Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals Revision Flashcards > GI - GORD, PUD, IBD, IBS, Coeliac > Flashcards

GI - GORD, PUD, IBD, IBS, Coeliac Flashcards

1
Q

GORD - what is it?

A

Acid from stomach refluxes up through lower oesophageal sphincter and irritates lining of oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

GORD - what epithelium lines the oesophagus?

A

Squamous - sensitive to stomach acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

GORD - what epithelium lines the stomach?

A

Columnar - more protected against stomach acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

GORD - what is the classic clinical presentation?

A 
Retrosternal or epigastric pain
Heartburn
Acid regurg
Bloating
Nocturnal cough
Odynophagia - painful swallowing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

GORD - when is heartburn worst?

A

After meals

Lying down or bending forward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

GORD - diagnosis and investigations

A

GORD is a clinical diagnosis based on symptoms

There are red flag symptoms - consider upper GI endoscopy in this case

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

GORD - what are the red flag symptoms to consider upper GI endoscopy?

A
  1. Weight loss
  2. Anaemia
  3. Dysphagia
  4. New onset Dyspepsia >55 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

GORD - what investigations can be done if diagnosis is uncertain?

A

pH monitoring - combined with gastroscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

GORD - what are the reflux phenotypes

A
  1. Erosive oesophagitis - erosions seen on gastroscopy
  2. Non-erosive oesophageal reflux - normal gastroscopy, but pathological acid exposure on pH test
  3. Acid hypersensitive oesophagus - normal gastroscopy, non-pathological acid exposure on pH test, but temporal association of reflux events with symptoms
  4. Functional heartburn - normal gastroscopy, non-pathological acid exposure on pH test, and no temporal association of reflux events with symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

GORD - what is the management? (conservative, medical, surgical)

A

Conservative:

  1. Weight loss
  2. Smoking cessation

Medical:

  1. PPIs, Omeprazole, Lansoprazole - PPIs reduce acid secretion by inhibition of H+/K+ATPases in parietal cells
  2. Ranitidine, alternative, H2 receptor antagonist

Surgical:
Nissen fundoplication - tying fundus of stomach around lower oesophagus to narrow LOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

GORD - what is the major complication of constant reflux, and what happens?

A

Barretts Oesophagus

Constant relux in oesophagus causes metaplasia

Metaplasia is the change in epithelium

So oesophagus goes from squamous to columnar

This change to columnar is called Barretts oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

GORD - why does Barretts oesophagus have to be monitored?

A

Considered premalignant condition

RF for developing adenocarcinoma

So monitored regularly by endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

GORD - what is the treatment of Barretts oesophagus

A

Medical:
PPIs, omeprazole
Aspirin - new evidence, not in current guidelines yet

Surgical:
Ablation treatment during endoscopy - destroys epithelium, so replaced with normal squamous cells, prevents progression of cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Peptic Ulcer - what are they?

A

Ulceration of the mucosa of the stomach or duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Peptic Ulcer - why does it occur?

A

Protective layer in stomach and duodenum - comprised of mucus and bicarbonate secreted by stomach mucosa

This LAYER GETS BROKEN DOWN by medications (steroids, NSAIDs) and H.Pylori

OR

INCREASE IN STOMACH ACID, which can result from:
Alcohol
Smoking
Spicy food
Caffeine
Stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Peptic Ulcer - what are the symptoms?

A

Epigastric pain or discomfort

N+V

Bleeding causing HAEMATEMESIS - coffee ground vomiting

Melaena

Iron deficiency anaemia - due to constant bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Peptic Ulcer - how does eating affect gastric and duodenal ulcers?

A

Eating makes gastric ulcers pain WORSEN

Eating makes duodenal ulcers pain IMPROVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Peptic Ulcer - what is the hallmark triad of PUD?

A
  1. Epigastric pain
  2. Heartburn
  3. Dyspepsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Peptic Ulcer - what are the two acute, severe complications of PUD, and how do they present?

A
  1. Acute upper GI bleed (UGIB):
    Haematemesis and/or melaena
    Features of shock could be present
  2. Perforation ‘acute abdomen’:
    Acute severe abdo pain
    Localised or generalised guarding
    Ulcer creates hole, fluid leaks out into peritoneum causes peritonitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Peptic Ulcer - what is the definitive diagnosis technique?

