GI Tract Conditions Flashcards
What is the pathology of achalasia?
Lack of oesophageal peristalsis
What are the symptoms of achalasia?
Dysphagia
Nausea/vomiting
Weight loss
What investigations would be done if achalasia was suspected?
Barium swallow
Endoscopy
How is achalasia treated?
Endoscopic balloon dilatation
Surgery
What is the pathology of GORD?
Decreased LOS tone
What are the secondary causes of GORD?
Smoking Pregnancy Drugs Alcohol Obesity
What are the symptoms of GORD?
Dyspepsia
Heartburn
Acid regurgitation
Epigastric pain
How is GORD investigated?
Endoscopy if dysphagia/ALARM symptoms
24hrs oesophageal pH monitoring
How is GORD treated?
Weight loss Avoid smoking and alcohol Antacids PPI - omeprazole Surgery - nissan's fundoplication
What is barrett’s oesophagus?
When the normal lower squamous epithelium of the oesophagus becomes columnar
Pre-malignant
What causes barrett’s oesophagus
Chronic GORD
How is barrett’s oesophagus investigated?
Endoscopy and biopsy
How is barrett’s oesophagus treated?
Endoscopic ablation
What are the complications of barrett’s oesophagus?
Oesophageal adenocarcinoma
What are the risk factors for oesophageal cancer?
Obesity Smoking Barrett's oesophagus GORD Excessive alcohol
What is the pathology of oesophageal cancer?
Middle 1/3 - squamous
Lower 1/3 - adenocarcinoma
What are the symptoms of oesophageal cancer?
Progressive dysphagia
Weight loss
How is oesophageal cancer investigated?
Endoscopy and biopsy
Barium swallow
CT
How is oesophageal cancer treated?
Oesophagectomy
If non-op - chemo, radiotherapy, palliative
What are the causes of peptic ulcers?
Helicobacter pylori - 85%
NSAIDs
Smoking
Alcohol
What are the symptoms of peptic ulcers?
Epigastric pain
Heartburn
Nausea/vomiting
If the pain gets better after a meal - duodenal ulcer
How are peptic ulcers investigated?
<55 and no alarm symptoms - urea breath test
>55/alarm - endoscopy
How are gastric ulcers treated?
H.pylori - triple eradication (PPI, amoxicillin, clarithromycin)
PPI
Avoid worsening factors
Gastric ulcers need repeat endoscopy to ensure healing
What are complications of gastric ulcers?
Gi bleed
Perforation
What is the pathology of coeliac disease?
Gluten sensitivity
T cells respond to gluten
Results in villous atrophy and malabsorption
What are the symptoms of coeliac disease?
Diarrhoea Abdominal pain Bloating Lethargy Anaemia
What investigations would be done if coeliac disease was suspected?
FBC - anaemia
Coeliac serology - anti-tissue transglutaminase, anti-endomysial antibodies, IgA
Endoscopy
Intestinal biopsy
How is coeliac disease treated?
Gluten free diet
What are the associations with coeliac disease?
Other autoimmune diseases - type 1 DM, thyroid disease
What are the causes of malabsorption?
Coeliac Chronic pancreatitis Crohn's disease Bacterial overgrowth Lactose intolerance
What are the symptoms of malabsorption?
Diarrhoea Steatorrhoea Weight loss Bloating Anaemia
What investigations would be done if malabsorption was suspected?
FBC, U&Es, LFT, albumin, Ca, folate, B12, vit D Coagulation Coeliac serology Stool microscopy H breath test Endoscopy Small bowel biopsy
How is malabsorption treated?
Aimed at cause
What is the pathology of irritable bowel syndrome?
No pathological cause
Functional disorder
What are the causes of IBS?
Stress
Post-infective
Anxiety
Adverse life events
What are the symptoms of IBS?
Abdominal discomfort
Relief with defaecation
Alternating bowel habit
Bloating
What investigations would be done if IBS was suspected?
Routine bloods
Coeliac serology
Sometimes sigmoidoscopy if >45 and persistent symptoms
How is IBS treated?
Avoid triggers
Antispasmodics - mebeverine
Diarrhoea - codeine phosphate/loperamide
What is the pathology of ulcerative colitis?
Continuous inflammation of the colonic mucosa starting at the rectum and working its way up
What causes UC?
Unknown
Genetic predisposition
Non-smokers
What are the symptoms of UC?
Diarrhoea Rectal bleeding Mucous Abdominal pain Weight loss Fever Erythema nodosum
What investigations would be done if UC was suspected?
Bloods - FBC, increased CRP, increased ERP, increased platelets, decreased albumin, decreased Hb Stool microscopy and culture Abdominal x-ray Faecal caprotectin Sigmoidoscopy AXR - rule out toxic megacolon
How is UC treated?
5-ASA - mesalazine
Steroids
Azathioprine
What are the complications of UC?
Toxic megacolon
Haemorrhage
Colorectal carcinoma
What is the pathology of Crohn’s disease?
Affects any part of the GI tract
Transmural - full thickness
Pathy
Cobblestone appearance
What causes crohn’s disease?
Unknown
Genetic predisposition
Smoking
What are the symptoms of crohn’s disease?
Depends on site affected Diarrhoea Abdominal pain Weight loss Fever Anaemia Anal strictures Erythema nodosum
What investigations would be done if crohn’s disease was suspected?
Stool microscopy and culture Increased CRP, ESR Decreased Hb, albumin Colonoscopy with biopsies B12, folate, vit D, Ca Faecal calprotectin Capsule endoscopy
How is crohn’s disease treated?
Steroids
Azaithoprine
Nutrition
What are the complications of crohn’s disease?
Sticturing
Bowel obstruction
Perforation
What is the pathology of colorectal cancer?
Adenocarcinoma
What are the predisposing factors for colorectal cancer?
Neoplastic polyps IBD Genetic predisposition - FAP, HNPCC Alcohol Smoking Previous cancer
What are the symptoms of colorectal cancer?
Depends on site
Left - bleeding, mucus, altered bowel habit, obstruction
Right - weight loss, abdominal pain
How is colorectal cancer investigated?
Sigmoidoscopy
Colonoscopy
CT
How is colorectal cancer treated?
Laparoscopic surgery
Radiotherapy
Chemotherapy
Where does colorectal cancer metastasise to?
Liver
Lung
Bone
How is colorectal cancer staged?
Dukes staging
What are ALARM symptoms?
Anaemia Loss of weight Anorexia Recent onset of progressive symptoms Masses and melaena/haematemesis Swallowing difficulty
What are signs of an upper GI bleed?
Haematemesis Melaena Elevated urea Associations - dyspepsia, reflux NSAID use
What are the signs of a lower GI bleed?
Fresh blood/clots
Magenta stools
Normal urea
Typically painless
