common GI pathologies Flashcards

Question

what is haemachromatosis?

Answer 1

an iron storage disorder excess total body iron and deposition of iron in tissues HFE gene on chromosome 6 autosomal recessive

Answer 2

Chronic tiredness Joint pain Pigmentation (bronze / slate-grey discolouration) Hair loss Erectile dysfunction Amenorrhoea Cognitive symptoms (memory and mood disturbance) *usually after age of 40 when overload becomes symptomatic *female- menstruation used to act as a regular elimination of iron frmo the body

Answer 3

- serum ferritin levels (acute phase reactant- increases in inflammation) - genetic testing - Liver biopsy with Perl's stain to establish iron conc in the parenchymal cells CT abdomen for increase attenuation of the liver MRI deposits of iron in liver and heart.

Answer 4

Type 1 Diabetes (iron affects the functioning of the pancreas) Liver Cirrhosis Iron deposits in the pituitary and gonads lead to endocrine and sexual problems (hypogonadism, impotence, amenorrhea, infertility) Cardiomyopathy (iron deposits in the heart) Hepatocellular Carcinoma Hypothyroidism (iron deposits in the thyroid) Chrondocalcinosis / pseudogout (calcium deposits in joints) causing arthritis

Answer 5

venesection (a weekly protocol of removing blood to decrease total iron) Monitoring serum ferritin Avoid alcohol Genetic counselling Monitoring and treatment of complications

Answer 6

excessive accumulation of copper in body and tissues caused by a mutation in 'wilson disease protein' chromosome 13. responsible for removal of excess copper in the liver autosomal recessive

Answer 7

Hepatic problems (40%) Neurological problems (50%) Psychiatric problems (10%) chronic hepatitis- cirrhosis CNS- neurological *dysarthria *dystonia *if in basal ganglia= Parkinsonism (Tremor, bradykinesia, rigidity) assymetrical in Wilsons CNS psychiatrical *depression *psychosis Kayser-Fleischer rings in cornea brownish circles surrounding the iris can be seen on naked eye visualised on slit lamp exam Haemolytic anaemia Renal tubular damage leading to renal tubular acidosis Osteopenia (loss of bone mineral density)

Answer 8

1. serum caeruloplasmin low =Wilsons (this is the protein which carries copper in the blood) can be falsely normal or elevated in cancer or inflammatory conditions 2. liver biopsy. gold standard. 3. 24 hour urine copper assay is sufficiently elevated 4. scoring system which takes into account features and lab tests: Low serum copper Kayser-Fleischer rings MRI brain shows nonspecific changes

Answer 9

copper chelation, using Penicillamine Trientene

Answer 10

ulceration of the mucosa of the stomach (gastric ulcer) or the duodenum - break down of protective layer of stomach/duodenum - increase in stomach acid protective layer of stomach = mucus and bicarbonate but this can be broken down by meds (NSAIDs, steroids) and H Pylori. increased acid: stress, alcohol, caffine, smoking, spicy foods

Answer 11

Epigastric discomfort or pain Nausea and vomiting Dyspepsia Bleeding causing haematemesis, “coffee ground” vomiting and melaena Iron deficiency anaemia (due to constant bleeding) gastric= worse with eating duodenal= better with eating (pain comes on 2-3 hrs later)

Answer 12

endoscopy rapid urease test CLO test for H Pylori biopsy during endoscopy considered if exclude malignancy PPI

Answer 13

Bleeding from the ulcer is a common and potentially life threatening complication. Perforation resulting in an “acute abdomen” and peritonitis. This requires urgent surgical repair (usually laparoscopic). Scarring and strictures of the muscle and mucosa. This can lead to a narrowing of the pylorus (the exit of the stomach) causing difficulty in emptying the stomach contents. This is known as pyloric stenosis. This presents with upper abdominal pain, distention, nausea and vomiting, particularly after eating.

Answer 14

No blood or mucus Entire GI tract Skip lesions- can be anywhere from mouth to anus Terminal Ileum / Transmural Inflammation Smoking is a risk factor weight loss, strictures, fistulas

Answer 15

Continuous Inflammation Limited to colon and rectum Only superficial mucosa affected Smoking is protective + Excrete blood and mcus Use aminosalicylates Primary sclerosing cholangitis COLitis= COLONS and CONTINUOUS

Answer 16

Diarrhoea Abdominal pain Passing blood Weight loss

Answer 17

Routine bloods for anaemia, infection, thyroid, kidney and liver function CRP indicates inflammation and active disease Faecal calprotectin (released by the intestines when inflamed) is a useful screening test (> 90% sensitive and specific to IBD in adults) Endoscopy (OGD and colonoscopy) with biopsy is diagnostic Imaging with ultrasound, CT and MRI can be used to look for complications such as fistulas, abscesses and strictures.

