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GI AM > GI conditions > Flashcards

GI conditions Flashcards

1
Q

What is oesophageal hypermotility?

A

Exaggerated, uncoordinated hypertonic contractions

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2
Q

What are the symptoms of oesophageal hypermotility?

A

Severe episodic pain, with or without dysphagia

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3
Q

Wat investigations can be done for oesophageal hypermotilty?

A

Barium swallow- corkscrew appearance

Manometry- exaggerated, uncoordinated hypertonic contractions

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4
Q

What is the treatment of oesophageal hypermotility?

A

Smooth muscle relaxants

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5
Q

What is oesophageal hypomotility?

A

Failure of lower oesophageal sphincter mechanism

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6
Q

What are the risk factors for oesophageal hypomotility?

A

Connect tive tissue disease
Diabetes
Neuropathy

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7
Q

What are the symptoms of oesophageal hypomotility?

A

Hertburn

Reflux

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8
Q

What are the complications of oesophageal hypomotility?

A

Can lead to gastro-oesophageal reflux disease

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9
Q

What is achalasia?

A

Functional distal obstruction of oesophagus

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10
Q

What causes achalasia?

A

Functional loss of myenteric plexus ganglion cells in distal oesophagus and lower oesophageal sphincter, causing LOS to fail to contract

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11
Q

What are the signs and symptoms of achalasia?

A 
Progressive dysphagia
Weight loss
Chest pain
Regurgitation
Chest infections
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12
Q

What is the treatment of achalasia?

A

Nitrates and CCBs
Pneumatic balloon dilatation
SUrgical myotomy

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13
Q

What are the complications of achalasia?

A

Aspiration pneumonia and lung disease

Increased risk of squamous cell carcinoma

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14
Q

What happens in gastro-oesophageal reflex disease?

A

Mucosa exposed to pepsina nd bile
Increased cell loss and regenerative activity
Erosive oesophagitis

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15
Q

What are the types of gastro-oesophageal reflux disease?

A

With normal anatomy

Due to hiatus hernia

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16
Q

What are the causes of gastro-oesophageal reflux disease with normal anatomy?

A 
Increased transient relaxations of LOS
Hypotensive LOS
Delayed gastric emptying
Delayed oesophageal emptying
Decreased oesophageal acid clearance
Decreased tissue resistance to acid/bile
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17
Q

What causes gastro-oesophageal reflux disease in hiatus hernia?

A

Anatomical distortion of gastro-oesophageal junction

Fundus of stomach moves proximally through diaphragmatic hiatus

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18
Q

What are the types of gastro-oesophageal reflux disease due to hiatus hernia?

A

Sliding

Paraoesophageal

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19
Q

What ar the risk factors for gastro-oesophageal reflux disease?

A 
Pregnancy
Obesity
Drugs lowering LOS pressure
Smoking
Alcohol
Hypomotility
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20
Q

What are the signs and symptoms of gastro-oesophageal reflux disease?

A

HErtburn
Cough
Water brash
Sleep disturbance

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21
Q

What investigations are done for gastro-oesophageal reflux disease?

A

Endoscopy only if alarm features- dysphagia, weight loss or vomiting

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22
Q

How is gastro-oesophageal reflux disease diagnosed?

A

Based on characteristic symptoms

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23
Q

What is the treatment of gastro-oesophageal reflux disease?

A

Lifestyle measures
Alginates, H2RA, PPI
Anti-reflux surgery in severe cases

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24
Q

What are the complications of gastro-oesophageal reflux disease?

A

Ulceration
Stricture
Barrett’s oesophagus
Carcinoma

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25
Q

What ar the types of oesophageal cancer?

A

Squamous cell carcinoma

Adenocarcinoma

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26
Q

What is a squamous cell oesophageal carcinoma?

A

Large, exophyti occulting tumour

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27
Q

Where does squamous cell oesophageal carcinoma occur?

A

Proximal 2/3 oesophagus

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28
Q

What is squamous cell oesophageal carcinoma proceeded by?

A

Dysplasia and carcinoma in situ

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29
Q

What is squamous cell oesophageal carcinoma associated with?

A

Achalasia
Caustric strictures
Plummer-Vinson syndrome

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30
Q

What are the risk factors for squamous cell oesophageal carcinoma?

A

Smoking

Alcohol

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31
Q

What is oesophageal adenocarcinoma?

A

Change of squamous epithelium to glandular epithelium

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32
Q

Where does oesophageal adenocarcinoma occur?

A

Distal 1/3 oesophagus

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33
Q

What causes oesophageal adenocarcinoma?

A

Barrett’s oesophagus

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34
Q

What are the risk factor for oesophageal adenocarcinoma?

A

Obesity
Caucasian
Male
Middle aged

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35
Q

What are the signs and symptoms of oesophageal cancer?

A 
Progressive dysphagia
Odynophagia
Anorexia and weight loss
Chest pain
Cough and haemetemesis
Pneumonia
Vocal cord paralysis
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36
Q

How is oesophageal cancer diagnosed?

A

Endoscopy and biopsy

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37
Q

How is oesophageal cancer staged?

A

CT
ENdoscopic ultrasound
PET
Bone scan

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38
Q

Where are the common sites of metastases for oesophageal cancer?

A

Liver
Lung
Brain
Bone

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39
Q

What is the curative treatment of oesophageal cancer?

A

Oesophagectomy

With or without neoadjuvant and/or adjuvant chemo

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40
Q

What is the treatment of oesophageal cancer for localised but inoperable disease?

A

Combined chemo and radiotherapy

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41
Q

What is the palliative treatment of oesophageal cancer?

A

Chemo
Radiotherapy
Brachytherapy
Endoscopic- stent, laser/APG, PEG

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42
Q

What is dyspepsia?

A

Group of symptoms rather than a disease

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43
Q

What are the upper GI causes of dyspepsia?

A

Peptic ulcer
Gastritis
Nonulcer dyspepsia
Gastric cancer

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44
Q

What are the lower GI causes of dyspepsia?

A

IBS

Colonic cancer

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45
Q

What are the non GI causes of dyspepsia?

A

Metabolic or cardiac disease
Psychological
Drugs

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46
Q

What are the “other” GI causes of dyspepsia?

A

Hepatic causes
Gallstones
Pancreatic disease
Coeliac

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47
Q

What are the signs and symptoms of dyspepsia?

