GI disease quiz Flashcards
1
Q
Describe Oesophageal reflux
A
Gastric acid refluxes into oesophagus causing thickening of squamous epithelium cells and eventually ulceration
2
Q
What are some risk factors for oesophageal reflux?
A
poorly functioning oesophageal sphincter, obesity, hypertension, smoking, certain drugs eg for asthma
3
Q
Symptoms for oesophageal reflux?
A
bloating, nausea, heart burn, dysphagia, chronic sore throat
4
Q
Describe oesophageal cancer
A
Squamous cell or adenocarcinoma cancer in oesophagus
5
Q
Risk factors for squamous cell oesophageal cancer
A
smoking and alcohol
6
Q
Risk factors for adenocarcinoma?
A
Obesity and Barrett’s oesophagus
7
Q
Oesophageal cancer symptoms and signs?
A
dysphagia, coughing, hoarseness, chest pain, worsening heartburn, weight loss
8
Q
What investigations would you do for oesophageal cancer?
A
endoscopy, bloods (FBC,glucose,CRP), contrast meal, laproscopy, CT scan
9
Q
What treatment options are there for oesophageal cancer?
A
surgery- gastrectomy, total gastrectomy, roux en Y reconstruction
chemotherapy, radiotherapy
10
Q
What are some local effects of oesophageal cancer?
A
obstruction, ulceration and perforation
11
Q
Describe gastritis
A
Inflammation in the gastric mucosa
12
Q
What are the 3 different classes of cause for gastritis
A
Autoimmune
Bacterial (helicobacter pylori)
Chemical (drugs(NSAIDS, smoking, alcohol)
13
Q
Symptoms of gastritis?
A
Nausea, abdomical bloating, heartburn, burning or gnawing feeling between meals and at night, loss of appetite
14
Q
Peptic ulceration description?
A
Ulcers that develop in lining of stomach due to an imbalance between acid secretion and mucosal barrier
15
Q
What are some risk factors for peptic ulceration?
A
NSAIDs, helicobacter pylori, alcohol excess, systemic illness
16
Q
Signs and symptoms for peptic ulceration?
A
heartburn, abdominal/hunger pain, burping, n/v, weight loss, epigastric tenderness and upper GI bleed
17
Q
Tests for peptic ulceration?
A
Endoscopy, bloods
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
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
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
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
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
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
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
25
Describe stomach cancer?
An adenocarcinoma that develops in the lining of the stomach, can be a consequence of h.pylori infection
26
Signs and symptoms of stomach cancer
dysphagia, abdominal pain, heartburn, blood in stools, n/v, weightloss, bloated, iron deficiency anaemia
27
Investigations for stomach cancer?
endoscopy, endoscopic ultrasound, barium meal Xray
28
Treatments for stomach cancer?
gastrectomy, oesophagogastrectomy, chemotherapy, radiotherapy
29
Describe peritonitis
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
30
Symptoms of peritonitis
abdominal pain, bloating, fever, n/v, loss of appetite, diarrhoea, low urine output, inability to pass stool or gas and fatigue
31
Investigations for peritonitis
peritoneal fluid analysis, blood tests
32
Treatment for peritonitis
antibiotics, though may need surgery to remove infected tissue
33
There are 2 types of peritonisits, what are they?
Localised or generalised, generalised is when there has been a rapid/ persistent contamination or an abscess has burst
34
What are complications from peritonitis
fluid loss and sepsis
35
Describe intestinal obstruction
obstruction within, on or surrounding the intestinal tubes, causes are commonly: tumour, hernia, clot
36
What are the symptoms of intestinal obstruction
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)
37
What investigations would you use for intestinal obstruction?
urine test, FBC, UandE, LFT, ultrasouns, CT, laproscopy, laparotomy
38
What treatment would you use for intestinal obstruction?
restore circulating fluid volume, oxygenation, antibiotics, analgesia, endoscopic balloon dilatation
39
Define dyspepsia
dys= bad, pepsia= digestion
40
Symptoms of dyspepsia?
upper abdominal discomfort, retrosternal pain, anorexia, n/v, bloating, fullness, early satiety, heartburn
41
What alarm symptoms, require reference for endoscopy?