Answer 18

Inducing remission: 1st line: steroids (oral prednisolone / IV hydrocortisone) if does not work alone, consider adding: azathioprine mercaptopurine methotrexate infliximab adalimumab maintaining remission: azathioprine, mercaptopurine alternative: methotrexate infliximab adalimumab surgery if isease effects distal ileum treat strictures and fistulas

Answer 19

mild-moderate: 1st: aminosalicylate (masalazine oral /rectal) 2nd: corticosteroids (prednisolone) severe: 1st line: IV corticosterods (hydrocortisone) 2nd line: IV ciclosproin maintain remission aminosalicylate (mesalazine) azathioprine mercaptopurine surgery: typically UC only affects colon and rectum can remove coln and recutm (panproctocolectomy) leave a permanent ileostomy (ileo-anal anastomosis J pouch)

Answer 20

Diarrhoea Constipation Fluctuating bowel habit Abdominal pain Bloating Worse after eating Improved by opening bowels Abdominal pain / discomfort: Relieved on opening bowels, or Associated with a change in bowel habit AND 2 of: Abnormal stool passage Bloating Worse symptoms after eating PR mucus

Answer 21

Normal FBC, ESR and CRP blood tests Faecal calprotectin negative to exclude inflammatory bowel disease Negative coeliac disease serology (anti-TTG antibodies) Cancer is not suspected or excluded if suspected

Answer 22

General healthy diet and exercise advice: Adequate fluid intake Regular small meals Reduced processed foods Limit caffeine and alcohol Low “FODMAP” diet (ideally with dietician guidance) Trial of probiotic supplements for 4 weeks

Answer 23

1st line: loperamide (diarrhoea) laxatives (consiptation) *avoid lactulose as this can cause bloating *linclotide is a specialist laxative if not responding to 1st line antispasmodic (hyoscine butylbromide (buscopan) 2nd line: TCA's amitryptiline 3rd line: SSRI CBT

Answer 24

autoimmune condition, inflammation of the small bowel caused by auto antibodies in response to exposure to gluten targeting the epithelial cells of the intestine early childhood but can start at any age 2 antibodies: 1. anti tissue transglutaminase (anti TTG) 2. anti endomysial (anti EMA) *related to disease activity affects any part of the small bowel in paticular jejunum

Answer 25

atrophy of the intestinal villi (this usually absorbs nutrients from food which passes through the intestine) - asymptomatic - failure to thrive - Diarrhoea - Fatigue - Weight loss - Mouth ulcers - Anaemia secondary to iron, B12 or folate deficiency - Dermatitis herpetiformis (an itchy blistering skin rash typically on the abdomen) (rare) neurological symptoms Peripheral neuropathy Cerebellar ataxia Epilepsy

Answer 26

HLA-DQ2 gene (90%) HLA-DQ8 gene Tissue transglutaminase antibodies (anti-TTG) Endomysial antibodies (EMAs) Deaminated gliadin peptides antibodies (anti-DGPs) anti TTG and anti EMA are IgA. some pt have IgA deficiency so test total IgA as well*

Answer 27

carry investigations out whilst pt on a diet containing gluten (to detect antibodies/inflamamtion) 1. check total IgA 2. check coeliac disease specific antibodies (anti TTG antibodies, anti endomysial antibodies) 3. crypt hypertrophy, villous atrophy on endoscopy and intestinal biopsy.

Answer 28

association: Type 1 Diabetes Thyroid disease Autoimmune hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis complications Vitamin deficiency Anaemia Osteoporosis Ulcerative jejunitis Enteropathy-associated T-cell lymphoma (EATL) of the intestine Non-Hodgkin lymphoma (NHL) Small bowel adenocarcinoma (rare)

Answer 29

Lifelong gluten-free diet is essentially curative. Relapse will occur on consuming gluten again. Checking coeliac antibodies can be helpful in monitoring the disease.

Answer 30

Oesophageal varices Mallory-Weiss tear, which is a tear of the oesophageal mucous membrane Ulcers of the stomach or duodenum Cancers of the stomach or duodenum

Answer 31

Haematemesis (vomiting blood) “Coffee ground” vomit. This is caused by vomiting digested blood that looks like coffee grounds. Melaena, which is tar like, black, greasy and offensive stools caused by digested blood Haemodynamic instability occurs in large blood loss, causing a low blood pressure, tachycardia and other signs of shock. Bear in mind that young, fit patients may compensate well until they have lost a lot of blood. underlying pathology Epigastric pain and dyspepsia in peptic ulcers Jaundice for ascites in liver disease with oesophageal varices

Answer 32

establishes risk of having an upper GI bleed or not >0 indicated high risk Drop in Hb Rise in urea Blood pressure Heart rate Melaena Syncopy

Answer 33

used for patients that have had an endoscopy to calculate their risk of re- bleeding / overall mortality. online calculator Age Features of shock (e.g. tachycardia or hypotension) Co-morbidities Cause of bleeding (e.g. Mallory-Weiss tear or malignancy) Endoscopic stigmata of recent haemorrhage such as clots or visible bleeding vessels

Answer 34

A – ABCDE approach to immediate resuscitation B – Bloods A – Access (ideally 2 large bore cannula) T – Transfuse E – Endoscopy (arrange urgent endoscopy within 24 hours) D – Drugs (stop anticoagulants and NSAIDs) Send bloods for: Haemoglobin (FBC) Urea (U&Es) Coagulation (INR, FBC for platelets) Liver disease (LFTs) Crossmatch 2 units of blood

Answer 35

Transfuse blood, platelets and clotting factors (fresh frozen plasma) to patients with massive haemorrhage Transfusing more blood than necessary can be harmful Platelets should be given in active bleeding and thrombocytopenia (platelets < 50) Prothrombin complex concentrate can be given to patients taking warfarin that are actively bleeding

Answer 36

erlipressin Prophylactic broad spectrum antibiotics The definitive treatment is oesophagogastroduodenoscopy (OGD) to provide interventions that stop the bleeding, for example banding of varices or cauterisation of the bleeding vessel. NICE recommend against using a proton pump inhibitor prior to endoscopy, however you may find senior doctors that do this.

Answer 37

opportunistic, blood diarrhoea usually after amoxicillin 1st Metronidazole 2nd Vancomycin

Answer 38

pulsatile mass with pain radiating to the back Contrast enhanced CT gold standard for diagnosis

common GI pathologies Flashcards

(62 cards)