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GASTROINTESTINAL > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What is the definition of diarrhoea?

A

loss of fluid and solutions from the GI tract in excess of 500ml per day

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2
Q

List some causes of diarrhoea

A 
Infection - viral/bacterial/parasites 
IBD 
IBS 
Excess bile salts 
Hyperthyroidism 
Drugs
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3
Q

What can use of broad spectrum antibiotics cause the development of?

A

Clostridium Difficile Colitis

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4
Q

What are some of the adverse effects diarrhoea has on the body?

A

Dehydration
Hypokalaemia
Metabolic acidosis

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5
Q

What percentage of body weight contitutes severe fluid loss?

A

> 10%

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6
Q

What are the three classes of drugs/ management used for the treatment of diarrhoea?

A

Rehydration supplements
Antimicrobials
Anti-motility agents

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7
Q

What are some of the causes of constipation?

A

Lack of exercise
Suppressing the urge to defecate
Decreased colonic motility - age, metabolic disorders e.t.c

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8
Q

Which two drug classes are used to manage constipation?

A

Laxatives

Purgatives

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9
Q

What are the 4 main classes of laxatives and purgatives and which is the most commonly used?

A

BULK LAXATIVES (most commonly used)
OMOTIC LAXATIVES
STIMULANT PURGATIVES
FAECAL SOFTENERS

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10
Q

What are some of the clinical indications of laxatives?

A 
Straining with constipation 
Painful defecation 
Bedridden patients 
For expulsion of parasites
To prepare the GI tract before surgery e.t.c
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11
Q

If acute travellers diarrhoea occurs after the patient has spent time on a cruise ship, what should be suspected?

A

Norovirus and Rotavirus

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12
Q

How does cholera present?

A

Profuse watery diarrhoea

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13
Q

What can be given as a single dose for 3 days for people who are travelling to prevent worsening of diarrhoea?

A

Fluoroquinolone / Ciprofloxacin

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14
Q

What is enteric fever?

A

A food born illness which includes typhoid and paratyphoid fever

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15
Q

Does enteric fever have a long or short incubation period?

A

Quite long (7-18 days - can be up to 60)

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16
Q

Which type of jaundice is associated with HUS as a complication?

A

Pre-hepatic (haemolytic)

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17
Q

What are the genetic associations of IBD?

A

NOD2

HLADR1

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18
Q

In terms of IBD, which disease is TH1 mediated and which is TH1/ TH2 mediated?

A

Crohn’s - TH1 mediated

Ulcerative Colitis - TH1/ TH2 mediated

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19
Q

Which inflammatory bowel disease is aggravated by smoking?

A

Crohn’s Disease

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20
Q

Which drug class can aggravate inflammatory bowel disease and should be avoided if possible?

A

NSAIDs

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21
Q

Where in the GI tract does Crohn’s disease affect?

A

Anywhere from mouth to anus, most commonly in the terminal ileum and proximal colon

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22
Q

Where in the GI tract does ulcerative colitis affect?

A

Colon and rectum

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23
Q

Which inflammatory bowel disease can be described as being patchy with skip lesions?

A

Crohn’s Disease

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24
Q

Which kind of inflammation does Crohn’s disease involve and which kind does ulcerative colitis involve (in terms of layers of the GI tract wall affected)

A

Crohn’s = transmural inflammation

Ulcerative Colitis = Inflammation of the mucosa and submucosa

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25
Q

Which inflammatory bowel disease is continuous?

A

Ulcerative Colitis

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26
Q

Which inflammatory bowel disease involves; granulomas and a thickened bowel and strictures?

A

Crohn’s disease

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27
Q

In which IBD are fistulas most common?

A

Crohn’s disease

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28
Q

Which IBD has the highest risk of cancer?

A

Ulcerative colitis

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29
Q

What are some of the complications of IBD? List 3!

A

Fistulas
Toxic megacolon
Cancer (colorectal)

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30
Q

What are some of the extra intestinal associations of IBD?

A 
Mouth ulcers 
Swollen lips 
Angular cheillitis 
Clubbing 
Erythema nodosum 
Pyoderma Gangrenosum 
Arthritis
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31
Q

Ulcerative Colitis is named depending on how much of the GI tract it affects, name the 3 possibilities from smallest to largest

A

Proctitis, Left-sided colitis, Pancolitis

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32
Q

What investigations would be done for IBD?

A

History and clinical examination
Bloods (CPR and Albumin)
Endoscopy and Colonoscopy + mucosal biopsy
Small bowel MRI (crohn’s) / plain AXR (Ulcerative Colitis)
Barium swallow (crohn’s)

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33
Q

What are the 4 classes of drugs used to treat IBD and which of these is mainly only used in Ulcerative Colitis?

A

5 ASA (ulcerative colitis)
Steroids
Immunosuppressants
Anti- TNFa

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34
Q

Suppositories and Enemas are used for topical therapy of 5ASA in IBD, What is the difference between these and which has better adherence to mucosal surfaces?

A 
Suppositories = solid (better adherence) 
Enemas = liquid
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35
Q

What is a possible side effect of 5 ASA?

A

Nephritis (Renal function should therefore be monitored)

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36
Q

Which steroids are used to treat IBD?

A

Prednisolone!

Budesonide

37
Q

What are some of the side effects of steroids?

A 
Oseteoporosis 
Acne 
Thinning of the skin 
Weight gain 
Diabetes
38
Q

Name an immunosuppressant drug used for the treatment of IBD?

A

Azathioprine

39
Q

How does the active form of azathioprine work?

A

It affects DNA synthesis, inhibiting T cell proliferation in inflammation

40
Q

What are some of the side effects of immunosuppressant drugs?

A 
Pancreatitis 
Hepatitis 
Leucopaenia 
Hepatitis 
Lymphoma/ Skin cancer
41
Q

In azathioprine metabolism, 6-MP can accumulate in toxic concentrations, what enzyme converts this substance in to a non-toxic form?

A

TPMT

42
Q

How does anti- TNF therapy for IBD work?

A

It promotes apoptosis of activated T-lymphocytes

43
Q

Name an Anti-TNF drug used in the treatment of IBD

A

Infliximab

44
Q

What are the side-effects of anti-TNF therapy?

A

Infection (TB!)

Cancer

45
Q

Which form of IBD can be cured by surgery?

A

Ulcerative Colitis

46
Q

What is meant by a colectomy?

A

Permanently removing the colon

47
Q

There are two options for finishing a colectomy operation for allowing passage of faeces out of the body, what are these?

A

Ileostomy - the S.I is diverted out of a hole in the abdomen and a stoma bag is attached
Ileo-Anal Pouch - Part of the S.I is used to create an internal pouch which is attached to the anus

48
Q

In a subtotal colectomy for emergency ulcerative colitis surgery, what two different things can be done with the rectum?

A

The rectum can be left in the body and stable off

The rectum can be left as a mucous fistula

49
Q

What are some of the complications of an Ileo-anal pouch?

A

Infertility
Pouchitis
Ileus
Haemorrhage

50
Q

What are some of the indications for surgery for IBD?

A 
Failed medical therapy 
Dysplasia/ malignancy 
Perforation 
Toxic megacolon 
Abscesses 
Fistulas
51
Q

What kinds of surgery can be done for crohn’s disease?

A

Resection of the worst areas

Temporary Ileostomy

52
Q

What does diarrhoea caused by staph aureus involve?

A

Onset 1-6 hours after exposure, with diarrhoea lasting 6-10 hours.
Afebrile
Abdominal Pain
Diarrhoea (but no blood or mucus)

53
Q

Which organism is the common cause of traveller’s diarrhoea?

A

ETEC (Enterotoxigenic E.coli)

54
Q

What symptoms does infection with E.coli 0157 cause?

A

Crampy abdominal pain
Diarrhoea + lots of blood
Little/ no fever

55
Q

What changes occur in HUS?

A

Renal injury

Thrombocytopaenia - haemolytic anaemia

56
Q

What is a rare but important complication of campylobacter not to forget about?

A

Guillain- Barre syndrome

57
Q

What does ‘thumb printing colitis’ in radiography indicate?

A

Mucosal oedema and inflammation as a consequence of diarrhoea

58
Q

What are the symptoms of enteric fever/ typhoid?

A

Fever
Abdominal pain
Constipation
Diarrhoea

59
Q

What can cause clostridium difficile infection and what kind of organism is it?

A

Use of broad spectrum antibiotics (kills of normal microbe in the GI tract)
C.diff = an anaerobic gram +ve and spore bearing bacillus

60
Q

What is amoebiasis?

