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Gastrointestinal pathophysiology > PBL 52 > Flashcards

PBL 52 Flashcards

1
Q

What are the main sites for GI bleeding?

A
  1. Upper GI (70%)
  2. Small bowel GI bleed (<1%)
  3. Large bowel GI bleed (<30%)
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2
Q

What constitutes the upper GI tract?

A

Oesophagus, stomach and duodenum

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3
Q

What are the main causes of upper GI bleeds?

A
  1. PEPTIC ULCER (50%)
  2. Varices (10%)
  3. Gastroduodenal erosions (10%)
  4. Idiopathic (20%)
  5. Oesophageal (10%)
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4
Q

Main causes of small bowel bleeding

A

Jejunal/ileal diverticulae

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5
Q

Main causes of large bowel bleeding

A
  1. Angiodysplasia (40%)
  2. Diverticular disease (40%)
  3. Carcinoma/polyp (<5%)
  4. UC/Crohn’s (<5%)
  5. Haemorrhoids/fissure/fistula
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6
Q

Main approaches to investigation of GI bleeding?

A
  1. FBC
  2. U&E
  3. Haematinics
  4. Endoscopy/colonoscopy/CT colonography
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7
Q

Scoring systems for GI bleeding

A
  1. Rockall

2. Blatchford

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8
Q

Which of the Rockall and Blatchford scorings systems are better and why?

A

Blatchford is better because it does not require an endoscopy

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9
Q

What is first line treatment for an upper GI bleed?

A

Therapeutic endoscopy

  • Injection of adrenaline, sclerosants, thrombin or fibrin glue
  • Electrocoagulation
  • APC
  • Clips
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10
Q

How do you treat oesophageal varices?

A

Injection sclerotherapy

Therapy banding

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11
Q

First line investigations for an acute lower GI bleed

A
  1. Normal upper GI endoscopy (to make sure the upper GI tract is fine)
  2. Colonoscopy
  3. Angiography - CT or MR angiography
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12
Q

How do you treat polyps during a colonoscopy?

A

Diathermy and excision

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13
Q

Different methods for visualising the GI tract (7)

A
  1. Barium swallow
  2. Barium enema
  3. Endoscopy
  4. Colonoscopy
  5. Plain X-ray
  6. Cross-section anatomy
  7. CT colonoscopy
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14
Q

What are the different barium techniques used to view the upper GI tract?

A
  1. Barium swallow (oesophagus –> stomach)
  2. Barium meal - double contrast (oesophagus –> small intestine)
  3. Small bowel barium enema (small intestine)
  4. Double contrast barium enema (large intestine)
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15
Q

Difference between single and double contrast visualising techniques?

A
  1. Single contrast - Lumen distended with barium, gives a large vague image, there is poor mucosal detail
  2. Double contrast - Mucosa coated with barium and lumen distended with air (CO2 etc), there is better mucosal detail with double contract due to mucosal coating so you can see smaller lesions (e.g. adenocarcinomas)
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16
Q

What can single contrasts be used for?

A
  1. To check that the patient is aspirating (barium swallow)
  2. To check vague outline of the GI tract
  3. To check for pharyngeal pouching (pseudodiverticulum) or pharyngeal bar (constriction)
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17
Q

How is a double contrast barium technique administered?

A

As a barium meal

  • Patients take carbex with lemon juice, produces gas (CO2) in the stomach
  • Patient takes barium, then rolls around on the bed to coat mucosa
  • Much better mucosal detail
  • Double contrast
  • Checks for stomach and duodenal conditions e.g. ulcers, tumours
18
Q

What is a barium swallow?

A

• A barium swallow is drinking barium liquid (250-500ml):

  • Single contrast
  • Checks for conditions in the upper GI tract e.g. strictures, pouching
  • Appears bright on imaging
  • Can miss small lesions
  • Well tolerated by patients
  • Good for high dysphagia, motility disorders and assessment of anatomy
19
Q

What is a barium enema?

A
  • Injection of very dilute barium via syringe
  • Can be followed by water to wash it round
  • Can use double contrast technique (sensitive)
20
Q

Advantages of double contrast barium enemas?

A
  • Great quality images
  • Can be zoomed in and out of
  • Safe procedure
  • Mostly tolerated well
  • Good for detecting intrinsic and extrinsic disease
21
Q

Disadvantages of double contrast barium enemas?

A
  • Patient must be mobile and able to retain the air
  • Not as sensitive as a colonoscopy
  • Not tolerated by some patients
  • Cant take histological samples
22
Q

What is the gold standard of visualising the large bowel?

A

COLONOSCOPY

23
Q

What sort of lesion is seen with colorectal adenocarcinoma?

A

Apple core lesion

  • Stricture
  • Visible on DBCE
24
Q

What is an endoscopy?

A

Endoscopy is a procedure in which the GI tract is viewed with a lighted, flexible tube with a camera at the end (endoscope).

  • Tissue samples can be obtained by biopsy
  • Direct inspection of the mucosa
  • Detects early pathology
  • Allows biopsy/therapeutic procedure
25
Q

What is a gastroscopy?

A

An upper endoscopy

26
Q

What are limitations of gastroscopy?

A
  • Not good at assessing anatomy, motility and extrinsic disease
  • Limited view of the pharynx and oesophagus
  • Significant complication rate and very slight mortality rate
27
Q

Why is an endoscopy not great for imaging the small bowel?

A

It can only get as far as the duodenum

28
Q

What are the 3 types of endoscopy that exist for the large bowel?

A
  1. Colonoscopy (colonoscope) - Requires full prep, camera to cecum and terminal ileum
  2. Flexible sigmoidoscopy (sigmoidoscope) - Shorter and more flexible, enema prior to use, can reach transverse colon
  3. Proctoscopy (proctoscope) - Short and rigid, no prep, able to examine only the rectum
29
Q

Where is bowel cancer most prevalent?

A

Western countries

30
Q

Explain the aetiology of colorectal cancer

A

Colorectal cancer (CRC) most often occurs as transformation within adenomatous polyps 3-5 years earlier. About 80% of cases are sporadic, and 20% have an inheritable component

31
Q

How do colonic adenomas form (neoplastic polyps)

A
  • Sporadic
  • Familial: FAP - APC gene
  • Majority do not progress into adenocarcinoma
32
Q

How do adenocarcinomas AKA colorectal cancer arise?

A
  • Sporadic: 80% Wnt pathway - 20% DNA MMR genes

- Familial - HNPC (lynch syndrome) - DNA MMR genes

33
Q

Signs and symptoms of colorectal cancer

A
  1. Colicky abdominal pain
  2. Abdominal distension
  3. Vomiting
  4. Change in bowel habits
  5. Fatigue & weakness
  6. Anaemia symptoms
  7. Melaena
34
Q

NOTES SLIDE: The underlying cause of iron deficiency in older men or post-menopausal women is GI cancer until proven otherwise

A
35
Q

Signs and symptoms of rectal cancer

A
  1. Visible bleeding or mucous
  2. Often palpable on digital rectal examination
  3. Tenesmus
  4. Pain –> poor prognosis
  • Reasons for no PR —- NO ANUS OR NO FINGER
36
Q

Risk factors for colorectal cancer

A
  • FHx of CRC
  • FHx of intestinal adenomatous polyps
  • Ulcerative colitis
  • Crohn’s disease
  • High fat, high refined carbohydrate, high animal protein, low fibre diet
37
Q

Screening tests for colorectal cancer

A
  • Colonoscopy
  • Stool tests
  • Sigmoidoscope
  • CT colonography
  • Faecal DNA testing
38
Q

What is the classification system used for colorectal cancer?

A

Dukes’ staging

39
Q

Treatment for colorectal cancer

A
  1. Surgery is the ONLY curative option
    - Adjuvant radiation therapy and chemotherapy is widely used
    - Antibody therapy is also now used
40
Q

What is the main cause of death in colorectal cancer?

A

Tumour spread, to which liver is the most common

Gastrointestinal pathophysiology (22 decks)

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