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GI pathology > GI disease quiz > Flashcards

GI disease quiz Flashcards

1
Q

Describe Oesophageal reflux

A

Gastric acid refluxes into oesophagus causing thickening of squamous epithelium cells and eventually ulceration

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2
Q

What are some risk factors for oesophageal reflux?

A

poorly functioning oesophageal sphincter, obesity, hypertension, smoking, certain drugs eg for asthma

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3
Q

Symptoms for oesophageal reflux?

A

bloating, nausea, heart burn, dysphagia, chronic sore throat

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4
Q

Describe oesophageal cancer

A

Squamous cell or adenocarcinoma cancer in oesophagus

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5
Q

Risk factors for squamous cell oesophageal cancer

A

smoking and alcohol

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6
Q

Risk factors for adenocarcinoma?

A

Obesity and Barrett’s oesophagus

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7
Q

Oesophageal cancer symptoms and signs?

A

dysphagia, coughing, hoarseness, chest pain, worsening heartburn, weight loss

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8
Q

What investigations would you do for oesophageal cancer?

A

endoscopy, bloods (FBC,glucose,CRP), contrast meal, laproscopy, CT scan

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9
Q

What treatment options are there for oesophageal cancer?

A

surgery- gastrectomy, total gastrectomy, roux en Y reconstruction
chemotherapy, radiotherapy

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10
Q

What are some local effects of oesophageal cancer?

A

obstruction, ulceration and perforation

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11
Q

Describe gastritis

A

Inflammation in the gastric mucosa

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12
Q

What are the 3 different classes of cause for gastritis

A

Autoimmune
Bacterial (helicobacter pylori)
Chemical (drugs(NSAIDS, smoking, alcohol)

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13
Q

Symptoms of gastritis?

A

Nausea, abdomical bloating, heartburn, burning or gnawing feeling between meals and at night, loss of appetite

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14
Q

Peptic ulceration description?

A

Ulcers that develop in lining of stomach due to an imbalance between acid secretion and mucosal barrier

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15
Q

What are some risk factors for peptic ulceration?

A

NSAIDs, helicobacter pylori, alcohol excess, systemic illness

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16
Q

Signs and symptoms for peptic ulceration?

A

heartburn, abdominal/hunger pain, burping, n/v, weight loss, epigastric tenderness and upper GI bleed

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17
Q

Tests for peptic ulceration?

A

Endoscopy, bloods

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18
Q

Treatment for peptic ulceration

A

Depends on severity and cause, if caused by H.pylori use h.pylori eradication therapy, if mild use antacid, H2 receptor antagonist, PPI, stopping bad drugs,
if more serious use endotherapy- injection of adrenaline, thermal contact, mechanical clip, haemospray, or angiography embolisation- if bleed

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19
Q

A patient presents with hoarseness, dysphagia, heartburn and weight loss, they are also a smoker and alcoholic, what is the likely diagnosis and what investigations will you carry out?

A

Squamous cell carcinoma of oesophagus,

would take bloods (FBC, glucose and CRP), endoscopy, laparoscopy

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20
Q

A patient presents with a complaint of bloating, heartburn and a really sore throat, they are obese, what is the likely diagnosis?

A

oesophageal reflux

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21
Q

A patient presents with hoarseness, dysphagia, heartburn and weight loss, they are obese and have a PMH of severe oesophageal reflux which developed into Barrett’s oesophagus what is the likely diagnosis?

A

Adenocarcinoma of the oesophagus

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22
Q

A patient with celiac disease presents with nausea, heartburn and bloating and complaint of a burning sensation in their stomach at night and between meals, what is the likely diagnosis and what investigations will you carry out?

A

Gastritis with autoimmune cause

Endoscopy, CBC, stool test

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23
Q

A patient asks for a description of their recently diagnosed disease, peptic ulceration?

A

You have an ulcer that has developed int he lining of your stomach, it is normally caused by an imbalance between acid secretion and mucosal barrier

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24
Q

A patient presents with complaint of a hunger pain at night, weight loss, taste of acid in mouth and nausea, when you examine them you find epigastric tenderness, what is the likely cause and how will you treat?

A

Peptic ulceration, i would complete blood tests and an endoscopy to determine the severity and depending on results woul treat with antacids, PPI, H2 receptor antagonists or with endotherapy- injetion of adrenaline, thermal contact, mechanical clip, haemospray

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25
Q

Describe stomach cancer?

A

An adenocarcinoma that develops in the lining of the stomach, can be a consequence of h.pylori infection

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26
Q

Signs and symptoms of stomach cancer

A

dysphagia, abdominal pain, heartburn, blood in stools, n/v, weightloss, bloated, iron deficiency anaemia

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27
Q

Investigations for stomach cancer?

A

endoscopy, endoscopic ultrasound, barium meal Xray

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28
Q

Treatments for stomach cancer?

A

gastrectomy, oesophagogastrectomy, chemotherapy, radiotherapy

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29
Q

Describe peritonitis

A

Inflammation of the peritoneum, which is normally spread by a bacterial infection from perforation of GI, biliary tract, female genital tract, penetration of abdominal wall, haematogenous spread

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30
Q

Symptoms of peritonitis

A

abdominal pain, bloating, fever, n/v, loss of appetite, diarrhoea, low urine output, inability to pass stool or gas and fatigue

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31
Q

Investigations for peritonitis

A

peritoneal fluid analysis, blood tests

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32
Q

Treatment for peritonitis

A

antibiotics, though may need surgery to remove infected tissue

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33
Q

There are 2 types of peritonisits, what are they?

A

Localised or generalised, generalised is when there has been a rapid/ persistent contamination or an abscess has burst

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34
Q

What are complications from peritonitis

A

fluid loss and sepsis

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35
Q

Describe intestinal obstruction

A

obstruction within, on or surrounding the intestinal tubes, causes are commonly: tumour, hernia, clot

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36
Q

What are the symptoms of intestinal obstruction

A

pain, n/v, distenstion, constipatio, borborgmi (strange bowel sounds), early sanity, weight loss, gastric splash, dehydration, metabolic alkalosis (low Cl, Na, K- due to renal impairment)

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37
Q

What investigations would you use for intestinal obstruction?

