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Phase 2A revision > GI to work on COPY > Flashcards

GI to work on COPY Flashcards

1
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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2
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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3
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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4
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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5
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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6
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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7
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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8
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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9
Q

Give 3 causes of squamous cell carcinoma

A
  1. Smoking
  2. Alcohol
  3. Poor diet/obesity
  4. coeliac disease
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10
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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11
Q

Give 3 symptoms and signs of gastric cancer

A
  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
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12
Q

what are the red flag signs for upper GI cancer?

A

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
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13
Q

Give 3 causes of appendicitis

A
  1. Faecolith
  2. Lymphoid hyperplasia
  3. Filarial worms
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14
Q

Give 3 causes of Gastro-oesophageal reflux disease (GORD)

A
  1. Hiatus hernia - sliding or rolling hiatus
  2. Smoking
  3. Obesity
  4. Alcohol
  5. pregnancy
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15
Q

Name 3 oesophageal symptoms of GORD

A
  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)
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16
Q

What investigations are done for someone you suspect has GORD?

A
  • Diagnosis can be made without investigations
  • Endoscopy (if red flags)
  • Barium swallow
  • 24hr oesophageal pH monitoring
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17
Q

What is the treatment of GORD?

A

conservative

  • stop smoking
  • stop alcohol
  • lose weight
  • change sleep position

medical

  • PPI (omeprazole)
  • H2 receptor antagonist (ranitidine)

surgical
- nissen fundoplication

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18
Q

Give an example of a differential diagnosis for IBS

A
  1. Coeliac disease
  2. Lactose intolerance
  3. Bile acid malabsorption
  4. IBD
  5. Colorectal cancer
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19
Q

what are the risk factors for crohn’s disease?

A
  • genetic association - mutation on NOD2 (CARD15) gene on chromosome 16
  • smoking
  • NSAIDs
  • family history
  • chronic stress and depression
  • good hygiene
  • appendicectomy
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20
Q

what are the risk factors for ulcerative colitis?

A
  • family history
  • NSAIDs
  • chronic stress and depression
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21
Q

what are the risk factors for coeliac disease?

A
  • 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
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22
Q

what are the risk factors for oesophageal cancer?

A

ABCDEF

  • Achalasia
  • Barret’s oesophagus
  • Corrosive oesophagitis
  • Diverticulitis
  • oEsophageal web
  • Familial
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23
Q

what are the causes of adenocarcinoma of the oesophagus?

A
  • smoking
  • tobacco
  • GORD
  • obesity - increases reflux
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24
Q

what are the complications of GORD?

