GI to work on Flashcards
Give 2 common causes of large bowel obstruction
- Colorectal malignancy - most common in UK
2. Volvulus - more common in Africa
Give 5 risk factors for colorectal cancer
- Increasing age
- Family history
- Western diet - saturated animal fat, red meat consumption, low fibre, high sugar
- Alcohol
- Smoking
Give 4 signs of rectal carcinoma
- rectal bleeding and mucus
- when cancer grows there will be thinner stools and tenesmus (cramping rectal pain)
- Abdominal mass
- Perforation
- Haemorrhage
- Fistulae
Explain Dukes staging and prognosis
A = limited to muscularis mucosae = 95% 5-year survival B = extension through muscularis mucosae (not lymph) = 75% 5-year survival C = involvement of regional lymph nodes = 35% 5-year survival D = distant metastases = 25% 5-year survival
How do you treat H. pylori?
Triple therapy:
Normal –> amoxicillin, omeprazole and clarithromycin/metronidazole
Penicillin resistance –> clarithromycin, omeprazole and metronidazole
Give 3 symptoms of peptic ulcers
- recurrent burning epigastric pain
- pain relieved by antacids and is worse when hungry
- pain occurs at night
- nausea
- anorexia and weight loss
Give 5 broad causes of malabsorption
- Defective intraluminal digestion
- Insufficient absorptive area
- Lack of digestive enzymes
- Defective epithelial transport
- Lymphatic obstruction
Malabsorption: what can cause defective intraluminal digestion?
- Pancreatic insufficiency due to pancreatitis/CF - lack of digestive enzymes
- Defective bile secretion due to biliary obstruction or ileal resection
- Bacterial overgrowth
give 3 microscopic features that will be seen in ulcerative colitis
- Crypt abscess
- goblet cell depletion
- mucosal inflammation - does not go deeper
Name 3 causes of IBD
- Genetic
- Stress/depression
- Inappropriate immune response
Give 4 signs and symptoms of Ulcerative colitis
- Episodic/chronic diarrhoea +/- blood/ mucus
- Abdominal pain - left lower quadrant
- Systemic - fever, malaise, anorexia, weight loss
- Clubbing
- Erythema nodosum
- Amyloidosis
Give 4 signs and symptoms of Crohn’s disease
- Diarrhoea - urgency
- Abdominal pain
- Systemic - weight loss, fatigue, fever, malaise
- Bowel ulceration
- Anal fistulae/stricture
- Clubbing
- Skin/joint/eye problems
What investigations might you do in someone with IBD?
- Bloods - FBC, ESR, CRP
- Faecal calprotectin - shows inflammation but is not specific for IBD
- Flexible sigmoidoscopy
- Colonoscopy - biopsy to confirm
- examination
What is the treatment for Crohn’s disease?
- Smoking cessation
- 1st line = Corticosteroids - BUDESONIDE (controlled release) or ORAL PREDNISOLONE (for severe attacks)
- Surgical resection - only minimal
What are the complications for Ulcerative colitis?
- Colon –> blood loss, colorectal cancer, toxic dilatation
- Arthritis
- Iritis, episcleritis
- Fatty liver and primary sclerosing cholangitis
- Erythema nodosum
Give 5 complications of Crohn’s
PERFORATION AND BLEEDING = MAJOR
- Malabsorption
- Obstruction –> toxic dilatation
- Fistula/abscess formation
- Anal skin tag/fissures/fistula
- Neoplasia
- Amyloidosis
Describe the pathophysiology of Coeliac disease
- Gliadin from gluten deaminated by tissue transglutaminase –> increases immunogenicity
- Gliadin recognised by HLA-DQ2 receptor on APC –> inflammatory response
- Plasma cells produce anti-gliadin and tissue transglutaminase –> T cell/cytokine activated
- Villous atrophy and crypt hyperplasia –> malabsorption
Give 5 symptoms of Coeliac disease
- Diarrhoea and steatorrhoea (stinking/fatty)
- Weight loss
- Irritable bowel
- Iron deficiency anaemia
- Osteomalacia
- Fatigue
- abdominal pain
- angular stomatitis
- dermatitis herpetiform
What 3 histological features are needed in order to make a diagnosis of coeliac disease?
- Raised intraepithelial lymphocytes
- Crypt hyperplasia
- Villous atrophy
What part of the bowel is mostly affected in coeliac disease?
Proximal small bowel (duodenum)
mean B12, folate and iron cannot be absorbed = anaemia
Give 3 complications of Coeliac disease
- Osteoporosis
- Anaemia
- Increased risk of GI tumours
- secondary lactose intolerance
- T-cell lymphoma
Give 3 causes of squamous cell carcinoma
- Smoking
- Alcohol
- Poor diet/obesity
- coeliac disease
Give 5 symptoms of oesophageal carcinoma
- progressive dysphagia
- Weight loss
- Heartburn
- Haematemesis
- Anorexia
- Pain
Give 3 causes of gastric cancer
- Smoked foods
- Pickles
- H. pylori infection
- Pernicious anaemia
- Gastritis
- family history
Describe how gastric cancer can develop from normal gastric mucosa
Smoked/pickled food diet leads to intestinal metaplasia of normal gastric mucosa
Several genetic changes lead to dysplasia and then eventually intra-mucosal and invasive carcinoma
Give 3 symptoms and signs of gastric cancer
- Weight loss
- Anaemia (pernicious)
- nausea and Vomiting
- Dyspepsia and dysphasia
- palpable epigastric mass
- Hepatomegaly, jaundice and ascites
- Enlarged supraclavicular nodes
- epigastric pain
What investigations might you do in someone who you suspect has gastric cancer?
- gastroscopy - biopsy
- endoscopic USS - depth of invasion
- CT /MRI /PET
what are the red flag signs for upper GI cancer?
For people with an upper abdominal mass consistent with stomach cancer:
- Dysphagia of any age
- Aged ≥ 55yr + weight loss with any of the following:
- Upper abdominal pain/(or)
- Reflux/ (or)
- Dyspepsia
Give 3 causes of appendicitis
- Faecolith
- Lymphoid hyperplasia
- Filarial worms
What investigations might be done in a patient you suspect has appendicitis?
- Blood tests = raised WCC,
- CRP, ESR
- USS
- CT - gold standard
Give 2 complications of appendicitis
- Ruptured appendix –> peritonitis
- Appendix mass
- Appendix abscess
Give 3 causes of Gastro-oesophageal reflux disease (GORD)
- Hiatus hernia - sliding or rolling hiatus
- Smoking
- Obesity
- Alcohol
- pregnancy
Describe the pathophysiology of GORD
Lower oesophageal sphincter dysfunction –> reflux of gastric contents –> oesophagitis
Name 3 oesophageal symptoms of GORD
- Heartburn - retrosternal chest pain, after meals, worse when lying down, relieved by antacids
- Bleching
- Food/acid and water brash
- Odynophagia - (painful swallowing)
- Dysphagia - (difficulty swallowing)
Name 3 extra oesophageal symptoms of GORD
- Nocturnal asthma
- Chronic cough
- Laryngitis
- Sinusitis
What investigations are done for someone you suspect has GORD?
- Diagnosis can be made without investigations
- Endoscopy (if red flags)
- Barium swallow
- 24hr oesophageal pH monitoring
What is the treatment of GORD?
conservative
- stop smoking
- stop alcohol
- lose weight
- change sleep position
medical
- PPI (omeprazole)
- H2 receptor antagonist (ranitidine)
surgical
- nissen fundoplication
Describe the multi-factorial pathophysiology of IBS
The following factors can all contribute to IBS:
- Psychological morbidity
- trauma in early life
- Abnormal gut motility
- Genetics
- Altered gut signalling (visceral hypersensitivity)
Give an example of a differential diagnosis for IBS
- Coeliac disease
- Lactose intolerance
- Bile acid malabsorption
- IBD
- Colorectal cancer
Describe the non pharmacological treatment of IBS
Education
Resistance
Dietary modification - reduce caffeine, plenty of fluids, increase fibre intake
A 50-year-old man presents with dysphagia. Which one of the following suggest a benign nature of his disease?
a. Weight loss
b. Dysphagia to solids initially then both solids and liquids
c. Dysphagia to solids and liquids occurring form the start
d. Anaemia
e. Recent onset of symptoms
c. Dysphagia to solids and liquids occurring form the start
A 52-year-old lady presents with fatigue and itching. She noticed pale stool and dark urine. She suffers from hypercholesterolaemia and rheumatoid arthritis. She takes simvastatin and cocodamol. Examination revealed jaundice, xanthelasma, spider naevi, and hepatomegaly. Her bloods showed Bili 150, ALP 988, ALT 80, positive AMA and a raised IgM. What is the most likely diagnosis?
a. Simvastatin induced liver injury
b. Primary biliary cirrhosis
c. Gallstones
d. Autoimmune hepatitis
e. Primary sclerosing cholangitis
b. Primary biliary cirrhosis
what are the microscopic features of crohns disease?
- transmural inflammation
- granulomas
- increase in inflammatory cells
- goblet cells
- less crypt abscesses
what are the risk factors for crohn’s disease?
- genetic association - mutation on NOD2 (CARD15) gene on chromosome 16
- smoking
- NSAIDs
- family history
- chronic stress and depression
- good hygiene
- appendicectomy
what are the risk factors for ulcerative colitis?
- family history
- NSAIDs
- chronic stress and depression
what are the risk factors for coeliac disease?
- HLA DQ2/DQ8
- other autoimmune diseases e.g. T1DM, thyroid disease, Sjogren’s
- IgA deficiency
- breast feeding
- age of introduction to gluten into diet
- rotavirus infection in infancy
what are the risk factors for oesophageal cancer?
ABCDEF
- Achalasia
- Barret’s oesophagus
- Corrosive oesophagitis
- Diverticulitis
- oEsophageal web
- Familial
what are the causes of adenocarcinoma of the oesophagus?
- smoking
- tobacco
- GORD
- obesity - increases reflux
what are the complications of GORD?
- peptic stricture
- barrett’s oesophagus