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Phase 2A revision > GI > Flashcards

GI Flashcards

1
Q

Define intestinal obstruction

A

Blockage of the lumen of the gut

Arrest of onward propulsion of intestinal contents

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2
Q

Name 3 broad types of causes of intestinal obstruction

A
  1. Intraluminal obstruction = something in the bowel
  2. Intramural obstruction = something in the wall of the bowel
  3. Extraluminal obstruction = something outside of the bowel
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3
Q

Give 3 causes of intraluminal obstruction of the intestine

A
  1. Tumour - carcinoma, lymphoma
  2. Diaphragm disease
  3. Meconium ileus
  4. Gallstone ileus
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4
Q

What is diaphragm disease?

A

Mucosa/submucosa fold due to fibroid diaphragm leaving a pinhole lumen

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5
Q

What is thought to cause diaphragm disease?

A

NSAIDs

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6
Q

Give 3 causes of intramural obstruction of the intestine

A
  1. Inflammatory disease = Chron’s, Diverticulitis
  2. Tumours
  3. Neural = Hirschsprung’s disease
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7
Q

Describe how Crohn’s disease can cause intestinal obstruction

A

Crohn’s disease –> fibrosis –> contraction –> obstruction

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8
Q

Describe how diverticular disease can cause intestinal obstruction

A

Out pouching of mucosa –> faeces trapped –> inflammation in bowel wall –> contraction –> obstruction

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9
Q

What is Hirschsprung’s disease?

A

A congenital condition where there is a lack of nerves in the bowel –> no ganglion cells –> no contraction –> distal obstruction and gross dilation of the bowel

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10
Q

Give 3 causes of extraluminal obstruction of the intestine

A
  1. Adhesions
  2. Volvulus
  3. Peritoneal tumour
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11
Q

What are adhesions?

A

Fibrous bands stick 2 bits of bowel together so bowel is pulled and distorted

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12
Q

What causes adhesions?

A

Often formed after abdominal surgery (pelvic, gynaecologist, colorectal)

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13
Q

What is volvulus?

A

Bowel twisting around each other cuts off blood supply/ lumen
Risk of ischaemia, necrosis and perforation

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14
Q

Which areas of the bowel are most likely to be affected by volvulus?

A

Occurs in areas of bowel that have mesentery

Often in the sigmoid colon

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15
Q

Give 4 common causes of small bowel obstruction in adults

A
  1. Adhesions
  2. Hernias
  3. Crohn’s disease
  4. Malignancy
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16
Q

Give 3 common causes of small bowel obstruction in children

A
  1. Appendicitis
  2. Volvulus
  3. Intussusception
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17
Q

What is intussusception?

A

One part of the intestine telescopes into another section of the intestine
Caused by force in-balances

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18
Q

Give 5 symptoms of small bowel obstruction

A
  • vomiting more common
  • periumbilical
  • cramping and intermittent pain
  • lasts for a few minutes at a time
  1. Nausea and anorexia
  2. Early feculent vomit
  3. Diffuse colicky pain
  4. Late constipation
  5. Distention
  6. Tenderness
  7. bowel sounds
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19
Q

Does abdominal distension occur more distal or proximal to an intestinal obstruction?

A

More distal = greater distension

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20
Q

What investigations might you do in someone who you suspect to have a small bowel obstruction?

A
  • FBC
  • abdominal x-ray - shows central gas shadow that completely cross the lumen, distended loops of bowel proximal to obstruction, fluid levels seen
  • CT - gold standard to localise lesion accurately
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21
Q

What is the management/treatment for small bowel obstruction?

A
  1. Fluid resuscitation
  2. Bowel decompression
  3. Analgesia and antiemetics
  4. Antibiotics
  5. Surgery - laparotomy, bypass segment, resection
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22
Q

Which is more common, small or large bowel obstruction?

A

Small bowel obstruction = 60-75% of intestinal obstruction

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23
Q

What can untreated intestinal obstruction lead to?

A
  1. Ishcaemia
  2. Necrosis
  3. Perforation
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24
Q

Give 2 common causes of large bowel obstruction

A
  1. Colorectal malignancy - most common in UK

2. Volvulus - more common in Africa

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25
Q

Where is the usual site of perforation in large bowel obstruction if the ileocaecal valve is competent?

A

Caecum

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26
Q

How long does acute presentation of large bowel obstruction last?

A

Average of 5 day of symptoms = abdominal pain and constipation

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27
Q

Give 5 symptoms of large bowel obstruction

A
  • lower abdominal pain
  • less frequent pain
  • episodes last longer
  1. Bloating/fullness/nausea
  2. Late vomiting (more faecal like) - may be absent
  3. Colicky pain - more constant than SBO
  4. Distension
  5. Blood in stool
  6. constipation
  7. palpable mass
  8. bowel sounds normal then increase then quiet later
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28
Q

What investigations might you do in someone who you suspect to have a large bowel obstruction?

