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Phase 2a Revision > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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1
Q

Coeliac Disease

A

Autoimmune T-cell mediated condition where exposure to gluten causes a reaction that causes inflammation in the small bowel.

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2
Q

Coeliac Disease Pathology

A
  • Gluten broken into Gliadin
  • Binds to IgA antibodies on gastric mucosa
  • Gliadin- Antibody complex presents to transferrin receptor
  • Complex endocytosed across gastric Mucosa into lamina propria
  • Tissue Transglutaminase removes an amide
  • Deaminated gliadin phagocytosed by HLADQ8/2 macrophages
  • Macrophages signal chimune response causing inflamm.
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3
Q

Coeliac Disease Symptoms

A

Inflammation causes: Crypt hyperplasia + Lymphocyte infiltration + Villous atrophy

→ Malabsorption = steatorrhoea & diarrhoea
→ Iron deficiency anaemia
→ Weight loss
→ Fatigue
→ Mouth ulcers
→ Dermatitis herpetiformis = bumpy papular

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4
Q

Coeliac Disease investigations & management

A

Gluten= more than 1 meal per day

  • Serology
    1st Line = Total IgA + tTG + antigliadin + anti endomysial antibodies
    Gold = duodenal biopsies - see villous atrophy, crypt hyperplasia, Raised intraepithelial lymphocytes

Management = Gluten free diet

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5
Q

Intestinal Obstruction Categories

A

→ Blockage

→ Pressure

→ Contraction

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6
Q

Intestinal obstruction Blockage causes

A
  • Tumour
  • Diaphragm disease - caused by NSAIDs
  • Crohn’s = fibrosis - coarctation - obstruction
  • Diverticular disease = Outpouching - faeces trapped
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7
Q

Intestinal obstruction Pressure causes

A
  • Adhesions
  • Volvulus - free floating areas with mesentery - Sigmoid
  • Intussusception
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8
Q

Intestinal Obstruction Contraction causes

A
  • Inflammation
  • Intramural tumours
  • Hirschsprung’s disease
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9
Q

Small bowel Obstruction Causes

A

Adults: Adhesions, Hernias, Crohn’s & Malignancy

Children: Volvulus, Intussusception, Hirschsprung ‘s, Appendicitis

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10
Q

Bowel obstruction Symptoms

A
  • Vomiting
  • Constipation/ Obstipation
  • Abdo pain & Distension
  • Tenesmus
  • Weight loss
  • Bowel sounds
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11
Q

Bowel obstruction signs

A

Perforation (peritonitis), Strangulation

Increased HR, Hypotension & High temp., Swelling

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12
Q

Bowel obstruction Investigations

A
  • Digital Rectal Exam- large bowel
  • X-Ray → Dilated jejunum / ileum, absense of gas distal to obstruction
  • FBC + U&E
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13
Q

Bowel obstruction Treatment

A
  • IV Fluids resus. (Nil by mouth)
  • BoweI decompression
  • Correct electrolyte imbalance
  • Analgesia & anti - emetics
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14
Q 
Definitions :
Diverticulum
Diverticulosis
Diverticular
Diverticulitis
A 
Diverticulum = Outpouches
Diverticulosis = asymptomatic condition of outpouches 
Diverticular = Symptomatic condition of outpouches
Diverticulitis = Inflammation of outpouches
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15
Q

Diverticulosis Risk factors

A
  • Low fibre diet
  • NSAIDs
  • COPD
  • Old age
  • Connective tissue disease
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16
Q

Diverticular /itis Symptoms & Investigations

A
  • LLQ tenderness
  • Constipation
  • Rectal bleeding
  • Fever
  • Diarrhoea

Investigations = CT or Colonoscopy

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17
Q

Diverticulitis Complications

A
  • Perforation
  • Peritonitis
  • Fistula
  • Obstruction
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18
Q

Diverticular/ osis Treatment

A

Diverticulosis: High fibre diet

Diverticular:

  • Bulk forming laxatives (Ispaghula husk)
  • Surgery

Contraindications : Stimulants (sena)

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19
Q

Diverticulitis Treatment

A

Mild:

  • 5 days of Co amoxiclav or Cephalexin with Metronidazole
  • Analgesics (not opioids / NSAIDs)
  • Liquid food

Severe:

  • Nil by mouth
  • IV Fluids & antibiotics
  • CT & Surgery
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20
Q

