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Digestive Flashcards

1
Q

What are two key histological findings in Crohn disease?

A
  • Transmural inflammation (mucosa to serosa)

- Non-necrotising granuloma

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2
Q

Why might patients with Crohn disease present with anaemia and/or iron and B12 deficiency?

A
  • Anaemia due to bleeding from chronic inflammation

- Iron/B12 deficiency if small intestine is affected, less efficient absorption

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3
Q

Which part of the GI tract is affected by Crohn disease?

A

Entire tract can be affected, most commonly ileum + colon

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4
Q

What is the most commonly used anti-inflammatory for Crohn disease?

A

5-ASA

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5
Q

Which investigations are most commonly used for structural conditions of the oesophagus?

A

Gastroscopy and barium swallow

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6
Q

Which investigations are most commonly used for functional conditions of the oesophagus?

A

Manometry and pH study

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7
Q

How would a baby with an oesophageal fistula present?

A

Frequent vomiting following feeding

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8
Q

A patient presents with:

  • Heartburn
  • Regurgitation
  • Bitter taste in the mouth
  • Exacerbation when lying down

What GI pathology could this relate to?

A

GORD

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9
Q

What is Barrett’s Oesophagus?

A

Transition from stratified squamous to columnar, glandular epithelium in the oesophagus following chronic acid exposure

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10
Q

What are key symptoms of reflux oesophagitis?

A
  • Pain/discomfort in chest
  • Bleeding (haematmesis)
  • Dysphagia
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11
Q

Chronic GORD can lead to which conditions?

A
  • Reflux oesophagitis
  • Peptic stricutration
  • Oesophageal cancer (AdenoCa)
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12
Q

Anatomically, where are you most likely to find oesophageal SqCC?

A

High in the oesophagus

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13
Q

Which form of oesophageal cancer is associated with smoking, alcohol and poor diet?

A

SqCC

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14
Q

What is Zenker’s diverticulum?

A

A pouch that develops at the weakest portion of the pharynx due to excessive pressure

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15
Q

What are viral causes of oesophageal ulceration?

A

Herpes simplex, cytomegalovirus

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16
Q

What are pill induced causes of oesophageal ulceration?

A

Dioxycycilne and bisphosphonates

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17
Q

What is a characteristic macroscopic feature of eosinophilic oesophagitis?

A

Rings/circles/fissures in the oesophagus

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18
Q

What is achalasia?

A

Degeneration of the myenteric plexus and LOS inhibitory nerve

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19
Q

What causes the ‘bird beak’ appearance of an x-ray of a patient with achalasia?

A
  • Loss of peristalsis in distal oesophagus

- Failure of LOS to relax with swallow

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20
Q

How does scleoderma affect the oesophagus?

A
  • Absent peristalsis
  • LOS has no tone
  • Weak contraction
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21
Q

Why would manometry show high amplitude of contraction for nutracker oesophagus?

A

Normal peristalsis but amplitude of contraction is too strong

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22
Q

Why is vomiting of patients with congenital hypertrophic pyloric stenosis non-billous?

A

Stomach contents do not enter the duodenum due to thickening of pyloric wall

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23
Q

Which gastric tumour produces excess gastrin, causing destruction of gastric mucosa?

A

Gastrinoma

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24
Q

Which cell type is destroyed in pernicious anaemia?

A

Parietal cells

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25
What are the symptoms of peptic ulcer disease?
- Burning epigastric pain - Bleeding - Perforation - Obstruction
26
Which antibiotics comprise 'triple therapy' for peptic ulcer disease?
- Omeprazole - Clarithromycin - Amoxycillin
27
Which gastric cells secrete HCl?
Parietal cells
28
Why are cramping and diarrhoea symptoms of rapid gastric emptying?
Due to osmotic effect of large particles and fluid in the small intestine
29
What is the mechanism of H2 antagonists?
- Bind to H2 receptors on parietal cells for histamine | - Prevents parietal cell stimulation
30
What is the most commonly used H2 receptor antagonist?
Ranitidine
31
Why are H2 antagonists not effective for heartburn/oesophagitis?
Don't allow mucosal healing - acid still secreted
32
What is the mechanism of action of PPIs?
Irreversibly bind to an activated proton pump
33
What are consequences of prolonged acid inhibition (e.g. chronic use of PPIs)?
- Bacterial overgrowth - Lack of sterilisation - Impaired absorption - ECL hyperplasia
34
Increase in unconjugated bilirubin would be indicative of what kind of problem?
Vascular - bilirubin is not able to travel to the liver to become conjugated
35
What are symptoms of increase in conjugated bilirubin?
- Dark urine | - Obstructive jaundice
36
What causes steatorrhoea?
Loss of bile -> inability to break down fats
37
Which type of hepatitis is benign?
Hepatitis A
38
What is the incubation period of hepatitis A?
2-6 weeks
39
What are the causes of hepatitis A?
Poor sanitation and hygiene
40
What is the mechanism of hepatitis B?
Viral antigens expressed on hepatocytes -> immune response -> damage of liver cells
41
What is the current treatment for hepatitis C?
Direct acting antiviral agents (tablets)
42
What is the mechanism of alcoholic liver disease?
Repeat exposure to alcohol -> alterations in lipid metabolism -> decreased export of lipoproteins
43
What is haemochromatosis?
Abnormality in iron absorption -> excessive iron deposits on organs
44
What is Budd-Chiari syndrome?
Acute thrombosis of hepatic veins -> restriction of blood outflow from liver -> liver damage
45
A patient presents with: - Acute, rapidly progressive severe abdominal pain - Hepatomegaly - Ascites - Hepatic encephalopathy What could be a suspected diagnosis?
Budd-Chiari syndrome
46
How is Budd-Chiari syndrome treated?
- Portocaval shunting - Anticoagulants - Diuretics
47
Which enzyme is affected by Gilbert syndrome?
UDP glucuronyl transferase
48
Oesophageal varices, splenomegaly and intestinal congestion are indicative of which kind of portal blood flow restriction?
Prehepatic (impaired inflow)
49
Which liver enzymes are indicative of liver inflammation?
ALT and AST
50
Which liver enzymes are indicative of biliary/cholestatic pathology?
ALP and GGT
51
Which liver enzyme does alcohol induce?
GGT
52
Which is more liver specific, ALT or AST?
ALT
53
Where is albumin produced?
The liver
54
What is the prothrombin ratio?
Reflects the rate of clotting factor synthesis | Liver failure or vitamin K deficiency
55
How is excessive ammonia causing encephalopathy treated?
Lactulose
56
How does lactulose treat hepatic encephalopathy?
- Converts ammonia into a non-soluble molecule - Inhibits ammonia synthesis by bacteria - Increases bowel transit
57
What does CEA test for?
A cancer marker
58
Why might albumin levels be normal in an acute hepatic pathology?
Half life is 3 weeks (not enough time for levels to drop)
59
What is choledocholithiasis?
Gall stone blockage in the biliary tree
60
What would be the expected findings of a blood test for a patient with acute cholecystitis?
- Neutrophil leucocytosis | - Raised bilirubin, ALP, GGT
61
Why might a patient with prolonged biliary obstruction be vitamin K deficient?
Fat soluble vitamin - loss of bile means fat absorption is impaired
62
What controls enzyme release from the pancreas?
CCK
63
What are the most common causes of acute pancreatitis?
Alcohol consumption and gall stones
64
Why would oedema be seen on a CT in an individual with acute pancreatitis?
Accumulation of fluid -> active enzymes cause fat necrosis -> oedema and local inflammation
65
Which enzymes are expected to be elevated in acute pancreatitis?
Serum amylase and lipase
66
How do you treat chronic pancreatitis?
Oral administration of pancreatic enzymes
67
What are the symptoms of pancreatic adenocarcinoma?
- Obstructive jaundice - Pain - Weight loss - Pancreatitis - Thrombophlebitis
68
What is thrombophlebitis?
Blood clotting in a vein causing inflammation and pain
69
Why might IBS occur after an episode of gastroenteritis?
- Disruption of normal gut flora | - Upregulation of nociceptors
70
A patient presents with - Swinging bowel habit - Abdominal pain relieved by defecation - Feelings of incomplete evacuation - Abdominal bloating What could these symptoms be associated with?
Irritable Bowel Syndrome (IBS)
71
IBS symptoms should have been present for at least ___ months prior to diagnosis
6
72
What is loperamide?
An anti-motility drug for bowel frequency
73
What is used for pain management in IBS?
Low dose tricyclics - Amitriptyline - Nortriptyline
74
The genetic mutation in Coeliac disease is HLA ___ and ____
DQ2 and DQ8
75
In coeliac disease antibodies are created against ____
Gliadin
76
Which histological changes occur in coeliac disease?
- Villous atrophy - Hypertrophy of crypts - Intraepithelial lymphocytes
77
What is dermatitis herpetiformis?
Skin manifestation of coeliac disease
78
Why may individuals with coeliac be iron and/or folate deficient?
Due to lack of absorption in the duodenum
79
What is the recommended antibody test for coeliac disease?
Anti-TTG
80
Why can small intestinal bacterial overgrowth cause maldigestion?
Bacteria deconjugate bile acids so fats cannot be digested
81
What distinguishes ulcerative colitis from Crohn disease?
Affects mucosa and submucosa of large intestine only
82
What pattern of inflammation is followed in ulcerative colitis?
Circumferential and continuous
83
Ulcerative colitis/Crohn disease shows small ulcers on the gut mucosa (cobblestone appearance)
Crohn disease

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