GI/Liver Flashcards
1
Q
What are the two major causes of acute pancreatitis?
What is the pneumonic for other causes?
A
BIG TWO: Gallstones + Alcohol
I GET SMASHED - Idiopathic, Gallstone, Ethanol Abuse, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion stings, Hyperlipidaemia & Hypercalcaemia, ERCP procedure, Drugs
2
Q
What is the characteristic presentation of acute pancreatitis?
Symptoms?
A
Severe epigastric pain that radiates to the back
Weight loss, nausea/vomiting, shock
3
Q
2 names of bruising signs in acute pancreatitis?
Why can hypocalcaemia occur?
A
Cullen’s sign (belly button bruise), Grey Turner’s sign (bruising along flank)
Hypocalcaemia (used up by fat necrosis - saponification)
4
Q
Two major complications of acute pancreatitis?
How is acute pancreatitis managed?
How is it diagnosed? 2 out of 3 of what…
A
DIC & ARDS
Analgeisa, drainage of fluid, antibiotics if needed, rest
2 out of 3 of: Characteristic pain, raised serum amylase & lipase, abdominal CT scan
5
Q
What is chronic pancreatitis? What is the most common cause?
Name two other causes
A
“Multiple bouts of acute inflammation leading to irreversible damage”
Most common cause: ALCOHOL
Autoimmune pancreatitis & cystic fibrosis
6
Q
What is the characteristic presentation of chronic pancreatitis?
Signs based off of pancreatic insufficiency?
A
Similar presentation to acute:
Severe abdominal pain, epigastric pain radiating to the back, nausea/vomiting, anorexia
Malabsorption, weight loss, steatorrhoea (greasy + smelly stools), ADEK vitamin deficient
7
Q
What is a pancreatic pseudocyst? Accounts for how much of pancreatic masses
What are two dangers of a pseudocyst doing?
A
A collection of fluid rich in pancreatic enzymes, blood and necrotic tissue.
Form 75% of all pancreatic masses
Can rupture or form an abscess
8
Q
What is the cell type in the vast majority of pancreatic carcinoma?
Symptoms of pancreatic carcinoma?
Two signs of pancreatic carcinoma?
A
Epithelial cells lining ducts
Mid-epigastric pain radiates to mid or lower back, worse when lying flat
Nausea, vomiting, fatigue
Weight loss
Trousseau sign of malignancy - blood clots felt as small lumps under skin
Courvoisier sign - Gallbladder is enlarged & palpable & non-tender (unlike gallstones)
9
Q
Name the risk factors of pancreatic carcinoma
What key antigen and enzymes would be raised in pancreatic carcinoma? Is this diagnostic?
What is a Whipple procedure?
A
Family history (BRCA2), Diabetes, Chronic pancreatitis, Liver cirrhosis, Smoking, Obesity, Red meat, Male, Over 65
CA19-9 antigen is elevated along with serum amylase and serum lipase (NOT DIAGNOSTIC)
A complex surgical operation used to remove the head of the pancreas, first part of the small intestine, the gall bladder and the bile duct
10
Q
What is biliary atresia?
When would it present and what with?
A
Failure to form or early desturction of extrahepatic biliary tree
Present very early in life (within 3 months) with Jaundice
11
Q
What is primary sclerosing cholangitis?
Two important GI conditions it is associated with?
A
Inflammation and scarring of the bile ducts both inside and outside the liver
Ulcerative colitis and Crohn’s
12
Q
What does cholelithiasis mean?
Two types? More common?
Three reasons they occur?
A
Formation of gallstones
Cholesterol (70%) and bilirubin (30%)
- Supersaturation
- Decreased phospholipids or bile acids - Crohn’s and Cirrhosis
- Stasis
13
Q
Do cholesterol gallstones show up on X-ray?
What are the risk factors for cholesterol gallstones?
A
Generally no
Risk factors: 5 F’s: Female, Fertile, Fat, Fair, Forty
14
Q
Do bilirubin/pigmented gallstones show up on X-ray?
What are the risk factors for bilirubin/pigmented gallstones? (2)
A
Generally yes
Risk factors:
Extravascular haemolysis, biliary tract infection
15
Q
When do you treat gallstones?
What is the general symptoms of gallstones?
Two treatment options?
