wk 3/4 GI Flashcards

Question

coeliac disease general

Answer 1

- Small bowel disorder characterized by - Mucosal inflammation - Villous atrophy - Crypt hyperplasia - Which occur upon exposure to dietary gluten and which demonstrate improvement after withdrawal of gluten from the diet

Answer 2

- Diarrhoea - Anaemia - Dyspepsia - Abd pain, bloating - Weight loss - Mouth ulcers - Fatigue - Neuropsychiatric symptoms

Answer 3

- Anaemia - Iron, folate deficiency - Macrocytosis without anaemia - Hyposplenic blood film - Low calcium, elevated alk phos - Raised transaminases - Hypalbuminaemia

Answer 4

- Serological markers - Anti-tissue transglutaminase antibody (IgA) (TGG) sensitivity and specificity >95% - Anti-endomysial antibody (IgA) - Anti-gliadin antibody (IgA, IgG) - Small intestinal biopsy

Answer 5

- Gluten free diet (life-long) - Dietician - Nutritional supplements - Screen for complications - Bone disease - Very rarely, need for immunosuppressant medication for refractory cases

Answer 6

- Pancreas produces 1.5L/day of bicarbonate and enzyme-rich fluid - Enzymes for digestion of fat, protein, CHO - Lipolytic activity declines at first so fat absorption mainly affected - Overt clinical consequences unlikely unless 90% function loss - Steatorrhea, weight loss, vit. Deficiency (A, D, E, K) also more minor symptoms

Answer 7

- Chronic pancreatitis (alcohol) - Pancreatic cancer - Cystic fibrosis - Haemochromatosis - Pancreatic resection - Gastric resection

Answer 8

- Risk factors (alcohol, CF) - Symptoms - Pancreatic imaging (CT, MRI) - Tests of exocrine pancreatic function - Direct – eg secretin stimulation tests - Indirect – eg faecal elastase, pancreolauryl (only reliably detect mod. To severe PEI)

Answer 9

- Pancreatic enzyme replacement - Taken with meals and snacks - Gastric acid suppression - Vitamin supplements

Answer 10

- Normally 10^5 to 10^9 bacteria/ml present in distal small bowel - Colon has up to 10^12 - Older patients, immunosuppressed, disturbed function/ anatomy of gut - Mostly gram- aerobic bacteria in ileum, gram+ anaerobic bacteria in colon - In bacterial overgrowth this balance is lost - Bacteria moves up to s. intestine - Competes for food

Answer 11

- Stasis (stop in flow of gut) - Strictures - Crohn’s disease - TB - Hypomobility - Old age - Opiate analgesics - Diabetes - Systemic sclerosis Blind loops, diverticulae - Used to be common, now more common again - Bacteria less likely to be flushed through - As a result of gastric surgery for peptic ulcer disease - Now patients with obesity having surgery - Immunodeficiency - Obesity?

Answer 12

- Quantative culture of jejunal fluid is gold standard - Glucose/ hydrogen breath test - More practical - Oversenstive - Small bowel radiology to look for anatomical abnormalities

Answer 13

- Treatment with 2 weeks of antibiotics - Eg tetracycline, ciprofloxacin, rifaximin - Often needs repeat treatments

Answer 14

- Bile acids specifically absorbed in ileum - Cause secretory diarrhoea in colon - Affected by ileal disease or resection - Also impaired in post-cholecystectomy, rapid transit and other malabsorptive states - Primary BAM may reflect over-production rather then malabsorption

Answer 15

- Non-invasive pathogen - Malabsorption due to multiple factors - Brush border damage - Reductions in surface area - Bile acid utilization - Induction of hypermotility - Enterotoxin - Treatment of choice is metronidazole

Answer 16

- Not all colonic polyps progress to adenocarcinoma - Adenomas have the highest progression potential to adenocarcinomas - Hyperplastic (metaplastic polyps don’t have malignant potential) - A special type of hyperplastic polyp called serrated polyp has some malignant potential

Answer 17

- diet high in red meats and processed meats - cooking meat at vv high temp - cretes chemicals - diet low in fibre - obesity - physical inactivity - smoking - alcohol excess - family history of colorectal polyps or colorectal cancer - a family history of colorectal polyps or colorectal cancer - history of IBS - older age

Answer 18

Oesophagus innervated by vagus nerve and sympathetic fibres | - Branch of vagus -> left recurrent laryngeal nerve

Answer 19

Superiorly - Level of cricoid cartilage - At juncture of pharynx Middle - Crossed by aorta - Left main bronchos inferior - diaphragmatic sphincter

Answer 20

mucosa - starified squamous - non keratinizing - muscularis mucosa submucosa - mucous glands muscularis externa adventitia - loose conn. Tissue - no serosa

Answer 21

any tumour that invades 3 layers (mucosa, submucosa, muscularis mucosa) - considered T1 once tumour goes to muscularis propria - T2 Once touches adventitia/serosa of oesophagus - T3 Once tumour out of layers of oesophagus and into nearby organs - T4

Answer 22

- Dysphagia of solids (and liquids when worse) - Feeling of food getting stuck / choking - Hoarse voice - Weight loss

Answer 23

Draws blood from small bowel and right side of large bowel

Answer 24

Draws blood from left side of large bowel Joined by splenic vein that gets blood from vein

Answer 25

Take blood from lesser curve of stomach and branches from fondus of stomach

Answer 26

superior mesenteric vein inferior mesenteric vein splenic vein

Answer 27

Brings blood from portal vein into the peri oesophageal plexus Lower end of oesophagus drains from this vein into the portal system

Answer 28

- Liver becomes nodular and stiff - Blood from portal vein can’t get through the liver easily - Inc. pressure in portal systems Flow of blood slows down - Leading to collateral circulation - Shunting of blood = reversal of flow of blood down to the portal vein from the liver - Blood from portal vein goes into the peri oesophageal plexus and forms ESOPHAGEAL VARICES - Collaterals drain into hemi-azygos and azygos systems - Eventually blood goes into the superior vena cava and returns into the systemic circulation

Answer 29

- Then there’s reversal of flow of the splenic vein - Blood can no longer be drained from spleen down to the portal vein Collateral circulation forms that joins in fundus of stomach – peri oesophageal plexus - GASTRIC VARICES - Through this system blood finds its way back into systemic circulation

Answer 30

- Eg in acute pancreatitis - Then blood no longer drains from the spleen Has to create collaterals - So drains through the fundus of stomach - Gastric varices Called SEGMENTAL PORTAL HYPERTENSION

Answer 31

- Due to lots of inflammation in the area of the small bowel - Eg bowel ischaemia or trauma - Regional formation of collaterals - Forms varices in small bowel - Blood may bypass this area creating anastomoses with nearby vessels

Answer 32

- Endoscope goes down - Suction - Place bands - Thombose/ clot areas - Trying to divert blood flow from superficial layers of oesophagus to deeper layer

Answer 33

Banding gastric varices is harder because they’re bigger - Risk that band falls off and there’s a hole left - Could lead to life threatening bleeding So treatment of gastric varices is… - Inject thrombotic agent such as thrombin into the varix - Varix will swell due to thrombosis

Answer 34

- Cardiac - Fundus (where gastric varices form) - Corpus - Pyloric -> antrum, pyloric canal, sphincter

Answer 35

- Glands in all zones have mucous cells and enteroendocrine cells Fundic glands - Parietal (oxyntic cells) cells – HCI, intrinsic factor - Chief (zymogenic) cells – pepsinogen, rennin, lipases - Mucous neck cells - Enteroendocrine cells gastrin, cholecystokinin, secretin, serotonin, glucagon

Answer 36

the Coeliac trunk is in the abdominal aorta it contains... Left gastric artery Common hepatic artery - Right gastric - Proper hepatic artery - Right, left and middle - 2 branches that go to duodenum - Supra duodenal artery - Gastro duodenal artery Splenic artery

Answer 37

upper part of stomach and lesser curve

Answer 38

supplies stomach

Answer 39

goes behind stomach and supplies blood to the spleen, pancreas and stomach

Answer 40

supplies blood to duodenal bulb and the posterior aspect of the duodenum - Post. Aspect of duodenum is often area of duodenal ulcers - Gastro duodenal artery can be invaded by ulcers - Causing significant bleeding

Answer 41

- With gastric cancer coeliac axis area often affected - Important area in staging of cancer - If coeliac access is affected in oesophageal cancer it’s considered as metastasis

Answer 42

- Form in gall bladder - If stone leave gall bladder and goes down bile duct - Cause obstruction - Bile no longer flows down - Bile Spills over into blood - Patients can develop jaundice

Answer 43

- Stops the flow of bile down into the duodenum - Gall bladder becomes enlarged - Unlike with gallstones it's not painfuL - If there’s a mass the duct dilates – gall bladder big - So jaundice but painless - Present with weight loss and back pain]

Answer 44

- Coeliac trunk = foregut - Superior mesenteric = mid gut (small intestine, right of large intestine) - Inferior mesenteric = hind gut (left side of large bowel, descending colon, sigmoid, rectum) Transverse colon supplied by sup. and inf. Depending on anatomy

Answer 45

- Leads to ischaemia in small intestine - Called ABDOMINAL ANGINA - Patients complain of abdominal pain after eating - Bc after eating lots of blood has to go into intestines for digestion - So when that can’t happen = pain

