Diseases Flashcards
(431 cards)
1
Q
A
2
Q
What are the signs of spontaneous bacterial peritonitis?
A
Renal impairment
Signs of sepsis
Tachycardia
Temperature
3
Q
What is spontaneous bacterial peritonitis?
A
infection of ascitic fluid
4
Q
What investigations are done for spontaneous bacterial peritonitis?
A
Ascitic tap
5
Q
What is the neutrophil count in spontaneous bacterial peritonitis?
A
>0.25x109/L
6
Q
What sex metabolises alcohol slower?
A
Women
7
Q
What are the risk factors for fatty liver disease?
A
Obesity
Diabetes
Hypercholesterolaemia
Alcohol
8
Q
What are the symptoms of Non alcoholic steatohepatitis (NASH)?
A
Asymptomatic
9
Q
What is the treatment for NASH?
A
Weight loss
Exercise
10
Q
What is the protein count is spontaneous bacterial peritonitis?
A
<25g/l
11
Q
What are the treatment options for spontaneous bacterial peritonitis?
A
IV antibiotics
Ascitic fluid drainage
IV albumin infusions
12
Q
What is seen on blood tests for NASH?
A
Raised alanine amino transferase
13
Q
What are the signs of alcoholic hepatitis?
A
Jaundice
Encephalopathy
Decompensated hepatic function
14
Q
What is common in alcoholic hepatitis?
A
Infection
15
Q
What is steatohepatitis?
A
fatty liver with inflammation
16
Q
What is steatosis?
A
fatty liver
17
Q
What is seen on the blood test for alcoholic hepatitis?
A
Raised bilirubin
Raised GGT and AlkP
18
Q
What are the causes of hepatic encephalopathy?
A
Infection
Drugs
Constipation
GI bleed
Electrolyte disturbances
19
Q
What are the supportive treatments for hepatic encephalopathy?
A
ITU
Airway support
Nasogastric tube
20
Q
What is the mortality of alcoholic hepatitis?
A
40%
21
Q
What are the medical treatments for hepatic encephalopathy?
A
Bowel clear out
Lactulose
Enemas
Antibiotics
22
Q
What is seen in lab tests due in alcoholic liver disease?
A
AAT/ALT ratio >2
Raised Gamma GT
Macrocytosis
Low platelets
23
Q
What is hepatic encephalopathy?
A
impaired brain function associated with hepatic insufficiency
24
Q
What are the treatment options for alcoholic hepatitis?
A
Treat infection
Treat encephalopathy
Treat alcohol withdrawal
Protect against GI bleed
25
When would you give steroids for alcoholic hepatitis?
If grading severe
Glasgow alcoholic hepatitis score \>9
26
Why would steroids only be given in severe alcoholic hepatitis?
Due to increased risk of GI bleed and infection
27
What percentage of those with alcoholic hepatitis are malnourished?
100%
28
What are the symptoms of spontaneous bacterial peritonitis?
Abdominal pain
Fevers
Rigours
29
What vitamin are those with alcoholic hepatitis deficient in?
Thiamine
30
What are the nutritional requirements of those with alcoholic hepatitis?
Frequent feeds
High energy requirement
31
What is bilirubin general by?
Senescent RBC's in spleen
32
What are unconjugated bilirubin bound to?
Albumin
33
What are the signs of post-hepatic jaundice?
Palpable gall bladder
34
What is bilirubin?
Byproduct of haeme metabolism
35
What are the causes of hepatic jaundice?
Defective uptake of bilirubin
Defective conjugation
Defective excretion
36
What is alkaline phosphatase?
Enzyme present in bile duct
37
What is the most important investigation for jaundice?
Ultrasound of abdomen
38
What can liver screen determine?
Hep B and C serology
Autoantibody profile
Ferritin
39
What solubisises bilirubin to conjugate it?
Liver
40
What are the causes of post-hepatic jaundice?
Defective transport of bilirubin by the biliary ducts
41
Where is alkaline phosphatase found?
Bone
Placenta
Intestines
Liver
42
When is alkaline phosphatase elevated?
With obstruction of liver infiltration
43
Which CP can only image ducts?
ERCP
44
What is Gamma GT?
Non specific liver enzyme
45
What are the detoxification functions of the liver?
Urea production from ammonia
Detoxification of drugs
Bilirubin metabolism
Breakdown of insulin and hormones
46
When is Gamma GT elevated?
With alcohol use
47
What drugs can raise levels of Gamma GT?
NSAIDS
48
What are the post hepatic causes of bilirubin elevation?
Obstructive
49
What are the signs of pre-hepatic jaundice?
Pallor
Splenomegaly
50
What are the pre hepatic causes of bilirubin elevation ?
Haemolysis
51
What does low levels of albumin suggest?
Chronic liver disease
52
What are the functions of the carbohydrates in the liver?
Gluconeogenesis
Glycogenolysis
Glycogenesis
53
What are the hepatic causes of bilirubin elevation?
Parenchymal damage
54
What are aminotransferases?
Enzymes present in hepatocytes?
55
What does the prothrombin time tell?
Degree of liver dysfunction
56
What are the hormones of the liver?
Angiotensinogen
57
Name the aminotransferases?
ALT
AST
58
What CP does not use radiation?
MRCP
59
What aminotransferase is more specific?
ALT
60
What is the prothrombin time used to calculate?
Stage of liver disease
61
What can therapeutic ERPC be used for?
Acute gallstone pancreatitis
Stenting of biliary tract obstructuin
Post-op biliary complications
62
What does creatinine determine?
Survival from liver disease
63
What does the AST/ ALT radio suggest?
Parenchymal involvement
64
What are the procedure related complications of ERCP?
Pancreatitis
Cholangitis
Sphincterotomy
65
What are the uses of PTC?
ERCP not possible due to duodenal obstruction
Hilar stenting
66
What are the functions of the lipids in the liver?
Cholesterol synthesis
Lipoprotein
TG synthesis
67
What results in low platelet count?
Cirrhosis
68
what are the functions of the proteins in the liver?
Albumin synthesis
69
What are the symptoms of liver failure?
Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy
70
What are the disadvantages of PTC?
More invasive
71
What are the immune functions of the liver?
Combating infections
Clearing the blood of particles and infections, including bacteria
Neutralising and destroying all drugs and toxins
72
When is jaundice detectable?
When total plasma bilirubin \>34umol/l
73
What does the liver store?
Glycogen
Vitamins
Copper
Iron
74
What is an endoscopic ultrasound used for?
Characterising pancreatic masses
Staging of tumours
75
What is the differential diagnosis for jaundice?
Carotenemia
76
What are the signs of hepatic jaundice?
Stigmata of CLD
Ascites (fluid in abdo)
Asterixis (flap)
77
What vitamins does the liver store?
A, D, E, K, B12
78
What are the causes of pre-hepatic jaundice?
Increased quality of bilirubin
Impaired transport
79
What can choledocholithiasis lead to?
Acute pancreatitis
Ascending cholangitis
80
What are the blood tests done to investigate gallstone?
LFT's
Amylase
Lipase
WCC
81
What are the palliative options cholangiocarcinoma?
Surgical bypass
Stenting
Palliative radiotherapy
Chemotherapy
PDT
82
What are the imaging investigations done for gallstones?
CT scan
USS
EUS
HIDA
83
What is the gold standard of operative treatments of gallstones?
Laparoscopic cholecystectomy +/- OTC
84
What are the functions of the gallbladder?
Bile reservoir
Concentrates bile
Secrete CCK after meal
85
What are the treatments of CBD stones?
Lap/ open exploration
ERCP
Transhparic stone retrieval
86
Name congenital benign biliary tract diseases?
Biliary atresia
Cholecdochal cysts
87
Name benign biliary structure biliary tract disease?
Iatrogenic
Gallstones related
Inflammatory
88
What are the imaging investigations done for cholangiocarcinoma?
USS
EUS
CT
MRA
MRCP
89
What is cholangiocarcinoma?
bile duct cancer
90
How common is gallbladder cancer?
Rare
2-5% of GI cancers
91
What are the non operative treatment of gallstones?
Dissolution
Lithotripsy
92
Where is most cholangiocarcinoma found?
Extrahepatic hilar
93
Describe the prognosis of gallbladder cancer?
Poor except if detected early
94
What are does cholangiocarcinoma peak?
80 years
95
What are the treamtent options for ampullary tumours?
Endoscopic excision
Trans-duodenal excision
Pancreatico-duodenectomy
96
What are the risk factors for cholangiocarcinoma?
PSC
Congenital cystic disease
Biliary enteric drainage
Thorotrast
97
What is the treamtent for intrahepatic cholangicarcinoma?
Surgery
98
What is the composition of gallstones?
Cholesterol
Pigment
99
Name the types of intrahepatic cholangiocarcinomas?
Mass forming
Peri-ductal
Intra-ductal
100
What are the symptoms of cholangiocarcinoma?
Obstructive jaundice
Itching
101
What are the risk factors for gallstones?
Age
Gender
Parity
Cholesterol
Pigment
102
What are the symptoms of gallstones?
Dyspeptic symtpoms
Jaundice
Perforation
Empyema
103
What is choledocholithiasis?
gallstones in the common bile duct
104
What are the symptoms of obstructive jaundice due to choledocho-litiasis?
Pain
Jaundice
Dark urine
Pale stool
Pruritus
Steatorrhoea
105
What is IBD-U?
Unclassified
Symptoms of both Crohn's and UC
106
What do genes that cause IBD affect?
Epithelial barrier
Immune responses
Bacterial handling
107
What causes genetic susceptibility to IBD?
Single nucleotide polymorphism
108
What is the change of an offspring developing IBD if the parent has it?
10% chance
109
Give examples of genes that can cause IBD?
NOD2
XBP1
110
What are the symptoms of UC?
Bloody diarrhoea
Abdominal pain
Weight loss
Fatigue
111
What is present in microbial communities in IBD?
Dysbiosis
112
Where does continuous inflammation in UC occur?
Only colon
113
Define inflammatory bowel disease
Chronic relapsing, remitting inflammation of GI tract
114
What percentage of patients will be a colectomy within ten years of diagnosis of UC?
20-30%
115
What is proctitis?
inflammation of the rectum
116
What age does IBD commonly present?
Teens and twenties
117
What are the symptoms of proctitis?
Increased Frequency
Increased urgency
Incontinence
Tenesmus
118
What is the treatment for proctitis?
Topical therapy
119
What is found in the stool in proctitis?
Small volume mucus and blood
120
How many people in the UK have IBD?
620,000
121
What is the risk of emergency colectomy in acute severe colitis?
20-30%
122
name the types of inflammatory bowel disease
Chohn's
Ulcerative colitis
123
When is UC classed as mild?
\<4 stools a day +/- blood
No signs of toxicity
124
When is UC classed as moderate?
4-6 stools a day
Occasional blood
CRP \> 30mg/l
125
What would bloods show in UC?
126
What are treatments options for Hepatitis B?
Pegylated interferon
Oral antiviral drugs
127
What antibodies is present in primary biliary cholagnits?
Anti-mitochondrial antibody
128
What are the organ therapies available for hepatitis B?
Lamivudine
Adefovir
Tenofovir
Entercavir
Teldivudine
129
What sex does primary sclerosing cholangitis affect more?
Men
130
What are the biochemical tests done for diagnosis fo NAFLD?
AST/ ALT radio
131
What are the imaging tests done for the diagnosis of NAFLD?
MR
CT
Ultrasound
132
What are the pharmacological treatments of NAFLD?
Insulin sensitisers
GLP-1
Farnesoid X nuclear receptors ligand
Vit E
133
Give examples of contraindications for liver transplant?
Active substance of alcohol abuse
Malignancy
Anatomical barriers
134
When would you list for transplant in acetaminophen-induced ALF?
Arterial ph \<7.3
Arterial lactate \>3
135
What hepatitis viruses are enteric?
A and E
136
What percentage of those with Hep C present with jaundice?
10%
137
When would you list for transplant in non acetaminophen induced ALF?
INR \> 6.5 and encephalopathy present
138
What scores are used in order to determine cirrhosis prioritisation for transplant?
Child's Pugh scoring A, B and C
MELD
UKELD
139
What is the treatment for Hep C?
Direct acting antivirals (DAA)
140
What are the anti-rejection drugs given following a liver transplant?
Steroids
Azathioprine
Tacrolimus/ cyclosporine
141
What hepatitis viruses are parenteral?
B, C and D
142
What does HBcAg indicate?
Active replication
Not detected in blood
143
What is the transmission of hepatitis A?
fecal-oral
Sexual
Blood
144
What are the difficulties in treating hepatitis D?
Very resistant to treatment
145
Name the drugs used to treat hepatitis C?
Ledipasvir
ABT-267
146
What is the most common cause of acute hepatitis in NHS Grampian?
Hepatitis E
147
what age is hepatitis A most common?
5-14
148
What is the treatments for primary sclerosing cholangitis?
Liver transplant
Biliary stents
149
where is Hepatitis E mostly found?
Tropical countries
150
What does Anti-HBs (hep B surface antibody) indicate?
Recovery from infection or immunization
151
What conditions would a liver transplant be considered?
Acute liver failure
Hepatocellular carcinoma
Chronic liver disease
Genetic diseases
152
What is acute hepatitis A diagnosed by?
IgM antibodies
153
What are the surgical treatments for NAFLD?
Weight reduction surgery
154
What is hepatitis F?
Variant of hepatitis B
155
What immunoglobulin in increased in autoimmune hepatitis?
IgG
156
who do we immunize for hep A?
Travellers
Patients with chronis liver disease
Haemophiliacs
Occupational exposure
Men who have sex with men
157
What type of virus is hepatitis D?
Small RNA virus
158
What does the NAFLD term encompass?
Simple steatosis
Non-alcoholic steatohepatitis
Fibrosis and cirrhosis
159
What sex is autoimmune hepatitis most predominant in?
Females
160
What does IgM anti-HBc indicate?
acute infection
161
What antibodies are present in autoimmune hepatitis?
ANA
SMA
LKM1
SLA
162
What does IgG anti-HBc indicate?
Chronic infection/ exposure
163
What is found in the inner protein core of Hepatitis B?
HBV DNA
DNA polymerase
164
What investigation is used to diagnose autoimmune hepatitis?
Liver biopsy
165
What is the treatment for autoimmune hepatitis?
Azathioprine
166
What immunoglobin is elevated in primary biliary cholangitis?
IgM
167
What does Anti-HBe indicate?
Inactive virus
168
What is the inner core of hepatitis B made of?
HBeAg
169
What duct is involved in primary biliary cholangitis?
Intrahepatic bile duct
170
What does HBsAg indicate?
Active HBV infection
171
What are the symptoms of primary biliary cholangitis?
Pruritus
Fatigue
172
What does HBeAg indicate?
Active replication
173
What antibodies is found in primary sclerosing cholangitis?
PANCA
174
What is the test of choice to diagnose primary sclerosing cholangitis?
MRCP
175
What genes give an increased risk of NAFLD?
PNPLA3
176
What type of condition is hereditary pancreatitis?
Autosomal dominant
177
What are the clinical features of chronic pancreatitis?
Abdominal pain
Exocrine insufficiency
Endocrine insufficiency
178
What are the investigations done to diagnose chronic pancreatitis?
CT
MRI
EUS
179
What are medical managements for chronic pancreatitis?
Non opioid analgesics
Antiodixens
180
What are the imaging investigations done for pancreatic cysts?
CT
MRI
EUS
181
Define chronic pancreatitis
Continuing inflammatory disease characterised by irreversible glandular destruction and typically causing pain or loss of function
182
What are the non pharmacological treatments of chronic pancreatitis?
Well balanced diet
Cessation of alcohol and tobacco
183
What are the high risk factors of pancreatic cysts?
Jaundice
\>10mm
184
What does EUS determine in pancreatic cysts?
Mucinous vs non- mucinous
Benign vs malignant
185
What is the incidence of chronic pancreatitis?
5-8 cases per 100,000
186
What are the causes of chronic pancreatitis?
Alcohol
CF
Congenital anatomical abnormalities
Hypercalcaemia
187
What are the DNA bio markers foe pancreatic cysts?
GNAS
KRAS
188
What amylase level would be found in a lab test for pancreatic cysts?
\<250
189
What are the symptoms of carcinoma of the pancreas?
Upper abdominal pain
Jaundice
Weight loss
Anorexia
190
What happens to the fat nodules in carcinoma in the pancreas?
Tender subcutaneous fat nodules due to metastatic
191
Give examples of congenital anatomical abnormalities that may cause chronic pancreatitis
Annular pancreas
Pancreas divisum
192
Where would the cancer of the pancreas most likely be if a patient presented with abdominal pain?
Body and tail
193
What are the signs of carcinoma of the pancreas?
Thrombophlebitis migrants
Ascites
Portal hypertension
194
What is used for block is EUS Guided coeliac plexus block and neurolysis?
0.25% Bupivacaine
Triamcinolone
195
What is used for neurolysis in EUS Guided coeliac plexus block and neurolysis?
0.25% Bupivacaine
Absolute alcohol
196
What are the BD-IPMN indications for surgery of mucinous cystic neoplasia of the pancreas in the elderly?
\>3cm without high risk stigmata
197
What are the BD-IPMN indications for surgery of mucinous cystic neoplasia of the pancreas in younger patients?
\>2cm
198
What are the symptoms of head of pancreas cancer?
Obstructive jaundice
Diabetes
Abdominal pain
Anorexia
Weight loss
199
Name the methods of reception of mucinous cystic neoplasia of the pancreas
Pancreatectomy
Focal
Laparoscopic
Robotic
Total
200
What are the tumour bio markers for head of pancreas cancer?
CA19-9
201
When is CT scanning useful in acute pancreatitis?
In severe disease
To acccess for complications
202
What are the general investigations done for head of pancreas cancer?
Blood tests
CXR
203
When is CT scanning done for acute pancreatitis?
Days 4-10 to identify necrosis
204
What is the nutritional management of those with acute pancreatitis?
Nasogastric feeding
205
what are the imaging investigations done for head of pancreas cancer?
USS
CT
MRCP
206
How can acute pancreatitis be prevented in future?
Management of gallstones
Investigations of non gallstone pancreatitis
Alcohol abstinence
207
Name the types of surgery's used for head of pancreas cancer?
Kausch- Whipple's
PPPD
208
What is the management of infected necrosis in acute pancreatitis?
Laporotomy
209
What is the treatment for obstructive jaundice in palliative head of pancreas cancer?
Palliative bypass
ERCP
PTC stent
210
What is the treatment for duodenal obstructive in the palliative head of pancreas cancer?
Palliative bypass
Duodenal stent
211
What are the late complications of acute pancreatitis?
Haemorrhage
Portal hypertension
212
What are the causes of chronic pancreatitis?
Obstruction
Autoimmune
Toxin
Idiopathic
Genetic
Environmental
Recurrent injuries
213
What dominates genes if present give an increased risk of Ch pancreatitis?
Condon 29 and 122
214
What recessive genes if present give and increased risk of Ch pancreatitis?
CFTR
SPINK1
Codon 1
215
Define acute pancreatitis
Acute inflammatory process of the pancreas
216
What are the complications of surgery for chronic pancreatitis?
Pancreatic duct stenosis
Cyst
Biliary track obstructive
Splenic vein thrombosis
217
What age is head of pancreas cancer most common?
60-80 years
218
What are the intervential produces done for chronic pancreatitis?
Endoscopic PD sphincetotomy dilation and lithotripsy
Coeliac plexus block
219
What is severe acute pancreatitis associated with?
Organ failure
Local complication
220
What are the local complications of acute pancreatitis?
Acute fluid collections
Pseudo cyst
Pancreatic abscess
Pancreatic necrosis
221
What are the main causes of acute pancreatitis?
Gallstones
Alcohol
222
How does alcohol cause acute pancreatitis?
Direct injury
Increased sensitivity to simulation
Oxidation pro cuts
Non oxidative metabolism
223
How does gallstones cause acute pancreatitis?
Raises pancreatic ductal pressure
224
What are the symptoms of acute pancreatitis?
Abdominal pain
Nausea
Vomiting
Collapse
225
What are the risk factors for head of pancreas cancer?
Smoking
Chronic pancreatitis
Diabetes
Hereditary pancreatitis
226
What are the types of resection surgery for chronic pancreatitis?
DPPHR
PPPD
Whipples pancreatic-duodenectomy
227
What are the signs of acute pancreatitis?
Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure
228
What is the initial management for acute pancreatitis?
Analgesia
IV fluids
229
Periampullary cancer is a feature of which genetic marker?
FAP
230
What are the MD-IPMN high risk stigmata features of mucinous cystic neoplasia of the pancreas?
MPD \>10mm
Enchanted solid component
231
What are the MCN high risk stigmata features of mucinous cystic neoplasia of the pancreas?
\>1cm with enchhanced solid component
MPD \>1C,
232
What are the imaging investigations done for acute pancreatitis?
CXR
USS
CT
233
What markers indicate severe acute pancreatitis?
CRP \> 200
IL 6
TAP
234
What faecal calprotectin is classed as normal?
0-50ug/g
235
What faecal calprotectin is classed as elevated?
\>200
236
What are the investigations done for UC?
Bloods
Stool culture
Faecal calprotectin
Colonoscopy
237
What is faecal calprotectin?
Marker for inflammation in GI tract
238
What drugs are given in acute severe colitis?
Low weight molecule heparin
IV glucocorticoids
IV hydration
239
What investigations of done for acute severe colitis?
Blood tests
Stool chart
4 stool cultures for C. Diff
240
What imaging investigation is done for acute severe colitis?
Abdo XR
241
What can precipitate toxic mega colon?
Low potassium or magnesium
242
What are the symptoms of Crohn's disease?
Diarrhoea
Abdominal pain
Weight loss
Malabsorption
243
What may malabsorption due to Crohn's disease lead to?
Anaemia
Vitamin deficiency
244
What are the investigations done for Crohn's disease?
Bloods
Stool culture
Faecal calprotectin
Colonoscopy
MRI small bowel study
Capsule endoscopy
245
What are the complications of Crohn's disease due to?
Transmural inflammation
246
Which type of IBD shows granulomas in its histology
Crohn's disease
247
What cells are depleted in UC?
Goblet cells
248
Which IBD has more crypt abscesses?
UC
249
What are the symptoms of perianal Crohn's disease?
Perianal pain
Pus secretion
Unable to sit down
250
what are the investigations done for perianal Crohn's disease?
MRI pelvis
Examination under anaesthetic
251
What are the medical treatment(s) of perianal Crohn's disease?
Antibiotics and biblical therapy
Surgery
252
v
What are some extra-intestinal manifestations of IBD?
Mouth ulcers
Skin rashes
Eye problems
Musculoskeletal problems
Primary sclerosing cholangitis
253
What are other causes of chronic diarrhoea?
Malabsorption
IBS
Overflow diarrhoea
254
What are the long term complications of colitis?
Colonic carcinoma
255
Give examples of aminosalicylates (5-ASAs)
Mesalazine
Ethylcelluluse microgranules
256
How does 5-ASAs work?
Blocking prostaglandin and Leukotrienes
Release mechanisms lead to colonic delivery
257
How much 5ASAs are given for induction of remission?
\>3g orally per day
258
What is 1st line therapy for UC?
5ASA
259
What IBD is 5ASA effective in?
UC
260
Why are steroids not long term use for IBD?
Adverse side effects
261
Give examples of steroids to induce remission in IBD?
Prednisolone
Budesonide
262
What is the optimal dose of prednisolone to give for IBD?
40mg a day
263
What immunomodulators are used in IBD?
Azathioprine
264
What are the side effects of Azathioprine?
Leukopenia
Hepatotoxic
Pancreatitis
265
What is methotrexate used for?
Crohn's
266
What are the risks of methotrexate?
10-18% intolerant
Teratogenic
267
What patients are methotrexate used for?
Steroid dependant patients
268
Give examples of Anti TNF antibodies used for IBD?
Infliximab - 8 weekly IV
Adalimumab - 2 weekly injection
269
Give examples of 4b7 integrins blockers used for IBD?
Vedolizumab
8 weekly IV infusions
270
What is tofacitinib an inhibitor of?
Pan JAK
271
Describe use of elemental feeding in IBD?
Can be as effective as steroids
More efficacious in children
272
When would you operate in an emergency for IBD?
Acute severe colitis not responding to therapy
Complications such as perforation, obstruction and abscess
273
When would you electively operate for IBD?