```
Anorexia
Loss of weight
Anaemia (iron)
Recent onset >55yrs or persistent despite treatment
Melaena/ haematemesis or Mass
Swallowing problems
```
42
Define H.pylori infection
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
43
H.pylori symptoms?
upper abdominal discomfort, retrosternal pain, anorexia, n/v, bloating, fullness, early satiety and heartburn
44
H.pylori investigations
serology (increase IgG= sign of), urea breath test, stool antigen test, endoscopy
45
H.pylori treatment?
eradication therapy:
Triple therapy for 7 days:
Clarithromycin 500mg, amoxycillin 1g bd (tetracycline if allergic to penicillin), PPI eg omeprazole 20mg
CAO
46
Acute liver failure description?
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
47
Acute liver failure symptoms?
loss of appetite, loss of sex drive, jaundice, fatigue, n/v, itchy skin
48
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?
Stomach cancer, need to complete and endoscopy, endoscopic ultrasound or barium meal xray to determine if diagnosis is correct
49
Your patient has been diagnosed with stomach cancer what are your treatment options?
gastrectomy, oesophagogastrectomy, chemotherapy, radiotherapy
50
The patient with stomach cancer is a past doctor and asks what type of cancer it is of the stomach?
adenocarcinoma
51
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?
intestinal obstruction- could be a tumour, hernia or clot
52
The consultant asks what tests you should complete for a patient with intestinal obstuction?
urine test, FBC, U andE, LFT, ultrasound, Ct, laproscopy, lapartomy
53
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?
peritonitis
54
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?
Helicobacter pylori infection
55
Define jaundice
Increasing circulating bilirubin causing yellowing of the skin and eyes
56
What are the 3 types of jaundice?
Pre-hepatic, hepatic and post-hepatic
57
Define pre-hepatic jaundice
Increased release of haemoglobin from red cells (Haemolysis) and thus increased quantity of bilirubin but impaired transport
58
Define hepatic jaundice
Defective uptake of bilirubin, conjugation and excretion eg caused by cholestasis, intra-hepatic bile duct obstruction
59
Define post-hepatic jaundice
Defective transport of bilirubin by the biliary ducts eg cholelithiasis, disease of gallbladder, extra-hepatic duct obstruction
60
Symptoms and signs of pre-hepatic jaundice
yellowing of skin and cornea, history of anemia, pallor, splenomegaly
61
Symptoms and signs of hepatic jaundice
yellowing of skin and cornea, ascites, variceal bleed, spider naevi, gynacomastia, asterixis
62
Symptoms and signs of post-hepatic jaundice
yellowing of skins and cornea, abdominal pain, cholestasis, pruritus, pale stools, high-coloured urine, palpable gallbladder
63
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?
Hepatic jaundice, often caused by cholestasis or intra-hepatic bile duct obstruction
64
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?
Pre-hepatic jaundice, often caused by increased haemolysis causing increased release of haemoglobin
65
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?
Post-hepatic jaundice, often due to cholelithiasis, disease of gallbladder and extra-hepatic duct obstruction
66
What are the different causes of intrahepatic bile duct obstruction?
primary biliary cholangitis, primary sclerosing cholangitis, tumours od liver
67
Describe primary biliary cholangitis?
