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Flashcards in Gastroenterology Deck (115):
1

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

2

What is the stool volume in secretory diarrhoea?

Very large

3

What is odynophagia?

Painful swallowing

4

At what level does the superior mesenteric artery arise from the abdominal aorta?

L1 vertebra

5

Which artery supplies the jejenum and ileum?

Superior mesenteric artery

6

What can untreated GORD lead to?

Barretts oesophagus

7

Name two IBD.

Crohns disease
Ulcerative colitis

8

What are the parasympathetic fibres of the stomach?

Gastric branches of the left and right vagus nerves

9

From what does the stomach get sympathetic innervation?

Splanchnic nerves
Coeliac ganglion

10

What is the ion gap in secretory diarrhoea?

Less than 100mOsm/kg

11

What is the most common cause of PUD?

H. pylori infection

12

What are the four layers of the gut?

Mucosa
Submucosa
Muscularis externa
Serosa

13

What are the three types of diarrhoea?

Osmotic
Secretory
Inflammatory

14

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

15

Name a possible cause of inflammatory diarrhoea.

IBD
Infections

16

What is secretory diarrhoea?

Diarrhoea due to an increase in active secretion or an inhibition of absorption

17

Name a possible cause of secretory diarrhoea.

Cholera toxin - stimulates secretion of anions, especially chloride ions

18

Name symptoms of GORD.

Heartburn
Acid reflux
Dysphagia
Chest pain
Water brash
Odynophagia
Nausea

19

What happens to osmotic diarrhoea in response to fasting?

It stops

20

What happens to secretory diarrhoea in response to fasting?

The diarrhoea continues

21

What is the main cause of steattorrhoea?
Name something that can cause it.

Malabsorption of fat
Pancreatic disease or Coeliac disease

22

What is osmotic diarrhoea?

Water is drawn into the bowels resulting in watery stool

23

Name a possible cause of osmotic diarrhoea.

Maldigestive cause such as coeliac disease

24

What is GORD?

Symptoms of mucosal damage produced by the abnormal reflux of gastric contents into the oesophagus

25

What is the ion gap in osmotic diarrhoea?

More than 100mOsm/kg

26

What are the symptoms of giardiasis?

Steatthorrea
Normally associated with recent travel, for example India

27

What bacteria can cause traveller's diarrhoea?

ETEC - Enterotoxigenic Escherichia coli

28

What can sometimes precipitate a C. diff infection?

Antibiotic treatment

29

What types of drugs neutralise stomach acid?

Antacids

30

Name two side effects of alginates and which two products cause them.

Constipation (aluminium)
Diarrhoea (magnesium)

31

What is the mechanism of action of sucralfate and misoprostol?

Promote mucosal defense

32

Name side effects of sucralfate.

Constipation
Reduction in absorption of some drugs
Nausea
Dry mouth
Bezoar formation
Vomiting
Headaches
Rashes

33

How does misoprostol work?

Binds to prostaglandin receptors on parietal cells causing a negative feedback on the proton pump

34

What is the most common adverse effect of misoprostol?

Diarrhoea

35

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

36

What drugs can cause gastric ulceration?

NSAIDs

37

What are metoclopramide and domperidone's mechanism of action?

Gastric stimulants (increase food transit through stomach)
Act as D2 receptor antagonists

38

What class of drug inhibit histamine actions at H2 receptors?

H2 receptor antagonists:
Ranitidine
Cimetidine
Nizatidine
Famotidine

39

What effect do H2 receptor antagonists have?

Inhibit gastric secretion

40

What does PPI stand for and give examples of them.

Proton pump inhibitor:
Omeprazole
Lansoprazole
Pantoprazole
Esomeprazole

41

How do PPIs work?

Irreversibly inhibit action of proton pump, reducing both basal and stimulated gastric acid secretion

42

Although uncommon, what are some side effects of PPIs?

