G.I Disease Flashcards
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:
Have they been traveling anywhere
Name some drugs that may cause Diarrhea:
Metformin
PPIs
If someone has rashes developing in the presence of ongoing diarrhea - especially around the elbows - what may this be?
Dermatitis Herpetiformis
- underlying coeliac disease
What other disease is Coeliacs disease associated with?
DM1
Hyperactive thyroid
Autoimmune Hepatitis
What marker may be found that indicates ongoing inflammation within the bowel?
Faecal Calprotectin
sensitive but non specific
If a patient presents with weight loss, long standing diarrhea and lethargy what investigations are you going to carry out?
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
What investigations would you do in after treating Pancreatitis?
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
What is a neuroendocrine tumour?
Carcinoid tumour
usually benign ones found at appendix
What cell arises from the Cajal cells? and what drug targets it?
Gastrointestinal Stromal Tumour
Imatinib
What T cell lymphoma is found in the bowel and what is it associated with?
Enteropathy Associated T cell lymphoma
- celiac disease
Give some differentials for Crohn’s disease:
Diverticular disease
Sarcoidosis
Infective colitis
If a person has lymphocytic Colitis, what kind of diarrhoea will they have?
Chronic non - bloody watery diarrhoea
What disease may Precede Crohn’s?
Collagenous Colitis
List some histological findings of Coeliacs disease:
Villi Atrophy
Crypt hyperplasia
Intraepithelial lymphocytes
What kind of granulomas does Crohn’s form?
Non necrotising
List some common complications of Crohn’s:
Fibrosing Strictures
Fistula
Malabsorption
Toxic megacolon
What is a major cause of colon cancer?
Miss match repair defects
What system is used assess polyps becoming malignant?
Size
Histology type
Number
Epithelial dysplasia
What is it called when the bottom of the esophagus tears?
Mallory Weiss Tears
What is the management of peptic ulcer bleed?
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
In the initial tests of an upper G.I bleed, what things in particularly should one remember?
Urea rises disportionately to creatinine when bleeding
Send blood group off, in preparation for transfusion
*remember place a large cannula during blood taking
If a patient is on Aspirin, following an upper G.I bleed should they be stopped?
No - risk of cardiovascular issues is greater
If a patient is on NSAIDs, following an upper G.I bleed should they be stopped?
Yes
At what stage do you transfuse blood?
Hb <7-8g/L
paradoxically anything above this can cause further side effects.
List your management of acute variceal bleeding:
Resuscitation
- bloods
- transfuse <7g/dL
- airway protection
Diagnosis
- endoscopy
Therapy
- antibiotics - prophylactic
- Terlipressin
- Endoscopic ligation / TIPS
What cells are present in Oesphageal candida, and where are they located?
Neutrophils
- especially near the luminal surface of the epithelium
What stain confirms Candida albicans?
PAS stain
What are the two types of cancer in the oesophagus and which one is related to what?
Squamous carcinoma
- smoking
- drinking
Adenocarcinoma
- GORD
What is autoimmune gastritis?
Autoimmune destruction of the parietal cells to autoantibodies.
leads to complete loss of parietal cells
- achlorhydria
There are two patterns of H. Pylori infection seen, what are they and what is thought to lead to these differences?
Antral - predominant gastritis - hypergasatrinaemia
Pangastritis
- hypochlorhydydria
Is thought to be due to IL-8
*higher levels are thought to be associated with Pangastritis
Gastric cancer:
Strongly associated with:
- H. Pylori
- Autoimmune
background of Atrophic, mucosa, chronic inflammation and dysplasia.
Morphologically classified as:
- intestinal
- Diffuse
Diffuse Gastric:
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)
Where do gastric cancers often metastasis too?
Supraclavicular node
- virchow’s node
Ovaries
- Krukenberg
Umbilical
- sister Joseph’s nodule
**also associated with acanthosis Nigricans
Outline your management of Acute Pancreatitis:
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.
Name some complications of pancreatitis:
Pancreatic pseudocysts
- which contains the digestive enzymes and nectrotic tissue.
- high risk of haemorrhage
- pancreatic amylase will remain high.
Pancreatic abscess
- contains pseudomonas
What is the further management for Pancreatitis?
ESRP
Cholecystectomy
No alcohol
- 3 months
Medications
- certain that need to be discussed with Rheumatology
What is the pancreatic enzymes that can be given in replace of endogenous pancreatic enzymes?
Creon