A

urine test, FBC, UandE, LFT, ultrasouns, CT, laproscopy, laparotomy

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38
Q

What treatment would you use for intestinal obstruction?

A

restore circulating fluid volume, oxygenation, antibiotics, analgesia, endoscopic balloon dilatation

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39
Q

Define dyspepsia

A

dys= bad, pepsia= digestion

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40
Q

Symptoms of dyspepsia?

A

upper abdominal discomfort, retrosternal pain, anorexia, n/v, bloating, fullness, early satiety, heartburn

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41
Q

What alarm symptoms, require reference for endoscopy?

A 
Anorexia
Loss of weight
Anaemia (iron)
Recent onset >55yrs or persistent despite treatment
Melaena/ haematemesis or Mass 
Swallowing problems
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42
Q

Define H.pylori infection

A

Bacterial infection in digestive tract, the h.pylori invades in the antrum or higher, if in antrum- likely to get ulcers in duodenum and small bowel, if higher- gastric cancer

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43
Q

H.pylori symptoms?

A

upper abdominal discomfort, retrosternal pain, anorexia, n/v, bloating, fullness, early satiety and heartburn

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44
Q

H.pylori investigations

A

serology (increase IgG= sign of), urea breath test, stool antigen test, endoscopy

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45
Q

H.pylori treatment?

A

eradication therapy:
Triple therapy for 7 days:
Clarithromycin 500mg, amoxycillin 1g bd (tetracycline if allergic to penicillin), PPI eg omeprazole 20mg

CAO

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46
Q

Acute liver failure description?

A

Complication of acute or chronic liver injury, injury such as hepatitis (viruses, alcohol, drugs) causes inflammation of liver and cell damage and death to hepatocytes

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47
Q

Acute liver failure symptoms?

A

loss of appetite, loss of sex drive, jaundice, fatigue, n/v, itchy skin

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48
Q

A patient presents with dysphagia, abdominal pain and n/v, you take blood tests and determine they have iron deficient anaemia and now the patient returns they say they have had weight loss, what is the likely diagnosis and what is your next step?

A

Stomach cancer, need to complete and endoscopy, endoscopic ultrasound or barium meal xray to determine if diagnosis is correct

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49
Q

Your patient has been diagnosed with stomach cancer what are your treatment options?

A

gastrectomy, oesophagogastrectomy, chemotherapy, radiotherapy

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50
Q

The patient with stomach cancer is a past doctor and asks what type of cancer it is of the stomach?

A

adenocarcinoma

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51
Q

A patient is referred from a GP with complaint of pain, vomiting, and weight loss, they completed blood tests, which showed low Cl, Na and K levels, you then complete an examination which was postive for borborgmi, what is the likely diagnosis?

A

intestinal obstruction- could be a tumour, hernia or clot

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52
Q

The consultant asks what tests you should complete for a patient with intestinal obstuction?

A

urine test, FBC, U andE, LFT, ultrasound, Ct, laproscopy, lapartomy

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53
Q

A patient comes in as an emergency with severe abdominal pain, fever, vomiting and complaint of having inability to pass stool or gas, and a PMH of a mild appendicitis treated with antibiotics, what is the likely diagnosis?

A

peritonitis

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54
Q

A patient presents with upper abdominal discomfort and retrosternal pain, n/v and when serology was complete, showed an increase in IgG, what is the likely diagnosis?

A

Helicobacter pylori infection

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55
Q

Define jaundice

A

Increasing circulating bilirubin causing yellowing of the skin and eyes

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56
Q

What are the 3 types of jaundice?

A

Pre-hepatic, hepatic and post-hepatic

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57
Q

Define pre-hepatic jaundice

A

Increased release of haemoglobin from red cells (Haemolysis) and thus increased quantity of bilirubin but impaired transport

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58
Q

Define hepatic jaundice

A

Defective uptake of bilirubin, conjugation and excretion eg caused by cholestasis, intra-hepatic bile duct obstruction

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59
Q

Define post-hepatic jaundice

A

Defective transport of bilirubin by the biliary ducts eg cholelithiasis, disease of gallbladder, extra-hepatic duct obstruction

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60
Q

Symptoms and signs of pre-hepatic jaundice

A

yellowing of skin and cornea, history of anemia, pallor, splenomegaly

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61
Q

Symptoms and signs of hepatic jaundice

A

yellowing of skin and cornea, ascites, variceal bleed, spider naevi, gynacomastia, asterixis

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62
Q

Symptoms and signs of post-hepatic jaundice

A

yellowing of skins and cornea, abdominal pain, cholestasis, pruritus, pale stools, high-coloured urine, palpable gallbladder

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63
Q

A patient presents with yellowing of skin, spider naevi and asterixis, what type of jaundice is likely and what is a common cause of this type?

A

Hepatic jaundice, often caused by cholestasis or intra-hepatic bile duct obstruction

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64
Q

A patient presents with yellowing of skin, pallor and on examination you notice there is spleenomegaly, what type of jaundice is likely and what is a common cause of this type?

A

Pre-hepatic jaundice, often caused by increased haemolysis causing increased release of haemoglobin

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65
Q

A patient presents with yellowing of skin, abdominal pain, pale stools and high coloured urine, what type of jaundice is likely and what is a common cause of this type?

A

Post-hepatic jaundice, often due to cholelithiasis, disease of gallbladder and extra-hepatic duct obstruction

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66
Q

What are the different causes of intrahepatic bile duct obstruction?

A

primary biliary cholangitis, primary sclerosing cholangitis, tumours od liver

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67
Q

Describe primary biliary cholangitis?

A

organ specific auto-immune disease that causes granulomatous inflammation of bile ducts

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68
Q

Describe primary sclerosing cholangitis

A

chronic inflammation and fibrous obliteration of bile ducts

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69
Q

Risk factors for intrahepatic bile duct obstruction

A

gallstones, inflammation of bile ducts, trauma, cysts, enlarged lymph nodes, pancreatitis, injury to gallbladder, obestiy, chronic pancreatitis, sickle cell anaemia

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70
Q

Symptoms of intrahepatic bile duct obstruction

A

n/v, weight loss, fever, itching, pain in upper right side of abdomen, light coloured stools, dark urine, jaundice

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71
Q

Signs of primary biliary cholangitis

A

anti-michondrial auto-antibodies in serum, raised serum alkaline phosphatase

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72
Q

Investigations for intrahepatic bile duct obstruction

A

CBC, LFT, ultrasound, biliary radionuclide scan, cholangiography, MRI, endoscopicretrograde cholangiopancreatography, magnetic resonance cholangiopancreatography

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73
Q

treatment of intrahepatic bile duct obstruction

A

treat underlying cause, cholecystectomy, endoscopic retrograde cholangiopancreatography

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74
Q

Describe Cirrhosis

A

End stage chronic liver disease, in which liver looks very nodular and scarred, as normal liver structure is replaced by nodules of hepatocytes and fibrous tissue

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75
Q

Cirrhosis symptoms

A

fatigue, loss of appetite, weight loss, muscle wasting, n/v, tenderness or pain in liver area, itchy skin

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76
Q

Cirrhosis signs

A

jaundice, vomiting blood, dark tarry stools, oedema, abdominal ascites

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77
Q

Investigations for cirrhosis

A

magnetic resonance elastography

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78
Q

Treatment for cirrhosis

A

changing lifestyle, diet, easing symptoms: diuretics, hypertension tablets, creams for itching

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79
Q

Describe hepatocellular carcinoma?

A

malignant tumour of hepatocytes

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80
Q

Risk factors for hepatocellular carcinoma

A

chronic alcohol, hept B,C, Wilson’s disease, primary biliary cirrhosis, non-alcoholic fatty liver disease

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81
Q

Symptoms and signs of hepatocellular carcinoma

A

abdominal pain or tenderness, easy bruising or bleeding, ascites, distended abdomen, jaundice, weight loss, pale chalky bowel movements and dark urine

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82
Q

Describe cholangiocarcinoma

A

Malignant tumour of bile duct epithelium

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83
Q

Risk factors of cholangiocarcinoma

A

primary sclerosing cholangitis, congenital liver malformation

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84
Q

Symptoms and signs of cholangiocarcinoma

A

abdominal pain, loss of appetite, weight loss, itching, n/v,jaundice, greasy stools, dark urine

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85
Q

Investigations for liver carcinomas

A

bloods- AFP, ultrasound, CT, MRI, liver biopsy, endoscopy, laproscopy

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86
Q

Treatment for liver carcinomas

A

chemotherapy, radiotherapy, transplant, hepatectomy

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87
Q

Describe acute cholecystitis

A

Acute inflammation of gallbladder

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88
Q

Symptoms and signs of acute cholecystitis

A

pain (typically after meals), n/v, chills, abdominal bloating, jaundice, clay-coloured stools

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89
Q

Describe chronic cholecystitis

A

Chronic inflammation of gallbladder

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90
Q

Cholecystitis risk factors

A

gallstones, tumour, genetic predisposition, obesity, diabetes, tumours in liver, pancreas or gallbladder, pregnancy

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91
Q

Symptoms or signs of chronic cholecystitis

A

severe sharp or dull abdominal pains, abdominal cramping and bloating, pain that spreads to back or below right shoulder pain, fever, chills, n/v, itching, loose, light coloured stools, jaundice

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92
Q

Acute/chronic cholecystitis investigations

A

ultrasound, hepatobiliary scintigraphy, cholangiography, CT, bloods: LFT, CBC

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93
Q

Acute/chronic cholecystitis treatment

A

cholecystectomy

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94
Q

What are some complications from chronic cholecystitis

A

pancreatitis, perforation of gallbladder, enlarged gallbladder, cancer of gallbladder

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95
Q

A patient presents with jaundice, n/v and pain in upper right side of abdomen, the consultant has ordered a cholangiography, what do you think the diagnosis is

A

Intrahepatic bile duct obstruction

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96
Q

A patient presents with jaundice, n/v and pain in upper right side of abdomen, and the GP sends blood results which showed anti-mitochondiral auto-antibodies and raised serum alkaline phosphatase, what do you think the diagnosis is

A

Intrahepatic bile duct obstruction caused by primary biliary cholangitis

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97
Q

A patient presents with jaundice, n/v and pain in upper right side of abdomen, and the the endoscopicretrograde cholangiopancreatography shows inflammation of intrahepatic bile ducts, what do you think the diagnosis is

A

Primary sclerosing cholangitis, causing intrahepatic bile duct obstruction

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98
Q

A patient presents with loss of appetite, pain and tenderness in the upper right quadrant, jaundice and on examination shows positive for abdominal ascites, they have a PMH of hepatitis C, what is the likely diagnosis?

A

cirrhosis

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99
Q

A patient presents as an emergency with severe sharp abdominal pains, bloating and a pain that spreads to back and below right shoulder pain, they alos have a fever and show signs of jaundice, what is the likely diagnosis?

A

Chronic cholecystitis

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100
Q

A patient presenst with complaint of easily bruising, they also have abdominal pain, signs of jaundce and chalky bowel movements, and weight loss, what is the likely diagnosis?

A

Hepatocellular carcinoma

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101
Q

A patient presents with abdominal pain, no appetite, greasy stools, yellowing of skin and weight loss, they have a PMH of primary sclerosing cholangitis what is the likely diagnosis?

