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Revision Year 2 > GIT Pathologies > Flashcards

GIT Pathologies Flashcards

1
Q

Hepatic Adenoma

Risk Factors

Symptoms

Investigations

Treatment

A

Women, Oral Contraceptive Pill

Asymptomatic, If Large = Abd Pain, Haemorrhage

LFTs, USS, CT, MRI, Liver Biopsy

Embolisation (injects substances to try to block or reduce the blood flow to cancer cells), Surgery

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2
Q

Hepatocellular Carcinoma (HCC)

Risk Factors

Symptoms

Investigations

Treatment

A

a1-antitrypsin deficiency, Men, Cirrhosis,
Viral / Autoimmune Hepatitis

Weight Loss, Anorexia, Abd Pain, Ascites, Polycythemia
Tender Hepatomegaly, Fever, Lymphadenopathy, Cachexia, Jaundice

ALT, AST, Increased apha-fetoprotein, CRP, ESR

Surgery

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3
Q

Steatosis

A

Increased Synthesis and uptake of fatty acids from the blood. Fat Droplets form in Hepatocytes

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4
Q

Non Alchoholic Steatohepatitis

A

Once cell death is initiated Inflammation starts taking place. Fatique, Malaise, Ascites, Hepartomegaly, Jaundice, Pain
Increase in ALT > AST in contrast to alcoholic steatohepatitis which causes the opposite AST>ALT

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5
Q

Acute Pancreatitis

Symptoms

Investigations

Leading Causes

A

Sudden Inflammation and damage of Pancreas due to Autodigestion (zymogens prematurely converted)
usually reversible

Grey Turners Sign ((bruising along the bellybutton)
Cullens Sign (bruising along the flank)

Nausea, Vomiting, High Epigastric pain radiating back

Increase in Serum Amylase (>specific) and Lipase
CT Inflammation, Necrosis, Pseudocysts

Alcohol Abuse + Gallstones

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6
Q

Alcohol

A

Stimulates Cytokine release and ROS formation

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7
Q

Acute Pancreatitis Causes

A 
Idiopathic
Gallstones
Ethanol
Steroids
Mumps Virus
Autoimmune Disease
Scorpion
Hypertryglyceridemia / Hypercalcemia 
ERCP - Endoscopic Retrogate Cholangiopancreatography 
Drugs
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8
Q

Chronic Pancreatitis

Symptoms

Investigations

Treatment

A

Persistent Inflammation
Changes to Structure (Fibrosis, Atrophy, Calcification)
Duct Dilatation, Acinar Cell Atrophy

Endoscopic Retrograde Colangiopancreatography

High Epigastric pain radiating back
Malabsorption, Loss Weight, Steatorrhoea, DM

Insulin replacement therapy, Pancreatic Enzymes

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9
Q

Gallstones Causes

A

Female
Fat - Obesity
Fertile - Pregancy
Forty 40

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10
Q

Ascending Cholangitis

A

Bacteria from gut work their way up the bile duct which is obstructed by a gallstone after stricture is caused by cancer or ERCP.

Charcots Triad - RUQ Pain, Fever, Jaundice
Cx - Septic Shock = Hypotension + Confusion

Cholecystectomy, Widen Ducts with Stent,
ERCP - remove obstruction

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11
Q

Cholecystitis

A

Chronic Inflammation of Cystic Ducts, Gallstones block duct, e.coli grow in gallbladder after stasis

Pain in RUQ radiating to scapula
Pain after eating meal
Peritonitis - rebound tenderness

Positive Murphys Sign (Stop breathing while pressing the gallbladder on inhalation)

ERCP, USS, HIDA Scan (Cholecintigraphy)

Bile duct can also be obstructed leading to Jaundice but more likely to cause ascending cholangitis

Cholescintigraphy Ix

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12
Q

Primary Sclerosing Cholangitis

A

Autoimmune Disease (IBD)

Onion Skin Fibrosis seen in microscopy
Beaded appearance of bile ducts

Genetic Link
HLA-B8, HLA-DR3, Human Leukocyte Ag

Ix IgM, p-ANCA, ALP, GGT

Cx Portal Hypertention, Pruritus,

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13
Q

Hypetrophic Pyloric Stenosis

A

Gastric Outlet Obstruction in Infants
Non Bilous Projectile Vomiting
Paplable olive-shaped mass in epigastric region
USS shows thickened and lengthened pylorus
Tx Pyloromyotomy

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14
Q

Annular Pancreas

A

Abnormal rotation of ventral pancreatic buds causing duodenal narrowing and vomiting

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15
Q

Pancreas Divisum

A

Abnormal fusion of ventral and dorsal pancreatic buds

chronic abdominal pain and pancreatitis

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16
Q

Esophageal Atrisia

A

Bilous Vomiting and abdominal distension
Duodenum: Double Bubble on Xray
Jejunal: Disruption of mesenteric veins - ishcaemia

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17
Q

Courvoisier sign

A

Enlarged Gallbladder with painless Jaundice

Obstruction of common bile duct due to tumour in head of the pancreas

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18
Q

Hernias

A

Protrusion of peritoneum through and opening. Contents might be at risk of ischaemia.
Tenderness, erythema and Fever

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19
Q

Achalasia

A

Failure of LOS to relax leading to progressive dysphagia to solids and liquids and possible solid obstruction. (Degenerative changes
Barium Swallow shows dilated oesophagus with an area of distal stenosis
Oesophageal Manometry shows decreased peristalsis
Video Fluoroscopy of Swallow

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20
Q

GORD

Causes and Complications

A

Heartburn, Hoarseness, Dysphagia, Regurgitation
Associated with Asthma
Leads to Barret Oesophagus (stratified squamous epithelium turns simple columnar with goblet cells)
Increased risk of adenocarcinoma

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21
Q

Cancer Prevalence

A

Upper 2/3 rds Squamous Cell Carcinoma
Alcohol, Strictures, Smoking, Achalasia

Lower 1/3 rd Adenocarcinoma
Barret, Obesity, GORD, Smoking, Achalasia

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22
Q

Acute Gastritis Causes

A

NSAIDs,

Brain Injury increasing vagal stimulation and therefore Ach and H+ production

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23
Q

Chronic Gastritis Cuases

A

Mucosal Inflammation leading to atrophy and intestinal metaplasia. H.Pylori Increase risk of peptic ulcer and
Autoimmune Abs to parietal cells and Intrinsic factor

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24
Q

Gastric Adenocarcinoma

A

Acanthosis Nigricans
Nausea, Vomiting, Dysphagia, Haematemesis, Malaena
Virchow node involvement of left supraclavicular node
H.Pylori, Nitrosamines, Tobacco
Mucus Secreting Cells

Gastroscopy, Barium meal
Endoscopic USS, CT Thorax/Abd, FDG-PET

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25
Gastric Ulcer
Malignant NSAIDs associated Pain Increases with eating so looses weight
26
Duodenal Ulcer
Benign H.Pylori, Zollinger Elisson Syndrome associated Pain decreases with eating so gain weight Hypertrophic Brunners Glands
27
Ulcer Complications
Haemorrhage, (G, D) Obstruction - Pyloric or Duodenal Obs Perforation (D) - free air under diaphragm with referred pain to the shoulder via irritation of phrenic nerve
28
Celiac Disease
Autoimmune intolerance to gliadin - 1% population Malabsorption and Steatorrhoea– failure to thrive as a child; iron deficiency anaemia, fatigue, GI symptoms – loose stool, abdominal pain Risk Factors: HLA-DQ2, HLA-DQ8 Cx: Dermatitis Herpetiformis Ix: Anti Tissue Transglutaminase, anti-Endomysial, gliadin peptide Abs, Villous Atrophy, D-xylose test to see if mucosal absorption is affected
29
Lactose Intolerance
Osmotic Diarrhoea with decreased stool pH
30
Whipple Disease
``` Tropheryma Whipplei Foamy Macrophages Cardiac Symptoms Arthralgias Neurological Symptoms ```
31
MacBurneys point
1/3 rd of a distance from right anterior superior iliac spine to umbilicus
32
Rovsings Sign
palpation of the left iliac fossa causing pain to be felt in the right iliac fossa
33
Differential Diagnosis safe choices
Idiopathic, Drugs,
34
Biliary Pain
Epigastrium + sometimes RUQ | Cholestasis features - pale stools, dark urine, jaundice
35
Persistent Right upper quadrant discomfort
Hepatic Distension due to RHF or hepatic disease
36
Pancreatic Pain
Epigastric and radiates to the the back | Fatty Foods and alcohol are common precipitates
37
Foregut Pain
Gastroduodenal Pain in Epigastrium Eating will relieve Acidic, Dyspeptic symptoms Exacerbate Obstructive/Irritative causes
38
Midgut Pain
Small Intestine Colicky, Periumbilically Bloating, Nausea, Vomiting
39
Hindgut Pain
Colicky | Change in Bowel Habits and Rectal Bleading
40
Peritonic Pain
Highly Localised - sensory innervation
41
Jaundice Causes
PreHepatic - Haemolysis (excess Hb Destruction) Hepatic - Hepatitis (LFTs abnormal, ALT) PostHepatic - (Pancreas, Cancer, Biliary Stones (AST - tissue injury indicative)
42
Gilbert's Syndrome
Unconjugated Hyperbilirubinaemia | Jaundice after Exercise
43
Jaundice Ix
BT's, LFT's, Viral hepatitis Serology IgG, IgA, IgM MRCP - Magn Resonance CholangioPancreatography, Liver Ultrasonography, EUS (Endoscopic Ultrasound), Endoscopic Retrogade Cholangiopancreatographhy
44
Ascites Exudate Transudate
>30, Pancreatitis | <25, Liver Disease, HF
45
Causes of Increased portal venous pressure
``` Cirrhosis Vascular Obstruction (Portal Vein Thromb, Budd Chiari) ```
46
Pathogenesis in Colorectal Cancer
APC (Adenomatous polyposis coli) gene loss - Decreased intracellular adhesion - Increased Proliferation KRAS mutation - Unregulated Intracellular Signalling - Adenoma Loss of p53, DCC (Tumour Suppressor Genes) - Tumorigenesis - Carcinoma
47
Colorectal Cancer RF, Presentation, Ix
Hereditary Non Polyposis colorectal cancer Family History Iron Deficiency Colicky Pain Hematochezia ``` Flexible Sigmoidoscopy Feacal Occult Blood Testing FOBT Feacal Immunochemical Testing FIT Apple Core Lesion on Barium Enema CEA tumour biomarker recurrence screening ```
48
exophytic mass infiltrating mass
“ball-shaped” mass - compresses ascending colon “bean-shape'' of kidney maintained - invades descening colon
49
Bacterial Peritonitis
Gram -ve Klebsiella, E.coli Gram +ve Streptococcus Paracentesis with ascitic fluid ANC - absolute neutrophil count
50
Alcoholic Liver Disease Ix Viral Hepatitis Liver Disease Ix
AST > ALT ? 1:1? , gamma glutamyl transferase AST>ALT 2:1 ALT > AST, Decreased Albumin and Platelets, Increased Bilirubin and Prothrombin time
51
Hepatic Encephalopathy
Increase NH3 production (GI Bleed, constipation, infection) Dereased NH3 removal (Diuretics, TIPS, renal failure) Treatment: Lactulose, Neomycin
52
Budd Chiari Sydrome
Thrombosis or Compression of hepatic veins Hepatic Outflow Obstruction Triad: Abdominal pain, ascites, and hepatomegaly
53
Wilson Disease Gilberts Syndrome Hemochromatosis
AR, Increased Copper Decreased UDP-glucuronosyltransferase conjucation Increased Bilirubin Increased Iron
54
IgM IgG IgA
IgM is an indicator of a current infection, IgG indicates a recent or past exposure to the illness IgA - mucosal surfaces, serum immunoglobulin,
55
Biliary Colic
Stone in cystic duct - RUQ Pain, nausea, vomiting
56
Choledocholithiasis
Gallstone in common bile duct (Increased ALP, GGT)
57
Pancreatitic Insufficiency Manifestations
Steatorrhea, Fat Soluble Vitamin (ADEK) Deficiency Diabetes Mellitus Acute Pancr. Amylase and Lipase are elevenated
58
Pancreatic Adenocarcinoma
Abd Pain radiating to the back Weight Loss Migratory Thrombophlebitis (redness and tenderness on palpation of extremities - Trousseau Syndrome) Courvoisier Sign (Obstructive Jaundice with palpable non tender gallbladder) Tx Whipple Procedure, Chemo, Radiotherapy
59
Whipple Procedure
Pancreaticoduodenectomy removes the head of the pancreas, first part of the small intestine (duodenum), the gallbladder and the bile duct.
60
Histamine-2 Blockers
-dine eg. Ranitidine Decrease H+ secretion from parietal cells PU, Gastritis, Mild Esophageal Reflux
61
PPI
-zole eg. Omeprazole Irreversibly Inhibit H+/K+ ATPase PU, Gastritis, Esophageal Reflux, ZE Syndrome
62
Laxatives for Constipation Adverse Effect
Bulk Forming - Methylcellulose - Promotes Peristalsis - Bloating Osmotic - Mg Hydroxide - Draws Water into GI lumen Stimulants - Colonic Contraction (Enteric Nerve Stimul) AE: Diarrhoea
63
Gastroscopy Cx
``` Iron Deficiency Vit B12 / Vit D Deficiency Dumping syndrome Alkaline reflux Oesophagitis Anastomotic Stricture ```
64
Dumping syndrome
Weakness, abdominal discomfort, abnormally rapid bowel evacuation, occurring after meals
65
Acanthosis nigricans
Brown to black, poorly defined, velvety hyperpigmentation of the skin. usually found in body folds
66
Achalasia Treatment
Endoscopic injection of botulinum toxin | Hydrostatic balloon under imaging to dilate LOS
67
``` 18 month history Heartburn Water brash Belching Pain on Swallowing ```
Hiatus Hernia with reflux oesophagitis (sliding hearnia is also usually associated) Oesophageal pH monitoring Antacids (Al/Mg Hydroxide) PPIs
68
H.Pylori Tx
PPI (Omeprazole) Clarythromycin Amoxycillin
69
hematemesis
Coffee ground (coagulated blood) vomiting
70
Budd Chiari Syndrome
Hepatomegaly Ascitis Abd Pain
71
Conjugated | Uncojugated Bilirubin
``` Coca Cola Urine (Post Hepatic/Hepatic) Urine Normal (Haemolysis) ```
72
Osmotic Laxatives Stimulants Bulking Agents
Lactulose Senna (Motility) Methylcellulose (Drink Water)
73
Tarry Black Stool
Malena - Upper GI Bleed
74
Commonest UGI Bleed
PU | Mallory Weiss
75
Acute Abdomen:Investigation
FBC, U+E, LFT Radiology: plain,US, axial (CT) ?other Laparoscopy vs. laparotomy ``` Resuscitation Restore circulating fluid volume Ensure tissue perfusion Enhance tissue oxygenation Treat sepsis Decompress gut Ensure adequate pain relief ```
76
High risk features of Rectal Bleeding
Persistent change in bowel habit (>6 weeks) Persistent rectal bleeding without anal symptoms Right sided abdominal mass Palpable rectal mass Unexplained iron deficiency anaemia
77
Bowel anastomosis Success Criteria Complications
Tension free Well perfused Well oxygenated Clean surgical site ``` Complications Anaesthetic related Bleeding Sepsis Anastomotic breakdown Small bowel obstruction Wound hernia ```
78
Immunological Functions of Epithelial layer Mucus layer Innate immune responses Antigen presenting cells Soluble mediators of immunity
Specialized tight junctions that regulate permeability Physical barrier keeping microbes from host cells Sensing of bacteria + anti-microbial peptides + IgA Dendritic cells and macrophage Chemokines and cytokines
79
IBD
dysbiosis in microbial communities Anti-TNF biologics - vedolizumab
80
Haematemesis Brown vomit, Melaena Magenta stools Haematochezia Dyspepsia
Vomiting of blood due to active haemorrhage from the oesophagus, stomach or duodenum poor correlation with significant GI bleeding in isolation, often reflection of systemic illness Black tar-like loose stools per rectum, Considered as partially digested blood Red-purple stools, typically from right colon or distal small bowel Passage of fresh or altered blood per rectum – may be from upper GI cause as “fast transit” or lower GI Epigastric discomfort, may be exacerbated by eating, “indigestion”

Revision Year 2 (14 decks)

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