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GI > Lower GI diseases (medicine) > Flashcards

Lower GI diseases (medicine) Flashcards

1
Q

Coeliac Disease

A

inflammation of the mucosa of the upper small bowel when exposed to gluten

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2
Q

In people with coeliac disease, proteins in gluten containing foods are resistant to digestion by ———— and remain in the intestinal lumen, triggering ———-

A

digestion by pepsin & chymotrypsin

triggering immune responses

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3
Q

In coeliac disease, immune response causes inflammation, which leads to ———–

A

villous atrophy and crypt hyperplasia; this in turn leads to malabsorption of other nutrients

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4
Q

Coeliac disease affects about —–% of the population

A

1%

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5
Q

Coeliac disease can present at any age. True/false?

A

True.

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6
Q

Coeliac disease - associated Diseases (other autoimmune diseases)

A 
Thyroid disease
Type 1 diabetes
Sjogren Syndrome
IBD
IgA deficiency
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7
Q

Coeliac disease - signs/symptoms

A 
Abdo pain
Weight loss (failure to thrive in kids)
Diarrhoea/steatorrhea
Angular stomatitis on corners of mouth
Dermatitis herpetiformis on extensor surface of elbows
Anaemia, malnutrition
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8
Q

What are the long-term problems associated with coeliac disease?

A

iron/folate deficiency

osteoporosis

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9
Q

Coeliac disease - investigations

A 
1st line = serology
tTG antibodies (IgA tissue transglutaminase antibodies)
EMA (IgA endomysial antibodies)

2nd line = biopsy

Other blood tests e.g. iron and folate def.
DEXA scan to check bone density

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10
Q

Coeliac disease - management

A 
Gluten-free diet
Vitamin supplements
Pneumococcal vaccines for pts with splenic atrophy
Annual blood tests (serology and FBC)
Screen for other autoimmune conditions
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11
Q

Coeliac disease - differential

A

IBS

IBD

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12
Q

GI Malabsorption

A

Defective mucosal absorption. The digestive system does not have the function and/or enzymes to break down the substances from the diet.

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13
Q

GI Malabsorption - common causes

A

Coeliac, Lactose intolerance, Crohn’s, post infective, chronic pancreatitis, Biliary obstruction, liver cirrhosis

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14
Q

GI Malabsorption - rarer causes

A

Whipple’s disease, drugs, PSC, short bowel

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15
Q

Whipple’s disease

A

A multisystem bacterial infection that mainly affects the digestive system and joints. Leads to impaired breakdown of nutrients and malabsorption.

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16
Q

GI Malabsorption

A

Diarrhoea, weight loss, bloating, abdo pain.

Signs: Anaemia, oedema, steatorrhea, bleeding disorders, neuropathy.

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17
Q

Lactose intolerance is an allergic reaction. True/false?

A

False.

Intolerance is different to allergy

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18
Q

How is lactose malabsorption different to an allergy?

A

Lactose intolerance = patient produces little/no lactase&raquo_space; will not break down lactose into glucose/galactose&raquo_space; undigested molecule will cause digestive problems e.g. diarrhoea, abdominal pain.

Allergy = mediated by the immune system, commonly involving IgE antibodies. (rashes, swelling, hives, wheezing)

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19
Q

Tropical sprue

A

A rare digestive disease of unknown cause that affects the small bowel’s ability to absorb nutrients. Especially vitamin B12 and folic acid.

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20
Q

Tropical sprue leads to hypertrophy of villi of digestive wall. True/false?

A

False.

Atrophy of villi.

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21
Q

Tropical sprue - symptoms

A

Fatigue, diarrhoea, anorexia

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22
Q

Vitamin C deficiency

A

Scurvy.

Symptoms/ signs: gum disease, anorexia, weakness.

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23
Q

Vitamin D deficiency

A

Osteomalacia, rickets

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24
Q

Scurvy is caused by vitamin D deficiency. True/false?

A

False.

Vitamin C deficiency

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25
Q

Malnutrition

A

State of nutrition in which a deficiency or imbalance of energy and nutrients leads to adverse effects on body tissue, function and clinical outcome.

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26
Q

Malnutrition - treatment

A

Food first
Oral supplements

Enteral Feeding Tube = into stomach or small intestines by tube
Parenteral nutrition = via a central or peripheral vein

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27
Q

Small bowel tumours

3 types =

A

Adenocarcinoma
Lymphoma
Carcinoid tumours

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28
Q

In the small bowel, primary tumours are common; secondary tumours are much more rare. True/false?

A

False

Primary tumours are rare, secondary tumours are much more common.

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29
Q

Crohn’s is a predisposing factor to which cancer?

A

Adenocarcinoma of the small bowel

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30
Q

Small bowel adenocarcinomas are most commonly found in ————–
Lymphomas are most commonly found in ————-

A 
Adenocarcinomas = duodenum, jejunum
Lymphomas = ileum
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31
Q

The most common small bowel lymphoma is T cell arising from MALT. True/false?

A

False.

B cell arising from MALT.

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32
Q

Adenocarcinomas are the most common tumour found in the small bowel. True/false?

A

True

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33
Q

Adenocarcinomas and Lymphomas of the small bowel are managed with chemo/radio. True/false?

A

False.

SURGICAL RESECTION + chemo/radio

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34
Q

Carcinoid tumours are a type of fast-growing neuroendocrine tumour. True/false?

A

False.

Slow-growing neuroendocrine tumour

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35
Q

Carcinoid tumours originate from ———- cells of the intestine.

A

enterochromaffin

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36
Q

In the small bowel, carcinoid tumours are most commonly found in ———–

A

appendix and terminal ileum

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37
Q

Carcinoid syndrome tends to occur only if ———-

A

the tumour has metastasised

commonly to liver

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38
Q

A key substance that is overproduced by carcinoid tumours is ————-

A

serotonin

increases motility and peristalsis, bronchoconstriction and can produce collagen via fibroblasts in the heart

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39
Q

Carcinoid syndrome - symptoms

A

Spontaneous flushing
Diarrhoea
Shortness of breath/wheezing
Pulmonary stenosis or tricuspid incompetence

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40
Q

Carcinoid tumours usually cause symptoms e.g. diarrhoea, shortness of breath, tricuspid regurg etc. True/false?

A

False.
Most carcinoid tumours are asymptomatic.
These are symptoms of carcinoid syndrome.

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41
Q

Carcinoid tumour - investigations

A

Serum chromogranin A
24hr urine secretion of 5-hydroxyindoleacetic acid

(imaging to check for mets)

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42
Q

Carcinoid tumour - treatment

A

Surgical resection

Octreotide/lanreotide (somatostatin analogues) inhibit the release of hormones, alleviating symptoms

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43
Q

Irritable Bowel Syndrome (IBS) is a functional bowel disorder in which abdominal pain is associated with structural pathology and a change in bowel habit. True/false?

A

False.

Abdominal pain is associated with change in bowel habit in the ABSENCE of structural pathology

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44
Q

IBS is associated with which other non-GI related medical conditions?

A

anxiety/stress/depression

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45
Q

IBS is more common in men. True/false?

A

False.

more common in women

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46
Q

What examinations would you conduct for suspected IBS?

A

Check BMI for unexplained weight loss
Abdo exam to check for tenderness/masses
PR exam to check for rectal pathology

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47
Q

Which conditions should be ruled out in the diagnosis of IBS?

A

IBD and coeliac

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48
Q

IBS - investigations

A

FBC - anaemia, raised platelets (may suggest inflam)
ESR/CRP - raised in infection/inflam
Coeliac serology

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49
Q

If the patient reports >6 months of abdo discomfort with ———- they can be diagnosed with IBS

A

Improvement with defecation/
change in frequency of stool/
change in appearance of stool

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50
Q

IBS - management

A

Identify dietary/mental triggers
Dietary advice
Recommend increased probiotic intake

Consider anti-diarrhoeals (e.g. loperamide)
Consider laxatives
Antispasmodics if abdo pain not resolving

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51
Q

Inflammatory Bowel Disease (IBD) has 2 types =

A 
Crohn’s Disease (CD)
Ulcerative Colitis (UC)
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52
Q

IBD - environmental triggers

A

Smoking, NSAID use, hygiene, diet and nutrition, stress.

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53
Q

Crohn’s disease only affects the colon. True/false?

A

False.
CD affects any part of the GI tract
UC only affects the colon

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54
Q

There is evidence of altered bacteria flora in IBD. True/false?

A

True

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55
Q

IBD occurs due to ———–

A

an overactive mucosal immunological response to luminal antigens e.g. bacteria

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56
Q

IBD patients have leaky epithelium which increases chance of detection of antigen by immune cells. True/false?

A

True

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57
Q

How is the T cell response altered in IBD?

A

Overactive effector T cell response

An absence of regulatory T cells

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58
Q

What T cells mediate:
Crohn’s?
UC?

A

Crohn’s - TH1 mediated

UC - mixed Th1/Th2

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59
Q

IBD increases the risk of developing ———–

A

Colon cancer
Toxic megacolon (in UC)
Bowel obstruction
Sclerosing cholangitis

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60
Q

Eye manifestations of IBD

A

uveitis, episcleritis, conjunctivitis

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61
Q

Skin manifestations of IBD

A

erythema nodosum, pyoderma gangrenosum

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62
Q

Joint manifestations of IBD

A

arthralgia, ankylosing spondylitis

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63
Q

Liver and biliary tree manifestations of IBD

A

sclerosing cholangitis, fatty liver, chronic hepatitis, cirrhosis, gallstones

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64
Q

Crohn’s Disease

A

Autoimmune inflammatory disorder that involves the entire GI tract.
(terminal ileus most commonly affected)

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65
Q

Crohn’s disease - signs/symptoms

A 
Abdominal Pain- depends on site of inflammation
Diarrhoea (rarely blood or mucus)
Weight loss/reduced growth in children 
Fatigue
Malaise
Fever
Mouth ulcers
Angular stomatitis
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66
Q

Angular stomitis

A

common inflammatory condition affecting the corners of the mouth

67
Q

Blood in the stool is more commonly seen in UC patients, rather than CD patients. True/false?

A

True

tends to be seen when the inflammation is in the colon

68
Q

Crohn’s disease - bloods?

A

CRP, ESR, Ferritin, B12.

Faecal calprotectin?

69
Q

What does Crohn’s disease look like on a biopsy?

A

patchy, granuloma, loss of villi

70
Q

Transmural inflammation is seen in UC. True/false?

A

False.

Crohn’s

71
Q

Faecal calprotectin is released from ————

A

the bowel when inflamed

72
Q

When doing an endoscopy for suspected Crohn’s disease, look for ———–

A

cobble-stoning, skip lesions

73
Q

When doing imaging for suspected Crohn’s disease, look for ———–

A

strictures, fistulas

74
Q

What is the first-line medicine in the management of Crohn’s?

A

Steroids e.g. prednisolone, budenoside (short course of 6-8 weeks to induce remission)

75
Q

Steroid - side effects

A

Weight gain, osteoporosis, thinning of the skin, hypertension, etc

76
Q

What is the second-line medicine in the management of Crohn’s?

A

Immunosuppressants e.g. azathioprine, methotrexate

maintenance therapy

77
Q

Steroids are the first-line maintenance therapy in the medical management of Crohn’s disease. True/false?

A

False.
Although first-line, steroids are only used in the short-term in induce remission.
Immunosuppressants are the maintenance therapy for Crohn’s.

78
Q

What is the third-line medicine in the management of Crohn’s?

A

Anti-TNF “-imab”

79
Q

What is the mechanism of action of anti-TNF therapy?

A

TNF is a cytokine and is involved in loads of inflammatory response pathways.
Anti-TNF therapy will promote the apoptosis of T cells.

80
Q

Surgery for Crohn’s disease can be curative. True/false?

A

False.

Non-curative

81
Q

What are the complications/risks of surgery in the management of Crohn’s?

A

Strictures, fistulas and obstruction.
Risk of malnutrition, short gut syndrome and low quality of life.
Patient may require parenteral nutrition., or may need stoma.

82
Q

Ulcerative Colitis

A

A chronic, remitting inflammatory condition affecting just the colon

83
Q

Peak incidence of UC is in early adolescence. True/false?

A

False.

Late adolescence

84
Q

UC forms ordered from least severe&raquo_space; most severe are:
proctitis > left-sided colitis > proctosigmoiditis > extensive colitis
True/false?

A

False

proctitis > proctosigmoiditis > left-sided colitis > extensive colitis

85
Q

UC - macroscopic changes

A 
Mucosa looks red & inflamed
Very friable
Continuous appearance
Pseudo-polyps present
Thin wall
86
Q

UC - microscopic changes

A

Inflammation limited to mucosa (superficial)
Goblet cells depleted
Crypt abscesses

87
Q

UC - risk factors

A

NOT smoking
Family history
No appendectomy
NSAIDs

88
Q

Smoking is a risk factor for ulcerative colitis. True/false?

A

False.
Smoking is a risk factor for Crohn’s
It is a PROTECTIVE factor for UC

89
Q

UC - GI symptoms

A 
History of bloody diarrhoea > 6wks/rectal bleeding
Faecal urgency/incontinence
Tenesmus
Abdo pain (esp in LIF)
Pain before defecation, relieved after
90
Q

UC - non-GI symptoms

A

Malaise, fatigue, fever, anorexia, anaemia

91
Q

Smoking cessation not recommended for smokers with UC. True/false?

92
Q

Signs of UC

A

Aphthous ulcers
Finger clubbing
Pallor (anaemia)
Abdo tenderness in LIF

93
Q

Angular stomitis is a sign of UC. True/false?

A

False

Sign of Crohn’s or Coeliac

94
Q

UC rarely presents with blood in diarrhoea. True/false?

A

False
UC = bloody
Crohn’s = no blood

95
Q

Signs/symptoms of UC vs Crohn’s

A

UC vs Crohn’s
Bloody diarrhoea vs no blood
Crypt abscesses vs skip lesions, cobble-stoning
lower GI symptoms, urgency, tenesmus vs weight loss, sometimes a palpable mass, upper GI symptoms

96
Q

The gold standard investigation for Coeliac disease is a duodenal biopsy. True/false?

A

True

TTG antibodies is first-line (NOT gold standard)

97
Q

A palpable abdominal mass in the right iliac fossa is sometimes felt in Crohn’s disease. True/false?

98
Q

Arthritis is the most common extra-intestinal feature in UC, but not Crohn’s. True/false?

A

False.

Arthritis is most common in BOTH

99
Q

Crohn’s increases a patient’s risk of developing colorectal cancer. True/false?

A

True

NOT as high a risk as UC

100
Q

Stricture, fistula, abscess and obstruction are all complications of UC. True/false?

A

False

Complications of Crohn’s

101
Q

What is Kantor’s string sign?

A

string-like appearance of a contrast-filled bowel loop caused by its severe narrowing in Crohn’s disease.

102
Q

UC disease is pANCA positive. True/false?

A

True

pANCA = type of antibody

103
Q

UC - investigations

A 
FBC - anaemia?, high platelets?
CRP - raised
LFTs - may be deranged
U&Es - may be deranged
Coeliac serology - to exclude coeliac
Stool culture - to exclude infective causes
Faecal calprotectin - raised suggests active inflammation
Colonoscopy - diagnostic
104
Q

What is the medical management of UC?

A

1st line - topical rectal aminosalicylate
2nd line - oral aminosalicylate or rectal steroids
3rd line - add on topical/oral steroid
4th line - biologics (e.g. anti-TNF like infliximab)

105
Q

Acute exacerbations of UC are treated with high-dose oral steroids. True/false?

A

False

IV steroids

106
Q

Azathioprine (immunosuppressant) is also used in the treatment of UC. True/false?

107
Q

Apart from medicine/surgery, what else is important in the treatment of UC?

A 
Lifestyle, support groups
Bone health assessment (risk of osteoporosis)
Colonic cancer surveillance
Monitor nutrition status (supplements)
Flu and pneumococcal vaccines
108
Q

UC - surgical management

A

Elective colectomy with/without ileostomy or colostomy (stoma)

109
Q

Aminosalicyclic acid examples

A

sulfasalazine, mesalazine

110
Q

Aminosalicyclic acid - benefits

A

Reduces risk of colon cancer

Anti-inflammatory

111
Q

Aminosalicyclic acid - side effects

A 
diarrhoea, GI upset
Idiosyncratic nephritis (kidney inflammation)
112
Q

Refeeding syndrome

A

metabolic problem when a malnourished person is introduced to food too quickly

113
Q

Osmotic diarrhoea occurs due to secretion of electrolytes into the lumen in response to a signal, followed by the movement of water. True/false?

A

False
This is secretory diarrhoea
Osmotic diarrhoea = non-absorbable substances cause water to move into lumen

114
Q

What are the three types of diarrhoea?

A

Osmotic
Secretory
Inflammatory

115
Q

———- diarrhoea can be caused by certain purgatives, or a malabsorption condition (e.g. lactose intolerance)

A

Osmotic diarrhoea

*resolved by avoiding the substance

116
Q

Inflammatory diarrhoea can be caused by enterotoxin from E. coli, C. diff and Cholera. True/false?

A

False

These are causes of secretory diarrhoea

117
Q

Secretory diarrhoea can be caused by ————- and can be resolved by ———–

A

Caused by enterotoxin from E. coli, C. diff, cholera. or hormones.
Resolved by replacing the electrolytes and fluids.

118
Q

Inflammatory diarrhoea can be caused by ——–

119
Q

Osmotic diarrhoea

A

large quantities of non-absorbable substances cause water to move into the lumen.

120
Q

Secretory diarrhoea

A

secretion of electrolytes into the lumen in response to a signal, followed by movement of water.

121
Q

Inflammatory diarrhoea

A

damage to mucosal cells, leading to loss of blood/fluid&raquo_space; decrease in absorptive function&raquo_space; build up of malabsorped substances

122
Q

Diarrhoea of sudden onset, crampy abdominal pain, fever.

Diagnosis?

A

Infective
e.g. E. coli, C. diff, cholera
(cholera = explosive)

123
Q

Loose, blood stained stools, chronic history, extra- GI symptoms.
Diagnosis?

A

IBD

most likely UC if blood

124
Q

No blood, triggering events, alternating diarrhoea/constipation.
Diagnosis?

125
Q

Steatorrhea

A

Pancreatic

excess fat in faeces - pale, oily, foul-smelling

126
Q

Bloody diarrhoea, mass present in abdomen.

Diagnosis?

A

Colorectal cancer

127
Q

Diarrhoea with malabsorption, raised MCV, low folate, positive auto-antibodies.
Differential?

A

Small bowel lesions
e.g. Coeliac disease, tropical sprue, Giardia
(MCV = mean cell volume)

128
Q

Diarrhoea with malabsorption, low Hb.

Differential?

A

Small bowel lesions

e.g. Crohn’s

129
Q

Diarrhoea with malabsorption, normal Hb, MCV, folate, no auto-antibodies.
Differential?

A

Pancreatic lesions.

e.g. chronic pancreatitis, carcinoma

130
Q

Constipation

A

<2 bowel movements per week.

Can involve straining, hard stools, incomplete emptying, abdominal pain, perianal pain and bleeding.

131
Q

Constipation - causes

A

Poor diet, poor fluid intake
Obstruction - stricture, colorectal cancer, diverticulosis
IBS
Anorectal disease - stricture, prolapse, fissure
Functional/idiopathic
Metabolic
Drugs

132
Q

Constipation - treatment

A 
Treat underlying
Diet, exercise, fluid
Bulking agents eg Ispaghula husk 
Stool softeners
Osmotic laxative eg Lactulose
Stimulant laxative eg Senna
133
Q

Lactulose is an example of a stimulant laxative. True/false?

A

False.
Lactulose = osmotic
Senna = stimulant

134
Q

Ispaghula husk is used to treat diarrhoea. True/false?

A

False

Bulking agent used in constipation.

135
Q

Necrotising enterocolitis is a disease that affects children. True/false?

A

False.

Premature babies

136
Q

Necrotising Enterocolitis

A

Life-threatening condition affecting premature babies.

GI wall invaded by bacteria&raquo_space; inflammation&raquo_space; necrosis&raquo_space; leakage of the bowel contents&raquo_space; peritonitis

137
Q

Necrotising Enterocolitis can cause the bowel contents then leak out into the peritoneal cavity and cause peritonitis. True/false?

138
Q

Necrotising Enterocolitis - symptoms

A

Poor feeding, abdominal distention,

bile stained vomit, sepsis.

139
Q

The complement system can get activated by the upregulation of mesothelial cells during infection, triggering the inflammatory cascade. True/false?

140
Q

Peritonitis - causes

A 
Underlying GI condition (e.g. appendicitis, pancreatitis, Crohn’s)
Perforated organ
Peritoneal dialysis
Ascites related to liver disease
TB
141
Q

Peritonitis can be caused by TB. True/false?

142
Q

Generalised peritonitis is seen with acute inflammation (e.g. acute appendicitis, acute cholecystitis). True/false?

A

False

Localised peritonitis

143
Q

Localised peritonitis - causes

A

acute inflammation (e.g. acute appendicitis, acute cholecystitis)

144
Q

Generalised peritonitis - causes

A

Irritation of peritoneum because of infection (e.g. perforation) or chemical irritation due to leakage of intestinal contents (e.g. perforated ulcer)

145
Q

Abdo pain/tenderness, rigid abdomen, rebound tenderness.

Diagnosis?

A

Peritonitis

also distended abdomen - related to ascites, high temp, tachycardia

146
Q

Blumberg’s sign

A

Rebound tenderness

Indicative of peritonitis

147
Q

In peritonitis, air can be seen under the diaphragm on an erect chest x-ray. True/false?

A

False

Air can only be seen if the cause of peritonitis is perforation.

148
Q

Peritonitis - management

A 
Resuscitate patient (NG tube, IV fluids, antibiotics)
Surgical - peritoneal lavage, treat underlying cause
149
Q

Peritonitis - complications

A

Sepsis
Multiorgan failure
Abscess formation (may need to be drained)

150
Q

Peutz-Jeghers Syndrome

A

Autosomal dominant condition characterised by: hamartomatous GI polyps
mucocutaneous hyperpigmentation

151
Q

Patients with Peutz-Jeghers syndrome have 15 fold increased chance of developing stomach cancer. True/false?

A

False
Intestinal cancer
(also pancreatic, breast)

152
Q

Peutz-Jeghers syndrome - assoc. complications

A

bowel obstruction and intussusception

153
Q

Peutz-Jeghers syndrome - management

A

Active cancer surveillance

Prophylactic polypectomy

154
Q

Hamartoma

A

benign, disordered overgrowth of cells normally found in that area
(e.g. in Peutz-Jeghers Syndrome)

155
Q

Dysphagia & odynophagia.

Diagnosis?

A

Think malignancy

156
Q

Heartburn & reflux, retrosternal pain, especially when lying down flat
Diagnosis?

A

think GORD

157
Q

Indigestion (dyspepsia)

Differential?

A

think peptic ulcer/GORD/H. pylori

158
Q

Haematemesis

Diagnosis?

A

due to upper GI bleeding (above duodennojejunal flexure)
Bright red = above stomach
“coffee grounds” = below stomach

159
Q

Bright red PR bleeding, separate from stool.

Diagnosis?

A

source = sigmoid colon/rectum/anal canal

usually haemorrhoids

160
Q

Darker blood, mixed with stool.

Diagnosis?

A

source is above rectum - carcinoma most common

161
Q

Melaena

Diagnosis?

A

(dark sticky faeces)

bleeding from above ileocecal valve, “tarry”, characteristic smell

162
Q

Tenesmus

A

feeling of incomplete emptying

163
Q

Sclerosing cholangitis

A

Chronic liver disease involving inflammation, scarring and narrowing of bile ducts.

164
Q

Finger-clubbing is commonly seen in which GI disease?

GI (9 decks)

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