4th yr- CMS- Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

(105 cards)

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1
Q

What is the GI tract lined with

A

Lines with mucosa from the mouth to the anus

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2
Q

Name some common gastrointestinal problems

A
  1. Inflammatory bowel disease
  2. IBS
  3. Colorectal cancer
  4. Haemorrhoids
  5. Diverticular disease
  6. Enteric infections
  7. Upper GI problems
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3
Q

Give examples of upper GI problems

A
  1. Dysphagia

2. PUD

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4
Q

What is inflammatory bowel disease (IBD)

A

A diverse collection of inflammatory disorders of the gastrointestinal tract

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5
Q

Give examples of soem IBDs

A
  1. Crohns disease

2. ulcerative colitis

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6
Q

Is inflammatory bowel disease fatal

A

Morbidity and mortality can be high

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7
Q

Describe the aetiology of IBD

A
  1. Environmental factors
  2. Genetic predisposition
  3. Host immune response
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8
Q

List some environmental factors for IBD

A
  1. Smoking

2. Depression

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9
Q

List some clinical features of IBD

A
  1. Diarrhoea
  2. Nocturnal symptoms
  3. Weight loss
  4. Fatigue
  5. Nausea/ vomiting
  6. Bloating and abdominal pain
  7. Perianal symptoms
  8. Genital symptoms
  9. Arthritidaes
  10. Skin lesions
  11. Eye disease
  12. Hepatobiliary disease
  13. Vascular disease
  14. Renal disease
  15. Pulmonary disease
    16 Amyloidosis
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10
Q

How can we manage IBD

A
  1. Medical management

2. Surgical management

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11
Q

How can we medically manage IBD

A
  1. Corticosteroids
  2. Aminosalicylates
  3. Immunomodulatory drugs
  4. Biologic agents
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12
Q

How can we surgically manage IBD

A
  1. Resections

2. Stoma formation

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13
Q

What is coeliac disease

A

A gluten specific enteropathy

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14
Q

What oral presentation can patients with coeliac disease have

A
  1. Aphthae
  2. Dermatitis herpetiformis
  3. Angular chelitis
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15
Q

What can patients with coeliac disease have a higher change of developing

A
  1. IBD
  2. CRC
  3. Lymphomas
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16
Q

How do we manage coeliac disease

A

A lifelong gluten free diet is effective curative

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17
Q

How do we diagnose coeliac disease

A
  1. Blood tests to look for antigens that they are reacting to (anti TT)
  2. Upper GI endoscopy
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18
Q

List some risk factors of Colorectal cancer

A

1, Age

  1. Diet
  2. Colorectal polyps
  3. Colorectal cancer
  4. Tobacco
  5. Acromegaly
  6. abdominal radiotherapy
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19
Q

Give some clinical features of Colorectal cancer

A
  1. Altered bowel habit
  2. PR bleeding, tenesmus
  3. Symptomatic anaemia
  4. Rectal/ abdo mass
  5. Asymptomatic
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20
Q

How can we manage Colorectal cancer

A
  1. Tumour resection
  2. Possible stoma formation
  3. Adjuvant chemotherapy
  4. Radiotherapy not useful for bowel lesions
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21
Q