A
  1. Digital rectal examination - empty rectum, hard stools, blood
  2. abdominal X ray - peripheral gas shadows proximal to blockage, caecum and ascending colon distended
  3. CT scan
  4. FBC - low Hb
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29
Q

Describe the management for a large bowel obstruction

A
  1. IV fluid replacement
  2. Bowel decompression
  3. Surgery - laparotomy
  4. analgesia and antiemetic
  5. antibiotics
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30
Q

Define hernia

A

Abnormal protrusion of an organ into a body cavity it doesn’t normally belong

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31
Q

What are the risks of hernia’s if left untreated?

A

Become strangulated

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32
Q

Give 2 symptoms of hernias

A
  1. Pain

2. Palpable lump

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33
Q

Describe the progression from normal epithelium to colorectal cancer

A

Normal epithelia –> adenoma –> colorectal adenocarcinoma –> metastatic colorectal adenocarcinoma

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34
Q

Define adenocarcinoma

A

A malignant tumour of glandular epithelium

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35
Q

What is familial adenomatous polyposis?

A

Autosomal dominant condition

- arise from mutation in APC gene- where you develop thousands of polyps in the duodenum and colorectal in teens

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36
Q

What are precursors to colorectal cancer?

A

Polyploid adenomas

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37
Q

Describe the epidemiology of colorectal cancer

A 
Normally adenocarcinoma 
- majority in distal colon
Incidence peaks around 60-65 years 
Males > females
2nd most common cause of cancer death in UK
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38
Q

Give 5 risk factors for colorectal cancer

A
  1. Increasing age
  2. Family history
  3. Western diet - saturated animal fat, red meat consumption, low fibre, high sugar
  4. Alcohol
  5. Smoking
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39
Q

Give 3 reasons why bowel cancer survival has increased over recent years

A
  1. Introduction of the bowel cancer screening programme
  2. Colonoscopic techniques
  3. Improvements in treatment options
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40
Q

What can affect the clinical presentation of a colorectal cancer?

A

How close the cancer is to the rectum

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41
Q

Give 2 signs of a left sided/sigmoid colorectal cancer

A
  1. Altered bowel habit
  2. diarrhoea
  3. blood in stool
  4. alternating diarrhoea and constipation
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42
Q

Give 3 signs of a right sided colorectal cancer

A
  1. assymptomatic until presenting with Iron deficiency anaemia
  2. Right iliac fossa mass
  3. Weight loss
  4. low Hb
  5. abdominal pain
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43
Q

Give 4 signs of rectal carcinoma

A
  • rectal bleeding and mucus
  • when cancer grows there will be thinner stools and tenesmus (cramping rectal pain)
  1. Abdominal mass
  2. Perforation
  3. Haemorrhage
  4. Fistulae
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44
Q

What investigations might you do in someone who you suspect might have colorectal cancer?

A
  • Faecal occult blood test
    >50 + bowel habit change / iron deficient anaemia
    >60 + anaemia
  • Colonoscopy + biopsy
  • Flexible sigmoidoscopy / barium enema / CT colonoscopy
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45
Q

How can adenoma formation be prevented?

A

NSAIDs

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46
Q

What screening programme is used to identify bowel cancer?

A

Faecal occult blood (FOB) screening

For over 65s+ve result = biopsy

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47
Q

What is the management for colorectal adenocarcinoma?

A
  • Surgical resection
  • endoscopic stenting for palliative care
  • radiation
  • chemotherapy - if duke’s stage C
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48
Q

What is the treatment for metastatic colorectal adenocarcinoma?

A

Chemotherapy and palliative

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49
Q

Explain Dukes staging and prognosis

A 
A = limited to muscularis mucosae = 95% 5-year survival 
B = extension through muscularis mucosae (not lymph) = 75% 5-year survival 
C = involvement of regional lymph nodes = 35% 5-year survival 
D = distant metastases = 25% 5-year survival
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50
Q

What does T refer to in the staging of cancer?

A

T = refers to primary tumour and suffixed by number that denotes tumour size

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51
Q

What does N refer to in the staging of cancer?

A

N = refers to lymph node status and is suffixed by numbers that denotes number of lymph nodes or group of lymph nodes containing metastases

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52
Q

What does M refer to in the staging of cancer?

A

M = refers to anatomical extent of distant metastases

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53
Q

What does the T mean for colorectal cancer staging?

A 
T1 = invades submucosa 
T2 = Muscularis propria
T3 = Bowel wall 
T4 = Peritoneum
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54
Q

What does the N mean for colorectal cancer staging?

A 
N1 = spread to lymph nodes
N2 = spread to lymph nodes above the diaphragm
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55
Q

What does the M mean for colorectal cancer staging?

