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GI Alimentary Year 2 Medicine > GI Pathology > Flashcards

GI Pathology Flashcards

1
Q

What is oesophageal reflux?

A

Reflux of gastric acid into oesophagus

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2
Q

What happens when there is secrete oesophageal reflex?

A

Ulceration of oesophageal epithelium

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3
Q

What is the affect of oesophageal reflex on the epithelium?

A

Thickening

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4
Q

Name the complications of oesophageal reflex

A

Healing by fibrosis
Barretts oesophagus

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5
Q

What are the affects of healing by fibrosis for oesophageal reflux?

A

Stricture formation
Impaired oesophageal motility
oesophageal obstruction

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6
Q

What is Barrett’s oesophagus?

A

Transformation from squamous epithelium to glandular epithelium

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7
Q

Name the histological types of oesophageal cancer?

A

Squamous carcinoma
Adenocarcinoma

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8
Q

What are the risk factors for squamous oesophageal carcinoma?

A

Smoking
Alcohol
Diet

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9
Q

What are the risk factors for adenocarcinoma oesophageal cancer?

A

Barrett’s oesophagus
Obesity

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10
Q

Name the local affects of oesophageal cancer?

A

Obstruction
Ulceration
Perforation

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11
Q

How does oesophagus cancer spread?

A

Direct
Lymphatic spread
Blood spread

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12
Q

Where does oesophageal cancer spread to though the blood?

A

Liver

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13
Q

What is the prognosis of oesophageal cancer?

A

Very poor
5 year survival rate >15%

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14
Q

What is type A gastritis?

A

autoimmune

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15
Q

What is type B gastritis?

A

Bacterial

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16
Q

What is type C gastritis?

A

Chemical injury

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17
Q

What is autoimmune gastritis caused by?

A

Autoantibodies to parietal cells and intrinsic factor

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18
Q

What is gastritis?

A

inflammation of the gastric mucosa

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19
Q

What are the affects of loss of specialised cells in autoimmune gastritis?

A

Decreased acid secretion
Loss of intrinsic factor

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20
Q

How does autoimmune gastritis affects the epithelium?

A

Atrophy of specialised acid secreting gastric epithelium

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21
Q

What is the most common type of gastritis?

A

type B

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22
Q

What bacteria causes bacterial gastritis?

A

Helicobacter pylori

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23
Q

Where is Helicobacter pylori found?

A

In gastric mucus on surface of gastric epithelium

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24
Q

What type of bacterium is helicobacter pylori?

A

Gram negative

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25
Q

What does Helicobacter pylori do?

A

Increased acid production

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26
Q

What are the causes of chemical gastritis?

A

Drugs
Alcohol
Bile reflex

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27
Q

What drugs most commonly cause chemical gastritis?

A

NSAIDS

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28
Q

What is peptic ulceration?

A

Imbalance between acid secretion and mucosal barrier

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29
Q

What parts of the oesophagus does peptic ulceration affect?

A

Lower oesophagus

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30
Q

What parts of the stomach does peptic ulceration affect?

A

Body
Antrum

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31
Q

What parts of the duodenum does peptic ulceration affect?

A

First and second parts

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32
Q

What parts of the GI tract does peptic ulceration affect?

A

Oesophagus
Stomach
Duodenum

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33
Q

What bacteria is peptic ulceration associated with?

A

H. Pylori

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34
Q

Name the complications of peptic ulceration?

A

Bleeding
Perforation
Healing by fibrosis

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35
Q

What is stomach cancer associated with?

A

Previous H. Pylori infection

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36
Q

How does stomach cancer develop?

A

Develops though phases of intestinal meta plasma and dysplasia

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37
Q

What is the histology of stomach cancer?

A

Adenocarcinoma

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38
Q

Name the ways stomach cancer spreads?

A

Direct
Lymphatic
Blood
Transoelomic

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39
Q

Where does transcoelomic spread of stomach cancer occur?

A

Within peritoneal cavity

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40
Q

What is the prognosis of stomach cancer?

A

Very poor
5 year survival >20%

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41
Q

What is liver failure a complication of?

