Flashcards in Gastroenterology Deck (115):
What is Peptic Ulcer disease?
A surface breach of the mucosal lining of the GI tract, occurring as a result of acid and pepsin attack
What is the stool volume in secretory diarrhoea?
What is odynophagia?
At what level does the superior mesenteric artery arise from the abdominal aorta?
Which artery supplies the jejenum and ileum?
Superior mesenteric artery
What can untreated GORD lead to?
Name two IBD.
What are the parasympathetic fibres of the stomach?
Gastric branches of the left and right vagus nerves
From what does the stomach get sympathetic innervation?
What is the ion gap in secretory diarrhoea?
Less than 100mOsm/kg
What is the most common cause of PUD?
H. pylori infection
What are the four layers of the gut?
What are the three types of diarrhoea?
What is inflammatory diarrhoea?
Diarrhoea occurring when there is damage to the mucosal lining or brush border, leading to passive loss of protein-rich fluids and decrease ability to absorb lost fluids
Name a possible cause of inflammatory diarrhoea.
What is secretory diarrhoea?
Diarrhoea due to an increase in active secretion or an inhibition of absorption
Name a possible cause of secretory diarrhoea.
Cholera toxin - stimulates secretion of anions, especially chloride ions
Name symptoms of GORD.
What happens to osmotic diarrhoea in response to fasting?
What happens to secretory diarrhoea in response to fasting?
The diarrhoea continues
What is the main cause of steattorrhoea?
Name something that can cause it.
Malabsorption of fat
Pancreatic disease or Coeliac disease
What is osmotic diarrhoea?
Water is drawn into the bowels resulting in watery stool
Name a possible cause of osmotic diarrhoea.
Maldigestive cause such as coeliac disease
What is GORD?
Symptoms of mucosal damage produced by the abnormal reflux of gastric contents into the oesophagus
What is the ion gap in osmotic diarrhoea?
More than 100mOsm/kg
What are the symptoms of giardiasis?
Normally associated with recent travel, for example India
What bacteria can cause traveller's diarrhoea?
ETEC - Enterotoxigenic Escherichia coli
What can sometimes precipitate a C. diff infection?
What types of drugs neutralise stomach acid?
Name two side effects of alginates and which two products cause them.
What is the mechanism of action of sucralfate and misoprostol?
Promote mucosal defense
Name side effects of sucralfate.
Reduction in absorption of some drugs
How does misoprostol work?
Binds to prostaglandin receptors on parietal cells causing a negative feedback on the proton pump
What is the most common adverse effect of misoprostol?
Why is misoprostol contraindicated in pregnant women and women of child-bearing age?
Can cause partial or complete abortions (due to being PGE1 analog)
Can cause birth defects
What drugs can cause gastric ulceration?
What are metoclopramide and domperidone's mechanism of action?
Gastric stimulants (increase food transit through stomach)
Act as D2 receptor antagonists
What class of drug inhibit histamine actions at H2 receptors?
H2 receptor antagonists:
What effect do H2 receptor antagonists have?
Inhibit gastric secretion
What does PPI stand for and give examples of them.
Proton pump inhibitor:
How do PPIs work?
Irreversibly inhibit action of proton pump, reducing both basal and stimulated gastric acid secretion
Although uncommon, what are some side effects of PPIs?
What are some adverse side effects of PPIs?
Increased risk of C. diff infection
Rebound acid hypersecretion (if drugs stopped)
Increased risk of fracture
Which bacterial infection is associated with development of gastric and duodenal ulcers and gastric cancers?
Name two viruses that may cause diarrhoea.
What is the most likely cause of diarrhoea in a patient who is or has recently been in hospital?
C. diff infection
What causes pernicious anaemia?
Reduction in vitamin B 12 absorption
Which cells in the stomach produce gastrin?
Which cells are stimulated by gastrin?
Which cells secrete somatostatin and what is its action?
Inhibit gastrin release
Where are G cells found?
Gastric pits of pyloric antrum
Where are chief cells primarily found and what do they produce?
Near base of gland
Where are parietal cells found and what do they secrete?
Proximal portion of gland
Secrete hydrochloric acid (H+ via proton pump with Cl-) and intrinsic factor
What does intrinsic factor do?
Aids in absorption of B12
What are the associated symptoms of dyspepsia that can increase cancer risk?
Loss of weight
Recent progressive symptoms
What do prostaglandins regulate in the stomach?
Release of bicarbonate and mucous
Maintain mucosal blood flow
In a patient with GORD and 'alarm' symptoms, how would you investigate?
What is 24-hour intraluminal pH monitoring reserved for?
Confirmation of GORD prior to surgery or in difficult diagnostic cases
What would a barium swallow show the presence of?
When would a plain abdomen X-ray be used?
Investigation of acute abdomen or acute colitis
Which abdominal organs is ultrasound a first-line investigation for?
What non-invasive tests are used to investigate H. pylori infection?
Urea breath test
Serological tests to detect H. pylori IgG antibodies
How would you treat H. pylori infection?
PPI plus metronidazole and clarithromycin; or
PPI plus amoxicillin and clarithromycin
(all twice daily for a week)
How should you investigate a patient over 60 years with ulcer-type symptoms and why?