A

Cholangiocarcinoma

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102
Q

define extrahepatic bile duct obstruction

A

common bile duct obstruction caused by gallstones, bile duct tumours, benign stricture, external compression- blood clots, lover trauma, liver fluke parasitet

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103
Q

Symptoms of extrahepatic bile duct obstruction

A

n/v, weight loss, fever, itching, pain in upper right side of the abdomen, light-coloured stools, dark urine, jaundice

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104
Q

Investigations of extrahepatic bile duct obstruction

A

CBC, LFT, ultrasound, biliary radionuclide scan, cholangiography, MRI, endoscopicretrograde cholangiopancreatography, magnetic resonance cholangiopancreatography

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105
Q

Describe Cholestasis

A

accumulation of bile within hepatocytes or bile canaliculi

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106
Q

Causes of cholestasis

A

viral hepatitis, alcoholic hepatitis, liver failure, drugs, gallstones, pregnancy, scarring of bile ducts

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107
Q

Symptoms and signs of cholestasis

A

itching, dark urine, pain in RUQ without gallstones, pale bowel movements, fatigue, loss of appetite, depression, jaundice

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108
Q

Investigations of cholestasis

A

ultrasound, endoscope

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109
Q

Treatment of cholestasis

A

ursodiol, itching relievingmedication, soaking itchy area in cool water

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110
Q

Define steatosis

A

Fatty liver, lipids accumulate in the hepatocytes as vacuoles

111
Q

Steatosis risk factors

A

type 2 diabetes, obesity, alcohol, hypertension

112
Q

Steatosis symptoms and signs

A

ascites, enlarged blood vessels, gynacomastia, spleenomegaly, pallor erethyma, jaundice

113
Q

Steatosis investigations

A

Serum AST, ALT, alkaline phosphatase, ultrasound, bloods (LFT, lipid profile), CT, magnetic resonance elastography

114
Q

Treatment of steatosis

A

weight loss, exercise

115
Q

Define steatohepatitis

A

fatty liver with inflammation

116
Q

Steatohepatitis symptoms and signs

A

bleeding and bruising easily, itchy skin, ascites, loss of appetite, nausea, raised alanine amino transferase, swelling in legs, jaundice

117
Q

Investigations for steatohepatitis

A

liver biopsy, ultrasound, LFT

118
Q

define hepatic encephalopathy

A

Liver failure causing spectrum of neuropsychiatric abnormalities in patients with liver dysfunction

119
Q

Symptoms and signs of hepatic encephalopathy

A

confusion, personality change, poor concentration, problems with small hand movments, confusion, forgetfullness, poor judgement, musty or sweat breath odor, lethargy, seizures

120
Q

Treatment for hepatic encephalopathy

A

bowel clear out via lactulose and enemas, antibiotics, supportive

121
Q

Define spontaneous bacterial peritonitis

A

Infection of ascitic fluid without apparent source, Polymorphonuclear cell coount of more than 250 cells/mm3 of ascitic fluid

122
Q

Signs and symptoms of spontaneous bacterial peritonitis

A

Abdominal pain, fever, rigors, renal impairment, signs of sepsis, tachycardia

123
Q

Investigations of spontaneous bacterial peritonitisi

A

FBC (increased wbc count), culture of ascitic fluid, neutrophil count (>0.25x10(9)/L), protein <25g/L

124
Q

Treatment of spontaneous bacterial peritonitis

A

IV antibiotics, ascitic fluid drainage, IV albumin infusion (20% ALBA)

125
Q

A patient presents with n/v, pain in RUQ, jaundice and light coloured stools, on ultrasound bile stones are noted, what is the likely diagnosis?

A

Extrahepatic bile duct obstruction caused by bile stones

126
Q

A patient presents with jaundice and pallor erethyma, he has a PMHof type 2 diabetes, on examination you notes gynocmastia, spleenomegaly and ascites, what is the likely diagnosis

A

Steatosis

127
Q

A patient with steatosis, now has swollen legs and is easily bruising, you take blooks and note a raised alanine amino transferase, waht is the likely diagnosis?

A

Steatohepatitis

128
Q

A patient has an ultrasound, showing a blockage within the bile canaliculi, they have a PMH of alcoholic hepatitis, what is the likely diagnosis?

A

cholestasis

129
Q

A patient presents with abdominal pain, a hr of 140b/m and signs of sepsis, what is hte likely diagnosis?

A

Spontaneous bacterial peritonitis

130
Q

Define alcohol hepatitis

A

An inflammatory condition of the liver caused by alcohol

131
Q

Symptoms of alcohol hepatitis

A

Jaundice, encephalopathy

132
Q

Signs of alcohol hepatitis

A

Low albumin, raised prothrombin, raised bilrirubin, raised GGT and AkP

133
Q

Treatment for alcohol hepatitis

A

Treat alcohol withdrawal, ITU care, protect against GI bleed, steroids (if high on Glasgow Hepatitis score or Maddreys score)

134
Q

Define gallstones

A

Stones made of cholesterol and pigment in the gallbladder

135
Q

Risk factors for gallstones

A

Female, higher cholesterol, high pigment levels (haemolytic anaemia, bile infection)

136
Q

Gallstones symptoms

A

Can appear asymptomatic, or as dyspeptic symptoms, biliary colic, acute cholecystits, empyema, jaundice, gallstones lieu’s

137
Q

Gallstones investigations

A

Blood tests: LFT, AST, ALT, ALP, Amylase and lipase, WBC
Ultrasound, endoscopi ultrasound, oral cholecystography, CT scan, radio isotope scan, IV cholangiography, magnetic resonance cholangiopancreatography, PTC, endoscopic retrograde cholangiopancreatography

138
Q

Treatment for gallstones

A

Dissolution, lithotripsy, open, mini, laparoscopic, single port cholecystectomy

139
Q

A patient presents with encephalopathy and jaundice, they have raised albumin and raised prothrombin and a PMH of alcohol abuse, what is the likely diagnosis?

A

Alcoholic hepatitis

140
Q

Define choledocho-lithiasis

A

Stones in the common bile duct

141
Q

Choledocho-lithiasis symptoms

A

obstructive jaundice (pain, jaundice, dark urine, pale stool, pruritus, steatorrhoea), acute pancreatitis, ascending cholangitis

142
Q

Choledocho-lithiasis tests

A

Blood tests- LFT, AST< ALT, amylase and lipase, WBC
ultrasound
endoscopic ultrasound, oral cholecystography, CT scan, radio iso-tope scan, iv cholangiography, magnetic resonance cholangiopancreatography, PTC, endoscopic retrograde cholangio-pancreatography

143
Q

Define cystic bile duct stones

A

gallstones in cystic bile duct

144
Q

Risk factors for cystic bile duct stones

A

Female, higher cholesterol (obestity, ileal disease, cirrhosis, CF), high pigment levels (haemolytic anaemia, bile infection)

145
Q

Symptoms of cystic bile duct stones

A

abdominal pain in RUQ or MUQ, loss of appetite, n/v, fever, jaudice, clay-coloured stools

146
Q

Cystic bile duct stones investigations

A

“Blood tests: LFT:AST, ALT, ALP, amylase and lipase, WBCC)
Ultrasound, endoscopic ultrasound, oral cholecystography, CT scan, radio iso-tope scan, iv cholangiography, Magnetic resonance cholangiopancreatography,PTC , Endoscopic retrograde cholangio-pancreatography”

147
Q

Cystic bile duct stones treatment

A

Lap trans-cystoc CBD exploaration, lap exploration/ open exploration of CBD, endoscopic retrograde cholangio-pancreatography, transhepatic stone retrieval

148
Q

Define cholangiocarcinoma

A

Cancer of the bile duct, can be intrahepatoc or extrahepatic, there are 3 types of intrahepatic: mass-forming, peri-ductal, intra-ductal

149
Q

Risk factors of cholangiocarcnioma

A

PSC, congenital cystic disease, bilary-enteric drainage, throotrast, hepatolithiasis, carcinogens (aflatoxins), risk increases with age

150
Q

Symptoms of cholangiocarcinoma

A

painless obstructive jaundice , itching, loss of appetite, nause/vomiting, weight loss

151
Q

Define gallbladder cancer

A

Cancer of the gallbladder

152
Q

Risk factors for gallbladder cancer

A

gallstones, gallbladder polyps, older age, women, smoking

153
Q

Symptoms and signs of gallbladder cancer?

A

RUQ pain, abdominal bloating, weight loss, nausea, jaundice, fever, abdominal distention

154
Q

Investigations of gallbladder cancer

A

Lab, radiology, EUS, CT, MRI, MRCP, PTC, angiography, FDG, PET, ERCP, cholangioscopy and cytology

155
Q

Treatment of gallbladder cancer

A

surgical bypass, stenting, aplliative radiotherapy, PDT, liver transplant

156
Q

Define ampullary cancer

A

Cancer of the ampulla of vater, can be adenoma or adenocarcinoma

157
Q

Risk factors of ampullary cancer?

A

PSC (primary sclerosing cholangitis), FAP

158
Q

Ampullary cancer symptoms and signs

A

abdominal pain, back pain, vomiting, GI bleed, pancreatitis, diarrhoea, jaundice, weight loss

159
Q

Ampullary cancer investigations

A

lab, radiology: USS, EUS, CT, MRI, MRCP, PTC, angiography, FDG, PET, ERCP, cholangioscopy and cytology

160
Q

Ampullary cancer treatment

A

endoscopic excision, trans-duodenal excision, pancreatico-duodenectomy

161
Q

Define achalasia

A

When your lower oesophageal sphincter fails to open during swallowing due to functional loss of myenteric plexus ganglion cells in the distal oesophagus

162
Q

Risk factors for achalasia

A

radiotherapy, alcohol, smoking

163
Q

Symptoms of achalasia

A

progressive dysphagia, weight loss, chest pain, regurgitation and chest infection

164
Q

Signs of achalasia?

A

manometry findings (high pressure in the LOS at rest)

165
Q

Investigations for achalasia

A

manometry, oesophagus-gastro-duodenoscopy, upper GI endoscopy

166
Q

Achalasia treatments

A

pharmacological: nitrates, CCB
Endoscopic: botulinumtoxin, pneumatic balloon dilation,
radiotherapy: pneumatic balloon dilation
myotomy

167
Q

Define Gastro-oesophageal reflux disease

A

Acid and bile exposure in lower oesophagus, mucosa is exposed to acid-pepsin and bile

168
Q

Define the pathology of Gastro-oesophageal reflux disease

A

Acid and bile exposure in lower oesophagus due to one of the following reasons: transient relaxations of the LOS, hypotensive LOS, delayed gastric emptying, delayed oesophageal emptying, oesophagus acid clearance, decreased tissue resistance to acid/bile, hiatus hernia (anatomical distortion of the OG junction

169
Q

Risk factors of GORD

A

pregnancy, obestity, drug lowering LOS pressure, smoking, alcoholism, hypomotility, male, caucasian

170
Q

Symptoms of GORD

A

heartburn, cough, water brash, sleep disturbance

171
Q

Treatment for GORD

A

alginates, H2 receptor antagonists, PPI, anti-reflux surgery (fundoplication)

172
Q

Oesophageal cancer

A

Cancer in the oesophagus, can be squamous cell carcinoma or adenocarcinoma

173
Q

Oesophageal cancer risk factors

A

male, >65, smoking, alcohol, obestity, low vitamin and mineral diet, caucasian (adenocarcinoma)

174
Q

Symptoms of oesophageal cancer

A

progressive dysphagia, anorexia, weight loss, odynophagia, chest pain, cough, pneumonia (via tracheo-oesophageal fistula), vocal cord paralysis, haematemesis

175
Q

Oesophageal cancer investigations

A

endoscopy, biopsy, CT scan, endoscopic ultrasound, PET, bone scan

176
Q

Oesophageal cancer treatment

A

surgical oesophagectomy with adjuvant or neoadjucant chemotherapy, endoscopic: stent, laser/APC, PEG (percutaneous endoscopic gastrostomy), chemotherapy, radiotherapy, brachytherapy

177
Q

A patient presents with weight loss, chest pain and complains of regurgitating food after eating it, what is the likely diagnosis and what would be your first investigation?

A

Achalasia, investigate with manometry

178
Q

A pregnant patient presents with heatburn and a sour taste in mouth, what is the likely diagnosis and what is the name of the sour taste symptom?

A

Gastro-oesophageal reflux disorder

Water Brash

179
Q

A caucasian female presents with weight loss, dysphagia, painful swallowing chest pain, vomiting up blood, what is the likely diagnosis and what is the clinical terms for pain on swallowing and vomiting up blood?

A

Oesophageal cancer

Odynophagia

haematemesis

180
Q

Define eosinophilic oesophagitis

A

chronic immune/ allergen mediated condition

181
Q

Symptoms of oesophilic oesophagitis

A

dysphagia and food bolus obstruction

182
Q

Endoscopic signs of eosinophilic oesophagitis

A

Spiral layers of oesophagus

183
Q

Treatment for eosinophillic oesophagitis

A

topical/ swallowed corticosteroids, endoscopic dilatation

184
Q

define acute pancreatitis

A

acute imflammation of the pancreas due to release of activated pancreatic enzymes causing autodigestion, the autodigestion releases pro-inflammatory cytokines and reactive oxygen species

185
Q

Acute Pancreatitis causes

A

GET SMASHED
Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune disease
Scorpion sting
Hypercalcemia/ Hyperlipidemia
ERCP
Drugs
186
Q

Symptoms of acute pancreatitis

A

upper abdominal pain, vomiting, pyrexia, tachycardia, hypovolaemic shock, oliguria (urine output less than 0.5mL/kg/h), paralytic ileus (obstruction of the intestine due to paralysis of intestinal muscles)

187
Q

Define chronic pancreatitis

A

COntinuing inflammatory disease of the pancreas characterised by irreversible glandular destruction

188
Q

Causes of chronic pancreatitis,

hint- O-A-TIGER

A

O= obstruction of MPD
A=autoimmune
T=toxin (ethanol, smoking, drugs)
I= idiopathic
G= genetic
E=environmental (tropical chronic pancreatitis)
R=recurrent injuries (biliary, hyperlipidaemia, hypercalcemia)

189
Q

Risk factors for chronic pancreatitis

A

CF, congenital abnormalities (annular pancrease and pancreas divisum, hereditary pancreatitis (PRSS1), hypercalcaemia

190
Q

Symptoms of chronic pancreatitis

A

abdominal pain (exacerbated by food or alcohol), weight loss, exocrine insufficiency (steatorrhoea), endocrine insufficiency (diabetes), jaundice, portal hypertension, GI haemorrhage

191
Q

scan signs of chronic pancreatitis

A

pseudocysts on scan

192
Q

investigations for chronic pancreatitis

A

AXR, ultrasound, EUS, CT, bloods: serum amylase, albumin, LFTs, prothrombin (vit K), glucose, pancreatic function tests (pancreolauryl test), diagnostic enzyme replacement

193
Q

Treatment for chronic pancreatitis

A

Pain: avoid alcohol, pancreatic enzyme supplements, opiate analgesia, coeliac plexus block, endoscopic treatment of pancreatic duct stones and strictures

Exocrine/Endocrine: low fat diet (30-40g/day), pancreatic enzyme supplement (need acid suppresion), insulin

Surgery: Endoscopic pancreatic duct sphincetortomy, dilation and lithotripsy, CBD stenting ot bypass, thoracoscopic, caeliac plaxus block, drainage (pancreatic duct sphincteroplasty, puestow), resection (whipple’s pancreaticoduodenectomy, spleen preserving distal pancreatectomy, central pancreatectomy)

194
Q

Define pancreatic cancer

A

Carcinoma of the pancreas, 75% are duct cell mucinous adenocarcinoma, others: carcinosarcoma, cystadenocarcinoma, acinar cell

195
Q

Risk factors for pancreatic cancer

A

smoking, chronic pancreatitis, hereditary pancreatitis, inherited predisposition(periampullary cancer, FAP)

196
Q

Symptoms of pancreatic cancer

A

upper abdominal pain, painless obstructuve jaundice, weight loss, anorexia, fatigue, diarrhoea/ steatorrhoea, n/v, recurrent bouts of pancratitis

197
Q

Signs of pancreatic cancer

A

tender subcutaneous fat nodules, thrombophlebitis migrans, ascites, portal hypertension, hepatomegal, jaundice, abdomial mass, abdominal tenderness, ascites, splenomegaly, supraclavicaular lymphadenopathy, palpable gallbladder

198
Q

Pancreatic cancer investigations

A

abdominal ultrasound, CT, EUS, ERCP, percutaneous needle biopsy, laprascopy,lapratomy

199
Q

pancreatic cancer treatment

A

pancreatoduodenectomy, stent, cholechuodenostomy, pain control (opiates, coeliac plexus block, radiotherapy), chemotherapy
surgery- kaush whipple, pylorus preserving pancreaticoduodenectomy

200
Q

Define coeliac disease

A

Sensitivity to gliadin fraction of gluten , gliadin produces an inflammatory response which causes partial or subtotal villous atrophy, increasing intra-epithelial lymphocytes

201
Q

Coeliac disease risk factors

A

autoimmune condition eg type 1 diabetes, rheumatoid arthritis, addison’s disease

202
Q

Coelic disease symptoms and signs

A

abdominal bloating and pain, chronic diarrhoea, vomiting, constipation, fatigue, anaemia, pale/foul smelling/ fatty stool, weight loss

203
Q

Coeliac disease investigations

A

serology (anti endomysial IgA, anti tissue transglutaminase), distal duodenal biopsy, HLA status (HLA DQ2 or DQ8)

204
Q

Coeliac disease treatment

A

withdraw gluten

205
Q

Define irritable bowel syndrome

A

condition of the digestive system causing abdominal symptoms, IBS is a functional GI conditon and thus has no pathology: believed to be caused by increased awareness of bodily function and disruption in communication between brain and GI tract, visceral hypersensitivity

206
Q

IBS risk factors

A

smoking, alcohol, younger age, psychological and physical stress

207
Q

IBS symptoms and signs

A

abdominal pain, altered bowel habit, abdominal bloating, belching wind and flatus, mucus in stools, urgent need for bowel movement

208
Q

IBS investigations

A

blood analysis (FBC, U&E, LFTs, Ca, CRP, TFTs, coeliac serology), stool culture, calprotectin (if +ve is IBD rather than IBS), FIT testing, rectal examination, maybe colonscopy

209
Q

IBS treatment

A

Dietic review- FODMAPS, antispasmodics, antidepressants, antimotility agents, laxatives

210
Q

Define Crohn’s disease

A

Chronic inflammatory condtion affecting anywhere from the mouth to anus, it is a strong immune response against normal flora with defects in the epithelial barrier function

211
Q

What ages are you likely to be affected by crohn’s disease

A

20-40yrs and over 60 years

212
Q

Symptoms and signs on crohn’s disease

A

diarrhoea, abdominal pain, weight loss, malaise, lethargy, anorexia, n/v, malabsorption (anaemia, vitamin deficiency), low grade fever

213
Q

Investigations for crohn’s disease

A

blood (high ESR and CRP, high platelet count, high wcc, low Hb, low albumin, pANCA), stool (calprotectin)

214
Q

Treatment for crohn’s disease

A

Aminosalicylates (mesalazine: acrylic resin (asacol, ipocol, mesren, salofalk) or ethylcellulose microgranules (pentasa))(pro-drugs (balsalazide,olzalazine, sulfasalazine)), steroids (prednisolone or budenoside)
Thiopurines (azathioprine, 6-mercaptopurine)
methotrexate
Other immunosuppresants (ciclosporin, mycophenolate, tacrolimus)
Biologics (anti-TNF alpha antibodies (infliximab, adulimumab), alpha4b7 integrin blockers (vedolizumab), IL12/IL23 blockers (ustekinumab))
elemental feeding

215
Q

Ulcerative colitis define

A

Colon and rectum become inflamed, continous inflammation starting at rectum

216
Q

risk factors fror ulcerative colitis

A

20-40 years, female

217
Q

Symptoms and signs

A

bloody diarrhoea, abdominal pain, weight loss

218
Q

Ulcerative colitis investigations

A

surveillance colonoscopy (colon cancer increased risk)

219
Q

Ulcerative colitis treatment

A

Aminosalicylates (mesalazine: acrylic resin (asacol, ipocol, mesren, salofalk) or ethylcellulose microgranules (pentasa))(pro-drugs (balsalazide,olzalazine, sulfasalazine)), steroids (prednisolone or budenoside)
Thiopurines (azathioprine, 6-mercaptopurine)
methotrexate
Other immunosuppresants (ciclosporin, mycophenolate, tacrolimus)
Biologics (anti-TNF alpha antibodies (infliximab, adulimumab), alpha4b7 integrin blockers (vedolizumab), IL12/IL23 blockers (ustekinumab))
elemental feeding

surgical: total colectomy, ileostomy, pouch procedure or proctocolectomy

220
Q

Define oesophagitis

A

inflammation of the lining ogf the oesophagus, Gastric acid refluxes into oesophagus causing thickening of squamous epithelium cells and eventually ulceration.

221
Q

Oesophagitis risk factors

A

Pregnancy, obestity, drugs lowering LOS pressure, smoking, alcoholism, hypomotility, male, caucasian

222
Q

Oesophagitis symptoms and signs

A

heartburn, acid reflux, bloating, belching, n/v, haematemesis, melaena

223
Q

Oesophagitis investigations

A

endoscopy, oesophageal biopsises

224
Q

Oesophagitis treatment

A

antacids, corticosteroids

225
Q

A patient presents with upper abdominal pain, producing less urine (oliguria), constipation and vomiting, on examination you note jaundice, tachycardia, abdominal tenderness and absence of bbowel sounds
PMH: alcoholic
WHat is the likely diagnosis

A

Acute pancreatitis

226
Q

A patient resturns multiple times with bouts of pancreatitis, they are now complaining of fatigue and weight loss, on examination you note ascites and splenomegaly and you can palpate the gallbladfder, what is the likely diagnosis?

A

Pancreatic cancer

227
Q

A patient presents with abdominal pain, fatigue , chronic diarrhoea which is pale and foul smelling, you test bloods and discover thy are iron anaemic, what investigation are you going to order and waht is the likely diagnosis?

A

Distal duodenal biopsy and coeliac disease

228
Q

A patient presents with diarrhoea, abdominal pain, n/v, ulcers in the mouth and weight loss though they say they eat normally, bloods display anaemian and a vitamin deficiency , also a high ESR and CRP and the stool test shows positive for calprotectin, what is the likely diagnosis?

A

Chron’s disease

229
Q

A patient presents with bloody diarrhoea, abdominal pain and weight loss, you do a colonscopy and notice inflammation, waht is the likely diagnosis?

A

Ulcerative colitis

230
Q

Define oesophageal varices

A

Abnormally dilated collaterol vessels, dilated sub-mucosal veins in the lower 1/3 of the oesophagus

231
Q

Risk factors for oesophgaeal varices

A

portal hypertension, cirrhosis

232
Q

Oesophageal varices symptoms and signs

A

lightheadedness, melaena, haematemesis

233
Q

Oesophageal varices investigations

A

endoscopy, CT, doppler ultrasound, splenic and portal veins, capusle endoscopy

234
Q

Oesophageal varices treatment

A

endotherapy (Band ligation (elastic band to tie of bleeding veins), glue injection), beta blockers, IV terlipressin, IV broad spectrum antibiotics, correct coagulopathy
Sengstaken-blakemore tube for uncontrlled bleeding

235
Q

Define a mallory-Weiss tear

A

linear tear at oesophago-gastric junction, tear in the mucus membrane of the oesophagus, where the oesophagus meets the stomach normally following a period of retching/ vomiting

236
Q

Mallory-Weiss tear symptoms

A

hematemesis- coffee ground blood appearance

237
Q

Mallory-Weiss tear investigations

A

endoscopy

238
Q

Mallory-Weiss tear treatment

A

self-limiting, 10% need endoscopic treatment

239
Q

Define diverticular disease

A

Small bulges or sacs formed in the wall of the colon, protrusion of the inner mucosal lining through the outer muscular layer forming a pouch

240
Q

Diverticular disease symptoms and signs

A

indigestion, abdominal pain in the LLQ, bloating, constipation, diarrhoea and magenta stools

241
Q

Diverticular disease investigation

A

lower GI endoscopy

242
Q

Diverticular disease treatment

A

self-limiting, severe IV antibiotics

243
Q

Haemorrhoids define

A

enlarged vascular cushions around anal canal, swollen and inflamed veins in rectum and anus

244
Q

Risk factors for haemorrhoids

A

straining, constipation, low fibre diet

245
Q

Haemorrhoids symptoms

A

Pain (if thrombosed or external), itching, bleeding around the anal area

246
Q

Haemorrhoids treatment

A

elective surgical intervention, corticosteroids

247
Q

Define ischaemic colitis

A

Inflammation and injury of the large intestine resulting from inadequate blood supply, disruption of blood supply to the colon resulting in cell death

248
Q

Risk factors for ischaemic colitis

A

high cholesterol, smoking, heart failure, previous abdominal surgery

249
Q

Ischaemic symptoms and signs?

A

crampy abdominal pain, sudden lower GI bleeding ,on endoscopy: dusky blue, swollen mucosa

250
Q

Ischaemic colitis investigation

A

lower GI endoscopy

251
Q

Ischaemic colitis treatment

A

self-limiting, IV fluids, bowel rest

252
Q

Radiation colitis definition

A

inflammation of the intestines that occur after radiation therapy, radiotherapy results in a no. of cells in the colon dying (blood vessels, crypt epithelium) resultin in inflammation

253
Q

Radiation colitis signs and symptoms

A

diarrhoea, vomiting, nausea, abdominal cramps and malabsorption

254
Q

radiation colitis investigations

A

colonscopy, flexible sigmoidscopy

255
Q

Radiation colitis treatment

A

argon plasma coagulation, sulcrafate enemas, hypebaricoxygen

256
Q

Appendicitis pathology

A

Appendix becomes inflammed @ histology level macro- there is fibrinopurulent exudate, perforation and abscess
micro- acute suppurative inflammation in wall and pus in lumen and eventually there is acute gangrenous causing full thickness necrosis and perforation

257
Q

Appendicitis symptoms

A

Dull pain near the umbilicus that becomes sharp and moves to RLQ, loss of appetite, nausea/vomiting, abdominal swelling, fever

258
Q

Define a colorectal adenocarcinoma

A

Cancer of the colon/ rectum
dysplasia in the colon/ rectum, low grade dysplasia (increased nuclear nos, increased nucelar size, reduced mucin), high grade dysplasia (crowded, very irregular, not yet invasive)

259
Q

Risk factors of colorectal adenocarcinoma

A

85% sporadic (>40yrs, male, environmental influences: diet, obesity, lack of exercise, smoking, diabetes mellitus), inheritable conditions (FAP, CRC), IBD, colorectal polyps

260
Q

Symptoms of colorectal adenocarcinoma

A

Different dependent on side of colorectal adenocarcinoma:
right sided: anaemia, vague pain, weakness, obstruction

left sided: looks like a napkin ring, bleeding (flesh blood), altered bowel habit, obstruction

261
Q

Colorectal adenocarcinoma signs

A

rectal bleeding, altered bowel opening to loose stools, iron deficiency anaemia in men and non-menstruating women, palpable rectal or right lower abdominal mass, acute colonic obstruction, weight loss, anorexia

262
Q

Colorectal adenocarcinoma investigations

A

colonscopy, barium enema, CT colonography (3D virtual colonscopy)
Staging: Ct scan, MRI, PET, rectal endoscopic ultrasound

263
Q

Colorectal adenocarcinoma treatment

A

Dukes A and “cancer polyps” use endoscopic or local resection

Operative procedure depends on site, size and stage of tumour:
Laparotomy, laparoscopic, stoma formation (colostomy), removal of lymph nodes for histological analysis, partial hepatectomy for metastases

For Dukes C or Dukes B use chemotherapy (adjuvant) and radiotherapy (neoadjuvant)

264
Q

Define binge eating disorders

A

eating disorder in which patient gains weight, binge eats and then purges, however purge doesn’t equall binge so weight is put on.

265
Q

Bulimia nervosa symptoms

A

Binge eating, fear of putting on weight, mood changed, being very critical of body weight and shape

266
Q

Treatment for eating disorders

A

cognitive behavioural therapy

267
Q

Bulimia nervosa description

A

binge eating followed by purging, however normal weight because eating matches purging

268
Q

Anorexia nervosa description

A

eating disorder resulting in significant weight loss, obsessively fears about gaining weight

269
Q

Anorexia nervosa symptoms

A

weight loss, perfectionism, significantly impaired decision making, body dysmorphia, over exercising, amenorrhoea (absence of menstruation)

270
Q

Define hepatocellular carcinoma

A

Primary liver cancer

271
Q

Hepatocellular carcinoma risk factors

A

cirrhoiss, chronic hepatitis B and C

272
Q

Hepatocellular carcinoma symptoms

A

easy bruising, bleeding, enlarged abdomen, jaundice, abdominal mass, pain, weight loss, bleeding from tumour

273
Q

Hepatoceullar carcinoma investigations

A

AFP, ultrasound, CT scan, MRI, not liver biopsy

274
Q

Treatment for hepatocellular carcinoma

A

hepatic resection, liver transplant, chemotherapy, local ablativetreatments (alcohol injection, radiofrequency ablation), sorafenib(tyrosinase kinase inhibitor), hormonal therapy (tamoxifen)

GI pathology (2 decks)

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