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GI to work on Flashcards

1
Q

Give 2 common causes of large bowel obstruction

A
  1. Colorectal malignancy - most common in UK

2. Volvulus - more common in Africa

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2
Q

Give 5 risk factors for colorectal cancer

A
  1. Increasing age
  2. Family history
  3. Western diet - saturated animal fat, red meat consumption, low fibre, high sugar
  4. Alcohol
  5. Smoking
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3
Q

Give 4 signs of rectal carcinoma

A
  • rectal bleeding and mucus
  • when cancer grows there will be thinner stools and tenesmus (cramping rectal pain)
  1. Abdominal mass
  2. Perforation
  3. Haemorrhage
  4. Fistulae
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4
Q

Explain Dukes staging and prognosis

A 
A = limited to muscularis mucosae = 95% 5-year survival 
B = extension through muscularis mucosae (not lymph) = 75% 5-year survival 
C = involvement of regional lymph nodes = 35% 5-year survival 
D = distant metastases = 25% 5-year survival
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5
Q

How do you treat H. pylori?

A

Triple therapy:
Normal –> amoxicillin, omeprazole and clarithromycin/metronidazole

Penicillin resistance –> clarithromycin, omeprazole and metronidazole

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6
Q

Give 3 symptoms of peptic ulcers

A
  1. recurrent burning epigastric pain
  2. pain relieved by antacids and is worse when hungry
  3. pain occurs at night
  4. nausea
  5. anorexia and weight loss
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7
Q

Give 5 broad causes of malabsorption

A
  1. Defective intraluminal digestion
  2. Insufficient absorptive area
  3. Lack of digestive enzymes
  4. Defective epithelial transport
  5. Lymphatic obstruction
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8
Q

Malabsorption: what can cause defective intraluminal digestion?

A
  1. Pancreatic insufficiency due to pancreatitis/CF - lack of digestive enzymes
  2. Defective bile secretion due to biliary obstruction or ileal resection
  3. Bacterial overgrowth
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9
Q

give 3 microscopic features that will be seen in ulcerative colitis

A
  1. Crypt abscess
  2. goblet cell depletion
  3. mucosal inflammation - does not go deeper
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10
Q

Name 3 causes of IBD

A
  1. Genetic
  2. Stress/depression
  3. Inappropriate immune response
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11
Q

Give 4 signs and symptoms of Ulcerative colitis

A
  1. Episodic/chronic diarrhoea +/- blood/ mucus
  2. Abdominal pain - left lower quadrant
  3. Systemic - fever, malaise, anorexia, weight loss
  4. Clubbing
  5. Erythema nodosum
  6. Amyloidosis
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12
Q

Give 4 signs and symptoms of Crohn’s disease

A
  1. Diarrhoea - urgency
  2. Abdominal pain
  3. Systemic - weight loss, fatigue, fever, malaise
  4. Bowel ulceration
  5. Anal fistulae/stricture
  6. Clubbing
  7. Skin/joint/eye problems
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13
Q

What investigations might you do in someone with IBD?

A
  1. Bloods - FBC, ESR, CRP
  2. Faecal calprotectin - shows inflammation but is not specific for IBD
  3. Flexible sigmoidoscopy
  4. Colonoscopy - biopsy to confirm
  5. examination
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14
Q

What is the treatment for Crohn’s disease?

A
  • Smoking cessation
  • 1st line = Corticosteroids - BUDESONIDE (controlled release) or ORAL PREDNISOLONE (for severe attacks)
  • Surgical resection - only minimal
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15
Q

What are the complications for Ulcerative colitis?

A
  1. Colon –> blood loss, colorectal cancer, toxic dilatation
  2. Arthritis
  3. Iritis, episcleritis
  4. Fatty liver and primary sclerosing cholangitis
  5. Erythema nodosum
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16
Q

Give 5 complications of Crohn’s

A

PERFORATION AND BLEEDING = MAJOR

  1. Malabsorption
  2. Obstruction –> toxic dilatation
  3. Fistula/abscess formation
  4. Anal skin tag/fissures/fistula
  5. Neoplasia
  6. Amyloidosis
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17
Q

Describe the pathophysiology of Coeliac disease

A
  1. Gliadin from gluten deaminated by tissue transglutaminase –> increases immunogenicity
  2. Gliadin recognised by HLA-DQ2 receptor on APC –> inflammatory response
  3. Plasma cells produce anti-gliadin and tissue transglutaminase –> T cell/cytokine activated
  4. Villous atrophy and crypt hyperplasia –> malabsorption
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18
Q

Give 5 symptoms of Coeliac disease

A
  1. Diarrhoea and steatorrhoea (stinking/fatty)
  2. Weight loss
  3. Irritable bowel
  4. Iron deficiency anaemia
  5. Osteomalacia
  6. Fatigue
  7. abdominal pain
  8. angular stomatitis
  9. dermatitis herpetiform
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19
Q

What 3 histological features are needed in order to make a diagnosis of coeliac disease?