A

Acute liver injury
Chronic liver injury

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42
Q

What can cause acute liver injury?

A

Hepatitis
Bile duct obstruction

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43
Q

What can cause hepatitis?

A

Viruses
Alcohol
Drugs

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44
Q

How does viral hepatitis affect the liver?

A

Inflammation of liver
Liver cell damage and death of individual liver cells

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45
Q

What type of hepatitis progresses to chronic hepatitis and cirrhosis?

A

Hepatitis B, C

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46
Q

What type of hepatitis can cause liver failure due to severe damage?

A

Hepatitis A,B,E

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47
Q

In what type of hepatitis does the liver return to normal?

A

Hepatitis A,E

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48
Q

What is alcoholic liver disease?

A

Response of liver to excess alcohol

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49
Q

What can alcoholic liver disease progress to?

A

Cirrhosis

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50
Q

What are the affects of alcoholic hepatitis?

A

Acute inflammation
Liver cell death
Liver failure

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51
Q

What is jaundice caused by?

A

Altered metabolism of bilirubin

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52
Q

What is jaundice?

A

Increased circulating bilirubin

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53
Q

Name the pathways of bilirubin metabolism

A

Pre-hepatic
Hepatic
Post-hepatic

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54
Q

Describe pre-hepatic bilirubin metabolism

A

Breakdown of haemoglobin in spleen to form haem and glob in
Haem converted to bilirubin which is released

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55
Q

Describe hepatic bilirubin metabolism

A

Uptake of bilirubin by hepatocytes
Conjugation of bilirubin in hepatocytes
Excretion of conjugated bilirubin into the biliary system

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56
Q

Describe post- hepatic bilirubin metabolism?

A

Transport of conjugated bilirubin in biliary system
Breakdown of bilirubin conjugate in intestine
Re-absorption

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57
Q

What is the cause of pre-hepatic jaundice?

A

Increased release of haemoglobin from red cells

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58
Q

What are the causes of hepatic jaundice?

A

Cholestasis
Intra-hepatic bile duct obstruction

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59
Q

What is cholestasis?

A

Accumulation of bile within hepatocytes or bile canaliculi

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60
Q

What are the causes of cholestasis?

A

Viral hepatitis
Alcoholic hepatitis
Liver failure
Drugs

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61
Q

What is predicable drug induced cholestasis

A

Dose related

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62
Q

Give examples of intra-hepatic bile duct obstruction

A

Primary bile cholangitis
Primary sclerosing cholagnits
Tumours of the liver

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63
Q

Name the tumours of the liver

A

Hepatocellular carcinoma
Tumours of intra-hepatic bile duct
Metastatic tumours

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64
Q

What sex does primary biliary cholangitis affect?

A

Females

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65
Q

What is primary biliary cholangitis?

A

Organ specific auto-immune disease

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66
Q

What are the effects of primary biliary cholangitis?

A

Anti-mitochondrial auto-antibodies in serum
Raised serum alkaline phosphatase

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67
Q

What happens to the bile ducts in primary biliary cholangitis?

A

Gramulamous inflammtion
Loss of intra-hepatic bile ducts

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68
Q

What is primary sclerosing cholangitis?

A

Chronic inflammation and fibrous obliteration of bile ducts

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69
Q

What is primary sclerosing cholangitis associated with?

A

inflammatory bowel disease

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70
Q

What does primary sclerosing cholangitis give an increased risk of?

A

Development of cholangiocarcinoma

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71
Q

What is hepatic cirrhosis?

A

End stage chronic liver disease

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72
Q

What are the causes of cirrhosis?

A

Alcohol
Hepatitis
Immune mediated liver disease
Metabolic disorders
Obesity

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73
Q

What metabolic disorders cause cirrhosis

A

Primary haemochromatosis
Wilson’s disease

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74
Q

What is Wilson’s disease?

A

Excess copper

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75
Q

What is primary haemochromatosis?

A

Excess iron

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76
Q

What immune mediated liver diseases cause cirrhosis?