A

M1 = surrounding structure involvement (liver)

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56
Q

Name 5 things that can break down the mucin layer in the stomach and cause gastritis

A
  1. Mucosal ischameia
  2. H. pylori
  3. Aspirin, NSAIDs - most common
  4. Increased acid (stress)
  5. Bile reflux
  6. Alcohol
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57
Q

Give 3 symptoms of gastritis

A
  1. Epigastric pain
  2. Nausea and vomiting (recurrent upset stomach)
  3. Indigestion
  4. Haematemesis
  5. dyspepsia
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58
Q

What investigations are done with someone you suspect has gastritis?

A
  • Endoscopy (erythema)
  • Biopsy (histology change)
  • Blood tests (inflammation)
  • H.pylori testing - urea breath test, stool antigen test
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59
Q

Describe the treatment for gastritis

A
  1. Decrease alcohol and smoking
  2. Antacid (magnesium carbonate)
  3. PPI (omeprazole)
  4. H2 receptor antagonist (ranitidine)
  5. Enteric coated aspirin
  6. decrease stress
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60
Q

How do you treat H. pylori?

A

Triple therapy:
Normal –> amoxicillin, omeprazole and clarithromycin/metronidazole

Penicillin resistance –> clarithromycin, omeprazole and metronidazole

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61
Q

Give 4 causes of peptic ulcers

A
  1. NSAIDs
  2. Mucosal ischaemia
  3. Increased acid production (stress)
  4. Bile reflux
  5. Alcohol
  6. H. pylori
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62
Q

How does mucosal ischaemia cause ulcer formation?

A

Lack of blood flow to cells –> no mucin production = no mucosal protection –> ulcer formation

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63
Q

How does increased acid production (stress) cause ulcer formation?

A

Mucosa overwhelmed –> corrosion –> ulcer formation

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64
Q

How does NSAIDs cause ulcer formation?

A

Reduced prostaglandin synthesis due to salicylic acid release –> cell death –> no mucin production = no mucosal protection –> ulcer formation

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65
Q

How does bile reflux cause ulcer formation?

A

Mucosal cell damages –> no mucin production = no mucosal protection –> ulcer formation

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66
Q

How does H. pylori cause ulcer formation?

A
  • causes decrease in HCO3- which increases acidity
  • H.pylori secretes urease
  • splits urea into CO2 and ammonia
  • ammonia + H+ forms ammonium which is toxic to gastric mucosa
  • Acute inflammatory reaction (neutrophils) with less mucosal defence
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67
Q

Give 3 symptoms of peptic ulcers

A
  1. recurrent burning epigastric pain
  2. pain relieved by antacids and is worse when hungry
  3. pain occurs at night
  4. nausea
  5. anorexia and weight loss
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68
Q

What investigations might you do in someone who you suspect to have peptic ulcers?

A

H. Pylori Test (Urease breath test)

Endoscopy (if Over 55 or Red Flags Present)

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69
Q

How can you treat peptic ulcers?

A
  • lifestyle changes
  • reduce stress, avoid irritating food, reduce smoking
  • Stop NSAIDs
  • H.Pylori eradication (triple therapy):
    - PPI - OMEPRAZOLE
    - 2 of following:
    - AMOXICILLIN
    - CLARITHROMYCIN
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70
Q

Name 2 complications of peptic ulcers

A
  • Haemorrhage due to erosion to artery

- Peritonitis due to erosion through wall

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71
Q

Give 5 broad causes of malabsorption

A
  1. Defective intraluminal digestion
  2. Insufficient absorptive area
  3. Lack of digestive enzymes
  4. Defective epithelial transport
  5. Lymphatic obstruction
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72
Q

Malabsorption: what can cause defective intraluminal digestion?

A
  1. Pancreatic insufficiency due to pancreatitis/CF - lack of digestive enzymes
  2. Defective bile secretion due to biliary obstruction or ileal resection
  3. Bacterial overgrowth
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73
Q

Malabsorption: what can cause insufficient absorptive area?

A
  1. Coeliac disease
  2. Crohn’s disease
  3. Extensive surface parasitisation
  4. Small intestinal resection or bypass
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74
Q

Malabsorption: give an example of when there is a lack of digestive enzymes

A

Lactose intolerance - disaccharide enzyme deficiency

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75
Q

Malabsorption: what can cause lymphatic obstruction?

A
  1. Lymphoma

2. TB

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76
Q

Describe the distribution of inflammation seen in Crohn’s disease

A

Patchy (skip lesions), granulomatous, transmural inflammation

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77
Q

Describe the distribution of inflammation seen in Ulcerative colitis

A

Continuous inflammation affecting only the mucosa

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78
Q

What part of the bowel is commonly affected by Crohn’s disease?

A

Can affect anywhere from the mouth to anus

Terminal ileum is most affected

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79
Q

What part of the bowel is commonly affected by Ulcerative colitis?

A

Spreads proximally from the rectum but only affects the colon

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80
Q

give 3 microscopic features that will be seen in ulcerative colitis

A
  1. Crypt abscess
  2. goblet cell depletion
  3. mucosal inflammation - does not go deeper
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81
Q

what are the macroscopic features of crohn’s disease?

