Gastroenterology Flashcards
(78 cards)
1
Q
What are the risk factors for developing GORD?
A
Alcohol Pregnancy Hiatus hernia Obesity Smoking
2
Q
In GORD, the lower oesophageal sphincter tone is reduced. This leads to more frequent lower oesophageal relaxations and reduces oesophageal clearance of acid. What are the complications of GORD?
A
Oesophagitis Ulcers Benign stricture Iron deficiency Barrett's oesophagus
3
Q
In Barrett’s oesophagus, the distal epithelium undergoes metaplasia. Which epitheliums are involved here?
A
Squamous —> Columnar
4
Q
What are the oesophageal symptoms of GORD?
A
Heartburn Belching Acid or bile regurgitation Increased salivation Odynophagia = painful swallowing
5
Q
What are the extra- oesophageal symptoms of GORD?
A
Nocturnal asthma
Chronic cough
Laryngitis - hoarse voice
Sinusitis
6
Q
Which investigations can you do to diagnose GORD?
A
Endoscopy
Barium swallow
24 hour oesophageal PH monitoring
7
Q
Which lifestyle changes can you advise for someone with GORD?
A
Weight loss Reduce alcohol, hot drinks, spicy foods, fizzy drinks Avoid eating <3 hours before bed Stop smoking Small regular meals Raise bed head
8
Q
Which drugs can you give to treat GORD?
A
Antacids
PPIs e.g. lansoprazole
H2 receptor antagonist e.g. ranitidine
9
Q
Surgery is indicated in severe GORD. What type of surgery is this?
A
Laparoscopic - increases lower oesophageal sphincter pressure
10
Q
How do PPIs work?
A
Inhibits gastric H+/K+ ATPase, blocking luminal secretion of gastric acid
11
Q
What is IBS?
A
Mixed group of abdominal symptoms for which no organic cause can be found
12
Q
What are the risk factors for IBS?
A
Smoking Excessive alcohol Young age Female sex Psychological stress
13
Q
What are the symptoms of IBS?
A
Chronic pattern, exacerbated by stress Abdominal pain relieved by defecation Urgency Diarrhoea/ constipation Incomplete evacuation Worsening of symptoms after food Mucus in rectum Bloating
14
Q
Which investigations would you do if you suspected IBS?
A
Routine bloods Coeliac screen Serum CA-125 to exclude ovarian cancer Faecal calprotectin - marker of bowel inflammation which is raised in IBS Colonoscopy if >50 years
15
Q
Outline the management of IBS.
A
Avoid trigger foods Ensure adequate water and fibre intake Laxatives Bulking agent + loperamide for loose stool Antispasmodic e.g. mebervine Probiotics
16
Q
UC is a chronic relapsing and remitting inflammatory disorder of the colonic mucosa. Define proctitis, left-sided colitis and pancolitis.
A
Proctitis = Just rectum
Left-sided colitis = Rectum, sigmoid colon, descending colon
Pancolitis = Extends to entire colon
17
Q
Does smoking increase or decrease risk of UC?
A
Decreases.
18
Q
State 5 key pathological features of UC.
A
- Only effects mucosa
- Only effects colon - rectum to caecum
- Continuous - no skip lesions
- Red and bloody mucosa
- Ulcers and pseudopolyps can develop
19
Q
What are the symptoms of UC?
A
Diarrhoea Blood and mucus in stool Crampy abdominal pain Urgency Tenesmus Fever Malaise Fatigue Weight loss
20
Q
What are the signs of UC?
A
Tachycardia Tender, distended abdomen Clubbing Pallor Blood on DRE Uveitis
21
Q
Which investigations can you do to diagnose UC?
A
Routine bloods Stool culture to exclude infection Faecal calprotectin - significantly raised in UC Abdominal X-ray Lower GI endoscopy - gold standard
22
Q
What are the signs of UC on an abdominal x-ray?
A
Mucosal thickening
Colonic dilatation
No faecal shadows
23
Q
What are the complications of UC?
A
Colorectal cancer Bowel perforation Severe bleeding Toxic megacolon Malnutrition Arthritis Ankolysing spondylitis Gallstones Anaemia Osteoporosis
24
Q
How would you treat mild and moderate UC?
A
5-ASA e.g. sulfasalazine
Steroids
25
How would you treat severe UC?
Nil by mouth
IV hydrocortisone
Rectal steroids
Immunosuppression e.g. Infliximab, anti-TNFa
26
What surgery can you do in UC patients with no improvement?
Colectomy
| Terminal ileostomy
27
What are the risk factors for developing UC?
```
FH
HLA-B27 positive
Recent GI infection
NSAID use
Smoking cessation
Ashkenazi Jewish descent
```
28
Crohn's disease is a chronic inflammatory disease of the bowel. What are the risk factors for developing Crohn's?
FH
Smoking
Stress
Depression
29
State 5 key pathological features of Crohn's disease.
1. Affects entire GI tract from mouth to anus
2. Skip lesions
3. Cobble stone mucosa
4. Transmural inflammation -= all layers of bowel wall are effected
5. Granulomas
30
What are the symptoms of Crohn's?
```
Fatigue
Diarrhoea
Constipation
Rectal bleeding
Incomplete evacuation
Urgency
Abdominal pain
Weight loss
Malaise
Night sweats
```
31
What are the signs of Crohn's?
```
Abdominal tenderness/mass
Perianal abscess/fistulae
Skin tags
Clubbing
Mouth ulcers
```
32
What are the complications of Crohn's?
```
Bowel perforation
Fistulae
Fissures
Strictures
Abscess
Rectal haemorrhage
Colon cancer
Primary sclerosing cholangitis
Small bowel obstruction
```
33
Which investigations can you do to diagnose Crohn's?
Routine bloods
Stool culture to exclude infection
Colonoscopy with rectal biopsy
MRI of small bowel
34
How would you treat mild Crohn's?
Oral prednisolone
35
How would you treat severe Crohn's?
IV hydrocortisone
Blood transfusion
Immunosuppressants
TNFa inhibitors
36
What surgery can be done in Crohn's?
Bowel resection
37
What are the risk factors for developing bowel cancer?
```
IBD
FH
Diet high in red meat, low in fibre
Excess alcohol
Smoking
Neoplastic polyps
```
38
Name 5 places in the GI tract where bowel cancer can develop
```
Rectum
Sigmoid colon
Ascending colon
Caecum
Appendix
```
39
What are the symptoms of bowel cancer?
```
Weight loss
Fatigue
Night sweats
Blood in stools
Mucus in stools
Tenesmus
Persistent unexplained change in bowel habit Abdominal pain
```
40
What are the signs of bowel cancer?
PR mass
Abdominal mass
Fistula
41
Outline 4 urgent referral criteria for someone presenting with bowel cancer.
1. Anyone >40 with PR bleeding + bowel habit change
2. Any age with right lower abdominal mass
3. Palpable rectal mass
4. Men or non-menstruating women with unexplained iron deficiency anaemia
42
What investigations can you do to diagnose bowel cancer?
```
FBC: microcytic anaemia
Faecal occult blood - screening
CE antigen levels
Colonoscopy - gold standard
CT/MRI to assess mets
```
43
Bowel cancer can be staged by TNM staging. Outline the Duke's criteria which classifies severity of bowel cancer.
A: Limited to muscularis mucosae, 95% 5 year survival
B: Extension through muscularis mucosae, 77% 5 year survival
C: Regional lymph nodes, 48% 5 year survival
D: Distant mets, 6.6% 5 year survival
44
What treatment options are available for bowel cancer?
Surgery: resection, colectomy etc
Radiotherapy
Chemotherapy
45
What is a diverticulum, which occurs in diverticular disease?
Outpouching of gut wall, usually at site of perforating arteries
46
What is diverticulitis?
Inflammation or infection of diverticula. Occurs when faeces obstruct neck of diverticulum.
47
Diverticular disease is where increased pressure in the bowel lumen, causes the mucosa to herniate into muscle. The faeces can then sit in the diverticulum and inflame, leading to rupture and peritonitis. What is a risk factor for this?
Low fibre diet as colon has to push harder
48
Which part of the colon does diverticular disease mainly occur?
Sigmoid colon
49
What are the symptoms of diverticular disease?
Asymptomatic
Abdominal pain
Constipation
PR bleeding
Diverticulitis:
Fever, nausea, LIF pain
50
What investigations can be done to diagnose diverticular disease?
Routine bloods: raised WCC, ESR
Colonoscopy
CT
Abdominal x-ray - shows free air, indicating perforation
51
What are the signs diverticulitis?
```
Tender abdomen
Abdominal pain
Ascites
Involuntary guarding - tensing of abdominal muscles
Rigid abdomen
Reduced or absent bowel sounds
Tachycardia
Hypotension
```
52
What are the complications of diverticular disease?
```
Ileus
Perforation
Peritonitis
Mortality
Haemorrhage
Fistulae
Abscess
Post infective stricture
```
53
How would you manage diverticular disease?
High fibre diet
| Antispasmodics
54
How would you manage diverticulitis?
```
CT guided percutaneous drainage
Analgesia
Nil by mouth
IV fluids
Antibiotics
```
55
A peptic ulcer is an ulcer of the mucosa adjacent to an acid-bearing area - therefore they can occur in the stomach or duodenum. What are the causes of peptic ulcers?
```
H.pylori infection
NSAIDs
Hyperparathyroidism
Sarcoidosis
Crohn's disease
```
56
How do NSAIDs cause peptic ulcers?
NSAIDs block prostaglandin synthesis by inhibiting COX-1. These prostaglandins are needed to provide mucosal protection, so without them, the stomach is irritated.
57
Which drug, which when taken with NSAIDs, increases risk of peptic ulcer formation?
Corticosteroids
58
What are the symptoms of peptic ulcer disease?
Bloating
Heartburn
Tender epigastrium
59
What are the signs of peptic ulcer disease?
```
ALARMS
Anaemia
Loss of weight
Anorexia
Recent onset
Melaena
Swallowing difficulty
```
60
Which investigations would you do for a patient who is <55 or has no ALARM symptoms?
Non-invasive h.pylori test:
1. 13C-urea breath test
2. Stool antigen test
61
Which investigations would you do for a patient who is >55 or has ALARM symptoms?
Endoscopy with biopsy
62
How would you treat +ve H.pylori peptic ulcer?
PPI + 2 antibiotics
| Eradication confirmed with breath test/stool sample
63
How would you treat -ve H.pylori peptic ulcer?
Stop NSAIDs
| PPI
64
What are the complications of peptic ulcers?
Bleeding
Perforation
Malignancy
Gastric outflow obstruction
65
In appendicitis, gut organisms invade the appendix wall after lumen obstruction. What causes appendicitis?
Faceolith (hardened stool)
IBD
Filarial worms
Infection
66
What are the symptoms of appendicitis?
```
Epigastric pain that moves to RIF
Pain worse on movement, coughing and sneezing
Sudden onset pain
Loss of appetite
Nausea + vomiting
Fever
Abdominal swelling
```
67
What are the signs of appendicitis?
```
Tachycardia
Fever
Furred tongue
Shallow breaths
Guarding
Rebound + percussion tenderness of RIF
Psoas sign = pain on extending hip
Rovsing's sign = Pain greater in RIF than LIF, when LIF is pressed
```
68
What investigations can you do to diagnose appendicitis?
Bloods: raised CRP and neutrophil leucocytosis
| CT - gold standard
69
What are the complications of appendicitis?
Perforation
| Abscess
70
How would you manage appendicitis?
Appendicectomy
| IV antibiotics
71
What are the causes of constipation?
```
Dehydration
Autonomic neuropathy
Opiates
Iron supplements
Ondansetron
```
72
What are the complications of constipation?
Haemorrhoids
Faecal impaction (stools collect in rectum) - leads to overflow diarrhoea
Bowel incontinence
73
What lifestyle advice can you give to someone with constipation?
Increase daily intake of fibre
Drink more water
Daily exercise
Keep to a routine when going to the toilet
74
Name the 3 types of laxative given in constipation
1. Bulk forming - help stools retain fluid
2. Osmotic - increase fluid in bowel
3. Stimulant - stimulates muscles in bowel to move stools
75
Name an osmotic laxative
Lactulose
| Macrogols
76
Name a stimulant laxative
Senna
| Bisacodyl
77
Name a bulk forming laxative
Isphaghula husk
78
How would you treat faecal impaction?
High dose macrogol with senna
Bisacodyl suppository
Enema of docusate
