Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GASTROENTEROLOGY SCE > Intestinal Disorders > Flashcards

Intestinal Disorders Flashcards

1
Q

HLA associated with coeliac

A

HLA-DQ2

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

Describe Marsh criteria for Coeliac disease

A
  1. Lymphocytic infiltration
  2. Crypt hyperplasia
  3. Villous atrophy (C is the worst category)
  4. Flat strophic mucosa (may develop T-cell lymphoma)

Mucosa architecture is normal

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

Complications of coeliac disease

A

Osteoporosis (do DXA scans)
Autoimmune disease
NHL (T-cell)
Pneumococcus sepsis (hyposplenism)

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

Where is bile stored

A

Gallbladder

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

Describe what happens when bile acids reach the colon

A

Colonic bacteria dehydroxylates bile acids to secondary bile acids that stimulates water and electrolyte release = diarrhoea

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

Possible pathology of bile acid malabsorption

A

Overproduction of bile acids

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

Causes of bile acid malabsorption

A

TI disease (Crohn’s) or resection
Cholecystectomy
Idiopathic

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

How can we assess for BAM?

A

Measure turnover of radiolabelled bile acids

Measure serum metabolites

Quantification of excreted bile by seHCAT - retained fraction assessed with gamma cameras 7 days after po administration.
- <15% = BAM

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

Treatment of BAM

A

Cholestyramine

Colesevelam

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

1st line medical treatment of anal fissure

A

Topical diltiazem

Can give Botox

Surgery - literal sphincterotomy

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

How acquire strongyloidiasis?

A

Walking barefoot on soil

Asymptomatic in acute phase

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

Treatment of strongyloidiasis

A

Ivermectin

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

Symptoms associated with strongyloidiasis

A

Area of pruritis at site (migration of larvae) of entry
Diarrhoea
Abdominal pain
Weight loss

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

Complications of strongyloidiasis

A

Hyper infection syndrome = widespread dissemination of larvae into tissues = bloody diarrhoea, bowel perforation, gram -Ve sepsis

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

Rome 3 criteria in IBS

A

Symptoms improve with defecation
Onset associated with change in frequency of stool
Onset associated with change in form (appearance) of stool

Other supportive symptoms = abnormal stool frequency, defecation straining, urgency, bloating

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

What test should be performed before diagnosing a patient with IBS

A

FBC, ESR, CRP, TTG

NOT necessary to perform USS, flexi, TFTs, FOB, breath tests

Women >50 do Ca-125 (if >35 do USS)

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

How can you reduce the risk of radiation enteritis

A

Insert tissue expander to push loops of bowel out of radiotherapy field

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

Treatment of radiation enteritis

A

Sucralfate enemas
Hyperbaric O2
Loperamide

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

Describe the different types of radiation enteritis

A

Acute = within 6 weeks - direct mucosal damage

Chronic = years after - atrophy and fibrosis of epithelium due to obliterative arteritis = chronically ischaemic segment of bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the different causes of proctitis

A 
HIV
LGV - histology can resemble Crohn's 
Gonorrhoea
Syphilius
HSV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Type of bacteria in c diff

A

Gram +Ve bacillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe different toxins in c diff

A

Toxin A - enterotoxin
Toxin B - cytotoxin

They produce inflammation = diarrhoea and possibly paeudomembranous colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which toxin do some c diff strain NOT produce

A

Toxin A - so may get false negative if just test for toxin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe different types of cytotoxin testing in c diff

A
  1. Cell culture cytotoxic assay - gold standard. If +Ve no further confirmatory tests are needed. Expensive
  2. Enzyme immune assay (EIA) - use reagents to detect toxin A and B. Quicker but more false negatives
  3. PCR - rapid. High sensitivity and specificity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the gold standard cytotoxic test in c diff
Cell culture cytotoxic assay
26
Gold standard diagnostic test in SBBO
Duodenal aspirates with cultures These can identify asymptomatic patients
27
Normally, why is there very few bacteria in the small bowel
Ileocaecal valve Acidity Peristalsis
28
Risk factors for SBBO
Billroth 2 procedure as anatomy involves blind-end loop | Dysmotility (DM), strictures
29
Which antibiotics can cause and false negative result and why
Staph, strep viridins, enterococcus, pseudomonas These bugs don't produce hydrogen so get false negative result
30
Diagnosis of SBBO
Hydrogen breath test
31
Describe the role of hydrogen breath test
Some bacteria ferment carbohydrates and produce H+ Get double peak pattern: 1. Metabolism by small bowel bacteria 2. Colonic bacteria metabolism - more prolonged peak
32
Which hormone stimulate sensory neurones
Serotonin. This activates myenteric plexus and then cholinergic neurones release substance P + acetylcholine = contraction of smooth muscle behind area of stretch = peristalsis
33
How can we improve continence in DM
Biofeedback therapy | Clonidine for gastroparesis (but lots of SE)
34
Life cycle of giardia
Cyst ingested - excystation of trophozoites - organism released - sexual reproduction in gut - colonise in small bowel by adhering to mucosa - cytokine release - water and electrolyte loss - trophozoites encyst and pass in faeces
35
Symptoms of giardia
``` Diarrhoea Bloating Flatulence Abdominal pain Malabsorption Weight loss ```
36
Treatment of giardia
Tinidazole
37
How is giardia spread
Faecal-oral route
38
Diagnosis of collagenous colitis
Increase in collagen layer Collagen band > 10micro-grams thick Usually type 1 or 3 collagen
39
Diagnosis of lymphocytic colitis
Increase intraepithelial lymphocytes >20 lymphocytes per 100 epithelial cells
40
Treatment of microscopic colitis
``` Stop offending meds (NSAIDS, SSRIs, PPI) Loperamide Cholestyramine Aminosalicylates Budesonide - if severe ```
41
Is microscopic colitis associated with malignancy?
No Associated with coeliac disease
42
Describe the screening involved for CRC in patients with acromegaly
Start screening age 40 or if raised ILGF-1 3 yearly screening - adenoma, raised ILGF-1 5 yearly if original colon negative Hyperplastic polyp or normal ILGF-1 = 5-10year screening intervals
43
Which hereditary condition associated with bowel cancer is inherited in an AR fashion
MUTYH ASSOCIATED EITH POLYPOSIS (MAP) 100% will have colon cancer by age 60 Start screen age 25 years and perform every 2-3 years with dye spray
44
Mode of inheritance in HNPCC
AD
45
Describe the gene mutations in HNPCC
MSH2, MLH1, MSH6, PMS2
46
When to start screening in HNPCC
Age 25 or 5years less than 1st case of 1st degree relative Repeat every 18/12 until age 70
47
Mutation in FAP
AD APC mutation on 5q21 Endoscopy at 20 years and then every 5 years
48
Describe the types of polyposis syndrome
Juvenile polyposis syndrome Peats-Jeghers syndrome PTEN
49
Mutation in PJS
AD serine threnonine kinase 11 (STK11) on chromosome 19
50
Diagnosis of PJS
>2 polyps histologically or single polyp and a first degree relative with condition
51
Surveillance in PJS
OGD at 8 years, then 3 yearly if polyps found
52
Mechanism of action of prucalopride
5HT4 receptor agonist For chronic constipation Give when tried 2 classes of laxatives at highest tolerated doses for 6/12
53
What is the weakest independent risk factor for faecal incontinence
Forceps delivery
54
What is the pigment found in melanosis coli What is the cause
Lipofuscin - brownish discolouration of colonic wall Laxative abuse Brown bowel syndrome - lipofuscin deposits at tunica muscularis
55
How can we measure colonic transit
Ingest radiopaque marker and perform AXR. 24 plastic markers, AXR on day 6. Normal transit time is <5 markers left Radioisotopes and scintigraphy Ingest of pressure and pH capsule and tracking its movement
56
How can we diagnose slow bowel transit
>6 radio-opaque markers left throughout the colon
57
Diagnose dyssynergic defecation
>6 markers in rectosigmoid region
58
Describe the causes of primary constipation
- slow transit - prolonged delay of transit time of stool - dyssnergic defecation - difficulty expelling stool from rectum - IBS-C = constipation and abdominal pain
59
Secondary causes of constipation
``` Drugs - opioids, anti-cholinergics Hypercalcaemia Cancer Stricture Fissure Hypothyroidism Parkinson's MS Psychiatric ```
60
Diagnosis and treatment of dyssnergic defecation
Anorectal manometry Rx -biofeedback therapy
61
Describe B12 absorption
- cobalamin released from food by action of Pepsins in acid in stomach - salivary R protein binds to free cobalamin protecting it from acid degradation - in duodenum, pancreatic enzymes hydrolyse the R-protein, releasing cobalamin which binds to IF (secreted from parietal cells) - complex taken up by cells in TI LACK OF PANCREATIC ENZYMES CAN RESULT IN DEFECTIVE RELEASE OF COBALAMIN FROM R PROTEIN FOR IF BINDING
62
Does nicorandil cause colonic ulceration?
Yes
63
Infective colitis histology
Normal crypt architecture Neutrophils Crypt abscesses
64
Signs in VIPoma
Diarrhoea Hypokalaemia High stool weight and no reduction in stool weight on day 4 (the fasting day)
65
Why do patients get diversion colitis
Deficiency of short chain fatty acids which normally provide nutrients to the colonocytes This causes reduced acetate, butyrate resulting in less absorption of Na and fluids
66
Y enterocolitica: - cause - mimics - symptoms - endoscopy findings
Gram negative bacilli/rod from contaminated pigs Resembles Crohn's - terminal ileitis Diarrhoea, abdo pain, fever Normal endoscopy findings
67
Typhoid fever: 1. Cause 2. Symptoms 3. What is Faget's sign? 4.
Salmonella typhi - more common in females ('typhoid Mary) Fever, headache, RIF pain, splenomegaly and rose spot on chest
68
When should chemoprophylaxis for diarrhoea be offered?
IBD pt Liver/kidney/heart disease pt Immunosuppressive Can give rifampicin
69
Treatment of giardia
Tinidazole Metronidazole

GASTROENTEROLOGY SCE (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions