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CMS > Week 3 - Gastroenterology > Flashcards

Week 3 - Gastroenterology Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q 
GI system: physiology
gut: function?
what do the following absorb:
- stomach?
- duodenum?
- jejunum?
- large intestine?
pancreas function? (exocrine and endocrine)
A

gut: digestion and absorption of nutrients
stomach: alcohol and water
duodenum: iron & B12
jejunum: folate
large intestine: water

pancreas:
exocrine - production of enzymes to digest food
endocrine: production of insulin

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2
Q

gall bladder: function?

A

concentration and storage of bile, fat absorption and digestion

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3
Q

liver: function? x3

A
  • metabolism of nutrients and toxins
  • production of bile
  • protein synthesis
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4
Q

examples of GI symptoms?

A
  • pain: can suggest site, but could also be referred pain
  • dysphagia
  • dyspepsia: discomfort related to upper GI tract (heartburn, acidity, pain)
  • nausea & vomiting
  • diarrhoea
  • constipation: infrequent <2/week stools
  • steatorrhoea: pale bulky stools
  • bleeding
  • weight loss: unintentional weight loss could be a sign that the patient is not absorbing well
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5
Q

bleeding: describe upper and lower GI types of bleeding

A

upper GI bleeding:

  • haematemesis: blood or “coffee grounds”
  • melaena: black sticky stools, as a result of digested blood

lower GI bleeding:
- fresh blood, may be mixed with stools

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6
Q

GI investigations - direct visualisation + biopsy:
methods for upper GI tract?
methods for lower GI tract?

A

upper GI tract: endoscopy

lower GI tract: sigmoidoscopy and colonoscopy

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7
Q

GI investigations: what other methods of investigation?

A
  • radiographs: plain or contrast. can be done by barium swallow, meal, or enema
  • ultrasound: for biliary tract, liver
  • MRI: biliary tract, liver, pancreas, gut (lesser degree)
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8
Q

upper GI disorders: acid suppression drugs?

A

antacids:

  • aluminium hydroxide, calcium carbonate
  • alginate based e.g. Gaviscon

gastric acid reduction:

  • histamine receptor antagonists (H2 blockers)
  • proton pump inhibitors
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9
Q

list examples of the following:

  • antacids?
  • alginate based antacid?
  • histamine receptor antagonist?
  • proton pump inhibitors?
A
  • aluminium hydroxide, calcium carbonate
  • gaviscon
  • ranitidine, cimetidine
  • omeprazole, lansoprazole
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10
Q

upper GI disorders: anti-emetics?

the drug used depends on?

A
  • dopamine antagonists
  • anti-histamines
  • serotonin antagonists
  • drug used depends on the cause of the nausea and vomiting:
    if chemical stimulation of vomiting centre: treat brain
    if distension of the gut: treat the gut
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11
Q

list examples of the following:

  • dopamine antagonists?
  • anti-histamines?
  • serotoni antagonists?
A
  • domperidone, metoclopramide
  • cyclizine
  • ondansetron (CNS and gut)
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12
Q 
upper GI disorders - GORD:
describe disease
causes?
associated with?
symptoms?
A
  • excess acid at lower oesophageal sphincter
  • due to loss of tone or delayed gastric emptying
  • obesity, lying flat, fatty foods, smoking
  • heartburn
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13
Q

upper GI disorders - GORD:
how to make diagnosis?
treatment? x4
what complications may arise?

A
  • clinical diagnosis: endoscopy
  • change lifestyle;
  • drugs: antacids, PPIs, rarely surgery
  • stricture formation (narrowing)
  • cancer (Barrett’s oesophagus)
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14
Q

upper GI disorders - peptic ulcer disease:

can occur where? which can become malignant?

A
  • can be gastric or duodenal

- gastric can become malignant

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15
Q

upper GI disorders - peptic ulcer disease:

epidemiology?

A
  • 15-20% of population
  • more in men
  • more in elderly
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16
Q

upper GI disorders - peptic ulcer disease:

aetiology?

