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AY Gastrointestinal > Summary > Flashcards

Summary Flashcards

1
Q

Most likely cause of aphthous ulcers

A

Crohn’s disease

Iron deficiency

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2
Q

Causes of leukoplakia

A 
Candida
Systemic disease (SLE)
Mechanical irritation
Trauma
Oral candidiasis from inhaled steroids
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3
Q

What causes hairy leukoplakia?

A

EB virus

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4
Q

What is erthyplakia indicative of?

A

Malignany (squamous cell carcinoma)

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5
Q

Where is erythroplacia most common found?

A

lateral border of the tongue

floor of the mouth

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6
Q

What is glossitis associated with?

A

Vitmain B12 & iron deficiency

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7
Q

What affect can calcium channel blockers have on the mouth?

A

They can cause gingivial hyperplasia

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8
Q

What affect can Nicorandil have on the mouth?

A

Can cause oral ulceration

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9
Q

What affect can atni-hypertensives have on the mouth?

A

Xerostomia
lichen planus
angioedema

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10
Q

How can HIV/AIDS present in the mouth?

A

Hairy leukoplakia
Kaposi sarcoma
Herpes lesions

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11
Q

Causes of GORD

A 
Incompetent LOS
Impaired oesophageal clearancer
Defective mucosal barrier
Pregnancy
Obesity
Ca2+ blockers, nitrates
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12
Q

Main complication of GORD

A

Barrett’s Oesophagus

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13
Q

Treatment of GORD

A

Antacids (Gaviscon)
H2 receptor antagonists (ranitidine)
PPI (omeprazole)

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14
Q

What is Barrett’s oesophagus?

A

Metaplsia of squamous epithelium to columnar epithelium

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15
Q

Why is Barrett’s oesophagus pre-malignant?

A

Mucosa becomes unstable and can undergo dysplastic change easily

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16
Q

Treatment of Barrett’s oesophagus

A

PPI
Argon
Endoscopic mucosal resection
Radiofrequency ablation

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17
Q

What is achalasia?

A

Intermittent dysphagia + impaired relaxation go LOS

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18
Q

Investigations of achalasia

A

Barium swallow (bird beak appearance)

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19
Q

Symptoms of oesphageal cancer

A

Progressive dysphagia
Weight loss
Hoarse voice
Chest pain

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20
Q

What is the most common cancer in the upper two thirds of the oesophagus?

A

Squamous cell carcinoma

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21
Q

What is the most common cancer in the lower third of the oesophagus?

A

Adenocarcinoma

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22
Q

Causes of acute gastritis

A

Chemical irritation
Trauma
Burns
Infection

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23
Q

What is autoimmune gastritis?

A

Antibodies attack parietal cells + intrinsic factor

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24
Q

Causes of chronic gastritis

A 
Chemicals (NSAIDs, Alcohol, bile reflux)
Bacterial infection (H. pylori)
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25
Q

What is gastroparesis

A

Delayed gastric emptying that is not due to obstruction

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26
Q

Investigations or gastroparesis

A

Oesophageal manometry

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27
Q

Treatment of gastroparesis

A

Change in diet

Gastric pacing

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28
Q

Where do gastric adenocarcinomas tend to occur?

A

Proximally to the GO junction

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29
Q

How does H. pylori infection progress to adenocarcinoma?

A 
H/ pylori
Chronic gastritis
Metaplasia
Dyplasia
Carcinoma
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30
Q

Treatment of gastric adenocarcinoma

A

if proximal - total resection

if distal - partial resection

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31
Q

What are GISTs linked with?

A

Defect of pacemaker cells (ICC’s)

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32
Q

What cells are gastric lymphomas linked with?

A

B-cells in lymph nodes

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33
Q

How are peptic ulcers formed?

A

Breach of GI mucosa and acid and pepsin attack

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34
Q

Rank in order from most common to least common; gastric ulcers, duodenal ulcers, oesophageal ulcers

A

Duondenal > Gastric > Oesophageal

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35
Q

Symptoms of peptic ulcers

A 
Burning epigastric pain
Loss of appetite and weight
Pain when eating
Feeling of fullness 
Nausea
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36
Q

Investigation to confirm H. pylori

A

C13 urea breath test
Serology (IgG)
Stool antigen

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37
Q

Treatment of peptic ulcer disease

A

Antacids (Gaviscon)
H2 antagonists (raitidine)
PPI (omeprazole)
H. pylori eradication

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38
Q

How is H. pylori eradicated?

