plasma oncotic pressure allows for extravasation of fluid from capillaries into tissues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What does reduced clotting factors cause ?

A

coagulopathy which will cause a prolonged prothrombin time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Why is PT more important than albumin as a test for deteriorating liver function?

A

as coagulation factors have a half-life for a few hours whereas albumin has have a half-life for 21 days.

Therefore a prolonged prothrombin time is a more sensitive reading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

what does prothrombin time measure?

A

How quickly it takes blood to clot.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

What are the main causes unconjugated hyperbilirubinaemia?

A

1 Prehepatic jaundice

  1. hepatic jaundice

note liver diseases seldom cause unconjugated hyperbilirubinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

What are the main causes of conjugated hyperbilirubinaemia?

A
  1. Post hepatic jaundice

2. Hepatic jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

What differentiates between hepatic jaundice ( intrahepatic cholestasis) and the other two forms of jaundice?

A

Intrahepatic cholestasis - no macroscopic obstruction in the hepatic biliary system

both forms of bilirubin concentrations also typically increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

What are the causes of gallstones?

A
  1. too much absorption of water in gallbladder
  2. Too much absorption of bile acids in gallbladder
  3. Too much fat in bile
  4. Inflammation of epithelium in the gall bladder.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What are the clinical uses of Bile acid sequestrants?

A

hyperlipidaemia (limited effect)
cholestatic jaundice (itch)
bile acid diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What are the adverse effects of bile acid sequestrants?

A
  1. unpalatable, inconvenient (large dosages)
  2. frequently cause diarrhoea
  3. reduced absorption of fat-soluble vitamins, and some drugs (e.g. thiazide diuretics)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Haemolytic disorders cause what type of jaundice?

A

Prehepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Biliary obstruction causes what type of jaundice?

A

Post hepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What is the cause of hepatic encephalopathy?

A

hyperammonaemia (acute)

Toxin absorption ( chronic) hyperammonaemia too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Describe the effect of heperammonaemia on the brain?

A

astrocytes in the brain removes ammonia by converting glutamate to glutamine

Glutamate + ATP + NH3 → Glutamine + ADP + phosphate

The excess glutamine causes an osmotic imbalance and a shift of fluid into these cells causing cerebral oedema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What are the effects of hepatic encephalopathy?

A

Grade 1- altered mood, sleep disturbance

grade 2- increased drowsiness ,confusion , slurred speech and liver flap

grade 3- incoherent

grade 4 - coma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

How do you treat hepatic encephalopathy

A

lactulose (laxative)

antibiotics (neomycin, rifamixin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

What does Ezetimibe treat?

A

hypercholesterolaemia - binds to NPC1L1 which stops cholesterol absoprtion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What issues may arise if bile salts arent able to be secreted?

A
  1. Steatorrhoea

2. secondary vitamin deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What does vitamin A deficiency cause?

A

night blindness and dermatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

What does vitamin D deficiency cause?

A

Osteomalacia

rickets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

What does vitamin K deficiency cause?

A

Coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

What does Vitamin C deficiency cause?

A

scurvy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

What procedure is used to drain ascitic fluid from the peritoneal cavity?

A

paracentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Where must the needle be placed during paracentesis?

ii. why is this?

A
  1. must be placed Lateral to the rectus sheath

ii Avoids the inferior epigastric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What can equipment can be avoided to make sure the inferior epigastric artery is not punctured?

A

use ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

What is the difference in characterisation of visceral pain vs somatic ( parietal pain)

A
  1. Visceral- tends to be dull, achy and nauseating

2. Parietal- tends to be sharp and stabbing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Where does foregut pain tend to be felt in?

A

epigastric region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

Where does midgut pain tend to be felt in?

A

umbilical region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Where does foregut pain tend to be felt in?

A

Pubic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Why is the spleen and liver timed with patients breathing when you palpate it?

A

as they are anatomically related to diaphragm so they moves when the muscle moves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Due to the properties of the functional segments of the liver what type of surgery can be performed?

A

Segmentectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

what is the name of the surgery to remove the gallbladder?

A

cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

what might be a potential hazard while performing the cholescystecomy?

A

there is a variation in the origin and course of the cystic artery in 25% of people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

Where can pain in the gallbladder present?

A

hypochondrium- with or without pain referral to the right shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

where will early pain from gallbladder inflammation present?

A

epigastric region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

What is an ERCP used for?

A

Investigate the biliary tree and pancreas

pathology wise can be used to remove gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

How does an ERCP work?

A

Endoscope inserted through oral cavity- then through to duodenum

cannula placed in the major duodenal papilla - radio opaque dye inserted into biliary tree

radiographic images taken of due-filled tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

What is the inflammation of the pancreas called?

A

pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

which region of the abdomen is pancreatic pain detected?

A

umbilical and/or epigastric- as it is midgut and foregut

Can radiate through to the patients back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What region of the abdomen is small intestine pain found?

A

epigastric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

What can sigmoid volvulus cause?

A

bowel obstruction which can lead to infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

what causes the opening of the ligamentum teres?

A

portal hypertension due to liver pathology (eg cirrhosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

Why do the portal systemic anastamoses become dilated? (ie how do varices form)

A

portal hypertension, causing collateral veins to receive a higher volume of blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

What are the clinical presentations of portal hypertension?

A
  1. oeosphageal varicies- dilated submucosal collateral veins
  2. caput medusae- dilated collateral veins and epigastric veins
  3. rectal varicies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

What are the differences between rectal varices and haemorrhoids?

A
  1. varices form in relation to portal hypertension
  2. Haemorrhoids- prolapses of the rectal venous plexus due to raised pressure from chronic constipation,staining or pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

How can faecal constipation form due to labor?

A

Branches of pudendal nerve potential stretched- leaves to fibres within puborectalis or external anal sphincter to be torn

therefore weakened muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

What is an ischioanal absess?

A

infection of the ischioanal fossae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

How do you exam the effectiveness of the external anal sphincter?

ii what do you palpate?

A

PR exam

ii Male- prostate anteriorly

Female- palpate the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

what is a proctoscopy used for?

A

Viewing anterior of the rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

What is a sigmoidoscopy used for?

A

viewing the interior of the sigmoid colon (quicker than colonoscopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

What is a colonoscopy used for?

A

Viewing interior of the colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

How should aphthous ulcers be managed?

A

No specific therapy

Sufferers avoid:

  1. oral trauma
  2. acidic drinks

can take:
3. Tetracycline or antimicrobial mouthwash

  1. topical analgesia
  2. corticosteroid for severe ulcers

Biopsy any ulcer if haven’t healed after three weeks to exclude malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

What is candidiasis?

A

also known as thrush. causes white patches or erythema of the buccal mucosa.

hard to remove white patches- can cause bleeding if removed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

What are the risk factors for candidiasis?

A

Age

antibiotics

immunosuppression ( long term corticosteroids and inhalers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

How do you treat candidiasis?

A

miconazole gel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

What is microstomia?

A

Small narrow mouth- thick and tight perioral skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

What are the causes for microstomia?

A

burns

systemic sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

What is angular stomatitis?

A

Fissuring of the mouths corners

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

What are the causes of angular stomatitis?

A

Denture related problems

deficiency of iron

riboflavin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

what are the main risk factors for oral cancer?

A 
age
tobacco
alcohol
diet/nutrition
previous head/neck cancer (especially in last 2 years)
HPV
Ultra Violet Light
candida
(syphylis
other dental factors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

what is the ratio of men: women for oral cancer?

A

2:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

what is lichen planus?

A

a white lacy looking atrophy, cause is unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

why might oral cancer cause a numb face/lip or drooping eye lid/facial palsy?

A

cancer targeting a cranial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

when can lichen planus become a pre-malignant condition?

A

when it become erosive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

What is achalasia?

A

Degenerative loss of ganglia from Auerbach’s plexus

oesophageal motility disorder. Oesophageal aperistalsis and impaired relaxation of LOS has occured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

What are the signs and symptoms of achalasia?

A
  1. intermittent Dysphagia from both liquids and solids
  2. Regurgitation of food
  3. weight loss can occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

How do you diagnose achalasia?

A

manometry- shows aperistalsis

contrast barium swallow - shows lack of peristalsis and synchronous contractions in the body of the oesophagus.

Chest x ray- shows dilated oesophagus (bird beak at distal oesophagus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

How do you manage achalasia?

A

Treatment is palliative

Endoscopic dilation of LOS using a balloon . repeat giving botulinum toxin injections to prevent perforation

or

Heller’s operation- surgical division of LOS. PPIs needed afterwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

What is diffuse oesophageal spasm?

A

Severe form of oesophageal dysmotiliy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

What are the signs and symptoms of diffuse oesophageal spasm?

A

Intermittent dysphagia

chest pain ( usually retrosternal)

marked contractions of oesophagus without peristalsis

can be asymptomatic- particularly over 60

208
Q

What disease can diffuse oesophageal spasm beassociated with?

A

GORD

209
Q

How do you diagnose oesophageal diffuse spasm?

A

Contrast barium swallow- shows corkscrew oesophagus

manometry

210
Q

How do you manage oesophageal spasm

A

PPIs if reflux is present

antispasmodics

nitrates

calcium channel blockers

balloon dilation sometimes used

211
Q

What are the causes of benign oeosphageal strictures?

A
  1. GORD- main one
  2. ingestion of corrosives
  3. radiotherapy
212
Q

what is a mallory weiss tear?

A

A linear mucosal tear at the oesophagogastric junction.

213
Q

What are the signs and symptoms of the mallory weiss tear?

A

Persistent vomiting which then leads to haematemesis

Tends to occur after alcoholic dry heaves

214
Q

How do you diagnose Mallory-weiss tear?

A

gastroscopy

215
Q

how do you manage a mallory-weiss tear?

A

usually nil active

endoscope guidance for clipping

or surgery for oversewing- rarely needed

216
Q

Give the main specific associated diseases/causes of dysphagia.

A
  1. MALIGNANT STRICTURE ( pharyngeal cancer, oesophageal cancer or gastric cancer)
  2. benign stricture ( esophageal web or peptic stricture)
  3. achalasia
  4. oepshageal spasm
  5. oesophagitis
  6. globus
  7. bulbar palsy
  8. extrinsic pressure ( lung cancer, mediastinal nodes or aortic aneurysm)
217
Q

What signs can be associated with dysphagia?

A
  1. anaemic
  2. weight loss
  3. cachexia
  4. Virchow’s node- suggest intra abdominal malignancy
  5. pharyngeal pouch forms when drinking (very rare)
218
Q

What tests should be carried out with dysphagia?

A
  1. FBC
  2. U&E - for dehydration
  3. Endoscopy and biopsy
  4. oesophageal manometry-measures pressures generated in the oesophagus
219
Q

what key questions should be asked in relation to dysphagia?

ii. What would different answers tell you to each question?

A
  1. Was there difficulty swallowing solids and liquids from the start?

yes= motility disorder

No= solids before liquids- stricture more likely

  1. is it difficult to initiate a swallowing movement?

Yes= bulbar palsy

  1. Does odynophagia occur?

yes=Ulceration- think of their causes

  1. Is the dysphagia constant or intermittent?

follow on by does the pain get worse?

Constant and gets worse= malignant stricture

intermittent= oesophageal spasm

  1. does the neck bulge or gurgle on drinking?

yes- pharyngeal pouch

220
Q

what is eosinophilic oesophagitis?

A

inflammation in the oesophagus caused by presence of eosinophils

also called allergic eosinophilic

221
Q

What are the signs and symptoms of eosinophilic oesophagitis?

A

Dysphagia

food impaction

heartburn

oesophageal pain

more present in young (average 35) white men

222
Q

How do you diagnose eosinophilic oesophagitis?

A

Endoscope to look for:

schatzki’s rings

thickened mucosa and mucosal furrowing

endoscopic biopsies

pH probe negative for reflux

223
Q

how do you manage eosinophilic oesophagitis?

A

Topical steroids( fluticasone spray)- if not effective then use systemic steroids

224
Q

What are the two histological subtypes of oesophageal cancer?

A

Squamous cell carcinoma (most common)

Adenocarcinoma

225
Q

Where do these two cancers occur in the oesophagus?

A

SCC- Upper and middle third

Adenocarcinoma- distal third ( and cardia of the stomach)

226
Q

What are the main risk factors for the both types of cancers?

A

SCC

  1. Smoking
  2. alcohol
  3. plummer-vinson syndrome
  4. achalasia
  5. corrosive strictures

Adenocarcinoma

  1. Longstanding heartburn
  2. Barrett’s oesophagus
  3. Smoking
  4. obesity
  5. older Age
227
Q

What are the epidemiology of both types of cancers?

A

SCC- more common in ethiopia,china,south and east Africa and the caspian sea region off iran

More common in men

Adenocarcinoma- West - more common in men

228
Q

What are the signs and symptoms of carcinomas in the oesophagus?

A

Signs:

  1. Weight loss
  2. Anorexia
  3. lymphadenopathy
  4. difficulty in swallowing
  5. coughing
  6. aspiration into the lungs

Symptoms

Dysphagia- constant and solids first to be found difficult to swallow then liquids

odynophagia

hoarseness

229
Q

How do you diagnose carcinomas of the oesophagus?

A

Endoscopy with biopsy

barium swallow

CT/MRI/US/Laparoscopy/PET for staging of tumour

230
Q

what are the different tumour staging for carcinoma of the oesophagus?

A

Tis- carcinoma in situ

T1- invading submucosa

T2- invading muscularis propria

T3-invading adventitia

T4- invasion of adjacent structures- both local and distant metastasis

231
Q

When is a laparoscopy used for staging of the tumor?

A

If tumour is at the cardia- looks for peritoneal and node metastases

232
Q

When is a PET scan used for staging the tumour?

A

used to confirm distant metastases after use of CT and fluorodeoxyglucose

233
Q

How do you manage the carcinomas of the oesophagus?

A

Depends on the patient and stage of disease

Surgery:

use if tumour has not infiltrated outside the oesophageal wall

oesophagectomy

or endoscopic mucosal resection

If localised T1/T2- radical curative esophagectomy

Pre Op chemotherapy: benefit stage 2b-3

Palliative: mainly for T4

chemo and radiotherapy

endoscopic dilatation
or
oesophageal stenting- helps drink food and solids

234
Q

What are the benign oesophageal tumour called?

A

Squamous papilloma- rare

lipomas- very rare

Leiomyomas- very rare

235
Q

What are squamous papiloma’s symptoms and associated diseases?

A

asymptomatic

Associated with HPV

236
Q

What is the main type of oesophagitis called?

A

reflux oesophagitis

237
Q

What are the characteristics of reflux oesophagitis?

A

inflammation of oesophagus due to refluxed low pH of gastric content

Basal xone epithelial expansion

Intraepithelial,neutrophils,lymphocytes and eosinophils are present

238
Q

What are the causes of reflux oesophagitis?

A

defective LOS

pregnancy

Abnormal oesophageal motility

all increase intra-abdominal pressure

239
Q

What does reflux oesophagitis cause

A

chronic oesophagitis- most common form

ulceration

strictures

Barrett’s oesophagus

240
Q

what causes acute oeosphagitis?

A

corrosives

infection e.g. candidiasis, herpes

241
Q

What symptoms make up dyspespsia?

A

Epigastric pain/burning (mainly retrosternal pain)

Postprandial fullness ( fullness after food)

Early satieity

tender epigastrium

242
Q

What are the alarm symptoms?

A

Anaemia

Loss of weight

Anorexia

recent onset/progressive symptoms

Melanea/haematesis

swallowing difficulty

remember older than 55 is also a good indication

243
Q

what are the two main types of dyspepsia?

A

organic

functional (non-ulcer)- no evidence of culprit structural disease via OGD

244
Q

What are the main causes of organic dyspepsia?

A

Helicobacter pylori infection

Peptic ulcers ( gastric and duodenal)

Gastritis

Drug induced

gastric cancers

245
Q

What is Helicobacter pylori

A

gram negative bacterium

246
Q

Where is Helicobacter pylori most commonly found?

A

high in developing countries

acquired mainly in childhood

247
Q

What does helicobacter pylori cause?

A

gastritis

peptic ulcer disease

Gastric cancers

asymptomatic patients

248
Q

How do you diagnose Helicobacter pylori infection?

A

Serological tests- detect IgG antibodies ( specific and sensitive test) (FBC)

C-urea breath test- make sure no PPIs or antibodies have been taken in the past 2-4 weeks

Stool antigen tests- becoming most popular. first step of diagnosing

or

Gastric biopsies- if H.pylori is present the urease enzyme that the bacteria produce splits the urea to release ammonia

culture- Biopsies can be cultured on a a special medium for testing antibiotics

249
Q

What would you do if the patient has dysphagia and/or the alarm symptoms for dyspepsia?

A

Use an upper GI endoscope

250
Q

What would you do if the patient DOES NOT dysphagia and/or the alarm symptoms for dyspepsia?

