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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
Q

what are the investigations for mallory-weiss tears?

A

Rockall score (assess blood loss: <3 = low risk)
FBC, U&E, coag studies, group & save
ECG & cardiac enzymes

endoscopy to confirm tear

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26
Q

what is the treatment for mallory weiss tears?

A
  • ABCDE
  • Terlipressin + Urgent Endoscopy
  • Rockall Score + Inpatient Observation
  • Banding/clipping, adrenaline, thermocoag
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27
Q

what is the clinical presentation of gastroesophageal varices?

A
  • 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)
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28
Q

what is the treatment for gastroesophageal varices?

A
  • 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
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29
Q

how can gastroesophageal varices be prevented?

A
  • PROPRANOLOL - reduce resting pulse rate to decrease portal pressure
  • variceal banding
  • liver transplant
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30
Q

what are the causes of IBS?

A 
depression, 
anxiety, 
stress, 
trauma, 
abuse
GI infection
eating disorders
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31
Q

what are the extra-intestinal symptoms of IBS?

A
  • painful periods
  • urinary frequency, urgency, nocturia, incomplete bladder emptying
  • back pain and joint hypermobility
  • fatigue
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32
Q

what are the red flag symptoms for GI cancers?

A
  • unexplained weight loss
  • PR bleeding/blood in stool
  • family history of bowel or ovarian cancer
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33
Q

what are the causes of diarrhoea?

A
  • viral (majority)
    - in children = rotavirus
    - in adults = norovirus
  • bacterial
    - Campylobacter jejuni
    - E.coli
    - Salmonella
    - Shigella
  • parasitic
    - Giardia lamblia
    - Entamoeba histolyitca
    - Cryptosporidium
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34
Q

what is the management for diarrhoea?

A
  • treat underlying causes
  • bacterial treated with METRONIDAZOLE
  • oral rehydration therapy
  • anti-emetics - METOCLOPRAMIDE
  • anti-motility agents - LOPERAMIDE
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35
Q

what is lynch syndrome?

A

hereditary non-polyposis colon cancer

autosomal dominant condition caused by mutation in hMSH1 or hMSH2 genes, in highly repeated short DNA sequences

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36
Q

what are the investigations for diverticulitis?

A

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
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37
Q

what is the management for diverticulitis?

A

Oral/IV Abx - Ciprofloxacin, Metronidazole
Analgesia + liquid diet +/- fluid resus
Surgical Resection - Rare Cases

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38
Q

what are the complications of diverticulitis?

A 
● Perforation 
● Fistula formation into the bladder or vagina 
● Intestinal obstruction 
● Bleeding 
● Mucosal inflammation
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39
Q

what are the causes of actue mesenteric ischaemia?

A

thrombus
embolism
non-occlusive

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40
Q

what are the investigations for acute mesenteric ischaemia?

A

ABG - raised lactate and acidosis
angiography, doppler ultrasound
CT with contrast

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41
Q

what are the causes of dysphagia?

A

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

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42
Q

what are the clinical features of achalasia?

A

Dysphagia of liquids and solids - solids more than liquids
regurgitation more than reflux
no apparent underlying cause

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43
Q

what are the causes/ risk factors of barrett’s oesophagus?

A 
GORD, 
Male (7:1), 
caucasian, 
FHx, 
Hiatus hernia, 
Obesity, 
Smoking, 
Alcohol
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44
Q

what is the management for barrett’s oesophagus?

A
  • 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

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45
Q

what are the red flag symptoms for GORD that requires further investigation?

A 
Dysphagia (difficulty swallowing)
> 55yrs
Weight loss
Epigastric pain / reflux
Treatment resistant dyspepsia
Nausea and vomiting
Anaemia
Raised platelets
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46
Q

what is the difference in presentation of gastric ulcers vs duodenal ulcers?

A

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

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47
Q

which drugs can cause gastric/duodenal ulcers?

A

NSAIDS
SSRI
corticosteroids
bisphosphonates

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48
Q

what are the causes/risk factors of gastritis?

A 
autoimmune disease
H.pylori
bile reflux
NSAIDS
stress
49
Q

what will imaging show in diverticulitis?

A 
Imaging May Show
Pneumoperitoneum 
Dilated Bowel Loops
Obstruction
Abscess
50
Q

what are the causes/risk factors of diverticular disease?

A

low fibre diet
obesity
age >40

51
Q

what are the investigations for diverticular disease?

A

CT (Acute)

Colonoscopy

52
Q

what are the 2 different types of gastric cancer?

A

type 1 = intestinal / differentiated (70-80%) - found in antrum and lesser curvature
type 2 = diffuse / undifferentiated (20%) - found elsewhere

53
Q

what are the non-infectious causes of diarrhoea?

A

IBS
IBD - crohns, ulcerative colitis
bowel cancer

54
Q

what are the causes of diarrhoea that are not related to disease or infection?

A
  • stress
  • medication related
  • toxin ingestion
55
Q

what is the prevention for diverticulitis?

A

Regular exercise, avoid smoking, high-fibre diet, drink plenty of water

56
Q

what is mesenteric ischaemia?

A

temporary restriction of blood supply to the large intestine due to vasoconstriction or low pressure flow

57
Q

what are the risk factors for ischaemic colitis?

A
  • 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
Q

what are the complications of ischaemic colitis?

A
  • sepsis
  • bowel necrosis
  • death
  • fear of eating
  • unintentional weight loss
59
Q

what are the investigations for ischaemic colitis?

A

CT abdomen - rule out IBD
colonoscopy
stool culture

60
Q

how would you treat mesenteric ischaemia?

A

surgical - stent

61
Q

how would you treat ischaemic colitis?

A
  • bowel resection due to necrosis

- surgically repair hole

62
Q

what is the treatment for ulcerative colitis

A
  • Aminosalicylates
  • 5-ASA (SULFASALAZINE)
  • PREDNISOLONE
  • HYDROCORTISONE
  • Surgical resection
63
Q

What is the surgical management for GORD?

A

Nissen fundoplication

64
Q

what is the criteria for dypepsia

A

postprandial fullness
early satiation
epigastric pain/burning

65
Q

give 5 causes of dyspepsia

A 
excess acid
prlonged NSAIDS
large volume meals
obesity
smoking/alcohol
pregnancy
66
Q

what investigations would you do for dypepsia?

A

endoscopy
gastroscopy
barium swallow
capsule endoscopy

67
Q

what is the management for dyspesia with red flags?

A
  • suspend NSAID use
  • endoscopy
  • refer malignancy to specialist
68
Q

what is the management for dypepsia without red flags?

A

review medication
lifestyle advice
full dose PPI for 1 month
test and treat for H.pylori infection

69
Q

what lifestyle advice can be given for dyspepsia?

A

lose weight
stop smoking
cut down alcohol
dietary modification

70
Q

what can cause exudative ascites

A

increased vascular permeability secondary to infectio
inflammation
maligancy

71
Q

what can cause transudative ascites?

A

increased venous pressure due to:

  • cirrhosis
  • cardiac failure
  • hypoalbuminaemia
72
Q

what 4 features would you expect to see in blood test results from someone who has overdosed on paracetamol?

A
  • metabolic acidosis
  • prolonged prothrombin time
  • raised creatinine
  • raised ALT
73
Q

what 2 products does haem break down into?

A

Fe2+

biliverdin

74
Q

what enzyme converts biliverdin into unconjugated bilirubin

A

biliverdin reductase

75
Q

what is the function of glucuronosyltransferase?

A

transfers glucoronic acid to unconjugated bilirubin to form conjugated bilirubin

76
Q

what protein does unconjugated bilirubin bind to and why?

A

albumin

isn’t H2O soluble

77
Q

what does conjugated bilirubin form

A

urobilinogen

78
Q

what is responsible for conversion of conjugated bilirubin into urobilinogen?

A

intestinal bacteria

79
Q

what can urobilinogen form?

A
  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
Q

what are the main causes of haemorrhoids?

A 
constipation
diarrhoea
effects of gravity due to posture
congestion from pelvic tumour
anal intercourse
81
Q

what are haemorrhoids?

A

Disrupted and dilated anal cushions (masses of spongy VASCULAR (veins
and arteries) tissue due to swollen veins around the anus

82
Q

what is the pathophysiology of haemorrhoids?

A

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
Q

what is the clinical presentation of haemorrhoids?

A

bright red rectal bleeding
mucus discharge
pruritus ani (itchy bottom)
severe anaemia

84
Q

what is the difference in presentation of internal haemorrhoids vs external haemorrhoids

A

internal = painless

external = painful as has sensory innervation below dentate line

85
Q

what are the investigations for haemorrhoids?

A

abdominal exam

PR exam - prolapsing piles visible

proctoscopy - see internal haemorroids

sigmoidoscopy

86
Q

what is the treatment for haemorrhoids?

A

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
Q

what is an anal fistula?

A

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
Q

what are the causes of anal fistulas?

A 
perianal abscess
abscess
crohns
TB
diverticular disease
rectal carcinoma
89
Q

what is the clinical presentation of anal fistulas?

A

pain
discharge (blood or mucus)
pruritus ani
systemic abscess

90
Q

what are the investigations for anal fistulas?

A

MRI - exclude sepsis + detect associated conditions

endoanal ultrasound - determine track location

91
Q

what is the treatment for anal fistulas?

A
  • surgical = fistulostomy + excision

- drain abscess with Abx if infected

92
Q

what is an anal fissure?

A

Painful tear in the sensitive skin-lined lower anal canal, distal to the dentate line
resulting in pain on defecation

93
Q

what are the causes of anal fisssures?

A
  • hard faeces - spasms may constrict inferior rectal artery making it hard to heal
  • syphilis
  • herpes
  • trauma
  • crohns
  • anal cancer
94
Q

what is the clinical presentation of anal fissures?

A

extreme pain on defecation

bleeding

95
Q

what is the treatment for anal fissures?

A
  • 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
Q

what is the clinical presentation of perianal abscesses?

A
  • Painful swellings
  • Tender
  • Discharge
97
Q

what is the treatment for perianal abscesses?

A
  • Surgical excision

- Drainage with antibiotics

98
Q

what are pilonidal sinuses/abscesses?

A

• 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
Q

what are the risk factors for pilonidal sinus/abscess?

A
  • 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
Q

what is the pathophysiology of pilonidal sinus?

A

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
Q

what is the clinical presentation of pilonidal sinus?

A
  • Painful swelling over days
  • Pus filled with foul smell from abscess
  • Systemic signs of infection
102
Q

what is the treatment for pilonidal sinus?

A
  • Surgery:
    • Excision of the sinus tract and primary closure and pus drainage
    • Pre-op antibiotics
  • Hygiene and hair removal advice (near sinus)
103
Q

what are the different types of hiatus hernia?

A
  • 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
Q

what is an inguinal hernia?

A

Protrusion of abdo contents through inguinal canal

Presents superior + medial to pubic tubercle

105
Q

what is a direct inguinal hernia?

A

20%, - medial to inferior epigastric artery, enters inguinal canal through weakness in posterior wall

106
Q

what is an indirect inguinal hernia?

A

80%, lateral to inferior epigastric artery, enters inguinal canal through deep inguinal ring

107
Q

what are the risk factors for inguinal hernias?

A

• Male,
chronic cough,
heavy lifting,
past abdo surgery

108
Q

what is the clinical presentation of inguinal hernias?

A
  • Swelling in groin / scrotum
  • Maybe painful
  • Impulse
  • Maybe reducible
109
Q

what are the investigations for inguinal hernias?

A
  • Clinical dx

* USS/CT/MRI

110
Q

what are femoral hernias?

A
  • Bowel comes through femoral canal

* Likely to be irreducible and strangulate (due to rigidity of canal’s borders)

111
Q

what is the clinical presentation of femoral hernias?

A
  • Mass in upper medial thigh
  • Neck of hernia is inferior and lateral to pubic tubercle
  • May be cough impulse
112
Q

what are the investigations for femoral hernias>

A
  • Clinical dx

* USS/CT/MRI

113
Q

what is the management for femoral hernias?

A

surgery

114
Q

what are the risk factors for hiatus hernia?

A 
obesity
female
pregnancy
ascites
advanced age
skeletal deformities
115
Q

what is the clinical presentation of hiatus hernia?

A

heartburn/GORD

dysphagia

116
Q

what are the investigations for hiatus hernia?

A
  • CXR
  • Barium swallow
  • Endoscopy
  • Oesophageal manometry
117
Q

what is the management for hiatus hernia?

A

lose weight
treat reflux
surgically treat to prevent strangulation

118
Q

what is the management for inguinal hernia?

A

● 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
Q

what is the management for femoral hernia?

A

● Surgical repair
● Herniotomy – ligation and excision of sac
● Herniorrhaphy -repair of hernial defect

Phase 2A revision (38 decks)

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