A
  • Deep ulcers and fissures –> cobblestone look
  • skip lesions
  • involved bowel often thickened and narrowed
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82
Q

In Crohn’s or UC is smoking a protective factor?

A

Ulcerative colitis

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83
Q

Name 3 causes of IBD

A
  1. Genetic
  2. Stress/depression
  3. Inappropriate immune response
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84
Q

Give 4 signs and symptoms of Ulcerative colitis

A
  1. Episodic/chronic diarrhoea +/- blood/ mucus
  2. Abdominal pain - left lower quadrant
  3. Systemic - fever, malaise, anorexia, weight loss
  4. Clubbing
  5. Erythema nodosum
  6. Amyloidosis
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85
Q

Give 4 signs and symptoms of Crohn’s disease

A
  1. Diarrhoea - urgency
  2. Abdominal pain
  3. Systemic - weight loss, fatigue, fever, malaise
  4. Bowel ulceration
  5. Anal fistulae/stricture
  6. Clubbing
  7. Skin/joint/eye problems
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86
Q

What investigations might you do in someone with IBD?

A
  1. Bloods - FBC, ESR, CRP
  2. Faecal calprotectin - shows inflammation but is not specific for IBD
  3. Flexible sigmoidoscopy
  4. Colonoscopy - biopsy to confirm
  5. examination
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87
Q

What is the treatment for Crohn’s disease?

A
  • Smoking cessation
  • 1st line = Corticosteroids - BUDESONIDE (controlled release) or ORAL PREDNISOLONE (for severe attacks)
  • Surgical resection - only minimal
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88
Q

What is the treatment for Ulcerative colitis?

A
  • Aminosalicylates
  • 5-ASA (SULFASALAZINE)
  • PREDNISOLONE
  • HYDROCORTISONE
  • Surgical resection
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89
Q

Give 5 complications of Ulcerative colitis

A
  1. Colon –> blood loss, colorectal cancer, toxic dilatation
  2. Arthritis
  3. Iritis, episcleritis
  4. Fatty liver and primary sclerosing cholangitis
  5. Erythema nodosum
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90
Q

Give 5 complications of Crohn’s

A

PERFORATION AND BLEEDING = MAJOR

  1. Malabsorption
  2. Obstruction –> toxic dilatation
  3. Fistula/abscess formation
  4. Anal skin tag/fissures/fistula
  5. Neoplasia
  6. Amyloidosis
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91
Q

Describe the pathophysiology of Coeliac disease

A
  1. Gliadin from gluten deaminated by tissue transglutaminase –> increases immunogenicity
  2. Gliadin recognised by HLA-DQ2 receptor on APC –> inflammatory response
  3. Plasma cells produce anti-gliadin and tissue transglutaminase –> T cell/cytokine activated
  4. Villous atrophy and crypt hyperplasia –> malabsorption
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92
Q

When does Coeliac disease usually present?

A

2 peaks - infancy and 5th decade

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93
Q

Give 5 symptoms of Coeliac disease

A
  1. Diarrhoea and steatorrhoea (stinking/fatty)
  2. Weight loss
  3. Irritable bowel
  4. Iron deficiency anaemia
  5. Osteomalacia
  6. Fatigue
  7. abdominal pain
  8. angular stomatitis
  9. dermatitis herpetiform
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94
Q

What investigations might you do in someone who you suspect to have coeliac disease?

A
  • anti-tTg antibody test - must keep gluten diet 6 weeks prior
  • Endoscopy - duodenal biopsy post 6 weeks gluten diet (gold standard)
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95
Q

What 3 histological features are needed in order to make a diagnosis of coeliac disease?

A
  1. Raised intraepithelial lymphocytes
  2. Crypt hyperplasia
  3. Villous atrophy
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96
Q

What part of the bowel is mostly affected in coeliac disease?

A

Proximal small bowel (duodenum)

mean B12, folate and iron cannot be absorbed = anaemia

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97
Q

How do you treat coeliac disease?

A
  • Lifelong gluten free diet
  • correction of mineral and vitamin deficiency
  • DEXA scan for osteoporosis risk
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98
Q

Give 3 complications of Coeliac disease

A
  1. Osteoporosis
  2. Anaemia
  3. Increased risk of GI tumours
  4. secondary lactose intolerance
  5. T-cell lymphoma
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99
Q

What cells normally line the oesophagus?

A

Stratified squamous non-keratinising cells

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100
Q

Give 3 causes of squamous cell carcinoma

A
  1. Smoking
  2. Alcohol
  3. Poor diet/obesity
  4. coeliac disease
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101
Q

Name 2 types of Oesophageal cancer

A
  1. Adenocarcinoma - distal 1/3rd of oesophagus

2. Squamous cell carcinoma - proximal 2/3rds of oesophagus

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102
Q

What can cause oesophageal adenocarcinoma?