What does the prognosis of Colorectal cancer depend on

A

Depends on cancer stage and presence of metastasis

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22
Q

What is the common name of Colorectal cancer

A

Bowel cancer

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23
Q

How common is Colorectal cancer

A

4th most common caner

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24
Q

Is Colorectal cancer fatal

A

2nd biggest killer in the uk

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25
At what age do you get sent a at home blood test for bowel cancer
60
26
What does the treatment of colorectal cancer depend on
Site of caner Dietary triggers
27
What are the benifets of adjuvant chemotherapy
improved disease free survival and overall survival in stage 3 cancer
28
When is radiotherapy not a useful treatment for colorectal cancer
When the cancer is proemial to the rectum
29
Why is radiotherapy not a suitable treatment for colorectal cancer when it is proximal to the rectum
As it would be difficult to administer a high enough dose without famafign adjacent structures eg small bowel
30
What are soem of the risks when removing colorectal cancer
1. Bleeding 2. Infection 3. Blood clots 4. Damage to nearby organs 5. Leaking joints
31
What are some safe effects of rectal cancer surgery
Sexual dysfunction Erectile dysfunction Bladder function changes
32
What are stomas
Small pouches that can be connected to your digestive tract to help taste to be diverted out of the body
33
what are the disadvantages of stomas
1They may lead to feelings of shame or prevent intimate relationships, swimming etc
34
Name the most common GI presentation
Irritable bowel syndrome
35
What triggers irritable bowel syndrome
Dietary triggers
36
How much does IBS cost the NHS
£45.6 MILLION per year
37
List some associations of IBS
1. Fibromyalgia 2. Menstrual dysfunction 3. Joint hyper mobility 4. Anxiety 5. Trauma
38
How can IBS affect a persons life
25% of patents with IBS take 7-13 days off work
39
How do we diagnose IBS
By symptom reading no physical exam
40
What requirement must be filled before we can diagnose a patient with IBS
In preceding 3 months they must have at least 3days/ mont of recurrent abdominal pain or discomforted associated with: 1. Improvement with dedication 2. Onset with change in frequency of stool 3. Onset with a change in the appearance of stool
41
What do we need to rule out before diagnosing a patient with IBS
§. IBD 2. CRC 3. Enteric infection
42
How do we treat IBS
Explain the symptoms to the patient No further treatment usually required just support and reassurance Try to avoid dietary triggers and maintain high fibre diet
43
What can we prescribe patents with diarrhoea associated with IBS
loperamide
44
What can we prescribe patents with CONSTIPATION associated with IBS
Laxitives and high fibre diet
45
What is dIverticular disease
The existence of out pouching along the intestines
46
What is diverticulitis
An acute infection of one or more pouches on the intestine
47
Is diverticular disease and diverticulitis the same
NO
48
What can cause diverticular disease
Chronic constipation due to poor dietary fibre intake which can lead to weaken of the bowel wall with out pouching developing
49
Why is out pouching of the intestines danger
As fecal matter can collect their prevention the removal of it from eh bowel
50
Other than chronic constipation why else can diverticular disease occur
Due to cholinergic denervation with age leads to hypersensitivity and less coordinated muscle contractions.
51
Where and in whom is diverticula usually found
Diverticula frequently found in the colon and occur in 50% of people >50yrs
52
What can diverticular disease be confused with
IBS
53
When do we usually diagnose diverticular disease
During a bowel endoscopy for a operate issue
54
Why is diverticular disease sometimes not diagnosed
As can be asymptomatic
55
What advise can we give patents to reduce the likelihood of developing diverticular disease
Implement a high fibre diet
56
What are soem complication of diverticular disease
1. Bowel perforation 2. Abscess Formation 3. Fistulae into adjacent organs 4. haemorrhage 5. peritonitis (potentially life threatening)
57
How are haemorrhoids classify
1. Primary 2. Second degree 3. Third degree
58
Describe a primary haemorrhoids
Internal
59
Describe a second degree haemorrhoids
Prolapsing
60
Describe a third degree haemorrhoids
Prolapsed
61
What can haemorrhoids cause
Rectal bleeding
62
How can we mange haemorrhoids with minor symptoms
No treatment usually only advise on how to avoid constipation
63
How can we mange haemorrhoids with severe symptoms
Rubber band ligation or injection of sclerosant this is to shirivel the haemorrhoids
64
Name a common enteric infection
Acute gastroenteritis
65
What can Acute gastroenteritis cause
Diarrhoea with or without vomiting
66
How can we help mange someone who is suffering from diarrhoea and vomitign
Giving oral rehydration solution
67
how many people die form diarrhoeal disease?
2 million per year
68
What can cause Acute gastroenteritis
1. Viral cause 2. Protozoal and helminthic infection 3. Bacterial cause
69
Which virus is most commonly known to cause Acute gastroenteritis
Norovirus
70
Name the most common cause of Acute gastroenteritis in adults
Bacterial infection by Clostridium difficile
71
What is Clostridium difficile also known as
pseudomembranous colitis
72
What might cause Clostridium difficile induced Acute gastroenteritis
Prolonger or inappropriate antibiotic use
73
How can we prevent bacteria induced Acute gastroenteritis
1. Responsible use of antibiotics 2. Have good Hand hygiene 3. Regular clean surveys in hospitals to reduce transmission 4. Isolation of patient with Clostridium difficile
74
How do we mange enteric infection
Oral rehydration solution | NO antibiotics required
75
Name the most common pathogens that can cause food poisoning
1. Campylobacter, 2. Cryptosporidium, 3. Salmonella, 4. Shiga toxin-producing E-Coli, 5. Shigella
76
How can we reduce the cases of food poisoning
1. Proper hand hygiene and surface cleaning 2. Separating risky foods 3. Storing food at a safe temperature 4. Ensuring food is cooked at a high enough temp
77
What does dysphagia mean
Difficulty swallowing
78
What does odynophagia mean
Painful swallowing
79
Why might a patient have dysphagia
1. Post stoke leading to weak tongue 2. Parkinsons disease 3. Cranial nerve palsy
80
What is a red flag for a patient with dysphagia
A persistent or progressive sensation of a lump in the throat or inability to swallow solids accompanied by weight loss
81
What is high dysphagia
Difficulty in swelling caused by problems with the mouth or throat
82
What can odynophagia be caused by
1. oesophageal inflammation (oesophagitis) due to gastro-oesophageal reflux disease (GORD) 2. infections of the oesophagus 3. drugs
83
How do we investigate dysphagia
1. Oesophagogastroduodenoscopy (OGD) 2, Contrast studies 3. MRI of small bowel 4. Oesophageal Manometry
84
What is a Oesophagogastroduodenoscopy (OGD)
When a flexible endoscope is navigated through the mouth into the oesophagus, stomach and duodenum
85
How do we perform contrast studies to investigate dysphagia
Patient can ingest barium and get a radiograph of the oesophagus, stomach and duodenum and small intestine to see how far the barium gets
86
When do we carry out a Oesophageal Manometry
Used to investigate suspected mortality disorders
87
how do we carry out a Oesophageal Manometry
A small tube which contains pressure inducers is passed through the nose and into the oesophagus Pressure and peristalsis is assed when patient swallow
88
What does PUD stand for
Peptic ulcer disease
89
What causes peptic ulcer disease
A peptic ulcer
90
What is a peptic ulcer
A mucosal ulcer un or adjacent to an acid bearing area
91
Where do peptic ulcers form
Stomach and proximal duodenum
92
How common are duodenum ulcers
15% of the population at any given time have a duodenum ulcer
93
What is the most common cause of peptic ulcers
H pylori and NSAIDS/ aspirin
94
Why does taking an excess of NSAID/ Aspirin cause ulcers
Due to reduced production of prostaglandins which provide mucosal protection in the upper GIT.
95
What is the most common symptom fo peptic ulcer dais
Burinng epigastric pain
96
How is Burinng epigastric pain relieved
By antacids and a variable response to food
97
When to duodenal ulcers cause pain
Usually when the patient is hungry or classically at night
98
List soem other symptoms of peptic and duodenal ulcers
1. Heartburn 2. Nausea 3. flatulence 4. Perforation or painless haemorrhage
99
What symptoms to patients with severe ulcerations usually present with
Usually asymptomatic
100
What can happen to the symptoms of duodenal ulcers if they go untreated
They can relapse and remit spontaneously if they go untreated
101
List soem complications of peptic ulcer disease
1. Haemorrhage 2. Perforation 3. Gastric outlet obstruction
102
What signs a symptoms would a patient with a haemorrhage due to peptic ulcers come with
1. Acute upper GI bleeds 2. Vomiting of blood 3. Passing of malaria (black tarry stool)
103
`Which type of ulcer is most likely to perforate
Duodenal ulcers
104
How do we manage the perforation of an ulcer
1. Laparoscopic surgery to close the perforation and drain abdomen 2. Conservative management using nasogastric suction
105
Wby does gastric outlet obstruct occur
Occurs due to oedema surround gin an active ulcer or due to scarring which occurs following ulcer healing
4th yr- CMS- Medicine
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