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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
What ar the types of oesophageal cancer?
Squamous cell carcinoma | Adenocarcinoma
26
What is a squamous cell oesophageal carcinoma?
Large, exophyti occulting tumour
27
Where does squamous cell oesophageal carcinoma occur?
Proximal 2/3 oesophagus
28
What is squamous cell oesophageal carcinoma proceeded by?
Dysplasia and carcinoma in situ
29
What is squamous cell oesophageal carcinoma associated with?
Achalasia Caustric strictures Plummer-Vinson syndrome
30
What are the risk factors for squamous cell oesophageal carcinoma?
Smoking | Alcohol
31
What is oesophageal adenocarcinoma?
Change of squamous epithelium to glandular epithelium
32
Where does oesophageal adenocarcinoma occur?
Distal 1/3 oesophagus
33
What causes oesophageal adenocarcinoma?
Barrett's oesophagus
34
What are the risk factor for oesophageal adenocarcinoma?
Obesity Caucasian Male Middle aged
35
What are the signs and symptoms of oesophageal cancer?
``` Progressive dysphagia Odynophagia Anorexia and weight loss Chest pain Cough and haemetemesis Pneumonia Vocal cord paralysis ```
36
How is oesophageal cancer diagnosed?
Endoscopy and biopsy
37
How is oesophageal cancer staged?
CT ENdoscopic ultrasound PET Bone scan
38
Where are the common sites of metastases for oesophageal cancer?
Liver Lung Brain Bone
39
What is the curative treatment of oesophageal cancer?
Oesophagectomy | With or without neoadjuvant and/or adjuvant chemo
40
What is the treatment of oesophageal cancer for localised but inoperable disease?
Combined chemo and radiotherapy
41
What is the palliative treatment of oesophageal cancer?
Chemo Radiotherapy Brachytherapy Endoscopic- stent, laser/APG, PEG
42
What is dyspepsia?
Group of symptoms rather than a disease
43
What are the upper GI causes of dyspepsia?
Peptic ulcer Gastritis Nonulcer dyspepsia Gastric cancer
44
What are the lower GI causes of dyspepsia?
IBS | Colonic cancer
45
What are the non GI causes of dyspepsia?
Metabolic or cardiac disease Psychological Drugs
46
What are the "other" GI causes of dyspepsia?
Hepatic causes Gallstones Pancreatic disease Coeliac
47
What are the signs and symptoms of dyspepsia?
``` Upper abdo discomfort Retrosternal pain Anorexia N&V Bloating Fullness and early satiety Heartburn ```
48
When are investigations carried out for dyspepsia?
``` Anorexia Weight loss anaemia Recent onset or persistent Melaena/haemetemesis Dysphagia ```
49
What bloods are done for dyspepsia?
``` FBC Ferritin LFTs U+Es Ca Glucose Coeliac serology ```
50
What should be asked about in drug history with dyspepsia?
``` NSAIDs Steroids Bisphosphates Ca antagonists Nitrates Theophyllines ```
51
What social history should be taken with dyspepsia?
Alcohol Smoking Diet Exercise
52
What is gastritis?
Inflammation of stomach
53
What are the 3 types of gastritis?
Type A= autoimmune Type B= bacterial Type C-= chemical
54
What is Type A gastritis?
Organ specific autoimmune disease with antibodies against parietal cells and intrinsic factor Atrophy of specialised acid secreting epithelium
55
What is the most common type of gastritis?
Type B
56
What is type B gastritis associated with?
H pylori
57
What are the common causes of type C gastritis?
NSAIDs Alcohol Bile
58
What does type A gastritis cause?
Decreased acid secretion | Loss of intrinsic factor= B12 deficiency
59
What are the signs and symptoms of dyspepsia?
Dyspepsia Nausea and vomiting Fullness
60
What investigations should be done for gastritis?
Stool test Breath test for H pylori Endoscopy Barium swallow
61
What is the treatment of gastritis?
H2 receptor blockers PPIs Eradication of H pylori (clairithromycin, amoxicillin and PPI)
62
What are the complications of gastritis?
Peptic ulcers Polyps Gastric tumours
63
What are peptic ulcers?
Sores that affect lower oesophagus, body and antrum of stomach and proximal 2/3 of duodenum
64
What are the causes of peptic ulcers?
H pylori NSAIDs SMoking Other conditions
65
What are the signs and symptoms of peptic ulcers?
``` Epigastric pain and tenderness Nocturnal/hunger pain Back pain Nausea and vomiting Weight loss and anorexia Haemetemesis/melaena/anaemia ```
66
What investigations are done for peptic ulcer?
UGIE | Identifying cause
67
What is the treatment of peptic ulcers?
H pylori eradication therapy- Clairithromycin, amoxicillin, PPI PPI, H2 receptor antagonist Stop NSAIDs/use only with extra protection Surgery- if severe or dilatation
68
What are the complications of peptic ulcers?
Acute or chronic bleeding Perforation Fibrotic stricture Gastric outlet obstruction
69
What ar the signs and symptoms of gastric outlet obstruction?