A

Auto-immune hepatitis
Primary biliary cholangitis

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77
Q

What are the affects of cirrhosis on liver structure?

A

Loss of normal structure
Replaced by nodules of hepatocytes and fibrous tissues

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78
Q

Name the complications of cirrhosis?

A

Liver failure
Portal hypertension

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79
Q

What does cirrhosis increase the risk for?

A

Hepatocellular carcinoma

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80
Q

What is hepatocellular carcinoma?

A

Malignant tumor of hepatocytes.

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81
Q

What is cholangiocarcinoma?

A

Malignant tumour of bile duct epithelium

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82
Q

What are the risk factors for gallstones?

A

Obesity
Diabetes

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83
Q

What is acute cholecystitis?

A

Acute inflammation of the gallbladder

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84
Q

How does acute cholecystitis affect the gallbladder?

A

Perforation of gall bladder
Biliary peritonitis

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85
Q

What is chronic cholecystitis?

A

Chronic inflammation and fibrosis of the gallbladder

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86
Q

What are the common causes of common bile duct obstruction

A

Gallstones
Bile duct tumours
Benign stricture
External compression

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87
Q

What are the affects of common bile duct obstruction?

A

Jaundice
No bile excreted into duodenum
Ascending cholangitis

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88
Q

What is ascending cholangitis?

A

Infection of bile prosimians to obstruction

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89
Q

What can happen if there is prolonged common bile duct obstruction?

A

Secondary biliary cirrhosis

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90
Q

How often are the cells in the small bowel renewed?

A

every 4-6 days

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91
Q

What type of crypts are found in the small bowel?

A

Stem
Goblet
Endocrine
Paneth

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92
Q

What cell types are found in the small bowel?

A

Goblet dells
Columnar absorptive cells
Endocrine cells

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93
Q

What type of crypts are found in the large bowel?

A

Tubular

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94
Q

What must the immune system balance in the GI tract?

A

Tolerance of harmless ingested substances against active defence reactions to potential microbial invaders

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95
Q

What is the bowel peristalsis mediated by?

A

Intrinsic myenteric plexus and extrinsic autonomic innervation neural control

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96
Q

What is the myenteric plexus made up of?

A

Meissener’s plexus
Auerbach plexus

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97
Q

Where is Meisseners plexus located?

A

Base of the submucosa

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98
Q

Where is Auerbach’s plexus located?

A

between the inner circular and outer longitudinal muscle layers of the muscularis propria

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99
Q

Define idiopathic inflammatory bowel disease

A

Chronic inflammatory conditions resulting from inappropriate and persistent activation of the mucosal immune system driven by the presence of normal intraluminal flora

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100
Q

Name the main idiopathic inflammatory bowel diseases

A

Crohn’s disease
Ulcerative colitis

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101
Q

What gene mutation is associated with Crohn’s disease?

A

NOD2

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102
Q

what gene is associated with ulcerative colitis?

A

HLA

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103
Q

What is the cause of IBD?

A

Strong immune response against normal flora with defects in epithelial barrier

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104
Q

What is used to diagnose IBD

A

pANCA

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105
Q

which type of IBD is associated with p-ANCA

A

UC

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106
Q

What age does UC peak?

A

20-30 years
70-80 years

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107
Q

Where is UC found?

A

Localised to rectum

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108
Q

Where does UC commonly spread

A

Proximally

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109
Q

What is found in UC?

A

Psudopolyps
Ulceration
Inflammation

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110
Q

What is UC associated with?

A

Systemic manifestations

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111
Q

Are granumolas present in UC?

A

No

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112
Q

Where is the wall is UC limited to?

A

Mucosa and submucosa

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113
Q

How does UC affect the mucosa?

A

Mucosal atrophy

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114
Q

How does UC affect crypts?

A

Cyptisis
Crypt abscesses
Architectural disarray of crypts

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115
Q

Name complications of UC

A

Haemorrhage
Perforation
Toxic dilation

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116
Q

Describe dysplasia of UC progressing to cancer

A

Flat epithelial atypica
Adenomatous change
Invasive cancer

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117
Q

What is there an increased risk of if pancolitis is present in UC?