A

Endoscopic examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Peptic Ulcer - What are the investigations that can be done?

A

Bedside:
Obs
H.Pylori testing

Bloods:
FBC - may show iron def anaemia
LFTs - biliary pathology or gallstones, could be differential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Peptic Ulcer - during an endoscopic exam, what tests are done and why?

A

Rapid urease test (CLO test) - check for H. Pylori

Biopsy during endoscopy - exclude malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Peptic Ulcer - what is the stepwise management?

A

Patients who test POSITIVE FOR H.PYLORI offered eradication therapy

If positive for H.Pylori, then assessed to see if there is association with NSAIDs

No association with NSAIDs - 1st line eradication therapy
Association with NSAIDs - 2 months full dose PPI, then given 1st line erad therapy

Patients who test NEGATIVE FOR H.PYLORI - 4 to 8 weeks full dose PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Peptic Ulcer - what is the 1st line eradication therapy course?

A

Given 7 day course of triple therapy - PPI and dual antibiotic therapy

Non-penicillin allergy

  1. PPI
  2. Amoxicillin
  3. Clarithromycin/metronidazole

Penicillin allergy:

  1. PPI
  2. Clarithromycin
  3. Metronidazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Crohn’s Disease - what is it?

A

Chronic inflammatory disorder

Affect any part of GI tract, mouth to anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Crohn’s Disease - aetiology

A

Thought to be an abnormal immunological response to one or more aetiological factors within a genetically susceptible individual

Aetiological factors include:
Genetics
Immune system
Environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Crohn’s Disease - what are the pathophysiological changes that occur?

A 
C - Cobblestone appearance, MAC
R - Rosethorn ulcers, MAC
O - Obstruction
H - Hyperplasia (lymph nodes), MIC
N - Narrowing (lumen), MAC
S - Skip lesions

Macroscopic change - seen in endoscopy (MAC)
Microscopic change - seen on histology (MIC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Crohn’s Disease - is superficial or full thickness of mucosa affected?

A

Transmural, full thickness, inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Crohn’s Disease - What are the symptoms?

A 
Low-grade fever
N+V
Abdo pain
Weight loss
Diarrhoea
Rectal bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Crohn’s Disease - what are the signs?

A 
Pyrexia
Angular stomatitis
Aphthous ulcers
Tachycardia
Hypotension
Dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Crohn’s Disease - what are the extra-intestinal manifestation areas?

A 
MSK, bones and joints
Skin
Eyes and mouth
Hepatobiliary
Blood
32
Q

Crohn’s Disease - what are the extra-intestinal manifestation of bones and skin?

A

Erythema Nodosum (also seen in sarcoidosis)

Arthritis

33
Q

Crohn’s Disease - what are the extra-intestinal manifestation of the eyes and mouth?

A

Episcleritis

Uveitis

Conjunctivitis

Aphthous ulcers

34
Q

Crohn’s Disease - what are the extra-intestinal manifestation of hepatobiliary?

A

Primary sclerosing cholangitis

Fatty liver disease

Gallstones

35
Q

Crohn’s Disease - what are the extra-intestinal manifestation of the blood?

A

B12 deficiency

Anaemia

36
Q

Crohn’s Disease - what is the diagnosis based on?

A

Endoscopy (colonoscopy) macroscopic assessment and biopsy taken to see histological changes

37
Q

Crohn’s Disease - what are some investigations you can do?

A

Faecal calprotectin - marker of intestinal inflammation

Stool Microscopy

Bloods:
FBC
LFT
U&E
CRP
38
Q

Crohn’s Disease - what imaging can you do?

A

Abdo X-Ray: shows bowel dilatation
perforation
wall thickening

CT: shows wall thickening
bowel obstruction

MRI small bowel: ‘disease mapping’

Barium follow through: used to identify strictures

39
Q

Crohn’s Disease - what is the general principle in managing Crohn’s?

A

To induce remission, then maintain remission

40
Q

Crohn’s Disease - what are the drugs to induce remission?

A

1st line - Steroids, oral prednisolone or IV hydrocortisone

If doesn’t work alone add - methotrexate, azathioprine, infliximab, adalimumab, mercaptopurine

41
Q

Crohn’s Disease - what are the drugs to maintain remission?