organ specific auto-immune disease that causes granulomatous inflammation of bile ducts
68
Describe primary sclerosing cholangitis
chronic inflammation and fibrous obliteration of bile ducts
69
Risk factors for intrahepatic bile duct obstruction
gallstones, inflammation of bile ducts, trauma, cysts, enlarged lymph nodes, pancreatitis, injury to gallbladder, obestiy, chronic pancreatitis, sickle cell anaemia
70
Symptoms of intrahepatic bile duct obstruction
n/v, weight loss, fever, itching, pain in upper right side of abdomen, light coloured stools, dark urine, jaundice
71
Signs of primary biliary cholangitis
anti-michondrial auto-antibodies in serum, raised serum alkaline phosphatase
72
Investigations for intrahepatic bile duct obstruction
CBC, LFT, ultrasound, biliary radionuclide scan, cholangiography, MRI, endoscopicretrograde cholangiopancreatography, magnetic resonance cholangiopancreatography
73
treatment of intrahepatic bile duct obstruction
treat underlying cause, cholecystectomy, endoscopic retrograde cholangiopancreatography
74
Describe Cirrhosis
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
75
Cirrhosis symptoms
fatigue, loss of appetite, weight loss, muscle wasting, n/v, tenderness or pain in liver area, itchy skin
76
Cirrhosis signs
jaundice, vomiting blood, dark tarry stools, oedema, abdominal ascites
77
Investigations for cirrhosis
magnetic resonance elastography
78
Treatment for cirrhosis
changing lifestyle, diet, easing symptoms: diuretics, hypertension tablets, creams for itching
79
Describe hepatocellular carcinoma?
malignant tumour of hepatocytes
80
Risk factors for hepatocellular carcinoma
chronic alcohol, hept B,C, Wilson's disease, primary biliary cirrhosis, non-alcoholic fatty liver disease
81
Symptoms and signs of hepatocellular carcinoma
abdominal pain or tenderness, easy bruising or bleeding, ascites, distended abdomen, jaundice, weight loss, pale chalky bowel movements and dark urine
82
Describe cholangiocarcinoma
Malignant tumour of bile duct epithelium
83
Risk factors of cholangiocarcinoma
primary sclerosing cholangitis, congenital liver malformation
84
Symptoms and signs of cholangiocarcinoma
abdominal pain, loss of appetite, weight loss, itching, n/v,jaundice, greasy stools, dark urine
85
Investigations for liver carcinomas
bloods- AFP, ultrasound, CT, MRI, liver biopsy, endoscopy, laproscopy
86
Treatment for liver carcinomas
chemotherapy, radiotherapy, transplant, hepatectomy
87
Describe acute cholecystitis
Acute inflammation of gallbladder
88
Symptoms and signs of acute cholecystitis
pain (typically after meals), n/v, chills, abdominal bloating, jaundice, clay-coloured stools
89
Describe chronic cholecystitis
Chronic inflammation of gallbladder
90
Cholecystitis risk factors
gallstones, tumour, genetic predisposition, obesity, diabetes, tumours in liver, pancreas or gallbladder, pregnancy
91
Symptoms or signs of chronic cholecystitis
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
92
Acute/chronic cholecystitis investigations
ultrasound, hepatobiliary scintigraphy, cholangiography, CT, bloods: LFT, CBC
93
Acute/chronic cholecystitis treatment
cholecystectomy
94
What are some complications from chronic cholecystitis
pancreatitis, perforation of gallbladder, enlarged gallbladder, cancer of gallbladder
95
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
Intrahepatic bile duct obstruction
96
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
Intrahepatic bile duct obstruction caused by primary biliary cholangitis
97
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
Primary sclerosing cholangitis, causing intrahepatic bile duct obstruction
98
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?
cirrhosis
99
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?
Chronic cholecystitis
100
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?
Hepatocellular carcinoma
101
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?
Cholangiocarcinoma
102
define extrahepatic bile duct obstruction
common bile duct obstruction caused by gallstones, bile duct tumours, benign stricture, external compression- blood clots, lover trauma, liver fluke parasitet
103
Symptoms of extrahepatic bile duct obstruction
n/v, weight loss, fever, itching, pain in upper right side of the abdomen, light-coloured stools, dark urine, jaundice
104
Investigations of extrahepatic bile duct obstruction
CBC, LFT, ultrasound, biliary radionuclide scan, cholangiography, MRI, endoscopicretrograde cholangiopancreatography, magnetic resonance cholangiopancreatography
105
Describe Cholestasis
accumulation of bile within hepatocytes or bile canaliculi
106
Causes of cholestasis
viral hepatitis, alcoholic hepatitis, liver failure, drugs, gallstones, pregnancy, scarring of bile ducts
107
Symptoms and signs of cholestasis
itching, dark urine, pain in RUQ without gallstones, pale bowel movements, fatigue, loss of appetite, depression, jaundice
108
Investigations of cholestasis
ultrasound, endoscope
109
Treatment of cholestasis
ursodiol, itching relievingmedication, soaking itchy area in cool water
110
Define steatosis
Fatty liver, lipids accumulate in the hepatocytes as vacuoles
111
Steatosis risk factors
type 2 diabetes, obesity, alcohol, hypertension
112
Steatosis symptoms and signs
ascites, enlarged blood vessels, gynacomastia, spleenomegaly, pallor erethyma, jaundice
113
Steatosis investigations
Serum AST, ALT, alkaline phosphatase, ultrasound, bloods (LFT, lipid profile), CT, magnetic resonance elastography
114
Treatment of steatosis
weight loss, exercise
115
Define steatohepatitis
fatty liver with inflammation
116
Steatohepatitis symptoms and signs
bleeding and bruising easily, itchy skin, ascites, loss of appetite, nausea, raised alanine amino transferase, swelling in legs, jaundice
117
Investigations for steatohepatitis
liver biopsy, ultrasound, LFT
118
define hepatic encephalopathy
Liver failure causing spectrum of neuropsychiatric abnormalities in patients with liver dysfunction
119
Symptoms and signs of hepatic encephalopathy
confusion, personality change, poor concentration, problems with small hand movments, confusion, forgetfullness, poor judgement, musty or sweat breath odor, lethargy, seizures
120
Treatment for hepatic encephalopathy
bowel clear out via lactulose and enemas, antibiotics, supportive
121
Define spontaneous bacterial peritonitis
Infection of ascitic fluid without apparent source, Polymorphonuclear cell coount of more than 250 cells/mm3 of ascitic fluid
122
Signs and symptoms of spontaneous bacterial peritonitis
Abdominal pain, fever, rigors, renal impairment, signs of sepsis, tachycardia
123
Investigations of spontaneous bacterial peritonitisi
FBC (increased wbc count), culture of ascitic fluid, neutrophil count (>0.25x10(9)/L), protein <25g/L
124
Treatment of spontaneous bacterial peritonitis
IV antibiotics, ascitic fluid drainage, IV albumin infusion (20% ALBA)
125
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?
Extrahepatic bile duct obstruction caused by bile stones
126
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
Steatosis
127
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?
Steatohepatitis
128
A patient has an ultrasound, showing a blockage within the bile canaliculi, they have a PMH of alcoholic hepatitis, what is the likely diagnosis?
cholestasis
129
A patient presents with abdominal pain, a hr of 140b/m and signs of sepsis, what is hte likely diagnosis?
Spontaneous bacterial peritonitis
130
Define alcohol hepatitis
An inflammatory condition of the liver caused by alcohol
131
Symptoms of alcohol hepatitis
Jaundice, encephalopathy
132
Signs of alcohol hepatitis
Low albumin, raised prothrombin, raised bilrirubin, raised GGT and AkP
133
Treatment for alcohol hepatitis
Treat alcohol withdrawal, ITU care, protect against GI bleed, steroids (if high on Glasgow Hepatitis score or Maddreys score)
134
Define gallstones
Stones made of cholesterol and pigment in the gallbladder
135
Risk factors for gallstones
Female, higher cholesterol, high pigment levels (haemolytic anaemia, bile infection)
136
Gallstones symptoms
Can appear asymptomatic, or as dyspeptic symptoms, biliary colic, acute cholecystits, empyema, jaundice, gallstones lieu’s
137
Gallstones investigations
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
Treatment for gallstones
Dissolution, lithotripsy, open, mini, laparoscopic, single port cholecystectomy
139
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?
Alcoholic hepatitis
140
Define choledocho-lithiasis
Stones in the common bile duct
141
Choledocho-lithiasis symptoms
obstructive jaundice (pain, jaundice, dark urine, pale stool, pruritus, steatorrhoea), acute pancreatitis, ascending cholangitis
142
Choledocho-lithiasis tests
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
Define cystic bile duct stones
gallstones in cystic bile duct
144
Risk factors for cystic bile duct stones
Female, higher cholesterol (obestity, ileal disease, cirrhosis, CF), high pigment levels (haemolytic anaemia, bile infection)
145
Symptoms of cystic bile duct stones
abdominal pain in RUQ or MUQ, loss of appetite, n/v, fever, jaudice, clay-coloured stools
146
Cystic bile duct stones investigations
"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
Cystic bile duct stones treatment
Lap trans-cystoc CBD exploaration, lap exploration/ open exploration of CBD, endoscopic retrograde cholangio-pancreatography, transhepatic stone retrieval
148
Define cholangiocarcinoma
Cancer of the bile duct, can be intrahepatoc or extrahepatic, there are 3 types of intrahepatic: mass-forming, peri-ductal, intra-ductal
149
Risk factors of cholangiocarcnioma
PSC, congenital cystic disease, bilary-enteric drainage, throotrast, hepatolithiasis, carcinogens (aflatoxins), risk increases with age
150
Symptoms of cholangiocarcinoma
painless obstructive jaundice , itching, loss of appetite, nause/vomiting, weight loss
151
Define gallbladder cancer
Cancer of the gallbladder
152
Risk factors for gallbladder cancer
gallstones, gallbladder polyps, older age, women, smoking
153
Symptoms and signs of gallbladder cancer?
RUQ pain, abdominal bloating, weight loss, nausea, jaundice, fever, abdominal distention
154
Investigations of gallbladder cancer
Lab, radiology, EUS, CT, MRI, MRCP, PTC, angiography, FDG, PET, ERCP, cholangioscopy and cytology
155
Treatment of gallbladder cancer
surgical bypass, stenting, aplliative radiotherapy, PDT, liver transplant
156
Define ampullary cancer
Cancer of the ampulla of vater, can be adenoma or adenocarcinoma
157
Risk factors of ampullary cancer?
PSC (primary sclerosing cholangitis), FAP
158
Ampullary cancer symptoms and signs
abdominal pain, back pain, vomiting, GI bleed, pancreatitis, diarrhoea, jaundice, weight loss
159
Ampullary cancer investigations
lab, radiology: USS, EUS, CT, MRI, MRCP, PTC, angiography, FDG, PET, ERCP, cholangioscopy and cytology
160
Ampullary cancer treatment
endoscopic excision, trans-duodenal excision, pancreatico-duodenectomy
161
Define achalasia
When your lower oesophageal sphincter fails to open during swallowing due to functional loss of myenteric plexus ganglion cells in the distal oesophagus
162
Risk factors for achalasia
radiotherapy, alcohol, smoking
163
Symptoms of achalasia
progressive dysphagia, weight loss, chest pain, regurgitation and chest infection
164
Signs of achalasia?
manometry findings (high pressure in the LOS at rest)
165
Investigations for achalasia
manometry, oesophagus-gastro-duodenoscopy, upper GI endoscopy
166
Achalasia treatments
pharmacological: nitrates, CCB
Endoscopic: botulinumtoxin, pneumatic balloon dilation,
radiotherapy: pneumatic balloon dilation
myotomy
167
Define Gastro-oesophageal reflux disease
Acid and bile exposure in lower oesophagus, mucosa is exposed to acid-pepsin and bile
168
Define the pathology of Gastro-oesophageal reflux disease
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
Risk factors of GORD
pregnancy, obestity, drug lowering LOS pressure, smoking, alcoholism, hypomotility, male, caucasian
170
Symptoms of GORD
heartburn, cough, water brash, sleep disturbance
171
Treatment for GORD
alginates, H2 receptor antagonists, PPI, anti-reflux surgery (fundoplication)
172
Oesophageal cancer
Cancer in the oesophagus, can be squamous cell carcinoma or adenocarcinoma
173
Oesophageal cancer risk factors
male, >65, smoking, alcohol, obestity, low vitamin and mineral diet, caucasian (adenocarcinoma)
174
Symptoms of oesophageal cancer
progressive dysphagia, anorexia, weight loss, odynophagia, chest pain, cough, pneumonia (via tracheo-oesophageal fistula), vocal cord paralysis, haematemesis
175
Oesophageal cancer investigations
endoscopy, biopsy, CT scan, endoscopic ultrasound, PET, bone scan
176
Oesophageal cancer treatment
surgical oesophagectomy with adjuvant or neoadjucant chemotherapy, endoscopic: stent, laser/APC, PEG (percutaneous endoscopic gastrostomy), chemotherapy, radiotherapy, brachytherapy
177
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?
Achalasia, investigate with manometry
178
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?
Gastro-oesophageal reflux disorder
Water Brash
179
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?
Oesophageal cancer
Odynophagia
haematemesis
180
Define eosinophilic oesophagitis
chronic immune/ allergen mediated condition
181
Symptoms of oesophilic oesophagitis
dysphagia and food bolus obstruction
182
Endoscopic signs of eosinophilic oesophagitis
Spiral layers of oesophagus
183
Treatment for eosinophillic oesophagitis
topical/ swallowed corticosteroids, endoscopic dilatation
184
define acute pancreatitis
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
Acute Pancreatitis causes
GET SMASHED
Gallstones
Ethanol
Trauma
```
Steroids
Mumps
Autoimmune disease
Scorpion sting
Hypercalcemia/ Hyperlipidemia
ERCP
Drugs
```
186
Symptoms of acute pancreatitis
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
Define chronic pancreatitis
COntinuing inflammatory disease of the pancreas characterised by irreversible glandular destruction
188
Causes of chronic pancreatitis,
| hint- O-A-TIGER
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
Risk factors for chronic pancreatitis
CF, congenital abnormalities (annular pancrease and pancreas divisum, hereditary pancreatitis (PRSS1), hypercalcaemia
190
Symptoms of chronic pancreatitis
abdominal pain (exacerbated by food or alcohol), weight loss, exocrine insufficiency (steatorrhoea), endocrine insufficiency (diabetes), jaundice, portal hypertension, GI haemorrhage
191
scan signs of chronic pancreatitis
pseudocysts on scan
192
investigations for chronic pancreatitis
AXR, ultrasound, EUS, CT, bloods: serum amylase, albumin, LFTs, prothrombin (vit K), glucose, pancreatic function tests (pancreolauryl test), diagnostic enzyme replacement
193
Treatment for chronic pancreatitis
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)
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Define pancreatic cancer
Carcinoma of the pancreas, 75% are duct cell mucinous adenocarcinoma, others: carcinosarcoma, cystadenocarcinoma, acinar cell
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Risk factors for pancreatic cancer
smoking, chronic pancreatitis, hereditary pancreatitis, inherited predisposition(periampullary cancer, FAP)
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Symptoms of pancreatic cancer
upper abdominal pain, painless obstructuve jaundice, weight loss, anorexia, fatigue, diarrhoea/ steatorrhoea, n/v, recurrent bouts of pancratitis
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Signs of pancreatic cancer
tender subcutaneous fat nodules, thrombophlebitis migrans, ascites, portal hypertension, hepatomegal, jaundice, abdomial mass, abdominal tenderness, ascites, splenomegaly, supraclavicaular lymphadenopathy, palpable gallbladder
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Pancreatic cancer investigations
abdominal ultrasound, CT, EUS, ERCP, percutaneous needle biopsy, laprascopy,lapratomy
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pancreatic cancer treatment
pancreatoduodenectomy, stent, cholechuodenostomy, pain control (opiates, coeliac plexus block, radiotherapy), chemotherapy
surgery- kaush whipple, pylorus preserving pancreaticoduodenectomy
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Define coeliac disease
Sensitivity to gliadin fraction of gluten , gliadin produces an inflammatory response which causes partial or subtotal villous atrophy, increasing intra-epithelial lymphocytes
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Coeliac disease risk factors
autoimmune condition eg type 1 diabetes, rheumatoid arthritis, addison's disease
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Coelic disease symptoms and signs
abdominal bloating and pain, chronic diarrhoea, vomiting, constipation, fatigue, anaemia, pale/foul smelling/ fatty stool, weight loss
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Coeliac disease investigations
serology (anti endomysial IgA, anti tissue transglutaminase), distal duodenal biopsy, HLA status (HLA DQ2 or DQ8)
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Coeliac disease treatment
withdraw gluten
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Define irritable bowel syndrome
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
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IBS risk factors
smoking, alcohol, younger age, psychological and physical stress
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IBS symptoms and signs
abdominal pain, altered bowel habit, abdominal bloating, belching wind and flatus, mucus in stools, urgent need for bowel movement
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IBS investigations
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
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IBS treatment
Dietic review- FODMAPS, antispasmodics, antidepressants, antimotility agents, laxatives
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Define Crohn's disease
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
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What ages are you likely to be affected by crohn's disease
20-40yrs and over 60 years
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Symptoms and signs on crohn's disease
diarrhoea, abdominal pain, weight loss, malaise, lethargy, anorexia, n/v, malabsorption (anaemia, vitamin deficiency), low grade fever
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Investigations for crohn's disease
blood (high ESR and CRP, high platelet count, high wcc, low Hb, low albumin, pANCA), stool (calprotectin)
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Treatment for crohn's disease
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
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Ulcerative colitis define
Colon and rectum become inflamed, continous inflammation starting at rectum
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risk factors fror ulcerative colitis
20-40 years, female
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Symptoms and signs
bloody diarrhoea, abdominal pain, weight loss
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Ulcerative colitis investigations
surveillance colonoscopy (colon cancer increased risk)
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Ulcerative colitis treatment
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
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Define oesophagitis
inflammation of the lining ogf the oesophagus, Gastric acid refluxes into oesophagus causing thickening of squamous epithelium cells and eventually ulceration.
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Oesophagitis risk factors
Pregnancy, obestity, drugs lowering LOS pressure, smoking, alcoholism, hypomotility, male, caucasian
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Oesophagitis symptoms and signs
heartburn, acid reflux, bloating, belching, n/v, haematemesis, melaena
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Oesophagitis investigations
endoscopy, oesophageal biopsises
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Oesophagitis treatment
antacids, corticosteroids
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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
Acute pancreatitis
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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?
Pancreatic cancer
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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?
Distal duodenal biopsy and coeliac disease
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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?
Chron's disease
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A patient presents with bloody diarrhoea, abdominal pain and weight loss, you do a colonscopy and notice inflammation, waht is the likely diagnosis?
Ulcerative colitis
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Define oesophageal varices
Abnormally dilated collaterol vessels, dilated sub-mucosal veins in the lower 1/3 of the oesophagus
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Risk factors for oesophgaeal varices
portal hypertension, cirrhosis
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Oesophageal varices symptoms and signs
lightheadedness, melaena, haematemesis
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Oesophageal varices investigations
endoscopy, CT, doppler ultrasound, splenic and portal veins, capusle endoscopy
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Oesophageal varices treatment
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
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Define a mallory-Weiss tear
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
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Mallory-Weiss tear symptoms
hematemesis- coffee ground blood appearance
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Mallory-Weiss tear investigations
endoscopy
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Mallory-Weiss tear treatment
self-limiting, 10% need endoscopic treatment
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Define diverticular disease
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
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Diverticular disease symptoms and signs
indigestion, abdominal pain in the LLQ, bloating, constipation, diarrhoea and magenta stools
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Diverticular disease investigation
lower GI endoscopy
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Diverticular disease treatment
self-limiting, severe IV antibiotics
243
Haemorrhoids define
enlarged vascular cushions around anal canal, swollen and inflamed veins in rectum and anus
244
Risk factors for haemorrhoids
straining, constipation, low fibre diet
245
Haemorrhoids symptoms
Pain (if thrombosed or external), itching, bleeding around the anal area
246
Haemorrhoids treatment
elective surgical intervention, corticosteroids
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Define ischaemic colitis
Inflammation and injury of the large intestine resulting from inadequate blood supply, disruption of blood supply to the colon resulting in cell death
248
Risk factors for ischaemic colitis
high cholesterol, smoking, heart failure, previous abdominal surgery
249
Ischaemic symptoms and signs?
crampy abdominal pain, sudden lower GI bleeding ,on endoscopy: dusky blue, swollen mucosa
250
Ischaemic colitis investigation
lower GI endoscopy
251
Ischaemic colitis treatment
self-limiting, IV fluids, bowel rest
252
Radiation colitis definition
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
Radiation colitis signs and symptoms
diarrhoea, vomiting, nausea, abdominal cramps and malabsorption
254
radiation colitis investigations
colonscopy, flexible sigmoidscopy
255
Radiation colitis treatment
argon plasma coagulation, sulcrafate enemas, hypebaricoxygen
256
Appendicitis pathology
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
Appendicitis symptoms
Dull pain near the umbilicus that becomes sharp and moves to RLQ, loss of appetite, nausea/vomiting, abdominal swelling, fever
258
Define a colorectal adenocarcinoma
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
Risk factors of colorectal adenocarcinoma
85% sporadic (>40yrs, male, environmental influences: diet, obesity, lack of exercise, smoking, diabetes mellitus), inheritable conditions (FAP, CRC), IBD, colorectal polyps
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Symptoms of colorectal adenocarcinoma
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
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Colorectal adenocarcinoma signs
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
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Colorectal adenocarcinoma investigations
colonscopy, barium enema, CT colonography (3D virtual colonscopy)
Staging: Ct scan, MRI, PET, rectal endoscopic ultrasound
263
Colorectal adenocarcinoma treatment
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)
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Define binge eating disorders
eating disorder in which patient gains weight, binge eats and then purges, however purge doesn't equall binge so weight is put on.
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Bulimia nervosa symptoms
Binge eating, fear of putting on weight, mood changed, being very critical of body weight and shape
266
Treatment for eating disorders
cognitive behavioural therapy
267
Bulimia nervosa description
binge eating followed by purging, however normal weight because eating matches purging
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Anorexia nervosa description
eating disorder resulting in significant weight loss, obsessively fears about gaining weight
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Anorexia nervosa symptoms
weight loss, perfectionism, significantly impaired decision making, body dysmorphia, over exercising, amenorrhoea (absence of menstruation)
270
Define hepatocellular carcinoma
Primary liver cancer
271
Hepatocellular carcinoma risk factors
cirrhoiss, chronic hepatitis B and C
272
Hepatocellular carcinoma symptoms
easy bruising, bleeding, enlarged abdomen, jaundice, abdominal mass, pain, weight loss, bleeding from tumour
273
Hepatoceullar carcinoma investigations
AFP, ultrasound, CT scan, MRI, not liver biopsy
274
Treatment for hepatocellular carcinoma
hepatic resection, liver transplant, chemotherapy, local ablativetreatments (alcohol injection, radiofrequency ablation), sorafenib(tyrosinase kinase inhibitor), hormonal therapy (tamoxifen)