To rule out gastric cancer
In an acute upper GI bleed what is your first choice of investigation?
In a lower GI bleed what investigations could you do to determine the site of bleeding?
What is Meckel's diverticulum?
Congenital abnormality where a diverticulum projects from the wall of the ileum
What is Crohn's disease characterised by?
Affect whole thickness of bowel wall
What is characteristic of Ulcerative colitis?
Only mucosal layer affected of rectum +/- colon
What produces the cobblestone appearance in CD?
Deep ulcers and fissures in mucosa
What are risk factors for CD?
What is a protective factor for UC?
What is the immune response mediated by in CD?
Th1 cells and macrophages (cell mediated immunity)
What is the immune response mediated by in UC?
Th2 and B cells (humoral immunity)
What part of the GIT is most commonly affected in CD?
What investigations would you do for suspected CD?
Bloods (FBC, Inflammatory markers, Antibody serology)
Barium follow through
How would you investigate a suspected UC?
Stool examination (microbiology)
Bloods (FBC, Inflammatory markers, U&Es, LFTs)
What are the possible complications of UC?
Primary sclerosing cholangitis
What is first line short term drug treatment for IBD?
Glucoorticoids - Prednisolone
What medication is used to maintain remission in IBD?
5-ASA drugs - e.g. mesalazine, olsazine
What immunosuppressant can be used for treatment of UC?
What immunosuppressant can be used for treatment in CD?
What would severe pain occurring after meals, with less frequent relief by antacids or food be indicative of?
What would epigastric discomfort, with pain radiating to the back, 2-5 hours after eating or when hungry, with burning and hunger-like pains be a sign of?
What is the most common functional bowel disorder?
Irritable bowel syndrome
What are some symptoms of IBS?
Nausea and vomiting
Abdo pain and bloating
Mucus in stool
What does the Rome III diagnostic criteria state a patient must have to be diagnosed with IBS?
In preceding 3 months, at least 3 days per month of recurrent abdo pain or discomfort, associated with at least 2 of following:
Improvement with defecation
Onset associated with change in frequency in stool
Onset associated with change in form of stool
What are the main three subtypes of IBS?
IBS with constipation
IBS with diarrhoea
Which are the most common subtypes of IBS?
IBS with constipation or mixed IBS
What are the three classified subgroups of constipation with a normal colon diameter?
Normal transit constipation
Slow transit constipation
What symptoms are associated with slow transit constipation?
Infrequent urge to defecate
In which patient is slow transit constipation most common?
Young women, with symptoms dating back to childhood
What is disordered defecation usually due to?
Rectal redundancy caused by:
Pelvic floor dysfunction
Anal sphincter dysfunction
Structural abnormality (eg rectocele)
What is severe constipation with gut dilatation normally secondary to?
Neuromuscular disorder of the colon:
Idiopathic mega colon
Chronic intestinal pseudo-obstruction
What is Hirschsprung's disease?
Congenital anganglionosis of colon, resulting in absence of anorectal reflexes
What are the main complications of idiopathic megarectum/megacolon?
How are the findings on an abdominal contrast study different between Hirschsprung's disease and idiopathic megarectum?
Hirschsprung's - colon proximal to narrowing is dilated
Megarectum - colon distal to narrowing shows continuous dilatation until point of narrowing
In presence of constipation what diagnosis would anaemia suggest?
What does an evacuation proctography show?
Functional abnormalities - eg incoordination of pelvic floor and anal sphincters
Structural abnormalities - eg intussusception, rectal prolapse or rectocele
What is a useful method of measuring motor function of the whole gut?
Radio-opaque marker study of whole gut transit
What diagnosis does the presence of a recto-anal inhibitory reflex exclude?
What might an ano-rectal sensory test show?
Loss of rectal sensation, seen in MS and Parkinson's
What diet advice is given to patients with constipation?
Increased fibre intake
Increased liquid intake
Name some stimulant laxatives and when would they be used?
Senna or bisacodyl
As required (to prevent laxative dependence)
What are some osmotic laxative agents and when are they used?
Magnesium salts and lactulose
Effective in slow transit constipation
How do bulk-forming laxatives work?
Retain fluid within stool, increasing faecal mass
What is the order of treatment for short duration constipation in adults?
1st line - bulk forming laxative
2nd - add/switch to osmotic laxative
3rd - if stools are soft, but still finds difficult to pass, add stimulant laxative
What is in probiotics used for treating IBS?
What is prucalopride?
Selective serotonin receptor agonist, acting on serotonin releasing enteroendocrine cells
What are antispasmodics used in chronic constipation?
What can be used for pain management in chronic constipation?
Antidepressants, eg fluoxetine, paroxetine, citalopram
What are the surgical options for constipation caused by dysmotility?
Sacral nerve stimulation
Antegrade colonic enema
What does sacral nerve stimulation involve?
Implantation of programmable stimulator subcutaneously, which delivers low amplitude electrical stimulation via a lead to sacral nerve
What does the antegrade colonic enema (ACE) procedure involve?
Surgical creation of stoma, which functions as irrigation port to introduce fluid to wash out colon at regular intervals