A

Tailored based on risks, side effects, patients wishes:

1st line: mercaptopurine, azathioprine

Alternatives: methotrexate, infliximab, adalimumab

42
Q

Crohn’s Disease - when is surgery as treatment indicated?

A

When the disease only affects the distal ileum, possible to surgically resect area

Surgery also used to treat strictures and fistulas secondary to Crohns

43
Q

Ulcerative Colitis - what is it?

A

Chronic, inflammatory disease characetrised by a relapsing-remitting course affecting the colon and/or rectum

44
Q

Ulcerative Colitis - what is the distribution in the GI tract?

A

Confined to rectum and colon

Continuous inflammation of the mucosa

45
Q

Ulcerative Colitis - what is pancolitis?

A

Inflammation of the entire colon

46
Q

Ulcerative Colitis - CLOSEUP mneumonic

A 
C - continuous inflammation
L - limited to colon and rectum
O - only superficial mucosa affected
S - smoking is protective
E - excrete blood and mucus
U - use aminosalicylates
P - primary sclerosing cholangitis
47
Q

Ulcerative Colitis - what are the macroscopic changes in UC?

A

Macroscopic changes - seen on endoscopy

  1. Red, inflamed mucosa
  2. Continuous inflammation
  3. Friable (easily crumbled)
  4. Inflammatory polyps
48
Q

Ulcerative Colitis - what are the microscopic changes in UC?

A

Microscopic changes - seen on histology

  1. Goblet cell depletion
  2. Crypt abscesses
  3. Inflammatory infiltrate in lamina propria
49
Q

Ulcerative Colitis - what is the hallmark clinical feature of UC?

A

Bloody diarrhoea/rectal bleeding

50
Q

Ulcerative Colitis - what are the symptoms?

A 
Rectum symptoms:
Loose stools
Rectal bleeding
Tenesmus - incomplete emptying
Urgency

Weight loss
Abdo pain

51
Q

Ulcerative Colitis - what are the signs?

A

Obs:
Tachycardic
Hypotensive
Febrile

Examination:
Abdo tenderness, distension/mass
Pale

52
Q

Ulcerative Colitis - what is the major complication of UC?

A

Toxic Megacolon - medical emergency

53
Q

Ulcerative Colitis - what is one example of the extra-colonic manifestations of the mouth, MSK, eyes, skin, hepatobiliary system and blood?

A

MSK - arthritis (most common extra-colonic manifestation)

Eyes - uveitis, strongly associated with UC

Mouth - aphthous ulcers

Skin - erythema nodosum

Hepatobiliary - primary sclerosing cholangitis

Haematological - anaemia

54
Q

Ulcerative Colitis - what is the diagnostic investigation of choice

A

Colonoscopy (macroscopic changes) with biopsy (microscopic changes)

55
Q

Ulcerative Colitis - what are the bedside Ix, bloods and imaging you can do?

A

Bedside:
Obs
FAECAL CALPROTECTIN
Stool sample for microscopy

Bloods:
FBC, U&E, CRP, LFTs

Imaging:
Abdo X-rays

56
Q

Ulcerative Colitis - what is the name of the tool used to assess the severity of UC?

A

Truelove and Witts’ classification (TLWC)

57
Q

Ulcerative Colitis - what is the TLWC scores and criteria?

A

Mild:
<4 bowel motions a day
Small amount of blood

Moderate:
4-6 bowel motions a day
Quantity of blood between mld and severe

Severe:
>6 bowel motions per day
Visible blood
Systemic upset

The other criterions under each severity heading include:
Pyrexia?
Tachycardia?
Anaemia?
ESR
58
Q

Ulcerative Colitis - what is the management steps and drugs?

A

General principle - induce remission, then maintain it

Inducing remission:
MILD to MODERATE - 1st line aminosalicylate (mesalazine)
2nd line - corticosteroids (prednisolone)

SEVERE - 1st line IV hydrocortisone
2nd line - IV ciclosporin

Maintaining remission:
Aminosalicylate (e.g. mesalazine oral or rectal)
Azathioprine
Mercaptopurine

59
Q

Ulcerative Colitis - what are the surgical management options?

A

Panproctocolectomy - removal of colon and rectum, will remove the disease

Patient is then left with an ileostomy or an ileo-anal anastomosis (J-pouch)

This is when ileum folded back on itself, fashioned into larger pouch, functions bit like a rectum -> J-pouch then attached to anus and collects stools prior to patient passing motion

60
Q

Irritable Bowel Syndrome - what is it?

A

It is a chronic, functional bowel disorder, characterised by abdo pain and altered bowel habits

61
Q

Irritable Bowel Syndrome - what are the symptoms?

A 
Abdo pain
Bloating
Constipation
Diarrhoea
Fluctuating bowel habits

Improved by opening bowels
Worse after eating

62
Q

Irritable Bowel Syndrome - what is the criteria fro diagnosis?

A

Other pathology excluded first:

Normal CRP, ESR, FBC
Negative Faecal Calprotectin
Negative coeliac disease serology (anti-TTG antibodies)
Cancer not suspected or been excluded

63
Q

Irritable Bowel Syndrome - what is the lifestyle advice?

A

Adequate fluids
Regular small meals
Limit caffeine and alcohol
Reduce processed foods

64
Q

Irritable Bowel Syndrome - what is the medical management?

A

1st line - Loperamide for diarrhoea
Laxatives for constipation, Linaclotide
Antispasmodics for cramps, buscopan

2nd line - Tricyclic antidepressants, amitriptyline

3rd line - SSRIs

65
Q

Coeliac Disease - what is it?

A

It is an autoimmune condition where exposure to gluten peptides causes inflammation in small bowel

66
Q

Coeliac Disease - what happens when gluten is ingested?

A

Auto-antibodies are created in response to gluten, and they target epithelial cells of the intestine, lead to inflammation

67
Q

Coeliac Disease - what are the names of the two auto-antibodies?

A

Anti-tissue transglutaminase (anti-TTG)

Anti-endomysial (anti-EMA)

68
Q

Coeliac Disease - what part of the system does the inflammation affect, what damage does it do, and what does that lead to?

A

Affects small bowel - particularly JEJUNUM

Damage:
Villous atrophy
Crypt hyperplasia
Inflammatory infiltration

Inflammation leads to malabsorption of nutrients and symptoms of coeliac

69
Q

Coeliac Disease - what are the symptoms?

A

Lots of variability and wide ranging symptoms

  1. Fatigue
  2. Weight loss
  3. Loose stools
  4. Steatorrhoea
  5. Abdo pain
  6. Failure to thrive
  7. Bloating
70
Q

Coeliac Disease - what are the signs?

A

Mouth:
Angular stomatitis
Mouth ulcers

Other:
Abdo distension
Neuropathy - secondary to hypocalcaemia or vit B12 def from malabsorption
Ecchymosis

71
Q

Coeliac Disease - what are some extra-intestinal manifestations?

A

Anaemia - from malabsorption or iron and folate

Osetoporosis - from malabsorption of calcium ad vitamin D

Dermatitis herpetiformis - pruritic rash, blistering skin condition typically on abdomen

Other - neuropathy, secondary to hypocalcaemia or vit B12 def from malabsorption

72
Q

Coeliac Disease - what autoantibodies do you test for when trying to diagnose?

A

Investigations must be carried out while patient is still on a gluten based diet

  1. Firstly check, total IgA immunoglobulin A levels - so to exlude IgA deficiency
  2. Then check for to see whether specific anti-TTG and anti-EMG autoantibodies are RAISED
73
Q

Coeliac Disease - what bedside and bloods investigations can you do?

A

Bedside:
Obs
ECG
Stool Culture

Bloods:
FBC
Blood film
LFTs

74
Q

Coeliac Disease - management?

A

Lifelong gluten free diet

75
Q

Coeliac Disease - associated medical conditions?

A

Associated with other autoimmune medical conditions such as:

Type 1 diabetes mellitus
Primary Sclerosing Cholangitis
Autoimmune hepatitis

76
Q

Coeliac Disease - what conditions can develop if you don’t treat CD?

A

Enteropathy-associated T cell lymphoma (EATCL)

Ulcerative jejunitis

Finals Revision Flashcards (49 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions