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Gastroenterology Flashcards

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1
Q

Crohn’s disease: Definition

A

Chronic inflammatory disease affecting any part of gut from mouth to anus

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2
Q

Crohn’s disease: Pathology (2)

A
  1. Transmural granulomatous inflammation
  2. Unaffected areas of bowel between active disease
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3
Q

Crohn’s disease: Part most often affected

A

Terminal ileus

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4
Q

Crohn’s disease: Cause

A

Inappropriate response against the gut flora in a genetically susceptible individual

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5
Q

Crohn’s disease: Typical age of presentation

A

20-40

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6
Q

Crohn’s disease: Environmental associations

A

Smoking (increases risk 3 fold)
NSAIDS

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7
Q

Crohn’s disease: 3 key symptoms

A

Diarrhoea
Abdominal pain
Malnutrition/failure to thrive

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8
Q

Crohn’s disease: 4 key systemic symptoms

A

Fatigue
Fever
Malaise
Anorexia

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9
Q

Crohn’s disease: key signs on examination (2)

A

Abdominal tenderness/mass
Erythema Nodosum

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10
Q

Crohn’s disease: 3 key findings on PR

A
  1. Perianal abscesses, fistulae, skin tags
  2. Bowel Ulceration
  3. Anal strictures
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11
Q

Crohn’s disease: Potential systemic signs on exam (2)

A
  1. Clubbing
    May also present with , skin, joint & eye problems
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12
Q

Crohn’s disease: Complications (4)

A
  1. Small bowel obstruction
  2. Toxic dilatation
  3. Abscess formation
  4. Fistulae
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13
Q

Crohn’s disease: Key blood tests (4)

A
  1. FBC
  2. CRP
  3. U&Es
  4. ferritin, B12, Folate
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14
Q

Crohn’s disease: 2 Key stool tests

A
  1. Stool culture to exclude bacterial cause
  2. Faecal calprotectin (GI inflammation)
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15
Q

Crohn’s disease: Key investigations (3)

A
  1. Colonoscopy and biopsy
  2. Endoscopy
  3. MRI
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16
Q

Crohn’s disease: What can capsule endoscopy be used to investigate?

A

Proximal disease

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17
Q

Crohn’s disease: MRI findings (2)

A

Pelvic disease and fistulae
Small bowel disease activity and strictures

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18
Q

Crohn’s disease: Non-pharmacological management (2)

A

Smoking cessation
Optimise nutrition

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19
Q

Crohn’s disease: Blood test results which are indications for steroid use (4)

A

High HR,
High WCC,
High CRP or low albumin

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20
Q

Crohn’s disease: Mild-moderate Disease treatment (2)

A

Prednisolone (high dose for 1 week, then decrease for 7 weeks)
Diet changes are effective in children

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21
Q

Crohn’s disease: Severe disease treatment (3)

A
  1. IV rehydration
  2. IV steroids (hydrocortisone)
  3. Thromboembolism prophylaxis
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22
Q

Crohn’s disease: Perianal disease epidemiology

A

Occurs in 50% of patients

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23
Q

Crohn’s disease: Perianal disease investigation (2)

A

MRI and examination

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24
Q

Crohn’s disease: Treatment of perianal disease (2)

A

Oral antibiotics
Immunosuppressant therapy (TNF-alpha - iximab)