A

stop drugs causing dyspepsia

change lifestyle

give antacids

review after 4 weeks- no improvement test for H.Pylori

251
Q

What do you do if the test for H.pylori is negative?

A

Give PPI or H2 blockers for 4 weeks ( omeprazole or ranitidine)

no improvement?- consider endoscopy or longer term medication

252
Q

What would you do if the test for H.pylori is positive?

A

eradication therapy

253
Q

How do you treat H.pylori infection?

A

eradication therapy

Patient must be compliant

triple therapy is main form

  1. omeprazole (PPI)+clarithromycin+amoxicillin
  2. Omeprazole (PPI)+ Clarithromycin + metronidazole

either given for 7-14 days. 2 weeks increase risk of side effects and reduced compliance. but higher eradication rate

oral metronidazole has frequent side effects.

if patient has risk of perforation or haemorrhage test for h.pylori after treatment for 6 weeks

General treatment

stop smoking

biopsies may be required to see that ulcers have gone

254
Q

what is gastritis?

A

inflammation associated with mucosal injury of the stomach

255
Q

What are the causes of gastritis

A
  1. H.pylori ( most common cause particularly in chronic)
  2. Drugs ( especially NSAIDs most common cause for acute)
  3. Autoimmune gastritis
  4. Cytomegalovirus
  5. Alcohol 9acute)
  6. ingestion of corrosives
  7. Crohns or sarcoidosis ( granulomas) -rare
256
Q

What are the signs and symptoms of gastritis?

A

Epigastric pain

vomiting

257
Q

What part of the stomach does autoimmune gastritis effect?

A

fundus and body

258
Q

What does autoimmune gastritis cause?

A

Atrophic gastritis and loss of parietal cells and then onto pernicious anaemia

259
Q

How does pernicious anaemia occur from atrophic gastritis?

A

Achlorhydria(absence of hydrochloric acid in the gastric secretions.)
and

intrinsic factor deficiency( no B12 absorption)

occurs

due to production of autoantibodies ( more common) for gastric parietal cells and for the intrinsic factor ( more important)

260
Q

What is gastropathy?

A

epithelial cell damage in the stomach but no inflammation

261
Q

WHat are the causes of gastropathy

A
  1. Irritants ( NSAIDs and alcohol mainly)- main cause
  2. bile reflux
  3. chronic congestion
  4. stress ulcers- acute these are secondary to; burns, trauma or shock
262
Q

WHat is the main type of gastritis caused by H.pylori infection?

A

antral gastritis

263
Q

What does gastritis potentially lead to?

A

metaplasia

264
Q

What are the two main forms peptic ulcers

A

Duodenal ulcers ( more common)

gastric ulcers

265
Q

Where do gastric ulcers mainly form?

A

Lesser curve of the stomach. elsewhere are often more malignant

266
Q

What is the epidemiology of peptic ulcer disease?

A

more common in the elderly especially women

considerable geographical variation

267
Q

What is a peptic ulcer?

A

consists of break in the superficial epithelial cells penetrating down to the muscularis mucosa of either the stomach or the duodenum

268
Q

Where do duodenal ulcers mainly form?

A

Duodenal cap- duodenitis occurs to the surrounding mucosa

269
Q

What are the causes of peptic ulcer disease?

A
  1. H.pylori- main for both types
  2. smoking
  3. Drugs ( NSAIDS and steroids)
  4. reflux of duodenal contents
  5. delayed gastric emptying
270
Q

What are the signs and symptoms of peptic ulcer disease?

A
  1. Recurring burning epigastric pain
  2. for some reason patient pointing to the epigastrium with ONE finger is a good sign of a peptic ulcer
  3. DU pain normally occurs at night or when patient is hungry
  4. Nausea
  5. vomiting
  6. weight loss
  7. anorexia
  8. epigastric tenderness
  9. can be asymptomatic
271
Q

How do you diagnose peptic ulcer disease?

A

Gastroscopy

test for H.Pylori infection

Measure gastrin concentration when off PPIs if there is suspected zolinger-ellison syndrome

Biopsy

272
Q

How do you treat peptic ulcer disease?

A

stop drinking and smoking

Eradication therapy for H pylori infection

If no positive result for H pylori then use PPIs or H2 blockers

Drug induced ulcers: stop taking those drugs. PPIs useful for NSAID induced ulcers

surgery only used for recurrent haemorrhage or perforation

273
Q

What are the complications of Peptic ulcer disease?

A

Haemorrhage

Perforation-More common with DUs

gastric outlet obstruction- main symptom is vomiting due to build up of gastric juice,ingested fluid and food. Occurs due to oedema around an active ulcer or because of scarring from a healed ulcer.

Malignancy

274
Q

What is zollinger-ellison syndrome?

A

Gastrin secreting adenoma ( gastrinoma) causes excess amount of gastric acid to be secreted leading to formation of peptic ulcers.

275
Q

Where are these gastrinomas found?

A

Mainly in the pancreas

but also in the stomach and duodenum

276
Q

What are the symptoms of Zollinger-ellison syndrome?

A

Dyspepsia (mainly abdominal pain)

chronic diarrhoea/steatorrhoea - due to inactivation of pancreatic enzymes

277
Q

How do you diagnose Zollinger-Ellison syndrome?

A

Increase in fasting gastrin level- hypochlorhydria should be excluded by recording ph ( hypochlorhydria causes pH 3-5 when it should be less than 2)

secretin stimulation test

Endoscopic ultrasound - for imaging

CT scan- localise and stage the adenoma

278
Q

How do you manage zollinger-ellison syndrome

A

High dose of PPI

Surgery- may be avoided if adenoma is MEN1 as metastasis is rare

279
Q

What are the three main types of malignant gastric tumours?

A

Adenocarcinoma

Lymphoma

Gastrointestinal stromal tumours (GISTs)

280
Q

What is the epidemiology of adenocarcinoma of the stomach?

A

More common in men than women

High in Japan,china,columbia and finland

rare under the age of 30 (50-70 is the peak)

281
Q

What are the causes of gastric Adenocarcinoma?

A

H. pylori infection (main cause)

dietary factors

Smoking

Pernicious anaemia

Genetic abnormality

282
Q

What are two main types of gastric adenocarcinoma?

A

Intestinal - differentiated well-formed glandular structures. Polypoid or ulcerating lesions. Mainly in distal stomach. Slightly better prognosis

Diffuse- undifferentiated poorly cohesive cells. Involved in any part of the stomach but cardia is mainly where it forms. form signet ring sign

283
Q

What are the signs and symptoms of gastric adenocarcinoma

A

50% at screening have no symptoms

Dyspepsia with Alarm symptoms.

Epigastric pain may be relieved by food and antacids

Palpable epigastric mass with abdominal tenderness is common

Palpable lymph node in the supraclavicular fossa ( Virchow’s Node)

284
Q

How do you diagnose Gastric adenocarcinoma?

A

Gastroscopy

Biopsy

CT scan of the chest and abdomen- stages cancer - limited ability to determine the depth of local tumour invasion

Endoscopic ultrasound

285
Q

How do you manage gastric adenocarcinoma?

A

endoscopic mucosal resection for removal of non ulcerative mucosal lesions

Surgery is best form of treatment

palliative chemotherapy

286
Q

What are GISTs?

A

subset of GI mesenchymal tumours

of stroma origin

287
Q

How do you treat GISTs?

A

surgery main choice

tyrosine kinase inhibitor - chosen for unresectable or metastatic disease

288
Q

What is Primary Gastric Lymphoma?

A

Mucosa associated lymphatic tissue tumours

Mainly B cell marginal zone lymphomas

289
Q

What is the main cause for Primary Gastric lymphoma?

A

H.pylori infection

290
Q

What are the signs and symptoms of gastric lymphoma?

A

Dyspepsia and Alarm symptoms

ulcers can be found

Rarely have systemic complaints ( fever or fatigue)

291
Q

How do you treat Gastric lymphomas?

A

H.pylori eradication therapy

surgery and chemotherapy

good prognosis- 90% 5 year survival

292
Q

What are the main features of GI bleeding?

A

Haematemesis

Melaena (sometimes accompanied with shock)

293
Q

What does Melaena usually indicate?

A

bleeding from any lesion proximal to the right colon

294
Q

What are the main causes of Upper GI bleeding?

A

Peptic ulcers

Mallory-Weiss tear

malignancy

Oesophageal varices

Gastritis

Drugs ( NSAIDs,aspirin,anticoagulants and steroids)

n.b Anticoagulation does not directly cause bleeding but an anticoagulated patient as a higher risk of bleeding.

portal hypertensive gastropathy (rare)

295
Q

What are the signs of Upper GI bleeding?