A
  1. Raised intraepithelial lymphocytes
  2. Crypt hyperplasia
  3. Villous atrophy
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20
Q

What part of the bowel is mostly affected in coeliac disease?

A

Proximal small bowel (duodenum)

mean B12, folate and iron cannot be absorbed = anaemia

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21
Q

Give 3 complications of Coeliac disease

A
  1. Osteoporosis
  2. Anaemia
  3. Increased risk of GI tumours
  4. secondary lactose intolerance
  5. T-cell lymphoma
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22
Q

Give 3 causes of squamous cell carcinoma

A
  1. Smoking
  2. Alcohol
  3. Poor diet/obesity
  4. coeliac disease
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23
Q

Give 5 symptoms of oesophageal carcinoma

A
  1. progressive dysphagia
  2. Weight loss
  3. Heartburn
  4. Haematemesis
  5. Anorexia
  6. Pain
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24
Q

Give 3 causes of gastric cancer

A
  1. Smoked foods
  2. Pickles
  3. H. pylori infection
  4. Pernicious anaemia
  5. Gastritis
  6. family history
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25
Describe how gastric cancer can develop from normal gastric mucosa
Smoked/pickled food diet leads to intestinal metaplasia of normal gastric mucosa Several genetic changes lead to dysplasia and then eventually intra-mucosal and invasive carcinoma
26
Give 3 symptoms and signs of gastric cancer
1. Weight loss 2. Anaemia (pernicious) 3. nausea and Vomiting 4. Dyspepsia and dysphasia 5. palpable epigastric mass 6. Hepatomegaly, jaundice and ascites 7. Enlarged supraclavicular nodes 8. epigastric pain
27
What investigations might you do in someone who you suspect has gastric cancer?
1. gastroscopy - biopsy 2. endoscopic USS - depth of invasion 3. CT /MRI /PET
28
what are the red flag signs for upper GI cancer?
For people with an upper abdominal mass consistent with stomach cancer: - Dysphagia of any age - Aged ≥ 55yr + weight loss with any of the following: - Upper abdominal pain/(or) - Reflux/ (or) - Dyspepsia
29
Give 3 causes of appendicitis
1. Faecolith 2. Lymphoid hyperplasia 3. Filarial worms
30
What investigations might be done in a patient you suspect has appendicitis?
- Blood tests = raised WCC, - CRP, ESR - USS - CT - gold standard
31
Give 2 complications of appendicitis
1. Ruptured appendix --> peritonitis 2. Appendix mass 3. Appendix abscess
32
Give 3 causes of Gastro-oesophageal reflux disease (GORD)
1. Hiatus hernia - sliding or rolling hiatus 2. Smoking 3. Obesity 4. Alcohol 5. pregnancy
33
Describe the pathophysiology of GORD
Lower oesophageal sphincter dysfunction --> reflux of gastric contents --> oesophagitis
34
Name 3 oesophageal symptoms of GORD
1. Heartburn - retrosternal chest pain, after meals, worse when lying down, relieved by antacids 2. Bleching 3. Food/acid and water brash 4. Odynophagia - (painful swallowing) 5. Dysphagia - (difficulty swallowing)
35
Name 3 extra oesophageal symptoms of GORD
1. Nocturnal asthma 2. Chronic cough 3. Laryngitis 4. Sinusitis
36
What investigations are done for someone you suspect has GORD?
- Diagnosis can be made without investigations - Endoscopy (if red flags) - Barium swallow - 24hr oesophageal pH monitoring
37
What is the treatment of GORD?
conservative - stop smoking - stop alcohol - lose weight - change sleep position medical - PPI (omeprazole) - H2 receptor antagonist (ranitidine) surgical - nissen fundoplication
38
Describe the multi-factorial pathophysiology of IBS
The following factors can all contribute to IBS: - Psychological morbidity - trauma in early life - Abnormal gut motility - Genetics - Altered gut signalling (visceral hypersensitivity)
39
Give an example of a differential diagnosis for IBS
1. Coeliac disease 2. Lactose intolerance 3. Bile acid malabsorption 4. IBD 5. Colorectal cancer
40
Describe the non pharmacological treatment of IBS
Education Resistance Dietary modification - reduce caffeine, plenty of fluids, increase fibre intake
41
A 50-year-old man presents with dysphagia. Which one of the following suggest a benign nature of his disease? a. Weight loss b. Dysphagia to solids initially then both solids and liquids c. Dysphagia to solids and liquids occurring form the start d. Anaemia e. Recent onset of symptoms
c. Dysphagia to solids and liquids occurring form the start
42
