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Gastro Flashcards

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1
Q

What are the differences between Crohn’s and UC?

A

In Crohn’s:
Less common to have blood or mucus in stool
Entire GI tract is affected unlike UC where it is colon and rectum
Skip lesions on endoscopy unlike UC where there is continuous inflammation
Terminal ileum most affected
Transmural inflammation unlike UC where inflammation only in superficial mucosa
Smoking is risk factor where it is protective in UC
Strictures and fistulas are present

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2
Q

What are the presenting features of IBD?

A

Diarrhoea, abdominal pain, rectal bleeding, fatigue, weight loss, faecal urgency, nocturnal defecation, tenesmus, clubbing, mouth ulcers

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3
Q

What diseases are associated with IBD?

A

Erythema nodosum, pyoderma gangrenosum, eneteropathic arthritis, primary sclerosing cholangitis, red eye condiitons e.g. episcelritis, scleritis, anterior uveitis

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4
Q

What investigations should initially be performed in patient presenting with IBD symptoms?

A

FBC, inflammatory markers, haematinics, U+E, LFTs, TFTs, anti-TTG (rule out coeliac), stool microscopy (rule out infection), faecal calprotectin (1st line)

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5
Q

What is the gold standard investigation for diagnosing IBD?

A

Colonoscopy with multiple intestinal biopsies

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6
Q

What is the management for acute mild UC?

A

1st line = Aminosalicylates - topical then oral (unless extensive disease when oral first)

2nd line = oral prednisolone

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7
Q

What is the management for acute severe UC?

A

1st line = IV hydrocortisone
2nd line = IV ciclosporin
3rd line = infliximab or surgery

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8
Q

How is remission maintained in UC?

A

1st line = aminosalicylates
2nd line = azathioprine or mercaptopurine
3rd line = methotrexate

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9
Q

How is remission induced in Crohn’s?

A

1st line = steroids PO/IV depending on severity
Enteral nutrition
2nd line = steroids + another immunosuppressant medication

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10
Q

What is used to maintain remission in Crohn’s?

A

1st line = azathioprine, mercaptopurine
2nd line = methotrexate

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11
Q

What are people with IBD at risk of developing?

A

Bowel cancer
Osteoporosis

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12
Q

What are the symptoms of IBS?

A

Abdominal pain, diarrhoea, constiption, fluctuating bowel habit, bloating, worse after eating, improved by opening bowels, straining - symptoms often triggered by something

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13
Q

What investigations need to be done to diagnose IBS?

A

All results will be normal in IBS
FBC, inflammatory markers, coeliac serology, faecal calprotectin, CA125

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14
Q

What criteria is used to help diagnose IBS?

A

Rome IV criteria

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15
Q

What lifestyle advise can be given to patients with IBS?

A

Regular small meals, adjust fibre intake, limit caffeine/alcohol/fatty foods, low FODMAP, regular exercise, reduce stress

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16
Q

What is 1st line antidiarrhoeal and laxative in IBS?

A

Loperamide for diarrhoea
Ispaghula husk and other bulk forming laxatives

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17
Q

What autoantibodies are associated with coeliac disease?

A

Anti-TTG, anti-EMA, anti-DGP

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18
Q

Which part of the bowel is most affected in coeliac disease?

A

Jejunum in small intestine

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19
Q

What is the presentation of someone with coeliac disease

A

Failure to thrive, diarrhoea, bloating, steatorrhoea, weight loss, mouth ulcers, dermatitis herptiformis, anaemia

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20
Q

How long do patients need to be eating gluten for before testing for coeliac serology?

A

6 weeks

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21
Q

What is the 1st line investigation for coeliac disease?

A

Total IgA and anti-TTG

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22
Q

What is the gold standard investigation for coeliac disease and what is seen?

A

Endoscopy and jejunal biopsy - crypt hyperplasia and villous atrophy

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23
Q

What are the complications of coeliac disease?

A

Nutritional deficiencies, anaemia, osteoporosis, hyposplenism, ulcerative jejunitis, non-hodgkin lymphoma

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24
Q

What are the symptoms of GORD?

A

Heartburn, acid reflux, retrosternal or epigastric pain, bloating, nocturnal cough, hoarse voice