A

Clammy hands

Capillary refill more than 2 seconds

look for signs of encephalopathy

Tachycardic

systolic BP greater than 100 mmHg

Postural drop > 20 mmHg

clinical signs of chronic liver disease

PR exam for meleana

Then calculate Rockall score

296
Q

How do you manage Upper GI bleeding?

A

stop drug causing the bleeds

Make sure patient is given high flow O2

Take FBC U&E and LFT, clotting and crossmatch

Note Urea will greatly increase which is indicative of massive blood meal

  1. Insert 2 large bore iv cannula to take blood
  2. Give IV fluid to restore blood volume - avoid saline if cirrhotic
  3. Give chest x ray and ECG
  4. Continue monitoring pulse and BP and hourly urine output (catheter must be used)
  5. Transfuse if patient is either in shock or hemoglobin has fallen below 70g/L
  6. Give urgent endoscopy in shocked patients
  7. If endoscopy fails then use surgery or emergency mesenteric angiography

sengstaken can be used as a backup - compresses varices

Treatment for varices:

  1. Terlipressin- only vasoconstrictor proven to reduce mortality. Don’t give to patients with ischaemic heart disease.
  2. Endoscopy- confirm diagnosis and to exclude bleeding from other site.

With endoscopy variceal banding can occur- Bands oesophageal varice which sucks varix to end of the scope.

Balloon tamponade is only temporary allows for preparation of TIPS or Banding

TIPS

  1. Acute Rebleed:

Transjugular intrahepatic portocaval shunt( TIPS)- used for rebleed or acute management. Creates total shunt decreasing both sinusoidal and portal vein pressures.

Far more effective at reducing rebleeding rates then endoscopic techniques

complication: Increase risk of encephalopathy
3. Primary prophylaxis ( patients with diagnosed cirrhosis and have varices that have not bled)

Endoscope to diagnose varices

Non selective beta blockers ( Propranolol and carvedilol)

If patients are tolerant or unreliable with beta blockers then use variceal band ligation.

  1. Secondary Prophaylaxis ( survived variceal bleed)

Variceal banding ligation and Non selective beta blockers are both used at the same time not like primary which is a choice between the two.

Poor liver function: Liver transplant

Treatment for Peptic ulcer:

Antral biopsies should be taken to look for H.Pylori. If positive eradication therapy. If negative gastric Histology should be checked

for bleeding ulcers or ones with stigmata of recent bleeding- Inject with adrenaline and thermal coagulation ( heater probe or bipolar probe) or endoscopic clipping. Dual or triple therapy is better than monotherapy

All Patients with active bleeding ulcers should be given IV PPI

Further management

If repeat bleeding then perform endoscopy. DUs have higher risk as they are nearest to gastro duodenal artery

Continue to check FBC, U&E,LFT and clotting daily

Keep nil by mouth if high rebleed risk

only discharge patients within 24 hours if Rockall score pre endoscopy was 1 or post was 0

297
Q

What are the causes of acute lower GI bleeding?

A

Diverticular disease

Ischaemic colitis

Hemorrhoids (common with smaller recurrent disease)

Anal fissure ( common)

Carcinoma

Polyps

IBD- often associated with diarrhoea

angiodysplasia

298
Q

How do you diagnose lower Gi bleeding?

A

Proctoscopy- for anorectal disease

SIgmoidoscopy or colonoscopy- IBD, cancer and ischemic colitis

angiography- last resort as yield. of angiography is low

299
Q

How do you manage Lower GI bleeding?

A

Most Lower GI bleedings start and stop spontaneously

use same principle for resuscitation for upper Gi if bleeding continues

300
Q

What are the signs and symptoms of chronic GI bleeding?

A

Haematemesis

Meleana

Iron deficiency anaemia (for women it occurs mainly after menopause)

301
Q

What are the main causes of chronic GI blood loss?

A

Lesions main cause ( benign or malignant ulcers)

Hookworm- uncommon in developed countries however

can be any cause of Acute upper or lower however oesophageal varices are a rare cause

302
Q

How do you diagnose chronic GI blood loss?

A

Endoscopy performed for both upper and lower Gi tracts in order to find the site of bleeding

First UGE then colonoscopy.

Then biopsy lesions or remove them completely

IV colloid may be used to show potential site of bleeding in a meckel’s diverticulum

303
Q

How do you manage Chronic GI blood loss?

A

Oral iron for the anaemia

treat cause of the bleeding

give transfusion as last resort

304
Q

what questions should be asked when taking a history for acute GI bleeding?

A

dypepsia?

known ulcers?

known liver disease/oesophageal varices?

serious comorbidity? bad sign ( cardiac failure, ischaemic heart disease, chronic kidney disease and malignant disease)

305
Q

What are the clinical features of shock?

A

Pallor, cold peripheries, tachycardia and low BP, clammy hands

306
Q

What are the two types of Functional dyspepsia?

A

Note there is overlap between the two

Epigastric pain syndrome- pain in the upper abdomen being the most annoying symptom

Postprandial distress syndrome- discomfort(not pain) centered in the upper abdomen as the main issue.

307
Q

What is the main cause of functional dyspepsia?

A

No structural abnormality

308
Q

How do you diagnose Functional dyspepsia

A

H pylori infection should be excluded via a stool antigen test

endoscopy for patients with alarm symptoms and older than 55

309
Q

How do you treat functional dyspepsia?

A

H pylori eradication therapy shown to help

PPIs help with epigastric pain

Psychotherapy ( placebo response has high rates)

reassurance and explanation helps

lifestyle changes are effective too

310
Q

what is gastroparesis?

A

delayed gastric emptying but with no physical obstruction

311
Q

what are the symptoms of gastroparesis?

A 
post-prandial fullnes
bloating
nausea
vomiting
weight loss
upper abdominal pain
312
Q

what illicit drug is associated with gastroparesis?

A

cannabis

313
Q

what medication is associated with gastroparesis?

A

opiates and anticholinergics

314
Q

how do you investigate suspected gastroparesis?

A

gastric emptying studies

315
Q

what is the management of gastroparesis?

A 
removal of precipitating factors eg drugs
liquid diet
eat little and often
promotility agents
gastric pacemaker
316
Q

diabetes is associated with gastroparesis true or false?

A

TRUE

317
Q

What is sepsis?

A

Life threatening organ dysfunction due to dysregulated host response to infection

318
Q

What is septic shock?

A

is a subset of sepsis in which underlying circulatory and metabolic abnormalities are profound enough to substantially increase mortality

319
Q

What are the local signs of abdominal infection?

A

pain

tenderness

guarding

320
Q

what are the systemic signs of abdominal infection?

A

fever

chills/rigors

nausea/vomiting

diarrhoea or constipation

malaise - from anorexia

321
Q

How do you treat intra abdominal infection?

A

Empiric policy :

Amoxicillin ( for streptococci and enterococci)+ gentamicin ( for aerobic coliforms) + metronidazole (for anaerobes)

322
Q

Discuss the SOFA score for sepsis from 0 to 4

A

Respiration: PaO2 decrease goes from 53.3 kpa at 0 to 13.3

Coagulation: platelets decrease from more than 150 to less than 20

Liver- bilirubin increases from 1.2 mg/dL to more than 12

cardio: MAP decreases from more than 70 mmHg to less

CNS: decreases from 15 to les than 6 ( glasgow coma scale)

Renal: creatine increases from less than 1.2 mg/dl to more than 5

323
Q

What is sepsis 6

A

designed to lower mortality in patients with sepsis

  1. give high low O2
  2. give IV fluid resuscitation
  3. take blood cultures
  4. Give IV antibiotics
  5. Measure lactate and FBC- high lactate implies higher level of care needed
  6. monitor accurate hourly urine output- useful assessment of kidney perfusion
324
Q

What are the causes of gastrointestinal malabsorption

A

Main: coeliac disease,chronic pancreatitis and crohn’s disease

Rare:
decrease in bile; PBC and ileal resection

small bowel mucosa: whipple’s disease, tropical sprue, small bowel resection, lactase insufficiency

Bacterial overgrowth: spontaneous and also in jejunal diverticular PPI IS A RISK FACTOR

infectious giardiasis

Gastrojejunostomy

325
Q

What are the signs and symptoms of Gi malabsoprtion?

A

Diarrhoea

weight loss

lethargy

steatorrhoea

bloating

deficiency signs:anemia, bleeding disorders and oedema

326
Q

How do you diagnose Gi malabsorption?