A

Barrett’s oesophagus

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103
Q

Give 5 symptoms of oesophageal carcinoma

A
  1. progressive dysphagia
  2. Weight loss
  3. Heartburn
  4. Haematemesis
  5. Anorexia
  6. Pain
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104
Q

What investigations might be done on someone you suspect has oesophageal cancer?

A

upper GI endoscopy and biopsy = 1st line
Barium swallow - to see strictures
CT/MRI for staging

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105
Q

How can you treat oesophageal cancer?

A
  • Surgical resection
  • best chance of cure if not infiltrated through oesophageal wall
  • Chemotherapy - Palliative care
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106
Q

Give 3 causes of gastric cancer

A
  1. Smoked foods
  2. Pickles
  3. H. pylori infection
  4. Pernicious anaemia
  5. Gastritis
  6. family history
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107
Q

Describe how gastric cancer can develop from normal gastric mucosa

A

Smoked/pickled food diet leads to intestinal metaplasia of normal gastric mucosa
Several genetic changes lead to dysplasia and then eventually intra-mucosal and invasive carcinoma

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108
Q

Give 3 symptoms and signs of gastric cancer

A
  1. Weight loss
  2. Anaemia (pernicious)
  3. nausea and Vomiting
  4. Dyspepsia and dysphasia
  5. palpable epigastric mass
  6. Hepatomegaly, jaundice and ascites
  7. Enlarged supraclavicular nodes
  8. epigastric pain
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109
Q

What investigations might you do in someone who you suspect has gastric cancer?

A
  1. gastroscopy - biopsy
  2. endoscopic USS - depth of invasion
  3. CT /MRI /PET
110
Q

What is the advantage of doing a laparoscopy in someone with gastric cancer?

A

It can detect metastatic disease that may not be detected on USS/endoscopy

111
Q

what is the management for gastric cancer?

A

Nutritional support
Surgical resection
Chemo

112
Q

what are the red flag signs for upper GI cancer?

A

For people with an upper abdominal mass consistent with stomach cancer:

  • Dysphagia of any age
  • Aged ≥ 55yr + weight loss with any of the following:
  • Upper abdominal pain/(or)
  • Reflux/ (or)
  • Dyspepsia
113
Q

What vitamin supplement will a patient need following gastrectomy?

A

They will be deficiency in intrinsic factor so will need vitamin B12 supplements to prevent pernicious anaemia

114
Q

Give 3 causes of appendicitis

A
  1. Faecolith
  2. Lymphoid hyperplasia
  3. Filarial worms
115
Q

Describe the pathophysiology of appendicitis

A

Lumen of appendix is obstructed –> invasion of gut organism into appendix wall –> inflammation
- if the appendix ruptures, faecal matter will enter the peritoneum resulting in peritonitis

116
Q

Give 4 symptoms of appendicitis

A
  1. Right sided pain located at McBurneys point
  2. Anorexia
  3. Nausea and vomiting
  4. Constipation
  5. Tenderness with guarding and rebound
  6. Tachycardia
117
Q

What investigations might be done in a patient you suspect has appendicitis?

A
  • Blood tests = raised WCC,
  • CRP, ESR
  • USS
  • CT - gold standard
118
Q

What is the treatment for appendicitis?

A
  • Appendicectomy

- IV antibiotics pre-op

119
Q

Give 2 complications of appendicitis

A
  1. Ruptured appendix –> peritonitis
  2. Appendix mass
  3. Appendix abscess
120
Q

Who is most likely to be affected by diverticular disease?

A

Patients over 50 and those with low fibre diets

121
Q

Describe the pathophysiology of diverticulitis

A

Out-pouching of bowel mucosa –> faeces can get trapped here and obstruct the diverticula –> abscess and inflammation –> diverticulitis

122
Q

What part of the bowel is most likely to be affected by diverticulitis?

A

sigmoid colon - smallest luminal diameter and highest pressure

also descending colon

123
Q

What is acute diverticulitis?

A

A sudden attack of swelling in the diverticula

Can be due to surgical causes

124
Q

Describe the signs of acute diverticulitis

A

Pain in left iliac fossa region
Fever and constipation
Tachycardia
signs and symptoms similar to appendicitis but on left side

125
Q

Give 3 causes of Gastro-oesophageal reflux disease (GORD)

A
  1. Hiatus hernia - sliding or rolling hiatus
  2. Smoking
  3. Obesity
  4. Alcohol
  5. pregnancy
126
Q

Describe the pathophysiology of GORD

A

Lower oesophageal sphincter dysfunction –> reflux of gastric contents –> oesophagitis

127
Q

Name 3 oesophageal symptoms of GORD

A
  1. Heartburn - retrosternal chest pain, after meals, worse when lying down, relieved by antacids
  2. Bleching
  3. Food/acid and water brash
  4. Odynophagia - (painful swallowing)
  5. Dysphagia - (difficulty swallowing)
128
Q

Name 3 extra oesophageal symptoms of GORD

A
  1. Nocturnal asthma
  2. Chronic cough
  3. Laryngitis
  4. Sinusitis
129
Q

What investigations are done for someone you suspect has GORD?

A
  • Diagnosis can be made without investigations
  • Endoscopy (if red flags)
  • Barium swallow
  • 24hr oesophageal pH monitoring
130
Q

What is the treatment of GORD?

A

conservative

  • stop smoking
  • stop alcohol
  • lose weight
  • change sleep position

medical

  • PPI (omeprazole)
  • H2 receptor antagonist (ranitidine)

surgical
- nissen fundoplication

131
Q

Give an example of a functional bowel disorder

A

IBS

132
Q

Describe the multi-factorial pathophysiology of IBS

A

The following factors can all contribute to IBS:

  • Psychological morbidity
  • trauma in early life
  • Abnormal gut motility
  • Genetics
  • Altered gut signalling (visceral hypersensitivity)
133
Q

Give 3 symptoms of IBS

A
  1. Abdominal pain
  2. Bloating
  3. Change in bowel habit
  4. Mucus
  5. Fatigue
  6. Backache
134
Q

Give an example of a differential diagnosis for IBS

A
  1. Coeliac disease
  2. Lactose intolerance
  3. Bile acid malabsorption
  4. IBD
  5. Colorectal cancer
135
Q

What investigations might you do in someone who you suspect has IBS?

A

Rule out differentials

  1. Bloods - FBC, U+E, LFT
  2. CRP
  3. Coeliac serology
  4. Colonoscopy
136
Q

Describe the non pharmacological treatment of IBS

A

Education
Resistance
Dietary modification - reduce caffeine, plenty of fluids, increase fibre intake

137
Q

Describe the pharmacological treatment of IBS

A
  1. Antispasmoidics for bloating - mebeverine, buscopan
  2. Laxatives for constipation - Senna, Movicol
  3. Anti-motility agent for diarrhoea - loperamide
  4. Tricyclic antidepressants
138
Q

Which of the following is FALSE regarding colorectal cancer?

a. Bowel cancer screening is offered to people aged 65 or over
b. The majority of cancers occur in the proximal colon
c. FAP and HNPCC are 2 inherited causes of colon cancer
d. Proximal cancers usually have a worse prognosis
e. Patients with PSC and UC have an increased risk of developing colon cancer

A

b. The majority of cancers occur in the proximal colon

139
Q

A 50-year-old man presents with dysphagia. Which one of the following suggest a benign nature of his disease?

a. Weight loss
b. Dysphagia to solids initially then both solids and liquids
c. Dysphagia to solids and liquids occurring form the start
d. Anaemia
e. Recent onset of symptoms

A

c. Dysphagia to solids and liquids occurring form the start

140
Q

A 19-year-old girl presents with abdominal pain and loose stool. Which of the features suggest that she has irritable bowel syndrome?

a. Anaemia
b. Nocturnal diarrhoea
c. Weight loss
d. Blood in stool
e. Abdominal pain relieved by defecation

A

e. Abdominal pain relieved by defecation

141
Q

Which statement is true regarding H. pylori?

a. It is a gram-positive bacterium
b. HP prevalence is similar in developing and developed countries
c. 15% of patients with a duodenal ulcer are infected with H. pylori
d. PPIs should be stopped 1 week before a H. pylori stool antigen test
e. It is associated with an increased risk of gastric cancer

A

e. It is associated with an increased risk of gastric cancer

142
Q

A 56-year-old man presents with abdominal distension and shortness of breath. Examination revealed fever of 38C, a tense distended abdomen with shifting dullness. He also has dullness to percussion in the right lung base. Several spider naevi are seen on his chest. Which is the most important test in the management of this patient?

a. CXR
b. USS abdomen
c. Echocardiogram
d. Ascitic tap

A

d. Ascitic tap

143
Q

Which of the following features best distinguishes Ulcerative colitis from Crohn’s disease?

a. Ileal involvement
b. Continuous colonic involvement
c. Non-caseating granuloma
d. Transmural inflammation
e. Perianal disease

A

b. Continuous colonic involvement

144
Q

A 68-year-old lady presents with abdominal pain and distention. She last opened her bowels 5 days ago. She has a poor appetite and has lost some weight recently. Her PMH includes an abdominal hysterectomy and diverticulosis. She drinks 20 units of alcohol a week and smokes 5 a day. Examination reveals a distended abdomen with tympanic percussion throughout. There is a small left groin lump with a cough impulse. Which one of the following is NOT likely to be the cause of her abdominal pain and distention?

a. Colon cancer
b. Adhesions
c. Ascites
d. Diverticulitis
e. Strangled hernia

A

c. Ascites

145
Q

A patient drinks 4 pints (567ml = 1 pint) of beer (4%) a day, and 2 standard (175ml) glasses of red wine (13%) on Saturday and Sunday additionally. How many units of alcohol is he drinking per week?

a. 73 units
b. 62 units
c. 94 units
d. 57 units
e. 49 units

A

a. 73 units

Alcohol unit = strength of the drink (%ABV) x amount of liquids in mls / 1000

146
Q

A 71-year-old man was admitted to hospital with pneumonia after he returned from a cruise holiday in the Mediterranean Sea. He was treated with a week of augmentin (co-amoxiclav) for his pneumonia. On day 7 of his admission, he started having diarrhoea 10 times a day without any blood. He feels unwell and dehydrated. He had a flexible sigmoidoscopy which showed this. What is the likely organism responsible for his diarrhoea?

a. Norovirus
b. Escherichia coli
c. Giardia lamblia
d. Clostridium difficile
e. Salmonella enteritidis

A

d. Clostridium difficile

147
Q

A 52-year-old lady presents with fatigue and itching. She noticed pale stool and dark urine. She suffers from hypercholesterolaemia and rheumatoid arthritis. She takes simvastatin and cocodamol. Examination revealed jaundice, xanthelasma, spider naevi, and hepatomegaly. Her bloods showed Bili 150, ALP 988, ALT 80, positive AMA and a raised IgM. What is the most likely diagnosis?

a. Simvastatin induced liver injury
b. Primary biliary cirrhosis
c. Gallstones
d. Autoimmune hepatitis
e. Primary sclerosing cholangitis

A

b. Primary biliary cirrhosis

148
Q

A 16-year-old girl is admitted with vomiting and abdominal pain. She reports taking 20 paracetamol tablets after her boyfriend split up with her. Which one of the following test results would you NOT expect to see?

a. A metabolic acidosis
b. A prolonged prothrombin time
c. A raised creatinine
d. Hyperglycaemia
e. ALT 1000

A

d. Hyperglycaemia

149
Q

A 68-year-old unkempt and malnourished homeless man was brought to the hospital with haematemesis. Endoscopy found bleeding varices. Subsequent USS showed a coarse shrunken liver. On day 2 admission he was found to be ataxic, confused with nystagmus. What is the most likely cause of his neurological presentation?

a. Alcohol toxicity
b. Alcohol withdrawal
c. Delirium tremens
d. Wernicke’s encephalopathy
e. Korsakoff syndrome

A

d. Wernicke’s encephalopathy

150
Q

A 23-year-old man was brought in at 2am with RIF pain and was diagnosed with acute appendicitis. He was stable and was scheduled for appendicectomy in the morning. During the ward round, he acutely deteriorated. He was immediately brought to theatre for a perforated appendix. What clinical signs would you NOT expect to see?

a. Fever
b. Bowel sounds
c. Tachycardia
d. Rebound tenderness
e. Guarding

A

b. Bowel sounds

151
Q

Which antibody is associated with coeliac disease?

a. Anti-ds-DNA
b. Anti-phospholipid
c. ANCA
d. Alpha gliadin
e. Rheumatoid factor

What are the other antibodies associated with?

A

d. Alpha gliadin = coeliac

a. Anti-ds-DNA = SLE
b. Anti-phospholipid = Anti phospholipid syndrome
c. ANCA = small vessel vasculitis
d. Alpha gliadin = coeliac
e. Rheumatoid factor = RA

152
Q

Jenny’s been non-stop to the loo and has recently been diagnosed with IBS using the Rome III criteria. She’s tried out a low FODMAP diet, but her diarrhoea won’t budge. Which of the following drug sis the most appropriate pharmacological intervention for this patient?

a. Ferrous sulphate
b. Loperamide
c. Methotrexate
d. Metronidazole
e. Omeprazole

What are the other types of medication?

A

b. Loperamide = anti-diarrhoeal, anti-motilitica.

Ferrous sulphate = iron supplement 
Loperamide = anti-diarrhoeal, anti-motilitic 
Methotrexate = DMARDs 
Metronidazole = Antibiotic 
Omeprazole = PPI
153
Q

A 34-year-old South African patient presents to A&E with severe pain in his left iliac abdominal region. He describes hat the pain has come on suddenly and since its onset he has not been able to pass stool. He has had no previous abdominal surgery, is a non-smoker and his tissue transglutamase results are negative. What is the most likely diagnosis?

a. Coeliac
b. Colorectal cancer
c. Large bowel obstruction – volvulus
d. Small bowel obstruction – adhesion
e. Strangulation hernia

A

c. Large bowel obstruction – volvulus

154
Q

Which if the following is not a feature of Crohns disease?

a. Mouth ulcers
b. Mucosal inflammation
c. Granulomatous skip lesion
d. Raised CRP levels
e. Smoking decreased the risk of the disease

A

e. Smoking decreased the risk of the disease

Protective in UC

155
Q

Which indicates IBD not IBS?

