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Phase 2a Medicine > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

(170 cards)

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1
Q

What is the most common intraluminal obstruction?

A

Colorectal cancer

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2
Q

What can cause intraluminal obstruction?

A
  1. Tumour
  2. Diaphragm disease
  3. Meconium ileum
  4. Gallstone ileus
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3
Q

What can cause intramural obstruction?

A
  1. Crohn’s
  2. Diverticulitis
  3. Tumours
  4. Hirschsprung’s disease
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4
Q

How can Crohn’s cause intramural obstruction?

A
  1. Fibrosis
  2. Inflammation
  3. Granulomas
  4. Cobble stone mucosa
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5
Q

How do diverticula form?

A

Weaknesses in bowel wall where vessels come in

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6
Q

What can occur if diverticula fill with faeces?

A

Faecal peritonitis

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7
Q

What causes extraluminal obstruction?

A
  1. Adhesions
  2. Volvulus
  3. Tumour
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8
Q

How does volvulus occur?

A

Sigmoid colon twists on itself

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9
Q

What is the most common tumour to cause extraluminal obstruction/

A

Ovarian cancer

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10
Q

What is an intestinal obstruction?

A

Blockage to lumen of gut

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11
Q

What is a volvus?

A

A rotation of a segment of bowel

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12
Q

What is intesussuption?

A

Telescoping one hollow structure into its distal hollow structure

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13
Q

What is atresia?

A

Absence of opening or failure of development of hollow structure

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14
Q

How can obstruction conditions be classified?

A
  1. Site
  2. Extent of luminal obstruction
  3. Mechanism
  4. Pathology
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15
Q

What are the symptoms of bowel obstruction?

A
  1. Anorexia
  2. Nausea
  3. Distension
  4. Abdominal pain
  5. Constipation
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16
Q

What is the most common type of intestinal obstruction?

A

Small bowel obstruction (SBO)

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17
Q

Give 4 causes of SBO

A
  1. Adhesions (surgery)
  2. Hernia
  3. Crohns
  4. Appendicitis
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18
Q

What is the acute presentation of large bowel obstruction (LBO)?

A
  1. Abdominal distention
  2. Abdominal discomfort
  3. Pain
  4. Vomiting
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19
Q

Give 4 causes of LBO

A
  1. Malignancy
  2. Volvulus
  3. Imperforate anus
  4. Hirschsprung disease
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20
Q

What increases incidence of adhesive obstruction?

A
  1. Pelvic surgery
  2. Gynaecology surgery
  3. Colorectal surgery
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21
Q

What is a hernia?

A

Abnormal protrusion of viscus through normal or abnormal defects of body cavity

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22
Q

What is a complication of untreated hernia?

A

Strangulation

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23
Q

What is the presentation of hernia?

A
  1. Lumps

2. Pain

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24
Q

Where do volvulus occur?