A

Omeprazole + amoxicillin + clarithromycin (metronidazole if allergic to amoxicillin’)

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39
Q

How to eradicate H. pylori infection if original attempt doesnt work?

A

Stop PPI for 2 weeks + retest

Try metoclopramide or bismuth chelate

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40
Q

Causes of upper GI bleed

A 
Duodenal ulcer
gastric ulcer
oesophageal varices
mallory-weiss tear
Gastric carcinoma
Reflux oesophagitis
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41
Q

How is severity of haematemesis measured?

A

Rule of 100

BP, HR, Hb

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42
Q

First line treatment of large upper GI bleed

A

ABCDE

IV omeprazole

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43
Q

How can endoscopy intervention stop upper GI bleed?

A

Adrenaline injection
Heater probe coagulation
Haemospray (last resort)
Sclerotherapy for varices

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44
Q

What is coeliac disease?

A

Autoimmune inflamation of the small mucosa in the presence of gluten causing villi atrophy (reduces capacity for absorption)

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45
Q

Blood test results expected in coeliac disease?

A

tTGA

IgA

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46
Q

Histological appearance of coeliac disease

A

Villous atrophy
Crypt hyperplasia
increased lymphocytes

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47
Q

Treatment of coeliac disease

A

Avoid gluten

Mineral & vitamin replacement

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48
Q

What is intestinal failure?

A

When nutrtional needs can no loner be supported by the gut

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49
Q

Investigation results for intestinal failure

A

Decreased albumin (not reliable)Decreased vitamin & zinc)

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50
Q

What is the main factor to treat in intestinal failure?

A

Nutrition

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51
Q

Types of small bowel obstruction

A

Luminal obstruction
Bowel wall obstruction
Mesenteric arterial occlusions
Starngulation obstructing venous return

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52
Q

Causes of small intestinal luminal obstrruction

A

Gallstone ileus
Food
Bezoar (hair)

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53
Q

Causes of bowel wall obstructio

A

Tumour
Crohns
enteritis

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54
Q

Causes od strangulation obstructing venous return to the small bowel

A

Hernia

Adhesion

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55
Q

Symptoms of small bowel obstruction

A

Colicky abdominal pain
Abdominal distension
Absent/ tinkling bowel sounds
Faeculent vomiting

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56
Q

Treatment of small bowel obstruction

A

Analgesia, fluids and K+ replacement

Surgery

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57
Q

What is Meckel’s diverticulum?

A

Tubular structure 0cm from ileocaecal valve

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58
Q

What is meckel’s diverticulum a remnant of?

A

Omphaomesenteric duct from development

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59
Q

Treatment of Meckel’s diverticulum

A

Surgery

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60
Q

What is more common in the small bowel, primary or secondary tumours?

A

Secondary

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61
Q

Symptoms of appendicitis

A

Epigastric pain that goes to RIF (McBurney’s point)
Rovings sign (pain on right when press in on left)
Low grade fever
Nausea/vomiting

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62
Q

What cells are involvede in carcinoid of the appendix?

A

enterochromaffin cells

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63
Q

Most common cause of food poisonin

A

Campylobacter

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64
Q

Which causes of food poisoning cause outbreaks?

A

Salmonella

E. coli 0157

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65
Q

Which virus causes expolsive vomiting?

A

Norovirus

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66
Q

What is the most common cause of viral diarrhoea in children

A

Rotavirus

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67
Q

Which organism have short incubation periods?

A

Staph aureus

Bacillus cereus

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68
Q

Which organisms have medium incubation periods?

A

Salmonella

Clostridium perfringens

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69
Q

What organisms have long incubation periods?

A

Campylobacter

E. coli 0157

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70
Q

Which bacteria are toxin producing?

A

Staph aureus
Clostridium perfringens
Bacillus cereus
E. coli 0157

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71
Q

What bacteria cause bloody diarrhoea?