A

20-30 x higher risk of developing cancer

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118
Q

Where is Crohn’s disease located?

A

Anywhere from mouth to anus

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119
Q

What sex does Crohn’s disease affect more?

A

Females

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120
Q

What age does Crohn’s disease peak?

A

20-30 years
60-70 years

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121
Q

What race is Crohn’s disease most common?

A

Caucasians - Jewish population

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122
Q

Where is most Crohn’s disease located?

A

Small intestine

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123
Q

How does CD affect the mesentary?

A

Thickened
Oedematous
Fibrotic
Wrapping mesenteric fat

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124
Q

How does CD affect the lumen?

A

Narrowing of lumen due to thickened wall

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125
Q

Describe ulceration in CD

A

Deep
Cobblestone apperance

126
Q

What granulomas are found in CD

A

Non-caseating granulomas

127
Q

How does CD affect crypt?

A

Cryptitis
Crypt destruction to due atrophy
Distortion

128
Q

Define lymphagiectasia

A

Dilation of lymph vessels
Seen in CD

129
Q

What type of inflammation is seen in CD?

A

Transmural

130
Q

What are the long term features of CD

A

Malabsorption
Strictures
Fistulas
Perforation

131
Q

How much increased risk of cancer is there due to CD?

A

5x increased risk

132
Q

What leads to infarction in colon?

A

Acute occlusion of 1 of 3 major supply vessels

133
Q

Where are ischaemic lesions found?

A

Either restricted to SI or LI
Or can affect both depending on vessel affected

134
Q

What causes ischaemic enteritis?

A

Transmural injury
Acute/ chronic hypoperfusion

135
Q

Name predisposing conditions for ischaemia

A

Arterial thrombosis/ embolism
Non- occlusive ischaemia

136
Q

What flexure is vulnerable in acute ischaemia?

A

Splenic flexure

137
Q

What occurs if acute ischaemia last for several days?

A

Bacteria gangrene and perforation

138
Q

What does the lumen contain in acute ischaemia?

A

Sanguinous mucin

139
Q

Is inflammation present in acute ischaemia?

A

Initial absence of inflammation

140
Q

What is radiation colitis?

A

Abdominal irradiation can impaired the normal proliferative activity of the bowel epithelium

141
Q

What radiotherapy usually caused radiation colitis?

A

Rectum- pelvic radiotherapy

142
Q

What does radiation colitis target?

A

Actively dividing cells especially blood vessels and crypt epithelium

143
Q

What are the symptoms of radiation colitis?

A

Anorexia
Abdominal cramps
Diarrhoea
Malabsorption

144
Q

What cells are inflamed due to radiation colitis?

A

Crypt abscesses and eosinophils

145
Q

What type of stenosis does radiation colitis cause?

A

Arterial stenosis

146
Q

What are the affects of severe radiation colitis?

A

Ulceration
Necrosis
Haemorrhage
Perforation

147
Q

What happens to the lymphoid tissue in the appendix?

A

Regresses with age

148
Q

What is the cause of appendicitis?

A

Obstruction

149
Q

What causes obstruction in the appendix?

A

Foe coli the
Enterobius vermicularis

150
Q

What causes ischaemia in appendicitis?

A

Increased intraluminal pressure

151
Q

What occurs in acute gangrenous appendicitis?

A

Full thickness necrosis and perforation

152
Q

What is dysplasia?

A

abnormal changes in the size, shape, and organization of mature cells

153
Q

Name the types of adenoma dysplasia?

A

Tubular
Villus
Tubulovillous

154
Q

What are the affects of low grade dysplasia?

A

Increased nuclear no and size
Reduced mucin

155
Q

What is the difference between high grade dysplasia and carcinoma?

A

Dysplasia is not yet invasive

156
Q

What do the cells look like in high-grade dysplasia?

A

Crowded
Very irregular

157
Q

What genes are a risk factor for colorectal adenocarcinoma?

A

FAP
HNPCC
Peutz-jeghers

158
Q

What are the risk factors for colorectal adenocarcinoma?