A
Only treat when symptomatic - often asymptomatic
Obstructive jaundice, colicky RUQ pain, nausea & vomiting
Only treated if symptomatic - cholecystectomy or bile acid dissolution therapy
16
Q
What are the 5 key complications of cholelithiasis?
A
Biliary colic:
Stone lodged causing colicky RUQ pain
Acute & chronic cholecystitis:
Inflammation of the gallbladder wall
Ascending cholangitis:
Bacterial infection of bile ducts
Gallstone ileus:
Rupture and stone enters small bowel
Gallbladder carcinoma:
Increased chance with cholelithiasis
17
Q
What is a positive Murphy’s sign?
Shows what condition?
Would differentiate from what other complication of gallstones?
A
Placing a hand at costal margic in RUQ - asking the patient to breathe deeply
Causing pain is positive
Acute cholecystitis
Differentiate from asecnding cholangitis
18
Q
What condition are Rokitansky-Aschoff sinuses associated with?
What is porcelain gallbladder?
A
Chronic cholecystitis
Calcified gall bladder from chronic inflammation
19
Q
What should be the texture of the liver normally? What does it become in cirrhosis? Why?
A
Should be smooth
Becomes bumpy - due to regenerative nodules from fibrosis
20
Q
What cells cause fibrosis in the liver? Where do they occupy? Name one other function of these cells
A
Stellate cells
Peri-sinusoidal space
Store vitamin A
21
Q
Name two main causes of cirrhosis?
3 other causes?
A
CHRONIC ALCOHOL & CHRONIC HEPATITIS
Autoimmune hepatitis
Iron or Copper overload
Other drug-related disease
22
Q
Complications of liver disease: Portal HTN leads to... (ABCDE) Increased oestrogen leads to (3) Ammonia leads to? Skin goes...? Hand tremors are called...?
A
Ascites Bleeding (from varices) Caput medusae Diminished liver function - hypoalbuminaemia, coagulation issues Enlarged spleen
Gynecomastia
Spider angiomata (more than 5)
Palmar erythema
Hepatic encephalopathy
Jaundice
Asterixis
23
Q
What number defines portal HTN?
A
> 12 mmHg
24
Q
What is Budd-Chiari syndrome?
A
A thrombus or tumour that obstructs venous flow in the liver towards the IVC
A rare cause of portal HTN
25
Flow-chart of non-alcoholic fatty liver disease?
| Associated with what syndrome? So, link with?
Steatosis -> Steatohepatitis -> Fibrosis -> Cirrhosis
Metabolic syndrome, link with insulin resistance
26
Symptoms of fatty liver disease:
Often?
Significant?
Often asymptomatic or non-specific (fatigue and malaise)
Significant damage - hepatomegaly, pain, jaundice, ascities
27
What does AST and ALT stand for?
Which of them is specific to liver, which is also found in other tissues?
What does GGT and ALP stand for?
Alanine transaminase
Aspartate transaminase
ALT: specific to liver
AST: also in heart, skeletal muscle kidney, pancreas etc
Gamma glutamyl transferase
Alkaline phosphatase
28
Which of ALT and AST is normally higher?
| High AST is often common with...
Normally ALT
High AST:
Alcoholic liver disease, Non-alcoholic fatty liver disease, cirrhosis
29
What level of fat is diagnostic for NAFLD?
>5% abnormal fat content
30
What is alcohol converted into in the liver?
What enzyme?
Why is this a problem with excess conversion?
Acetaldehyde
Alcohol dehydrogenase
Requires conversion of NAD+ into NADH which increases fat production leading to steatosis
31
What is ascites?
3 different causes?
Can investigate by...?
Accumulation of fluid in the peritoneal cavity caused an abdominal swelling
Portal HTN (cirrhosis/Budd-Chiari), Heart failure, infections (TB)
Can investigate by taking fluid and testing (neutrophils, protein, cytology, amylase)
32
3 types of jaundice/icterus?
Brief explanantion?
Colour of urine and stools?
Obstructive (extrahepatic) - bile duct obstruction (dark urine, pale stools)
Hepatocellular (intrahepatic) - disease of liver cells
(dark urine, normal stools)
Haemolytic (prehepatic) - increased destruction of RBCs (urine and stools normal)
33
What DILI stand for?
| What are the most common causes for this?
Drug Induced Liver Injury (DILI)
Paracetamol 50%, Idiosyncratic 15%
Also: antibiotics, CNS drugs, etc
34
What is the treatment for a paracetamol overdose?
| How does it work?
N acetyl cysteine (NAC)
Provides cysteine for glutathione synthesis - which gets conjugated with toxic metabolic of paracetmol
35
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HAV:
How is it spread?
Acute or chronic?
DNA or RNA?
Envelope?
Classicaly acquired by?
```
```
Faeco-oral route
Only acute (< 6 months)
RNA
No envelope
Travelers
```
36
```
HBV:
How is it spread?
Acute or chronic?
DNA or RNA?
Envelope?
```
Blood, perinatal transmission, sex, IV
Acute (normally) + Chronic
DNA
Does have envelope
37
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HCV:
How is it spread?
Acute or chronic?
DNA or RNA?
Envelope?
```
Blood, perinatal transmission, sex, IV
Acute + Chronic (normally)
RNA
Does have envelope
38
```
HDV:
How is it spread?
When does it occur (2 possibilities)m
DNA or RNA?
Envelope?
```
Blood, perinatal transmission, sex, IV
Co-infection with HBV or superinfection after HBV
RNA
Does have envelope
39
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HEV:
How is it spread?
Acute or chronic?
DNA or RNA?
Envelope?
Classicaly acquired from?
```
```
Faeco-oral route
Only acute (< 6 months)
RNA
No envelope
Contaminated water or undercooked seafood
```
40
What other two viruses can cause hepatitis?
EBV and CMV
41
What is the key marker of infection in hepatitis?
| When does it disappear?
Hepatitis B surface antigen (HBsAG)
| Only disappears if resolved
42
What does IgM (core) represent in hepatitis?
What does IgG (core) represent in hepatitis?
What does IgG (surface) represent in hepatitis?
IgM for HBcAB represents acute stage hepatitis
IgG for HBcAB represents chronic stage hepatitis
IgG for HBsAG represents resolution or immunization
43
Where will primary hepatocellular tumour normally spread to?
What do secondary liver cancers often come from? (4)
What is more common?
Lungs
Colon, Pancreas, Breast, Lung
Secondary is more common
44
What are common causes of hepatocellular carcinoma:
Most common? - which of these two is more dangerous?
Big category?
How can mouldy food be a problem?
```
Hep B (more dangerous due to being a DNA virus)
Hep C
```
Cirrhosis - alcoholic hepatitis, haemochromatosis, PBC, alpha1-antitrypsin deficiency
Aflatoxins due to aspergillus moulds in foods. Affects p53 gene
45
What is the name of the stool chart?
T1 and T2 = ?
T3 and T4 = ?
T5, T6, T7 = ?
BRISTOL Stool Chart
1, 2 = constipation
3, 4 = normal
5, 6, 7 = towards diarrhoea
46
What is gastroenteritis?
Main symptom
Other symptoms?
Same as "infective diarrhoea"
MAIN = DIARRHOEA
Other:
vomiting, abdominal pain, fever, fatigue, dehydration
47
Infectious diarrhoea causes:
VIRUS - percent, examples
BACTERIA - percent, examples
PARASITES - percent, example
In hospitals, risk is?
* Viruses (50-60%): Norovirus, Rotavirus, Astrovirus, Adenovirus
* Bacteria (30-40%): Salmonella (non-typhoidal, typhoidal, paratyphoidal), Campylobacter, E. Coli, Shigella, S. Aureus, C. Difficle, V. Cholerae
* Parasites (>2%): Giarda, Cryptosporidium
Hospitals - risk of C. diff
48
What are the drugs that frequently cause a C. difficle diarrhoea? (3)
What is the main two treatments?
How is it diagnosed?
Cephalosporins, Co-amoxiclav, Clindamycin
Metronidazole, Vancomycin
Using a stool sample - toxin test
49
What population does autoimmune hepatitis normally occur in?
Ratio of female to male?
Association with what two points?
ALT and AST
Common in young women
female:male = 4:1
HLA-DR3 and HLA-DR4, and other autoimmune disease
Both elevated, ALT > AST
50
What does PBC stand for?
Very basic pathophysiology?
Much more common in...?
Pimrary biliary cholangitis or Primary biliary cirrhosis
Autoimmune attack on bile duct
Much more common in females
51
What is the normal function of alpha-1 antitrypsin?
Therefore what does a deficiency lead to?
Affects which two orgnas?
How does it affect these?
A1AT normally inactivates elastase - therefore, lots of elastase breakdown with a deficiency
Lungs - can cause COPD
Liver - cirrhosis and liver failure
52
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Wilson's disease:
What is it?
What type of defect in what gene?
2 roles of this gene?
4 points that this affects?
```
Excess copper in the body
Autosomal recessive defect in the ATP7B gene
ATP7B enzymes binds Cu to apoceruloplasmin and excretes it into bile as well
Basal Ganglia - movement
Cerebral cortex - dementia
Cornea - Kayser-Fleischer rings
Liver - hepatitis, cirrhosis and liver failure
53
What is haemochromatosis?
Primary and Secondary?
How can it damage tissues?
Too much absorption of iron into the blood
Primary - gene mutation
Secondary - frequent blood transfusions
Forms free radicals via the Fenton reaction
54
List the tissues damaged in haemochromatosis and what the damage leads to?
Liver - cirrhosis, increased risk of cancer
Pancreas - T1DM and malabsorption
Heart - bronze pigmentation
Pituitary gland - amenorrhea and testicular atrophy
Joints - degenerative joint disease
Skin - Cardiomyopathies
55
Two types of peritonitis?
| Basic symptoms?
Localised - inflammation of an underlying organ
General - direct irritation of the peritoneum (more serious)
Dull pain that becomes sharp
Pain worse on coughing or moving
Systemic symptoms and generally unwell
56
Causes of peritonitis? (5) Bacteria - (3)
A (Appendicitis)
E (Ectopic pregnancy)
I (Infections) -
E. Coli, Enterococci, Streptococci
O (Obstruction)
U (Ulcer)
57
How would oesophageal cancer present?
Would it present early or late?
Specific SSC symptom?
Generally presents late
Progressive dysphagia, weight loss, haematemesis, chest pain
SSC: hoarse voice and cough
58
Two types of oesophageal cancer?
Where does each usually occur?
What is more common worldwide? What is more common in the west?
ADENOCARCINOMA
Normally lower 1/3rds
Most common type in the west
SQUAMOUS CELL CARCINOMA
Upper 2/3rds
Most common type worldwide
59
Oesophageal cancers:
What is the major risk factor for adenocarcinoma?
What are the risk factors for SSC - principle?
Special syndrome?
ADENOCARCINOMA:
GORD causing metaplasia in the oesophagus (Barrett's)
SSC: (irritation)
Alcohol, tobacco, very hot tea, achalasia (LES can't relax - food stuck), oesophageal webs
Plummer-Vinson Syndrome:
iron deficiency anaemia, glossitis, (big red tongue)
cheilosis, (side of mouth inflammation)
oesophageal webs/rings
60
How do you differentiate between a benign and malignant ulcer? (3 points)
Benign ulcers: small, punched out, no pile up of mucosa at edge
Malignant ulcers: large, irregular, pile up of mucosa at edge
61
Presentation of gastric carcinoma?
Risk factors?
3 rare signs?
What lymph node?
Presents late - weight loss, abdominal pain, dyspepsia and early satiety, nausea
Risk factors:
Family history, increases with age, alcohol, obesity, smoking
```
Acanthosis nigricans (thicken and darkening of skin at axilla
Leser-Trelat sign (brownish spots all over the skin)
Polyarteritis nodosa
```
Often spreads to left supraclavicular node (Virchow's node)
62
Two types of gastric adenocarcinoma?
| Which is more common?
INTESTINAL (more common) - large, irregular ulcer with heaped up margins
DIFFUSE (less common) - undifferentiated, worse prognosis
63
Intestinal gastric carcinoma:
Mainly associated with?
Where does it often occur?
Other risk factors?
Mainly associated with H. pylori
Less curvature of antrum
Risk factors: any intestinal metaplsia, nitrosamines (link to Japan), blood type A
64
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Diffuse gastric carcinoma:
Association with what mutation?
Where does it occur in the stomach?
What cells are seen?
What is linitis plastica?
```
CDH1 mutation
Anywhere in stomach
Signet ring cells
Thickening of stomach wall
65
3 other types of gastric cancer, other than adenocarcinoma?
Lymphoma in MALT
Carcinoid tumour - G-cell
Leiomyosarcoma - smooth muscle cells
66
What is Mallory-Weiss Syndrome?
What is the cause? Link to...
Main symptom?
Bleeding from a tear in the mucosa at the junction of the stomach and the oesophagus
Severe vomiting - often alcohol or bulimia
Painful haematemesis
67
Two complications of GORD?
What are the main risk factors?
What rare 3 conditions could also cause it?
Barrett's oesophagus and oesophageal stenosis
Risk factors:
Obesity, fat-rich diet, caffieine, alcohol, medications
Rare:
Hiatal hernia (stomach slides up through diaphragm)
Sclreoderma (muscle in LES is replaced with connective tissue)
Zollinger-Ellison Syndrome (gastroma which secretes gastrin)
68
Symptoms of GORD? - will worsen when....
3 investigations for diagnosis?
3 points on management?
Pyrosis (heartburn), Regurgitation, Stenosis, Chronic cough or hoarseness
WORSE WHEN LYING DOWN
pH monitoring, X-RAY w/ barium, Endoscopy w/ biopsy
Lifestyle changes - losing weight, avoiding certain foods (spice/fat/chocolate/coffee/alchol), keep head elevated during sleep, don't lie down after a meal
Antacids - neutralise acidity
PPIs (+ H2 receptor blockers if needed)
69
Two types of gastritis?
| Two subtypes of... (which of these is more common)
Acute and Chronic
Chronic - autoimmune or H. pylori (more common)
70
Risk factors for acute gastritis?
Curling ulcer = ?
Cushing ulcer = ?
3 complications?
NSAIDs, shock, chemotherapy, heavy alcohol
```
Curling = severe burns/trauma
Cushing = increased intracranial pressure (Vagal stimulation)
```
Superficial inflammation, erosion (loss of epithelium), ulcer (loss of mucosa)
71
Autoimmune chronic gastritis:
Where does it occur? (what cells does it attack?)
Associated with what type of anaemia?
Increases risk of?
Often occurs on the body and fundus - attack on gastric parietal cells
Pernicious anaemia - lack of intrinsic factor
Increased risk of gastric adenocarcinoma
72
Chronic H. pylori gastritis:
Where does it usually occur?
Increases risk of 3 things?
Treatment?
Antrum is common site
Increased risk of ulceration, gastric adenocarcinoma and MALT lymphoma
Treatment: triple therapy (2 antibiotics and 1 PPI)
Amoxicllin, Metronidazole, Esomeprazole
73
Two types of peptic ulcer disease: which is more common?
```
proximal duodenum (90%)
distal stomach (10%)
```
74
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What is the normal cause of a duodenal ulcer? Very rare other cause?
Does it worsen or improve with meals?
What happens to the Brunner glands?
Anterior or posterior usually?
Posterior complications (2)
```
H. pylori - rarely due to ZE syndrome (gastroma)
Improve with meals
Brunner glands will hypertrophy - more mucous for protection
Normally anterior
Acute pancreatitis and gastroduodenal artery affected
75
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What is the normal causes of a gastric ulcer?
Does it worsen or improve with meals?
Normally benign or malignant?
Where does it usually occur?
Complication due to this position?
```
Usually due to H pylori, but also NSAIDs and bile reflux
Worsens with meals
Normally benign - small, punched out, no pile up
Normally on lesser curvature of antrum
Risk of left gastric artery bleed
76
Normal presentation of peptic ulcer disease?
Main?
3 others
Weight loss vs Weight gain
Epigastric pain - aching or burning
Also - bloating, belching, vomiting/nausea
Weight loss: gastric
Weight gain: duodenal
77
Genes related to coeliac disease? Significance of these genes in practice?
What is the main antibody tested for?
What are the other two antibodies?
Note if these come back negative
HLA-DQ2 and HLA-DQ8 - high negative predictive value
IgA-tTG
IgA: endomysium & gliadin
Can be IgA deficient - test IgG instead
78
Usual presentation of coeliac disase:
Children & Adults
Association with what dermatological condition?