Stages of Nutrition

A

I. Ingestion

  1. Digestion
  2. Absorption
  3. Egestion
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21
Q

Malabsorption Causes

A
  • Intake
  • Digestion = Pancreatic / bile secretion
  • Absorption = Coeliac / Crohn’s - Villous atrophy
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22
Q

Malabsorption Symptoms

A
  • Diarrhoea
  • Steatorrhoea
  • Weight loss
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23
Q

Malabsorption Complications

A
  • Anaemia = low iron + Folate + B12
  • Bleeding disorder = low vit. K
  • Oedema = low protein
  • Bone disease = low vit. D

→ Tropical spure

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24
Q

Diarrhoea causes

A
  • Viral = Norovirus, Rota -virus
  • Bacteria = Staph. Aureus, Salmonella
  • Antibiotics - high risk of c.diff.
  • Drugs (NSAIDs)

→ IBD & IBS
→ Bowel cancer
→ Hyperthyroidism
→ Stress

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25
Antibiotics that cause c. diff
→ Clindamycin → Co-amoxiclav → Cephalosporins → Ciprofloxacin
26
Diarrhoea Red Flags
- Dehydration - Renal failure - Electrolyte imbalance - Rectal bleeding, weight loss → cancer
27
Diarrhoea Investigations
- History → Floaty diarrhoea - Fat → Watery diarrhoea - Infection → Bloody diarrhoea - Inflammation / Cancer - Stool test = culture + test for blood - Blood test = culture + CRP (C - Reactive Protein)
28
Diarrhoea Treatment
- Fluid & Electrolyte replacement - Antibiotics = Vancomycin - Antimotility agents - Antiemetics
29
IBS Types
→ IBS-D (Diarrhoea) → IBS-C (Constipation) → IBS-M (Mixed)
30
IBS Pathophysiology
- Stress - Genetics - Signalling - Motility
31
IBS Symptoms
1. Abdo pain & bloating relieved by defecation 2. Mucus in stool 3. Change in bowel habit - constipation, Straining
32
IBS Investigations
- Bloods - ESR & CRP - Coeliac Serology
33
IBS Treatment
Mild: Education + Low fodmap diet + Reassurance Moderate: - Laxatives = Linaclotide or Bulk forming laxatives - Anti- motility agents = Loperamide - Antispasmodics - CBT or Hypnotherapy Severe: TCA (Tricyclic Acids)
34
Ulcerative Colitis
Autoimmune Disease where there's inflammation & uIceration of colon & rectum
35
Crohn's Disease
Immune related. Bacteria over stimulating immune system - Mainly affects ileum Never affects rectum.
36
Crohn's Disease Pathology
- Pathogens pass through Gl lining. - Mutation allows pathogens through mucosa into deep Submucosa. - Bacteria stimulates T- helper cells = releases cytokines = causes inflammation & granulomas = more cells = more cytokines = more inflammation
37
General & Specific symptoms in IBD
- Diarrhoea - Abdo. pain & cramping - Mucous - Fever + Weight loss + Malaise Specific = → Rectal pain in UC → Ileum therefore RLQ pain in Crohn's → Inability to defecate
38
Extra- Intestinal Symptoms - UC
UC: → Crypt abscesses → Pauci - arthritis → Enthesitis + Tenosynovitis + Dactylitis → Erythema Nodosum (raised red subcut. nodules)
39
Extra- Intestinal Symptoms - Crohn's
→ Any part of Gl Tract → Skip lesions → Deep Ulcers & fissures (cobblestone mucosa) → Transmural inflam. → Goblet cells
40
IBD Complications
UC: - PR bleeding - Neoplasia - Toxic megacolon Crohn's: - Malabsorption - Fistula - strictured - Sinus tract - Obstruction & Abscess
41
IBD Investigations & Monitoring
- pANCA = - ve in Crohn's , + ve in UC - Endoscopy with biopsy → Transmural inflam. & granulomas Monitor : → Blood - CRP + ESR + Anaemia → Fecal occult blood test → Fecal calciprotein
42
IBD Treatment - Mild / Moderate
1st Line = Aminosalicylates (mesalazine & sulfasalazine) 2nd Line = + Corticosteroids e.g. Prednisolone 3rd Line = + Calcineurin inhibitor (ciclosporin) Biologics = Infliximab Crohn's - Prednisolone - Azathioprine - Infliximab
43
IBD Treatment - Severe
1st Line = Calcineurin Inhibitor (ciclosporin) + corticosteroids Immunosuppressive drugs [ Azathioprine & Methotrexate] Gold = Biological Therapy [ Tumour Necrosis Factor alpha + Infliximab + Subcut. Golimumab ] Last Line = Surgical resection then give Azathioprine + Metronidazole
44
IBD Treatment contraception advice
- Methotrexate = Contraception for male & female | - Monoclonal antibody & TNF alpha = Contraception for female
45
Colorectal Cancer Symptoms
- Blood & mucus in stool | - Mass
46
Colon cancer Investigations
- Endoscopy with biopsy - CT - Faecal occult blood - Tumour markers - Barium enema
47
Colon cancer Treatment
Resection
48
Main sites for Colon cancer
Descending colon + Sigmoid + Rectum
49
Metastases for Colon cancer
Liver → Lungs → Bones > Peritoneum → Brain → Spinal cord
50
Ischemic Colitis Causes + Symptoms
Causes: → Atherosclerosis of Superior & Inferior mesenteric artery → Thrombus/ Emboli → Low cardiac output & Arrhythmias Symptoms: - LLQ pain - Bloody diarrhoea
51
Ischemic Colitis Investigations
- CT/ MRI angiography | - Colonoscopy .with biopsy
52
Ischemic Colitis Treatment
- Fluid replacement - Antibiotics - Surgery for perforation
53
UC vs Crohn's
``` UC: → Ulcer goes through mucosa & submucosa → Inflammation in colon only → No interspaced healthy areas → Goblet cell depletion & crypt abscesses ``` Crohn's: → Transmural (mucosa + submucosa + muscle + Serosa) → Inflammation anywhere in GI tract → Areas of inflammation interspaced healthy areas → Skip Lesions (Cobblestone appearance)
54
Gastritis Causes + Risks
``` Causes: → Mucosal ischemia → H. pylori → Aspirin I NSAIDs → Autoimmune gastritis ``` Risks: - Diabetes - Travel + alcohol + old age - NSAIDs / Aspirin - Stress/ Autoimmune
55
Gastritis Symptoms
- Epigastric pain - Diarrhoea - Indigestion - vomiting & Nausea - Fever & Malaise - Dehydration
56
Gastritis Investigations
If pylori = Stool antigen test or urea breath test Gold = Endoscopy - Faecal occult blood - C-Reactive Protein blood test
57
Gastritis Treatment
Mild: Fluid Intake Small non fatty meals Antimotility agents Moderate/ Severe: If NSAID/ Aspirin cause = PPl / H2 receptor antagonist If H. Pylori cause = Clarithromycin + Amoxicillin + Omeprazole If Campylobacter cause = Clarithromycin
58
If Gastritis returns?
- Miss work until 48 hrs after last diarrhoea - No swimming for 2weeks after diarrhoea - E. coli - do 2 negative stool samples over 24 hrs
59
Peptic + Duodenal ulcer Pathology
Peptic ulcers = Break in epithelial cells Penetrating down to muscalaris mucosa → fibrous base & inflammatory cells increase. Duodenal ulcers = Brunners gland hypertrophy - reduce acidity of duodenum Affects gastroduodenal artery
60
Peptic & Duodenal Ulcer causes
- Prolonged NSAID & Aspirin use - H. pylori = Urease + Protease - Zollinger Ellison syndrome = Gastric acid hypersecretion + Tumour of pancreas + Peptic ulcer
61
Peptic & Duodenal ulcer symptoms
- Epigastric pain - Peptic ulcer = Pain when eating & goes after 2-3 hrs - Duodenal ulcer = Pain reduces when eating & comes after 2-3 hrs - Bloating - Nausea + Vomiting
62
Peptic & Duodenal ulcer complications
- Bleeding thus hypovolaemic shock - Perforation - Resp. distress → Sepsis + air under diaphragm
63
Peptic & Duodenal ulcer Investigation
Peptic: Endoscopy with biopsy Duodenal: urea breath test or Faecal antigen test 2 weeks without PPI 4 weeks without antibiotics
64
Peptic & Duodenal Treatment
- Stop alcohol & smoking - Stop NSAIDs - PPI or H2 antagonist - H. pylori = Clarithromycin + Amoxicillin + Omeprazole
65
GORD Pathology & Risk
