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Gastroenterology Flashcards

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1
Q

Name the 2 types of IBD.

A
  • Ulcerative colitis
  • Crohn’s disease
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2
Q

What antibodies are associated with UC?

A

pANCA

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3
Q

What antibodies are associated with CD?

A

ASCA

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4
Q

Where does UC vs CD affect?

A
  • UC only affects the colon - mucosa and submucosa (superficial)
  • CD affects any part of the GI tract, from mouth to anus - mucosa, submucosa, muscularis propria and serosa (transmaural)
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5
Q

Which type of IBD is of a higher incidence?

A

UC

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6
Q

Which ethnic group are more prone to IBD?

A

Jewish

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7
Q

Which gene is associated with IBD?

A

HLA-B27

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8
Q

Name 2 things which are protective of UC.

A
  • Smoking
  • Appendicectomy
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9
Q

What are 7 risk factors for IBD?

A
  • Family history
  • Female
  • NSAIDs
  • Chronic stress
  • Depression
  • Smoking (CD only)
  • Appendicectomy (CD only)
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10
Q

What is the 1st line investigation for IBD?

A

Faecal calprotectin - elevated

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11
Q

What is the gold standard investigation for IBD?

A

Endoscopy (OGD and colonoscopy) and biopsy

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12
Q

What are the extra-intestinal manifestations of IBD?

A

A PIE SAC:
- Aphthous ulcers/ankylosing spondylitis
- Pyoderma gangenosum - painful ulcers which develop on the legs
- Iritis
- Erythema nodosum - red bumps under the skin
- Sclerosing cholangitis
- Arthritis
- Clubbing

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13
Q

What is the most common extra-intestinal manifestation of IBD?

A

Erythema nodosum

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14
Q

Name 3 macroscopic features of UC.

A
  • Begins in the rectum and extends
  • No skip lesions
  • Pseudopolyps
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15
Q

Name 3 macroscopic features of CD.

A
  • Any part of the GI tract may be affected
  • Skip lesions
  • Cobblestone appearance
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16
Q

Name 3 microscopic features of UC.

A
  • Granuloma formation is rare
  • Depleted goblet cells
  • Increased crypt abscesses
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17
Q

Name 3 microscopic features of CD.

A
  • Non-caseating granulomas
  • Goblet cells not depleted
  • Fewer crypt abscesses
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18
Q

What is commonly associated with UC?

A

PSC

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19
Q

What is commonly associated with CD?

A

Strictures and fistulas

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20
Q

Describe the presentation of UC (6).

A
  • Pain in left lower quadrant
  • Blood and mucus in the stool more likely
  • Diarrhoea
  • Nausea and vomiting
  • Weight loss
  • Anaemia
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21
Q

Describe the presentation of CD (6).

A
  • Pain in right lower quadrant - terminal ileum most likely affected
  • Blood and mucus in the stool less likely
  • Diarrhoea
  • Nausea and vomiting
  • Weight loss
  • Anaemia
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22
Q

What are the 3 types of UC?

A
  • Proctitis - inflammation of the rectum only
  • Left-sided colitis - inflammation of the rectum and left colon
  • Pancolitis - inflammation of the entire colon, up to the ileo-caecal valve
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23
Q

Name the criteria used for UC.

A

Truelove and Witt’s criteria

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24
Q

What is 1st and 2nd line in treating mild to moderate UC?

