4. Gastroenterology Flashcards Preview

1. BDS2 BAMS Revision > 4. Gastroenterology > Flashcards

Flashcards in 4. Gastroenterology Deck (17):
1

Drugs

Action of antacids
Action of H receptor antagonists
PPIs are gold standard

Oral diseases (3)

Dysphagia causes

Eliminate formed acid/neutralise stomach acid

Reduce acid production by preventing histamine activation of acid production - alternative pathways still operate (can be inhibited by gastrin and ACh)

OFG, ROU, lichen plans

Functional, dysmobility, due to external compression

2

GORD

Definition
Complications (3)
Causes (3)
Signs and symptoms (4)
How does Barrett's oesophagus occur
GORD management (5)
GORD drugs (2)

Repetitive heartburn and acid reflux

May cause ulcers, inflammation and metaplasia

Due to defective lower oesophageal sphincter, impaired gastric emptying, impaired lower clearing

Epigastric burning, dysphagia, GI bleeding, severe pain

Recurrent acid reflux in lower oesophagus --> Barrett's (metaplastic change to gastric type mucosa in oesophageal lining)

Stop smoking, lose weight, avoid triggering activity, increase GI motility, increase gastric emptying

H blockers, PPI

3

PUD

Where can it occur
Causes (4)
Signs and symptoms (2)
Investigations (4)
Local complications (4)
Management (5)
Drug treatment

On any acid affected site

Due to high duodenal acid secretion (excessive acid --> oesophageal and duodenal ulcers), normal acid secretion (--> reduced productive layer/decreased mucus production), drugs (NSAIDs), H. pylori

Often none, epigastric burning (before/after meals)

Endoscopy, barium swallow, anaemia tests, H. pylori tests

Perforation, haemorrhage, stricture, malignancy

Stop smoking, small regular meals, ulcer healing drugs, lifestyle changes, surgery

Triple therapy - two antibiotics and one PPI

4

Coeliac disease

Definition
Features (2)
Causes
What does gluten sensitive enteropathy involve
Effects (2)
Signs and symptoms (8)
Investigations (2)
Management
What does management lead to (2)

Associated with dermatitis herpetiformis - what is this

a-gliaden gluten sensitivity (DQW2 gene)

Due to T-lymphocytes, villous atrophy

From iron/vitamin B12/folate/fat malabsorption

Subtotal villous atrophy of the jejunum

Growth failure, oral ulceration

Weight loss, lethargy, weak, abdominal pain/swelling, diarrhoea, aphthae/glossitis, dysphagia, steatorrhea

Jejunal biopsy, faecal fat

Gluten free diet

Jejunal atrophy reversal, increased well-being

Granular IgA depositions in skin and mucosa

5

Colonic carcinoma

Symptoms and signs (3)
Screening (5)
Causes (7)
Treatment (3)

Colonic cancer staging A-D (5yr survival %)

Often none, anaemia, PR bleed

FOB, barium enema, endoscopy, CT/MRI, CEA

Intestinal polyps (pedunculated/flat - bleed due to trauma), diet (reduced fibre and veg; increased fat and meat), alcohol, smoking, reduced exercise, p53 gene, UC

Surgery, chemotherapy, radiotherapy

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

6

IBDs

Causes (4)
Investigations (3)
Drug treatment (2)

Features of OFG (5)

Immunological, psychological, smoking, genetics

Blood tests, endoscopy, faecal calprotectin

5-ASAs, NSAIDs

Lip swelling, angular cheilitis, cobblestoning, ulcers, full thickness gingivitis

7

Crohn's

Definition of Crohn's
Causes (2)
Crohn's signs and symptoms (3)
Usually affects (2)
Complications (2)
Treatment

Granulomatous inflammation/non-caseous granulomas

Food intolerance, persisting viral infection/immune activation

Colonic disease, small bowel disease (pain, obstruction, malabsorption), oral and anal disease

Proximal colon and terminal ileum. Skip lesions

Obstruction, abscess formation

Surgery to palliate symptoms and signs (stoma)

8

UC

Features (6)
Signs and symptoms (7)
Complications (4)
Treatment

Ulcers just in mucosa, continuous along colon, increased bleeding, no goblet cells, distortion of crypts, flat and vascular

Diarrhoea, abdominal pain, urgency, PR bleeding, bile motions, mucus, tenesmus

Carcinoma, perforation, bleeding, toxic megacolon

Stoma - colectomy is a cure

9

Differences between Crohn's and UC (11 each)

Crohn's - continuous, non-vascular, inflamed serosa
Rectum 50% involved, ileum 10% involved, 75% anal fissures
Mucosa cobbled and fissures present
Microscopically - trans mucosal, oedematous, granulomas

UC - non-continuous, vascular, serosa normal
Rectum 100% involved, ileum 30% involved, 25% anal fissures
Mucosa granulomatous and ulcers present
Microscopically - mucosal, vascular, mucosal abscesses

10

Jaundice

Definition
Types (3) and definitions of each with examples (2)
Features (3)
Investigations (3)
Management (4)
Neonatal jaundice definition
Neonatal jaundice causes (2)
Risk of what with neonatal jaundice
Neonatal jaundice treatment

Accumulation of bilirubin in skin, which can lead to pigmentation and itch

Pre-hepatic (increased haem load due to increased RBC breakdown - malaria, autoimmune disease)
(Intra-)hepatic (disruption of bilirubin processing and metabolism - primary biliary cirrhosis, hepatitis)
Post-hepatic (damage, inflammation, obstruction in bile duct --> gallbladder can't secrete bile - primary biliary sclerosis, gallstones)

Urine/faecal excretion of conjugated bilirubin, pale stools, dark urine

Ultrasounds, X-ray, ERCP

Identify and treat cause, remove obstruction, prevent gallstone recurrence, prevent bile acid build-up/reabsorption from GIT

Increased haem breakdown

Birth trauma, ABO/Rh incompatibility --> poor liver funciton

Risk of kernicterus

Phototherapy

11

Gall bladder and pancreas

Diseases (2)
Usual population of gallstones sufferers (5)
Signs and symptoms (3)

Pancreas diseases (4)
Causes of pancreatic diseases (7)

Acute cholecystitis, gallstones

Fat, forty, fertile, female, fair

Shoulder tip pain, URQ pain, pain when eating fatty foods

Pancreatitis, cystic fibrosis, chronic pancreatic disease, cancer

I GET SMASHED - gallstones, alcohol, trauma, steroids, mumps/infections, autoimmune, spider bites/scorpion stings

12

Cirrhosis

Definition
Features (3)
Causes (6)
Signs and symptoms (10)

Chronic liver scarring due to long-term/irreversible damage

Damage, fibrosis and regeneration

Alcohol, primary biliary sclerosis, chronic active hepatitis, autoimmune disease, cystic fibrosis, haemachromatosis

None - enlarged/reduced liver, acute bleed, oesophageal varies, jaundice, oedema, ascites, encephalopathy, spider nave, palmar erythema

13

Liver failure

Types (2)
Liver function tests (2)
Effects (5)
Treatment (2)
Liver functions (4)
Liver failure complications (4)

Reduction in albumin leads to
Reduction in clotting factors leads to (2)

Definition and causes (2) of hepatitis

Loss of synthetic function (clotting factors), loss of metabolic function (drug breakdown, bilirubin conjugation)

INR, vitamin K test

Fluid retention, increased bleeding, portal hypertension, jaundice, can't remove waste

Supportive, transplant

Bile acid synthesis and secretion, bilirubin conjugation, coagulation factors, detoxification

Malabsorption of fat/fat-soluble vitamins, jaundice, increased bleeding, encephalopathy

Increase in free drug in blood

Reduction in vitamin absorption, no clotting factors produced --> cycle

Liver inflammation due to viral infection, liver damage (alcohol)

14

GI infections

Causative agent
Detection (3)
Treatment (3)

Gastroenteritis

Definition
Signs and symptoms (11)
Type of infection (10)





H. pylori
Endoscopy and biopsy, breath test, serology
PPIs, antibiotics, bismuth salts

Non-specific term for various terms of GIT - diarrhoea, nausea, vomiting, abdominal pain

Viral - abdominal cramps, vomiting, profuse watery stools, myalgia, fever, headaches. Bacterial dysenetry - small volume stools, fever, tenesmus, blood mucoid stools, suprapubic pain

Invasive infection - organism enters mucosal cell, destroys them --> diarrhoea and bloody stools.
Enterotoxic syndrome - organism doesn't enter mucosa but products enterotoxins, which act as chemical mediators --> fluid hypersecretion. Little tissue damage occurs

15

Norovirus

Structure
Transmission
Signs and symptoms (3)
Management

Non-enveloped single stranded RNA virus

Faecal-oral transmission

Abrupt onset of vomiting and watery diarrhoea, fever, abdominal pain

Correct fluid/electrolyte balance

16

Salmonella

Types (3)
Transmission
Incubation period length
Signs and symptoms (5)
Diagnosis
Treatment (2)

Gastroenteritis, enteric fever (typhoid), bacteraemia

Faecal-oral transmission

8-48 hour incubation period

No symptoms, cramps, watery/bloody diarrhoea, fever, vomiting

Stool sample

IV hydration, antibiotics

17

C. diff

Structure
Signs and symptoms
Infection
Transmission
Sights and symptoms
Incubation period length

CDI signs and symptoms (5)
CDI risk factors (6)
Treatment (4)

Gram positive obligate spore-forming anaerobe

Diarrhoea

CDI from toxin-producing strains

Faecal-oral transmission

Asymptomatic carriers, mild/moderate diarrhoea, pseudomembranous colitis

2-3 days incubation period

Watery diarrhoea, loss of appetite, fever, nausea, abdominal pain/cramp

Exposure to antimicrobials/healthcare, toxogenic CDI, >64yrs old, underlying illness, immunosuppression, GI surgery

Oral rehydration, antibiotics, probiotics, colectomy