Pathology: - Inflammation - Scarring - oesophageal Stenosis - Risk of neoplasia Risk: → Barrett's Oesophagus → Zollinger - Ellison Syndrome → Hiatal hernia - lowers LOS pressure = increases reflux
66
GORD symptoms
- Regurgitation - Dyspepsia & Dysphagia - Nocturnal asthma - worse when lying flat
67
GORD Investigations
Therapeutic challenge = Give PPl Gold - Oesophageal manometery X- Ray with barium Serum gastrin
68
GORD Treatment
``` PPl (Lanzoprazole) for 1mnth H2 antagonist (ranitidine) Gold = Anti -reflux surgery (laparoscopic fundoplication) - Antacids = neutralise acid - Prokinetic medication - GABA agonist baclofen ```
69
Achalasia + Investigations + Treatment
Lower oesophageal sphincter won't relax so food & liquid can't pass into Stomach Ix = Endoscopy / Barium swallow Tx = Isosorbide dinitrate or Nifedipine or Veramipril Gold - Surgery → pneumatic dilation
70
Mallory- Weiss Tear (M-W-T) Risk
- Alcohol-binge drinking - Chronic cough - Weight lifting - Bulimia
71
M-W-T Symptoms
- Haematemesis - Melaena - Hypovolaemic shock
72
M-W-T Treatment
- Resus - Antiemetic - PPI
73
Appendicitis & Causes
= Inflammation of Appendix - obstruction - Faceolith - Pinworm infection
74
Appendicitis Pathology
- Blockage= backed-up fluid & mucus → Increased pressure → Compresses nerves + blood vessels → Ischemia & Necrosis - Bacteria= (E. Coli) - WBCC increases - Necrosis= no mucus secretion - more bacterial growth
75
Appendicitis Symptoms
- Umbilical pain - migrates to RLQ - Rebound tenderness - McBurney's Point = 2/3 between umbilicus from ileac crest - Worse on coughing - Vomiting & Low grade fever
76
Appendicitis Sign
- Rosvings sign - Pressing in LLQ causes pain in RLQ - Obturator sign - Psoas sign
77
Appendicitis Investigations
- CT/ US - Bloods → WBC + CRP + high ESR - Pregnancy test
78
Appendicitis Treatment
- Laparoscopic Appendectomy - Antibiotics - Drain abscesses - Fluids
79
H. Pylori & Risk
Gram -ve bacilli with flagella Produces urease which makes ammonia → damages gastric mucosa Risk: - No clean water
80
H. Pylori Causes
- Gastritis - peptic ulcer - H. Pylori + Low gastric acid = Peptic/ Gastric cancer - H. Pylori + High gastric acid = Duodenal ulcer
81
H. Pylori Symptoms
- Ache /burning pain - Abdo pain - worse when stomach is empty - Bloating, weight loss & nausea
82
H. Pylori Investigations
- Urea breath test - Stool test - Endoscopy - Blood test
83
H. Pylori Treatment
2 Antibiotics & PPl Clarithromycin + Amoxicillin + Omeprazole
84
Oesophageal Cancer Risks
``` A = Achalasia B = Barret's Oesophagus C = Corrosive oesophagus D = Diverticulitis E = Esopheal web F = Family Hx ```
85
Hemorrhoids Sx: Tx:
Swollen veins in anus & lower rectum. Internal= Painless bleeding, can prolapse External= Painful, form at anal opening Sx: Bright red bleeding, Pain Tx: Stool softeners, high fibre diet, band ligation
86
C.diff.
- Occurs in hospital environment - due to contact -Due to C. antibiotics → watery diarrhoea → fever → Malaise - Treat with vancomycin
87
Barrett's Oesophagus cell change
Metaplasia | Simple columnar epithelium with goblet cells
88
Dyspepsia Sx Ix Tx
Epigastric Pain, Early satiation Sx: Reflux when lying flat, Heartburn, Bloating Ix: Stool culture, Blood test, Urea test Tx: Dietary manage., Antidepress. (Citalopram)
89
Oesophageal varices Sx: Ix: Tx:
Sx: vomiting blood, abdo. pain, Spider naevi, yellow sclera Ix: Blood test = Raised ALT, AST & ALP, high bilirubin & creatinine Tx: Band ligation, Antihypertensives
90
Diarrhoea types
- Secretary - Osmotic - Exudative - Desentery
91
Haematemesis from ruptured Oesophageal varices Sx: Tx:
Vomiting large volumes of blood. Tx: IV Terlipressin IV Somatostatin it contraindicated

Phase 2a Revision (9 decks)

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