A 
Upper abdo discomfort
Retrosternal pain
Anorexia
N&V
Bloating
Fullness and early satiety
Heartburn
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48
Q

When are investigations carried out for dyspepsia?

A 
Anorexia
Weight loss
anaemia
Recent onset or persistent
Melaena/haemetemesis
Dysphagia
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49
Q

What bloods are done for dyspepsia?

A 
FBC
Ferritin
LFTs
U+Es
Ca
Glucose
Coeliac serology
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50
Q

What should be asked about in drug history with dyspepsia?

A 
NSAIDs
Steroids
Bisphosphates
Ca antagonists
Nitrates
Theophyllines
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51
Q

What social history should be taken with dyspepsia?

A

Alcohol
Smoking
Diet
Exercise

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52
Q

What is gastritis?

A

Inflammation of stomach

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53
Q

What are the 3 types of gastritis?

A

Type A= autoimmune
Type B= bacterial
Type C-= chemical

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54
Q

What is Type A gastritis?

A

Organ specific autoimmune disease with antibodies against parietal cells and intrinsic factor
Atrophy of specialised acid secreting epithelium

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55
Q

What is the most common type of gastritis?

A

Type B

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56
Q

What is type B gastritis associated with?

A

H pylori

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57
Q

What are the common causes of type C gastritis?

A

NSAIDs
Alcohol
Bile

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58
Q

What does type A gastritis cause?

A

Decreased acid secretion

Loss of intrinsic factor= B12 deficiency

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59
Q

What are the signs and symptoms of dyspepsia?

A

Dyspepsia
Nausea and vomiting
Fullness

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60
Q

What investigations should be done for gastritis?

A

Stool test
Breath test for H pylori
Endoscopy
Barium swallow

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61
Q

What is the treatment of gastritis?

A

H2 receptor blockers
PPIs
Eradication of H pylori (clairithromycin, amoxicillin and PPI)

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62
Q

What are the complications of gastritis?

A

Peptic ulcers
Polyps
Gastric tumours

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63
Q

What are peptic ulcers?

A

Sores that affect lower oesophagus, body and antrum of stomach and proximal 2/3 of duodenum

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64
Q

What are the causes of peptic ulcers?

A

H pylori
NSAIDs
SMoking
Other conditions

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65
Q

What are the signs and symptoms of peptic ulcers?

A 
Epigastric pain and tenderness
Nocturnal/hunger pain
Back pain
Nausea and vomiting
Weight loss and anorexia
Haemetemesis/melaena/anaemia
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66
Q

What investigations are done for peptic ulcer?

A

UGIE

Identifying cause

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67
Q

What is the treatment of peptic ulcers?

A

H pylori eradication therapy- Clairithromycin, amoxicillin, PPI
PPI, H2 receptor antagonist
Stop NSAIDs/use only with extra protection
Surgery- if severe or dilatation

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68
Q

What are the complications of peptic ulcers?

A

Acute or chronic bleeding
Perforation
Fibrotic stricture
Gastric outlet obstruction

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69
Q

What ar the signs and symptoms of gastric outlet obstruction?

A 
Recurrent vomiting
Early satiety
Abdo distension
Weight loss
Gastric splash
Dehydration
Metabolic alkalosis
Low Cl, Na and K
Renal impairment
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70
Q

What are the majority of gastric cancers?

A

Adenocarcinoma

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71
Q

What are the causes of gastric cancer?

A 
Diet
Geetics 
Smoking
H pylori
Previous gastric resection
Biliary reflux
Premalignant gastric pathology
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72
Q

What are the signs and symptoms of gastric cancer?

A 
Dyspepsia
Early satiety
N&V
Weight loss
GI bleeding
Anaemia
Gastric outlet obstruction
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73
Q

What are the diagnostic investigations for gastric cancer?

A

Endoscopy and biopsy

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74
Q

What are the staging investigations for gastric cancer?

A

CT

PET

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75
Q

What is the treatment of gastric cancer?

A

Surgery and chemo

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76
Q

What are the causes of malabsorption?

A 
Inflammation
Infection
Infiltration
Impaired motility
Iatrogenic
Pancreatic
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77
Q

What are the inflammatory causes of malabsorption?

A

Coeliac

Crohn’s

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78
Q

What are the infective causes of malabsorption?

A 
Tropica sprue
HIV
Giardia lambila
Whipple's disease
Tropheryma whippelii
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79
Q

What are the infiltrative causes of malabsorption?

A

Amyloid

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80
Q

What are the motility causes of malabsorption?

A

Systemic sclerosis
Diabetes
Pseudo obstruction

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81
Q

What are the iatrogenic causes of malabsorption?

A

Gastric surgery
Short bowel syndrome
Radiation

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82
Q

What are the pancreatic causes of malabsorption?

A

Chronic pancreatitis

Cystic fibrosis

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83
Q

What are the signs and symptoms of malabsorption?

A

Weight loss
Increased appetite
Steatorrhoea
Specific deficiencies

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84
Q

What are the specific deficiencies associated with malabsorption?

A 
Iron
Folate, B12
Ca, Mg, vit D
Vit A
Vit K
Vit B complex
Vit C
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85
Q

What are the signs of a Ca, Mg or vit D deficiency?

A

Tetany

Osteomalacia

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86
Q

What is a sign of vit A deficiency?

A

Night blindness

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87
Q

What is a sign of vit K deficiency?

A

Raised PTR

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88
Q

What are the signs of vit B complex deficiencies?

A

Thiamine- dementia

Niacin- dermatitis, heart failure

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89
Q

What is the sign of vit C deficiency?

A

Scurvy

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90
Q

What is clubbing in malabsorption a sign of>

A

Coeliac

Crohn’s

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91
Q

What is scleroderma in malabsorption a sign of?

A

Systemic sclerosis

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92
Q

What is aphthous ulceration in malabsorption a sign of?

A

Coeliac

Crohn’s

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93
Q

What is dermatitis herpetiformis a sign of?

A

Coeliac

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94
Q

What is coeliac?

A

Sensitivity to the Gladin fraction of gluten, causing an inflammatory response

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95
Q

What does coeliac disease cause?

A

Partial or subtotal villous atrophy

Increased intraepithelial lymphocytes

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96
Q

What are the signs and symptoms of coeliac?

A 
Weight loss
Diarrhoea and/or constipation
Abdo pain
Anaemia
Fatigue
Bloating
Dermatitis herpetiformis
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97
Q

How is coeliac diagnosed?

A

Serology
HLA status
Distal duodenal biopsy

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98
Q

What dow e look for in coeliac serology?

A

Anti endomysial IgA

Anti tissue transglutaminase

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99
Q

Why is HLA status not an effective diagnostic tool for coeliac?

A

+ in 97% coeliacs and 30% general population

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100
Q

What are the 3 forms of villous atrophy in coeliac?

A

Partial- villi shortened
Subtotal- lining flat but glands extend
Total- lining down to thin line

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101
Q

What is the treatment of coeliac?

A

Withdraw gluten and refer to dietician

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102
Q

What are the complications of coeliac?

A 
Refractory coeliac
Small bowel lymphoma
Oesophageal carcinoma
Colon caner
Small bowel adenocarcinoma
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103
Q

What is refractory coeliac?

A

Doesn’t respond to diet

Treat with steroids

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104
Q

What conditions are associated with coeliac?

A 
Dermatitis herpetiformis
Type 1 diabetes
Atoimmune thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Autoimmune gastritis
Sjogren syndrome
IgA deficiency
Downs syndrome
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105
Q

What is ulcerative colitis (UC)?

A

Strong immune response against normal flora in large bowel

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106
Q

What is the histology of UC?

A 
Continuous pattern of inflammation
Pseudopolyps, ulceration
Cryptitis, crypt abscesses
Submucosal fibrosis
Inflammation does nt reach serosa
No granulomas
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107
Q

What are the causes of UC?

A

Idiopathic

Genetic

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108
Q

What are the risk factors for UC?

A

Male

20-30 years and 70-80 years

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109
Q

What are the signs and symptoms of UC?

A

Bloody diarrhoea
Abdo pain
Weight loss
Severe attacks

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110
Q

What are the signs and symptoms of a severe attack of UC?

A 
Stool frequency >6 times a day with blood
Fever >37.5
Tachycardia >90
High CRP
Anaemis Hb<10g/dl
Low albumin <30g/l
Leucocytosis, thrombocytosis
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111
Q

What investigations are done for UC?

A

History
Radiograph
pANCA

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112
Q

What % of UC patients of pANCA + in?

A

75%

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113
Q

What is the outpatient treatment of UC?

A

5ASA
Steroids
Immunosuppression

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114
Q

What are the 5ASAs used to treat UC?

A 
Acrylic resin
Ethylcellulose microgranules
Balsalazide
Olzalazine
Sulfasalazine
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115
Q

What steroids are used to treat UC?

A

Prednisolone- tapering reduction over 4 weeks

Budenoside- Ileal and ascending colon disease only

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116
Q

What immunosuppressants are used in UC?

A

Azathioprine
Methotrexate
Ciclosporin
Tacrolimus

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117
Q

What is the hospital treatment of UC?

A 
Steroids
Anticoagulation
Ciclosporin
Infliximab
Surgery
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118
Q

What surgery can be done for UC?

A

Total colectomy
Rectal preservation
Ileostomy
Pouch procedure

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119
Q

What is used in place of steroids in children with UC?

A

Elemental feeding

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120
Q

What would signify failure of treatment in UC?

A

Recurrent courses of steroids
Recurrent relapses
Failure to control symtpoms
Unacceptable complications- diabetes, osteoporosis, psychosis

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121
Q

What is Crohn’s?

A

Strong immune response against normal flora at any level in the GI tract

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122
Q

What % of cases of Crohn’s appear in small intestine, large intestine or both?

A

40% SI
30% both
30% LI

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123
Q

What is the histology of Crohn’s?

A 
Patchy disease- skip lesions and cobblestone appearance
Cryptitis and crypt abscesses, crypt destruction
Architectural distortion
Deep ulceration
Transmural inflammation
Non caveating granulomas
Fibrosis
Lymphangiectasia
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124
Q

What are the primary methods of distinguish the histology of Crohn’s from UC?

A

Crohn’s- cobblestone appearance and non caveating granulomas

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125
Q

What are the causes of Crohn’s?

A

Genetic

Idiopathic

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126
Q

What are the signs and symptoms of Crohn’s?

A 
Diarrhoea
Abdo pain
Weight loss
Malaise, lethargy, anorexia, N&amp;V, low grade fever
Malabsorption
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127
Q

What are the long term features of Crohn’s?

A 
Malabsorption
Strictures
Fistulas and abscesses
Perforation
Increased risk of cancer
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128
Q

What investigations are done for Crohn’s?

A

History
Radiography
pANCA

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129
Q

What % of Crohn’s patients have a + pANCA?

A

30%

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130
Q

What is the outpatient treatment of Crohn’s?

A

5ASA
Steroids
Immunosuppression

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131
Q

What 5ASAs are used to treat Crohn’s?

A 
Acrylic resin
Ethylcellulose
Balsalazide
Olzalazine
Sulfasalazine
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132
Q

What steroids are used to treat Crohn’s?

A

Prednisolone- tapering reduction over 4 weeks

Budenoside- ideal and ascending colon disease only

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133
Q

What immunosuppressants are used to treat Crohn’s?

A

Azathioprine
Methotrexate
Ciclosporin
Tacrolimus

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134
Q

What is the hospital treatment of Crohn’s?

A 
Steroids
Anticoagulation
Ciclosporin
Infliximab
Surgery
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135
Q

What surgeries can be done for Crohn’s?

A

Total colectomy
Rectal preservation
Ileostomy
Pouch procedure

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136
Q

What are the indications for surgery in Crohn’s?

A 
Failure of medical management
Relief of obstructive symptoms
Management of fistulae
Management of intra abdominal masses or anal conditions
Failure to thrive
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137
Q

What are the frequent areas of surgery in Crohn’s?

A

Small intestine- 30%
Ileocaecal- 40%
Colorectal- 30%

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138
Q

What is used in place of steroids in treating children with Crohn’s?

A

Elemental feeding

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139
Q

What signifies failure of therapy in Crohn’s?

A

Recurrent courses of steroids
Recurrent relapses
Failure to control symptoms
Unacceptable complications- diabetes, osteoporosis, psychosis

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140
Q

What is ischaemic enteritis?

A

Occlusion of vessels suppling SI and/or LI and can cause acute or chronic hypoperfusion

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141
Q

What is the histology of acute hypoperfusion in ischaemic enteritis?

A 
Oedema
Interstitial changes
Necrosis
Indistinct nuclei
Initial absence of inflammation
Vascular dilatation
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142
Q

What is the histology of chronic hypoperfusion in ischaemic enteritis?

A 
Mucosal inflammation
Ulceration
Submucosal inflammation
Fibrosis
Stricture
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143
Q

What are the risk factors of arterial thrombosis?

A 
Severe atherosclerosis
Systemic vasculitis
Dissecting aneurysm
Hypercoagulable
Oral contraceptive
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144
Q

What are the risk factors of arterial embolism?

A

Cardiac vegetation
Acute arteroembolism
Cholesterol embolism

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145
Q

What are the risk factors of non occlusive ischaemic enteritis?

A

Cardiac failure
Shock/dehydration
Vasoconstrictive drugs

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146
Q

What is radiation colitis?

A

Impaired proliferative activity of S and L bowel epithelium

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147
Q

What is the histology of radiation colitis?

A 
Inflammation
Arterial stenosis
Ulceration
Necrosis
Haemorrhage
Perforation
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148
Q

What are the signs and symptoms of radiation colitis?

A

Anorexia
Abdo cramps
Diarrhoea
Malabsorption

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149
Q

What is appendicitis?

A

Acute inflammation and fibrous obliteration of the appendix

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150
Q

What is the histology of appendicitis?

A

Fibrinopurulent exudate
Perforation
Abscess
Acute suprative inflammation in wall and pus in lumen of appendix
Acute gangrenous full thickness necrosis, with or without perforation

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151
Q

What are the signs and symptoms of appendicitis?

A 
Poorly localised pain that may come and go that progresses to sharp pain at McBurney's point
Fever
N&amp;V
Diarrhoea
Anorexia
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152
Q

What is the treatment of appendicitis?

A

Appendectomy

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153
Q

What are the complications of appendicitis?

A

Peritonitis

Abscesses

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154
Q

How do adenomas become adenocarcinomas?

A

Activation of oncogene
Loss of tumour suppressor gene
Defective DNA repair pathway

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155
Q

What are the 2 main histological types of colorectal adenoma?

A

Tubular

Villous

156
Q

What are the risk factors of sporadic colorectal cancer?

A 
Age
Male
Previous adenoma/cancer
Diet
Obesity
Lack of exercise
Smoking
Diabetes mellitus
157
Q

What are the risk factors of colorectal cancer?

A

Familial
Inheritable conditions
Underlying condition

158
Q

What are the signs and symptoms of colorectal cancer?

A

Rectal bleeding
Altered bowel habits- leaning towards diarrhoea
Weight loss, anorexia
Iron deficiency anaemia- in men and non menstruating women
Palpable rectal or lower right abdominal mass
Acute colonic obstruction

159
Q

What investigations are done for colorectal cancer?

A

Colonoscopy with biopsy
Barium enema- rare
CT colonography
CT abdo/pelvis

160
Q

What staging investigations are done for colorectal cancer?

A

CT
MRI- for rectal
PET

161
Q

What is the bonus of colonoscopy with biopsy?

A

Diagnostic and therapeutic

162
Q

What are the risks of colonoscopy with biopsy?

A

Perforation

Bleeding

163
Q

What is the staging of colorectal cancer?

164
Q

What are the stages of colorectal cancer?

A

A- tumour confined to mucosa
B- tumour extended through mucosa to muscle layer
C- involvement of lymph nodes
D- distant metastatic spread

165
Q

What is the population screening test for colorectal cancer?

A

FOB test in 50-74 year olds

166
Q

What happens if an FOB test returns a + result?

A

Colonoscopy

167
Q

What high risk groups get screening tests for colorectal cancer?

A 
Inheritable conditions
IBD
Familial risk
Previous adenomas
Previous colorectal cancer
168
Q

What heritable conditions get bowel screening tests?

A

Familial adenomatous polyposis

Hereditary non polyposis colorectal cancer

169
Q

What is the bowel screening test for those with familial adenomatous polyposis?

A

Annual colonoscopy from age 10-12

170
Q

What is the treatment for familial adenomatous polyposis?

A

Prophylactic polypectomy

NSAIDs chemoprevention

171
Q

How is hereditary non polyposis colorectal cancer diagnosed?

A

Those with clinical criteria get genetic testing

172
Q

What screening is offered for people with hereditary non polyposis?

A

2 yearly colonoscopy

173
Q

What screening for colorectal cancer is done for people with IBD?

A

Colonoscopy 10 years post diagnosis then at varying durations after

174
Q

What screening for colorectal cancer is done for people with a high familial risk?

A

5 yearly colonoscopy from age 50

175
Q

What screening test for colorectal cancer is done for people with a low familial risk?

A

Colonoscopy at 55

176
Q

What screening tests are done for people with previous colorectal adenomas?

A

Dependent on no of polyps, size, degree of dysplasia

177
Q

What screening test is done for people with previous colorectal cancer?

A

5 yearly colonoscopy

178
Q

What is the surgical treatment of Dukes’ A colorectal cancer?

A

Endoscopic or total resection

179
Q

What is the surgical treatment of colorectal cancer?

A

Stoma formation
Removal of lymph nodes
Partial hepatectomy for metastases

180
Q

What is the chemotherapy treatment for Dukes C and B?

A

Advuvant chemo

181
Q

When is radiotherapy used to treat colorectal cancer?

A

REctal cancer only

Neoadjuvamt

182
Q

What is palliative colorectal cancer treatment?

A

Chemo

Colonic stenting

183
Q

What is Hep A?

A

Acute infection caused by enteric virus acquired through ingestion

184
Q

What are the signs and symptoms of HEpA?

A 
Jaundice
Fatigue
Fever
Anorexia
Itching
185
Q

What investigation is done for Hep A?

A

IgM antibodies

186
Q

What antigens are present in a Hep B infection?

A

HBeAg
HBsAg
HBcAg
HBV DNA

187
Q

What is HBeAg a sign of?

A

Active replication of Hep B virus

188
Q

What is HBsAg a sign of?

A

Presence of Hep B virus

189
Q

Wha is HBcAg a sign of and where is it found?

A

Active replication of Hep B virus

Liver

190
Q

What is HBV DNA a sign of?

A

Active replication of Hep B virus

191
Q

What do IgM antibodies in Hep B show?

A

+ in newly acquired infection

- in chronic

192
Q

What do IgG antibodies in Hep B show?

A

Chronic infection

193
Q

What do anti HBe antibodies in Hep B show?

A

Inactive virus

194
Q

What is the usual progression of Hep B?

A

Chronic infection

195
Q

What can Hep B progress to?

A

Cirrhosis
Hepatocellular carcinoma
End stage liver disease

196
Q

What are the signs and symptoms of Hep B?

A 
Jaundice
Fatigue
Fever
Anorexia
Itching
197
Q

What is the treatment of Hep B?

A 
Lamivudine
Adefovir
Antecavir
Telbivudine
Tenofovir
198
Q

What does Hep C Normally progress to?

A

Chronic infection

199
Q

What can Hep C progress to?

A

Cirrhosis

Hepatocellular carcinoma

200
Q

What are the signs and symptoms of Hep C?

A 
JAundice
Fatigue
Fever
Anorexia
Itching
201
Q

What is the test for Hep C?

A

HCV antibody test

202
Q

What is the treatment of Hep C?

A

Direct acting antivirals

203
Q

When can Hep D occur?

A

Only with hep B

204
Q

What are the signs and symptoms hep D?

A 
Jaundice
Fatigue
Fever
Anorexia
Itching
205
Q

What is non alcoholic fatty liver disease?

A

Broad term encompassing 3 entities
Steatosis
Non alcohol steatohepatitis
Fibrosis and cirrhosis

206
Q

What is non alcoholic fatty liver disease associated with?

A

Diabetes mellitus
Obesity
Hypertriglyceridema
Hypertension

207
Q

What are the risk factors for non alcoholic fatty liver disease?

A

Age
Ethnicity
Genetic factors

208
Q

What investigations are done for non alcoholic fatty liver disease?

A 
Biochemical test
Enhanced liver fibrosis panel
Cytokeratin-18
Ultrasound
Fibroscan
MRI/CT
MR spectroscopy
Liver biopsy
209
Q

What is the treatment of non alcoholic fatty liver disease?

A 
Diet and weight reduction
Exercise
Insulin sensitisers
Glucagon like peptide 1
Vit E
Weight reduction surgeries
210
Q

How is autoimmune hepatitis diagnosed?

A

Liver biopsy

211
Q

What is the treatment of autoimmune hepatitis?

A

Steroids

Long term azathioprine

212
Q

What is primary biliary cholangitis?

A

Organ specific autoimmune disease

Granulomatous inflammation involving the bile ducts

213
Q

What does primary biliary cholangitis cause?

A

Loss of intrahepatic bile ducts

Can progress to cirrhosis

214
Q

What are the signs and symptoms of primary biliary cholangitis?

A

Pruritus

Jaundice

215
Q

What investigation is done for primary biliary cholangitis?

216
Q

What is found on bloods in primary biliary cholangitis?

A

IgM elevated
Raised serum alkaline phosphatase
Antimitochondrial antibody +

217
Q

What is the treatment of primary biliary cholangitis?

218
Q

What is primary sclerosis cholangitis?

A

Chronic inflammation and fibrotic obliteration of bile ducts

219
Q

What is primary sclerosis cholangitis associated with?

220
Q

What bile ducts are involved in primary sclerosis cholangitis?

A

Intra and extra hepatic bile ducts

221
Q

What are the signs and symptoms of primary sclerosis cholangitis?

A

Recurrent cholangitis

Jaundice

222
Q

What is found on investigation with primary sclerosis cholangitis?

223
Q

What is the treatment of primary sclerosis cholangitis?

A

Liver transplant

Biliary stents

224
Q

what are the complications of primary sclerosis cholangitis?

A

Increased risk of cholangiocarcinoma

225
Q

What is liver failure?

A

Complication of acute or chronic liver injury

226
Q

What can cause acute liver injury?

A

Hepatitis- viruses, alcohol, drugs

Bile duct obstruction

227
Q

What is alcoholic hepatitis?

A

Response of liver tp excess alcohol

Fatty change and decompensated hepatic function

228
Q

What are the signs and symptoms of alcoholic hepatitis?

A

Jaundice

Encephalitis

229
Q

What is found on investigation with alcoholic hepatitis?

A

Raised bilirubin
Raised GGT and ALP
History of alcohol

230
Q

What is the treatment of alcoholic hepatitis?

A 
Treat infections and encephalopathy
Supportive care
Treat alcohol withdrawal
Protect against GI bleeds
Nutrition
Steroids in severe cases
231
Q

What is jaundice?

A

Increased circulating bilirubin caused by altered metabolism of bilirubin

232
Q

What are the causes of jaundice?

A

Pre hepatic
Hepatic
Post hepatic

233
Q

What are the pre hepatic causes of jaundice?

A

Increased release f haemoglonin

234
Q

What are the hepatic causes of jaundice?

A

Cholestasis
Intrahepatic bile duct obstruction
Tumour of the liver

235
Q

What is cholestasis?

A

Accumulation of bile within hepatocytes or bile canaliculi

236
Q

What are the causes of cholestasis?

A

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs

237
Q

What are the causes of an intrahepatic bile duct obstruction?

A

Primary biliary or sclerosis cholangitis

238
Q

What are the post hepatic causes of jaundice?

A

Cholelithiasis

Extra hepatic bile duct obstruction

239
Q

What are the causes of extra hepatic bile duct obstruction?

A

Gallstoens
Bile duct tumours
Benign stricture
External compression

240
Q

What are the signs and symptoms of prehepatic jaundice?

A

History of anaemia
Alcoholic jaundice
Pallor
Splenomegaly

241
Q

What are the signs and symptoms of hepatic jaundice?

A 
Risk factors for liver disease
Decompensation
Ascites
Flapping tremor
SPider navel
Gynacomastia
242
Q

What are the signs and symptoms of post hepatic jaundice?

A

Abdo pain
Cholestasis
Palpable gallbladder

243
Q

What are the signs and symptoms of cholestasis?

A

Pruritis
Pale stools
High coloured urine

244
Q

What investigations are done for jaundice?

A

Liver screen
Abdo ultrasound
MRCP

245
Q

What is done on a liver screen for jaundice?

A 
Hep B and C serology
Antibody profile, serum Its
Caeruloplasmin and copper
Ferritin and transferrin
Alpha 1 antitrypsin
Fasting glucose and liver profile
246
Q

Wha is the treatment of jaundice?

A

ERCP
Percutaneous transhepatoc cholangiogram
ENdoscopic ultrasound

247
Q

What can ERCP treat in jaundice?

A

Dilated biliary tree
Acute gallstone pancreatitis
Post op biliary complications
Biliary tract obstruction

248
Q

What is cirrhosis?

A

End stage chronic liver disease

249
Q

What is the pathology cirrhosis?

A

Advanced fibrosis replaces functional parenchyma and prevents movement of blood into and out of the liver

250
Q

What parts of the liver are involved in cirrhosis?

A

Diffuse process involving entire lver

251
Q

What are the causes of cirrhosis?

A 
Alcohol
Hep B and C
Immune mediated liver disease
Metabolic disorders
Diabetes mellitus
Idiopathic
252
Q

What immune mediated liver disease can lead to cirrhosis?

A

Autoimmune hepatitis

Primary biliary cholangitis

253
Q

What metabolic disorders can lead to cirrhosis?

A

Primary haemochromatosis

Wilson’s disease

254
Q

What are the signs and symptoms of cirrhosis?

A 
Jaundice
HAemetemesis
Pruritus
Melaena
Oedema
Ascites
255
Q

What are the complications of cirrhosis?

A

Liver failure
Portal hypertension
Increased risk of hapatocellular carcinoma

256
Q

What is chronic liver disease?

A

Liver disease persisting for over 6 months

257
Q

What pathologies can constitute chronic liver disease?

A 
Chronic hepatitis
Chronic cholestasis
Fibrosis and cirrhosis
Luver tumous
Other
258
Q

What are the signs of compensated chronic liver disease?

A

Abnormal LFTs

259
Q

What are the signs and symptoms of decompensated chronic liver disease?

A

Ascites
Variceal bleeding
Hepatic encephalopathy

260
Q

What is hepatic encephalopathy?

A

Confusion brought on by chronic liver disease

261
Q

What are the grades of hepatic encephalopathy?

A

Grade 1= mild confusion

Grade 4= coma

262
Q

What are the causes of hepatic encephalopathy?

A 
GI bleeds
Infection
Constipation
Dehydration
MEdication
263
Q

What are the signs and symptoms of hepatic encephalopathy?

A

Confusion
Flappg tremor
Foetor hepaticas

264
Q

What is the treatment of hepatic encephalopathy?

A

Treat underlying cause

Admit to hospital

265
Q

What do repeat hospital admission due to hepatic encephalitis indicate?

A

Liver transplant needed

266
Q

Who is surveyed for hepaocellular carcinoma?

A

Those with cirrhosis

267
Q

What is the investigation for hepatocellular carcinoma?

A

Ultrasound
CT
MRI
Biopsy- rare

268
Q

What is the curative treatment of hepatocellular carcinoma?

A

Resection

Transplant

269
Q

What is the non curative treatment of hepatocellular carcinoma?

A

Chemo
Radiofrequency or alcohol ablation
SOrafenib
Hormonal therapy

270
Q

What is ascites?

A

Accumulation fo fluid in peritoneal cavity

271
Q

What are the direct signs and symptoms of ascites?

A

Dullness in flanks

Shifting dullness

272
Q

What are the corroborating signs and symptoms of ascites?

A

Spider navel, palmar erythema, foetor hepaticus
Umbilical nodule
Raised JVP
Flame haematoma

273
Q

What investigations are done for ascites?

A

Protein and albumin concentration
Cell count
Aerum ascites albumin gradient

274
Q

What is the treatment of ascites?

A

Diuretics
Large volume paracentesis
Liver transplant if all else fails

275
Q

What are varies?

A

Abnormally dilated vessel with tortuous course

276
Q

Where are varies found?

A

Porto-systemic anastamoses

277
Q

Where are the portosystemic anastomoses?

A 
Skin
Oesophageal and gastric
Rectal
Posterior abdo wall
Stomach
278
Q

What causes varies?

A

Portal hypertension

279
Q

What is the treatment of varies?

A

Blood transfusion and control bleeding
emergency endoscopy
Endoscopic band ligation

280
Q

What is cholelithiasis?

A

Gallstones in gallbladder

281
Q

What are gallstones formed from?

A

Cholesterol and pigment

282
Q

What are the risk factors for cholelithiasis?

A

Age

Gender

283
Q

What are the risk factors for cholesterol gallstones?

A

Obesity

Cirrhosis

284
Q

What are the risk factor for pigment gallstones?

A

Male

Bile infection

285
Q

What are the signs and symptoms of cholelithiasis?

A 
Asymptomatic
Dyspepsia
Biliary colic
Acute cholecystitis
Empyema
Perforation
Jaundice
Gallstone ileus
286
Q

What is the typical presentation of cholelithiasis?

A

Biliary colic

287
Q

What investigations are done for cholelithiasis commonly?

A

Ultrasound

Bloods

288
Q

What investigations are done for cholelithiasis less commonly?

A

Endoscopic ultrasound
CT
IV cholangiography

289
Q

What are the non operative treatments of cholelithiasis?

A

Dissolution

Lithotripsy

290
Q

What are the operative treatments of cholelithiasis?

A

Laproscopic or single port cholecystectomy

291
Q

What are the treatments of gallstones the bile duct?

A

ERCP

Transhepatic stone retrieval

292
Q

What ar the types of cholangiocarcinoma?

A

Intrahepatic
Extrahepatic
Gallbladder
Ampullary

293
Q

What are the 3 types of intrahepatic cholangiocarcinoma?

A

Mass forming
Intraductal
Periductal

294
Q

What are the risk factors for cholangiocarcinoma?

A

PSC
Congenital cystic disease
Hepatolithiasis
Carcinogens

295
Q

What are the signs and symptoms of cholangiocarcinoma?

A

Obstructive jaundice
Itching
Non specific symptoms

296
Q

What investigations are done for cholangiocarcinoma?

A

Bilirubin
MRA
CT
Biopsy

297
Q

What is the bilirubin level in cholangiocarcinoma?

298
Q

What is the curative treatment of cholangiocarcinoma?

299
Q

What is the palliative treatment of cholangiocarcinoma?

A

Surgical bypass
Stenting
Radiotherapy
PDT

300
Q

What is the treatment of ampullarf cholangiocarcinoma?

A

Endoscopic excision
Transduodenal excision
Pancreatic duodectomy

301
Q

What is spontaneous bacterial peritonitis?

A

Development of bacterial infection in peritoneum without obvious source of infection

302
Q

Who does spontaneous bacterial peritonitis normally happen in?

A

Those with high alcohol intake

303
Q

What are the signs and symptoms of spontaneous bacterial peritonitis?

A

Abdo pain
Fever/rigors
Renal impairment
Signs of sepsis- tachycardia, high temp

304
Q

What investigations are done for spontaneous bacterial peritonitis?

A

Ascitic tap- protein and glucose levels, cultures, cell count

305
Q

What is found on the ascitic cell count in spontaneous bacterial peritonitis?

A

Raised neutrophils

306
Q

What is the treatment of spontaneous bacterial peritonitis?

A

IV antibiotics
Ascitic fluid drainage
IV albumin infusion

307
Q

What is acute pancreatitis?

A

Acute inflammation of the pancreas wth variable involvement of other regional tissues or remote organ systems

308
Q

What is mild acute pancreatitis?

A

Associated wth minimal organ dysfunction and uneventful recovery
Mortality <2%

309
Q

What is severe acute pancreatitis?

A

Associated with organ failure or local complication

Mortality 15%

310
Q

What causes acute pancreatitis?

A 
Mainly alcohol abuse
Gallstones
Trauma
Drugs
Viruses
Pancreatic oedema
Metabolic'Autoimmune
311
Q

What trauma can cause acute pancreatitis?

A

Blunt
Post op
Post ERCP

312
Q

What are the signs and symptoms of acute pancreatitis?

A 
Abdo pain, may radiate to back
Vomiting
Pyrexia
Tachycardia
Oliguria, acute renal failure
Jaundice
Laralytic ileus
Retroperitoneal haemorrhage 
Hypoxia
Hypocalcaemia
Hyperglycaemia
Ascitic/pleural effusion
313
Q

What investigations are done for acute pancreatitis?

A 
Bloods
Abdo xray
CXR
Abdo ultrasound
Contrast enhanced CT
314
Q

What bloods are done for acute pancreatitis?

A 
FBC, U+E, LFT
Amylase/lipase
Ca
Glucose
ABG
Lipids
Coagulation
315
Q

What is the general treatment of acute pancreatitis?

A 
Analgesia
IV fluids
Blood transfusion
Monitor urine output
NG tube
O2
Insulin
Ca supplements
Nutrition
316
Q

What are the specific treatments of pancreatic necrosis in acute pancreatitis?

A

CT guided aspiration

Treat with antibiotics and surgey

317
Q

What is the treatment of gallstones n acute pancreatitis?

A

Cholecystectomy

318
Q

How is severe acute pancreatitis differentiated?

A 
WCC >15x10^9
Blood glucose >10
Blood urea >16
AST>200
LDH>600
Serum albumin <32
Serum calcium <2
Arterial Po2 <7.5
319
Q

What are the complications of acute pancreatitis?

A 
Abscess
Pseudocyst
Haemorrhage
Portal hypetension
Pancreatic duct stricture
320
Q

What is the treatment of an abscess in acute pancreatitis?

A

Antibiotics and drainage

321
Q

What is a pseudocyst?

A

Fluid collection without epithelial lining casing persistent hyperamylasaemia and/or pain

322
Q

What is the treatment fi a pseudocyst in acute pancreatitis?

A

Endoscopic drainage or surgery

323
Q

What is chronic pancreatitis?

A

Continuing inflammatory disease of the pacers characterised by irreversible glandular destruction and typically causing ain and/or permanent loss of function

324
Q

What causes pancreatitis?

A 
Alcohol
Obstruction of main pancreatitis duct
Cystic fibrosis
Congenital anatomical abnormalities
Hereditary pancreatitis
Hypercalcaemia
Diet
Autoimmune
Toxin
Idiopathic
Environmental
Recurrent injury
325
Q

What are the signs and symptoms of chronic pancreatitis?

A 
Abdo pain
Weight loss
Exocrine insufficiency
Diabetes
Jaundice
Portal hypertension
GI haemorrhage
Pseudocysts
Pancreatic carcinoma
326
Q

What are the signs and symptoms of an exocrine insufficiency in chronic pancreatitis?

A

Fat malabsorption

Deficiency in fat soluble vitamins, Ca and Mg

327
Q

What is the presentation of abode pain in chronic pancreatitis?

A

Exacerbated by food and alcohol

Severity decreased over time

328
Q

What investigations are done for chronic pancreatitis?

A 
AXR
Ultrasound
Endoscopic ultrasound
CT
Blood tests
Pancreatic function
ERCP/MRCP
329
Q

What is seen on bloods with chronic pancreatitis?

A

Serum amylase increased in exacerbations
Decreased albumin, Ca, Mg, vit B12
Increased LFTs, prothrombin time, glucse

330
Q

What is the treatment of chronic pancreatitis?

A

Pain control
Exocrine and endocrine control
COnservative management
Surgery

331
Q

What pain control is done in chronic pancreatitis?

A 
Avoid alcohol
Pancreatic enzyme supplements
Opiate analgesia
Celiac plexua block
Endoscopic treatment of pancreatic duct stones and strictures
Surgery
332
Q

What exocrine and endocrine control is done in chronic pancreatitis?

A

Low fat diet

Pancreatic enzyme supplements- Insulin

333
Q

What is the conservative management of chronic pancreatitis?

A 
Abstinence from alcohol
Management of acute attacks
Analgesia
Low fat, low protein diet
Antioxidant therapy
Pancreatic supplements
334
Q

What surgeries can be done for chronic pancreatitis?

A

Celiac plexus block
Drainage of cysts/pseudocysts
Stent or bypass obstructions

335
Q

What are the complications of chronic pancreatitis?

A 
Death from acute exacerbations
CVS complications of diabetes
Associated cirrhosis
Drug dependence
Suicide
336
Q

What are the types of pancreatic carcinoma?