A

Lifestyle
Family history
IBD
Genetics

159
Q

Describe the characterises of left sided colorectal adenocarcinoma?

160
Q

Describe the characterises of right sided colorectal adenocarcinoma?

A

Exophytic/ polypoid

161
Q

How does left-sided colorectal adenocarcinoma affect the blood?

A

Bleeding flesh/ altered blood rectally

162
Q

How does right-sided colorectal adenocarcinoma affect the blood?

163
Q

What are the effects of left-sided colorectal adenocarcinoma?

A

Altered bowel habit
Obstruction

164
Q

What are the effects of right-sided colorectal adenocarcinoma?

A

Vague pain
Weakness
Obstruction

165
Q

What does the prognosis of colorectal adenocarcinoma depend on?

A

Tumour grade
Tumour stage
Extramural venous invasion

166
Q

What is extramural venous invasion?

A

Direct invasion of a blood vessel by a tumour

167
Q

What is the treatment for colorectal cancer?

168
Q

What is oesophageal peristalsis produced by?

A

Oesophageal circular muscles

169
Q

What mediates contraction and relation of LOS?

A

Vagus nerve

170
Q

What muscle is the lower oesophageal sphincter?

A

Striated muscle of right crus of diaphragm

171
Q

Where is there high pressure is the LOS?

A

In distal smooth muscle

172
Q

What is a heart burn?

A

Restrosternal discomfort or burning

173
Q

What are the symptoms of oesophageal disease

A

Heartburn
Dysphagia

174
Q

What is heartburn associated with?

A

Waterbrash
Cough

175
Q

What is waterbrash?

A

Acidic taste at back of throat

176
Q

What is heartburn the consequence of?

A

Reflux of acid/ bilious gastric contents into the oesophagus

177
Q

What can reduce LOS pressure resulting in heartburn?

178
Q

What can persistent heartburn lead to?

A

Gastro-oesophageal reflux disease

179
Q

What is dysphagia?

A

subjective sensation of difficulty or abnormality of swallowing

180
Q

What is odynophagia?

A

painful swallowing

181
Q

Where are the locations of dysphagia?

A

Oropharyngeal
Oesophageal

182
Q

What are the causes of oesophageal dysphagia?

A

Benign stricture
Malignant stricture
Motility disorder
Eosinophilia oesophagitis

183
Q

What are the common investigations done for oesophageal disease?

A

Oesophago-gastro-duodenoscropy (OGD)
Upper GI endoscopy

184
Q

What are the less common investigations done for oesophageal disease?

A

Barium swallow
Ph- metry
Manometry

185
Q

What does pH-metry measure?

A

Acid levels in stomach

186
Q

What does manometry measure?

A

Pressure waves

187
Q

Name motility disorders?

A

Achalasia
Hypermotility
Hypomotilty

188
Q

What is hypermotility also known as?

A

Diffuse oesophageal spasm

189
Q

What are the symptoms of hypermotility?

A

Severe, episodic chest pain
Dysphagia

190
Q

What does manometry show in hypermotility?

A

Exaggerated, uncoordinated, hypertonic contractions

191
Q

What is the treatment for hypermotility?

A

Smooth muscle relaxants

192
Q

What is hypomobility associated with?

A

Connective tissue disease
Diabetes
Neuropathy

193
Q

What causes the symptoms of hypomotility?

A

Failure of LOS mechanism

194
Q

What are the symptoms of hypomotility?

A

Heartburn
Reflux

195
Q

What is achalasia?

A

Functional loss of myenteric plexus ganglion cells in distal oesophagus and LOS

196
Q

What is the cardinal feature of achalasia?

A

Failure of LOS to relax

197
Q

In what age is achalasia the most common?

A

30-50 years

198
Q

What can achalasia lead to?

A

Functional distal obstruction of oesophagus

199
Q

What are the symptoms of achalasia?

A

Progressive dysphagia
Regurgitation
Chest pain
Weight loss

200
Q

What are the pharmacological treatments of achalasia?