A 52-year-old lady presents with fatigue and itching. She noticed pale stool and dark urine. She suffers from hypercholesterolaemia and rheumatoid arthritis. She takes simvastatin and cocodamol. Examination revealed jaundice, xanthelasma, spider naevi, and hepatomegaly. Her bloods showed Bili 150, ALP 988, ALT 80, positive AMA and a raised IgM. What is the most likely diagnosis? a. Simvastatin induced liver injury b. Primary biliary cirrhosis c. Gallstones d. Autoimmune hepatitis e. Primary sclerosing cholangitis
b. Primary biliary cirrhosis
43
what are the microscopic features of crohns disease?
- transmural inflammation - granulomas - increase in inflammatory cells - goblet cells - less crypt abscesses
44
what are the risk factors for crohn's disease?
- genetic association - mutation on NOD2 (CARD15) gene on chromosome 16 - smoking - NSAIDs - family history - chronic stress and depression - good hygiene - appendicectomy
45
what are the risk factors for ulcerative colitis?
- family history - NSAIDs - chronic stress and depression
46
what are the risk factors for coeliac disease?
- HLA DQ2/DQ8 - other autoimmune diseases e.g. T1DM, thyroid disease, Sjogren's - IgA deficiency - breast feeding - age of introduction to gluten into diet - rotavirus infection in infancy
47
what are the risk factors for oesophageal cancer?
ABCDEF - Achalasia - Barret's oesophagus - Corrosive oesophagitis - Diverticulitis - oEsophageal web - Familial
48
what are the causes of adenocarcinoma of the oesophagus?
- smoking - tobacco - GORD - obesity - increases reflux
49
what are the complications of GORD?
- peptic stricture | - barrett's oesophagus
50
what are the risk factors for mallory weiss tears?
- alcoholism - forceful vomiting - eating disorders - NSAID abuse - male - chronic cough
51
what are the clinical features of mallory-weiss tears?
- vomiting - haematemesis after vomiting - retching - postural hypotension - dizziness
52
what are the investigations for mallory-weiss tears?
Rockall score (assess blood loss: <3 = low risk) FBC, U&E, coag studies, group & save ECG & cardiac enzymes endoscopy to confirm tear
53
what is the treatment for mallory weiss tears?
- ABCDE - Terlipressin + Urgent Endoscopy - Rockall Score + Inpatient Observation - Banding/clipping, adrenaline, thermocoag
54
what are oesophageal varices?
Abnormal, enlarged veins in the oesophagus, that develop when normal blood flow to the liver is blocked by a clot / scar tissue
55
when do gastroesophageal varices tend to rupture?
when blood pressure in portal vein exceeds 12mmHg
56
what are the main causes of gastroesophageal varices?
- alcoholism - viral cirrhosis - portal hypertension
57
what are the risk factors for gastroesophageal varices?
- cirrhosis - portal hypertension - schistosomiasis infection - alcoholism
58
what is the pathophysiology of gastroesophageal varices?
- liver injury causes increased resistance to flow -> portal hypertension - hyperdynamic circulation -> formation of collaterals between portal and systemic systems - pressure >10mmHg start to bleed (rupture >12mmHg)
59
what is the clinical presentation of gastroesophageal varices?
- haematemesis/melena - abdominal pain (epigastric) - shock (if major blood loss) - fresh rectal bleeding - hypotension and tachycardia - pallor - splenomegaly - ascites - hyponatraemia - signs of chronic liver damage (jaundice, increased bruising)
60
what investigations should be undertaken for gastroesophageal varices?
1. Urgent endoscopy 2. FBC, U&E, clotting (INR), LFTs, group & save 3. CXR / ascitic tap / further Ix for PHT
61
what is the treatment for gastroesophageal varices?
- ABCDE - Rockfall Score (Prediction of Rebleeding and Mortality) - Bleeding Varices - Terlipressin + Prophylactic Antibiotics (Ciprofloaxcin), Balloon tamponade (Sengstaken-Blakemore tube), Endoscopic Banding, TIPS - Bleed Prevention - BB + Endoscopic Banding. Cirrhosis = screening endoscopy
62
how can gastroesophageal varices be prevented?
- PROPRANOLOL - reduce resting pulse rate to decrease portal pressure - variceal banding - liver transplant
63
what are the risk factors for IBS?
- previous severe diarrhoea - female - high hypochondriac anxiety and neurotic score at time of illness
64
what are the causes of IBS?
``` depression, anxiety, stress, trauma, abuse GI infection eating disorders ```
65
what is the pathophysiology of IBS?
dysfunction in brain-gut axis results in disorder of intestinal mobility and/or enhanced perception
66