A

FBC ( mean cell volume increase)- anaemia

decrease in ca 2+

decrease in iron

decrease in B12 and folate

increase in INR

stool: sudan stains for fat globules as well as tool microscopy

endoscopy and small bowel biopsy

breath hydrogen analysis

327
Q

What is coeliac disease?

A

inflammation of the mucosa of the upper small bowel that improves when gluten is removed from the diet.

less severe towards ileum as gluten is digested into smaller fragments

328
Q

What occurs to the small intestine villi during coeliac disease?

A

villous atrophy- flat duodenum forms

crypt hyperplasia

enterocytes become cuboidal

presence of intra epithelial lymphocytes

329
Q

What are the signs and symptoms of coeliac disease?

A

May mimc IBS therefore test these patients

stinky diarrhoea/steatorrhoea

abdominal pain

weight loss

mouth ulcers and angular stomatitis

malnutrition physical signs (iron deficiency and other minerals plus fat soluble vitamins)

dermatitis herpetiformis- remember

330
Q

How do you diagnose coeliac disease?

A

small bowel biopsy is gold standard : subtotal villous atrophy intra epithelial lymphocytes and crypt hyperplasia. enterocytes become cuboidal

serology:

anti transglutaminase antibodies

decrease in haemoglobin

increase in RDCW

decrease in B12 and ferritin

HLA-DQ2 is present in 90-95% of coeliac disease

331
Q

How do you manage coeliac disease?

A

Replace vitamins and minerals

Gluten-free diet for life

poor compliance will be main issue if failure to respond

some patients might have non-responsive coeliac disease

332
Q

What is tropical sprue?

A

malabsorption and chronic diarrhoea that occurs in tropical areas . Villous atrophy is also present

333
Q

How do you diagnose tropical sprue?

A

must exclude acute effective causes of diarrhoea

malabsorption should be demonstrated particularly fat and vitamin B12

endoscopy and biopsy

334
Q

How do you manage tropical sprue?

A

tetracycline and folic acid

335
Q

What is whipple’s disease caused by?

A

tropheryma whippelii (gram positive)

336
Q

What is the epidemiology of whipple’s disease?

A

common in middle aged white males in europe

337
Q

What are the signs and symptoms of whipple’s disease?

A

arthralgia

ab pain

weight loss

diarrhoea/steatorrhoea

fever

sweats

chronic cough

endocarditis potentially as well as lypmhadenopathy

338
Q

how do you diagnose whipple’s disease?

A

PAS macrophages are present ( periodic acid-schiff)

jejunal biopsy

bacteria sen on electronic microscopy

339
Q

How do you treat whipple’s disease?

A

antibiotics across BBBIV

IV ceftriaxone then co-trimoxazloe

340
Q

What is meckel’s diverticulum

A

remnant vitleine duct- the proximal part of the viteline duct ( yolk stalk) fails to regress and involute

341
Q

Where is meckel’s diverticulum found?

A

anti mesenteric border of the ileum (found at distal part)

342
Q

What are the signs and symptoms of meckel’s diverticulum?

A

usually symptomless

Peptic ulcers can form - contains gastric mucosa which secretes HCL.

can have intestinal obstruction

diverticulitis can also occur

343
Q

How do you manage and diagnose meckels?

A

radio nucleotide scan

surgical excision ( laparoscopically)

344
Q

What are the complications of meckels?

A

Bleeds

ulcerate

obstruction

malignant change

345
Q

what is the rule of 2 for meckle’s?

A

2 feet from ileiocacecal junction

2% of population have it

346
Q

What are the causes of Bacterial overgrowth

A

Spontaneous in the elderly

stricture or diverticulum - structural abnormality in the small bowel

post op bind loops

PPI and diabetes mellitus are Risk factors

347
Q

How do you diagnose bacterial overgrowth?

A

Hydrogen breadth test

348
Q

How do you manage bacterial overgrowth?

A

Resection of strucutre

metronidazole or a tetracycline

349
Q

What happens to peristalsis in small bowel obstruction?

A

Disrupted

350
Q

What type of abdominal pain is felt in small bowel obstruction?

A

colicky pain

351
Q

What are the causes of bowel obstruction?

A

Mechanical obstruction causes

Small bowell:

Adhesions ( outside of bowel)- congenital,from post op or peritonitis

Hernias ( outside of bowel)

Large bowel:

colon cancer ( inside of bowel)

constipation (inside of bowel)

diverticular stricture- usually incomplete

Volvulus( sigmoid and caecal)

rarer causes; crohn’s stricture (usually incomplete) , Gallstone ileus and
foreign body or bolus obstruction or intussusception- a segment of bowel wall becomes telescoped into the segment distal to it ( common in children)

352
Q

What are the signs and symptoms of bowel obstruction?

A

vomiting- with nausea and anorexia

Constipation

colic - occurs early

abdominal distention- increases as obstruction increases with tinkling bowel sounds- sounds may be absent in examination or sound like ‘water lapping against a boat’

dehydration

visible peristalsis

relative lack of abdominal tenderness

353
Q

What is a volvulus?

A

type of bowel obstruction where bowel twists causing an obstruction

354
Q

What type of obstruction is a volvulus?

A

Closed loop

355
Q

Discuss how the two main types of volvulus occurs.

A

sigmoid vovlulus- when the bowel twists on its mesentery

caecal- when ileo caecal valve which is still competent cannot move backwards to relieve the pressure- causes distention of caecum lead to obstruction

356
Q

What are the main differences between gastric outlet ,small and large bowel obstruction?

A

Gastric outlet obstruction- semi digested food is vomited with no bile

Small bowel ( compared to large bowel obstruction mainly)

vomiting occurs more early

copious bile stained fluid present in vomiting

pain is more prominent

less distention

Large bowel

thicker, brown, foul smelling vomitus (faeculent)

pain is more constant

symptoms more gradual

absolute constipation a sign of distal obstruction

357
Q

What is the difference between incomplete and complete obstruction?

A

incomplete:
clinical features in incomplete are less clear

vomiting is intermittent and bowel habit is erratic

hypertrophy of the bowel wall muscle occurs in chronic cases - leads to far more prominent colicky pain than with complete obstruction

358
Q

What occurs with strangulated bowel obstruction?

A
  1. blood supply is compromised
  2. sharper, more localised and constant pain
  3. fever and increased white blood cell count
359
Q

What is the main sign of strangulated bowel obstruction?

A

peritonism

360
Q

What happens if the ileo caecal valve becomes incompetent?

A

small bowel distends which delays symptoms

361
Q

What is paralytic ileus?

A

adynamic bowel due to absence of normal peristalsis

362
Q

What are the signs and symptoms of paralytic ileus?

A

pain and high pitched sounds less common in comparison to bowel obstruction

363
Q

what are the risk factors of paralytic ileus?

A

abdominal surgery

pancreatitis (or any localised peritonitis)

hypokalaemia

peritoneal sepsis

diabetic keto acidosis

364
Q

How do you treat paralytic ileus

A

Drip and suck- NGT and IV fluids to correct electrolyte imbalance while awaiting restoration of peristalsis

365
Q

How do you diagnose bowel obstruction

A

AXR

distended small bowel- tend to lie in a central position and have valvulae coniventes

distended large bowel- tend to lie in its anatomical position and has haustra coli

sigmoid volvulus- coffee bean signs

erect EXR- assess for perforation- air under diaphragm

CT usually used after AXR to confirm diagnosis and look for a cause ( may show dilated, fluid filled bowel and a transition zone at the site of obstruction)

366
Q

How do you manage bowel obstruction

A

conservative:

Drip and suck - naso gastro tube and IV fluid to rehydrate and correct electrolyte imbalance as well as decompress stomach

specific management:

strangulation needs emergency surgery

large bowel needs surgery

small bowel and ileus only require conservative management

closed loop may need surgery or decompression

sigmoid volvulus- needs flatus tube or sigmoidoscopy

peritonitis- emergency laparotomy

367
Q

what is pseudo obstruction?

A

adynamic bowel obstruction- acute dilation of colon occurs but no obstruction present

368
Q

what is acute colonic form of pseudo obstruction called?

A

ogilvie’s syndrome

369
Q

what are the risk factors of pseudo obstruction?

A

surgery ( hip replacement and CABG)

pneumonia

elderly

370
Q

How do you diagnose ogilvie’s syndrome?

A

AXR and CT

371
Q

How do you manage ogilvie’s syndrome?

A

colonoscopy allows decompression - if causing pain or respiratory compromise

exclude mechanical causes

372
Q

What is a diverticulum?

A

outpouching of the gut wall usually at sites of entry of perforating arteries

373
Q

what is the difference between:

  1. diverticulosis
  2. diverticulitis
  3. diverticular colitis
A
  1. indicates presence of diverticular
  2. implies diverticular is inflamed
  3. crescentic inflammation on the folds in areas of diverticulosis
374
Q

what is the difference between diverticular disease and diverticulosis?

A

diverticular disease implies the diverticulosis is symptomatic

375
Q

where is the main place for diverticular diesease in the colon?

A

sigmoid colon

376
Q

What is the cause of diverticular disease?

A

low dietary fibre causes high intraluminal pressures forcing the mucosa to herniate through the walls

377
Q

What is the difference between a false and true diverticulum?

A

true- all three layers of colon wall are effected

false- only mucosa and sub mucosa are effected

378
Q

What are the signs and symptoms of diverticular disease?

A

majority of diverticular disease is asymptomatic

symptoms:

altered bowel habit: constipation and diarrhoea

LLQ pain - relieved by defecation, nausea and flatulence

occasional episodes of blood/mucous PR

379
Q

How do you diagnose diverticular disease?

A

mainly incidental via colonoscopy then barium enema exam

sometimes CT

380
Q

how do you manage diverticular disease?

A

well balanced fibre diet

antispasmodics

might need resection

381
Q

what are the signs and symptoms of diverticulitis?

A

severe left iliac fossa pain

fever

constipation

tachycardia

tender colon

altered bowel habits

382
Q

Where is acute diverticulitis normally found?

A

sigmoid colon

383
Q

How do you diagnose acute diverticulitis?

A

CT is main way - shows colonic wall thickening

Blood tests- raised WCC,CRP/ESR

AXR may identify obstruction or free air (perforation)

colonoscopy increases risk of perforation

384
Q

How do you manage acute diverticulitis?

A

Bowel rest

mild forms can give fluids

IV antibiotics , NBM

if Abscess form than percutaneous drainage

385
Q

What are the main complications of diverticular disease?

ii. how do they present?

A

Perforation- Ileus, peritonitis and shock

Haemorrhage- sudden and painless can be massive.

fistula- either enterocolic, colovaginal (causes discharge) or colovesical ( causes pneumatruria)

abcesss-swinging fever, raised WCC and boggy rectal mass on PR

strictures- constipation

386
Q

what is hartmanns procedure?

A

surgical resection of the recto sigmoid colon and formation of an end colostomy

387
Q

where are the 2 surgical operations used for diverticular disease?

A

hartmanns procedure
primary resection/anastomosis

both used mainly used for complicated diverticulitis

388
Q

What is the main site of ischaemic colitis ?

A

splenic flexure- where marginal artery of drummed connects IMA and SMA

leads to occulsion of IMA

389
Q

what are the signs and symptoms of ischaemic colitis?

A

LLQ pain

passage of bright red blood per rectum

sometimes diarrhoea
shock

evidence of PVD

390
Q

How do you diagnose lschaemic colitis?

A

colonoscopy(first use) and biopsy show epithelial cell apoptosis

AXR -shows thumb-printing at splenic flexure
Barium enema

may show signs of cardiovascular shock

CT - excludes perforation

mesenteric angiography

391
Q

How do you manage ischaemic colitis?

A

fluid replacement and antibiotics

if gangenous Ischaemic colitis then resuscitation followed by resection of the affected bowel and soma formation

392
Q

what are the main causes of colitis?

A

Infective colitis

UC

crohn’s colitis

ischameic colitis

393
Q

what are the signs and symptoms of colitis?

A

Diarrhoea + blood
abdominal cramps
dehydration
sepsis

wt loss, anaemia

394
Q

How do you diagnose colitis?

A

Plain X-ray

Sigmoidoscopy + biopsy
stool cultures
barium enema

first sigmoid

second colonoscopy

395
Q

what is microscopic colitis associated with?

A

watery diarrhoea

396
Q

what is the main way to diagnose microscopic colitis?

A

biopsy

397
Q

what is colonic angiodysplasia?

A

Submucosal lakes of blood

398
Q

where is angiodysplasia usually found?

A

right side of colon

399
Q

what are the signs and symptoms of angiodysplasia?

A

sometimes blood loss PR

signs of anaemia

400
Q

How do you diagnose colonic angiodysplasia?

A

Angiography

Colonoscopy

401
Q

How do you manage colonic angiodysplasia?

A

embolisation
endoscopic ablation
surgical resection

402
Q

what is a colonic polyp

A

an abnormal growth of tissue projecting from the the colonic mucosa

403
Q

are polyps malignant?

A

can be depends on the type

hyperplastic

inflammatory

hamartomatous - large and stalked include: juvenile syndrome and peutz-jeghers syndrome

neoplastic

404
Q

what is the main type of colonic polyps?

A

adenomas

405
Q

all adenomas are dysplastic true or false?

A

true

406
Q

What are the risks of adenomas?

A

they are premalignant and so can form adenocarcinomas of the colon and rectum

407
Q

how are adenomas removed?

A

endoscopically or surgically

408
Q

what are the main types of adenoma polyps of the colon?

A

Tubullovillous

tubular

villous

Sessile serated- separate pathway for formation

flat adenomas

409
Q

How do you diagnose and manage

A

colonoscopy and polypectomy

chromoscopy uses dye to help detect

410
Q

what are the signs and symptoms of colorectal polyps

A

bleeding PR

similar to colorectal cancer

411
Q

what is the main type of carcinoma which causes colorectal carcinoma?

A

adenocarcinoma

412
Q

what are the risk factors of colorectal carcinoma?

A
  1. neoplastic polyps ( adenomas)
  2. IBD
  3. genetic predisposition:
  4. Familial adenomatous polyposis (FAP)- 100% penetrance mutation of APC gene autosomal dominant on chromosome 5. Early onset
  5. Hereditary nonpolyposis colorectal cancer (HNPCC)- autosomal dominance mutation of DNA mismatch repair gene. Late onset
  6. smoking
  7. alcohol
  8. low fibre and increased red meat in take
  9. over age of 60 and male
413
Q

what are the signs and symptoms of colorectal cancer?

A

depends on site- most are on left side or rectum

left sided: bleeding/mucus PR and altered bowel habit- probs cause of obstruction

tenesmus- rectal

hard rectal mass

Right sided: weight loss, anaemia ,abdominal pain- less likely from obstruction

General: abdominal mass, perforation haemorrhage and fistula

414
Q

what is the most simple staging for colorectal cancer?

ii. how is it staged?

A

duke stagings

dukes A: confined by muscularis propria
dukes B: through muscularis propria
dukes C: metastatic to lymph nodes
dukes D: distant mets

415
Q

whats the difference between the two main types of inherited colorectal carcinomas?

A

HNPCC is late onset and mainly forms right sided tumours

it also has less than 100 polyps

has an inflammatory response

mucinous tumours

FAP is early onset and forms tumours throughout

has more than 100 polyps

has no inflammatory response.

adenocarcinomas

416
Q

How does colorectal cancer spread?

A

Direct spread

Lymphatic spread

blood spread ( liver lung bone)

transcoelomic spread ( rare)

417
Q

How do you diagnose CRC?

A

bowel screening programme - offered screening in via giving stool sample every 2 years- if positive offered colonoscopy

red flag symptoms- SOPD or straight to endoscopy

Bloods- FBC for microcytic anaemia and faecal occult blood(FOB) (part of screening).

CT colonoscopy

418
Q

What happens in TNM staging?

A

T1- invading submucosa

T2- invading muscularis propria

T3- invading suberos and beyong

T4- invasion of adjacent structures

419
Q

how do you stage colorectal carcinoma?

A

chest abdominal and pelvic CT

MRI for rectal cancers

420
Q

How do you manage CRC?

A

Surgery: Main Laparoscopic

right hemicolectomy- caecal ascending or proximal transverse colon

left hemicolectomy- distal transverse or descending

sigmoid colectomy- sigmoid

anterior resection- low sigmoid/hight rectum

AP- rectum

Harmann’s preocedure in emergency bowel obstruction

stenting decreases need for colostomy and can be used for palliative care

radiotherapy: pallation - post op only used for rectal tumours with high local recurrence
chemotherapy: higher stages of tumour palliation

can be used with cancer resection in advanced management
HIPEC for mesothelioma and peritoneal metastasis

monoclonal antibodies: cetuximab and pitumumab help too used in stage 4

421
Q

which is more common- primary or secondary tumours of the small bowel?

A

secondary tumours

422
Q

what are the 3 main types of primary tumours?

A

lymphomas
carcinoid tumours
carcinomas

423
Q

where is the most commonest site for a carcinoid tumour of the small bowel?

A

appendix

424
Q

what is IBS?

