gast path lumen Flashcards by Emma Sutcliffe

buzzword for allergic opesophagitis

feline or corrugated/spotty oesophagus

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treatment of allergic oesophagitis

steroids/montelukast/ sodium cromoglicate

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associations of squamous cell carcinoma of oesophagus (not barrets assoc)

vit A/ZINC deficiency
HPV
Smoking

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what type of Ig is produced in H.pylori infection

IgA

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treatment of barrets oesophagus

radiofrequency ablation - 1st line
resection if high grade

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how does h.pylori survive in the gastric environment - whta mechanisms

chemotaxis away from low pH areas, using its flagella to burrow into the mucous lining to reach the epithelial cells underneath
secretes urease → urea converted to NH3 → alkalinization of acidic environment → increased bacterial survival

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how does h.pylori cause disease

releases CagA toxin that disrupts the gastric mucosa

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associations of h.pylori - what does it casue

peptic ulcer
gastric cancer
b cell MALT lymphoma
atrophic gastritis

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what % of duodenal ulcers does h.pylori cause

95%

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managemnet of h.pylori infection (+ pen allergic) and time duration

7 days
PPI + AMOX + (CLARY or MET)
pen allergic = PPI + CLARY+ MET

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in urease breath test how long after drinking solution if test performed

30 mins

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how long shoudl PPI be stopped for before commencing urease breath test

2 weeks

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what test is used to indetify h.pylori infection

CLO test (rapid urease test)
breath test checks for eradication

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what particular lymph nodes may been seen in gastric cancer if lymphatic spread

virchows node- left supraclavicular
sister mary joseph node - peri-umbilical

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diagnostic test for gastric cancer

OGD with biopsy

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what cells would you expect to see in gastric cancer biopsy

signet ring cells due to large mucin vaculoe pushing nucleus to the side

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what infection is assoicated with a gastric MALT tumour

h.pylori

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casues of gastroparesis

idiopathic
cannabis
diabetic neuropathy
opiates

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treatment of gastroparesis

food little and ofte
metoclopramid
castric pacemakes

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features of achalasia

dysphagia to BOTH liquid and food
variation in symptom severity
heartburn
regurg of food

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diagnostic test in achalasia

oesophageal manometry

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first line treatment of achalasia

pneumatic balloon dilatation

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if first line treatment for achalasia doesnt succeed what surgicla intervention is available

heller cardiomyotomy

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most common cause of GI bleed

duodenal ulcer

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what is the rockall score used for

moratality of gi bleed

what is blatchford score used for

likelyhood of gi rebleed

treatment of peptic ulcer

1. adrenaline into ulcer to cause vasoconstriction 2. heater probe coag 3. clips 4.haemospray

what is given post endoscopic intervention in peptic ulcer

PPI AND H.PYLORI ERADICATION

treatment of variceal bleed pre-endoscopy

ABCDE - resus before endoscopy clotting factors Terlipressin prophylactiv IV -quinolones

what shoudl be given BEFORE endoscopy in variceal bleed

Terlipressin and ABX

treatment of variceal bleed in endoscopy

band ligation and sclerotherpay

options of variceal bleed treatment if endoscopy tx failed or not feasible

sengstak-blakemore tube TIPPS procedure

what is involved in a TIPPS procedure

Transjugular intrahepatic portosystemic shunt- a shunt/stent is placed to attached portal veins to systemic- heaptic vein (bypassing liver) to reduce pressure

complication of TIPPS procedure

exacerbation of hepatic encephalotpathy

prophylactic management of variceal bleed

propanalol band ligation

for prophylactic band ligation of oesophageal varices how often is this performed and what medication is given

performed every 2 weeks and a PPI id given to preveent ulcer

what length of bowel is classed as short gut

<200cm

normal length of small bowel

6-7m

what type of intestinal failure is short bowel syndrome

type 3

investigation of choice for suspected bowel ischamia

thumbing printing and ischaemic abdo pain

ischaemic colitis

cause of mesenteric ischaemia

emboli

which type of bowel ischaemia causes bloody diarrhoea

ischaemic colitis

cause of ischaemic collitis in younger adults

cocaine use

what investigation findings would you expect in a lower GI tract ischaemia

raised WCC and lactic acidosis

treamtnet of acute mesenteric ischaemia

laparotomy

what type of IBD causes inflammation through all layers

Chrons

in chrons transmural inflammation - what does this predispose individuals to

strictures fistula adhesions

what presents wiht peir-anal disease chrons or UC

chrons

what IBD is granulomatous

Chrons

whch IBD has the higher cancer ris

which IBD would show thumbprinting on X-ray

which IBD is assoc with psuedopolyps

what is the most common extra-intestinal feature of Chrons and UC

Arthritis

PSC is more related to which IBD

describes the common eye features of chrons and uc respectively

Chrons - episcelritis UC - uveitis

what skin manifstations are assoc with IBD

pyoderma gangrenosum and erythema nodosum

which IBD is assoc with crypt abscesses

features of UC

abdo pain partic LIF urgency bloody diarrhoea tenesmus

features of chrons

abdo pain weight loss diarrhoea peri-anal disease

loss of haustra markings IBD

what blood test is a good marker of disease activity in chrons

CRP

what is the investigation of choice for chrons

colonoscopy and biopsy

what should be done in UC in a flare of colitis instead of colonoscopy adn why

flexi sig as colonscopy may casue perforation

goblet cells on histology would be indicative of what IBD

chrons

what secondary investigation is good for IBD after colonscopy

barium enema

what would barium enema show in UC

loss of haustra, pseudopolyps drainpipe colon

what is kantor strign sign ? when and why is it seen

seen on barium enema in chrons diease looks like beads on long string- with the sting beinglong segments of strictures from disease

what IBD are rose thorn ulcers seen

Chrons

relationship between smoking and IBD

worsens Chrons protective for UC

what faecal test can be done in IBD

faceal calprotectin

what test shoudl be done before starting azathioprine or metocarpurine

TPMT

treatment of parianal abscess in chrons

incision and drainage

what drugs are used to maintain remission in chrons

azzathiprine or mercaptopurine

what is the investigation of choice for suspected peri-anal fistula in chrons

MRI

treatment for symptomatic peri-anal fistula in chrons

oral metronidazole

durgical options in UC

permanent ileostomy or restorative proctocoloectomy and J pouch