A
  • Helicobacter pylori

- NSAIDs (esp for gastric ulcers)

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17
Q

upper GI disorders - peptic ulcer disease:
symptoms?
complications?

A
  • epigastric pain, dyspepsia, vomiting, anorexia
  • complications: bleeding - haematemesis, melaena
  • perforation; could be lethal
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18
Q

upper GI disorders - peptic ulcer disease:

- methods for investigation?

A
  • endoscopy: biopsy if gastric

- presence of H. pylori: determined with breath test, biopsy, serology

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19
Q

upper GI disorders - peptic ulcer disease:

treatment for acute and non-acute disease?

A

acutely:

  • endoscope: can stop bleeding
  • rarely surgery

non-acute:

  • acid suppression: PPIs
  • treat H. pylori: PPIs and antibiotics
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20
Q

upper GI disorders - other disorders? (describe + treatment methods)

A
  • hiatus hernia: structural abnormality of stomach, leaving segment above diaphragm
    may cause heartburn, treated with medication or surgery
  • cancer
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21
Q

upper GI disorders - dental aspect:

for patients with oesophagus and stomach problems, what to take note of?

A
  1. caution with NSAIDs
    - especially in older patients
  2. anaemia can manifest as oral ulcerations
  3. non-carious tooth surface loss with acid reflux
22
Q

lower GI tract: coeliac disease - what is it? what kind of disease? why is it not an allergy? characterised as?

A
  • sensitivity to gluten: wheat, barley, rye
  • multi-system autoimmune disease, not an allergy as it involves IgA
  • atrophy of the villi in the small intestine, resulting in its flattened surface (reduction of surface area)
23
Q

coeliac disease: symptom? list the many ways it can manifest

A 
- malabsorption
malaise, 
diarrhoea, 
steatorrhoea, 
weight loss, 
iron and folate deficiency,
protein deficiency
24
Q

coeliac disease: diagnosis?

treatment?

A
  • antibodies
  • endoscopy with biopsy
  • gluten free diet
  • osteoporosis prophylaxis:
25
Q

diagnosis of coeliac disease: what antibody to check for?

A

TTGA: tissue transglutaminase antibody

26
Q

coeliac disease: dental aspects
what are the oral features of malabsorption?
what to take note of with pts taking bisphosphonates?

A
  • oral ulceration

- stop from losing bone density. can cause problems in the event of surgical procedures

27
Q

lower GI tract: inflammatory bowel disease (IBD): what are the 2 main forms? where does each occur? what kind of disease?

A
  • crohn’s disease: entire GI tract can be affected
  • ulcerative colitis: large intestine
  • IBD is an autoimmune inflammatory condition, with its cause unknown
28
Q

IBD: describe the distinct pathological appearance of crohn’s disease and ulcerative colitis

A

crohn’s disease:

  • not continuous (skip lesions)
  • transmural inflammation

ulcerative colitis:

  • continuous
  • mucosal inflammation (does not involve entire wall)
29
Q

IBD - crohn’s disease: symptoms? x5

A
  • malabsorption
  • abdominal pain
  • bleeding
  • abscess, fistula, sinus formation
  • oral features
30
Q

IBD - ulcerative colitis: symptoms? x2

A
  • bloody diarrhoea

- abdominal pain

31
Q

IBD - UC & crohn’s: what are the extra-intestinal symptoms?

A
  • autoimmune arthritis
  • skin lesions (erythema nodosum, pyoderma gangreonosum)
  • autoimmune hepatitis
  • DVT and PE
  • ocular inflammation
32
Q

IBD - UC & crohn’s:

cancer as a complication?

A
  • long term complication in UC, less so in Crohn’s disease
33
Q

IBD: diagnosis?

A
  • clinical
  • radiological: small bowel disease
  • colonoscopy and biopsy definitive
  • stool sample: rules out infective cause, faecal calcoprotein levels - higher meaning there is more infection ongoing
34
Q

IBD - treatment?