Frequent relapses despite medical therapy
Not able to tolerate medical therapy
Steroid dependant
Patient choice
274
What are the options of subtotal colectomy?
Pouch procedure
Completion proctectomy
275
How does pouch surgery work?
Mobilise and lengthen small bowel
Construct pouch
Insert stapler
276
What are the surgical indications for Crohn's disease?
Failure of medical management
Management of fistula
Failure to thrive
Relief of obstructive symptoms
277
What is the prognosis of functional GI disorders?
Long term prognosis good
278
What is the difference between structural and functional GI disorders?
Structural has detectable pathology
Functional does not
279
Where can functional GI disorders affect?
Whole of GI tract
280
How are most functional GI disorders diagnosed?
From history and examination
281
What is non-ulcer dyspepsia?
Typical ulcer pain without presence of ulcer
282
What bacteria is needed to be checked in non-ulcer dyspepsia?
H pylori
283
What is the treatment for non-ulcer dyspepsia if there is no H.pylori present?
Treat symptomatically
284
What is important to ask in the history of a patient presenting with vomiting?
Length of time after food
285
What is vomiting and 1 or more after food suggestive of?
Pyloric obstruction
Motility disorders
286
f
What is vomiting immediately after food suggestive of?
Psychogenic
287
What is vomiting 12 hours after food suggestive of?
Obstruction
288
What are the causes of vomiting?
Drugs
Pregnancy
Migraine
Cyclical vomiting syndrome
Alcohol
289
When is the onset for cyclical vomiting syndrome?
Childhood
290
What are the alarm symptoms for functional GI disorders?
Age \>50
Short symptom history
Unintentional weight loss
Nocturnal systems
Family history
291
What are the investigations done for functional GI disorders?
FBS
Blood glucose
U+ E
Thyroid status
Coeliac serology
FIT
Sigmoidoscopy
292
What are the organic causes of constipation?
Strictures
Tumours
Diverticula disease
Proctitis
Anal fissue
293
What are the functional causes of constipation?
Mega colon
Idiopathic constipation
Depression
Psychosis
294
What are the systemic causes of constipation?
Diabetes
Hypothyroidism
Hypercalcaemia
295
What are the neurogenic causes of constipation?
Autonomic neuropathies
Parkinson's disease
Strokes
MS
Spina bifida
296
What are the clinical features of IBS?
Abdominal pain
Altered bowel habit
Abdominal bloating
297
What is the ROME III diagnostic criteria of IBS?
Recurrent abdominal pain for \>3 days/ months in the past 3 months associated with two or more of
Improvement with dedication
Onset asssocited with changes in stool frequency
Onset associated with change in stool form
298
Where does abdominal pain occasionally radiate to in IBS?
Lower back
299
What is the feature present in IBS-C?
Constipation
300
What is the feature present in IBS-D?
Diarrhoea
301
What is IBS-M?
mix of diarrhea/constipation
302
What is bloating in IBS due to?
Relaxation in abdominal wall muscles
303
What is seen in the stool in IBS?
Mucus
304
What are the investigations done for IBS?
Blood
Stool culture
Calprotectin
FIT testing
305
What is calprotectin released by?
Inflamed gut mucosa
306
What is calprotectin used for?
Differentiating IBS and IBD
307
What makes diarrhoea worse?
Tea
Coffee
Alcohol
Sweetener
308
What are the treatment for IBS?
Dietetic review
Lactose, gluten exclusion trial
FODMAP
309
What are the drugs used to relieve of diarrhoea in IBS?
Antimotlity agents
310
What are the drugs used to relieve pain in IBS?
Antispasmodics
Linacloide
311
What are the drugs used to relieve bloating in IBS?
Probiotics
Linaclotide
312
What are the drugs used to relieve constipation in IBS?
Laxatives
Linaclotide
313
What are the psychological interventions used for IBS?
Relaxation training
Hypnotherapy
CBT
314
What may cause IBS?
Altered motility
Visceral hypersensitivity
Stress
315
How may intestinal motility cause IBS?
In IBS-D muscular contractions may be stronger and more frequent
316
How may gut responses to triggers be altered in IBS?
May be stronger in IBS-D or weaker in IBS-C
317
What are the majority of colorectal cancers histologically?
Adenocarcinomas
318
What are most colorectal cancers caused by?
Sporadic
319
What genes are risk factors for development of colorectal cancer?
HNPCC
FAP
320
What are the risk factors for colorectal cancer?
Age
Male
Previous adenoma
Environmental
321
What are the environmental influences on colorectal cancer?
Diet
Obesity
Lack of exercise
Smoking
Diabetes
322
What are colorectal polyps?
Protuberant growth
323
What do the majority of colorectal cancers arise from
Pre-existing polyps
324
What do adenoma polyps look like morphologically
Peduunculated or sessile
325
What are high-risk features of polyps?
Size
Number
Degree of dysplasia
Villous architecture
326
What oncogenes promote cell growth?
K-ras
C-myc
327
What causes cell growth leading to colorectal cancer?
Activation of oncogenes
Loss of tumour suppressor gene
Defective DNA repair pathway genes
328
Give examples of tumour suppressor genes that may be lost giving rise to colorectal cancer?
APC
P53
DCC
329
What are the symptoms of colorectal cancer?
Rectal bleeding
Altered bowel opening to loose stools \>4 weeks
Iron deficiency anemia
330
What is a sign that the colorectal cancer tumour is stenosing?
Acute colonic obstruction
331
What are the systemic symptoms of malignancy?
Weight loss
Anorexia
332
What is the investigation of chose for colorectal cancer?
Colonoscopy
333
What are the disadvantages of colonoscopy?
Sedation
Bowel preparation
334
What are the risks of colonoscopy?
Perforation
Bleeding
335
What is the radiological imaging investigation of choice for colorectal cancer?
CT colonoscopy
336
What are the staging investigations done for colorectal cancer?
CT scan
MRI
PET
337
What percentage of patients with colorectal cancer will have surgery?
80%
338
When would endoscopic or local resection be offered to treat colorectal cancer?
Dukes A and cancer polyps
339
What is formed during colorectal cancer surgery?
Stoma formation
340
What is removed during colorectal cancer surgery?
Lymph nodes
Liver for metastasis
341
When would chemotherapy be given in colorectal cancer?
Dukes C
Adjuvant
342
What is the reason chemotherapy is given after colorectal cancer surgery?
Mops up micrometastases
343
When would radiotherapy be given for colorectal cancer?
Neoadjuant
Rectal cancer only
344
What test is now done for screening colorectal cancer?
FIT test
345
What are the benefits of FIT screening over the Scottish bowel screening program?
Provides flexibility to alter the cut off to accomate risk factors inducing age and gender
346
What high risk groups are screened for colorectal cancer?
Heritable groups
IBD
Familial risk
Previous adenoma/ colorectal cancer
347
What age is invited to bowel screening?
50-74 years
348
What type of condition if FAP?
Autosomal dominant
349
What is FAP due to?
Mutations of the APC gene on chromosome 5
350
What is given to those with the FAP gene to reduce their risk of getting colorectal cancer?
Annual colonoscopy from age 10-12
Prophylactic proctocolectomy age 16-35 years
351
What type of condition is MAP?
Autosomal recessive
352
what is MAP caused by
Pathogenic variants in the MUTYH base excision repair gene
353
What side is CRC most likely to be on if due to MAP?
Right
354
What is done for those who have MAP gene to reduce their risk of CRC?
Upper GI surveillance starting age 35
Annular colorectal surveillance from 18-20 years
355
What is HNPCC due to?
Mutation in DNA mismatch repair genes
356
What type of condition is HNPCC?
Autosomal dominant
357
What do tumours caused by HNPCC typically have?
Microsatellite instability
358
What age do people with HNPCC gene get screening for CRC from?
25
2-year colonoscopy
359
What are the functions of the colon?
Water and electrolytes absorption
Production and absorption of vitamins
Storage of faeces
Hosts gut microbiota
360
What vitamins does the colon absorb?
K and B
361
What are the factors that ensure anorectal continence?
Anorectal sensation
Central control
Stool consistency
Renal compliance
362
Give examples of types of polyps?
Flat
GI rant
Pedunucalated
363
What is the protocol for a patient coming in with low-risk features of rectal bleeding lasting less than 6 weeks?
Watch and wait for 6 weeks before reviewing
364
What is the gold standard investigation done for colorectal cancer?
Colonoscopy +/- biopsies
365
What radiological imaging is done for suspected colorectal cancer?
CT colongraphy
Plain CT with contract
366
Where are most colorectal cancers found?
Proximal colon
367
Why is MRI important in rectal cancer?
Could dictate if neoadjuvant chemotherapy/radiotherapy is needed
368
What is needed to be recessed to reside local recurrence rate in rectal cancer?
Rectum and surrounding me sore Tim
369
What is the rectum surrounded by?
Mesorectum
Contains all lymph nodes of rectum
370
How long is surgery after neoadjuvant treatment for rectal cancer?
8-10 weeks
371
What are the principles for bowel anastomoses?
Tension free
Well perfused
Well oxygenated
Clean surgical site
Acceptable systemic state
372
where are ileostomies typically located?
Right iliac fossa
373
Where are colostomies located?
Left iliac fossa
374
Describe the apperance of an ileostomy
Spouted
375
Describe the appearance of a colostomy?
No spout
Flush with skin
376
What is the contents of an ileostomy?
Liquid
Looser stools
377
What are the contents of a colostomy?
Solid stools
378
What are the complications of rectal surgery?
Bleeding
Infection
Anastomotic leak
Stoma problems
379
What are the complications in lower anterior resections?
Damage to pelvic nerves
Impaired fecundity in younger women
380
What may be required post-op in rectal surgery?
Adjuvant chemotherapy
381
What are the signs of bowel obstruction?