A

Campylobacter
Shigella
E. coli 0157

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72
Q

Investigation for typhoid

A

blood culture

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73
Q

Investigation for campylobacter, shigella, salmonella

A

stool culture

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74
Q

Investigation for protozoas & parasites

A

Stool microscopy

75
Q

Investigation for C. diff & E. coli 0157

A

Stoll toxin

76
Q

INvestigation for norovirus

A

Stool PCR

77
Q

Treatment for amoebiasis & giardiasis

A

Metronidazole

78
Q

Treatment of mild C. diff

A

Metronidazole

79
Q

Treatment of severe C. diff

A

oral vancomycin +/- IV metronidazole

80
Q

Treatment of recurrent C. diff

A

Fidaxomicin

81
Q

What is smoking harmful in UC/Crohn’s?

A

Crohn’s

82
Q

Step up treatment of UC/Crohn’s

A 
5-ASA (mesalazine)
Steroids (prednisolone)
Immunosupression (aathioprine, methotrexate)
Anti-TNF (infliximab)
Surgery
83
Q

Features of Crohn’s disease

A 
Transmural inflammation
Any part of the GI tract
Skip lesions
Cobblestone appearance
Non-caseating granuloma 
TH1 - mediated
Complications = fistulas
surgwery rarely curative
84
Q

Features of UC

A 
Mucoal/sub-mucosal inflammation
In rectum & colon
Crypt abscesses
Inflammatory cell infiltrate
TH1 and TH2 mediated
Complication - toxic megacolon 
Surgery can be curative
85
Q

What is diverticular disease?

A

Outpouching of the epithelial lining usually due to high intraluminal pressure caused by low fibre

86
Q

Symptoms of diverticular disease

A

Left-sided abdominal pain
Altered bowl habit
Nausea
Sepsis

87
Q

Complications of diverticulitis

A

Fistulae
Perforation
Obstruction
Harmorrhage

88
Q

Investigations for diverticular disease

A

Gastrografin/barium enema

Sigmoid/colonoscopy

89
Q

Symptoms of colitis

A

Bloody diarhhoea
Cramping pain
Dehydration
Weight loss

90
Q

Investigations for colitis

A

AXR

Stool culture

91
Q

What are colorectal polyps?

A

ptotrusions of epithelial surface

either flat, stalk ot serrated

92
Q

What are adenomas?

A

sometimes formed from polyps

may form adeocarcinoma

93
Q

What is family adenomatous polyposis (FAP)?

A

Autosominal dominant condition arising from mutations in the APC gene

94
Q

How is FAP characterised?

A

Hundreds of colorectal + duodenal adenomas

95
Q

What is hereditay non-polyposis colon cancer (HNPCC)?

A

Mutation in DNA mismatch repair gene

96
Q

What is the Dukes staging system of colorectal cancer?

A

A = muscararis mucosa
B = extension through muscularis mucosa
C = regional lymph nodes
D distant metastasis

97
Q

What stage of Dukes does chemo reduce mortality?

A

C

98
Q

What is the Rome III criteria used to asses?

A

IBS

99
Q

Describe the Rome III criteria

A

Recurrent abdominal pain for 3 days for 3 months + at least 2 of:

  • improvement with defaecation
  • change in stool frequency
  • change in stool appearace
100
Q

Investigations for IBS

A

FBC
CRP
tTGA (rule out coelic)

101
Q

Treatment of IBS

A 
Low FODMAP diet
Anti-spasmodic (mebeverine, hyoscine)
Anti-diarrhoeal (loperamide)
Anti-depressant (amitryptilline
Stop opiates and analgesia
102
Q

What does albumin measure?

A

Synthetic function of the liver

103
Q

At what level of bilirubin is jaundice clinically detectable?

A

> 50

104
Q

What does PT time indicate?

A

Prolonged PT time = decreased clotting factors

105
Q

What do AST/ALT indicate?

A

Hepatocyte damage (level of inflammation)

106
Q

What do ALP, GGT indicate?

A

Increase = biliary damage/cholestaisi

problem with bile flow

107
Q

What is prehepatic jaundice?

A

Excess haemolysis

108
Q

What in intrahepatic jaundice?

A

Defects in coagulation of bilirubin within the liver (hepatocyte damage)

109
Q

What is post-hepatic jaundice?