Children: abdominal distension, diarrhoea and failure to thrive
Adults: chronic diarrhoea and bloating with gluten association
DERMATITIS HERPETIFORMIS (IgA deposition)
79
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Pathophysiology of coeliac:
What component of gluten?
First step?
Moves into?
Second step?
Leads to two negative points...
```
```
Gliadin
Gliadin is bound to IgA
Moves into lamina propria
Deamidated by tTG
Inflammation -
B cells form antibodies
Inflammatory cytokines damage endothelium
```
80
2 main histological changes in coeliac disease?
Where does it occur most?
Can a refractory period occur? Why? (2)
Biopsy: flattening of villi, hyperplasia of crypts,
Most prominent in duodenum
Refractory disease may be present despite good dietary control - indication of small bowel carcinoma (rare) or T-cell lymphoma
81
How does IBS present?
Pathological changes?
2 risk factors?
Relapsing abdominal pain and change in bowel habits - relieved with defecation
No identifiable pathological changes
Gastroenteritis (norovirus, rotavirus), Stress
82
What is the two points of treatment for IBS?
Modify fibre for constipation or diarrhoea
Reduces FODMAPs (apples, cherries, peaches, artificial sweeteners, legumes, green veg)
83
What is the classical presentation of IBD?
Which quadrant in UC vs CD?
Which is more common?
Which is autoimmune, whcih is immune-related?
Teen to 30 year old with recurrent bouts of diarrhoea and abdominal pain
UC: rectum - left lower quadrant, AUTOIMMUNE
CD: ileum - right lower quadrant, IMMUNE-RELATED
Ulcerative colitis is more common than Crohn's disease
84
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Ulcerative colitis:
What layers of GI tract?
Distribution? (2)
Histological hallmark?
Loss of ... ? Called ... on x-ray?
Smoking is ... ?
```
Mucosa (+ submucosa) only (ulcer)
Begins in the rectum and extends proximally up to caecum (continuous)
Crypt abscess - histology hallmark
Loss of haustra (lead pipe)
Smoking is protective
85
Ulcerative colitis:
2 associations?
3 complications?
3 medications?
Association: Primary sclerosing cholangitis and p-ANCA (vasculitis links)
Complications: toxic megacolon, dysplasia & carcinoma
Anti-inflammatory drugs - sulfasalazine, mesalazine
Immunosuppressants - corticosteroids
Biologics - infliximab, golimumab, adalimumab
86
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Crohn's disease
What layers of GI tract?
Distribution? (2)
Histological hallmark?
Appearance on endoscopy called?
Smoking is ... ?
Genetic link?
```
Transmural (full thickness)
Anywhere from mouth to anus with skip lesions (most common is terminal ileum & colon)
Granulomas
Cobblestone mucosa
Smoking increases risk of CD
NOD2 gene - family history is important
87
Crohn's disease:
Any associations?
Complications?
3 medications?
AS, sacroiliitis, migratory polyarthritis, erythema nodosum, uveitis
Malabsorption with nutritional deficiency, kidney stones, fistula, carcinoma (if colonic disease is present)
Anti-inflammatory drugs
Antibiotics - control gut bacteria and reduce immune response
Immunosuppressants (corticosteroids - prednisolone)
88
What are the two important points about faecal calprotectin in practice?
Correlation with on-going or up-coming flare-ups
High negative predictive value - can exclude IBD
89
What is the most common cause for appendicitis:
Adults?
Children?
Two others?
Adult - fecalith (poo stone)
Children - lymphoid hyperplasia
Undigested seeds and pinworm infection
90
How does appendicitis present?
Initally...
Then...
What is it ruptures...
Initially:
Periumbilical pain, fever and nausea
Pain will localise to the right lower quadrant at McBurney's point
Rupture results in peritonitis that presents with guarding and rebound tenderness
91
Two complications of acute appendicitis?
| What is the treatment of appendicitis?
Rupture
Periappendiceal abscess
Appendectomy and abscess drained if present
92
What are the two types of polyps?
Which can form adenocarcinoma of the colon?
What is removed in colonoscopy?
Colonic:
Hyperplastic polyp - benign with no malignant potential
Adenomatous:
Benign - but pre-malignant
Both are removed in colonscopy - can't distinguish between them
93
What is the technical name of colorectal cancer?
Where is it most common?
Where does it have a worse prognosis?
Link to what heart disease?
Adenocarcinoma
More common in the distal colon
Worse prognosis in proximal colon
Link to S. bovis endocarditis
94
Two types of colorectal cancer cells?
What gene mutation?
Appearance?
Adenomatous: APC mutation, cells look normal
Serrated: DNA repair gene mutation, saw-tooth appearance
95
What are the two staging systems for colorectal cancer?
| Explain one of these?
TNM & Duke's
A: Mucosa only
B: Full layer
C: Full layer and 1 lymph node close to the bowel
D: Metastasis to liver, lungs or bones
96
Risk factors for colorectal cancer:
Three non-modifiable?
Three modifiable?
Two specific disorders?
Increasing age & IBD & genetics
Obesity, smoking, lack of fiber
Familial adenomatous polyposis (FAP)
Hereditary non-polyposis (HNPCC) - also leads to ovarian and endometrial cancer
97
Symptoms of cancer:
Initially...
Normal in ascending?
Normal in descending?
Initially asymptomatic
Asecnding: pain & weight loss, later diagnosis, anaemia from bleeding
Descending: bowel obstruction, earlier diagnosis, doesn't bleed as much, makes a ring
98
Colorectal cancer:
Tumour marker? Note on it?
Treatment?
Tumour marker CEA - not very specific, need colonoscopy
| Surgery & chemotherapy
99
What is the difference between ischaemic colitis and mesenteric ischaemia?
Which is more common?
Where does ischaemic colitis most commonly occur and why?
ISCHAEMIC COLITIS = large bowel (colon) - more common
MESENTERIC ISCHAEMIA = small bowel
Splenic flexure - water-shed area
100
What is a volvulus?
3 types and who is most common in?
What is the major complication?
"Twisting of intestine and supporting mesentery leading to bowel obstruction"
Sigmoid - common, pregnancy
Caecal - young adults
Midgut - small babies and children
Major complication = infarction
101
Two types of ischaemic GI aetiologies?
Examples?
What layers wil each infarct?
OCCLUSIVE: thrombus, thromboembolism, tumour, hernia, volvulus, intussuception
TRANSMURAL infarct
NON-OCCLUSIVE (systemic decrease - hypovolemia, low cardiac output)
MUCOSAL infarct
102
How does ischaemic colitis often present:
Initial:
Infarction:
Post-pranidal pain and weight loss
Severe pain and bloody diarrhoea
103
What does SBO stand for?
What are the two main causes?
More or less common than LBO?
Small bowel obstruction
Previous surgery - adhesions (60%)
Crohn's disease (25%)
More common than LBO
104
What does LBO stand for?
What are the two main causes?
More or less common than SBO?
```
Large bowel obstruction
Colorectal malignancy (90% in west)
Volvulus (more common in Africa)
```
105
Difference in presentation of LBO vs SBO:
Pain?
Vomiting?
Pain:
colicky in SBO
constant in LBO
Vomiting:
earlier in SBO
later in LBO - more faecal like
106
What are diverticula?
Where is it more common globlally?
Having diverticula is called?
Major complication is called?
Out-pouches of the intestinal wall
More common in the west
Diverticulosis
Diverticulitis - inflamed
107
Where do diverticula normally occur? Why?
| Difference between a true or false/pseudo diverticula? Which of these is more common?
Normally occur in colon - specifically the sigmoid colon
Smallest lumen - highest pressure on intestinal wall
True - all layer out-pouched
False - only mucosa and submucosa
108
What are the risk factors for diverticulosis? (4)
Low fibre, increased age, obesity, Marfans & Ehlers-Danlos
109
How does diverticulosis normally present?
Two points?
How does diverticulitis present in contrast? (4)
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Asymptomatic
Possibly bleeding (haematochezia -fresh), vague abdominal pain
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Left lower quadrant pain, tenderness, abdominal distention and fever
110
Two complications of diverticulosis?
Two causes of first?
Two examples of second?
DIVERTICULITIS - inflamed diverticula
Erosion of wall from high pressure
Lodged fecalith - often pain left lower quadrant, without bleeding
FISTULA
Colovesicular - bladder
Colovaginal - vagina