Abdominal pain
Vomiting
Absolute constipation
Abdominal distension
382
When would vomiting occur in bowel obstruction?
If ileocaecal valve is not competent
383
What are the causes of large bowel obstruction?
Malignant
Strictures
Volvulis
Faecal impact ion
384
What investigations are done for bowel obstruction?
CT
Blood gase
Bloods
385
What are the nutritional needs of someone presenting with bowel obstruction?
NBM
Nasogastric tube if vomiting
fluid resucitation
386
What is the medical management of bowel obstruction?
Analgesia
Antiemetic
IV antibiotics
387
What is the function of the anorectum?
Control of defaecation
Maintenance of continence
388
What does the anorectum require in order to carry out its functions?
Pelvic floor
Rectal compliance
Intact pelvic neurology
389
What are the surgical treatments for haemorrhoids?
HALA
Anopexy
Haemorrhoidectomy
390
What are the characteristics of haemorrhoids?
Bleeding
Painless
Straining
391
What are the underlying causes of haemorrhoids?
Constipation
392
What is the OPD treatment for haemorrhoids?
Rubber band ligation
393
What is the characteristic of a fissure?
Pain
Bleeding
Glass splinters
394
What is the medical management for fissures?
GTN/ Diltiazem + Lignocaine
395
What are the surgical treatments for fissures?
Botox
Sphinncterotomy
396
What are the symptoms of a perianal abscess?
Excruciating pain
Signs of sepsis
397
When would you give antibiotics for a perianal abscess?
If septic
398
What are the risk factors for perianal abscess?
Diabetes
BMI
Immunosuppression
Trauma
399
What is the treatment for perianal abscess?
Incision and drainage
400
What are the symptoms of a fistula in ano?
Peri-anal sepsis
Persistent pus discharge with flare up
+/- faecal soiling
401
What is the failure rate of surgery for a fistula in ano?
50%
402
Name the treatments for fistula in ano?
Seton
Sphincter preservation techniques
Lay open
403
Why should a lay open not be done on women?
Due to thinner muscular walls
404
What test is positive when there is rectal cancer present?
FIT test
405
What are the routine investigations for rectal cancer?
PR examination
Proctoscopy
Rigid sigmoidoscopy
Colonoscopy
406
What are the imaging investigations for rectal cancer?
CT colonoscopy
CT scan
MRI rectum
407
What is pelvic floor dysfunction?
Collection of wide spectrum of symptoms related to defection
408
What are the categories of causes of pelvic floor dysfunction?
Child birth-related
All other causes - surgery, abuse etc
409
Who does pelvic floor dysfunction primarily affect?
Parous women
410
What are the causes of pelvic floor dysfunction in non-parlours women and men?
Surgical misadventure
Neurological/ connective tissue disorders
Psychological/ behavioural issues
411
Name the types of chronic constipation
Dietary
Drugs
Organic
Functional
412
Name the types of functional chronic constipation?
Slow transit
Evacuation related
Combination
413
Give examples of drugs that can cause constipation
Opioids
Verapamil
Diuretics
414
What investigations are done for chronic constipation to exclude sinister pathology?
Colonic imaging
Bloods
Symptomatic qFIT
Coeliac serology
Faecal calprotectin
415
What are first-line drugs for chronic constipation?
Regular baseline laxatives
416
Name the second-line drugs for chronic constipation?
Prucalopride
Lubiprostone
Linaclotine
417
What second-line drug for chronic constipation is for women only?
Proculopride
418
When would you give second-line drugs for chronic constipation?
Failure treatment with 2 or more regular laxatives from different classes at highest dose for 6 months and invasive measures considered
419
What are the surgical options for slow transit chronic constipation?
Subtotal colectomy with end ileostomy
Subtotal colectomy with ileorectal anastomoses
420
What are the other management options for chronic constipation?
Persistent irrigation system
Qufora irrigation
421
Name the types of faecal incontinence?
Passive
Urge
Mixed
Overflow
422
What investigations may be done for faecal incontinence?
Endo-anal USS
Defaecatory proctogram
423
what does an anal manometry measure?
Anal sphincter function
Length of the anal canal
Changes in anal pressure during the dedication
Recto-anal inhibitory reflex
Anorectal pressure responses
424
What may recto-anal inhibitory reflex be used to detect?
Congenital Hirshsprung
Systemic sclerosis
425
What does the defaecating proctogram provide information on?
Pelvic floor mobility
The pathological function of the musculature
Changes to form and axis or organs
Internal hernias
426
What are the non-pharmacological treatments of FI?
Low fibre diet
Pelvic floor exercises
Anal plug
427
What are the pharmacological treatments of FI?
Loperamide
Irrigation
428
What are the surgical treatments of FI?
Sphincter repair
Correct anatomical defect
Sacral nerve stimulator
429
What is rectocoel?
Passive loss of stool from being trapped due to incomplete evacuation
430
What is the treatment for internal rectal prolapse?
Improve rectal evacuation
Enemas
Loperamide
431
What is the choice of operation for rectal prolapse in a fit patient?
Rectopexy