A

Obstruction to bile flow = dilation of bile ducts = backflow of bile

110
Q

What causes intrahepatic jaundice?

A

Hepatitis
Drugs
Cirrhosis
Pregnancy

111
Q

Causes of post-hepatic jaundice

A

Gallstones
carcinoma
biliary stricture
sclerosing cholangitis

112
Q

How is Hep A spread?

A

faeco-oral route

113
Q

Does Hep A cause liver failure/cirrhosis?

A

No.

114
Q

Pattern of hepatitis in LFT’s

A

Increase AST/ALT

Increased bilirubin

115
Q

How is Hep B transmitted?

A

blood-blood
sexual transmission
vertical transmission

116
Q

What does the presence of Heb B antibody in the blood indicate?

A

natural immunity

117
Q

What does the presence of Heb B antigen in the blood indicate?

A

present in all infected individuals

118
Q

What does the presence of Heb B e Ag in the blood indicate?

A

Highly infectious individual

119
Q

Wht are the antivirals for Hep B?

A

adefovir
tenofovir
entecavir
peginterferon

120
Q

What are the antivirals for Hep C?

A

Peginterferonj

Ribavirin

121
Q

Classic presentation of autoimmune hepatits

A

Young woman on pill

122
Q

Blood results for autoimmune hepatits

A

Increase AST/ALT
Increase CRP
ANA +ve
anti-LKM +ve

123
Q

Treatment of autoimmune hepatits

A

Azathiprine
prednisolone
Ursodeoxycholic acid

124
Q

What is acute fulminant hepatic failure?

A

Encepathopathy + jaundice

125
Q

Causes of fulminant hepaticfailure

A 
Hepatits
EBV
Toxoplasmosis
Paracetamol
Malignancy
Wilson's 
Budd-Chiari
126
Q

Treatment of fulminant hepatic failure

A

Increase calroie intake

Sodium Bicarbonate bath (itch)

127
Q

Symptoms/signs of alcoholic liver disease

A 
Steattorhoea
Ascites
Spider naevi
Caput medussae
Jaundice
Nausea/ vomiting
128
Q

How does NAFLD lead to cirrhosis?

A 
Steatosis (fat deposition)
Oxidative stress
Non-alcoholic steatohepatitis
Fibrosis
Cirrhosis
129
Q

Investigation for NAFLD

A

Ultrasound

Liver biopsy

130
Q

Complications of cirrhosis

A

Ascites
Hepatic encephalopathy
Malnutrition

131
Q

Treatment of cirrhosis

A

Manage complications and support nutitionally
(ascites - no salt + spirnonlactone/paracentesis)
Laxatives to prevent hepatic encephalopathy
LIVER TRANSPLANT

132
Q

What is PBC?

A

chronic inflammation and destruction of the bie ducts leading to builf up of bile in the liver causing cirrhosis
WOMEN

133
Q

Symptoms fo PBC

A 
Jaundice
Itch
Fatigue
Arthralgia
Hepatospleomegaly
Xanthelasma
134
Q

Investigations for PBC

A

AMA +ve
ANA +ve
increased IgM
LFTs show cholestatic pattern

135
Q

Treatment of PBC

A

Urseodeoxycholic acid
Azathioprine
Prednisolone

136
Q

Investigations for liver cancer

A

Ultrasound > CT scan > liver biopsy

137
Q

What is a hemangioma?

A

benign well demarcated echogenic spot

138
Q

What is focal nodular hyperplasia?

A

central scar, bile ducts, sinusoids + kuppfer cells

young middle aged women

139
Q

What are heatic adenomas associated with?

A

Glycogen storage disease

Oral contraceptive pill

140
Q

What is typically raised in hepatocellular carcinoma?

A

AFP

141
Q

Who are hyatid cysts most common in?

A

Farmers

142
Q

What causes polycystic liver disease?

A

embyronic malformation of the bile ducts

143
Q

What is haemochromatosis?

A

Abnormal absoprtion of iron due to autosomal recessive mutation in HFE gene

144
Q

Symptoms of haemochromatosis

A

Signs of liver disease
Hepatoegaly
Hypothyroidism
Slate-grey appearance

145
Q

Treatment of haemochromatosis

A

Venesection
Low iron diet
Alcohol avoidance

146
Q

What is Wilson’s disease?