Answer 46

``` Gi secretions ischaemia drugs immunological infections radiation trauma idiopathic ```

Answer 47

- Inflammation - Apoptosis or necrosis - Erosion and ulceration - Hypoplasia and atrophy - Metaplasia - Dysplasia +/- neoplasia

Answer 48

- Acute erosive / haemorrhagic gastritis Ingestion of irritant chemicals - Acute H. pylori infection Usually no minor symptoms, so seldom seen in biopsies

Answer 49

- Non-atrophic gastritis - Chronic H. pylori infection - Atrophic gastritis - Autoimmune gastritis - Antibodies made against parietal cells - Loss of intrinsic factor secretion (B12) - Leads to anaemia - Chronic H. pylori infection

Answer 50

- Chemical gastritis - Eg bile reflux, NSAIDs - Radiation gastritis - Lymphocytic gastritis - Associated with coeliac disease - Non-infectious granulomatous gastritis - Eg crohn’s disease, sarcoidosis - Eosinophilic gastritis - Eg food sensitivities - Other infectious gastritides (non-H. pylori) - Bacteria viruses (eg CMV) fungi, parasites

Answer 51

- Hypersensitivity to glutamine-rich proteins in wheat, barley and rye - Strong link to certain HLA class II genes - Leads to malabsorption due to injury to mucosa of small intestine

Answer 52

- Typical histological changes from biopsy of small intestine (duodenum) - Autoantibodies in the blood - Improvement of symptoms after gluten-free diet - Often picked up in screening for iron deficiency

Answer 53

dermatitis herpetiforms

Answer 54

- Loss of villus architecture - Chronic inflammation in the lamina propria - Increased no. of T lymphocytes in epithelium - Epithelial damage - Crypt hyperplasia

Answer 55

- Having a family member with IBD is the biggest RF - Monozygotic twin studies have shown greater concordance for crohns disease than UC - Various susceptibility genes identified - NOD2 gene in crohn’s disease (involved in bacterial recognition)

Answer 56

- Exclude other aetiologies eg infection - Make initial diagnois of IBD - Distinguish between UC and Crohns - Assess response to treatment - Look for complications or other pathology - Surveillance for dysplasia

Answer 57

- Epithelial damage/ erosion/ ulceration - Mucin depletion - Neutrophil infiltration (“cryptitis’ and crypt abscesses) - Metaplasia

Answer 58

- Cell types (plasma cells, neutrophils etc) - Density of inflammatory infiltrate - Distribution of infiltrate (patchy vs. diffuse) - Presence of granulomas

Answer 59

- Surface topography | - Crypt architectural abnormalities/ atrophy

Answer 60

- Chronic relapsing and remitting clinical course - Recurrent episodes of rectal bleeding - Highest incidence 15-25, smaller in 60-70 yrs - No gender diff - Inflammation confined to mucosa unless severe - Typically involves rectum +/- left colon - Involvement of whole colon (pancolitis) is a continuous distribution

Answer 61

scar tissue projection from ulceration on bowel wall

Answer 62

- Regional enteritis - Chronic, multifocal, relapsing condition that can affect any part of the GI tract - Peak incidence 20-30, smaller peak 60-70 - No gender diff. - Variety of presenting complaints depending on what part of GI tract - Abdominal pain, diarrhoea, weight loss, strictures and obstruction, fistulae - Transmural inflammation (involves all the layers of the wall) - Patchy and discontinuous

Answer 63

- Presence of granulomas in 70% of cases - Due to activated macrophages - Fewer in right colon than left - More common in children - But larger in adults - Fewer after 2 years of illness - Granulomas can be identified in all layers of wall - If in mucosa can be associated with UC - So more helpful to diagnose CD is deeper within the wall - In lymph nodes**

Answer 64

- Not broad flat ulcers like in UC - Aphis ulcers - Small, superficial ulcers over mucosa - In crohn’s ulceration often extends into the anal canal and involves the peri anal skin

Answer 65

- If bowel stuck to adjacent organs/ other segments of bowel - The fissuring ulceration can give rises to a fistula - An abnormal structure between 2 hollow organs or hollow organ and skin surface

Answer 66

- subacute intestinal obstruction - fistulae - malabsorption - cobblestone patterns of ulcers in Crohns

Answer 67

- Emergency presentation - Massively distended large bowel loops - Cause damage to nerve supply of the colon - Large bowel wall becomes vv thin and perpherates easily

Answer 68

- higher risk for UC - risk inc. with time since diagnosis - risk inc. with severity and extent of disease - most commonly COLORECTAL CARCINOMAS - also SMALL BOWEL CARCINOMAS - other eg bile duct carcinomas, leukaemia’s - about 5% with CD - about 11% with UC

Answer 69

- infective colitis – bacterial and parasitic - sexually transmitted looks like UC - Ischaemic colitis - Most common in region of splenic flexure and descending colon - Can look like crohns endoscopically but not histologically - Diverticular disease - Most common in sigmoid colon - Can result in fistulaes to toher organs eg bladder - Mimics crohns histologically and radiologically - Drug induced colitis - NSAID – ileocolic region - Radiation colitis - Endoscopically resembelance - Neoplasia - Can give rise to mass lesions, fistulae and strictures

Answer 70

- Crohn’s disease - Ischaemic colitis - Diverticular disease - Diaphragm disease – NSAIDS - Neoplasia

Answer 71

- Usually seen in older patients - Chronic watery diarrhoea - Over several months - Normal appearance of colonic and rectal mucosa at endoscopy - Must look at microscopy - Inc. in chronic inflammatory cells in lamina propria - 2 patterns - Collagenous colitis - Lymphocytic colitis - Cause isn’t identified - Lymphocytic colitis can be assoc. with coeliac disease - Drugs implicated in some cases, particularly PPI, NSAIDS - Can be treated with steroids