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GI Tract Flashcards

1
Q

Mechanism of h2 receptor antagonists and examples

A

Decrease acid production by preventing histamine activation of acid production
(Limited benefit as alternative pathways still open- acetylcholine and gastrin)

Cimetidine- many drug interactions
Ranitidine- safer for clinical use

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2
Q

3 proton pump inhibitors

A

Omeprazole
Pantoprazole
Lansoprazole

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3
Q

Name 3 upper GI oral diseases

A

Recurrent oral ulceration
Lichen planus
Orofacial granulomatosis

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4
Q

Name 3 upper GI oesophageal disorders

A

Dysphagia
Dysmotility disorders
GORD (gastro oesophageal reflux disease)

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5
Q

3 mains causes of GORD

A

Defective lower oesophageal sphincter
Impaired lower clearing
Impaired gastric emptying

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6
Q

3 effects of GORD

A

Ulceration
Inflammation
Metaplasia (abnormal change in nature of tissue)

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7
Q

4 signs/symptoms of GORD and their causes

A

Epigastric burning
- worse lying down, bending over, pregnant

Dysphagia

  • oesophagitis (inflammation of oesophagus)
  • stricture (fibrosis and scarring narrow oesophagus)
  • dysmotiity

GI bleeding

Severe pain

  • mimics MI
  • oesophageal muscle spasm
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8
Q

Define Barretts oesophagus

A

Recurrent acid reflux into lower part of oesophagus resulting in metaplasia of oesophagus lining into gastric type mucosa

  • protects mucosa from damage
  • increased risk of carcinoma
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9
Q

Define Hiatus Hernia

A

Part of stomach protrudes through diaphragm opening (hiatus) into thorax

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10
Q

5 ways to manage GORD

A

Stop smoking- improves sphincter (increased muscular tone)
Lose weight and avoid triggering activities
Antacids
H2 blockers and PPIs
Improve GI motility and gastric emptying

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11
Q

2 functions of medicines used in upper GI tract

Examples

A

Eliminate formed acids
-antacids

Reduce acid secretion

  • H2 receptor blockers
  • proton pump inhibitors
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12
Q

Where can peptic ulcer disease (PUD) occur?

A

Any acid affected site

- oesophagus, stomach, duodenum

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13
Q

3 causes of PUD

A

Drugs (NSAIDs, steroids)
Excessive acid
Decreased protective barrier (usually H. Pylori involvement)

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14
Q

Signs/symptoms of PUD

A 
Asymptomatic 
Epigastric burning
- worse before/just after meal
- worse at night
- relieved by food, alkali and vomiting
Usually no physical signs (only when complications e.g. Bleeding)
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15
Q

4 investigations for PUD

A

Endoscopy
Radiology (barium meal)
Anaemia (FBC, FOB)
Test for H. Pylori

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16
Q

4 local complications of PUD

A

Perforation
Haemorrhage
Stricture
Malignancy

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17
Q

Systemic complication of PUD

A

Anaemia

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18
Q

4 treatments for PUD if it is a reversible problem, H. Pylori present

A

Stop smoking
Small, regular meals
Eradication therapy
Ulcer healing drugs

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19
Q

3 PUD treatments if there is stricture, acute bleeding, perforation or malignancy

A

Endoscope
Surgical and repair (gastrectomy- whole or part of stomach removed)
Vagotomy (cutting of branches of vagus nerve)

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20
Q

2 ways medication can treat PUD and examples

A
  1. Reduce acid secretion
    - h2 receptor blockers
    - protein pump inhibitors
  2. Improve mucosal barrier- eliminate H. Pylori- inhibit prostaglandin removal (involved in mucous production)
    : Reduce NSAID and steroid use
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21
Q

What is triple therapy?

A

Eliminates helicobacter pyloris

Two week course of:
2 antibiotics (amoxycillin and metronidazole)
Protein pump inhibitor (omeprazole)

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22
Q

3 lower GI diseases that affect the small bowel

A

Pernicious anaemia
Coeliac disease
Crohn’s disease

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23
Q

Where does Crohn’s occur?

A

Anywhere on GI tract

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24
Q

4 clinical presentations of Crohn’s

A

Discontinuous ‘skip’ lesions
Some rectal involvement (50%)
Transmural- penetrates full thickness of wall
Cobblestone appearance

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25
Q

6 symptoms of Crohn’s and where in GI tract they occur

A

Colon area:
Diarrhoea
Abdominal pain
PR bleeding (rectal)

Small bowel:
Intestinal obstruction
Malabsorption

Mouth:
Orofacial granulomatosis

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26
Q

4 treatments for Crohn’s

A 
Systemic steroids e.g. Prednisolone
Local steroids
Anti inflammatory drugs 
Palliative - remove obstructed bowel segments
                  drain abscesses
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27
Q

2 microscopic features of Crohn’s

A

Granulomatous

Oedematous (fluid retention)

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28
Q

Site of ulcerative colitis

A

Colon (large intestine)

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29
Q

3 clinical presentations of UC

A

Continuous
Rectum always involved
Mucosal inflammation and swelling

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30
Q

3 UC symptoms

A

Diarrhoea
Abdominal pain
PR bleeding

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31
Q

4 treatments of UC

A

Systemic steroids e.g. Prednisolone
Local steroids
Anti inflammatory e.g. Sulphasalazine
Surgery- colectomy (remove part causing disease)

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32
Q

6 clinical features of orofacial granulomatosis

A 
Lip swelling
Angular cheilitis
Cobblestoning
Gingivitis 
Ulceration
Microscopic granulomas
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33
Q

Define pernicious anaemia

A

Inability to absorb vitamin B12

Receptors only in terminal ileum

34
Q

Cause of pernicious anaemia

A

Failure to produce intrinsic factor, which is needed to absorb vitamin B12

35
Q

3 causes of Vit b12 deficiency

A

Pernicious anaemia
Low dietary intake
Disease of terminal ileum (Crohn’s disease)

36
Q

Define coeliac disease

A

Sensitivity to α-gliaden component of gluten

37
Q

8 symptoms of coeliac disease

A 
Weight loss
Lassitude (lack of energy)
Weakness
Abdominal pain/swelling
Diarrhoea
Aphthae (small ulcer)/glossitis (inflammation of tongue)
Steatorrhoea (fatty stools)
Dysphagia
38
Q

Effect of gluten free diet on coeliac disease

A

Reversal of jejunal atrophy (malabsorption goes away)
Improved well being
Decreased risk of lymphoma

39
Q

Symptoms of colonic carcinoma

A

None
Anaemia
Rectal blood loss

40
Q

4 ways to screen for colonic carcinoma

A 
FOB (faecal occult blood test)
- all over 50s invited
Barium enema
Endoscopy
CT/MRI scan
41
Q

Aetiology of colonic carcinoma (9)

A 
Diet:
Decreased fibre
Increased fat
Increased meat
Decreased veg
Smoking
Lack of exercise
Genetics
Ulcerative colitis
Intestinal polyps
42
Q

What causes most colonic carcinomas

A

Arise in polyps
Most will bleed due to irritation and trauma
Usually takes 5 yeRs to progress to malignancy

43
Q

3 treatments for colonic carcinoma

A

Surgery
Radiotherapy
Chemotherapy

44
Q

3 ways to diagnose helicobacter pylori

A

Endoscopy and biopsy
Breath test
Serology

45
Q

Define gastroenteritis

A

A non-specific term for various pathological states of the GI tract

46
Q

Primary manifestation of gastroenteritis and possible accompanying symptoms

A

Diarrhoea

Nausea
Vomiting
Abdominal pain

47
Q

5 key viral symptoms of gastroenteritis

A 
Abdominal cramps
Vomiting
Profuse WATERY stools
Fever
Headaches
48
Q

4 key bacterial dysentery symptoms of gastroenteritis

A

Small volume stools
Fever
BLOODY mucoid stools
Supra pubic pain

49
Q

Define norovirus and how it’s transmitted

A

Highly contagious non-enveloped ss RNA virus

Transmitted faecal to oral route

50
Q

Clinical features of norovirus

A

Abrupt onset of vomiting and watery diarrhoea

+/- Fever and abdominal pain

51
Q

Management of norovirus

A

Correct fluid/electrolyte balance

52
Q

3 types of salmonella

A

Gastroenteritis
Enteric Fever (typhoid)
Bacteraemia

53
Q

4 symptoms of salmonella

A

Cramps
Watery or bloody diarrhoea
Fever, sometimes vomiting
Lasts 1-4 days

54
Q

2 treatments for salmonella

A

Supportive (IV hydration)

Antibiotics

55
Q

Define clostridium difficile

A

Gram positive, spore forming, anaerobic bacillus

Carried by domestic animals

56
Q

4 treatments for C. Diff

A

Oral rehydration
Antibiotics
Colectomy
Faecal transplants

57
Q

Ways to prevent C. Diff infection

A

No vaccine

Food hygiene
Decrease likelihood of contamination 
- adequate food and storage
- segregation
- licensed premises
58
Q

3 ways to prevent GI infections

A

Safe food handling and hand washing
Infection control
Surveillance

59
Q

Name 4 liver issues

A

Viral liver disease
Jaundice
Cirrhosis
Liver failure

60
Q

Define jaundice

A

Accumulation of bilirubin in the skin due to excess bilirubin in blood

61
Q

What is conjugated bilirubin

A

Soluble bilirubin

62
Q

Define pre-hepatic jaundice

A

Jaundice due to factors before liver metabolism

63
Q

What usually causes pre-hepatic jaundice and give 3 examples

A

Usually excessive quantities of RBC breakdown products

  • haemolytic anaemia (RBC destruction)
  • post transfusion (bad match)
  • neonatal (maternal RBC induced)
64
Q

What causes jaundice in haemolysis

A

Increased bilirubin production beyond livers capacity to conjugate it

65
Q

What causes jaundice in Gilberts disease

A

Decreased bilirubin uptake by liver cells

66
Q

What causes hepatic jaundice

A

Due to ‘liver failure’

  • cirrhosis
  • drug induced liver dysfunction

Prevents metabolism of RBC breakdown products

67
Q

How does secretion failure cause jaundice

A

Defective secretion of conjugated bilirubin from liver cells (e.g. Back into bloodstream)

68
Q

Define canaliculus

A

Channels in liver that transport bile to gall bladder

69
Q

What causes post-hepatic jaundice

A

Obstruction to bile outflow

70
Q

Clinical feature of jaundice

A

Conjugated bilirubin is excreted in urine and faeces

  • colour changes
  • pale stool and dark urine suggest POST HEPATIC cause (conjugated bilirubin)
  • normal urine and faeces in HAEMOLYTICS (excess bilirubin unconjugated)
71
Q

Define acute cholecystits

A

Inflammation of gall bladder

72
Q

4 gall bladder symptoms

A

Pain in SHOULDER tip
Abdominal pain right side- radiates to back
Pain brought on by eating fatty food- stimulates bile release by contraction of gall bladder
Usually gall stones

73
Q

5 population traits for gallstone

A 
Fair
Fertile
Female
Fat
Forty
74
Q

3 ways jaundice patients are imaged

A

Ultrasound- detects dilated bile channels within liver

Plain radiographs- show RADIOPAQUE gall stones

ERCP- endoscopic retrograde cholangio pancreatography

75
Q

Management of prehepatic jaundice

A

Identify and treat cause

76
Q

Management of post hepatic jaundice

A

Remove obstruction

  • gall stones via ERCP/ ultrasound
  • force channel open with stent
77
Q

3 ways to prevent gall stone recurrence

A 
Remove gall bladder (cholecystectomy)
Prevent build up of bile acid
- ursodeoxycholic acid
- low calorie, low cholesterol diet 
Prevent bile acid reabsorption from GIT
78
Q

Define kernicterus

A

Brain damage from bilirubin build up in new born

79
Q

Define cirrhosis

A

Mixed picture of damage, fibrosis and regeneration of liver structure

80
Q

6 causes of cirrhosis

A 
Alcohol
Primary biliary cirrhosis
Viral disease- chronic active hepatitis 
Autoimmune chronic hepatitis
Haemochromatosis (excessive absorption and storage of iron)
CF
81
Q

5 signs/symptoms of cirrhosis

A 
Acute bleed 
Jaundice
Oedema and ascite (abdominal fluid)
Encephalopathy (toxic substances affect brain)
Spider naevi, palmar erythema

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