A

1st line - aminosalicyclates (5-ASAs) e.g mesalazine, sulfasalazine
2nd line - corticosteroids e.g prednisolone

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25
What is 1st and 2nd line in treating severe UC?
1st line - IV corticosteroids e.g IV hydrocortisone 2nd line - IV ciclosporin
26
What can be used to maintain remission when treating UC (3)?
- Aminosalicyclates - Azathioprine - Mercaptopurine
27
What may be curative of UC?
Surgery to remove the rectum and colon which is affected
28
How can CD be treated (4)?
- Smoking cessation - 1st line - oral prednisolone/IV hydrocortisone - 2nd line - add an immunosuppressant e.g azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab - Surgical resection
29
What can be used to maintain remission of CD (2)?
- Azathioprine - Mercaptopurine
30
What is IBS? What are the 3 types?
A mixed group of abdominal symptoms for which no organic cause can be found: - IBS-C - with constipation - IBS-D - with diarrhoea - IBS-M - mixed
31
What are 7 risk factors for IBS?
- Female - Family history - Anxiety - Depression - Stress - Gastroenteritis - Menstruation
32
Describe the presentation of IBS.
A - abdominal pain relieved by defaecation B - bloating C - change in bowel habits Others: - Nausea and vomiting - Urgency - Worsening of symptoms after food
33
How is IBS diagnosed?
Diagnosed by exclusion - nothing to be found: - Faecal calprotectin - exclude IBD - Endoscopy - exclude IBD and colorectal cancer
34
How can mild IBS be treated (3)?
- Education and reassurance - Alter fibre intake - Low FODMAP diet - cut out apples, artichokes, baked beans, cows milk
35
How can moderate IBS be treated (4)?
- Laxatives - for constipation - Anti-motility agents - for diarrhoea - TCAs e.g amitriptyline - Psychological treatment
36
How can severe IBS be treated?
Refer to pain centre
37
Name an anti-motility agent that can be used for diarrhoea.
Loperamide
38
Name some laxatives that can be used for constipation (3).
- Ispaghula husk - Senna - Movicol
39
Name drugs which can be used to treat pain/bloating/cramps associated with IBS.
- Peppermint oil - Buscopan - Mebeverine hydrochloride
40
What is coeliac disease?
An autoimmune reaction to gluten
41
Which part of the GI tract is most affected in coeliac disease?
Duodenum
42
Name 2 genes associated with coeliac disease.
HLA-DQ2 HLA-DQ8
43
Name 2 auto-antibodies associated with coeliac disease.
Anti-tissue transglutaminase (anti-TTG) - IgA Anti-endomysial (anti-EMA) - IgA
44
Which auto-antibody is sensitive to coeliac disease?
anti-TTG
45
Which auto-antibody is specific to coeliac disease?
anti-EMA
46
What are 6 risk factors for coeliac disease?
- Family history - IgA deficiency - Really young or really old - Early exposure to gluten - Type 1 diabetes - Autoimmune thyroid disease
47
Describe the presentation of coeliac disease (9).
- Failure to thrive in children - Steatorrhoea - Dermatitis herpetiformis - itchy, blistering rash on the abdomen - Abdominal pain - Bloating - Mouth ulcers - Angular stomatitis - Unintentional weight loss due to malabsorption - Anaemia
48
What is the 1st line investigation for coeliac disease?
Serology - look for anti-TTG and anti-EMA
49
What is it really important to ensure before making a diagnosis of coeliac disease?
Must be having gluten in their diet for the 6 weeks before a diagnosis is to be made
50
What is the gold standard investigation for coeliac disease?
Duodenal biopsy: - Villous atrophy - Crypt hyperplasia - Lymphocyte infiltration
51
How is coeliac disease treated?
Life-long gluten free diet
52
What vitamin is someone with coeliac disease likely to be deficient in? Why?
Iron - it is absorbed in the duodenum
53
What type of reaction of coeliac disease?
Type 4 hypersensitivity reaction
54
Name a complication of coeliac disease. How can this be managed?
Hyposplenism - greater risk of infections: - Annual flu vaccine - Pneumococcal booster every 5 years
