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Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Symptoms of IBS

A

Abdo pain (on defacation)
Diarrhoea/constipation
Bloating
Nausea
Mucus in poo

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2
Q

Diagnosis of IBS

A

Rule out DDs
Dx on hx

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3
Q

Treatment for IBS

A

Lifestyle changes
Cut out certain foods
Symptom management

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4
Q

Risk Factors for Diverticulitis

A

> 60 y/o
Low fibre diet
diverticulosis

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5
Q

Cause of diverticulitis

A

Increased intraluminal pressure in sigmoid + weakness of intestinal wall -> pouches (diverticula)
or
Chronic inflammation -> acute (erosion of diverticular wall)

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6
Q

Symptoms of diverticulitis

A

LLQ pain
Mass
Blood/mucus in poo
Acute constipation
Polyuria
Acute abdomen (emergency)

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7
Q

Dx of Diverticulitis

A

Contrast CT
raised WBC/CRP
neg dipstick
pos FOBT (faecal occult blood test)

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8
Q

Treatment for diverticulitis

A

If uncomplicated, no Abx, just pain relief
->
Oral Abx
->
IV Abx, surgical resection

Oral – co-amoxiclav 500/125mg TDS/5d OR trimethomprim 200mg BD/5d + Metronidazole 400mg TDS/5d (in penicillin allergic)
IV – co-amoxiclav 1.2g TDS or Ciprofloxacin 400mg BD/TDS + Metronidazole 500mg TDS (in penicillin allergic)
AGM (Amoxicillin, Gentamicin, Metronidazole) in severe cases

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9
Q

Risk Factors for Ulcerative Colitis

A

15-35/55-65 y/o
HLA-B27 gene
+ve FHx
more common in White population

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10
Q

Pathophysiology of Ulcerative Colitis

A

Increased permeability of the luminal epithelium -> more bacteria can enter -> upregulation of lymphatic cells in the bowels

Upregulated immune response -> inflammation and damage of the bowel mucosa and submucosa

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11
Q

Cause of Ulcerative Colitis

A

Autoimmune attack on the mucosal/submucosal layers of the rectum
Always begins in the rectum and the progresses continuously proximally, but never surpasses the ileocaecal valve

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12
Q

Symptoms & Signs of Ulcerative Colitis

A

bloody diarrhoea + mucus
urgency
LLQ pain
Tenesmus

Osteoarthritis/ankylosing spondylitis
Erythema nodosum
Pyoderma gangrenosum

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13
Q

Ix Ulcerative Colitis

A

pANCA -> +ve
raised WBC/CRP
anaemia
Calprotectin (raised)
Stool Cultures

Endoscopy & Biopsy:
- Early – friable mucosa that bleeds on contact, inflamed and erythematous, small ulcers covered by fibrin
Late - Widespread ulceration with preservation of surrounding mucosa (pseudopolyps – repeated ulceration -> granulation process), deep ulcers, loss of haustra (seen also on imaging)
Biopsy – inflammatory cells infiltrates in the lamina propria, crypt abscess (neutrophil infiltration of the lumen due to breakdown of crypt epithelium), epithelial dysplasia (increased risk of developing bowel cancer)

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14
Q

Treatment for Ulcerative Colitis

A

Aminosalicylates (mesalazine) rectal -> + oral
+/- oral steroids -> IV

IV Ciclosporin if severe
Azathioprine/Mercaptopurine

Proctocolectomy + J pouch

Smoking is protective

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15
Q

Risk Factors for Crohn’s Disease`

A

15-35/55-65 y/o
HLA B27 gene
+ve FHx
White

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16
Q

Pathophysiology of Crohn’s Disease

A

Autoimmune attack on all layers of the entire GI tract
Transmural fissures and inflammation

Areas of inflammation interrupted by healthy gut - known as skip lesions

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17
Q

Why is there a higher chance of perforation and fistula formation in Crohn’s compared to UC?

A

because Crohn’s involves all layers of the gut wall, whereas UC only involves the mucosal and submucosal layers

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18
Q

Signs and symptoms of Crohn’s

A

RLQ pain +/- mass
Chronic diarrhoea w/ NO bleeding
Malabsorption
Uveitis (eye)
Erythema nodosum
Pyoderma gangrenosum

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19
Q

Ix Crohn’s

A

pANCA is -ve, rules out UC
raised WBC/CRP
anaemia
calprotectin raised
stool cultures

Endoscopy + biopsy:
- cobblestone appearance: inflammation surrounded by deep necrosis
- granuloma formation
- inflammation in all layers of the gut

20
Q

Treatment for Crohn’s

A

Prednisolone +/- Azathioprine/Mercaptopurin for induction, no steroid for maintenance
Infliximab and Adalimumab (anti-TNF) for severe

Smoking is exacerbating

21
Q

What is oesophagitis?

A

Inflammation of the oesophagus most commonly due to GORD (gastro-oesophageal reflux disease)

22
Q

Sx of oesophagitis

A

retrosternal pain
vomiting a small volume of blood
resolves spontaneously

23
Q

Tx for oesophagitis

A

PPI cover for 8w
If not resolving test for H. Pylori (urea-breath)

24
Q

Tx for GORD

A

omeprazole 20mg OD -> 40mg OD

25
Q

What is erosive gastritis?

A

Inflammation and erosion of the gastrci mucosa, most commonly due to NSAIDs, H.Pylori, alcohol

26
Q

Causes of erosive gastritis

A

Alcohol
H. Pylori
NSAIDs

27
Q

Sx of erosive gastritis

A

Epigastric pain
dyspepsia
early satiety
small volume bleeding

28
Q

Tx for H. Pylori

A

Triple treatment:
- Amoxicillin (if penicillin allergic then metronidazole)
- Clarithromycin
- Omeprazole

For 7 days

29
Q

What is peptic ulcer disease?

A

Worsening erosive gastritis
Ulcers either of the gastric of duodenal mucosa

30
Q

How do you tell the difference between a gastric and duodenal peptic ulcer?

A

pain on eating -> gastric
Pain relieved by eating -> duodenal

31
Q

Tx of peptic ulcer disease?

A

PPI cover for 4-8wks
If perforation, surgical closure of hole

32
Q

What are varices?

A

dilated submucosal veins due to severe liver disease

33
Q

Presentation of a varice?

A

Haematemesis (vomiting blood)
melena (black tarry stools)
sudden onset severe bleeding

34
Q

Tx Varices

A

A-E assessment
Terlipressin
-> endoscopic ligation/adrenaline sclerotherapy

35
Q

What is a dieulafoy lesion?

A

Minor mucosal trauma over abnormal large blood vessel in proximal stomach

36
Q

What is a Mallory-Weiss tear?

A

Laceration of the distal oesophageal mucosa upon sudden increase in pressure (vomiting)

37
Q

Tx for C.diff infection

A

ORAL vancomycin
Severe infections -> PO vancomycin + IV metronidazole

Recurrent infections -> faecal transplant

38
Q

Features of vitamin C deficiency (scurvy)

A

Spontaneous bleeding and bruising
gingival swelling
coiled hairs
teeth loss

39
Q

Clinical features of vitamin B1 (thiamine) deficiency

A

Wernicke’s encephalopathy (confusion, ataxia, and ocular abnormalities)
Wet beriberi (high output cardiac failure)
Dry beriberi (peripheral neuropathy)

40
Q

Features of vitamin B3 deficiency

A

Diarrhoea
Dermatitis
Dementia

41
Q

Features of vitamin A deficiency

A

Night blindness
Xerophthalmia (risking corneal ulceration)
Complete blindness can occur

42
Q

Tx of vitamin B3 deficiency

A

nicotinamide

43
Q

Cause of typhoid fever

A

Spread by eating or drinking food or water contaminated w/ the faeces of a person infected with Salmonella typhi

44
Q

Risk factors for typhoid fever

A

Poor hygiene
Poor sanitation
Travelling in the developing world

45
Q

Clinical features of typhoid fever

A

Gradual onset of a high fever over several days
Weakness
Abdominal pain
Constipation
Headaches
Some people develop a skin rash w/ rose coloured spots
Confusion if severe

Medicine (13 decks)

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