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25
Crohn's disease: Azathioprine (type of drug and indication)
Immunomodulator Used if disease is refractory to steroids
26
Crohn's disease: Anti-TNFalpha (Mechanism of action)
Infliximab, Adalimumab TNF alpha plays key role in Crohn's pathology These block the drivers of the immune response
27
Crohn's disease: Anti-integrin (Mechanism of action)
Target molecules involved in lymphocyte trafficking in the gut
28
Crohn's disease: Indications for surgery (4)
1. Drug failure 2. GI obstruction due to stricture 3. Perforation 4. Fistulae or abcess
29
Primary Biliary Cholangitis: Definition
Interlobular bile ducts are damaged by chronic granulomatous inflammation
30
Primary Biliary Cholangitis: Pathophysiology
Inflammation may lead to cholestasis which leads to fibrosis, cirrhosis and portal hypertension.
31
Primary Biliary Cholangitis: Aetiology
Unknown environmental triggers (?pollutants, xenobiotics) + genetic predisposition leading to loss of immune tolerance to self-mitochondrial proteins
32
Primary Biliary Cholangitis: Testing hallmark of PBC
Anti-mitochondrial antibodies
33
Primary Biliary Cholangitis: Associations/aetiology
Female gender Autoimmune diseases Rheumatoid conditions
34
Primary Biliary Cholangitis: Factors increasing risk (4)
Family History Smoking Many UTIs Other immune diseases
35
Primary Biliary Cholangitis: Typical age of presentation
Approximately 50
36
Primary Biliary Cholangitis: How is this typically found?
Patient usually asymptomatic, and are diagnosed after incidental finding of raised ALP
37
Primary Biliary Cholangitis: What is cholestasis?
Obstruction of outflow of bile
38
Primary Biliary Cholangitis: Which chemicals does cholestasis cause to build up? (3)
Bilirubin Bile Acids Cholesterol
39
Primary Biliary Cholangitis: Effect of bile acid build up
Itching
40
Primary Biliary Cholangitis: Effect of bilirubin build up
Jaundice
41
Primary Biliary Cholangitis: Effect of Raised cholesterol (2)
Cholesterol deposits (Xanthelasma) and increased cardiovascular risk
42
Primary Biliary Cholangitis: 3 signs which may precede Jaundice
Lethargy Sleepiness Pruritus
43
Primary Biliary Cholangitis: Signs apart from the key 3 (2)
Skin pigmentation Hepatosplenomegaly
44
Primary Biliary Cholangitis: Effect of lacking bile acids in the stool (2)
GI disturbance Greasy stools (fat malabsorption)
45
Primary Biliary Cholangitis: Effect of lack of bilirubin in stool
Pale stools
46
Primary Biliary Cholangitis: Possible boney complications (2)
Osteoporosis Osteomalacia (decreased bilirubin in gut)
47
Primary Biliary Cholangitis: Hepatic complications
Cirrhosis Malabsorption of fat soluble vitamins Hepatocellular carcinoma
48
Primary Biliary Cholangitis: Liver function tests in early disease (3)
1. ALP is the first and most obviously raised 2. GGT may be raised 3. Can present with mildly raised AST and ALT
49
Primary Biliary Cholangitis: Liver function tests in late disease (3)
High bilirubin Low albumin Increased prothrombin time
50
Primary Biliary Cholangitis: Most common autoantibody finding
98% are +ve for anti-mitochondrial antibodies
51
Primary Biliary Cholangitis: Auto-antibody which may occur in low-titres
Anti-nuclear antibodies (present in 35%)
52
Primary Biliary Cholangitis: Blood tests which are affected (2)
Raises IgM ESR raised
53
Primary Biliary Cholangitis: 5 Key Tests
1. LFTs 2. Autoantibodies 3. Other blood tests 4. Liver biopsy 5. Ultrasound
54
Primary Biliary Cholangitis: Ultrasound findings
Excludes extra hepatic cholestasis
55
Primary Biliary Cholangitis: When might a liver biopsy be used
Not usually needed Can be used for diagnosis and staging or excluding drug-induced cholestasis or hepatic sarcoidosis
56
Primary Biliary Cholangitis: 4 Stages of treatment
1. Urso 2. Colestryamine 3. Fat-soluble vitamin prophylaxis 4. Liver-transplant for end-stage disease
57
Primary Biliary Cholangitis: What is the effect of Urso?
Reduces intestinal absorption of cholesterol
58
Primary Biliary Cholangitis: What is the effect of colestyramine?
Sequesters bile acids to prevent absorption in the gut - it can help with pruritus
59
Primary Biliary Cholangitis: Monitoring (2)
1. Regular LFTs 2. Ultrasound and AFP tumour marker (if cirrhosis)
60
Primary Biliary Cholangitis: Most important potential end results of disease (2)
Advanced liver cirrhosis Portal hypertension

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