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Phase 3 > G.I Disease > Flashcards

G.I Disease Flashcards

1
Q

When someone presents with Persistent Diarrhea and weight loss, out with the cancer questions, what other major thing should you ask that may guide diagnosis:

A

Have they been traveling anywhere

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2
Q

Name some drugs that may cause Diarrhea:

A

Metformin

PPIs

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3
Q

If someone has rashes developing in the presence of ongoing diarrhea - especially around the elbows - what may this be?

A

Dermatitis Herpetiformis

  • underlying coeliac disease
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4
Q

What other disease is Coeliacs disease associated with?

A

DM1

Hyperactive thyroid

Autoimmune Hepatitis

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5
Q

What marker may be found that indicates ongoing inflammation within the bowel?

A

Faecal Calprotectin

sensitive but non specific

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6
Q

If a patient presents with weight loss, long standing diarrhea and lethargy what investigations are you going to carry out?

A

it is important not to be only thinking about G.I disorders but also systemic disease such as:

  • cancer
  • TB
  • Lymphadenopathies

Key investigations would be:

Systemic Examination

  • lymph nodes
  • skin examination

*FBC

  • Biochemistry
  • including HB1AC
  • stool Microbiology
  • Faecal Calprotectin
  • Immunology - tTG - IgA

Faecal Elastase
- see how well pancreas is doing

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7
Q

What investigations would you do in after treating Pancreatitis?

A

Ultrasound of gallbladder

MRCP
- MRI

ERCP

CT

Amylase
- in pancreatitis will be into the 1000’s

**if the amylase is only in 100’s its likely to be perforation of the duodenum

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8
Q

What is a neuroendocrine tumour?

A

Carcinoid tumour

usually benign ones found at appendix

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9
Q

What cell arises from the Cajal cells? and what drug targets it?

A

Gastrointestinal Stromal Tumour

Imatinib

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10
Q

What T cell lymphoma is found in the bowel and what is it associated with?

A

Enteropathy Associated T cell lymphoma

  • celiac disease
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11
Q

Give some differentials for Crohn’s disease:

A

Diverticular disease

Sarcoidosis

Infective colitis

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12
Q

If a person has lymphocytic Colitis, what kind of diarrhoea will they have?

A

Chronic non - bloody watery diarrhoea

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13
Q

What disease may Precede Crohn’s?

A

Collagenous Colitis

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14
Q

List some histological findings of Coeliacs disease:

A

Villi Atrophy

Crypt hyperplasia

Intraepithelial lymphocytes

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15
Q

What kind of granulomas does Crohn’s form?

A

Non necrotising

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16
Q

List some common complications of Crohn’s:

A

Fibrosing Strictures

Fistula

Malabsorption

Toxic megacolon

17
Q

What is a major cause of colon cancer?

A

Miss match repair defects

18
Q

What system is used assess polyps becoming malignant?

A

Size
Histology type
Number
Epithelial dysplasia

19
Q

What is it called when the bottom of the esophagus tears?

A

Mallory Weiss Tears

20
Q

What is the management of peptic ulcer bleed?

A

Resuscitate

  • IV access
  • fluids
  • Check bloods
  • *urea is essential - will tell you situation before Hb

Risk assess

  • Rockall - decides who needs endoscopy asap
  • Glasgow Blatchford score

Drug therapy

Transfusion

21
Q

In the initial tests of an upper G.I bleed, what things in particularly should one remember?

A

Urea rises disportionately to creatinine when bleeding

Send blood group off, in preparation for transfusion

*remember place a large cannula during blood taking

22
Q

If a patient is on Aspirin, following an upper G.I bleed should they be stopped?

A

No - risk of cardiovascular issues is greater

23
Q

If a patient is on NSAIDs, following an upper G.I bleed should they be stopped?

A

Yes

24
Q

At what stage do you transfuse blood?

A

Hb <7-8g/L

paradoxically anything above this can cause further side effects.

25
Q

List your management of acute variceal bleeding:

A

Resuscitation

  • bloods
  • transfuse <7g/dL
  • airway protection

Diagnosis
- endoscopy

Therapy
- antibiotics - prophylactic

  • Terlipressin
  • Endoscopic ligation / TIPS
26
Q

What cells are present in Oesphageal candida, and where are they located?

A

Neutrophils

  • especially near the luminal surface of the epithelium
27
Q

What stain confirms Candida albicans?

A

PAS stain

28
Q

What are the two types of cancer in the oesophagus and which one is related to what?

A

Squamous carcinoma

  • smoking
  • drinking

Adenocarcinoma
- GORD

29
Q

What is autoimmune gastritis?

A

Autoimmune destruction of the parietal cells to autoantibodies.

leads to complete loss of parietal cells
- achlorhydria

30
Q

There are two patterns of H. Pylori infection seen, what are they and what is thought to lead to these differences?

A

Antral - predominant gastritis - hypergasatrinaemia

Pangastritis
- hypochlorhydydria

Is thought to be due to IL-8
*higher levels are thought to be associated with Pangastritis

31
Q

Gastric cancer:

A

Strongly associated with:

  • H. Pylori
  • Autoimmune

background of Atrophic, mucosa, chronic inflammation and dysplasia.

Morphologically classified as:

  • intestinal
  • Diffuse
32
Q

Diffuse Gastric:

A

Individual Malignant cells
- signet rings which invade

create [Linitis plastica] which makes the stomach leather like.

**no association with H. Pylori (unlike intestinal gastric cancer)

33
Q

Where do gastric cancers often metastasis too?

A

Supraclavicular node
- virchow’s node

Ovaries
- Krukenberg

Umbilical
- sister Joseph’s nodule

**also associated with acanthosis Nigricans

34
Q

Outline your management of Acute Pancreatitis:

A

ABC management

  • fluids
  • oxygen
  • analgesics
  • organ support
  • potential for antibiotics - usually withheld.

Depending on severity - those without organ failure, usually oral feeding is restarted shortly afterwards.

35
Q

Name some complications of pancreatitis:

A

Pancreatic pseudocysts

  • which contains the digestive enzymes and nectrotic tissue.
  • high risk of haemorrhage
  • pancreatic amylase will remain high.

Pancreatic abscess
- contains pseudomonas

36
Q

What is the further management for Pancreatitis?

A

ESRP

Cholecystectomy

No alcohol
- 3 months

Medications
- certain that need to be discussed with Rheumatology

37
Q

What is the pancreatic enzymes that can be given in replace of endogenous pancreatic enzymes?

A

Creon

Phase 3 (50 decks)

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