``` Recurrent vomiting Early satiety Abdo distension Weight loss Gastric splash Dehydration Metabolic alkalosis Low Cl, Na and K Renal impairment ```
70
What are the majority of gastric cancers?
Adenocarcinoma
71
What are the causes of gastric cancer?
``` Diet Geetics Smoking H pylori Previous gastric resection Biliary reflux Premalignant gastric pathology ```
72
What are the signs and symptoms of gastric cancer?
``` Dyspepsia Early satiety N&V Weight loss GI bleeding Anaemia Gastric outlet obstruction ```
73
What are the diagnostic investigations for gastric cancer?
Endoscopy and biopsy
74
What are the staging investigations for gastric cancer?
CT | PET
75
What is the treatment of gastric cancer?
Surgery and chemo
76
What are the causes of malabsorption?
``` Inflammation Infection Infiltration Impaired motility Iatrogenic Pancreatic ```
77
What are the inflammatory causes of malabsorption?
Coeliac | Crohn's
78
What are the infective causes of malabsorption?
``` Tropica sprue HIV Giardia lambila Whipple's disease Tropheryma whippelii ```
79
What are the infiltrative causes of malabsorption?
Amyloid
80
What are the motility causes of malabsorption?
Systemic sclerosis Diabetes Pseudo obstruction
81
What are the iatrogenic causes of malabsorption?
Gastric surgery Short bowel syndrome Radiation
82
What are the pancreatic causes of malabsorption?
Chronic pancreatitis | Cystic fibrosis
83
What are the signs and symptoms of malabsorption?
Weight loss Increased appetite Steatorrhoea Specific deficiencies
84
What are the specific deficiencies associated with malabsorption?
``` Iron Folate, B12 Ca, Mg, vit D Vit A Vit K Vit B complex Vit C ```
85
What are the signs of a Ca, Mg or vit D deficiency?
Tetany | Osteomalacia
86
What is a sign of vit A deficiency?
Night blindness
87
What is a sign of vit K deficiency?
Raised PTR
88
What are the signs of vit B complex deficiencies?
Thiamine- dementia | Niacin- dermatitis, heart failure
89
What is the sign of vit C deficiency?
Scurvy
90
What is clubbing in malabsorption a sign of>
Coeliac | Crohn's
91
What is scleroderma in malabsorption a sign of?
Systemic sclerosis
92
What is aphthous ulceration in malabsorption a sign of?
Coeliac | Crohn's
93
What is dermatitis herpetiformis a sign of?
Coeliac
94
What is coeliac?
Sensitivity to the Gladin fraction of gluten, causing an inflammatory response
95
What does coeliac disease cause?
Partial or subtotal villous atrophy | Increased intraepithelial lymphocytes
96
What are the signs and symptoms of coeliac?
``` Weight loss Diarrhoea and/or constipation Abdo pain Anaemia Fatigue Bloating Dermatitis herpetiformis ```
97
How is coeliac diagnosed?
Serology HLA status Distal duodenal biopsy
98
What dow e look for in coeliac serology?
Anti endomysial IgA | Anti tissue transglutaminase
99
Why is HLA status not an effective diagnostic tool for coeliac?
+ in 97% coeliacs and 30% general population
100
What are the 3 forms of villous atrophy in coeliac?
Partial- villi shortened Subtotal- lining flat but glands extend Total- lining down to thin line
101
What is the treatment of coeliac?
Withdraw gluten and refer to dietician
102
What are the complications of coeliac?
``` Refractory coeliac Small bowel lymphoma Oesophageal carcinoma Colon caner Small bowel adenocarcinoma ```
103
What is refractory coeliac?
Doesn't respond to diet | Treat with steroids
104
What conditions are associated with coeliac?
``` Dermatitis herpetiformis Type 1 diabetes Atoimmune thyroid disease Autoimmune hepatitis Primary biliary cirrhosis Autoimmune gastritis Sjogren syndrome IgA deficiency Downs syndrome ```
105
What is ulcerative colitis (UC)?
Strong immune response against normal flora in large bowel
106
What is the histology of UC?
``` Continuous pattern of inflammation Pseudopolyps, ulceration Cryptitis, crypt abscesses Submucosal fibrosis Inflammation does nt reach serosa No granulomas ```
107
What are the causes of UC?
Idiopathic | Genetic
108
What are the risk factors for UC?
Male | 20-30 years and 70-80 years
109
What are the signs and symptoms of UC?
Bloody diarrhoea Abdo pain Weight loss Severe attacks
110
What are the signs and symptoms of a severe attack of UC?
``` 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 ```
111
What investigations are done for UC?
History Radiograph pANCA
112
What % of UC patients of pANCA + in?
75%
113
What is the outpatient treatment of UC?
5ASA Steroids Immunosuppression
114
What are the 5ASAs used to treat UC?
``` Acrylic resin Ethylcellulose microgranules Balsalazide Olzalazine Sulfasalazine ```
115
What steroids are used to treat UC?
Prednisolone- tapering reduction over 4 weeks | Budenoside- Ileal and ascending colon disease only
116
What immunosuppressants are used in UC?
Azathioprine Methotrexate Ciclosporin Tacrolimus
117
What is the hospital treatment of UC?
``` Steroids Anticoagulation Ciclosporin Infliximab Surgery ```
118
What surgery can be done for UC?
Total colectomy Rectal preservation Ileostomy Pouch procedure
119
What is used in place of steroids in children with UC?
Elemental feeding
120
What would signify failure of treatment in UC?
Recurrent courses of steroids Recurrent relapses Failure to control symtpoms Unacceptable complications- diabetes, osteoporosis, psychosis
121
What is Crohn's?
Strong immune response against normal flora at any level in the GI tract
122
What % of cases of Crohn's appear in small intestine, large intestine or both?
40% SI 30% both 30% LI
123
What is the histology of Crohn's?
``` Patchy disease- skip lesions and cobblestone appearance Cryptitis and crypt abscesses, crypt destruction Architectural distortion Deep ulceration Transmural inflammation Non caveating granulomas Fibrosis Lymphangiectasia ```
124
What are the primary methods of distinguish the histology of Crohn's from UC?
Crohn's- cobblestone appearance and non caveating granulomas
125
What are the causes of Crohn's?
Genetic | Idiopathic
126
What are the signs and symptoms of Crohn's?
``` Diarrhoea Abdo pain Weight loss Malaise, lethargy, anorexia, N&V, low grade fever Malabsorption ```
127
What are the long term features of Crohn's?
``` Malabsorption Strictures Fistulas and abscesses Perforation Increased risk of cancer ```
128
What investigations are done for Crohn's?
History Radiography pANCA
129
What % of Crohn's patients have a + pANCA?
30%
130
What is the outpatient treatment of Crohn's?
5ASA Steroids Immunosuppression
131
What 5ASAs are used to treat Crohn's?
``` Acrylic resin Ethylcellulose Balsalazide Olzalazine Sulfasalazine ```
132
What steroids are used to treat Crohn's?
Prednisolone- tapering reduction over 4 weeks | Budenoside- ideal and ascending colon disease only
133
What immunosuppressants are used to treat Crohn's?
Azathioprine Methotrexate Ciclosporin Tacrolimus
134
What is the hospital treatment of Crohn's?
``` Steroids Anticoagulation Ciclosporin Infliximab Surgery ```
135
What surgeries can be done for Crohn's?
Total colectomy Rectal preservation Ileostomy Pouch procedure
136
What are the indications for surgery in Crohn's?
``` Failure of medical management Relief of obstructive symptoms Management of fistulae Management of intra abdominal masses or anal conditions Failure to thrive ```
137
What are the frequent areas of surgery in Crohn's?
Small intestine- 30% Ileocaecal- 40% Colorectal- 30%
138
What is used in place of steroids in treating children with Crohn's?
Elemental feeding
139
What signifies failure of therapy in Crohn's?
Recurrent courses of steroids Recurrent relapses Failure to control symptoms Unacceptable complications- diabetes, osteoporosis, psychosis
140
What is ischaemic enteritis?
Occlusion of vessels suppling SI and/or LI and can cause acute or chronic hypoperfusion
141
What is the histology of acute hypoperfusion in ischaemic enteritis?
``` Oedema Interstitial changes Necrosis Indistinct nuclei Initial absence of inflammation Vascular dilatation ```
142
What is the histology of chronic hypoperfusion in ischaemic enteritis?
``` Mucosal inflammation Ulceration Submucosal inflammation Fibrosis Stricture ```
143
What are the risk factors of arterial thrombosis?
``` Severe atherosclerosis Systemic vasculitis Dissecting aneurysm Hypercoagulable Oral contraceptive ```
144
What are the risk factors of arterial embolism?
Cardiac vegetation Acute arteroembolism Cholesterol embolism
145
What are the risk factors of non occlusive ischaemic enteritis?
Cardiac failure Shock/dehydration Vasoconstrictive drugs
146
What is radiation colitis?
Impaired proliferative activity of S and L bowel epithelium
147
What is the histology of radiation colitis?
``` Inflammation Arterial stenosis Ulceration Necrosis Haemorrhage Perforation ```
148
What are the signs and symptoms of radiation colitis?
Anorexia Abdo cramps Diarrhoea Malabsorption
149
What is appendicitis?
Acute inflammation and fibrous obliteration of the appendix
150
What is the histology of appendicitis?
Fibrinopurulent exudate Perforation Abscess Acute suprative inflammation in wall and pus in lumen of appendix Acute gangrenous full thickness necrosis, with or without perforation
151
What are the signs and symptoms of appendicitis?
``` Poorly localised pain that may come and go that progresses to sharp pain at McBurney's point Fever N&V Diarrhoea Anorexia ```
152
What is the treatment of appendicitis?
Appendectomy
153
What are the complications of appendicitis?
Peritonitis | Abscesses
154
How do adenomas become adenocarcinomas?
Activation of oncogene Loss of tumour suppressor gene Defective DNA repair pathway
155
What are the 2 main histological types of colorectal adenoma?
Tubular | Villous
156
What are the risk factors of sporadic colorectal cancer?
``` Age Male Previous adenoma/cancer Diet Obesity Lack of exercise Smoking Diabetes mellitus ```
157
What are the risk factors of colorectal cancer?
Familial Inheritable conditions Underlying condition
158
What are the signs and symptoms of colorectal cancer?
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
What investigations are done for colorectal cancer?
Colonoscopy with biopsy Barium enema- rare CT colonography CT abdo/pelvis
160
What staging investigations are done for colorectal cancer?
CT MRI- for rectal PET
161
What is the bonus of colonoscopy with biopsy?
Diagnostic and therapeutic
162
What are the risks of colonoscopy with biopsy?
Perforation | Bleeding
163
What is the staging of colorectal cancer?
Dukes'
164
What are the stages of colorectal cancer?
A- tumour confined to mucosa B- tumour extended through mucosa to muscle layer C- involvement of lymph nodes D- distant metastatic spread
165
What is the population screening test for colorectal cancer?
FOB test in 50-74 year olds
166
What happens if an FOB test returns a + result?
Colonoscopy
167
What high risk groups get screening tests for colorectal cancer?
``` Inheritable conditions IBD Familial risk Previous adenomas Previous colorectal cancer ```
168
What heritable conditions get bowel screening tests?
Familial adenomatous polyposis | Hereditary non polyposis colorectal cancer
169
What is the bowel screening test for those with familial adenomatous polyposis?
Annual colonoscopy from age 10-12
170
What is the treatment for familial adenomatous polyposis?
Prophylactic polypectomy | NSAIDs chemoprevention
171
How is hereditary non polyposis colorectal cancer diagnosed?
Those with clinical criteria get genetic testing
172
What screening is offered for people with hereditary non polyposis?
2 yearly colonoscopy
173
What screening for colorectal cancer is done for people with IBD?
Colonoscopy 10 years post diagnosis then at varying durations after
174
What screening for colorectal cancer is done for people with a high familial risk?
5 yearly colonoscopy from age 50
175
What screening test for colorectal cancer is done for people with a low familial risk?
Colonoscopy at 55
176
What screening tests are done for people with previous colorectal adenomas?
Dependent on no of polyps, size, degree of dysplasia
177
What screening test is done for people with previous colorectal cancer?
5 yearly colonoscopy
178
What is the surgical treatment of Dukes' A colorectal cancer?
Endoscopic or total resection
179
What is the surgical treatment of colorectal cancer?
Stoma formation Removal of lymph nodes Partial hepatectomy for metastases
180
What is the chemotherapy treatment for Dukes C and B?
Advuvant chemo
181
When is radiotherapy used to treat colorectal cancer?
REctal cancer only | Neoadjuvamt
182
What is palliative colorectal cancer treatment?
Chemo | Colonic stenting
183
What is Hep A?
Acute infection caused by enteric virus acquired through ingestion
184
What are the signs and symptoms of HEpA?
``` Jaundice Fatigue Fever Anorexia Itching ```
185
What investigation is done for Hep A?
IgM antibodies
186
What antigens are present in a Hep B infection?
HBeAg HBsAg HBcAg HBV DNA
187
What is HBeAg a sign of?
Active replication of Hep B virus
188
What is HBsAg a sign of?
Presence of Hep B virus
189
Wha is HBcAg a sign of and where is it found?
Active replication of Hep B virus | Liver
190
What is HBV DNA a sign of?
Active replication of Hep B virus
191
What do IgM antibodies in Hep B show?
+ in newly acquired infection | - in chronic
192
What do IgG antibodies in Hep B show?
Chronic infection
193
What do anti HBe antibodies in Hep B show?
Inactive virus
194
What is the usual progression of Hep B?
Chronic infection
195
What can Hep B progress to?
Cirrhosis Hepatocellular carcinoma End stage liver disease
196
What are the signs and symptoms of Hep B?
``` Jaundice Fatigue Fever Anorexia Itching ```
197
What is the treatment of Hep B?
``` Lamivudine Adefovir Antecavir Telbivudine Tenofovir ```
198
What does Hep C Normally progress to?
Chronic infection
199
What can Hep C progress to?
Cirrhosis | Hepatocellular carcinoma
200
What are the signs and symptoms of Hep C?
``` JAundice Fatigue Fever Anorexia Itching ```
201
What is the test for Hep C?
HCV antibody test
202
What is the treatment of Hep C?
Direct acting antivirals
203
When can Hep D occur?
Only with hep B
204
What are the signs and symptoms hep D?
``` Jaundice Fatigue Fever Anorexia Itching ```
205
What is non alcoholic fatty liver disease?
Broad term encompassing 3 entities Steatosis Non alcohol steatohepatitis Fibrosis and cirrhosis
206
What is non alcoholic fatty liver disease associated with?
Diabetes mellitus Obesity Hypertriglyceridema Hypertension
207
What are the risk factors for non alcoholic fatty liver disease?
Age Ethnicity Genetic factors
208
What investigations are done for non alcoholic fatty liver disease?
``` Biochemical test Enhanced liver fibrosis panel Cytokeratin-18 Ultrasound Fibroscan MRI/CT MR spectroscopy Liver biopsy ```
209
What is the treatment of non alcoholic fatty liver disease?
``` Diet and weight reduction Exercise Insulin sensitisers Glucagon like peptide 1 Vit E Weight reduction surgeries ```
210
How is autoimmune hepatitis diagnosed?
Liver biopsy
211
What is the treatment of autoimmune hepatitis?
Steroids | Long term azathioprine
212
What is primary biliary cholangitis?
Organ specific autoimmune disease | Granulomatous inflammation involving the bile ducts
213
What does primary biliary cholangitis cause?
Loss of intrahepatic bile ducts | Can progress to cirrhosis
214
What are the signs and symptoms of primary biliary cholangitis?
Pruritus | Jaundice
215
What investigation is done for primary biliary cholangitis?
Bloods
216
What is found on bloods in primary biliary cholangitis?
IgM elevated Raised serum alkaline phosphatase Antimitochondrial antibody +
217
What is the treatment of primary biliary cholangitis?
UDCA
218
What is primary sclerosis cholangitis?
Chronic inflammation and fibrotic obliteration of bile ducts
219
What is primary sclerosis cholangitis associated with?
IBD
220
What bile ducts are involved in primary sclerosis cholangitis?
Intra and extra hepatic bile ducts
221
What are the signs and symptoms of primary sclerosis cholangitis?
Recurrent cholangitis | Jaundice
222
What is found on investigation with primary sclerosis cholangitis?
pANCA +
223
What is the treatment of primary sclerosis cholangitis?
Liver transplant | Biliary stents
224
what are the complications of primary sclerosis cholangitis?
Increased risk of cholangiocarcinoma
225
What is liver failure?
Complication of acute or chronic liver injury
226
What can cause acute liver injury?
Hepatitis- viruses, alcohol, drugs | Bile duct obstruction
227
What is alcoholic hepatitis?
Response of liver tp excess alcohol | Fatty change and decompensated hepatic function
228
What are the signs and symptoms of alcoholic hepatitis?
Jaundice | Encephalitis
229
What is found on investigation with alcoholic hepatitis?
Raised bilirubin Raised GGT and ALP History of alcohol
230
What is the treatment of alcoholic hepatitis?
``` Treat infections and encephalopathy Supportive care Treat alcohol withdrawal Protect against GI bleeds Nutrition Steroids in severe cases ```
231
What is jaundice?
Increased circulating bilirubin caused by altered metabolism of bilirubin
232
What are the causes of jaundice?
Pre hepatic Hepatic Post hepatic
233
What are the pre hepatic causes of jaundice?
Increased release f haemoglonin
234
What are the hepatic causes of jaundice?
Cholestasis Intrahepatic bile duct obstruction Tumour of the liver
235
What is cholestasis?
Accumulation of bile within hepatocytes or bile canaliculi
236
What are the causes of cholestasis?
Viral hepatitis Alcoholic hepatitis Liver failure Drugs
237
What are the causes of an intrahepatic bile duct obstruction?
Primary biliary or sclerosis cholangitis
238
What are the post hepatic causes of jaundice?
Cholelithiasis | Extra hepatic bile duct obstruction
239
What are the causes of extra hepatic bile duct obstruction?
Gallstoens Bile duct tumours Benign stricture External compression
240
What are the signs and symptoms of prehepatic jaundice?
History of anaemia Alcoholic jaundice Pallor Splenomegaly
241
What are the signs and symptoms of hepatic jaundice?
``` Risk factors for liver disease Decompensation Ascites Flapping tremor SPider navel Gynacomastia ```
242
What are the signs and symptoms of post hepatic jaundice?
Abdo pain Cholestasis Palpable gallbladder
243
What are the signs and symptoms of cholestasis?
Pruritis Pale stools High coloured urine
244
What investigations are done for jaundice?
Liver screen Abdo ultrasound MRCP
245
What is done on a liver screen for jaundice?
``` Hep B and C serology Antibody profile, serum Its Caeruloplasmin and copper Ferritin and transferrin Alpha 1 antitrypsin Fasting glucose and liver profile ```
246
Wha is the treatment of jaundice?
ERCP Percutaneous transhepatoc cholangiogram ENdoscopic ultrasound
247
What can ERCP treat in jaundice?
Dilated biliary tree Acute gallstone pancreatitis Post op biliary complications Biliary tract obstruction
248
What is cirrhosis?
End stage chronic liver disease
249
What is the pathology cirrhosis?
Advanced fibrosis replaces functional parenchyma and prevents movement of blood into and out of the liver
250
What parts of the liver are involved in cirrhosis?
Diffuse process involving entire lver
251
What are the causes of cirrhosis?
``` Alcohol Hep B and C Immune mediated liver disease Metabolic disorders Diabetes mellitus Idiopathic ```
252
What immune mediated liver disease can lead to cirrhosis?
Autoimmune hepatitis | Primary biliary cholangitis
253
What metabolic disorders can lead to cirrhosis?
Primary haemochromatosis | Wilson's disease
254
What are the signs and symptoms of cirrhosis?
``` Jaundice HAemetemesis Pruritus Melaena Oedema Ascites ```
255
What are the complications of cirrhosis?
Liver failure Portal hypertension Increased risk of hapatocellular carcinoma
256
What is chronic liver disease?
Liver disease persisting for over 6 months
257
What pathologies can constitute chronic liver disease?
``` Chronic hepatitis Chronic cholestasis Fibrosis and cirrhosis Luver tumous Other ```
258
What are the signs of compensated chronic liver disease?
Abnormal LFTs
259
What are the signs and symptoms of decompensated chronic liver disease?
Ascites Variceal bleeding Hepatic encephalopathy
260
What is hepatic encephalopathy?
Confusion brought on by chronic liver disease
261
What are the grades of hepatic encephalopathy?
Grade 1= mild confusion | Grade 4= coma
262
What are the causes of hepatic encephalopathy?
``` GI bleeds Infection Constipation Dehydration MEdication ```
263
What are the signs and symptoms of hepatic encephalopathy?
Confusion Flappg tremor Foetor hepaticas
264
What is the treatment of hepatic encephalopathy?
Treat underlying cause | Admit to hospital
265
What do repeat hospital admission due to hepatic encephalitis indicate?
Liver transplant needed
266
Who is surveyed for hepaocellular carcinoma?
Those with cirrhosis
267
What is the investigation for hepatocellular carcinoma?
Ultrasound CT MRI Biopsy- rare
268
What is the curative treatment of hepatocellular carcinoma?
Resection | Transplant
269
What is the non curative treatment of hepatocellular carcinoma?
Chemo Radiofrequency or alcohol ablation SOrafenib Hormonal therapy
270
What is ascites?
Accumulation fo fluid in peritoneal cavity
271
What are the direct signs and symptoms of ascites?
Dullness in flanks | Shifting dullness
272
What are the corroborating signs and symptoms of ascites?
Spider navel, palmar erythema, foetor hepaticus Umbilical nodule Raised JVP Flame haematoma
273
What investigations are done for ascites?
Protein and albumin concentration Cell count Aerum ascites albumin gradient
274
What is the treatment of ascites?
Diuretics Large volume paracentesis Liver transplant if all else fails
275
What are varies?
Abnormally dilated vessel with tortuous course
276
Where are varies found?
Porto-systemic anastamoses
277
Where are the portosystemic anastomoses?
``` Skin Oesophageal and gastric Rectal Posterior abdo wall Stomach ```
278
What causes varies?
Portal hypertension
279
What is the treatment of varies?
Blood transfusion and control bleeding emergency endoscopy Endoscopic band ligation
280
What is cholelithiasis?
Gallstones in gallbladder
281
What are gallstones formed from?
Cholesterol and pigment
282
What are the risk factors for cholelithiasis?
Age | Gender
283
What are the risk factors for cholesterol gallstones?
Obesity | Cirrhosis
284
What are the risk factor for pigment gallstones?
Male | Bile infection
285
What are the signs and symptoms of cholelithiasis?
``` Asymptomatic Dyspepsia Biliary colic Acute cholecystitis Empyema Perforation Jaundice Gallstone ileus ```
286
What is the typical presentation of cholelithiasis?
Biliary colic
287
What investigations are done for cholelithiasis commonly?
Ultrasound | Bloods
288
What investigations are done for cholelithiasis less commonly?
Endoscopic ultrasound CT IV cholangiography
289
What are the non operative treatments of cholelithiasis?
Dissolution | Lithotripsy
290
What are the operative treatments of cholelithiasis?
Laproscopic or single port cholecystectomy
291
What are the treatments of gallstones the bile duct?
ERCP | Transhepatic stone retrieval
292
What ar the types of cholangiocarcinoma?
Intrahepatic Extrahepatic Gallbladder Ampullary
293
What are the 3 types of intrahepatic cholangiocarcinoma?
Mass forming Intraductal Periductal
294
What are the risk factors for cholangiocarcinoma?
PSC Congenital cystic disease Hepatolithiasis Carcinogens
295
What are the signs and symptoms of cholangiocarcinoma?
Obstructive jaundice Itching Non specific symptoms
296
What investigations are done for cholangiocarcinoma?
Bilirubin MRA CT Biopsy
297
What is the bilirubin level in cholangiocarcinoma?
Raised
298
What is the curative treatment of cholangiocarcinoma?
Surgery
299
What is the palliative treatment of cholangiocarcinoma?
Surgical bypass Stenting Radiotherapy PDT
300
What is the treatment of ampullarf cholangiocarcinoma?
Endoscopic excision Transduodenal excision Pancreatic duodectomy
301
What is spontaneous bacterial peritonitis?
Development of bacterial infection in peritoneum without obvious source of infection
302
Who does spontaneous bacterial peritonitis normally happen in?
Those with high alcohol intake
303
What are the signs and symptoms of spontaneous bacterial peritonitis?
Abdo pain Fever/rigors Renal impairment Signs of sepsis- tachycardia, high temp
304
What investigations are done for spontaneous bacterial peritonitis?
Ascitic tap- protein and glucose levels, cultures, cell count
305
What is found on the ascitic cell count in spontaneous bacterial peritonitis?
Raised neutrophils
306
What is the treatment of spontaneous bacterial peritonitis?
IV antibiotics Ascitic fluid drainage IV albumin infusion
307
What is acute pancreatitis?
Acute inflammation of the pancreas wth variable involvement of other regional tissues or remote organ systems
308
What is mild acute pancreatitis?
Associated wth minimal organ dysfunction and uneventful recovery Mortality <2%
309
What is severe acute pancreatitis?
Associated with organ failure or local complication | Mortality 15%
310
What causes acute pancreatitis?
``` Mainly alcohol abuse Gallstones Trauma Drugs Viruses Pancreatic oedema Metabolic'Autoimmune ```
311
What trauma can cause acute pancreatitis?
Blunt Post op Post ERCP
312
What are the signs and symptoms of acute pancreatitis?
``` 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
What investigations are done for acute pancreatitis?
``` Bloods Abdo xray CXR Abdo ultrasound Contrast enhanced CT ```
314
What bloods are done for acute pancreatitis?
``` FBC, U+E, LFT Amylase/lipase Ca Glucose ABG Lipids Coagulation ```
315
What is the general treatment of acute pancreatitis?
``` Analgesia IV fluids Blood transfusion Monitor urine output NG tube O2 Insulin Ca supplements Nutrition ```
316
What are the specific treatments of pancreatic necrosis in acute pancreatitis?
CT guided aspiration | Treat with antibiotics and surgey
317
What is the treatment of gallstones n acute pancreatitis?
Cholecystectomy
318
How is severe acute pancreatitis differentiated?
``` WCC >15x10^9 Blood glucose >10 Blood urea >16 AST>200 LDH>600 Serum albumin <32 Serum calcium <2 Arterial Po2 <7.5 ```
319
What are the complications of acute pancreatitis?
``` Abscess Pseudocyst Haemorrhage Portal hypetension Pancreatic duct stricture ```
320
What is the treatment of an abscess in acute pancreatitis?
Antibiotics and drainage
321
What is a pseudocyst?
Fluid collection without epithelial lining casing persistent hyperamylasaemia and/or pain
322
What is the treatment fi a pseudocyst in acute pancreatitis?
Endoscopic drainage or surgery
323
What is chronic pancreatitis?
Continuing inflammatory disease of the pacers characterised by irreversible glandular destruction and typically causing ain and/or permanent loss of function
324
What causes pancreatitis?
``` Alcohol Obstruction of main pancreatitis duct Cystic fibrosis Congenital anatomical abnormalities Hereditary pancreatitis Hypercalcaemia Diet Autoimmune Toxin Idiopathic Environmental Recurrent injury ```
325
What are the signs and symptoms of chronic pancreatitis?
``` Abdo pain Weight loss Exocrine insufficiency Diabetes Jaundice Portal hypertension GI haemorrhage Pseudocysts Pancreatic carcinoma ```
326
What are the signs and symptoms of an exocrine insufficiency in chronic pancreatitis?
Fat malabsorption | Deficiency in fat soluble vitamins, Ca and Mg
327
What is the presentation of abode pain in chronic pancreatitis?
Exacerbated by food and alcohol | Severity decreased over time
328
What investigations are done for chronic pancreatitis?
``` AXR Ultrasound Endoscopic ultrasound CT Blood tests Pancreatic function ERCP/MRCP ```
329
What is seen on bloods with chronic pancreatitis?
Serum amylase increased in exacerbations Decreased albumin, Ca, Mg, vit B12 Increased LFTs, prothrombin time, glucse
330
What is the treatment of chronic pancreatitis?
Pain control Exocrine and endocrine control COnservative management Surgery
331
What pain control is done in chronic pancreatitis?
``` Avoid alcohol Pancreatic enzyme supplements Opiate analgesia Celiac plexua block Endoscopic treatment of pancreatic duct stones and strictures Surgery ```
332
What exocrine and endocrine control is done in chronic pancreatitis?
Low fat diet | Pancreatic enzyme supplements- Insulin
333
What is the conservative management of chronic pancreatitis?
``` Abstinence from alcohol Management of acute attacks Analgesia Low fat, low protein diet Antioxidant therapy Pancreatic supplements ```
334
What surgeries can be done for chronic pancreatitis?
Celiac plexus block Drainage of cysts/pseudocysts Stent or bypass obstructions
335
What are the complications of chronic pancreatitis?
``` Death from acute exacerbations CVS complications of diabetes Associated cirrhosis Drug dependence Suicide ```
336
What are the types of pancreatic carcinoma?
Duct cell mucinous adenocarcinoma Carcinosarcoma Cystadenocarcinoma Acinar cell carcinoma
337
What is the prognosis for pancreatic carcinoma?
Non op= 1% 5 year | Op= 15% 5 year
338
What are the signs and symptoms of pancreatic carcinoma?
``` Upper abdo and back pain Painelss obstructive jaundice Abdo mass Splenomegaly Weight loss and anorexia Fatigue Supraclavicular &V Tender subcutaneous fat nodules Thrombophlebitis migraines Ascites, portal hypertension ```
339
What general investigations are done for pancreatic carcinoma?
Bloods | CXR
340
What imaging and invasive tests are done fr pancreatic carcinoma?
``` Ultrasound ERCP CT MRCP LAproscopy and laparoscopic ultrasound Periotneal cytology Endoscopic ultrasound and biopsy PET ```
341
What is the patient assessment in pancreatic carcinoma?
history and exam CXR, ECG Resp function Performance status
342
What is the curative treatment of pancreatic carcinoma?
Pancreatoduodectomy
343
What is the palliative treatment of pancreatic carcinoma?
Stent Choleduodectomy Pain control
344
What pain control is given in pancreatic carcinoma?
Opiates Celiac plexus block Radiotherapy
345
What are haemorrhoids?
Painful, swollen veins that may bleed
346
What causes haemorrhoids?
Increased pressure in lower rectum
347
What are the signs and symptoms of haemorrhoids?
``` Extreme itching around anus Irritation and pain around anus Itchy or painful lup or swelling around anus Faecal leakage Painful bowel movements Melaena ```
348
What is the treatment of haemorrhoids?
Pain relief Fibre supplements Rubbar band ligation Stapled anopexy
349
Wha are the complications of haemorrhoids?
Anaemia | Bleeding
350
What is an anal fissure?
Tear on the lining of the anus/anal canal
351
What causes an anal fissure?
COnstipation Persistant diarrhoea IBD Pregnancy and childbirth
352
What are the signs and symptoms of an anal fissure?
Sharp pain when passing stool followed by burning sensation that may last several hours Melaena
353
What is the treatment f an anal fissure?
``` Should resolve independently Fibre supplements Hydration Pain relief Possiby laxatives ```
354
What is an anal abscess?
Collection of pus near anus
355
What is the most common type of anal abscess?
Perianal abscess
356
What is a perianal access?
Painful, boil like swelling near anus | Red in colour, warm to touch
357
What is an anal abscess usually caused by?
Infection in small anal glands
358
What causes an anal abscess?
Infected fissure STI Blocked anal glands
359
What are the signs and symptoms of an anal abscess?
``` Content throbbing pain that's worse when seated Skin irritation around anus Discharge of pus COntipation Pain when passing stool ```
360
What is the treatment of an anal abscess?
Surgical incision and drainage | Post drainage pain relief and possible antibiotics
361
What is the possible complication of an anal abscess?
Fistula formation
362
What is an anal fistula?
Narrow channel with internal opening in anal canal and external opening in skin near anus
363
What causes an anal fistula?
Post abscess IBD Diverticulitis
364
What are the signs and symptoms of an anal fistula?
``` 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
What is the treatment of an anal fistula?
Fistulotomy Seton suture Glue/block/cover fistula
366
What is a fistulotomy?
Cut open length of fistula so it heals as a flat, open scar
367
What is the purpose of a seton suture?
Keep fistula open and allow pus to drain
368
What is the classification of anal cancer?
Dukes
369
What is Dukes A anal cancer?
Submucosa
370
What is Dukes B anal cancer?
``` B1= muscle B2= wall ```
371
What is Dukes C anal cancer?
``` C1= not apical C2= apical ```
372
What is Dukes D anal cancer?
Distant mets
373
What are the signs and symptoms of anal cancer?
``` Rectal bleeding Itching and pain around anus Small lumps around anus Discharge f mucous from anus Bowel incontinence ```
374
What investigations are done for anal cancer>
Exam Colonoscopy CT colonography MRI guided colonoscopy
375
What are the types of anal cancer?
Anal squamous cell carcinoma | Rectal adenocarcinoma
376
What is the treatment of anal squamous cell carcinoma?
Radiotherapy
377
What is the treatment of rectal adenocarcinoma?
Neoadjuvant chen-radiation | Laproscopic resection
378
What are the 2 types of incontinence?
Urge bowel ncontinence | Passive bowel incontinence
379
What can cause incontinence?
Problems wth rectum Problems with sphincter muscles Nerve damage
380
What problems with the rectum can cause incontience?
Constipation Diarrhoea Scarring of rectum Severe haemorrhoids
381
How does constipation cause incontinence?
Bowel impaction can cause rectal wall muscles to weaken, allowing watery stools to lead around and out of the anus
382
What can cause problems with sphincter muscles leading to incontinence?
Childbirth Injury Bowel/rectal surgery
383
What supplies internal anal sphincter muscles?
Sympathetic fibres of inferior hypogastric plexua
384
What supplies external anal sphincter muscles?
Inferior rectal nerve and perianal branch of S4
385
What is the nerve supply of the upper 1/2 of the anal canal?
Hypogastric plexua
386
What is the nerve supply of the lower 1/2 of the anal canal?
Inferior rectal nerves
387
What can cause nerve damage leading to incontinence?
Diabetes MS Stroke Spina bifida

GI AM (34 decks)

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