Non-specific GI pathologies Flashcards
What are possible causes of malabsorption
Coeliac disease
Crohn’s disease
Infection
Biliary obstruction
Cirrhosis
What are risk factors for malabsorption
Gastric or small bowel resection
GI diversion
Travel
Exposure to radiation
Alcohol
Drugs
What are possible symptoms of malabsorption (3)
diarrhoea (fat globules, bad smell, floating)
Abdominal swelling
Oedema
What are signs of malabsorption
early bruising
Acrodermatis enteropathica
Dermatitis herpetiformis
Glossitis and angular stomatitis
Spooning of nails
What investigations can be carried out for malabsorption
bloods (Ca/Mg/FBC/coagulation/albumin)
Stool culture
Liver function tests
Endoscopy
Imaging
How is malabsorption managed (3)
underlying cause treated
Replace deficiency
Nutritional support
What are the types of GI bleeding (2)
Occult
Acute/overt
What does occult GI bleeding mean
There is a small volume of GI blood loss without symptoms/signs of bleeding
What can cause occult GI bleeding (2)
neoplasia
Vascular causes
What is the clinical presentation of upper GI bleeds (3)
traces of altered blood (coffee ground vomit)
Fresh blood (haematemesis)
Malaena
What is the clinical presentation of Lower GI bleeds
Blood urea is not significantly elevated
What are possible causes of acute lower GI bleeding
Diverticulosis
Ischaemic colitis
Haemorrhoids
Colorectal cancer
Angiodysplasia
Meckel’s diverticulum
What is meant by anaemia
reduced total red cell mass
What are the markers used in anaemia (2)
haemoglobin concentration
Haematocrit
What are some symptoms of anaemia
fatigue
Weakness
Dizziness
Irritability
Shortness of breath
Rapid heart rate
Chest pain
What are signs of anaemia
cold peripheries
Pale skin
What are possible causes of anaemia (5)
Problems related to haemoglobinisation
Lack of iron
Problems with red cell maturation
Lack of folic acid/B12
Chronic diseases
In what form does iron enter plasma
Ferrous form
In what form is iron stored in mucosal cells
as ferritin
What must happen for iron to be converted from ferrous form to ferric from
oxidation
Where is folic acid absorbed
small intestine (duodenum)
What is meant by dyspepsia (2)
Combined upper Gi symtpoms
such as pain/discomfort, heart burn, acid reflux, and nausea/vomiting
What are causes of dyspepsia (2)
PUDGORD
Functional dyspepsia
What are types of functional dyspepsia (2)
Epigastric pain syndrome
Postprandial distress syndrome
What additional features are associated with functional dyspepsia (3)
Postprandial fullness
Early satiation
No evidence of structural disease
What are some risk factors for dyspepsia (6)
IBS
Female
Psychological co-morbidity
Infection (esp H.pylori)
NSAIDs
High BMI
How can dyspepsia be treated (lifestyle) (2)
regular aerobic exercise
Avoiding dietary triggers
How can dyspepsia be treated (pharmacological) (3)
Acid suppressor (PPI, H2 antagonists)
Prokinetics
Neuromodulators (tricyclic antidepressants)
What type of bacteria is h.pylori
gram negative bacillus
How does H.pylori spread occur
Oral-oral or faecal-oral
What can acute H.pylori infection lead to (2)
neutrophilic gastritis
Epigastric discomfort with nausea and vomiting
What can chronic H.pylori infection lead to
non atrophic superficial gastritis
What are possible complications that can arise due to H.pylori infection (2)
peptic ulcer disease
Gastric cancer
What investigations can be used to diagnose H.pylori (4)
gastric biopsy
Urease breath test
Faecal antigen test
Serology (IgA)
What is the first lien treatment for H.pylori (3)
PPI
Amoxicillin
Clarithromycin or metronidazole
What is the 2nd line treatment for H.pylori infection (3)
PPI
Amoxicillin
Whichever antibiotic wasn’t used first line
What is the 3rd line treatment for H.pylori infection (3)
PPI
Bismuth subsalicylate
Ribabutin/furazolidone/other
What is meant by peptic ulcer is disease
when there are open sores in the stomach lining/duodenum
What is a possible symptom of peptic ulcer disease
Burning/gnawing stomach pain
What are the possible causes of peptic ulcer disease (5)
H.pylori infection
NSAIDs or aspirin (esp with SSRIs, corticosteroids, or aldosterone antagonists/anticoagulants)
Gastric dysmotility
Outflow obstruction
Psychological stress
How can peptic ulcer disease be managed (5)
PPIs
Eradication of H.pylori
NSAID cessation
Lifestyle changes
Optimisation of comorbidities
What are possible complications of peptic ulcer disease (5)
anaemia
Bleeding
Perforation
Gastric outlet/duodenal obstruction
Fibrotic scar
What is meant by liver cirrhosis
when there is development of regenerative nodules surrounded by fibrous bands in responses to chronic liver injury
What are possible causes of liver cirrhosis (7)
viral infection (hep B and C)
Alcohol
Metabolic dysfunction associated liver disease MASLD
Autoimmune disorders
Wilson’s disease
Alpha 1 anti-trypsin
Budd-Chiari
What are the pathological features associated with liver cirrhosis (4)
Increased fibrillar collagen
Increased angiogenesis, sinusoidal remodelling, and HSCs
Increased sinusoidal resistance and portal hypertension
Decreased exchange of metabolites and oxygen across the space of Disse
What can be used to diagnosis liver cirrhosis (5)
liver biopsy
Serum markers
Elastrography
ELF
Fibrous scan
What is haemochromatosis (3)
a mono-genetic autosomal recessive disease
Related to HFE gene
Associated with iron overload
What is the clinical presentation of haemochromatosis (3)
cirrhosis
Cardiomyopathy
Pancreatic failure
What is Wilson’s disease (3)
a mono-genetic autosomal recessive disease
Associated with loss of function of caerulopasmin
Copper deposits occur in tissues (brain and liver)
What is the clinical presentation of alpha 1 ant-trypsin deficiency (3)
lymph emphysema
Deposits of mutated proteins in the liver
Cell damage in liver
What is Budd-Chiari (2)
Thrombosis of hepatic veins
Associated with congenital webs and thrombotic tendency
What is the clinical presentation of Budd-Chiari (3)
jaundice and tender hepatomegaly if acute
Ascites if chronic