A

irritable bowel syndrome- common functional bowel disorder. No organic cause can be found.

425
Q

what is the epidemiology of IBS?

A

under the age of 45

female ( 2:1)

have a family history of IBS

mental health issues- anxiety and depression, psychological stress and trauma

post infectious IBS

426
Q

what is the pathophysiology of IBS?

A

disturbed GI motility
visceral perception

microbial dysbiosis

427
Q

what are the signs and symptoms of IBS?

A

recurring abdominal pain for at least three days a week and is chronic ( more than 3 months)
(rome criteria III)
associated with at least 2 of these factors:

pain relieved by defection

altered stool form ( bristol chart)

altered bowel frequency

other symptoms

incomplete emptying of bladder

nocturia ( passing urine at night)

poor sleep

dyspareunia (pain after intercourse)

mucus PR

abdominal bloating

sign- can have abdominal tenderness

428
Q

what are the main subtypes of IBS?

A

IBS-C- where more than 25% of stool is hard and lumpy( or less than 25% is watery)

IBS-D - where more than 25% of stools are watery( or less than 25% are hard and lumpy)

IBS-M where both hard lumpy and watery stools make up more than 25% of stools

unsubtyped IBS

429
Q

How do you diagnose IBS?

A

first through symptoms

then do history to see if symptoms match with IBS

Do FBC to exclude anemia

CRP/ESR,TSH and TTG

can do selective AXR

can do serum CA to exclude ovarian cancer

lower GI testing if FH of CRC

430
Q

what symptoms suggest that it might not be IBS?

A 
age > 50 
short duration of symptoms
woken from sleep to run to toilet
rectal bleeding
weight loss
anaemia
FH of colorectal cancer

abnormal CRP and ESR

431
Q

How do you manage IBS?

A

if no positive result from test then in the clear!

Validate their concerns

Reassure- everything is groovy

Inform- ts chronic

IBS-C

diet- adequate water and fibre intake ( avoid insoluble fibre increases bloating) and more exercise

simple laxatives- polyethene glycol or lactulose( lactulose can ferment and cause bloating)

antispasmoidics- may not work well ( colofac and spasmonal) stops bloating

can also use 5-HT4 receptor agonists (prucalopride)

IBD- avoid alcohol and caffeine and reduce dietary fibre

can use antispasmodics to reduce bloating

use bulking agent and loperamide ( antidiarrhoeal agent)

General-
antidepressants ( tricyclics)- much lower doses than for depression

psychological therapy- CBT, psychotherapy and hypnotherapy

432
Q

what is a haemorrhoid?

A

enlarged vascular cushions in the lower rectum and anal canal

433
Q

what are anal cushions

A

discontinuous spongey vascular tissue which are involved in anal cushion

434
Q

what are the causes of haemorrhoids?

A

constipation with prolonged straining

CCF

pregnancy

portal hypertension

pelvic tumour

435
Q

what are the signs and symptoms of haemorrhoids?

A

bright red rectal bleeding sometimes found on stools but mainly found on paper

pruitius ani ( itch bottom)

should have no change in bowel habit or weight

maceration of the perianal skin

436
Q

viewed from the lithotomy position where are the three anal cushions?

A

3 o clock

7 o clock

11 o clock

437
Q

what type of haemorrhoids are there?

A

external- origin below dentate line

internal- origin above dentate line

mixed- origin above and below

438
Q

what are the classification of haemorrhoids?

A

1st degree- remain in the rectum

2nd- prolapse through the anus on defecation but spontaneously reduce

3rd- 2nd degree but require digital reduction

4th- remain persistently prolapsed

439
Q

How do you diagnose haemorrhoids?

A

PR exam- internal haemorrhoids are not palpable

rigid sigmoidoscopy

proctoscopy

flexible sigmoid over age of 50

440
Q

How do you manage haemorrhoids?

A

Increase fruit and fibre topical analgesic and stool softener

Sclerosation therapy- 2ml of 5% phenol in almond oil is injected into the pile above the dentate line

rubber band ligation- cheap

open haemorrhoidectomy

stapled haemorrhoidectomy- for prolapsing haemorrhoids- less pain but higher recurrence

HALO- uses Doppler US to identify and ligate feeding arteries to haemorrhoids- can replace surgery. use general or spinal anaesthesia

441
Q

what are the two types of rectal prolapse?

A

partial- mucosa (anterior mucosal prolapse)

complete -all layers (full thickness) more common

442
Q

what are the signs and symptoms of a rectal prolapse?

A

protruding mass from anus especially during defecation

bleeding and passing mucus per rectum
- can be incontinent
poor anal tone

can reduce spontaneously

443
Q

How do you treat rectal prolapse?

A

complete prolapse

most patients to frail for surgery -use bulking agents and education for manual reduction

delorme’s procedure

perineal rectopexy

abdominal rectopexy

anterior resection

incomplete

children- give dietary advice and treatment of constipation

adults- treatment similar to that of haemorrhoids

444
Q

what is a fistula-in-ano

A

anal fissure - tear in the squamous lining of the lower anal canal

445
Q

where are anal fissures found normally?

A

90% posteriorly

10% anterior- follow parturition

446
Q

what are the causes of anal fissuers?

A

Hard stool main cause

rare causes: herpes and crohn’s, UC and anal cancer

447
Q

what are the signs and symptoms of anal fissures?

A

severe anal pain

pain lasts for up to 30 mins after defecation

can have bright rectal bleeding

448
Q

How do you manage anal fissures?

A

Dietary fibre, fluids and stool softener and dietary advice

lidocaine ointment and 0.3% GTN ointment or diltiazem 2%

2nd line botox injection

surgery- lateral sphyncterotomy

449
Q

what is a fistula-in-ano?

A

abnormal communication between the skin and anal canal/rectum

450
Q

what are the causes of fistula-in ano?

A

perinanal sepsis

abscess- due to delay or inadequate treatment of an abscess , fistulas form

CD
TB
diverticular disease
rectal carcinoma

451
Q

what is goodsall’s rule?

A

determines path of fistula’s track

anterior- track is in a straight line

posterior- internal opening is always at a 6 o clock position track is tortuous

452
Q

what are the signs and symptoms of an anal fistula?

A

abscess and visible external opening (anorectal ulcer)

could have underlying condition (crohns)

453
Q

how do you diagnose an anal fistula?

A

exam under anaesthetic of anorectum

rigid sigmoidoscopy and proctoscopy

or flexible sigmoidoscopy

MRI

454
Q

How do you manage an anal fistula?

A

“laying open”

stage 1. Fistulotomy- opening up of fistula and allow to heal by secondary intention

stage 2. seton drain- done if anal sphincter involved

455
Q

what are the causes of anorectal abscesses?

A

gut organisms or idiopathic

456
Q

what are the diseases associated with abscesses?

A

crohns

cancer

fistulas

457
Q

what is pruritus ani?

A

itchy ass

458
Q

how do you manage pruritus ani?

A

don’t scratch

perianal hygiene

avoid foods which loosen stool

soothing ointment/topical corticosteroids

459
Q

what are common causes of RUQ pain?

A

Biliary colic and cholecystitis

Hepatomegaly

hepatitis

duodenal ulcer

appendicitis

460
Q

what are common causes of LUQ pain?

A

gastritis

ruptured spleen

pancreatitis

gastric ulcer

perforated colon

461
Q

what are common causes of epigastric pain?

A

pancreatitis

peptic ulcer

acute cholecystitis

perforated oesophagus

myocardial ischaemia

462
Q

what are common causes of RLQ pain?

A

appendicitis

renal stone

meckels diverticulititis

strangulated hernia

crohns

perforated caecum

463
Q

what are causes of LLQ pain?

A

sigmoid diverticulitits

ruptured ectopic pregnancy

IBD ( both types)

perforated colon

salpingitis

464
Q

what are common causes of umbililcal pain?

A

intestinal obstruction

acute pancreattitis

early appendicititis

salpingitis

465
Q

what are the common causes of acute abdominal pain?

A

Non specific abdominal pain

acute appendicitis

Gall bladder diseases

rare causes: intestinal obstruction, peforated ulcer, renal colic,UTI and gynaecological disorder

466
Q

what are the signs and symptoms of acute abdomen?

A

Tachycardia

shock

abdomen pain:

sudden onset pain suggests- perforation, rupture, torsion, acute pancreatitis or infarction

back pain: pancreatitis, rupture of aortic aneurysms or renal tract disease

vomiting- associated with all abdomen pain but if persistent suggest obstructive lesion of the gut. what type of colour does it have?

bowel habit?- any change should be taken down

cullen’s sign (brusing)- pancreatitis

bowel sounds: no sound then peritonitis or ileus

tinkling sound- obstruction

pulsatile mass-aortic aneurysm

467
Q

what are the specific symptoms of peritonitis?

A

prostration

shock

lying still

abdominal rigidity and guarding

no bowel sounds

468
Q

what are the main specific symptoms of a ruptured organ?

A

shock

abdominal swelling

469
Q

How do you diagnose acute abdomen?

A

Bloods: FBC, WCC, serum amylase (five times above=acute pancreatitis),CRP,LFT and Lactate (mesenteric ischaemia?)

urine dipstick and and serum hCG to exclude pregnancy

Erect chest X ray - first line excludes pneumonia . detects air under diaphragm caused by perforation

AXR- may show rigler’s sign -pneumoperitoneum

CT- gold standard- spiral CT very accurate

US useful for acute cholangitis, cholecystitis and AA. useful in Kids and women with pelvic pain

470
Q

How do you manage acute abdomen?

A

Initial management: ABC

urinalysis

give oxygen and fluids (resuscitate)

treat pain- analgesia

antibiotics

urgent surgery for: ectopic pregnancy, bowel ischaemia and peritonitis. Laparotomy

don’t go to surgery if pancreatitis or DKA and anyone that is non trauma

471
Q

what is the main cause of appendicitis?

A

lumen of appendix becomes obstructed with faecolith

472
Q

what happens if the appendix isn’t removed when inflammation occurs?

A

potentially leads to gangrene with perforation which can then cause general peritonitis

473
Q

what are the signs and symptoms of acute appendicitis?

A

poorly localised periumbilical pain

pain also spreads to the RIF

tachycardia

fever

guarding- due to localised peritonitis

tender mass in RIF- particularly over mc Burney’s point

anorexia

Rovsing’s sign ( pain greater in RIF when LIF is pressed)

474
Q

how do you investigate acute appendicitis?

A

bloods: raised WCC and ESR and CRP
imaging: not always used

US is helpful but appendix is not alway visualised

CT is very accurate and so only used if not certain

475
Q

How do you manage acute appendicitis?

A

Antibiotics and IV fluid - conservative treatment mainly if appendix mass is present. formed when inflamed and covered by omentum. usually disappears

laparoscopic surgery removes appendix

476
Q

What are the causes of mesenteric ischaemia?

A

thrombotic or embolic blockage of SMA

477
Q

what are the signs and symptoms of mesenteric ischamia?

A

Acute abdomen symptoms

history of AF or vascular disease

478
Q

how do you diagnose mesenteric ischaemia?

A

same with acute abdomen

mesenteric angiography

479
Q

How do you manage MI?

A

Resuscitation and stabilise

Emergency laparotomy: bowel resection and revascularisation

480
Q

What is a hernia?

A

An abnormal protrusion of a cavity’s contents through a weakness in the wall of the cavity

481
Q

what are the causes of hernias?

A

anatomical- openings in cavity

ingeirted collagen disorders

sites where surgical incisions are made

482
Q

How are hernias classified?

A

reducible- can be pushed back

irreducible- cannot be pushed back

obstructed- hernia blocks bowel contents

strangulated- hernia causes ischaemia

incarceration: hernia stuck down by adhesion

483
Q

What type of abdominal hernias are there?

A

Inguinal- most common type

femoral- shows as a mass in the upper medial thigh. more common in women. more likely to be irreducible or strangulated

epigastric - above the umbilicus

paraumbilcal- just above or below the umbilicus.

spigelian- occur through the linea semilunaris at the lateral edge of the rectus.

lumbar hernia- occur through the inferior or superior lumbar triangles in the Post ab wall

incisional hernias- occur after breakdown of muscle closure after surgery

richter’s

maydl’s

littres

sliding

paediatric hernias ( include umbilical and indirect inguinal)

femoral - pear shaped no symptoms

484
Q

what types of inguinal hernias are there?

A

indirect- more common

direct- push through hesselbach’s triangle

485
Q

what are the anatomical relations of the hesselbach’s triangle?

A

medial to the epigastric vessels and lateral to the rectus abdominus

486
Q

what is the epidemiology of inguinal hernias?

A

more frequent in males

right sided hernias more common

487
Q

what are the risk factors of adominal hernias?

A

obesity, heavy lifting , pregnancy and congenital defects in abdominal wall, ascites and chronic cough

constipation

488
Q

How do you identify the inguinal internal and external rings which are the openings to its canal?

A

internal ring- mid point of the inguinal ligament. just above femoral pulse

external ring - just superior and medial to the pubic tubercle

489
Q

what age do congenital umbilical hernias usually resolve by?

A

3

490
Q

what are the anterior, medial, lateral and posterior boundaries of the femoral canal?

A

anterior- inguinal ligament
medial- lacunar ligament
lateral- femoral vein
posterior- pectinate ligament

491
Q

what are the signs and symptoms of hernias?

A

abdominal mass is present

abdominal pain- frequent with paraumbilcal hernia due to strangulation

strangulated or incarcerated causes symptoms

492
Q

How do you diagnose hernias?

A

anatomical position

for inguinal hernia:

feel mass- make sure not scrotum lumo

get patient to cough- exaggerates it

make patient stand- then ask to cough if the hernia while placing hand on internal inguinal ring. Direct hernia will return. Indirect will not.

493
Q

how do you manage abdominal hernias?

A

weight loss and stop smoking.

surgery either open or laparoscopic repair

tell patient they might return

494
Q

what is step 1 of MUST?

A

BMI above 20= 0

18.5-20= 1

less than 18.5=2

495
Q

what is step 2 of MUST?

A 
weight loss score
(unexplained weight loss in past 3-6 months)
less than 5 percent = 0
5- 10 percent = 1
greater than 10 percent = 2
496
Q

what is step 3 of MUST?

A

if patient is acutely ill AND likely to be no nutritional intake for >5days = 2 points

497
Q

what is Step 4?

A

add scores from step 1, 2 and 3 to calculate overall risk of malnutrition
0 = low risk
1 = medium risk
2+ = high risk

498
Q

how do you calculate BMI?

A

mass (kg)/

height^2(m)

499
Q

what is the 4 step pyramid of nutritional support?

A

food
oral nutritional supplements
enteral nutrition
parenteral nutrition

500
Q

what is refeeding syndrome?

A

occurs when previously malnourished are fed with high carbohydate loads
this causes a rapid decline in electrolytes and an increase in extracellular volume which results in organ dysfunction

501
Q

what are the main metabolic features of refeeding syndrome?

A 
hypokalaemia
hypophosphataemia
hypomagnesaemia
altered glucose metabolism
fluid overload
502
Q

what are the physiological features of refeeding syndrome?

A 
arrhythmias
altered level of consciousness
seizures
respiratory failure
cardiovascular collapse
death
503
Q

how do you prevent refeeding syndrome in moderate risk patients?

A

how do you prevent refeeding syndrome in moderate risk patients?

504
Q

what must you do to prevent refeeding syndrome in high risk patients?

A

rehydrate carefully and supplement potassium, magnesium, phosphate, calcium, thiamine and vit B
start feeding at 5-10kcal/kg/day

505
Q

what part of the hypothalamus seems to be associated with decreased and increased energy expenditure?

A
  1. decrease- lateral

2. increased ventromedial

506
Q

what is ghrelin?

A

a gut hunger signal secreted from oxyntic cells in stomach

507
Q

what is scurvy?

A

nutrintional disorder due to lack of vitamin C

508
Q

what is the patient like associated with scurvy?

A

pregnant

poor

odd diet

509
Q

what are the signs and symptoms of scurvy?

A

listlessness anorexia and cahexic

gingivitis and halitosis

bleeding from gums and nose

muscle pain

oedema

510
Q

how do you manage scurvy?

A

dietary education

ascorbic acid

511
Q

what is pellagra?

A

lack of nicotinic acid big in China and Africa

512
Q

what are the symptoms of pellagra?

A
  1. diarrhoea, dementia and dermatitis (classic)

neuropathy, depression insomnia and fits

513
Q

how do you manage pellagra?

A

electrolyte replacement and nicotinamide added

514
Q

what are the 6 major classes of antiemetic drugs?

A 
5HT3 receptor antagonists
Muscarinic ACh receptor antagonists
Histamine H1 receptor antagonists
Dopamine receptor antagonists
NK1 receptor antagonists
Cannabinoid receptor agonists
515
Q

what are the clinical features of vitamin B1 defiency?

A

Wernicke’s encephalopathy: Encephalopathy,

oculomotor dysfunction - lateral rectal palsy

gait ataxia

My GI (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions