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ESA 3 Clinical Conditions > GI Conditions > Flashcards

GI Conditions Flashcards

1
Q

Name two types of inflammatory bowel disease

A

Crohn’s Disease

Ulcerative Colitis

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2
Q

Where does Ulcerative Colitis (UC) affect?

A

Usually begins in the rectum and can extend to involve the entire colon

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3
Q

Who is UC most commonly seen in?

A

Young adults

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4
Q

What GI symptoms can be seen in UC?

A

Mildly tender abdomen
Gross bleeding
Mucosal inflammation

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5
Q

Is there peri-anal disease seen with UC?

A

No

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6
Q

Describe the pathological appearance of UC

A

Chronic inflammatory infiltrate of the lamina propria

Continuous pattern

Pseudopolyps and crypt abscesses

Loss of haustra

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7
Q

What non-GI symptoms can be seen in UC?

A

Erythema nodosum (inflammation commonly seen in the shins) (affects ~30%)

MSK pain (affects ~50%)

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8
Q

What blood tests would be used to investigate UC?

A

Tests for serum markers and anaemia

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9
Q

What imaging techniques would be used to investigate UC?

A

Plain radiographs

Barium enema - lead pipe colon sign

CT/MRI (less useful)

Colonoscopy

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10
Q

What sample may be taken from a patient with suspected UC other than blood?

A

Stool samples for culture

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11
Q

How is surgery used in UC?

A

A colectomy performed for curative purposes, particularly in cases of:

Toxic megacolon

Pre-cancerous

Not settling with medical intervention

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12
Q

What medical interventions are used in UC?

A

Corticosteroids

Immunomodulators

Aminosalicylates - for flares and remission

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13
Q

Who is Crohn’s disease common in?

A

15-30 year olds and 60+ year olds

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14
Q

What part of the GI tract can Crohn’s affect?

A

ANYWHERE - ileum involved in most cases

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15
Q

What GI symptoms present with Crohn’s disease?

A

Tender RLQ

Mild peri-anal inflammation (75% of cases)

Gross bleeding (25%)

Fistula formation

Malnutrition - including mild anaemia

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16
Q

Describe the gross pathological appearance of Crohn’s disease

A

Skip lesions (non-continuous isolations)

Transmural - deep ulcers (can lead to fistulae)

Cobblestone appearance

Narrowing of bowel lumen

Hyperaemia

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17
Q

Describe the histological appearance of Crohn’s disease

A

Granuloma formation

Fibrosis

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18
Q

What imaging techniques can be used to investigate Crohn’s disease and what problems can they identify?

A

CT/MRI - obstructions, extramural problems, and bowel wall thickening

Barium enema/follow through (used less) - strictures/fistulae

Colonoscopy - bleeding, skip lesions, narrowing

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19
Q

What is looked for in blood tests in Crohn’s disease?

A

Anaemia

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20
Q

What medical interventions are used in Crohn’s disease?

A

THE SAME AS IN UC:

Corticosteroids

Aminosalicylates - for flares and remission

Immunomodulators

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21
Q

What type of surgery is used in Crohn’s disease?

A

Non-curative surgery to remove/repair strictures/fistulae

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22
Q

Name 3 defects of embryological origin that can affect the foregut

A

Pyloric stenosis

Abnormal positioning of the tracheoesophageal septum

Atresia or stenosis of the duodenum (can also be midgut depending on position)

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23
Q

Describe pyloric stenosis

A

There is narrowing of the stomach exit due to hypertrophy of the sphincter

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24
Q

How does pyloric stenosis present?

A

Projectile vomiting

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25
Q

What types of tracheoesophageal defects can occur?

A

Blind ended oesophagus

Fistula between trachea and oesophagus

Combinations of the two

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26
Q

How common are abnormalities of the tracheoesophageal septum?

A

~1/3,000 births

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27
Q

How can atresia/stenosis of the duodenum occur?

A

Lack of recanalisation after obliteration during development

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28
Q

Atresia/stenosis can occur in all parts of the intestine, where is it most common?

A

Duodenum > jejunum = ileum > colon

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29
Q

Name two embryological defects affecting the midgut

A

Malrotation

Vitelline duct defects

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30
Q

What are the two types of malrotation defects?

A

Incomplete rotation

Reversed rotation

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31
Q

What happens in incomplete rotation?

A

Only one 90˚ rotation

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32
Q

What is the result of an incomplete rotation?

A

Left sided colon

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33
Q

What happens in reversed rotation?

A

90˚ clockwise rotation

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34
Q

What is the result of reversed rotation?

A

The transverse colon passes posterior to the duodenum

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35
Q

What do both malrotation defects result in?

A

Hypermobile guts

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36
Q

What can hypermobile guts lead to an increased risk of?

A

Volvulus

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37
Q

What happens in a volvulus?

A

The bowel twists around itself

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38
Q

What can a volvulus risk?

A

Strangulation of the bowel, possibly leading to ischaemia and necrosis

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39
Q

What are the three types of vitelline duct defects?

A

Vitelline cyst

Vitelline fistula

Meckel’s diverticulum

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40
Q

What is the most common embryological GI abnormality?

A

Meckel’s diverticulum

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41
Q

Describe a Meckel’s diverticulum

A

An ileal cul-de-sac:

The vitelline duct fuses partially but remains as an out-pouching of the ileum

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42
Q

What ectopic tissue can present in a Meckel’s diverticulum?

A

Gastric tissue

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43
Q

What effect does ectopic gastric tissue have in Meckel’s?

A

Can release proteolytic enzymes as in the stomach and lead to ulceration

44
Q

What mnemonic rule can be applied to Meckel’s?

A

The rule of 2’s

45
Q

Explain the rule of 2’s of Meckel’s diverticulum

A

Affects 2% of the population

2:1 male to female ratio

Found 2ft from the iliocecal valve

2 inches long

Usually detected in under 2’s

46
Q

Describe a vitelline cyst

A

A remnant of the Vitelline duct sealed at both ends and connected to the umbilicus and ileum by fibrous strands

47
Q

Describe a vitelline fistula

A

Failure of the Vitelline duct to close, resulting in a direct communication between the ileum and the umbilicus

48
Q

What can occur as a result of a vitelline fistula?

A

Faeces can leak out of the umbilicus

49
Q

What embryological defects can affect the abdominal wall?

A

Gastroschisis

Omphalocoele

50
Q

What happens in gastroschisis?

A

There is failure of the abdominal wall to close, causing the gut tube to herniate into the amniotic cavity

51
Q

What happens at birth as a result of gastroschisis?

A

The gut tube remains outside of the body cavity with no covering

52
Q

How does omphalocoele occur?

A

There is persistence of the physiological herniation of the gut tube

53
Q

What happens at birth as a result of omphalocoele?

A

The gut tube remains herniated into the umbilical cord and is covered by a peritoneal layer

54
Q

What embryological abnormalities can affect the hindgut?

A

Anal/anorectal agenesis

Imperforate anus

Hindgut fistulae

55
Q

What is anal/anorectal agenesis?

A

Failure of the anal/anorectal canal to develop

56
Q

What is a hind gut fistula?

A

Where the hindgut communicates with the urethra

57
Q

What is an imperforate anus?

A

Failure of the anal membrane to rupture

58
Q

What percentage of abdominal hernias do inguinal hernias account for?

A

75%

59
Q

What percentage abdominal hernias do direct inguinal hernias account for?

A

25%

60
Q

What types of inguinal hernias are there?

A

Direct

Indirect

61
Q

What area of weakness is exploited in a DIRECT inguinal hernia?

A

Hesselbach’s triangle

62
Q

What is the inferior border of Hesselbach’s triangle?

A

The inguinal ligament

63
Q

What is the medial border of Hesselbach’s triangle?

A

Lateral border of rectus abdominis muscle

64
Q

What is the lateral border of Hesselbach’s triangle?

A

The inferior epigastric blood vessels

65
Q

What percentage abdominal hernias do indirect inguinal hernias account for?

A

50%

66
Q

In a DIRECT inguinal hernia describe the route taken by the herniated viscera

A

The viscera herniates through Hesselbach’s triangle (medial to the inferior epigastric vessels) to sit behind the inguinal canal, pushing the posterior wall of the canal with it partially “through” the superficial ring.

67
Q

In an INDIRECT inguinal hernia describe the route taken by the herniated viscera

A

The viscera passes through the deep ring of the inguinal canal (lateral to the inferior epigastric vessels), traverses through the inguinal canal and passes out through the superficial ring.

68
Q

What other hernia can occur as a result of an indirect inguinal hernia?

A

Scrotal hernia

69
Q

How does a scrotal hernia occur?

A

The processus vaginalis re-opens or fails to close properly, allowing the herniated viscera to pass into the scrotum via the same route the testis take during their descent

70
Q

What happens in a femoral hernia?

A

The viscera passes through the femoral ring into the femoral canal and pass out through the saphenous opening

71
Q

What sex are femoral hernias more common in?

A

Females

72
Q

What do femoral hernias put the patient at risk of?

A

Incarceration (get viscera stuck) and resultant strangulation (blood supply cut off, risks ischaemia and necrosis)

73
Q

At what stages in life can umbilical hernias occur?

A

Acquired infantile

Acquired adult

74
Q

What is an infantile umbilical hernia?

A

The contents herniates through the weakness at the scar of the umbilicus

75
Q

What is an adult umbilical hernia?

A

Technically a para-umbilical hernia where the contents herniates through the linea alba

79
Q

Define gastro-oesophageal reflux disease

A

Excessive reflux of stomach contents into the oesophagus

80
Q

What are the symptoms of GORD

A

Heartburn

Cough

Sore throat

Dysphagia

81
Q

What can cause GORD?

A

Lower oesophageal sphincter problems

Delayed gastric emptying (leads to raised intra-gastric pressure)

Hiatus hernia (LOS slips though diaphragm and there is loss of

Obesity

82
Q

What complications can GORD lead to?

A

Oesophagitis

Strictures

Barrett’s oesophagus

83
Q

What is Barrett’s oesophagus?

A

Metaplasia of the squamous epithelium of the oesophagus to columnar

84
Q

What does Barrett’s oesophagus increase the risk of?

A

Development of adenocarcinoma of the oesophagus (30-40x risk)

85
Q

What are the three classes of treatment for GORD?

A

Lifestyle modifications

Pharmacological

Surgery (rare)

86
Q

Give an example of a lifestyle modification used to treat GORD

A

Sitting upright after eating

87
Q

When is pharmacological intervention for GORD used?

A

When lifestyle interventions are insufficient

88
Q

Give examples of pharmacological treatments used for GORD

A

Antacids

H₂ antagonists

PPIs (usually the first choice)

89
Q

What surgical intervention can be used to treat GORD?

A

Fundoplication

90
Q

What is the purpose of a fundoplication?

A

The fundus is wrapped around the lower oesophageal sphincter to strengthen it and reduce the risk of hiatus hernia

91
Q

What is acute gastritis?

A

Inflammation of the stomach mucosa (can be due to decreased blood flow to the mucosa)

92
Q

What are the main causes of acute gastritis?

A

Heavy use of NSAIDS (decreases prostaglandin production and so decreases blood flow to mucosa)

Lots of alcohol

Chemotherapy

Bile reflux (bile is irritant to the stomach)

93
Q

What are the symptoms of acute gastritis?

A

Asymptomatic

OR;

Pain, nausea, vomiting

OCCASIONALLY;

Bleeding (can be fatal)

94
Q

What are the main causes of chronic gastritis?

A

Bacterial - H. pylori (most common)

Autoimmune - antibodies to gastric parietal cells

Chemical/reactive (the causes of acute gastritis)

95
Q

How will chronic gastritis as a result of H. pylori infection present?

A

Asymptomatic or similar to acute gastritis

96
Q

What complications can develop as a result of H. pylori infection?

A

Peptic ulcers, adenocarcinoma, MALT lymphoma

97
Q

What can chronic gastritis with an autoimmune aetiology lead to?

A

Pernicious anemia

98
Q

What symptoms can chronic gastritis with an autoimmune aetiology present with?

A

Symptoms of anaemia

Glossitis

Anorexia

Neurological symptoms

99
Q

What causes susceptibility to peptic ulcers?

A

Unusually a deficiency in one or more mechanism that defends the mucosa from damage

100
Q

What sources can damage the vulnerable mucosa?

A

Stomach acid

H. pylori

NSAIDS

Smoking (mainly contributes to relapse)

Stress (massive physiological stress e.g. Burns)

101
Q

What are the mild symptoms of peptic ulcers?

A

Epigastric pain (sometimes back pain)

  • Burning/gnawing pain
  • Follows meal times
  • Often at night (especially duodenal ulcers)
102
Q

Why does epigastric pain often occur at night?

A

Because there is no food present and so the pH is especially low

103
Q

What are the serious symptoms of peptic ulcers?

A

Bleeding/anaemia (from the gastroduodenal artery)

Early satiety

Weight loss

104
Q

What is functional dyspepsia?

A

Symptoms of ulcer disease but no physical evidence of the disease or any obvious causes

105
Q

How are H. pylori infections diagnosed?

A

Urease breath tests

106
Q

How is a H. pylori infection treated?

A

PPI + Clarithromycin + Amoxicillin

107
Q

Define peptic ulcer disease

A

Defects of the gastric/duodenal mucosa that extend through the muscularis mucosa

108
Q

Where are peptic ulcers most commonly seen?

A

First part of duodenum

109
Q

Where else can peptic ulcers commonly affect?

A

The lesser curve of the stomach

ESA 3 Clinical Conditions (2 decks)

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