4. BAMS Gastroenterology Flashcards Preview

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Flashcards in 4. BAMS Gastroenterology Deck (16):
1

What do antacids do

What do PPIs and H receptor antagonists do

How do H receptor antagonists do this

What is the disadvantage of using an H receptor antagonist and how is this disadvantage prevented

List 3 causes of dysphagia

List 2 oral consequences of GI disease

Neutralise stomach acid

Reduce acid secretion

Preventing histamine activation of acid production

Other pathways still operate, so limited drug benefit. These pathways are inhibited by gastrin or ACh

Functional, dysmobility or due to external compression

Direct (erosion) and indirect (nutritional deficiency)

2

GORD (Gastro-Oesophageal Reflux Disease)

What 2 things is GORD a combination of

List 3 reasons why GORD occurs

List 4 symptoms of GORD

List 3 complications of GORD

List 5 components of managing GORD

What is Barrett's Oesophagus

How does this occur

Acid reflux and repetitive heartburn

Defective lower sphincter, impaired gastric emptying, impaired lower clearing

Epigastric burning, severe pain, dysphagia, GI bleeding

Metaplasia, inflammation, ulcer formation

Stop smoking, lose weight, medication (PPIs), increase GI motility and gastric emptying

Metaplastic change to gastric-type mucosa in oesophageal lining

Due to recurrent acid reflux in the lower part of the oesophagus

3

PUD (Peptic Ulcer Disease)

Where does PUD occur

List 4 causes of PUD

How is H. pylori treated

Name 2 investigations that could lead to a PUD diagnosis

List 4 local complications and one possible systemic complication of PUD

What are the 3 components in PUD treatment

On any acid affected site

H. pylori, drugs (NSAIDs, steroids), high duodenal acid secretion, normal gastric acid secretion (and reduced mucus production)

Triple therapy - two antibiotics and one PPI

Endoscopy, radiology (barium meal)

Local - perforation, stricture, haemorrhage/bleeding, malignancy. Systemic - anaemia

Stop smoking, small regular meals, lifestyle changes

4

Coeliac Disease

What is coeliac disease

List 3 components of coeliac disease presentation

What is the main reason coeliac disease occurs

What does gluten sensitivity enteropathy involve

List 5 symptoms of coeliac disease

List 2 investigations that could diagnose coeliac disease

What 3 things can adhering to a gluten free diet (coeliac disease treatment/management) lead to

A sensitivity to the a-gliaden component of gluten (found in barley, etc.)

Genetics (DEQ2 gene), T lymphocytes, villous atrophy

Usually results from a malabsorption of iron/vitamin B12/folate/fat

Subtotal villous atrophy of the jejunum

Weight loss, tiredness, weakness, abdominal pain, diarrhoea

Jejunal biopsy, blood test (measure haematinics)

Jejunal atrophy reversal, improved well-being, reduced risk of lymphoma

5

Colonic Carcinoma

List 2 (uncommon) symptoms associated

List 2 investigations that could make a diagnosis

List 7 causes of a colonic carcinoma

Describe the staging of colonic carcinoma (with 5yr survival rates - %)

What 3 ways can this be treated

Anaemia, PR bleeding

FOB, endoscopy

Intestinal polyps, diet, alcohol, smoking, reduced exercise, p53 gene, ulcerative colitis

A - submucosal (80%), B - muscular (65%), C - lymph nodes (45%), D - liver (5%)

Radiotherapy, chemotherapy, surgery

6

Crohn's Disease

What is Crohn's

What 3 things can it be caused by

List the presentation of Crohn's

What 3 microscopic features does this disease have

List 2 symptoms of Crohn's disease

List 2 complications of Crohn's disease

What effect does a colectomy have

Granulomatous inflammation

Food intolerance, persisting viral infection, immune activation

Discontinuous, affects entire GIT, non-vascular, serosa inflamed, mucosa cobbled and fissures present rectum 50% involved, 75% anal fissures (skip lesions present), mainly affects proximal colon and terminal ileum (ileum 10% involved)

Granulomas, transmucosal, oedematous

Colonic disease, small bowel disease (pain, obstruction, malabsorption)

Obstruction, abscess formation

Palliates symptoms

7

Ulcerative Colitis (UC)

List the presentation of UC

What 3 microscopic features does this disease have

List 2 symptoms of UC

List 2 complications of UC

What effect does a colectomy have

Continuous, affects bowel/colon only, vascular, serosa normal (not inflamed), mucosa granulomatous and ulcers present, rectum always involved, 25% anal fissures, ileum 30% involved

Mucosal, vascular, mucosal abscesses

Diarrhoea, PR bleed, abdominal pain, bile motions

Bleeding, perforation, toxic megacolon, carcinoma

Cures the disease

8

IBDs (Inflammatory Bowel Diseases)

List 4 causes of IBDs

List 2 IBD investigations

List 6 differences between Crohn's and UC

Psychological, immunological, smoking, genetic

Endoscopy, blood tests, faecal calprotectin

Crohn's - discontinuous, affects entire GIT, non-vascular, serosa inflamed, mucosa cobbled and fissures present, colectomy palliates symptoms
UC - continuous, affects bowel/colon only, vascular, serosa normal, mucosa granulomatous and ulcers present, colectomy cures disease

9

Jaundice

What is jaundice

Describe the 3 types of jaundice, giving 2 examples of each

Give 2 features of jaundice

List 3 jaundice investigations

What does treatment involve

How is neonatal jaundice caused

What is there a risk of and what is this

How is neonatal jaundice treated

Excessive bilirubin - bilirubin accumulation in the skin

Pre-hepatic - excess bilirubin due to increased RBC breakdown. Malaria, anaemia, autoimmune disease
Intra-hepatic - failure of liver cells leads to failure to metabolise/conjugate bilirubin. Hepatitis, primary biliary cirrhosis, Gilberts syndrome
Post-hepatic - damage, inflammation, obstruction of bile duct prevents gall bladder from secreting bile. Primary biliary sclerosis, gallstones, pancreatic carcinoma

Pale stools, dark urine

ERCP, ultrasound, radiograph

Remove obstruction and treat cause (prevent gallstone recurrence, prevent bile acid build-up)

Birth trauma, incompatible blood types

Kernicterus (bilirubin-induced brain dysfunction)

Phototherapy

10

Gall Bladder

What is the function of the gall bladder

List 2 gall bladder diseases

List the features of the commonly affected population for one of these diseases

List 2 common gall bladder related disease symptoms

Secrete bile for breakdown of fat

Acute cholecystitis, gallstones

Female, forty, fat, fertile, fair

Abdominal (URQ) pain, pain when eating fatty foods

11

Pancreas

List 3 pancreatic diseases

List 4 causes of one of these diseases

Pancreatitis, cystic fibrosis, malignancy

Gallstones, alcohol, trauma, steroids, mumps (and other infections), autoimmune disease - I GET SMASHED

12

Liver Failure

In what 2 ways can liver failure be described and give one example of each type

What 5 things can liver failure lead to

In what ways can liver failure be managed/treated

List 4 liver functions and associated complications of liver failure

Loss of synthetic function (clotting factors) or loss of metabolic function (drug metabolism, detoxification)

Fluid retention, prolonged bleeding, portal hypertension, jaundice, inability to remove waste

Supportive, transplant

Production of coagulation factors - bleeding
Bilirubin conjugation - jaundice
Glucose haemostasis - hypoglycaemia
Detoxification - encephalopathy

13

Cirrhosis

What 3 components contribute to cirrhosis

List 5 causes of cirrhosis

List 4 symptoms of cirrhosis

Damage, fibrosis (scarring) and regeneration (reduced function) of the liver. Caused by irreversible (long-term) damage

Alcohol, chronic active hepatitis, cystic fibrosis, primary biliary sclerosis

Spider naevi, palmar erythema, jaundice, oedema and ascites

14

Hepatitis

What is hepatitis

What are 2 main causes of hepatitis

Inflammation of the liver

Alcohol, viral infection

15

GI Infections

What is the main causative agent associated with GI infection

What is gastroenteritis and list 4 ways it can present

List 2 features (each) of viral and bacterial gastroenteritis

Give the viral structure or norovirus

How is this transmitted

List 4 ways this presents

How is it treated

List 3 types of salmonella

How is this transmitted

List 4 ways this presents

How is it diagnosed

How is it treated

H. pylori

A term used to describe various pathologic states of the GIT. Diarrhoea, abdominal pain, nausea, vomiting

Viral - cramps, vomiting, diarrhoea, fever
Bacterial - small volume stools, suprapubic pain

Non-enveloped single stranded RNA virus

Faecal-oral transmission

Abrupt onset of diarrhoea, vomiting, abdominal pain, fever

Correct fluid/electrolyte balance

Gastroenteritis, enteric fever, bacteraemia

Faecal-oral transmission

Cramps, (bloody) diarrhoea, fever, vomiting

Stool sample

IV hydration and sometimes antibiotics

16

Clostridium Difficile (C. diff)

What is the structure of this micro-organism

How does it commonly present

How is it transmitted

What 3 diseases can it cause

List 5 presentation of one of these diseases

List 4 risk factors associated with the same disease

List 3 ways this disease is treated

Spore-forming gram-positive obligate anaerobe

Diarrhoea

Faecal-oral transmission

CDI, C. diff colitis or pseudomembranous colitis

Diarrhoea, loss of appetite, fever, nausea, abdominal pain

Exposure to antimicrobials/healthcare, >64 years old, underlying illness, immunosuppressed, toxigenic C. diff infection

Rehydration, antibiotics, probiotics