what are the extra-intestinal symptoms of IBS?
- painful periods - urinary frequency, urgency, nocturia, incomplete bladder emptying - back pain and joint hypermobility - fatigue
67
what is the clinical presentation of IBS?
ABC - A = abdominal pain/discomfort - relieved by defecation - B = bloating - C = change in bowel habit 2 or more of following - urgency - incomplete evacuation - abdominal bloating/distention - mucous in stool - worsening of symptoms after food
68
what are the red flag symptoms for GI cancers?
- unexplained weight loss - PR bleeding/blood in stool - family history of bowel or ovarian cancer
69
what investigations should be undertaken for IBS?
diagnosis is made by ruling out differentials - bloods - FBC - ESR and CRP - coeliac serology - faecal calprotectin - colonoscopy
70
what is the rome III diagnostic criteria for IBS?
- recurrent abdominal pain at least 3 days a month in last 3 months - associated with 2 of following: - onset associated with change in frequency of stool - onset associated with change in form (appearance) of stool
71
what should be considered if you see atrial fibrillation and abdominal pain?
mesenteric ischaemia
72
what is the definition of acute diarrhoea?
diarrhoea lasting less than 2 weeks
73
what is the definition of chronic diarrhoea?
diarrhoea lasting more than 2 weeks
74
what are the causes of diarrhoea?
- viral (majority) - in children = rotavirus - in adults = norovirus - bacterial - Campylobacter jejuni - E.coli - Salmonella - Shigella - parasitic - Giardia lamblia - Entamoeba histolyitca - Cryptosporidium
75
what is the management for diarrhoea?
- treat underlying causes - bacterial treated with METRONIDAZOLE - oral rehydration therapy - anti-emetics - METOCLOPRAMIDE - anti-motility agents - LOPERAMIDE
76
what are the effects of helicobacter pylori?
- inflammation - antral gastritis - gastric cancer - peptic ulcers
77
what is lynch syndrome?
hereditary non-polyposis colon cancer autosomal dominant condition caused by mutation in hMSH1 or hMSH2 genes, in highly repeated short DNA sequences
78
what is the effect of lynch syndrome?
polyps form in the colon and rapidly progress to colon cancer
79
what is diverticulosis?
presence of diverticulum
80
what is diverticular disease?
diverticula are symptomatic
81
what is diverticulitis?
inflammation of diverticulum
82
what is the clinical presentation of diverticulitis?
- febrile - tachycardia - tenderness, guarding and rigidity on left side - palpable tender mass sometimes felt in left iliac fossa
83
what are the investigations for diverticulitis?
Bloods - Raised WCC, ESR & CRP Pregnancy test in women of childbearing age Stool culture Imaging - Erect CXR, AXR and CT ``` Imaging May Show Pneumoperitoneum Dilated Bowel Loops Obstruction Abscess ```
84
what is the management for diverticulitis?
Oral/IV Abx - Ciprofloxacin, Metronidazole Analgesia + liquid diet +/- fluid resus Surgical Resection - Rare Cases
85
what are the complications of diverticulitis?
``` ● Perforation ● Fistula formation into the bladder or vagina ● Intestinal obstruction ● Bleeding ● Mucosal inflammation ```
86
what are the clinical features of volvulus?
consistent with bowel obstruction (absolute constipation and distention) Comes on extremely quickly Rarely nausea and vomiting
87
what are the investigations for volvulus?
abdominal XR - coffee bean sign
88
what is the management for volvulus?
rigid sigmoidoscopy and rectal tube
89
what are the biliary complications of crohns disease vs ulcerative colitis?
crohn's = gallstones ulcerative colitis = primary sclerosing cholangitis
90
what are the causes of actue mesenteric ischaemia?
thrombus embolism non-occlusive
91
what are the investigations for acute mesenteric ischaemia?
ABG - raised lactate and acidosis angiography, doppler ultrasound CT with contrast
92
what are the causes of dysphagia?
Disease of mouth and tongue - tonsillitis Neuromuscular disorders - bulbar palsy, myasthenia gravis Esophageal motility - achalasia, scleroderma, DM Extrinsic pressure - goitre, mediastinal glands Intrinsic lesion - stricture, pharyngeal pouch
93
what are the clinical features of achalasia?
Dysphagia of liquids and solids - solids more than liquids regurgitation more than reflux no apparent underlying cause
94
where do pharyngeal pouches occur?
Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
95
what are the causes/ risk factors of barrett's oesophagus?
``` GORD, Male (7:1), caucasian, FHx, Hiatus hernia, Obesity, Smoking, Alcohol ```
96
what is the management for barrett's oesophagus?
- Lifestyle: weight loss, smoking cessation, reduce alcohol, small reg meals, avoid hot drinks/alcohol/eating <3hrs before bed, avoid certain drugs (nitrates, anticholinergics, TCAs, NSAIDs, K+ salts, alendronate) Endoscopic Surveillance with Biopsies High Dose PPI Dysplasia - Endoscopic Mucosal Resection, Radiofrequency Ablation Severe: oesophagectomy
97
what are the red flag symptoms for GORD that requires further investigation?
``` Dysphagia (difficulty swallowing) > 55yrs Weight loss Epigastric pain / reflux Treatment resistant dyspepsia Nausea and vomiting Anaemia Raised platelets ```
98
what is the difference in presentation of gastric ulcers vs duodenal ulcers?
gastric ulcers = epigastric pain worse after eating, eased by antacids. haematemesis, weight loss, heart burn duodenal ulcers = epigastric pain before meals and at night, relieved by eating or milk. melaena, weight gain
99
which drugs can cause gastric/duodenal ulcers?
NSAIDS SSRI corticosteroids bisphosphonates
100
what are the causes/risk factors of gastritis?
``` autoimmune disease H.pylori bile reflux NSAIDS stress ```
101
what will imaging show in diverticulitis?
``` Imaging May Show Pneumoperitoneum Dilated Bowel Loops Obstruction Abscess ```
102
what are the causes/risk factors of diverticular disease?
low fibre diet obesity age >40
103
what is the clinical presentation of diverticular disease?
Altered Bowel Habit Abdominal Pain Bleeding PR
104
what are the investigations for diverticular disease?
CT (Acute) | Colonoscopy
105
what is the management for diverticular disease?
High Fibre Diet and Fluids +/- Laxatives | Surgery
106
what are the 2 different types of gastric cancer?
type 1 = intestinal / differentiated (70-80%) - found in antrum and lesser curvature type 2 = diffuse / undifferentiated (20%) - found elsewhere
107
what are the following features for crohns and ulcerative colitis? - location - inflammatory pattern - layers affected - granuloma - crypt abscesses - goblet cells
location - crohns = any part of GI tract - UC = colon only inflammatory pattern - crohns = skip lesions (cobblestone appearance) - UC = continuous layers affected - crohns = transmural - UC = mucosal granulomas - crohns = granulomas - UC = no gramulomas crypt abscesses - crohns = present - UC = present goblet cells - crohns = present - UC = depletion
108
what are the non-infectious causes of diarrhoea?
IBS IBD - crohns, ulcerative colitis bowel cancer
109
what are the causes of diarrhoea that are not related to disease or infection?
- stress - medication related - toxin ingestion
110
which HLA is associated with coeliac disease?
HLA DQ2/DQ8
111
what is the difference in presentation of internal and external haemorrhoids?
internal = painless bleeding with bowel movements external = pain and discomfort
112
what is the prevention for diverticulitis?
Regular exercise, avoid smoking, high-fibre diet, drink plenty of water
113
what is the clinical presentation of c.diff?
- watery diarrhoea with mucus/blood - abdominal distention, cramps - malaise - fever
114
what is the treatment for c.diff?
1st line = vancomycin orally for 10 days
115
what is a pilonidal sinus?
abnormal pocket in the skin near the tailbone containing hair and skin debris
116
what is mesenteric ischaemia?
temporary restriction of blood supply to the large intestine due to vasoconstriction or low pressure flow
117
what are the risk factors for ischaemic colitis?
- age >60 - sex F>M - factor V Leiden - high cholesterol - reduced blood flow - HF, low BP, shock, DM, RA - previous abdominal surgery - heavy exercise - surgery on aorta
118
what are the complications of ischaemic colitis?
- sepsis - bowel necrosis - death - fear of eating - unintentional weight loss
119
what are the investigations for ischaemic colitis?
CT abdomen - rule out IBD colonoscopy stool culture
120
how would you treat mesenteric ischaemia?
surgical - stent
121
how would you treat ischaemic colitis?
- bowel resection due to necrosis | - surgically repair hole
122
what is the treatment for ulcerative colitis
- Aminosalicylates - 5-ASA (SULFASALAZINE) - PREDNISOLONE - HYDROCORTISONE - Surgical resection
123
What is the surgical management for GORD?
Nissen fundoplication

Phase 2A revision (38 decks)

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