A

Autosomal recessive disorder due to reduced eruloplasmin (excess copper)

147
Q

Treatment of Wilson’s disease

A

penicillinamine

148
Q

What is Budd-Chiari syndrome?

A

Hypercoagulation in the hepatic vein causes clotting - obstruction and thrombosis

149
Q

Causes of Budd-Chiari

A

Oral contraceptive pill
Thromphilia
Leukaemia

150
Q

Investigations for Budd Chiari

A

High protein ascetic fluid

US/CT/MRI shows obstruction

151
Q

Treatment of Budd-Chiari

A

Thrombolys (streptokinase & aspirin)

152
Q

5 F’s of gallstones

A 
Fat
Fair
Forty
Fertile
Female
153
Q

Symptoms of gallsontes

A

Nausea vomiting

Biliary colic Radiation to shoulder

154
Q

What is acute cholecystitis?

A

Infection of the gall bladder due to accumulated bile as a result of obstruction

155
Q

What is the first line investigation for imaging the ducts?

A

Ultrasound

156
Q

What is ascending cholangitis?

A

Gallstones impact in CBD leadsing to infection of the biliary system

157
Q

What is Chorcoats triad?

A

Jundice
Fever
RUQ pain

158
Q

What is PSC?

A

Progressive fibrosis and obliteration of the biliary trars

159
Q

What is PSC associated wiht?

A

UC

160
Q

Who is most affected with PSC?

A

Men

161
Q

Tests for PSC

A

pANCA +ve

ANA +ve

162
Q

Treatment of PSC

A

prednisolone

methotrexate

163
Q

Investigation for cholangiocarcinoma

A

US

164
Q

Treatment of cholangiocarcinoma

A

resection (surgery)

165
Q

What is the progression to adenocarcinoma?

A

Polyps
Cholecystitis
Diffuse calcification
Adenocarcinoma

166
Q

Causes of acute pancreatitis

A 
G - gallstones
E - ethanol
T - trauma
S - steroids
M - mumps
A - autoimmune
S - scorpion bites/spider bites
H - hyperlipidaemia/hypercalceamia
E - ERCP
D - drugs
167
Q

Symptom of acute pancreatits

A 
Sever epigastric pain going to the back
Fever 
nausea
vomting
Grey-turners sign
cullens sign
168
Q

Investigations in acute pancreatitis

A 
increased amylase
increased lipase
increased Ca2+
Ultrasound
Glasgow prognostic score
169
Q

Treatment of acute pancreatitis

A

Analgesia & fluids

ERCP

170
Q

Investigations for chornic pancreatitis

A

Amylase may be normal

171
Q

Treatment of pancreatitis

A 
Stop alcohol
Address diabetes 
EnzyMe supplements
Opiates/ NSAIDs for pain
Surgery
172
Q

Where are the most common sites of pancreatic cancer?

A

Head of pancreas

Ampulla of Vater

173
Q

3 types of endocrine tumours

A

Insulinoma (hypoglycaemia)
Glucagonoma (hyperglycaemia)
Gastrinoma (acid hypersecretion)

174
Q

How to identify a hernia?

A

Can get under it

reducible/irreducible

175
Q

What causes gastric hernias?

A

Malformation of linea alba

176
Q

What is the difference in location of emoral and inguinal hernias?

A

Femoral - below and lateral to pubic tubercle

Inguinal - Aove and medial to pubic tubercle

177
Q

Which hernia is more common in old men, direct or indirect?

A

Direct

178
Q

What are haemorrhoids?

A

prolapse of venous plexus

179
Q

Treatment of haemorrhoids?

A

nothing if assymptomatic
sclerosant
band ligation

180
Q

What is a rectal prolapse?

A

Protruding mucosal mass from anus usually during/due to defecation

181
Q

What is an anal fissure?

A

tear in the anal margin distal to dentate line

182
Q

What is fistula in ano?

A

Abnormal epthelial connection between anal canalnd perianal skin

183
Q

Treatment of fistula in ano

A

DrainagE

AY Gastrointestinal (21 decks)

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