A

Duct cell mucinous adenocarcinoma
Carcinosarcoma
Cystadenocarcinoma
Acinar cell carcinoma

337
Q

What is the prognosis for pancreatic carcinoma?

A

Non op= 1% 5 year

Op= 15% 5 year

338
Q

What are the signs and symptoms of pancreatic carcinoma?

A 
Upper abdo and back pain
Painelss obstructive jaundice
Abdo mass
Splenomegaly
Weight loss and anorexia
Fatigue
Supraclavicular &amp;V
Tender subcutaneous fat nodules
Thrombophlebitis migraines
Ascites, portal hypertension
339
Q

What general investigations are done for pancreatic carcinoma?

A

Bloods

CXR

340
Q

What imaging and invasive tests are done fr pancreatic carcinoma?

A 
Ultrasound
ERCP
CT
MRCP
LAproscopy and laparoscopic ultrasound
Periotneal cytology
Endoscopic ultrasound and biopsy
PET
341
Q

What is the patient assessment in pancreatic carcinoma?

A

history and exam
CXR, ECG
Resp function
Performance status

342
Q

What is the curative treatment of pancreatic carcinoma?

A

Pancreatoduodectomy

343
Q

What is the palliative treatment of pancreatic carcinoma?

A

Stent
Choleduodectomy
Pain control

344
Q

What pain control is given in pancreatic carcinoma?

A

Opiates
Celiac plexus block
Radiotherapy

345
Q

What are haemorrhoids?

A

Painful, swollen veins that may bleed

346
Q

What causes haemorrhoids?

A

Increased pressure in lower rectum

347
Q

What are the signs and symptoms of haemorrhoids?

A 
Extreme itching around anus
Irritation and pain around anus
Itchy or painful lup or swelling around anus
Faecal leakage
Painful bowel movements
Melaena
348
Q

What is the treatment of haemorrhoids?

A

Pain relief
Fibre supplements
Rubbar band ligation
Stapled anopexy

349
Q

Wha are the complications of haemorrhoids?

A

Anaemia

Bleeding

350
Q

What is an anal fissure?

A

Tear on the lining of the anus/anal canal

351
Q

What causes an anal fissure?

A

COnstipation
Persistant diarrhoea
IBD
Pregnancy and childbirth

352
Q

What are the signs and symptoms of an anal fissure?

A

Sharp pain when passing stool followed by burning sensation that may last several hours
Melaena

353
Q

What is the treatment f an anal fissure?

A 
Should resolve independently
Fibre supplements
Hydration
Pain relief
Possiby laxatives
354
Q

What is an anal abscess?

A

Collection of pus near anus

355
Q

What is the most common type of anal abscess?

A

Perianal abscess

356
Q

What is a perianal access?

A

Painful, boil like swelling near anus

Red in colour, warm to touch

357
Q

What is an anal abscess usually caused by?

A

Infection in small anal glands

358
Q

What causes an anal abscess?

A

Infected fissure
STI
Blocked anal glands

359
Q

What are the signs and symptoms of an anal abscess?

A 
Content throbbing pain that's worse when seated
Skin irritation around anus
Discharge of pus
COntipation
Pain when passing stool
360
Q

What is the treatment of an anal abscess?

A

Surgical incision and drainage

Post drainage pain relief and possible antibiotics

361
Q

What is the possible complication of an anal abscess?

A

Fistula formation

362
Q

What is an anal fistula?

A

Narrow channel with internal opening in anal canal and external opening in skin near anus

363
Q

What causes an anal fistula?

A

Post abscess
IBD
Diverticulitis

364
Q

What are the signs and symptoms of an anal fistula?

A 
Skin irritation around anus
Constant throbbing pain, worse when seating, moving, having a bowel movement or coughing
Smelly discharge from anus
Melaena
Pus in stool
Swelling and redness around anus
Bowel incontinence
365
Q

What is the treatment of an anal fistula?

A

Fistulotomy
Seton suture
Glue/block/cover fistula

366
Q

What is a fistulotomy?

A

Cut open length of fistula so it heals as a flat, open scar

367
Q

What is the purpose of a seton suture?

A

Keep fistula open and allow pus to drain

368
Q

What is the classification of anal cancer?

369
Q

What is Dukes A anal cancer?

370
Q

What is Dukes B anal cancer?

A 
B1= muscle
B2= wall
371
Q

What is Dukes C anal cancer?

A 
C1= not apical
C2= apical
372
Q

What is Dukes D anal cancer?

A

Distant mets

373
Q

What are the signs and symptoms of anal cancer?

A 
Rectal bleeding
Itching and pain around anus
Small lumps around anus
Discharge f mucous from anus
Bowel incontinence
374
Q

What investigations are done for anal cancer>

A

Exam
Colonoscopy
CT colonography
MRI guided colonoscopy

375
Q

What are the types of anal cancer?

A

Anal squamous cell carcinoma

Rectal adenocarcinoma

376
Q

What is the treatment of anal squamous cell carcinoma?

A

Radiotherapy

377
Q

What is the treatment of rectal adenocarcinoma?

A

Neoadjuvant chen-radiation

Laproscopic resection

378
Q

What are the 2 types of incontinence?

A

Urge bowel ncontinence

Passive bowel incontinence

379
Q

What can cause incontinence?

A

Problems wth rectum
Problems with sphincter muscles
Nerve damage

380
Q

What problems with the rectum can cause incontience?

A

Constipation
Diarrhoea
Scarring of rectum
Severe haemorrhoids

381
Q

How does constipation cause incontinence?

A

Bowel impaction can cause rectal wall muscles to weaken, allowing watery stools to lead around and out of the anus

382
Q

What can cause problems with sphincter muscles leading to incontinence?

A

Childbirth
Injury
Bowel/rectal surgery

383
Q

What supplies internal anal sphincter muscles?

A

Sympathetic fibres of inferior hypogastric plexua

384
Q

What supplies external anal sphincter muscles?

A

Inferior rectal nerve and perianal branch of S4

385
Q

What is the nerve supply of the upper 1/2 of the anal canal?

A

Hypogastric plexua

386
Q

What is the nerve supply of the lower 1/2 of the anal canal?

A

Inferior rectal nerves

387
Q

What can cause nerve damage leading to incontinence?

A

Diabetes
MS
Stroke
Spina bifida

GI AM (34 decks)

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