A

Part of the bowel with mesentery

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25
What causes volvulus?
1. Caecal rotation 2. Congenital band 3. Adhesional band
26
What is the mechanism of intesussuption?
Imbalance in longitudinal forces along intestinal wall
27
What are the symptoms of intesussuption?
1. Colicky pain 2. Vomiting 3. Constipation 4. Abdominal distention
28
What is the pathophysiology of familial adenomatous polyposis?
1. Mutation in gene causes misfiled protein 2. Protein won't bind to beta catenin so levels go up 3. Binds to DNA to up regulate genes that cause epithelial proliferation 4. Adenoma etc. form
29
What is the Rx for familial adenomatous polyposis?
Remove colon to prevent cancer
30
What is missing in hereditary nonpolyposis colorectal cancer (HNPCC)?
Gene that encodes DNA repair proteins
31
What are the implications for therapy in HNPCC?
1. Tolerance of 5-FU 2. Don't recognise DNA damage 3. Apoptosis not activated
32
Where is most colorectal cancer?
Lower end (38%); rectum (28%)
33
How can lower end colorectal cancer be identified?
Digital rectal exam
34
Where is the first place GI tumours metastasise to?
Liver
35
What is resected during endoscopy to prevent colorectal adenocarcinoma?
Adenoma
36
What is the pathophysiology for gastric ulcers?
1. Mucosal ischaemia means cells are unable to produce mucin 2. Cells are not protected from stomach acid 3. Stomach acid kills cells and get micro-ulcer 4. Acid enters hold and damages more cells to get bigger ulcer
37
What are the signs of gastric ulcers?
1. Tachycardia 2. Low BP 3. High RR 4. Bleeding (see on scans)
38
What is the Rx for gastric ulcers?
1. Fluids/blood 2. Reversal mucosal ischaemia 3. H2 blocker/PPI inhibitor - reduce acid
39
What are the risks for increased stomach acid?
1. Stress 2. Helicobacter 3. Aspirin 4. Bile reflux 5. Alcohol
40
How does helicobacter cause ulceration?
Produce chemicals which attract inflammatory cells which enter gastric epithelium to damage cells and cause ulceration
41
Why does helicobacter increase risk of gastric cancer?
Changes gastric epithelium into intestinal metaplasia
42
What are the results of ulceration?
1. Bleeding 2. Haemorrhage (vomit blood) 3. Peritonitis 4. Pancreatitis
43
How does malabsorption manifest?
1. Weight loss with normal calories 2. Pale floating faeces 3. Anaemia
44
What are the causes of malabsorption?
1. Insufficient intake 2. Defective intraluminal digestion 3. Insufficient absorptive areas 4. Lack of digestive enzymes 5. Defective epithelial transport 6. Lymphatic obstruction
45
What causes defective intraluminal digestion?
1. Pancreatic insufficiency 2. Defective bile secretion 3. Bacterial overgrowth
46
Give an example of gluten sensitive enteropathy
Coeliac disease
47
What causes gluten sensitive enteropathy?
Villous atrophy and hyper plastic crypts
48
Describe gluten sensitive enteropathy gut wall
Flat epithelium and marked increase in epithelial lymphocytes
49
What is the pathophysiology of coeliac disease?
1. Gliadin peptide from gluten is absorbed and presented to antigen presenting cell 2. Produces toxic T cells --> lymphocytes 3. Lymphocytes release inflammatory mediators when exposed to gluten
50
What happens if Crohn's disease is uncontrolled?
Get cobblestone mucosa which reduces SA
51
What are the complications of small intestinal resection?
1. Malabsorption | 2. Fatty liver
52
When might a small intestinal resection or bypass be done?
1. Morbid obesity 2. Crohn's disease 3. Infarcted small bowel
53
What can cause lack of digestive enzymes?
1. Disaccharidase deficiency | 2. Bacterial overgrowth
54
What can cause lymphatic obstruction?
1. Lymphoma | 2. Tuberculosis
55
What can cause intestinal inflammation?
1. Diverticulitis 2. Ischaemic colitis 3. Infective colitis
56
What can cause chronic idiopathic inflammatory bowel disease (CIIBD)?
1. Crohn's disease | 2. Ulcerative colitis
57
What is the histology of Crohn's?
1. Patchy inflammation from mouth to anus 2. Transmural 3. White ulcers with patchy distribution 4. Fibrosis and cobblestone mucosa 5. Granulomas
58
What are 6 complications of Crohn's?
1. Malabsorption 2. Chronic fibrosis 3. Perforation 4. Fistula formation 5. Anal fissure 6. Colorectal cancer
59
What are the signs of colon fistula?
Watery diarrhoea and malabsorption
60
What can confirm Crohn's diagnosis?
Skin tags full of granulomas
61
What is the pathology of ulcerative colitis?
1. Inflammation is all mucosal 2. Starts in rectum and is continuous 3. Stops before ilium 4. Red inflamed mucosa
62
What are 5 complications of ulcerative colitis?
1. Fatty change to liver 2. Blood loss from colon 3. Arthritis 4. Iritis 5. Erythema nodosum
63
What gene is associated with colitis?
HLA B27
64
What is coeliac disease?
Chronic autoimmune enteropathy triggered by ingested gluten in genetically susceptible individuals
65
What is the prevalence of coeliac disease in the UK?
1%
66
What is the commonest age for presentation of coeliac disease?
4th to 6th decade
67
What environmental factors can cause coeliac disease?
1. Viral infections 2. Dysbiosis 3. Gluten
68
What individual factors cause coeliac disease?
1. Genetic predisposition 2. Association with HLA DQ2 (95%) or DQ8 3. Tissue transglutanimase
69
What is gluten made off?
Glutenins and gliadins
70
What do the mutations in HLA DQ2/8 cause?
Affect ability to bind gluten peptides properly
71
What are the classical symptoms of coeliac disease?
1. Diarrhoea 2. Steatorrhoea 3. Weight loss 4. Failure to thrive
72
Give 4 non-classical symptoms of coeliac disease
1. Irritable bowel symptoms 2. Osteoporosis 3. Anaemia 4. Chronic fatigue
73
Give 3 diseases associated with coeliac disease
1. T1DM 2. Autoimmune thyroid disorders 3. Dermatitis herpetiformis
74
What is dermatitis herpetiformis?
Chronic autoimmune blistering skin condition
75
What proportion of dermatitis herpetiformis pt. have coeliac disease?
70%
76
What is the Dx for coeliac disease?
1. IgA tissue transglutanimase 2. IgA anti-endomysial antibody 3. Upper GI endoscopy 4. Histology
77
When is testing for coeliac disease done?
When on a gluten-containing diet for 6 weeks
78
What is it called when squamous epithelium changes to glandular mucosa in the oesophagus?
Columnar lined lower oesophagus (CELLO) or Barrett's oesophagus
79
What is metaplasia?
Change in differentiation of a cell from one fully-differentiated type to a different fully-differentiated type
80
What can cause metaplasia in the oesophagus?
Repeated acid reflux
81
What are the risk factors for oesophageal squamous cell carcinoma?
1. Heavy smoking | 2. Alcohol
82
What are the risk factors for oesophageal adenocarcinoma?
1. Obesity | 2. Acid reflux
83
What is the most common age for oesophageal cancer?
80s and 90s
84
What is the prognosis for oesophageal cancer?
<10% in most prevalent age
85
What are risk factors for gastric cancer?
1. Smoked food 2. Pickled food 3. Helicobacter pylori 4. Pernicious anaemia
86
What is the most prevalent age for gastric cancer?
70s
87
What is the 5 year survival if gastric cancer is caught early?
90%
88
What is the 5 year survival if gastric cancer invades the muscular wall?
60% if completely resected
89
What is the 5 year survival for gastric cancer if it can't be resected?
10-15%
90
What are the diagnostic criteria for anorexia nervosa?
1. Restriction of energy intake leading to a significantly low body weight 2. Intense fear of gaining weight, even though underweight 3. Disturbance in experience of body shape
91
What are the subtypes of anorexia nervosa?
1. Restricting | 2. Binge eating/purging
92
What are the diagnostic criteria of bulimia nervosa?
1. Recurrent episodes of binge eating 2. Recurrent inappropriate compensatory behaviour to prevent weight gain 3. Bing eating and compensating at least once a week for 3 months 4. Self-evaluation influenced by body shape
93
How are binge eating episodes characterised?
1. Eating in a discrete amount of time large amounts of food | 2. Sense of lack of control over eating during an episode
94
What are binge eating episodes associated with?
1. Eating much more rapidly than normal 2. Eating until feeling uncomfortably full 3. Eating large amounts of food when not feeling physically hungry 4. Eating alone because of feeling embarrassed by how much one is eating 5. Feeling disgust, depressed or guilty following a binge