A

Nitrates
Calcium channel blockers

201
Q

What are the endoscopic treatments of achalasia?

A

Botulinum toxin pneumatic balloon dilation

202
Q

What are the surgical treatments of achalasia?

203
Q

What are the radiological treatments of achalasia?

A

Pneumatic balloon dilation

204
Q

What are the complications of achalasia?

A

Aspiration pneumonia and lung disease
Increased risk of squamous cell oesophageal carcinoma

205
Q

What is GORD due to?

A

Pathological acid exposure in lower oesophagus

206
Q

What are the symptoms of GORD?

A

Heartburn
Cough
Waterbrash
Sleep disturbances

207
Q

What are the risk factors for GORD?

A

Pregnancy
Obesity
Drugs lowering LOS pressure
Smoking
Alcoholism
Hypomotility

208
Q

What sex is more affecte by GORD?

209
Q

What race is more affected by GORD?

210
Q

How can GORD be diagnosed?

A

Basis of the characteristic symptoms, without diagnostic testing

211
Q

When would endoscopy be performed for GORD?

A

In presence of alarm features suggestive of malignancy

212
Q

What is the cause of GORD due to hiatus hernia?

A

Anatomical distortion of the OG junction

213
Q

What is the cause of GORD without abnormal anatomy?

A

Relaxed/ hypotension LOS
Delayed oesophageal/gastric emptying
Delayed oesophageal acid clearing

214
Q

What are the two main types of hiatus hernia?

A

Sliding
Para-oesophageal

215
Q

What happens in a hiatus hernia?

A

Fundus of stomach moves proximally through the diaphragmatic hiatus

216
Q

What are risk factors for hiatus hernia?

A

Obesity
Age

217
Q

What can happen to the oesophagus in severe cases of GORD?

A

Erosive oesophagitis

218
Q

What happens to the cells in GORD?

A

Mucosa exposed to acid-pepsin and bile
Increased cell loss and regenerative activity

219
Q

What are the complications of GORD?

A

Ulceration
Stricture
Glandular metaplasia
Carcinoma

220
Q

What is Barretts oesophagus a precursor to?

A

Dysplasia
Adenocarcinoma

221
Q

What is Barrett’s oesophagus?

A

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus

222
Q

What sex is most affected by Barrett’s oesophagus

223
Q

What is the risk of developing oesophageal cancer due to Barretts oesophagus

224
Q

What are the main treatment for Barretts oesophagus ?

A

Endoscopic mucosal resection
Radio-frequency ablation

225
Q

What is Oesophagectomy rarely done for treatment of Barretts oesophagus?

A

Due to mortality of 10%

226
Q

What are the pharmacological treatments for empirical GORD?

A

Alginates
H2RA
Proton pump inhibitor

227
Q

What is the treatment of refractory GORD

A

Anti-reflux surgery

228
Q

What is the median age of diagnosis for oesophageal cancer?

229
Q

What type of oesophageal cancer is most common?

A

Adenocarcinoma is Western Europe/USA
Squamous everywhere else

230
Q

What are the main symptoms of oesophageal cancer?

A

Progressive dysphagia
Anorexia and weight loss

231
Q

What part of the oesophagus does squamous cell carcinoma occur?

A

Proximal and middle third of oesophagus

232
Q

What is oesophageal squamous cell carcinoma associated with?

A

Achalasia
Caustic stricture
Plummer-Vinson syndrome

233
Q

What is oesophageal squamous cell carcinoma preceded by?

A

Dysplasia
Carcinoma in situ

234
Q

Describe the characteristics of oesophageal squamous cell carcinoma

A

Large exophyic occluding tumours

235
Q

what are significant risk factors for oesophageal squamous cell carcinoma?

A

Tobacco
Alcohol

236
Q

What part of the oesophagus does adenocarcinoma occur?

A

Distal oesophagus

237
Q

What are the predisposing factors for oesophageal adenocarcinoma?

A

Obesity
Male
Middle age
Caucasian

238
Q

What limits surgery for oesophagus cancer?

A

Local invasion due to no peritoneal lining in mediastinum

239
Q

Where does oesophageal cancer commonly metastasis?

A

Hepatic
Brain
Pulmonary
Bone

240
Q

What is oesophageal cancer diagnosed by?

A

Endoscopy
Biopsy

241
Q

What is used in the staging of oesophageal cancer?

A

CT scan
Endoscopic ultrasound
PET scan
Bone scan

242
Q

What is the treatment for oesophageal cancer?

A

Surgical oesophagectomy +/- adjuvant or neoadjuvant chemotherapy

243
Q

Who is oesophagectomy limited to?

A

Patients with localised disease, without co-morbid disease usually <70 years of age

244
Q

What is the mortality rate for oesophagectomy?

245
Q

What is the priority in oesophageal cancer treatment?

A

palliative treatment to Alleviate Symptoms

246
Q

What are the treatment options of swallowing difficulties in oesophageal cancer?

A

Endoscopic
Chemotherapy
Radiotherapy
Brachytherapy

247
Q

How is eosinophilic oesophagitis defined clinically?

A

Symptoms of oesophageal dysfunction

248
Q

How is eosinophilia oesophagitis defined pathologically?

A

Eosinophilic infiltration of the oesophageal epithelium in the abscesses of secondary causes of local or systemic eosinophilia

249
Q

What age is eosinophilia oesophagitis more commonly seen in?

A

Children and young adults

250
Q

What are the symptoms of eosinophilic oesophagitis?

A

Dysphagia
Food bolus obstruction

251
Q

What is the treatment for eosinophilic oesophagitis

A

Corticosteroids
Dietary elimination

252
Q

What is the treatment for severe eosinophilic oesophagitis

A

Endoscopic dilatation

253
Q

Define satiety

A

feeling of fullness

254
Q

What is dyspepsia?

A

Pain or discomfort in the upper abdomen for 4 weeks

255
Q

What causes the symptom of dyspeptisa?

A

Gallstones
Coeliac disease
Drugs
Psychological
GI

256
Q

What are the symptoms of dyspepsia?

A

Upper abdominal discomfort
Retro sternal pain
Anorexia
Nausea

257
Q

What drugs can cause dyspepsia?

A

NSAIDS
Steroids
Bisphophonates
Ca antagonists
Theophylline

258
Q

When would you refer to endoscopy for dyspepsia?

A

Anorexia
Loss of weight
Anaemia
Recent onset >55 years
Melaena
Swallowing problems

259
Q

What are the risk factors of upper GI endoscopy

A

Bleeding
Perforation
Reaction to drugs given

260
Q

What is the shape of helicobacter pylori?

261
Q

When is H.pylori acquired?

262
Q

Where does H.pylori colonize?

A

Gastric type mucosa

263
Q

where does h.pylori reside?

A

In the surface mucous layer

264
Q

What does H.pylori evoke?

A

Response in underlying mucosa

265
Q

How does H. pylori survive in the stomach?

A

Produces ammonia from urea to neutralize the acid

266
Q

What happens when H.pylori progresses to antral predominant gastritis?

A

Increased acid
Du disease

267
Q

What happens when H.pylori progresses to corpus predominant gastritis?

A

Decreased acid
Gastric atrophy
Gastric cancer

268
Q

What are the non invasive tests for diagnosis of H. Pylori?

A

Serology - IgG
Urea breath test
Stool antigen test - ELISA

269
Q

What are the invasive tests for the diagnosis of H.pylori?

A

Culture of gastric biopsies
Rapid slide urease test
Histology

270
Q

What is utilised in breath tests for H.pylori infection diagnosis?

A

13C or 14C labelled CO2

271
Q

What are the majority of peptic ulcers caused by?

A

H. Pylori infection

272
Q

What sex is most affected by peptic ulcers?

273
Q

When are peptic ulcers more common?

A

In elderly

274
Q

what are the risk factors for peptic ulcers?

A

NSAIDS
Smoking

275
Q

What conditions can cause peptic ulcers?

A

Zollinger-Ellison syndrome
Hyper parathyroid so
Crohn’s disease

276
Q

What are the symptoms of peptic ulcer?

