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gastroenterology Flashcards

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1
Q

ulcerative colitis on barium enema

A 
colon has irregular mucosa
loss of haustral markings
continuous - no skip lesions
pseudopolyps
longstanding disease - drainpipe colon - colon narrow + short
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2
Q

where is inflammation in UC?

A

starts at rectum (commonest site)

never spreads beyond ileocaecal valve

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3
Q

initial presentation of UC

A 
insidious + intermittent
bloody diarrhoea
urgency
tenesmus
LLQ pain
extra-intestinal features
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4
Q

peak incidence of UC (age)

A

15-25

55-65

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5
Q

extra-intestinal features of IBD

A

arthritis - esp sacroiliitis in UC
episcleritis
osteoporosis
clubbing

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6
Q

what type of oesophageal cancer is associated with GORD + barrett’s?

A

adenocarcinoma (commonest type of OC)

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7
Q

where in the oesophagus are tumours most likely to lie?

A

middle 1/3

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8
Q

diagnosis + staging of oesophageal cancer

A

upper GI endoscopy
staging - CT TAP
if CT doesn’t show mets - endoscopic USS

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9
Q

management of oesophageal cancer

A

surgical removal + adjuvant chemo

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10
Q

risk of surgery for oesophageal cancer

A

anastomotic leak - can cause mediastinitis

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11
Q

chrons - where affected + whats it like?

A

mouth-anus - terminal ileum + colon most affected

skip lesions

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12
Q

what acute complication can occur in UC?

A

toxic megacolon

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13
Q

what acute complication can occur in chron’s?

A

caecal volvulus

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14
Q

what are the RFs for caecal volvulus in chron’s?

A

adhesions secondary to chron’s

previous surgery

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15
Q

how does volvulus present + show on xray?

A

abdo pain + distension
constipation
N/V

large dilated loop of bowel

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16
Q

what are 3 associations of sigmoid volvulus?

A

chronic constipation
neuro or psych conditions
old age

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17
Q

2 associations of caecal volvulus

A

adhesions
pregnancy

(all ages)

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18
Q

how does sigmoid volvulus look on xray?

A

LBO: large dilated loop of colon
air + fluid levels
coffee bean sign

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19
Q

how does caecal volvulus look on xray?

A

small bowel obstruction

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20
Q

management of sigmoid volvulus

A

rigid sigmoidoscopy + rectal tube insertion

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21
Q

management of caecal volvulus

A

operative - right hemicolectomy often

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22
Q

classic appearance of chron’s on barium enema

A

kantor’s string sign: long segment of narrowed terminal ileum in string-like configuration - ie a long stricture
proximal bowel dilation
rose thorn ulcers + fistulae

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23
Q

what’s a marker of activity in chron’s?

A

CRP

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24
Q

how do you diagnose bowel perforation?

