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GI 1 Flashcards

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1
Q

What are some causes of GORD?

A

Hiatus hernia (sliding 80%, rolling 20%)

Loss of oesophageal peristaltic function

Abdominal obesity

Gastric acid hypersecretion

Slow gastric emptying

Overeating

Smoking

Alcohol

Pregnancy

Drugs

Systemic sclerosis

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2
Q

How does GORD present?

A

Heartburn

Belching

Food/Acid regurg

Increased salivation

Odynophagia (pain on swallowing)

Nocturnal asthma

Chronic cough

Laryngitis

Sinusitis

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3
Q

How would you investigate GORD?

A

trial PPI

oesophagogastroduodenoscopy (OGD)

ambulatory pH monitoring

Oesophageal manometry

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4
Q

How would you manage GORD?

A

PPI - omeprazole

Lifestyle changes : weight loss, head-of-bed elevation, avoid late night eating

H2 antagonist - ranitidine

Nissen fundoplication

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5
Q

What are some complications of GORD?

A

Peptic Stricture - inflamm of oesophagus = causes narrowing and a stricture

Barrett’s oesophagus - metaplasia from squamous to columnar (premalignant for adenocarcinoma of the oesophagus)

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6
Q

Where does a Mallory-Weiss tear occur? What are some causes?

A

mucosal tear occurring at the oesophagogastric junction produced by a sudden increase in intra-abdominal pressure

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7
Q

What are some risk factors for Mallory-Weiss tear?

A

Alcoholism

Forceful vomiting

Eating disorders

Male

NSAID abuse

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8
Q

How would you investigate a Mallory-Weiss tear?

A

FBC - initial evaluation of patient with bleed

Urea - should be high in patient with ongoing bleeding

LFTs - liver disease may predispose a patient to oesophageal varices

Prothrombin time

Oesophagogastroduodenoscopy - after bleed stabilisation

cross-match/blood grouping

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9
Q

How would you manage Mallory-Weiss tear?

A

IV fluids (PPI in high risk patients)

Phytomenadione (vit K) - if prolonged PT/INR

Hemoclip placement

Adrenaline

Endoscopic band ligation

anti-emetic - ondansetron

Sengstaken-Blackmore tube

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10
Q

What are the two sphincters of the stomach?

A

gastro-oesophageal sphincter

pyloric sphincter - controls gastric contents into the duodenum

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11
Q

What cells are present in the muscosa in the upper 2/3rds of the stomach?

What are their functions?

A

Parietal cells - secrete HCL

Chief cells - pepsinogen and initiate proteolysis

Enterochromaffin-like cells - releases histamine (stimulates acid release)

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12
Q

What cells are found in the antral muscosa of the stomach?

What are their functions?

A

Mucus secreting cells - secrete mucin (protect gastric mucosa) and bicarb

G cells - secrete gastrin - stimulates acid release

D cells - secrete somatostatin - suppressant of acid secretion

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13
Q

What glands in the duodenum release alkaline mucus?

A

Brunner’s glands - in combination with pancreatic and biliary secretions = neutralise the acid secretion from the stomach

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14
Q

What are peptic ulcers? Where are duodenal ulcers and gastric ulcers found?

A

Break in the superficial epithelial cells penetrating down to the muscularis mucosa

Duodenal ulcers are more commonly found in the dueodenal cap

Gastric ulcers are most commonly seen on the lesser curve of the stomach

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15
Q

What are some causes of peptic ulcers?

A

Helicobacter pylori infection

Drugs - NSAIDs, steroids and SSRIs

Smoking

Delayed gastric emptying

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16
Q

Which is more common? Duodenal or gastric ulcers?

A

Duodenal ulcers more common

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17
Q

How do peptic ulcers present?

A

Recurrent burning epigastric pain

Duodenal ulcers = night and worse when hungry

Nausea

Anorexia and weight loss - particularly with gastric ulcers

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18
Q

What are some red flag symptoms to be aware when investigating peptic ulcers?

A

Unexplained weight loss

Anaemia

GI bleeding - melena or hematemesis

Dysphagia

Upper Abdominal mass

Persistent vomiting

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19
Q

How would you investigate peptic ulcers?

A

H.pylori urea breath test or stool antigen test

Upper GI endoscopy

FBC - microcytic anaemia

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20
Q

How would you treat a peptic ulcer?

A

PPI - omeprazole

H2 antagonist - ranitidine

If H.pylori positive - TRIPLE THERAPY = PPI, clarithromycin, metronidazole

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21
Q

What are causes of gastrointestinal varices?

A

All due to portal hypertension

  1. Alcoholism
  2. Viral cirrhosis
  3. Pre-hepatic - thrombosis in portal or splenic vein
  4. Intra-hepatic - cirrhosis, schistosomiasis, sarcoid, congenital hepatic fibrosis
  5. Post-hepatic - budd-chiari syndrome, right heart failure, constrictive pericarditis
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22
Q

How would a oesophago-gastric varices present?

A

if ruptured:
Haematemesis

Abdo pain

Shock

Fresh rectal bleeding

Hypotension and tachycardia

Pallor

signs of chronic liver damage : splenomegaly

ascites

hyponatraemia

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23
Q

How would you investigate an oesophago-gastric varices?

A

FBC - microcytic anaema or thrombocytopenia

LFTs - elevated transaminases, Alk phos and bilirubin

Urea and creatinine

Oesophagogastroduodenoscopy (OGD)

blood typing/cross-matching

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24
Q

How would you manage an oesophago-gastric varices?

Study These Flashcards
A

Vasoactive drugs - terlipressin

Prophylatic abx - ceftriaxone

TIPS - trans-jugular intrahepatic porto-systemic shint

25
What is Achalasia? What causes it?
Oesophageal aperistalsis and impaired relaxation of the lower oesophageal sphincter caused by degeneration of mesenteric plexus of the oesophagus
26
How does Achalasia present?
Dysphagia for fluids and solids Regurg of food particularly at night Substernal cramps
27
How would you investigate Achalasia?
Endoscopy Barium swallow - loss of peristalsis and delayed oesophageal emptying Oesophageal manometry
28
How would you treat achalasia?
Nifedipine Pneumatic dilation Injection of botulinum toxin A Laparoscopic cardiomyotomy
29
What is the difference between gastritis and gastropathy?
Gastritis = inflammation assoc with muscosal injury Gastropathy = indicates epithelial cell damage and regeneration WITHOUT inflammation - commonest cause is mucosal damage associated with Aspirin/ NSAIDs
30
What are some causes of gastritis?
H.Pylori infection Autoimmune gastritis Viruses - CMV, herpes simplex Duodenogastric reflux Mucosal ischaemia Increased acid Aspirin and NSAIDs Alcohol
31
How does gastritis present?
Nausea or recurrent upset stomach Abdo bloating Epigastric pain Vomiting Indigestion Hematemesis
32
How do you investigate Gatritis?
H.pylori urea breath test H.pylori faecal antigen test FBC
33
How would you manage gastritis?
Ranitidine H.pylori - triple therapy Autoimmune - cyanocobalamin
34
What are some causes of malabsorption?
Pancreatic insufficiency Defective bile secretion Bacterial Overgrowth Coeliac disease Crohn's Giardia Lamlia Surgical resection of bowel Lack of digestive enzymes Defective epithelial transport Lymphatic obstruction
35
What is coeliac disease ?
T-cell mediated autoimmune disease of the small bowel in which PROLAMIN intolerance causes villous atrophy and malabsorption
36
What are some forms of Prolamin?
Gliadin = wheat Hordeins = barley Secalins = rye
37
What are some risk factors for coeliac disease?
Type 1 diabetes Thyroid disease Sjogrens IgA deficiency Breast feeding Age of introduction to gluten into diet Rotavirus infection in infancy
38
Which part of the bowel is most affected by coeliac disease? What is the consequence of this part being affected?
proximal small bowel Meaning B12, folate and iron cannot be absorbed = anaemia
39
How does coeliac disease present?
1/3 asymptomatic steatorrhoea diarrhoea abdominal pain bloating nausea & vomiting angular stomatitis weight loss fatigue anaemia osteomalacia
40
How would you investigate coeliac disease?
Small bowel histology - gold-standard FBC and blood smear - low Hb and microcytic red cells IgA-tTg - increased titre endomysial antibody - alt to IgAtTG with greater specificity and lower sensitiviy skin biopsy - IgA dermal deposits Endoscopy -
41
How would you manage coeliac disease?
gluten-free diet calcium and iron supplements correct electrolytes prednisolone
42
What are histological findings on biopsy that would indicate coeliac disease?
villous atrophy crypt hyperplasia increased intraepithelial white cell count
43
What are the forms of Ulcerative Colitis?
Proctitis - just rectum - 50% Left-sided colitis - rectum and left colon - 30% Entire Colon/up to ileocaecal valve- pancolitis/extensive colitis - 20%
44
What are some risk factors for UC?
Fam Hx NSAIDs smoking is protective chronic stress and depression trigger flares
45
How does UC present?
runs a course of remissions and exacerbations restricted pain usually in lower left quadrant episodic or chronic diarrhoea with blood and mucus cramps in acute UC - may be fever, tacycardia and tender distened abdomen
46
What are some extra intestinal signs of UC?
clubbing apththous oral ulcers erythema nodusum amyloidosis
47
How would you investigate UC?
Stool studies - faecal calprotectin ESR/CRP - suggestive of flare-ups flexible sigmoidoscopy colonoscopy biopsy
48
What are some macroscopic findings of UC?
only colon up to ileocaecal valve begins in the rectum and extends NO skip lesions
49
What are some microscopic findings of UC?
mucosal inflammation ONLY - it is not transmural depleted goblet cells increased crypt abscesses
50
How would you manage UC?
Acute - methylprednisolone IV fluids ciclosporin non-acute - mesalazine (5ASA) prednisolone ciclosporin colectomy
51
Which part of the GI tract is affected by Crohn's?
Any part of the gut from mouth to anus Esp. terminal ileum and proximal colon There are parts of unaffected bowel = skip lesions
52
What are some risk factors for Crohn's?
genetic association (mutation in NOD2) smoking NSAIDs may exacerbate Fam Hx Chronic stress and depression Appendictomy may increase risk
53
What are macroscopic features of Crohn's?
not continuous = skip lesions involved bowel is usually thickend and often narrowed Cobblestone appearance due to ulcers and fissures
54
What are some microscopic features of Crohn's?
Transmural inflammation = through all layers lymphoid hyperplasia granulomas present - non-caseating epitheloid cells goblet cells present
55
How does Crohn's present?
diarrhoea with urgency bleeding pain - acute right iliac fossa pain weight loss malaise lethargy perinal abscess anal strictures
56
What are some extra-intestinal features of Crohn's?
apthous ulcers, clubbing, skin, joint and eye problems
57
How would you investigate Crohn's?
FBC Iron studies B12 and folate ESR and CRP CT scan Colonoscopy and biopsy
58
How would you treat Crohn's?
Budesonide/Mesalazine Azathioprine MTX

Gastro (4 decks)

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