A

A tropical infection cause by a protozoa (Entamoebe histolytica)

61
Q

How would an amoebic liver abscess present?

A

Fever
Upper abdominal pain
Hepatomegaly

62
Q

What is giardiasis?

A

A tropical infection caused by a protozoa (Giardia intestinalis )

63
Q

List some ways that infections can be transmitted during sex

A

Contact with secretions
Fomites (sex toys)
Drug use during sex

64
Q

How are gonorrhoea and chlamydia passed on and how do they differ?

A

Transmission of both is by direct contact with mucosal surfaces
Gonorrhoea can have more serious symptoms E.g ; abdominal pain, rectal bleeding and tenesmus

65
Q

What organism is characteristic of gonorrhoea?

A

Gram -ve diplococci

66
Q

Why are patients with gonorrhoea at a higher risk of catching HIV?

A

Because gonorrhoea involves inflammation and thus there are many CD4 receptors for the HIV virus

67
Q

Which are the bacterial causes of STIs and which are the viral causes?

A 
BACTERIAL 
- Gonorrhoea 
- Chlamydia 
- Syphilis 
VIRAL 
- Herpes simplex virus 
- HIV 
- Human papilloma Virus
68
Q

How does primary syphilis present and how does secondary syphilis present?

A

Primary - painless ulcer

Secondary - Systemic inflammatory response

69
Q

What is conchylomata lata and which STI is it associated with?

A

Wart like lesions, associated with syphilis

70
Q

What is lymphomagranuloma and which groups of patients is it associated with?

A 
Inguinal lymphadenopathy and ulceration 
Patients; 
HIV 
Syphilis 
Hep C 
Men who have sex with men
71
Q

Why does HIV drastically affect the gut?

A

The gut is the major immune component in the body

72
Q

Which cancer is the second most common cause of death in the UK?

A

Colorectal

73
Q

Which genes can be mutated, leading to development of colorectal cancer?

A 
APC 
KRAS 
p53 
18q 
(Tumour suppressor genes and oncogenes)
74
Q

Where is common site of metastasis from a colorectal cancer?

A

The liver, due to the blood supply draining here for cleaning

75
Q

What are some protective and causative lifestyle factors of colorectal cancer?

A 
PROTECTIVE 
Exercise 
Vegetables and fibre 
CAUSATIVE 
Obesity 
Red and processed meat 
Smoking and alcohol
76
Q

What are two forms of autosomal dominant inheritance of colorectal cancers?

A

FAP

HNPCC

77
Q

What are some o the clinical features of colorectal cancer?

A 
Anaemia 
Cachexia 
Lymphadenopathy 
Hepatomegaly 
Abdominal distension 
Abdominal mass 
PR bleeding 
Rectal mass
78
Q

What are the investigations for colorectal cancer?

A 
Barium enema 
CT colonography 
Sigmoidoscopy and colonoscopy  
FOBT (screening test) 
CT of lungs and liver for metastasis 
MRI (for staging)
79
Q

What might the emergency presentation of colorectal cancer involve?

A

Bleeding
Perforation
Obstruction - distension, constipation, ab pain, vomting

80
Q

How is colorectal cancer treated?

A

Surgery
Radiotherapy
Chemotherapy

81
Q

What is meant by acute gastroenteritis?

A

Inflammation of the lining of the stomach, small intestine or large intestine

82
Q

What is a severe and worrying complication of intestinal bacterial enteritis?

A

Severe dehydration and renal failure

83
Q

What is the major cause of diarrhoea and colitis in patients who have been exposed to antibiotics?

A

Clostridium Difficile

84
Q

How can acute travellers diarrhoea be defined?

A

3 loose stool in 24 hours + self-reported fever

85
Q

List 4 things which could be possibilities in a differential diagnosis of a change in bowel habit

A

IBS
IBD
Infective gastroenteritis
Bowel cancer

86
Q

List some ‘types’ of diarrhoea

A

Secretory
Inflammatory
Dysentery

87
Q

How is constipation defined?

A

Infrequent bowel movements, difficulty or straining during defecation and hard stools

88
Q

What signs of coeliac disease can be found from outwith the GI tract?

A

Anaemia
Itchy rash
Aphthous ulcers
Angular stomatitis

GASTROINTESTINAL (13 decks)

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