Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PLAB Dra. Sommerhalder > GIT (gastro) > Flashcards

GIT (gastro) Flashcards

1
Q

What is celiac disease?

A

An autoimmune, malabsorption disease due to sensivity to gluten

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Manifestations of celiac disease

A 
°Chronic or intermittent diarrhea
°Steatorrhea
°Stinking, bad smell/offensive stools
°Weight loss
°Iron deficiency anemia (or Folate or B12 deficiency)
°Manifestations of anemia (fatigue)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Complications of celiac disease

A

Osteoporosis
T-cell lymphoma (rare)
Associated to dermatitis herpetiformis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Diagnosis of celiac disease

A

First line: Positive TTG (tissue transglutaminase antibodies)+IgA
refered as tTG-IgA test.
sensivity of 98%
specificity of 95%

And Positive endomysial antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does a celiac disease diagnosis be confirmed?

A 
If tTG (+) then...
Jejunal or duodenal biopsy. 
(shows Villous atrophy, crypt hyperplasia, increased inter-epithelial lymphocyte)

***REMEMBER
For the biopsy to be accurate, introduce gluten SIX WEEKS before the biopsy!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Celiac disease treatment

A

Gluten-free diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

33YO male, non smoker. Presents with recurrent and chronic diarrhea for 6 months. His clothing appears to be ill-fitting. Hb 11 and MCV 105.

Most likely diagnosis?

A

Celiac disease.

Endoscopy+duodenal biopsy will show?
Villous atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Crohn’s disease endoscopy

A

Skip lesions, transmural (deep ulcers) and Cobblestone appearance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Crohn’s disease histology

A

Granuloma and increased Goblet cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Crohn’s disease symptoms and examination

A

°Abdominal pain or mass on the right iliac fossa
°Usually non-bloody diarrhea
°Weight loss
°Perianal fistulas, fistulae
°Aphthous oral ulcers (more common in CD than UC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Histology of Ulcerative Colitis

A

Crypt abscesses

decreased goblet cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Barium enema in Ulcerative Colitis

A

°Loss of haustration

°Drain pipe appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Symptoms and examination in Ulcerative Colitis

A

°Left lower quadrant pain (abdominal)
°Bloody diarrhea more common
°Primary Sclerosing Cholangitis is more common
°Aphthous oral ulcers (more common in CD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does smoking affects CD and UC?

A

Smoking INCREASES the risk of CD

Smoking DECREASES the risk of UC (protective)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Colonoscopy in Chrohn’s Disease

A

Cobble stone appearance, deep ulcers (transmural) and skip lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Small bowel enema in CD

A

Kantor’s string sign (“refers to the string-like appearance of a contrast-filled bowel loop caused by its severe narrowing.”), thorn ulcers and fistulae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Barium enema in UC

A

loss of haustral markings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Crohn’s disease treatment

A

°Oral prednisolone (1st line to induce remission)
°Mesalazine

REMEMBER
Crohn’s=Corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ulcerative Colitis treatment

A

5-ASA (Mesalazine) as 1st line to induce remission

Severe UC exacerbation = IV hydrocortisone

20
Q

Physiopathology of Barret’s Oesophagus

A

Prolonged hydrochloric acid reflux to the oesophagus.
The lower oeasophagus undergoes “METAPLASIA”
From Squamous to Columnar epithelium.
Tip: “Shampoo for children”

21
Q

Histology expected in Barret’s oesophagus

A

COLUMNAR metaplasia

can develop adenocarcinoma of the lower 1/3 of the oesophagus

22
Q

Cancer in achalasia vs cancer in Barret’s oesophagus

A

Achalasia= squamous cell carcinoma of the upper 2/3 of the oesophagus

Barret’s = adenocarcinoma of the lower 1/3 of the oesophagus. (common in GERD too)

23
Q

What is achalasia?