A
  • peptic stricture

- barrett’s oesophagus

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25
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
26
what is the treatment for mallory weiss tears?
- ABCDE - Terlipressin + Urgent Endoscopy - Rockall Score + Inpatient Observation - Banding/clipping, adrenaline, thermocoag
27
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)
28
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
29
how can gastroesophageal varices be prevented?
- PROPRANOLOL - reduce resting pulse rate to decrease portal pressure - variceal banding - liver transplant
30
what are the causes of IBS?
``` depression, anxiety, stress, trauma, abuse GI infection eating disorders ```
31
what are the extra-intestinal symptoms of IBS?
- painful periods - urinary frequency, urgency, nocturia, incomplete bladder emptying - back pain and joint hypermobility - fatigue
32
what are the red flag symptoms for GI cancers?
- unexplained weight loss - PR bleeding/blood in stool - family history of bowel or ovarian cancer
33
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
34
what is the management for diarrhoea?
- treat underlying causes - bacterial treated with METRONIDAZOLE - oral rehydration therapy - anti-emetics - METOCLOPRAMIDE - anti-motility agents - LOPERAMIDE
35
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
36
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 ```
37
what is the management for diverticulitis?
Oral/IV Abx - Ciprofloxacin, Metronidazole Analgesia + liquid diet +/- fluid resus Surgical Resection - Rare Cases
38
what are the complications of diverticulitis?
``` ● Perforation ● Fistula formation into the bladder or vagina ● Intestinal obstruction ● Bleeding ● Mucosal inflammation ```
39
what are the causes of actue mesenteric ischaemia?
thrombus embolism non-occlusive
40
what are the investigations for acute mesenteric ischaemia?
ABG - raised lactate and acidosis angiography, doppler ultrasound CT with contrast
41
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
42
what are the clinical features of achalasia?
Dysphagia of liquids and solids - solids more than liquids regurgitation more than reflux no apparent underlying cause
43
what are the causes/ risk factors of barrett's oesophagus?
``` GORD, Male (7:1), caucasian, FHx, Hiatus hernia, Obesity, Smoking, Alcohol ```
44
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
45
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 ```
46
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
47
which drugs can cause gastric/duodenal ulcers?
NSAIDS SSRI corticosteroids bisphosphonates
48
what are the causes/risk factors of gastritis?
``` autoimmune disease H.pylori bile reflux NSAIDS stress ```
49
what will imaging show in diverticulitis?
``` Imaging May Show Pneumoperitoneum Dilated Bowel Loops Obstruction Abscess ```
50
what are the causes/risk factors of diverticular disease?
low fibre diet obesity age >40
51
what are the investigations for diverticular disease?
CT (Acute) | Colonoscopy
52
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
53
what are the non-infectious causes of diarrhoea?
IBS IBD - crohns, ulcerative colitis bowel cancer
54
what are the causes of diarrhoea that are not related to disease or infection?
- stress - medication related - toxin ingestion
55
what is the prevention for diverticulitis?
Regular exercise, avoid smoking, high-fibre diet, drink plenty of water
56
what is mesenteric ischaemia?
temporary restriction of blood supply to the large intestine due to vasoconstriction or low pressure flow
57
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
58
what are the complications of ischaemic colitis?
- sepsis - bowel necrosis - death - fear of eating - unintentional weight loss
59
what are the investigations for ischaemic colitis?
CT abdomen - rule out IBD colonoscopy stool culture
60
how would you treat mesenteric ischaemia?
surgical - stent
61
how would you treat ischaemic colitis?
- bowel resection due to necrosis | - surgically repair hole
62
what is the treatment for ulcerative colitis
- Aminosalicylates - 5-ASA (SULFASALAZINE) - PREDNISOLONE - HYDROCORTISONE - Surgical resection
63
What is the surgical management for GORD?
Nissen fundoplication
64
what is the criteria for dypepsia
postprandial fullness early satiation epigastric pain/burning
65
give 5 causes of dyspepsia
``` excess acid prlonged NSAIDS large volume meals obesity smoking/alcohol pregnancy ```
66
what investigations would you do for dypepsia?
endoscopy gastroscopy barium swallow capsule endoscopy
67
what is the management for dyspesia with red flags?
- suspend NSAID use - endoscopy - refer malignancy to specialist
68
what is the management for dypepsia without red flags?
review medication lifestyle advice full dose PPI for 1 month test and treat for H.pylori infection
69
what lifestyle advice can be given for dyspepsia?
lose weight stop smoking cut down alcohol dietary modification
70
what can cause exudative ascites
increased vascular permeability secondary to infectio inflammation maligancy
71
what can cause transudative ascites?
increased venous pressure due to: - cirrhosis - cardiac failure - hypoalbuminaemia
72
what 4 features would you expect to see in blood test results from someone who has overdosed on paracetamol?
- metabolic acidosis - prolonged prothrombin time - raised creatinine - raised ALT
73
what 2 products does haem break down into?
Fe2+ | biliverdin
74
what enzyme converts biliverdin into unconjugated bilirubin
biliverdin reductase
75
what is the function of glucuronosyltransferase?
transfers glucoronic acid to unconjugated bilirubin to form conjugated bilirubin
76
what protein does unconjugated bilirubin bind to and why?
albumin isn't H2O soluble
77
what does conjugated bilirubin form
urobilinogen
78
what is responsible for conversion of conjugated bilirubin into urobilinogen?
intestinal bacteria
79
what can urobilinogen form?
1. can go back to liver via enterohepatic system 2. can go to kidneys forming urinary urobilin 3. can form stercobilin which is excreted in faeces
80
what are the main causes of haemorrhoids?
``` constipation diarrhoea effects of gravity due to posture congestion from pelvic tumour anal intercourse ```
81
what are haemorrhoids?
Disrupted and dilated anal cushions (masses of spongy VASCULAR (veins and arteries) tissue due to swollen veins around the anus
82
what is the pathophysiology of haemorrhoids?
The effects of gravity, increased anal tone and the effects of straining when defecating may make them become both bulky and loose, and so protrude to form piles - They are very vulnerable to trauma (e.g. from hard stools) and bleed readily from the capillaries of the underlying lamina propria
83
what is the clinical presentation of haemorrhoids?
bright red rectal bleeding mucus discharge pruritus ani (itchy bottom) severe anaemia
84
what is the difference in presentation of internal haemorrhoids vs external haemorrhoids
internal = painless external = painful as has sensory innervation below dentate line
85
what are the investigations for haemorrhoids?
abdominal exam PR exam - prolapsing piles visible proctoscopy - see internal haemorroids sigmoidoscopy
86
what is the treatment for haemorrhoids?
1st line = increase fluid and fibre, topical analgesic and stool softener 2nd line = rubber band ligation or IR coagulation 3rd line = excisional haemorrhoidectomy (surgical removal)
87
what is an anal fistula?
An abnormal connection between the epithelised surface of the anal canal and skin - essentially a track communicates between the skin and anal canal/rectum
88
what are the causes of anal fistulas?
``` perianal abscess abscess crohns TB diverticular disease rectal carcinoma ```
89
what is the clinical presentation of anal fistulas?
pain discharge (blood or mucus) pruritus ani systemic abscess
90
what are the investigations for anal fistulas?
MRI - exclude sepsis + detect associated conditions endoanal ultrasound - determine track location
91
what is the treatment for anal fistulas?
- surgical = fistulostomy + excision | - drain abscess with Abx if infected
92
what is an anal fissure?
Painful tear in the sensitive skin-lined lower anal canal, distal to the dentate line resulting in pain on defecation
93
what are the causes of anal fisssures?
- hard faeces - spasms may constrict inferior rectal artery making it hard to heal - syphilis - herpes - trauma - crohns - anal cancer
94
what is the clinical presentation of anal fissures?
extreme pain on defecation | bleeding
95
what is the treatment for anal fissures?
- Increase dietary fibre and fluids to make stools softer - LIDOCAINE OINTMENT + GTN OINTMENT or topical DILTIAZEM - BOTULINUM TOXIN (botox) INJECTION (2nd line) - Surgery if medication fails
96
what is the clinical presentation of perianal abscesses?
- Painful swellings - Tender - Discharge
97
what is the treatment for perianal abscesses?
- Surgical excision | - Drainage with antibiotics
98
what are pilonidal sinuses/abscesses?
• Hair follicles get stuck under the skin in the natal cleft (butt crack) resulting in irritation and inflammation leading to small tracts which can become infected (abscess)
99
what are the risk factors for pilonidal sinus/abscess?
- Obese caucasians and those from Asia, Middle East and Mediterranean are at increased risk - Large amount of body hair - Sedentary job - Occupation involving sitting or driving - Family history
100
what is the pathophysiology of pilonidal sinus?
The ingrowing of hair excites a foreign body reaction and may cause secondary tracks to open laterally with or without abscesses, with foul-smelling discharge
101
what is the clinical presentation of pilonidal sinus?
* Painful swelling over days * Pus filled with foul smell from abscess * Systemic signs of infection
102
what is the treatment for pilonidal sinus?
- Surgery: • Excision of the sinus tract and primary closure and pus drainage • Pre-op antibiotics - Hygiene and hair removal advice (near sinus)
103
what are the different types of hiatus hernia?
- sliding (80%) = stomach and gastro-oesophageal junction slides up into chest above diaphragm - rolling (20%) = gastro-oesophageal junction remains in abdomen but fundus prolapses into chest
104
what is an inguinal hernia?
Protrusion of abdo contents through inguinal canal Presents superior + medial to pubic tubercle
105
what is a direct inguinal hernia?
20%, - medial to inferior epigastric artery, enters inguinal canal through weakness in posterior wall
106
what is an indirect inguinal hernia?
80%, lateral to inferior epigastric artery, enters inguinal canal through deep inguinal ring
107
what are the risk factors for inguinal hernias?
• Male, chronic cough, heavy lifting, past abdo surgery
108
what is the clinical presentation of inguinal hernias?
* Swelling in groin / scrotum * Maybe painful * Impulse * Maybe reducible
109
what are the investigations for inguinal hernias?
* Clinical dx | * USS/CT/MRI
110
what are femoral hernias?
* Bowel comes through femoral canal | * Likely to be irreducible and strangulate (due to rigidity of canal’s borders)
111
what is the clinical presentation of femoral hernias?
* Mass in upper medial thigh * Neck of hernia is inferior and lateral to pubic tubercle * May be cough impulse
112
what are the investigations for femoral hernias>
* Clinical dx | * USS/CT/MRI
113
what is the management for femoral hernias?
surgery
114
what are the risk factors for hiatus hernia?
``` obesity female pregnancy ascites advanced age skeletal deformities ```
115
what is the clinical presentation of hiatus hernia?
heartburn/GORD | dysphagia
116
what are the investigations for hiatus hernia?
* CXR * Barium swallow * Endoscopy * Oesophageal manometry
117
what is the management for hiatus hernia?
lose weight treat reflux surgically treat to prevent strangulation
118
what is the management for inguinal hernia?
● Medically – use of truss to contain and prevent further progression ● Surgery if very symptomatic o Prosthetic mesh, open repair, laparoscopy o Pre-op – diet and stop smoking o May recur
119
what is the management for femoral hernia?
● Surgical repair ● Herniotomy – ligation and excision of sac ● Herniorrhaphy -repair of hernial defect

Phase 2A revision (38 decks)

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