95
How does binge eating disorder differentiate from bulimia?
No compensatory or purging behaviours
96
What is the most common age for eating disorders?
14-40
97
What is the prevalence of eating disorders amongst females?
7%
98
What are the risk factors for eating disorders?
1. Genes 2. Temperament 3. Family interaction 4. Social pressures 5. Trauma
99
What factors lead to a need for control?
Low self-esteem and perfectionism
100
What are some triggers for eating disorders?
1. Teasing about appearance 2. Positive comments about weight loss 3. Illness 4. New social circle
101
What are the maintaining factors for eating disorders?
1. Positive reinforcement initially | 2. Later, terror at losing control
102
What must be tested for in eating disorders?
1. Severe restriction of food/fluid 2. Electrolyte imbalance - K 3. Bone deterioration - bone scan 4. Physical damage e.g. blood in vomit 5. Alcohol/drug intake
103
What are the urgent signs to assess for in eating disorders?
1. Muscular weakness 2. Problems breathing 3. Deterioration of consciousness 4. Cardiac signs 5. Rapid weight loss 6. Risky behaviours
104
What is the most effective motivator in eating disorders?
Early behavioural change with reinforcement for doing well
105
What are the Rx for bulimia nervosa and binge eating disorder?
1. CBT 2. Guided CBT self help 3. Group CBT
106
What are the Rx for anorexia nervosa?
1. Family therapy 2. CBT 3. Maudsley AN treatment model 4. Specialist supportive clinical management
107
What are the Crohn's symptoms?
1. Diarrhoea 2. Fever 3. Fatigue 4. Abdo pain 5. Bloody stool
108
What are the Crohn's Ix?
1. Bloods e.g. CRP, FBC 2. Colonoscopy 3. MRI small bowel 4. USS 5. CT 6. Pelvic MRI
109
What is the Rx for Crohn's?
1. Prednisolone 2. Liquid diet 3. Azathioprine 4. MTX 5. Adalimumab 6. Surgical resection
110
What are the colitis symptoms?
1. Diarrhoea with blood or pus 2. Abdo pain 3. Rectal pain 4. Rectal bleeding 5. Urgency to defecate
111
What is the investigation for colitis?
1. Routine bloods 2. Faecal calprotectin 3. Stool sample 4. Colonoscopy with biopsy 5. AXR 6. CT abdomen
112
What is the Rx for colitis?
1. Mesalazine 2. IV corticosteroids 3. Total proctocolectomy
113
What are the IBS symptoms?
1. Stomach cramp 2. Bloating 3. Diarrhoea 4. Constipation
114
What foods trigger IBS?
1. Fibre foods 2. Alcohol 3. Caffeine 4. Carbonated drinks 5. Fatty foods
115
What is the Ix for IBS?
1. Coeliac test 2. Colonoscopy 3. Sigmoidoscopy 4. AXR 5. Stool tests
116
What is the Rx for IBS?
1. Lifestyle changes 2. Dietary change 3. Loperamide 4. Laxatives e.g. celevac
117
What is the pathophysiology of gastroesophageal reflux disease (GORD)?
1. Lower oesophageal sphincter relaxations 2. Reflux of bile, acid, pepsin 3. Oesophageal mucosal injury
118
What are the symptoms of GORD?
1. Heartburn 2. Acid reflux 3. Oesophagitis 4. Bad breath 5. Bloating
119
What are the Ix for GORD?
1. Oesophageal pH monitoring test 2. Endoscopy 3. Oesophageal pressure test 4. Barium meal
120
Wha are the Rx for GORD?
1. Lifestyle changes 2. PPIs 3. H2-receptor antagonists
121
What is the pathophysiology of appendicitis?
Appendix acutely inflamed as lumen becomes blocked
122
What are the symptoms of appendicitis?
1. Pain in central abdomen 2. Pain moves to LRQ 3. Pain on palpitation 4. Nausea 5. Anorexia
123
What are the Ix for appendicitis?
1. FBC 2. Abdominal and pelvic CT 3. Urinary pregnancy test 4. USS 5. Urinalysis
124
What is the Rx for appendicitis?
Appendectomy
125
What is the pathophysiology of pseudo-obstruction?
Severe impairment in ability of intestines to push food through
126
What are the symptoms of pseudo-obstruction?
1. Distension 2. Abdo pain 3. N&V 4. Constipation 5. Diarrhoea
127
What is the Ix for pseudo-obstruction?
1. Abdominal exam 2. AXR 3. Bloods
128
What is the Rx for pseudo-obstruction?
1. Abx 2. Analgesia 3. Endoscopic decompression 4. Neostigmine
129
What is diverticulitis?
Inflammation of diverticula
130
What are the risk factors for diverticulitis?
1. Low dietary fibre 2. Obesity 3. Smoking 4. FHx 5. NSAID use
131
What are the symptoms of diverticulitis?
1. Acute abdominal pain 2. Altered bowel habit 3. Anorexia 4. Pyrexia
132
What are the Ix for diverticulitis?
1. Routine bloods 2. Venous blood gas 3. Group and Save 4. Sigmoidoscopy 5. CT abdomen-pelvis
133
What is the Rx for diverticulitis?
1. IV Abx 2. IV fluids 3. Bowel rest 4. Sigmoid colectomy
134
What usually causes gastritis?
H pylori
135
What are the symptoms of gastritis?
1. Indigestion 2. Burning stomach pain 3. Nausea 4. Feeling full
136
What is the diagnosis of gastritis?
1. Stool test 2. Breath test for H pylori 3. Endoscopy 4. Barium swallow
137
What is the Rx for gastritis?
1. Antacids 2. H2 blockers 3. Omeprazole 4. Abx
138
What is the pathophysiology of ischaemic colitis?
Inflammation and injury of large intestine result from inadequate blood supply
139
What are the symptoms of ischaemic colitis?
1. Abdo pain 2. Bright red blood in stool 3. Urgency to move bowels 4. Diarrhoea 5. Nausea
140
What is the investigation for ischaemic colitis?
1. Stool sample 2. CT 3. MR angiography 4. Colonoscopy
141
What is the Rx for ischaemic colitis?
1. Abx 2. IV fluids 3. Surgical repair 4. Colectomy
142
What is mesenteric ischaemia?
Injury to small intestine occurs due to not enough blood supply
143
What are the symptoms of mesenteric ischaemia?
1. Abdo pain 2. Urgent need for bowel movement 3. Fever 4. N&V
144
What is the Ix for mesenteric ischaemia?
1. ABG 2. Routine bloods 3. CT with contrast 4. CXR
145
What is the Rx for mesenteric ischaemia?
1. Broad spectrum Abx 2. Urgent surgical resuscitation 3. Excision of necrotic bowel 4. Revascularisation of bowel
146
What is a Mallory-Weiss tear?
Tear of tissue of lower oesophagus
147
What are the common causes of Mallory-Weiss tear?
Violent coughing or vomiting
148
What are the complications of Mallory-Weiss tear?
1. Anaemia 2. Fatigue 3. SOB 4. Shock
149
What are the symptoms of Mallory-Weiss tear?
1. Bright red/coffee grain vomit 2. Black tar-like stools 3. Bloody stools 4. Weakness 5. SOB
150
What is the Ix for Mallory-Weiss tear?
1. Endoscopy 2. Routine bloods 3. ECG
151
What is the Rx for Mallory-Weiss tear?
1. Resuscitation | 2. Endoscope to relieve bleeds
152
What is the pathology of haemorrhoids?
1. Abnormal venous dilatation to anal cushions 2. Vascular thrombosis 3. Degeneration in collagen fibres
153
What are the symptoms of haemorrhoids?
1. Pain when sitting 2. Pain during bowel movement 3. Itching around anal region 4. Bright red blood on stools
154
What is the Ix for haemorrhoids?
1. DRE | 2. Sigmoidoscopy
155
What is the Rx for haemorrhoids?
1. High fibre diet 2. Topical cream with hydrocortisone 3. Soak in warm bath 4. Analgesia
156
What is an anal fistula?
Small tunnel that develops between end of bowel and skin near anus
157
What are the symptoms of anal fistula?
1. Frequent anal abscesses 2. Pain around anus 3. Pus from opening 4. Pain with bowel movement
158
What are the Ix for anal fistula?
1. Proctoscopy | 2. MRI
159
What are the Rx for anal fistula?
1. Fistulotomy | 2. Seton placement
160
What is an anal fissure?
Tear or ulcer that develops in lining of large intestine near anus
161
What are the symptoms of anal fissure?
1. Visible tear in skin around anus 2. Skin tag near tear 3. Pain during bowel movements 4. Bloody stools 5. Burning or itching in anal area
162
What are the Ix for anal fissure?
1. Rectal exam | 2. Anoscopy
163
What is the Rx for anal fissure?
1. Stool softeners 2. Drink more fluids 3. Lidocaine 4. Hydrocortisone cream 5. CCB
164
What are the symptoms for perianal abscess?
1. Pain throbbing and constant 2. Skin irritation around anus 3. Pus discharge 4. Constipation 5. Pain on bowel movement
165
What are the Ix for perianal abscess?
1. Anal USS 2. CT 3. Anal exam
166
What is the Rx for perianal abscess?
1. Surgical drainage | 2. Abx
167
What is a pilonidal sinus?
Small hole of tunnel in skin that may fill with fluid or pus in cleft at top of buttocks
168
What are the symptoms for pilonidal sinus?
1. Pain 2. Swelling 3. Pus-filled abscess
169
What are the Ix for pilonidal sinus?
Clinical diagnosis
170
What is the Rx for pilonidal sinus?
1. Abx 2. Surgical drainage 3. Analgesia

Phase 2a Medicine (15 decks)

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