A

Inability to relax the lower oeasophageal sphincter (LOS) due to idiopathic loss of the normal neural structure

24
Q

Main symptom in achalasia

A

Progressive dysphagia to both solids and liquids

There might be weight loss and chest pain

Key word: regurgitation (also in pharyngeal pouch)

25
Q

Pharyngeal pouch symptoms

A 
Regurgitation
Halitosis (stale food or fluid)
Gurgling sound in the chest when drinking
A lump sensation in the throat
Neck bulge
26
Q

Investigation of a patient with achalasia

A

X-ray: Megaoesophagus (dilated)

Barium meal: Bird’s beak appearance of the distal end of the oesophagus

Oesophageal manometry: the most accurate, increased lower oeasophageal resting pressure

27
Q

Treatment of Achalasia

A

Dilation of the lower oeasophageal sphincter.

28
Q

45 YO woman presents with productive cough and moderate fever. She also complains of central chest pain, REGURGITATION of undigested food and DYSPHAGIA to both SOLIDS AND FLUIDS.

The X-ray shows megaesophagus

What is the most likely diagnosis?

A

Achalasia

productive cough and fever–> aspiration pneumonia from regurgitation

29
Q

Upper GI endoscopy diagnostic indications

A 
Haematemesis/melaena
Dysphagia
Dyspepsia (>55yrs old+alarm symptoms or tx refractory)
Duodenal biopsy (coeliac?)
Persistent vomiting
Iron deficiency (cancer?)
30
Q

Therapeutic indications of upper GI endoscopy

A 
Treatment of bleeding lesions
Variceal banding and schlerotherapy
Argon plasma coagulation for suspected vascular abnormality
Stent insertion, laser therapy
Stricture dilatation, polyp resection
31
Q

Upper GI endoscopy pre-procedure and procedure

A

Stop PPIs 2 weeks preop (if possible–> pathology masking)
Nil by mouth (ayuno) 6 hrs before
Don’t drive for 24 hrs if sedated

Sedation optional with midazolam 1-5mg IV
Propofol if deeper sedation is needed
Nasal prong O2
Local anesthetic in the pharynx (optional)
Continuous suction must be available

32
Q

Upper GI endoscopy complications

A

Sore throat
Amnesia from sedation
Perforation (0.1%)
Bleeding (if on aspirin, clopidogrel, warfarin or Direct Oral Anti Coagulants= DOAC)

33
Q

Duodenal Biopsy in Upper GI endoscopy for….

A

Gold Standard in Coeliac disease

Useful in unusual causes of malabsorption (giardiasis, lymphoma, Whipple’s disease)

34
Q

Sigmoidoscopy

A

PR (rectal examination) first!

Views rectum+distal colon (approx splenic flexure)
Flexible has displaced rigid for diagnosis of distal colon pathology BUT STILL ~25% of cancers remain out of reach

Therapeuthic= decompression of sigmoid volvulus

Preparation with phosphate enema PR

DO BIOPSIES! macroscopic appearances may be normal! (Like amyloidosis and microscopic colitis)

35
Q

Diagnostic indications for colonoscopy

A

Rectal bleeding (when settled if acute)
Iron-deficiency anaemia (bleeding cancer)
Persistent diarrhoea
Positive faecal occult blood test
Assessment or suspicion of IBD (Inflammatory Bowel Disease)
Colon Cancer Surveillance

36
Q

Therapeutic indications for colonoscopy

A 
Haemostasis (eg. Clipping vessel)
Bleeding angiodysplasia lesion (argon beaker photocoagulation) 
Colonic stent deployment (cancer)
Volvulus decompression 
Pseudo-obstruction
Polypectomy
37
Q

Preparation and procedure for colonoscopy

A 
Stop iron 1 week prior 
Discuss with local endoscopy unit bowel preparation and diet
DO PR (rectal exam) FIRST!
Sedation and analgesia as in endoscopy
38
Q

Colonoscopy complications

A

Abdominal discomfort
Incomplete examination
Haemorrhage after biopsy or polypectomy
Perforation (<0.1%)

NO ALCOHOL and NO OPERATING MACHINERY FOR 24h!

39
Q

Video capsule endoscopy (VCE) uses

A

Evaluate obscure GI bleeding and detect small bowel pathology
Use small bowel imaging or patency capsule ahead of VCE when px has abdominal pain or sugestion of small bowel obstruction

40
Q

Video capsule endoscopy (VCE) preparation and procedure

A

Clear fluids only the evening before then nil by mouth (ayuno) from morning until 4h after capsule is swallowed

Capsule is swallowed and transmits video wirelessly to capture device worn by patient
Normal activity can take place for the day

41
Q

Video Capsule Endoscopy (VCE) complications and problems

A 
Capsule retention in <1% (endoscopic or surgical removal)
Avoid MRI for 2 weeks after, unless AXR (abdominal X-Ray) confirms capsule has cleared
Obstruction
Incomplete exam (slow transit or achalasia)

No therapeutic options
Poor localisation of lesions
May miss subtle lesions

42
Q

Video Capsule Endoscopy (VCE) complications and problems

A 
Capsule retention in <1% (endoscopic or surgical removal)
Avoid MRI for 2 weeks after, unless AXR (abdominal X-Ray) confirms capsule has cleared
Obstruction
Incomplete exam (slow transit or achalasia)

No therapeutic options
Poor localisation of lesions
May miss subtle lesions

43
Q

Liver biopsy route and indications

A

Percutaneous if INR in range
If not, transjugular with FFP (fresh frozen plasma)

Increased enzymes (liver function test- LFT) of unknown aetiology.
Assessment of fibrosis in chronic liver disease (now being replaced by ultrasound elastography)
Suspected cirrhosis
Suspected hepatic lesions/cancer

44
Q

Liver biopsy pre procedure, procedure and complications

A

Nil by mouth for 8h (ayuno)
INR <1.5 and platelets >50x10^9/L
Analgesia

Under US/CT guidance
Liver borders percussed–> where dullness is found in the mid-axillary line in expiration. Infiltrate lidocaine 2% down to the liver capsule
Rehearse breathing and take needle biopsy with the breath held in expiration
Lie on the right side for 2h, then in bed for 4h
Pulse and blood pressure every 15 mins for 1h
Then every 30 mins for 2h
Hourly for 4h and discharge

Complications: pain, pneumothorax, bleeding (<0.5%) and death (<0.1%)

45
Q

Causes of dysphagia

A

Mechanical: malignant stricture, benign structure, extrinsic pressure and pharyngeal pouch

Motility disorders: achalasia, diffuse oesophageal spasm, systemic sclerosis, neurological bulbar palsy

Other: oeasophagitis, globus (lump in throat=try to distinguish from true dysphagia)

46
Q

5 key questions of dysphagia

A

Difficulty swallowing solids and liquids from the start?
Yes–> motility disorder (achalasia, CNS, pharyngeal causes)
No –> solids then liquids = Stricture (benign or malign)

Is it difficult to initiate swallowing movement?
Yes= bulbar palsy, especially if patient coughs on swallowing

Is swallowing painful? (Odynophagia)
Yes= ulceration (malignancy, oeasophagitis, viral infection or Candida in immunocompromised, poor steroid inhaler technique) or spasm

Intermittent dysphagia or constant and getting worse?
Intermittent: suspect oesophageal spasm
Constant and worsening: malignant stricture

Does the neck bulge or gurgle on drinking?
Yes: Pharyngeal pouch

47
Q

Signs in patients with dysphagia

A

Anaemia or cachectic? Examine mouth
Feel for supraclavicular nodes (Virchow’s node)
Signs of systemic disease (systemic sclerosis or CNS disease)

PLAB Dra. Sommerhalder (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions