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phase 2a > GI > Flashcards

GI Flashcards

1
Q

4 features of Crohn’s disease at biopsy?

A

patchy skip lesions
cobblestone mucosa (due to fibrosis)
deep fissuring ulcers
granuloma

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2
Q

3 features of UC inflammation at biopsy?

A

cut off
only mucosa
pseudopolyps
(crypt abscesses)

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3
Q

5 presentations of IBD?

A 
abdo tenderness 
malapsorbtion eg iron deficiency anaemia, etc 
weight loss 
blood on DRE
blood/mucus in stools 
diarrhoea 
urgency / tehesmus 
mouth ulcers 
fever, tachycardia
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4
Q

3 extra intestinal features of IBD?

A 
arthritis, anklyosing spondylitis 
osteoporosis 
iron deficiency anaemia
clubbing 
uveitis, etc 
PSC
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5
Q

first line prophylaxis for crohns, and some other options?

A

azathiopurine

methotrexate
infliximab

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6
Q

laxative and anti-diarrhoeal for IBS?

A

laxative = loperamide

anti diarrhoeal = linaclotide

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7
Q

What class of antibodies are there in coeliac?

A

IgA

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8
Q

what is the rash associated with coeliac called?

A

dermatitis herpatiformis

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9
Q

4 features of coeliac on a duodenal biopsy?

A

crypt hyperplasia
villous atrophy
increased epithelial lymphocytes
flattened mucosa ‘mosaic’

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10
Q

3 complications of poorly controlled coeliac?

A 
malignancy
lymphoma 
infertility
osteoporosis 
ulcerative jejunitis 
refractory coeliac disease
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11
Q

what type of epithelium is normally in the:
stomach
oesophagus
what transformation does the oesophageal epithelium undergo in Barrets?

A

stomach = columnar
oesophagous = squamous
squamous to columnar

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12
Q

causes / risk factors for Barretts oesophagus & GORD?

A 
obesity
oesophageal hypermobility
gastric acid hypersecretion/zollinger-ellison 
pregnancy
smoking
NSAIDs
caffeine, alcohol 
hiatus hernia
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13
Q

What is the difference between Barrett’s and GORD?

A

GORD = reflux of the stomach contents into the oesophagus, through the gastro-oesophageal sphincter

persistent GORD causes Barrett’s, which is a premalignant transformation from squamous to columnar epithelium

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14
Q

5 clinical presentations of GORD?

A 
heartburn espesh when lying down
regurgitation
dyspepsia
retrosternal chest pain
bloating 
nocturnal cough
hoarse voice
dysphagia
water brash
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15
Q

5 red flags for GORD that warrant endoscopy?

A 
new onset over 55
weight loss
dysphagia
upper abdo pain
nausea / vomitting 
refractory 
anaemia 
high platelets but anaemia
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16
Q

What are the two most common kinds of oesophageal cancer and some basic epidemiology of them?

A

adenocarcinoma = common here - GORD/fat smoking man. at the bottom of the oesoph

squamous cell carcinoma = common in Japan. nitrosamines, hot drinks and achlasia. top of the oesoph

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17
Q

what is the dysphagia like in oesophageal cancer?

A

progressive so starting with solids then progresing to liquid

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18
Q

5 clinical presentations in stomach cancer?

A 
iron deficiency anaemia
mass 
malaena 
acanthosis nigrans (black armpits)
troiser's sign: enlarged hard left supraclavicular node 
early satiety

nausea
dyspepsia
weight loss, anorexia
abdo pain

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19
Q

what is the investigation for ?stomach cancer and what will you see (3)

A

upper GI endoscopy with biopsy

ulcer with heaped edges
leinitis plastica (leatherbottle stomach)
poor inflation in response to the endoscopy/barium meal
fibrosis
may be HER2 pos (then you can treat with trastuzumab :) )

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20
Q

2 benign colon lesions that can lead to colorectal cancer?

A

benign adenoma
familial adenomatous polyposis (dominant inheritance = cancer in 20s)
hereditary non polyposis colon cancer (mutation in DNA repair protein)

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21
Q

what is the staging system used for colorectal cancer and what are the stages?

A

Dukes

A: only submucosa
B: muscular / transmural
C: lymph nodes
D: metastasis

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22
Q

how does right sided colon cancer present?

A

right sided is hard to find

iron deficiency anaemia due to chronic low level bleeding

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23
Q

how does left sided colon cancer present? 3

A 
rectal bleeding 
diarrhoea / constipation 
colicky pain 
weight loss 
rectal mass 
N&V
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24
Q

If the FOB is pos and you suspect colon cancer what inv do you do next?

A

screening sigmoidoscopy

then if thats pos you can do a full colonoscopy

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25
Q

What is peutz-jeghers syndrome?

A

mutation in a tumour supressor gene
= polyps in the small bowel
bleeding, intusseption, malignant transformation to cancer

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26
Q

How can the history tell you if its a gastric or duodenal ulcer?

A

eating - worsens gastric and improves duodenal

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27
Q

3 examples of intraluminal intestinal obstruction?

A 
tumour eg colon cancer 
diaphragm disease (caused by NSAIDs,  = fibrosis)
diverticulitis 
IBS 
sliding hernia 
gallstone ileus
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28
Q

3 causes of intramural obstruction?

A

inflammation - Crohns, diverticulitis
skirous tumour
Hirsprung’s neuropathy

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29
Q

3 causes of extramural intestinal obstruction?

A 
adhesions 
volvulus 
intusseption
hernia 
peritoneal tumour
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30
Q

3 non mechanical causes of intestinal obstruction?

A 
paralytic ileus 
mesenteric thromboembolism
pseudo obstruction 
retroperitoneal haematoma 
slow transit bowel
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31
Q

4 cardinal features of bowel obstruction?

A

abdo pain
nausea and vomitting
absolute constipation
distention

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32
Q

how does the presentation of small vs large bowel obstruction differ?

A

small = acute. bilious feculent vomiting. central pain

large = chronic. constipation. peripheral pain

33
Q

what is the name of bowel sounds that you can hear without a stethoscope?

A

borborygmi

34
Q

Two signs of a large intestine volvulus on imaging?

A

whorl in mesentery on CT

coffee bean on x ray (= sigmoid colon is affected)

35
Q

what does jejenum distention look like on abdo x ray?

A

volvuli columnentis (stack of coins)

36
Q

if you see ‘shouldering’ on an abdo CT what does this mean?

A

cancer

37
Q

What are the symptoms & abdo exam findings in appendicitis?

A 
abdo pain. epigastric -- RIF 
Tenderness @ McBurneys point
Rosvig sign. press LIF = RIF pain
anorexia 
nausea/vom
38
Q

first line investigations (2) for ?appendicitis?

A

CT abdo / pelvis + contrast
USS/ hCG to exclude preg
CRP

39
Q

gold standard inv for appendicitis?

A

CT scan

40
Q

3 differentials for appendicitis?

A

ectopic preg
ovarian cysts
Meckle’s diverticulum
mesenteric adenitis

41
Q

where is the most common place for diverticulae to form?

A

sigmoid colon

42
Q

guarding, rebound or percussion tenderness on an abdo exam suggests?

A

perforation/peritonitis

43
Q

what imaging is best to look for diverticulosis?

A

CT abdo and pelvis with contrast

44
Q

best abx for diverticulitis in primary care?

A

co amoxiclav

45
Q

2 complications of diverticular disease?

A

perforation – peritonitis
haemorrhage
fistula: colon-bladder / colon-vagina
ileus / bowel obstruction

46
Q

3 aetiology of gastritis?

A 
H pylori
pernicious anaemia 
Crohns 
ischaemia 
CMV, HSV 
duodenogastric reflux (bile salts from SI into stomach)
NSAIDs 
alcohol/caffeine/smoking
47
Q

presentation of gastritis? 4 features

A 
nausea/vom
bloating
epigastric pain
indigestion
haematemesis 
malaena
48
Q

how do GI hormones/enzymes change in gastritis?

A

gastrin raised

pepsinogen decreased

49
Q

Treatment for H pylori? 3

A

metronidazole
quinolone / clarithromycin
lansoprazole

2nd line: + bismuth subsalicylate
3rd line: + rifabutin (and take away the abx)

50
Q

what are the two most vulnerable places to ischaemia?

A
  1. splenic flexure

2. rectosigmoidal junction

51
Q

What is the difference between ischaemic colitis and mesenteric ischaemia?

A

ischaemic colitis = large bowel ischaemia. pain but not too severe. usually non occlusive eg hypotension, shock

mesenteric ischaemia = occlusion of the superior mesenteric artery. associated with AF, etc. super bad pain if acute, if chronic lose loads of weight cos so painful to eat

52
Q

investigation for ischaemic colitis & chronic mesenteric ischaemia?

A

IC: CT without contrast - thumbprinting

MI: CT angiography with contrast

53
Q

what is a pilondal sinus & how does it normally develop?

A

in the natal cleft
a tunnel forms under the skin
male age 18-30 sitting a lot with thick hair and deep natal cleft :S

54
Q

what is a peri-anal fistula?

A

abnormal connection between anal canal & surrounding skin

from abscess, Crohns

55
Q

what is a perianal fissure?

A

tear in anal canal
childbirth, hard faeces, crohns

bleeding
sharp pain when passing stools

56
Q

what is Parks classification for?

A

peri anal fistula

57
Q

what is the most common type of anorectal abcess?

A

peri anal

58
Q

where is iron absorbed?

A

duodenum

59
Q

where is B12 absorbed?

A

terminal ileum

60
Q

where is folate absorbed?

A

jejunum

duodenum

61
Q

what is autoimmune gastritis?

A

affects corpus and fundus of stomach
loss of oxynctic glands = hypochlorrhydia
lack of parietal cells = pernicious anaemia

62
Q

can ischaemia cause ulcers?

A

yes

because the mucus producing cells die off, and cant produce mucus to protect the underlying cells

63
Q

where is the most common location for colorectal cancer?

A

rectum

64
Q

what is the marsh categorisation for and what is each level?

A

coeliac = intraepithelial lymphocytes

1 - lymphocytes NO crypt hyperplasia
2 - crypt hyperplasia 
3a - crypt hyperplasia, mild villous atrophy 
3b - subtotal/moderate villous atrophy 
3c total villous atrophy
65
Q 
chronic cough
difficulty swallowing and sometimes aspirates 
badbreath
midline gurgling throat lump 
what is this?
A

pharyngeal pouch

66
Q

achalasia dysphagia?

A

achalasia = difficulty with solids and liquids from start

67
Q

difficulty initiating swallow suggests ..

A

bulbar palsy

68
Q

what node is lumpy in stomach cancer?

A

Virchow’s

69
Q

classic presentation of haemorrhoids?

A

fresh blood and mucus in stools
anus is itchy and sore but no pain when passing stools
risk factors - obesity, constipation, coughing etc

70
Q

where is a mallory weiss tear?

A

gastro-oesophageal junction

71
Q

what is the gold standard investigation for acute flare of diverticulitis?

A

contrast CT colonography

you would see in on a colonscopy but not first line bc its invasive, especially in acute flare we dont want that

72
Q

what things suggest inflammatory diarrhoea?

A 
severe
blood 
tenesmus
fever
mucus 
abdo pain
73
Q

what is the pain like in small bowel obstruction?

A

severe
colicky
intermittent

74
Q

what on an abdo x ray confirms small bowel obstruction?

A

dilated jejunum/ileum
absence of gas distal to obstruction
volvuli columnentis

75
Q

what is the supportive management of small intestine obstruction? (before surgery)

A 
nil by mouth
nasogastric tube to decompress bowel
IV fluids + electrolytes 
anti emetics 
urinary catheter
76
Q

complications of small bowel obstruction which would need surgery?

A

bowel ischaemia

strangulation

77
Q

describe the two types of haemorrhoids?

A

internal: painless, reducible, covered in mucus
external: in the anal opening painful and covered by skin

78
Q

complications of diverticulitis? 4

A

excessive bleeding
perforation leading to peritonitis
large bowel obstruction
colon-vaginal fistula

79
Q

what is the drug for burst oesophageal varices?

A

IV terlepressin

somatostatin = 2nd line

phase 2a (10 decks)

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