55
What is GORD?
Reflux of stomach contents into the oesophagus
56
What are the risk factors for GORD (10)?
- LOS hypotension - Hiatus hernia - Gastric acid hypersecretion - Delayed gastric emptying - Over-eating - Pregnancy - Obesity - Smoking - Alcohol - Caffeine
57
Describe the presentation of GORD (4).
- Heartburn - aggravated by bending or lying down, worsens with hot drinks or alcohol, seldom radiates to the arm - Sour/bitter taste in the mouth due to acid regurgitation into the mouth - Enamel erosion - Dysphagia
58
What is the 1st line investigation for GORD?
Therapeutic challenge - giving a PPI usually improves symptoms - GORD is common and usually does not require investigation
59
What is the gold standard investigation for GORD?
24 hour PH monitoring of the lower oesophagus
60
Give 5 lifestyle changes for GORD.
- Weight loss - Smoking cessation - Avoid alcohol, caffeine, spicy and fatty foods - Small, regular meals - Avoid eating 3 hours before going to bed
61
Name drugs which can be used to treat GORD (4).
- PPIs e.g lansoprazole - H2 receptor antagonists e.g cimetidine - Antacids e.g aluminium hydroxide, magnesium trisilicate - Alginates e.g Gaviscon
62
What can be used as a last resort to treat GORD?
Nissen fundoplication - gastric fundus is wrapped around LOS to make it tighter
63
Name 3 complications of GORD.
- Barrett's oesophagus - Oesophagitis - Laryngitis
64
What happens in Barrett's oesophagus?
Oesophageal epithelium undergoes metaplasia from stratified squamous epithelium to columnar epithelium, there is an increased risk of progression to oesophageal adenocarcinoma
65
What are peptic ulcers? Where can they occur?
A break in the mucosal lining of the stomach or duodenum: - Gastric ulcers - Duodenal ulcers
66
Which type of peptic ulcer is more common?
Duodenal ulcers
67
Where do gastric ulcers usually occur?
Lesser curvature of the stomach
68
Where do duodenal ulcers usually occur?
Duodenal cap - first part of the duodenum
69
What are the risk factors and causes of peptic ulcers (6)?
- H. pylori - NSAIDs - Ischaemia - Gastric acid hypersecretion - Smoking - Stress
70
Describe the presentation of peptic ulcers (4).
- Burning epigastric pain - Bloating - Nausea and vomiting - Weight changes
71
How can gastric vs duodenal ulcers be differentiated?
- Gastric ulcers - pain increases whilst eating --> weight loss - Duodenal ulcers - pain decreases whilst eating --> weight gain
72
Name a complication of peptic ulcers.
Perforation - ulcer erodes the wall of the stomach or duodenum allowing contents to enter the sterile peritoneal cavity, this can lead to peritonitis
73
Name a complication of gastric ulcers.
Ulcer erodes the left gastric artery causing massive haemorrhage
74
Name a complication of duodenal ulcers.
Ulcer erodes the gastroduodenal artery causing massive haemorrhage
75
How are peptic ulcers investigated?
Under 55 - non-invasive testing first - stool antigen test, urea breath test Over 55/red flag symptoms - endoscopy and biopsy
76
Why should endoscopy be repeated 6-8 weeks after peptic ulcers are treated (2)?
- To check ulcer has healed - To ensure there is no malignancy
77
What lifestyle changes can be made to treat peptic ulcers (4)?
- Avoid irritating foods - Smoking cessation - Manage stress - Stop NSAIDs
78
How is H. pylori treated?
Triple therapy: - PPI - lansoprazole, omeprazole - Amoxicillin - Clarithromycin
79
Where is the appendix located?
McBurney's point - 2/3 of the way along a line running from the umbilicus to the right asis
80
Who does appendicitis usually affect?
- Males - Aged 10-20 years old
81
What are the causes of appendicitis (4)?
- Faecolith (stone made of faeces) - most common - Lymphoid hyperplasia - Undigested seeds - Fliarial worms
82
What is a complication of appendicitis?
Appendix ruptures - faecal matter can enter the peritoneal cavity causing peritonitis
