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YEAR 1 > GI theory > Flashcards

GI theory Flashcards

1
Q

barrett’s oesophagus

A

complication of reflux
metaplasia of oesophagus mucosa -> intestinal

increased risk of dysplasia / neoplasia

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2
Q

eosinophilic oesophagus

A

allergic oesophagitis
Fx of allergies / asthma

feline looking oesophagus
treat w/ steroids / montelukast

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3
Q

benign oesophageal tumours

A

RARE
squamous papilloma (HPV)
leiomyomas - SM

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4
Q

malignant oesophageal tumours

A

squamous cell carcinoma (upper 2/3)
adenocarcinoma (lower 1/3, reflux risk)

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5
Q

peptic ulcer formation

A

increased acid production + failure of mucosal defence

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6
Q

benign gastric tumours

A

hyperplastic polyps
cystic fundic gland polyps

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7
Q

malignant gastric tumours

A

adenocarcinoma (H. pylori - intestinal / diffuse type)
lymphoma (maltoma - also H. pylori)
gastrointestinal stromal tumour (GIST) - gut pacemaker cells

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8
Q

coeliac histology

A

loss of villous height
intra-epithelial lymphocytes

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9
Q

small intestine tumours

A

primary RARE
lymphoma (maltoma / enteropathy associated T cell lymphoma - coeliac)
carcinoma (crohn’s / coeliac assoc)

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10
Q

appendix tumours

A

neuroendocrine neoplasm (most common)
LAMN / HAMN

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11
Q

oral tumours

A

squamous cell carcinoma (most common)
salivary gland tumour
lymphoma

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12
Q

oral malignancy signs

A

white patches
red patches
ulceration (painless)
lumps / swelling

floor of mouth + lateral tongue - HIGH RISK

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13
Q

intestinal failure defintion

A

inability to maintain adequate nutrition / fluid stasis via intestines

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14
Q

intestinal failure types

A

type 1 - short-term (surgical ileus, crit illness, vomiting)
self-limiting (+ fluids)

type 2 - medium (post surgery awaiting reconstruction)
PN support

type 3 - chronic (short bowel, crohn’s etc)
home PN, transplant

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15
Q

functional dyspepsia

A

bothersome indigestions symptoms + no evidence of structural disease

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16
Q

dyspepsia types

A

epigastric pain syndrome
- epigastric pain / burning

post-prandial distress syndrome
- postprandial fullness / early satiation

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17
Q

dyspepsia RF

A

younger, female, IBS, psychological comorbid, enteric infection, high BMI, NSAIDs, H. pylori

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18
Q

zollinger ellison syndrome

A

tumour in head of pancreas / duodenum -> increased stomach acid production -> peptic ulcer

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19
Q

outcomes of H. pylori infection

A

increased acid -> no atrophy -> ulcer

decreased acid -> atrophy -> gastric cancer

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20
Q

anaemia definition

A

reduced total RBC mass

Hb concentration
haematocrit (proportion)

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21
Q

mean corpuscular volume (MCV)

A

average volume of RBC

microcytic = low MCV, lack of iron
macrocytic = high MCV, lack of folic acid / B12

normal MCV - anaemia of chronic disease

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22
Q

B12 absorption

A

2 steps - gastric + small intestine

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23
Q

folic acid absorption

A

duodenum
(deficiency = will’s disease)

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24
Q

iron absorption

A

ferric form (eaten) -> ferrous form (ascorbic acid in gastric) -> soluble iron-ascorbate chelate -> absorption in duo / upper jejunum

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25
Q

causes of anaemia

A

dietary (rare)
malabsorption (lack of acid / small bowel disease)
blood loss (GI bleeding)

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26
Q

glasgow-blatchford score

A

identifies low risk GI bleeds

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27
Q

acute upper GI bleeding

A

cautery, clips, pro-coag spray
interventional radiology / surgery

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28
Q

acute lower GI bleeding

A

majority self-limiting
transfusion most commonly needed

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29
Q

barrett’s treatments

A

radiofrequency ablation
endoscopic mucosal resection (EMR)

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30
Q

achlasia

A

failure for LOS to relax + absent peristalsis

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31
Q

types of oesophageal dysmotility

A

distal oesophageal spasm (DES)
jackhammer oesophagus
absent peristalsis

dysphagia, retrosternal pain, reflux

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32
Q

cyclical vomiting syndrome

A

functional
recurrent episodes of N+V

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33
Q

somatic symptom disorder

A

mental illness
distressing bodily Sx

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34
Q

factious disorder

A

(munchausen’s’)
malingering for psychological gain

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35
Q

crohn’s complications

A

malabsorption
fistulas
anal disease
intractable disease
bowel obstruction
amyloidosis

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36
Q

UC complications

A

intractable disease
toxic megacolon
CRC
blood loss
electrolyte imbalance
extra GI manifestations

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37
Q

crohn’s vs UC

A

anywhere
skip lesions
thickened bowel + strictures
transmural inflamm
granulomas
fistulae

colon + rectum
mucosal ulceration +
thin walls
superficial inflamm
high cancer risk
extra GI common

38
Q

polyp styles

A

pedunculated - bros OUT
sessile - texture pad core
flat - also exists ??

39
Q

colon adenoma

A

MUST be removed

40
Q

inherited CRC

A

HNPCC + FAP

41
Q

pseudomembranous colitis

A

abx induced
patchy yellow membranous exudate on mucosal surface

42
Q

collagenous colitis

A

thickened basal lamina
patchy disease

43
Q

lymphocytic colitis

A

raised intraepithelial lymphocytes

44
Q

severity judge for UC

A

severe =
>6 bloody stools / 24h
+ 1 or more of:
1. fever
2. tachycardia
3. anaemia
4. elevated CRP

45
Q

haemorrhoid grades

A
  1. bleeding, not out
  2. bleeding, in and out
  3. bleeding, push back in
  4. bleeding, always out
46
Q

seton stitch

A

keeps fistulae open

47
Q

ogilvie’s syndrome

A

acute dilation of the colon in absence of colonic obstruction

hip replacement / CABG / pneumonia / elderly

48
Q

hernia classification

A

hiatal - into thorax
internal - within abdomen
external - outside abdomen

49
Q

divarification of recti

A

NOT a hernia
thinning budge of linea alba

50
Q

hernia types

A
  1. spigelian - linea semilunaris
  2. incisional - failure of fascia to fully restore strength in surgical wound
  3. parastomal - type of ^
  4. obturator - through hip bone
51
Q

hernia complications

A
  1. irreducible - cant get it back in
  2. obstructed - bowel loop non-functioning
  3. strangulation - bowel loop ischaemic
52
Q

space of Disse

A

between hepatocytes + sinusoids

53
Q

liver metabolism

A
  1. fasting = glycogen breakdown + gluconeogenesis
  2. feeding = glycogen deposits
  3. lipids = chylomicrons (digested in bile)
  4. proteins = via CAC
  5. ammonia = converted to urea
54
Q

cirrhosis mech

A
  1. chronic inflamm damaged hepatocytes
  2. hepatic stellate cells activated (space of Disse)
  3. increase fibrosis
  4. cirrhosis!
55
Q

hazardous vs harmful drinking

A

14 - 35 (women)
14 - 50 (men)

35+ (women)
50+ (men)

56
Q

HBV bloods

A
  1. HBsAg - infection present
  2. HBeAg - high viral replication
  3. HBsAb - infection clearance / immunity (vaccine)
  4. HBeAb - reduced viral replication
  5. HBcAb - previous infection (NOT vaccine)
57
Q

HBV stages

A
  1. immune tolerant
    +HBeAg, yes HBV DNA, normal ALT, highly contagious
  2. immune reactant
    +HBeAg, yes HBV DNA, raised ALT
  3. inactive carrier
    -HBeAg, +HBeAb, lower HBV DNA, normal ALT
  4. chronic hep B
    -HBeAg, +HBeAb, high HBV DNA, raised ALT
  5. occult infection
    -HBsAg, +HBcAb / HBsAb, normal ALT, low HBV DNA
58
Q

TIPSS

A

contraindicated in hepatic encephalopathy

59
Q

ascites mech

A
  1. portal HTN
  2. splanchnic dilation (NO)
  3. SVR + MAP decrease
  4. RAAS activated -> sodium + water retention

(RAAS can also be decrease in albumin)

60
Q

spontaneous bacterial peritonitis (SBP)

A

complication of (decompensated) ascites
bacteria in ascitic fluid

raised neutrophils on tap
broad spec abx

61
Q

liver transplant

A

UKELD <49 to be eligible
BSG / BASL bundle first 24h post

62
Q

hepatorenal syndrome

A

same mech as ascites, renal vasoconstriction instead of Na retention

Dx of exclusion

63
Q

endocrine pancreas

A

islets of langerhans

  1. blood glucose up
  2. increased diffusion into cell (GLUT2)
  3. aerobic resp
  4. ATP/ADP ratio increase
  5. ATP-K+ channels CLOSE
  6. voltage-gated Ca2+ open
  7. intracellular Ca2+ triggers insulin release
64
Q

exocrine pancreas

A

duct cells - HCO3- out
acinar cells - enzymes

  1. cephalic - vagal stim (AC)
  2. gastric - gastric distension -> vagovagal reflex / parasymth (AC/DC)
  3. intestinal - (acid in duo -> secretin from S -> NaHCO3 from DC / pat + protein in deo -> CCK from I -> enzymes from AC)
65
Q

ALT 50-200

A

MASLD, chronic viral hep

autoimmune hep, haemochromatosis, wilson’s, a1 anti-trypsin

66
Q

ALT 1000s

A

viral hep, shock liver, paracetamol overdose, autoimmune hep, budd-chiari

67
Q

ALT >3000

A

drugs (paracetamol) or ischaemia

68
Q

ALT / AST ratio

A

usually ALT >AST
ALT < AST - fibrosis
AST 2x ALT - alcoholic

69
Q

gen ALT / AST

A

AST can be normal in HCV / fatty liver

ALT rarely >3x normal in alcoholic
ALT raised in acute biliary obstruction

70
Q

autoimmune markers

A

antinuclear (ANA)
anti SM (ASMA)
anti liver/kidney microsomal (anti-LKM1)
antimitochondrial (AMA)

71
Q

GGT

A

also raised in fatty liver / alcohol related

72
Q

cholestatic LFTs

A

USS
yes dilation -> malignancy (painless) or gallstones (colicky). MCRP Ix

no dilation -> PBC (AMA+), seronegative PBC (AMA-, MCRP rule out ->), PSC (MCRP)

73
Q

drug induced LFTs

A

hepatic (isoniazid / phenytoin / methyldopa)
cholestatic (augmentin / ocpill / androgens)
steatosis (TPN / methotrexate)

74
Q

cirrhosis pathology

A

bands of fibrosis separating regenerative nodules (hepatocytes)

75
Q

fatty liver / alcoholic hep / fibrosis pathology

A

FL - fat vacuoles clear in hepatocytes
AH - fat vacuoles, hepatocyte necrosis, neutrophils
fibrosis - collagen deposits

76
Q

HAV / acute pathology

A

individual cell necrosis

77
Q

HBV / HCV / chronic pathology

A

dense portal drone inflammation + fibrosis

78
Q

PBC / autoimmune hep / PSC pathology

A

PBC - granulomas + bile duct loss
AH - chronic hep pattern
PSC - periductal fibrosis (onion skin), duct destruction

79
Q

acute liver disease / failure definition

A

disease - insult to (normal) liver causing damage - <6m

FAILURE - ^ + encephalopathy + prolonged coag

80
Q

benign liver masses

A
  1. haemangioma
    most common
  2. focal nodular hyperplasia
    hyperplastic resp to abnormal arterial flow
  3. hepatic adenoma
  4. liver abscesses
81
Q

hepatic cysts

A
  1. simple cyst
  2. hydatid cyst
    tapeworms
  3. polycystic liver disease
    a) von meyenburg complexes
    dilated cystic bile ducts
    b) PCLD
    c) ADPKD
82
Q

malignant liver tumours

A
  1. HCC - most common
  2. fibro-lamellar carcinoma
    young patients, not cirrhosis
  3. metastases
83
Q

types of gallstone

A
  1. cholesterol
  2. pigment
  3. calcium
  4. mixed
84
Q

complications of gallstones

A
  1. biliary colic
  2. cholecystitis (acute / chronic)
  3. gallbladder mucocele
  4. gallbladder empyema
    - carcinoma -
  5. choleclocholithiasis
  6. ascending cholangitis
    - obstructive jaundice -
  7. gallstone ileus
  8. pancreatitis (acute / chronic)
85
Q

pancreatitis pathology

A

fat necrosis
chronic = fibrosis

86
Q

parasites

A
  1. cryptosporidium
    food / shellfish
  2. giardia lamblia
    pools / lakes / rivers etc
  3. entamoeba histolytica
87
Q

bacteria

A
  1. campylobacter (chicken)
  2. salmonella (foodborne)
  3. E.coli (0157 (HU syn) / shiga-toxin)
  4. listeria (IM compromised / pregnancy)
88
Q

normal flora

A

mouth -
viridans strep, neisseria sp. candidia sp, staph

jejunum -
coliforms + anaerobes (small numbers)

colon -
coliforms + anaerobes + enterococcus faecalis (large numbers)

89
Q

bloody causes

A
  1. shigella
  2. E.coli
  3. salmonella
  4. campylobacter
  5. parasites
90
Q

malnutrition management

A
  1. food first
  2. oral supplements (shakes etc)
  3. ETF
  4. PN
91
Q

refeeding syndrome

A

rapid refeeding (EN or PN)
hypo- (kalaemia / phosphataemia / magnesaemia), altered glucose metabolism, fluid overload

arrythmias, altered conciousness, seizures, resp failure, CV collapse, death

YEAR 1 (11 decks)

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