Headaches
Diarrhoea
Rashes

43

What are some adverse side effects of PPIs?

Pneumonia
Increased risk of C. diff infection
Rebound acid hypersecretion (if drugs stopped)
Increased risk of fracture
Drug interactions

44

Which bacterial infection is associated with development of gastric and duodenal ulcers and gastric cancers?

H. pylori

45

Name two viruses that may cause diarrhoea.

Rotavirus
Norovirus

46

What is the most likely cause of diarrhoea in a patient who is or has recently been in hospital?

C. diff infection

47

What causes pernicious anaemia?

Reduction in vitamin B 12 absorption

48

Which cells in the stomach produce gastrin?

G cells

49

Which cells are stimulated by gastrin?

Chief cells
Parietal cells

50

Which cells secrete somatostatin and what is its action?

D cells
Inhibit gastrin release

51

Where are G cells found?

Gastric pits of pyloric antrum

52

Where are chief cells primarily found and what do they produce?

Near base of gland
Secrete pepsinogen

53

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

54

What does intrinsic factor do?

Aids in absorption of B12

55

What are the associated symptoms of dyspepsia that can increase cancer risk?

Anaemia
Loss of weight
Anorexia/vomiting
Recent progressive symptoms
Melaena/haematemesis

56

What do prostaglandins regulate in the stomach?

Release of bicarbonate and mucous
Maintain mucosal blood flow

57

In a patient with GORD and 'alarm' symptoms, how would you investigate?

Gastroscopy
Barium swallow

58

What is 24-hour intraluminal pH monitoring reserved for?

Confirmation of GORD prior to surgery or in difficult diagnostic cases

59

What would a barium swallow show the presence of?

Hiatus hernia
Motility disorders

60

When would a plain abdomen X-ray be used?

Investigation of acute abdomen or acute colitis

61

Which abdominal organs is ultrasound a first-line investigation for?

Liver
Gall-bladder
Spleen
Pancreas

62

What non-invasive tests are used to investigate H. pylori infection?

Urea breath test
Serological tests to detect H. pylori IgG antibodies
Stool tests

63

How would you treat H. pylori infection?

PPI plus metronidazole and clarithromycin; or
PPI plus amoxicillin and clarithromycin
(all twice daily for a week)

64

How should you investigate a patient over 60 years with ulcer-type symptoms and why?

Endoscopy
To rule out gastric cancer

65

In an acute upper GI bleed what is your first choice of investigation?

Endoscopy

66

In a lower GI bleed what investigations could you do to determine the site of bleeding?

Rectal examination
Proctoscopy
Sigmoidoscopy
Barium enema
Colonoscopy
Angiography

67

What is Meckel's diverticulum?

Congenital abnormality where a diverticulum projects from the wall of the ileum

68

What is Crohn's disease characterised by?

Skip lesions
Affect whole thickness of bowel wall
Granulomatous nature

69

What is characteristic of Ulcerative colitis?

Only mucosal layer affected of rectum +/- colon
Continuous distribution
Non-granulomatous nature

70

What produces the cobblestone appearance in CD?

Deep ulcers and fissures in mucosa

71

What are risk factors for CD?

Genetics
Diet
Smoking
Female

72

What is a protective factor for UC?

Smoking

73

What is the immune response mediated by in CD?

Th1 cells and macrophages (cell mediated immunity)

74

What is the immune response mediated by in UC?

Th2 and B cells (humoral immunity)

75

What part of the GIT is most commonly affected in CD?

Terminal ileum

76

What investigations would you do for suspected CD?

Bloods (FBC, Inflammatory markers, Antibody serology)
Barium follow through
Colonoscopy

77

How would you investigate a suspected UC?

Stool examination (microbiology)
Bloods (FBC, Inflammatory markers, U&Es, LFTs)
Abdo X-ray
Endoscopy (colonoscopy)

78

What are the possible complications of UC?