83
Describe the presentation of appendicitis (5).
- Abdominal pain that starts in the umbilicus then migrates to the right iliac fossa - Fever - Nausea and vomiting - Anorexia - Abdominal guarding
84
What is the 1st line investigation for appendicitis?
Ultrasound
85
What is the gold standard investigation for appendicitis?
CT
86
How is appendicitis treated?
Laparoscopic appendicectomy
87
What is McBurney's sign (appendicitis)?
Pain at the right lower quadrant of the abdomen
88
What is Rovsing's sign (appendicitis)?
Right lower abdominal pain on palpation of the left lower abdomen
89
What is Psoas sign (appendicitis)?
Patient is lying on their left side whilst right hip is extended which causes pain
90
What is Obturator sign (appendicitis)?
Patient is supine and whilst the flexed right hip is being internally and externally rotated, this causes pain
91
What are diverticula?
Outpouchings of the colon
92
What is diverticulosis?
Presence of diverticula
93
What is diverticular disease?
Diverticula cause symptoms
94
What is diverticulitis?
Inflammation of the diverticula
95
Where are diverticula most commonly found? Why?
Sigmoid colon - smallest lumen diameter
96
Give some risk factors for diverticula forming (6).
- Over 50 - Obesity - Low fibre diet - NSAIDs - Smoking - Connective tissue disorders e.g Marfans syndrome, Ehlers Danlos syndrome
97
Describe the presentation of diverticulitis (6).
- Mostly asymptomatic - Left iliac fossa pain - Fever - Nausea and vomiting - Constipation - Rectal bleeding
98
Give 2 complications of diverticulitis.
- Diverticula can rupture causing peritonitis - Fistula formation with bladder causing stool and air to enter the bladder
99
How should diverticulitis be diagnosed?
CT abdomen
100
Why should a colonoscopy not be done if diverticulitis is suspected?
Risk of perforation
101
How can diverticulitis be managed (3)?
- Lifestyle changes e.g high-fibre diet, weight loss, smoking cessation, avoid NSAIDs - Paracetamol - Laxatives
102
What antibiotics are usually used for diverticulitis?
- Co-amoxiclav - Metronidazole
103
What are oesophageal varices?
Dilated veins found at the lower end of the oesophagus
104
What is the cause of oesophageal varices (4)?
Portal hypertension: - Cirrhosis - Alcoholic liver disease - Schistosomiasis - Hepatitis
105
What is the most common complication of oesophageal varices?
Variceal bleeding due to rupture
106
Describe the presentation of oesophageal varices rupture (6).
- Haematemesis - Meleana - Haematochezia - Pallor - Tachycardia - Hypotension (Asymptomatic if not ruptured)
107
How are oesophageal varices diagnosed?
Upper endoscopy
108
How is bleeding from oesophageal varices managed (4)?
- IV fluids - Blood transfusion - Terlipressin or octreotide - Band ligation
109
What does low RBC count and high urea indicate?
GI bleed
110
What is a Mallory-Weiss tear?
A tear in the lower oesophageal mucosa
111
What condition is associated with Mallory-Weiss tears?
Bulimia nervosa
112
What can cause a Mallory-Weiss tear?
Violent coughing and vomiting due to binge drinking and forceful eating
113
How is a Mallory-Weiss tear diagnosed?
Gastroscopy
114
How are Mallory-Weiss tears treated (2)?
- Most bleeds heal on their own in 24 hours - Surgery to sew the tear together is rare
115
What are the 2 types of bowel obstruction?
- Small bowel obstruction - Large bowel obstruction
116
What are the 2 types of causes of bowel obstruction?
- Mechanical - Functional
117
What is meant by a mechanical obstruction of the bowel?
An actual blockage in the large or small intestine which can be partial or complete
118
What is meant by a functional obstruction of the bowel?
Disruption to the peristaltic contractions that move food through the intestines
119
What is the most common cause of SBO?
Post-operative adhesions
120
What is the most common cause of LBO?
Malignancy
121
What are causes of mechanical bowel obstruction (6)?
- Post-operative adhesions - Malignancy - Volvulus - Hernias - Inflammatory bowel disease - Ingestion of a foreign body which becomes lodged
122
What are causes of functional bowel obstruction (5)?
- Post-operative ileus - trauma during surgery causes paralysis of intestinal smooth muscle contractions - Infection e.g appendicitis, peritonitis - Hypothyroidism - Hypokalaemia - Hypercalcaemia
123
Describe the presentation of bowel obstruction.
- Abdominal pain - Abdominal distension - Nausea and vomiting - Constipation
124
Give 3 features of SBO.
- Vomiting is more common - Pain in umbilical region - Pain is more frequent, but only lasts a few minutes
125
Give 3 features of LBO.
- Vomiting is less common - Pain in lower abdomen - Pain is less frequent, but lasts longer
126
What can be heard on auscultation in mechanical bowel obstruction?
High pitched tinkling bowel sounds
127
What can be heard on auscultation in functional bowel obstruction?
Absence of normal bowel sounds
128
What is the 1st line investigation for bowel obstruction? What will it show?
X-ray - distended loops of bowel proximal to obstruction
129
What is the gold standard investigation for bowel obstruction?
CT scan of abdomen
130
Why should a colonoscopy not be done for suspected bowel obstruction?
Due to risk of perforation
131
How is bowel obstruction treated (3)?
Drip and suck: - Nil by mouth - IV fluids - Nasogastric suction
132
Which type of bowel obstruction is more common?
SBO
133
What type of bowel obstruction is usually seen in children under 2? Explain
Intussusception - one part of the intestine slides into the adjacent part of the intestine like a telescope
134
Explain the 3/6/9 rule for abdominal X-rays.
Upper limit of the normal diameter of the bowel: - 3 cm for small bowel - 6 cm for colon - 9 cm for caecum
135
Define diarrhoea.
Having 3 or more loose stools in 24 hours
136
How can diarrhoea be classified by time (3)?
- Acute - less than 2 weeks - Persistent - 2 - 4 weeks - Chronic - more than 4 weeks
137
What is important in the treatment of diarrhoea?
Rehydration
138
What investigations can be done for diarrhoea (8)?
- FBC - Blood culture - CRP - ESR - Faecal calprotectin - Stool occult blood - Stool culture - Endoscopy
139
What are non-infectious causes of diarrhoea (9)?
- IBD - IBS - Coeliac disease - Bowel cancer - Stress - Hyperthyroidism - Hyperkalaemia - Drug-induced e.g laxatives - Menustration
140
What is dyspepsia?
Pain or discomfort in the upper abdomen that usually occurs after eating or drinking (indigestion)
141
What is pseudomembranous colitis?
Inflammation of the colon due to overgrowth of clostridium difficile bacteria
142
When does pseudomembranous colitis usually occur?
Following antibiotic use - antibiotics disrupt normal bacterial flora but clostridium difficile is resistant to many antibiotics so will thrive
143
How can pseudomembranous colitis be treated (4)?
- Discontinue antibiotics - Vancomycin - Rehydration - Probiotics
144
Describe the presentation of pseudomembranous colitis (3).
- Abdominal pain - Fever - Diarrhoea
145
What is a complication of pseudomembranous colitis?
Toxic megacolon - colon gets dilated and may rupture which can cause death
146
What is the 1st line investigation for pseudomembranous colitis?
Stool testing - presence of clostridium difficile
147
What is the gold standard investigation for pseudomembranous colitis?
Sigmoidoscopy/colonoscopy
148
What is achalsia?
An oesophageal motor disorder characterised by oesophageal aperistalsis and insufficient relaxation of the LOS in response to swallowing
149
Describe the presentation of achalasia.
- Sudden onset dysphagia to solids and liquids - Adopts certain positions to aid swallowing - Regurgitation - Retrosternal pain - Gradual weight loss
150
How can achalasia be diagnosed?
- Upper GI endoscopy - exclude malignancy - Barium swallow - bird beak appearance - Manometry
151
How can achalasia be treated?
- Drugs to relax LOS e.g isosorbide dinitrate, nifedipine, verapamil - Pneumatic dilation - uses a balloon to open LOS - Laparoscopic hellers myotomy
152
What are the 3 types of bowel ischaemia?
- Acute mesenteric ischaemia - Chronic mesenteric ischaemia - Ischaemic colitis
153
Which area of the bowel is most prone to ischaemia? Why?
Splenic flexure - it is a watershed region
154
What are risk factors for bowel ischaemia (9)?
- Atherosclerosis - Older age - Smoking - Heavy exercise - Heart failure - Atrial fibrillation - Hypercoagulability - Hyperlipidaemia - Vasculitis
155
What are the 2 types of oesophageal cancers?
- Adenocarcinoma - Squamous cell carcinoma
156
Where is an oesophageal adenocarcinoma found?
Lower 1/3 of the oesophagus
157
Where is an oesophageal squamous cell carcinoma found?
Upper 2/3 of the oesophagus
158
Which type of oesophageal cancer is most common in the UK?
Adenocarcinoma
159
What are the risk factors for oesophageal cancer (10)?
- Older age - Male - Smoking - Alcohol - Hot drinks - Achalasia - GORD - Oesophagitis - Barrets oesophagus - Hiatus hernia
160
Describe the presentation of oesophageal cancer.
ALARMS VC: - Anaemia - Loss of weight - Anorexia - Recent onset, progressive symptoms - Meleana - Swallowing difficulties - progressive dysphagia - Vomiting - Chest pain
161
What is the 1st line investigation for oesophageal cancer?
Upper GI endoscopy and biopsy
162
What can be used for staging of cancers?
CT scan
163
What are the risk factors for gastric cancer (6)?
- Male - Older age - Family history - Smoking - H. pylori - Pernicious anaemia
164
Describe the presentation of gastric cancer (3).
- Epigastric pain - Weight loss - Lymphadenopathy: --> Virchow's node - left supraclavicular node --> Sister Mary Joseph's node - umbilical node --> Irish node - left axillary node
165
What is the 1st line investigation for gastric cancer?
Upper GI endoscopy and biopsy
166
What is the most common cancer of the GI tract?
Colorectal cancer
167
Where are colon cancers usually found?
Left side: - Rectum - Sigmoid colon
168
What are the risk factors for colon cancer (8)?
- Older age - Family history - Obesity - Smoking - Red meat - IBD - Familial adenomatous polyposis (FAP) - Hereditary non-polyposis colorectal cancer (HNPCC)
169
How is colon cancer diagnosed?
Colonoscopy and biopsy
170
Name the staging system used for colon cancer.
Dukes staging system
171
Name the tumour marker associated with colon cancer.
Carcinoembryonic antigen (CEA)
172
Which gene is associated with HNPCC?
MSH2/MLH1
173
What is used to screen for bowel cancer?
FIT test - detects small amount of blood in the stool - Sent to those every 2 years between the ages of 60 - 74
174
What are haemorrhoids?
Swollen veins found in the anus or rectum
175
What are the 2 types of haemorrhoids?
- Internal - painless, covered in mucus - External - painful, covered in skin
176
Describe the presentation of haemorrhoids (4).
- Perianal pain - Constipation - Itchy anus - Fresh, bright, red blood on paper and outside of stools
177
How are haemorrhoids diagnosed?
Anoscopy
178
How are haemorrhoids treated (4)?
- Lifestyle changes e.g increased fluid and fibre intake - Stool softeners - Analgesia - topical anusol - Haemorrhoidectomy
179
What is an anal fistula?
An abnormal connection between the anal canal and perianal skin
180
Which condition is associated with anal fistulas?
Crohns disease
181
What is an anal fissure?
A tear in the sensitive skin-lined lower anal canal, distal to the dentate line
182
What is the main cause of anal fissures?
Hard faeces
183
Describe the presentation of anal fissures (3).
- Intense pain on defaecation - Tearing sensation of defaecation - No fresh blood on stool or paper

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