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25
What are the 2ww referral criteria for urgent endoscopy?
Difficulty swallowing >55 AND weight loss, upper abdo pain, reflux, treatment resistant symptoms, N+V, upper abdo mass, anaemia, rasied platelet count
26
What is a hiatus hernia?
Herniation of the stomach up through the diaphragm, allows contents of stomach to reflux into oesophagus very easily
27
What are the best investigations to diagnose hiatus hernia?
CXR, CT scan, endoscopy, barium swallow test
28
What lifestyle advice can be given to someone with GORD?
Reduce tea/coffee/alcohol, weight loss, avoid smoking, smaller meals, avoid heavy meals before bedtime, stay upright after meals
29
What medications can be used to treat GORD?
Antacids (e.g. Gaviscon), PPI (e.g. omeprazole), H2 receptor antagonists (e.g. famotidine)
30
When should a H.pylori test be offered to someone?
Should be offered to anyone with dyspepsia - need 2 weeks without using PPI before testing Always consider testing in treatment resistant symptoms
31
What is the treatment for H.pylori infection?
PPI + two antibiotics e.g. amoxicillin + clarithromycin
32
What change occurs in the epithelium in Barrett's oesophagus?
Metaplasia from squamous (oesophagus) to columnar epithelium (stomach epithelium)
33
What treatment can be done in Barrett's oesophagus to prevent development into adenocarcinoma?
Endoscopic ablation
34
What is Zollinger-Ellison syndrome ?
Rare condition in which duodenal and pancreatic tumours secrete excessive gastrin --> GORD Associated with multiple endocrine neoplasia type 1
35
What is the most common type of oesophageal cancer in UK?
Adenocarcinoma in lower 1/3 of oesophagus
36
What is the treatment for oesophageal and stomach cancer?
Surgical resection and adjuvant chemotherapy
37
What is the investigation of choice for diagnosing stomach cancer and what is seen?
Endoscopy and biopsy Signet ring cells may be seen
38
What are the two genetic conditions associated with increased risk of bowel cancer?
Famiilial adenomatous polyposis Hereditary nonpolyposis colorectal cancer (Lynch syndrome) = most common and also associated with endometrial cancer
39
What are the 2ww criteria for suspected bowel cancer?
Over 40 with abdo pain and weight loss Over 50 with unexplained rectal bleeding Over 60 with change in bowel habit or iron deficiency anaemia Positive FIT test
40
What test is used in bowel cancer screening and when is bowel cancer screening used?
FIT test Done in those aged 60-74 every 2 years If positive send for colonoscopy
41
What is the tumour marker associated with bowel cancer?
CEA (not useful in diagnosis but used in follow up after cancer diagnosis)
42
What are the risk factors for peptic ulcers?
H.pylori, NSAIDs, alcohol, caffeine, smoking, spicy foods, SSRIs, steroids
43
What pain is associated with gastric and duodenal ulcers ?
Epigastric pain Gastric - worse when eating Duodenal - 2-3 hours after eating that it presents
44
What is the management for peptic ulcers?
Stop any offending medication Treat H.pylori infection if present PPI Repeat endoscopy to ensure they heal
45
What complications can occur due to peptic ulcers?
Bleeding, perforation, gastric outlet obstruction
46
What are the presenting features of appendicitis?
Abdominal pain - starts central and moves down to McBurney's point Anorexia, N+V, low grade fever, constipation, abdominal distention, guarding, rebound tenderness, percussion tenderness
47
What is Rosving's sign?
Palpation of the LIF causes pain in the RIF
48
What is psoas sign?
Passive extension of the right thigh with the person in left lateral position elicits pain in right lower quadrant
49
What is obturator sign?
Passive internal rotation of the flexed right thigh elicits pain in the right lower quadrant
50
What are the differential diagnoses for appendicitis?
Ectopic pregnancy, ovarian cysts, Meckel's diverticulum, mesenteric adenitis, testicular torsion, incarcerated hernia (groin should always be examined)
51
What are the risk factors for developing diverticular disease?
Low fibre diet, obesity, use of NSAIDs
52
What laxative should be used in diverticular disease?
Bull-forming laxatives e.g. ispaghula husk AVOID stimulant laxatives
53
What are the key presenting features of diverticulitis?
Pain in left iliac fossa, fever, diarrhoea, N+V, rectal bleeding, palpable abdominal mass, raised inflammatory markers
54
What is the management of uncomplicated diverticulitis? (in GP)
Oral co-amoxiclav, analgesia, only take clear liquids, follow up to review
55
What is the management of severe diverticulitis? (in secondary care)
Nil by mouth, IV antibiotics, IV fluids, analgesia, urgent investigations
56
Which is more common small bowel obstruction or large?
SBO
57
What are the causes of small bowel obstruction?
Adhesions, hernias, strictures, intussception
58
What are the causes of large bowel obstruction?
Malignancy, volvulus, diverticular disease
59
What is the presentation of bowel obstruction?
Vomiting (billous vomiting), abdominal distention, diffuse abdominal pain, absolute constipation, lack of flatulence
60
What is the management for bowel obstruction?
Nil by mouth, IV fluids to hydrate, NG tube with free drainage to allow stomach contents to freely drain Surgery to correct underlying cause
61
What is ileus?
Normal peristalsis that pushes the contents along the length of the intestines temporarily stops due to bowel surgery/injury
62
What are the symptoms of ileus?
Bilious vomiting, abdominal distention, diffuse abdominal pain, absolute constipation and lack of flatulence, absent bowel sounds
63
What is the management of ileus?
Supportive care - nil by mouth, NG tube, IV fluids, mobilisation, TPN
64
Where is the most common location for volvulus?
Sigmoid colon
65
What are the risk factors for volvulus?
Chronic constipation, nursing home residents, high fibre diet, pregnancy, adhesions
66
What is seen on an abdominal XR of someone with sigmoid volvulus?
Coffee bean sign
67
What investigation is required to diagnose volvulus?
Contrast CT abdomen/pelvis
68
What is the management of volvulus?
Supportive care Endoscopic decompression can be attempted - flexible sigmoidoscope inserted Surgery - Hartmann's procedure (sigmoid), ileocaecal resection (caecal)
69
What are the causes of upper GI bleed?
Peptic ulcers (most common), mallory-weiss tear, oesophageal varices, stomach cancers
70
What is the presentation of upper GI bleed?
Haematesmesis, coffee ground vomit, melaena
71
What scoring system is used in those with suspected upper GI bleed?
Glasgow-Blatchford bleeding score - a score above 0 = high risk of bleeding
72
What scoring system is used post endosocpy to estimate risk of rebleeding and mortality in upper GI bleed?
Rockall score
73
What is the management of upper GI bleed?
ABCDE Bloods - high urea in upper GI bleeds, crossmatch Transfusions - blood, platelets and clotting factors If due to oesophageal varices - terlipressin and broad spectrum antibiotics OGD within 24 hours - diagnose and treat the source of bleeding
74
What medication can be used as prophlyaxis of oesophageal bleeding in those with GI bleed?
Non-cardioselective beta blockers e.g. propranolol
75
What causes chronic mesenteric ischaemia?
Narrowing of the mesenteric blood vessels by atherosclerosis (intestinal angina)
76
What are the classic triad of signs/symptoms associated with chronic mesenteric ischaemia?
Central colicky abdominal pain after eating Weight loss Abdominal bruit
77
What is the management of chronic mesenteric ischaemia?
CT angiography to diagnose Secondary prevention and reduction in risk factors Revascularisation to improve blood flow to intestines
78
What is acute mesenteric ischaemia?
Caused by rapid blockage in blood flow through the mesenteric artery - usually a thrombus
79
What is a key risk factor for acute mesenteric ischaemia?
AF
80
What are the presenting features of acute mesenteric ischaemia?
Acute, non-specific abdominal pain (pain disproportionate to examination findings), shock, peritonitis and sepsis
81
What is the investigation of choice in acute mesenteric ischaemia?
Contrast CT
82
What is the management of acute mesenteric ischaemia?
Surgery to remove necrotic bowel and remove thrombus in the blood vessel
83
What are the risk factors for developing haemorrhoids?
Constipation, straining, pregnancy, obesity, increased age
84
What are the symptoms associated with haemorrhoids?
Painless bright red bleeding typically on tissue, sore/itchy anus, feeling lump around anus
85
What is the stepwise management for haemorrhoids?
Lifestyle advice 1. Topical treatments - anusol 2. Rubber band ligation 3. Surgery e.g. hamorrhoid artery ligation or removal
86
What is the presentation of anal fissure?
Painful bright red rectal bleeding
87
What is the management of anal fissure?
High fibre diet and bulk forming laxatives If chronic topical GTN followed by surgery
88
What are the symptoms of pilonidal sinus abscess?
Pain, discharge, swelling at site Cycles of being asymptomatic and periods of pain and discharge
89
What is the management of pilonidal sinus abscesses?
If asymptomatic - no management required If acute - incision and drainage If chronic - excision of pits and obliteration of underlying cavity
90
What are the complications associated with hernias and what do they mean?
Incarceration - where the hernia cannot be reduced back into the proper position Obstruction - when hernia causes of blockage in passage of faeces Strangulation - hernia is non-reducible and base of hernia is tight and blood supply is cut off (painful)
91
When is conservative management appropriate with hernias?
When the hernia has a wide neck (less complications) and patient has significant morbidities
92
How is a hernia repaired surgically?
Tension-free repair - mesh over the defect in the abdominal wall
93
What is an indirect inguinal hernia?
Bowel herniates through inguinal canal/tract, consequence of deep inguinal ring not shutting after the testes have descended through it during foetal development
94
What is a direct inguinal hernia?
Occurs due to weakness in abdominal wall, hernia protrudes directly through abdominal wall and not along tract
95
What is a femoral hernia?
Herniation of abdominal contents through femoral canal Have narrow opening making femoral hernias high risk for complications
96
What is seen on histology in Crohn's disease?
Granulomas and increased goblet cells
97
What is seen on histology in UC?
Crypt abscesses, depletion of goblet cells
98
How does oesophageal rupture present?
Emphysema in neck, vomiting and chest pain after eating

Finals (21 decks)

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