Primary sclerosing cholangitis
Bowel cancer
Toxic megacolon

79

What is first line short term drug treatment for IBD?

Glucoorticoids - Prednisolone

80

What medication is used to maintain remission in IBD?

5-ASA drugs - e.g. mesalazine, olsazine

81

What immunosuppressant can be used for treatment of UC?

Ciclosporin

82

What immunosuppressant can be used for treatment in CD?

Methotrexate

83

What would severe pain occurring after meals, with less frequent relief by antacids or food be indicative of?

Gastric ulcer

84

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?

Duodenal ulcer

85

What is the most common functional bowel disorder?

Irritable bowel syndrome

86

What are some symptoms of IBS?

Nausea and vomiting
Bowel urgency
Abdo pain and bloating
Mucus in stool

87

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

88

What are the main three subtypes of IBS?

IBS with constipation
IBS with diarrhoea
Mixed IBS

89

Which are the most common subtypes of IBS?

IBS with constipation or mixed IBS

90

What are the three classified subgroups of constipation with a normal colon diameter?

Normal transit constipation
Slow transit constipation
Disordered defecation

91

What symptoms are associated with slow transit constipation?

Bloating
Abdo pain
Infrequent urge to defecate

92

In which patient is slow transit constipation most common?

Young women, with symptoms dating back to childhood

93

What is disordered defecation usually due to?

Rectal redundancy caused by:
Pelvic floor dysfunction
Anal sphincter dysfunction
Structural abnormality (eg rectocele)

94

What is severe constipation with gut dilatation normally secondary to?

Neuromuscular disorder of the colon:
Hirschsprung's disease
Idiopathic mega colon
Chronic intestinal pseudo-obstruction

95

What is Hirschsprung's disease?

Congenital anganglionosis of colon, resulting in absence of anorectal reflexes

96

What are the main complications of idiopathic megarectum/megacolon?

Faecal impaction
Overflow incontinence

97

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

98

In presence of constipation what diagnosis would anaemia suggest?

Colon cancer

99

What does an evacuation proctography show?

Anorectal morphology
Functional abnormalities - eg incoordination of pelvic floor and anal sphincters
Structural abnormalities - eg intussusception, rectal prolapse or rectocele

100

What is a useful method of measuring motor function of the whole gut?

Radio-opaque marker study of whole gut transit

101

What diagnosis does the presence of a recto-anal inhibitory reflex exclude?

Hirschsprung's disease

102

What might an ano-rectal sensory test show?

Loss of rectal sensation, seen in MS and Parkinson's

103

What diet advice is given to patients with constipation?

Increased fibre intake
Increased liquid intake

104

Name some stimulant laxatives and when would they be used?

Senna or bisacodyl
As required (to prevent laxative dependence)

105

What are some osmotic laxative agents and when are they used?

Magnesium salts and lactulose
Effective in slow transit constipation

106

How do bulk-forming laxatives work?

Retain fluid within stool, increasing faecal mass
Stimulate peristalsis
Stool-softening properties

107

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

108

What is in probiotics used for treating IBS?

Bifidobacterium

109

What is prucalopride?

Selective serotonin receptor agonist, acting on serotonin releasing enteroendocrine cells

110

What are antispasmodics used in chronic constipation?

Anticholinergic agents
Antimuscarinic agents
Peppermint oil

111

What can be used for pain management in chronic constipation?

Antidepressants, eg fluoxetine, paroxetine, citalopram

112

What are the surgical options for constipation caused by dysmotility?

Colectomy
Ileorectal anastomosis
Sacral nerve stimulation
Antegrade colonic enema

113

What does sacral nerve stimulation involve?

Implantation of programmable stimulator subcutaneously, which delivers low amplitude electrical stimulation via a lead to sacral nerve

114

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

115

What are surgical indications for treatment of obstructed defecation syndrome?

External prolapse
Rectocele
Internal intussusception