A

Epigastic pain
Hunger pain
Back pain
Nausea

277
Q

What are the symptoms of a chronic peptic ulcer?

A

Weight loss and anorexia

278
Q

What symptoms are more common in DU peptic ulcers?

A

Back pain
Nocturnal/ hunger pain

279
Q

what are the symptoms of a peptic ulcer bleeding?

A

Haematemesis
Melaena
Anaemia

280
Q

What is the treatment for complicated peptic ulcer?

281
Q

What is the treatment of peptic ulcers?

A

Antacid medication
Proton pump inhibitors

282
Q

What is the treatment of a peptic ulcer caused by H.pylori?

A

Eradication therapy to get rid of the bacteria

283
Q

How is a H.pylori infection eradication

A

Triple therapy for 7 days
Clarithromycin
Amoxicillin
PPI

284
Q

What is given for treatment of H.pylori infection if patient has penicillin allergy?

A

Tetracycline instead of amoxicillin

285
Q

What is the main reason for failure in eradicating H.pylori infection?

A

Resistance to antibiotics and poor compliance

286
Q

What are the complications of a peptic ulcer?

A

Bleeding
Perforation
Fibrosis stricture
Gastric outlet obstruction

287
Q

What are the complications of a peptic ulcer which is bleeding acutely?

A

Melaena
Haematemesis

288
Q

What are the complications of a peptic ulcer which is bleeding chronically?

A

Iron deficiency anaemia

289
Q

What is seen on bloods for gastric outlet obstruction?

A

Low Cl
Low Na
Low K

290
Q

How is gastric outlet obstruction diagnosed?

A

endoscopy of upper gastrointestinal tract

291
Q

What are the symptoms of gastric outlet obstruction?

A

Vomiting
Early satiety
Abdominal distension
Weight loss
Gastric splash

292
Q

What does the vomit look like in gastric outlet obstruction?

A

Lacks bile
Fermented foodstuffs

293
Q

How is gastric outlet obstruction treated?

A

Endoscopic balloon dilatation
Surgery

294
Q

What are the majority of gastric cancers?

A

adenocarcinomas

295
Q

What are the symptoms of gastric cancer?

A

Dyspepsia
Early satiety
Nausea
Weight loss
GI bleeding

296
Q

What are the risk factors of gastric cancer?

A

H. Pylori
Smoking
Diet
Genetics

297
Q

What genes are associated with gastric cancer?

A

HDGC
AD
CDH-1 gene

298
Q

What are the majority of gastric cancers caused by?

A

Sporadic with no demonstratble inherited component

299
Q

What is needed to made a histological diagnosis of gastric cancer?

A

Endoscopy
Biopsies

300
Q

What is the treatment for gastric cancer?

A

Chemotherapy
Surgical

301
Q

What are the staging investigations done for gastric cancer?

A

CT chest/abdo

302
Q

Endoscopic mucosal resection or mucosal ablation, esophagectomy, and chemoradiation are treatment options for cancer.

A

options for esophageal cancer.

303
Q

____ is the most common type of esophageal carcinoma in the United uk.

A

Adenocarcinoma

304
Q

The ____ segment of the esophagus is typically affected by esophageal adenocarcinoma.

A

The lower third segment

305
Q

The most common presenting sign of esophageal cancer is ____, initially for solids and then for liquid

A

esophageal cancer is dysphagia,

306
Q

Risk factors for squamous cell oesophagal carcinoma include ____

A

alcohol, hot liquids, caustic strictures, smoking, and achalasia

307
Q

The _____ segments of the esophagus are typically affected by esophageal squamous cell carcinoma.

A

The upper two third segments

308
Q

____ is a neoplasm associated with Barrett esophagus.

A

Esophageal adenocarcinoma

309
Q

____ is the imaging study that allows direct visualization and biopsy of esophageal cancer

A

Esophagogastroduodenoscopy

310
Q

____ is the most common type of esophageal carcinoma worldwide.

A

Squamous cell carcinoma

GI Alimentary Year 2 Medicine (7 decks)

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