A
  • suppress inflammation
  • surgery
  • parenteral nutrition/elemental diet
  • antibiotics
35
Q

IBD - treatment: methods to suppress inflammation?

A
  • 5-Aminosalicylic acid preparations: sulfasalazine, mesalazine, olsalazine
  • corticosteroids (oral, enema)
  • immunosuppressants: azathioprine, methotrexate (crohn’s)
  • biologics: anti-TNF agents
36
Q

IBD - treatment: methods to carry out surgery?

A
  1. remove diseased bowel:
    - UC: colectomy (curative)
    - sections of bowel in Crohn’s (not curative)
  2. abscess drainage
37
Q

IBD: dental aspects?

A
  • recognize oral features of Crohn’s and UC

- take note of side effects of immunosuppresants and steroids

38
Q

lower GI tract - diverticulitis:
what is it?
how common?
symptoms?

A
  • inflammation of a diverticulum in the colon, causing pain and disturbance of bowel function
  • 50% over 50’s
  • usually NIL, if not bleeding and pain: due to abscess formation/obstruction
39
Q

functional GI disease: symptoms present without demonstrable disease - what could be the causes?

A
  • psychological
  • altered bowel smooth muscle tone
  • high CHO diet in childhood
40
Q

functional GI disease: common symptoms - think about oesophagus, gastric, and irritable bowel syndrome

A
  • oesophageal: lump in throat “globus”, regurgitation
  • gastric: dyspepsia
  • irritable bowel syndrome: cramps, wind, diarrhoea, constipation, bloating
41
Q

functional GI disease:

treatment?

A
  • reassurance
  • fibre/other dietary changes
  • anti-spasmodics
  • amitriptyline or SSRIs
42
Q

liver disease:

types of liver disease?

A
  • acute inflammation: hepatitis
  • chronic inflammation: cirrhosis
  • cancer
43
Q

liver disease: causes?

A
  • alcohol
  • viruses: Hep A-E
  • iron overload: haemachromatosis
  • drugs: formulary, herbal
  • autoimmune
    primary biliary cirrhosis
    chronic active hepatitis
    sclelrosing cholangitis
  • diabetes
  • cryptogenic
44
Q

liver disease: clinical features?

A
  • jaundice
  • ascites: accumlation of fluid in peritoneal cavity, resulting in abdominal swelling
  • telangiectasia; dilation of capillaries causing them to appear as red or purple clusters
  • renal failure/hepato-renal syndrome
  • encephalopathy: confusion, impaired consciousness
  • variceal haemorrohage: life threatening upper GI bleeding
  • coagulopathy
  • prone to infections
45
Q

liver disease: treatment?

A
  • remove and treat underlying cause
  • supportive treatment: liver has capacity for regeneration if not cirrhotic
  • liver transplant
46
Q

liver, pancreas and biliary tract: dental aspects?

A
  • coagulopathy, reduced platelets: bleeding risk
  • possible infectious underlying cause: hepatitis viruses, liability to infection
  • liver transplant: patient will be on immunosuppresants
47
Q

gall stones:
results in?
symptoms?

A
  • cholecystitis/cholangitis

- pain, jaundice, pancreatitis

48
Q

gall stones:

treatment?

A
  • surgery: endoscopic, open cholecystectomy (remove gallbladder)
49
Q

pancreatitis:
cause?
diagnosis?
treatment?

A

inflammation of the pancreas

  • caused by gallstones, alcohol, drugs
  • high amylase enzyme in blood
  • supportive (hospitalization)
50
Q

upper GI bleeding: signs?

A
  • haematemesis: fresh blood, “coffee grounds”
  • melaena
  • rectal bleeding
51
Q

upper GI bleeding: causes?

A
  • oesophagitis
  • varices
  • mallory-weiss tear
  • peptic ulcers
  • gastritis

CMS (16 decks)

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