A

erect CXR - pneumoperitoneum - air under the diaphragm

CT now preferred

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25
what do positive anti-endomysial antibodies indicate?
coeliac
26
how to manage a patient with dysphagia (GP)
urgent referral
27
age 55+ with weight loss and: | upper abdo pain / reflux / dyspepsia
urgent referral
28
management of general dyspepsia
trial of full dose PPI for 1mo
29
diagnosis of h pylori
carbon-13 urea breath test or stool antigen test
30
h pylori - test of cure
carbon-13 urea breath test
31
jejunal biopsy shows villous atrophy, raised intra-epithelial lymphocytes + crypt hyperplasia - what is it?
coeliac: repeated gluten exposure → villous atrophy → malabsorption (reverses on gluten elimination) (cancer would be dysplasia)
32
c diff - 1st line treatment
oral metronidazole 10-14 days
33
giardia lamblia - what medication treats?
giardia lamblia
34
coeliac - diagnosis
immunology (TTG, endomyseal antibody) + jejunal biopsy reintroduce gluten for at least 6wk prior to testing
35
diagnosis of coeliac - immunology
``` TTG (IgA) - 1st choice endomyseal antibody (IgA) ```
36
what is achalasia?
lack of relaxation of LOS on swallowing
37
achalasia - investigations when scope normal
assess oesophageal motility: fluoroscopic barium swallow oesophageal manometry - pressures usually high pH studies
38
pain on swallowing (odynophagia) + hx heartburn (no weight loss, systemically well)?
oesophagitis
39
achalasia pattern + symptoms
dysphagia of liquids + solids from the start heartburn regurgitation → cough, asp pneumonia
40
systemic sclerosis - how does it affect GI system?
oesophageal dysmotility | LOS pressure decreased
41
associated symptoms of IBS
lethargy nausea backache bladder symptoms
42
IBS symptoms in someone over 60 - significance?
red flag
43
bowel obstruction + fistulae - what kind of IBD?
chron's
44
goblet cells + granulomas - what kind of IBD?
chron's
45
abdo mass in RIF - what kind of IBD?
chron's
46
chron's - histology
inflammation in all layers from mucosa to serosa - more prone to strictures, fistulas + adhesions goblet cells granulomas think - chrons everywhere - mouth to anus, down to serosa
47
UC - histology
``` no inflammation beyond submucosa inflammatory cell infiltrate in lamina propria crypt abscesses depleted goblet cells + mucin granulomas infrequent ```
48
deep ulcers + cobble-stone appearance on scope?
chron's
49
widespread ulceration + pseudopolyps om scope?
UC
50
where does diverticulosis most commonly occur?
sigmoid colon
51
diverticulitis - presentation
LIF pain + tenderness anorexia, N+V, diarrhoea features of infection
52
management of diverticulitis
mild - oral abx | severe - admit, NBM, IV fluids + abx (a cephalosporin + metronidazole)
53
diverticulitis - complications
abscess peritonitis obstruction perforation
54
oesophageal cancer - gold standard investigation
endoscopy
55
toxic megacolon - mgmt
aggressive medical therapy 24-72h | no improvement - colectomy
56
what is clindamycin associated with (adverse)?
c diff
57
complication of c diff
toxic megacolon
58
c diff - diagnosis
c diff toxin on stool test
59
3 causes of bowel ischaemia
AF endocarditis malignancy cocaine
60
bowel ischaemia - features
``` abdo pain rectal bleeding diarrhoea fever high WCC + lactic acidosis ```
61
bowel ischaemia - diagnosis
CT
62
oesophageal variceal haemorrhage - mgmt (after resus)
``` correct clotting - FFP, vit K terlipressin prophylactic IV abx if liver cirrhosis endoscopic variceal band ligation SB tube → TIPSS if all fail ```
63
prophylaxis of variceal haemorrhage
propanolol | endoscopic variceal band ligation + PPI (2-weekly)
64
coeliac - presentation (kids + adults)
kids - failure to thrive, diarrhoea, abdo distension adults - lethargy, anaemia, diarrhoea, weight loss, poss other AI conditions
65
factors used to classify liver cirrhosis (MELD)
bilirubin creatinine INR
66
what does reduced serum caeruloplasmin indicate?
wilson's caeruloplasmin carries 95% of plasma copper
67
wilson's - initial presentation
age 10-25 kids - liver disease adults - neuro disease
68
wilson's - diagnosis
reduced serum caeruloplasmin reduced serum copper increased 24h urinary copper excretion
69
wilson's - mgmt
penicillamine (chelates copper)
70
staging of gastric cancer
endoscopic USS or CT laparoscopy to identify peritoneal disease PET CT
71
gastric cancer - mgmt
partial/gastrectomy lymphadenectomy chemo
72
Duodenal ulcers on histology
Granulation tissue
73
SBO - investigations + management
AXR + erect CXR IV fluids sucking via NG tube CT + surgery if no improve
74
SBO - what seen on AXR?
dilated bowel loops
75
SBO - what seen on erect CXR?
pneumoperitoneum
76
small bowel on AXR
valvulae extend all way across
77
large bowel on AXR
haustra extend 1/3 way across
78
coeliac disease - link to immunisations?
functional hyposplenism - have pneumococcal vaccine
79
what is the modified hartmann's procedure?
mainly for carcinoma w acute obstruction primary resection w delayed anastomosis excise lesion, create colostomy + cross-staple rectal stump can have restorative anastomosis at later date
80
what scar does a hartmann's leave?
emergency laparotomy scar - midline abdo (confirm this and get name)
81
what is an abdominoperineal resection? what is the main indication?
rectal carcinoma in the distal 1/3 of the rectum removal of the anus, rectum, part of sigmoid + regional LNs incisions made in abdo + perineum end of remaining sigmoid is brought out permanently as a colostomy
82
how can you tell if a stoma is the result of an emergency hartmann's or an AP resection?
need to palpate anus + inspect perineal area | in an APR, pt has imperforate anus - can't do DRE
83
indications for an anterior resection vs AP resection
tumours in upper and middle ⅓ of rectum | lower ⅓ rectum
84
how do fistulae form in chron's?
chron's inflammation can go all way through bowel wall, creating fistulae from erosion - entero-enteric fistulae
85
what does an apple core sign suggest?
infiltrating carcinoma in bowel wall causing stricture
86
signet ring histology - significance
gastric cancer
87
gastric cancer - presentation - symptoms + OE
epigastric fullness/pain anorexia + weight loss vomiting anaemia cachexia hepatomegaly virchow's node
88
gastric cancer - investigations
endoscopy + biopsy Ba meal CT - local spread
89
gastic cancer - mgmt
partial gastrectomy; or gastroenterostomy radical gastrectomy if v early polypoid lesion (eg incidental finding) chemo + radio of little benefit

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