a. Smelly stool
b. DXA scan revealing decreased bone mineral density
c. Nocturnal diarrhoea
d. Abdominal cramps
e. Feeling fatigued

A

c. Nocturnal diarrhoea

156
Q

Which 2 of the following statements about ascending cholangitis are false?

a. Caused by bacterial infection of biliary tree
b. Patients experience epigastric pain
c. Patients present with temperature
d. Patients present with yellowing of the skin and sclera
e. Murphy’s sign is negative

A

b. Patients experience epigastric pain

e. Murphy’s sign is negative

157
Q

What is the cystic artery a branch of?

a. Coeliac trunk
b. Gastroduodenal artery
c. Last gastroepiploic artery
d. Right hepatic artery
e. Splenic artery

A

d. Right hepatic artery

158
Q

Haemochromatosis is a metabolic liver disease caused by uncontrolled intestinal absorption of which ion?

a. Ca2+
b. Cu2+
c. Fe2+
d. Li+
e. K+

A

c. Fe2+

159
Q

H. pylori eradication = PPI and 2 antibiotics. Which antibiotics?

a. Amoxicillin and clarithromycin
b. Doxycycline and metronidazole
c. Ethambutol and trimethoprim
d. Lithium and clarithromycin
e. Rifampicin and amoxicillin

A

a. Amoxicillin and clarithromycin

160
Q

what are the microscopic features of crohns disease?

A
  • transmural inflammation
  • granulomas
  • increase in inflammatory cells
  • goblet cells
  • less crypt abscesses
161
Q

what is the epidemiology of crohns disease?

A
  • highest incidence and prevalence in Northern Europe, UK and N America
  • lower incidence than UC
  • female>male
  • 1/5 have 1st degree relative with disease
  • present mostly 20-40 yrs old
162
Q

what are the risk factors for crohn’s disease?

A
  • genetic association - mutation on NOD2 (CARD15) gene on chromosome 16
  • smoking
  • NSAIDs
  • family history
  • chronic stress and depression
  • good hygiene
  • appendicectomy
163
Q

what are the macroscopic features of ulcerative colitis?

A
  • affect the colon only
  • begins in rectum and extends proximally
  • continuous involvement - no skip lesions
  • red mucosa that bleeds easily (friability)
  • ulcers and pseudo-polyps in severe disease
164
Q

what are the risk factors for ulcerative colitis?

A
  • family history
  • NSAIDs
  • chronic stress and depression
165
Q

what is the epidemiology of ulcerative colitis?

A
  • highest prevalence in Northern Europe, UK and N America
  • higher incidence than Crohn’s
  • Male = females
  • present 15-30yrs
  • 3x more common in non-smokers/ex-smokers
  • 1 in 6 will have 1st degree relative with UC
166
Q

what are the different types of ulcerative colitis?

A
  • proctitis = just affects rectum
  • left-sided colitis = rectum and left colon
  • pancolitis = affects entire colon up to ileocecal valve
167
Q

what are the risk factors for coeliac disease?

A
  • HLA DQ2/DQ8
  • other autoimmune diseases e.g. T1DM, thyroid disease, Sjogren’s
  • IgA deficiency
  • breast feeding
  • age of introduction to gluten into diet
  • rotavirus infection in infancy
168
Q

what is the epidemiology of coeliac disease?

A
  • 1% of population affected- peaks in infancy, and 50-60 years
  • 10% risk in 1st degree relatives and 30% risk in siblings
169
Q

what are the risk factors for oesophageal cancer?

A

ABCDEF

  • Achalasia
  • Barret’s oesophagus
  • Corrosive oesophagitis
  • Diverticulitis
  • oEsophageal web
  • Familial
170
Q

what are the causes of adenocarcinoma of the oesophagus?

A
  • smoking
  • tobacco
  • GORD
  • obesity - increases reflux
171
Q

what is the epidemiology of oesophageal cancer?

A
  • 6th most common cancer worldwide
  • mainly occurs 60-70yrs
  • poor prognosis (10% 5yr survival)
  • squamous = 5-10 per 100,000 in UK
  • male>female- incidence increasing in western world
172
Q

what is the epidemiology of appendicitis?

A
  • most common surgical emergency
  • males>females
  • high incidence 10-20yrs
  • rare before age of 2
  • should be considered for all RHS pain if appendix is present
173
Q

what are the complications of GORD?

A
  • peptic stricture

- barrett’s oesophagus

174
Q

how is intestinal obstruction classified?

A
  • according to site
  • extent of luminal obstruction
  • according to mechanism
  • according to pathology
175
Q

what is a mallory-weiss tear?

A

a linear mucosal tear occurring at the gastroesophageal junction

176
Q

when do mallory-weiss tears happen?

A
  • produced by a sudden increase in intra-abdominal pressure

- follows a bout of coughing or retching - classically seen after alcoholic dry heaves

177
Q

what is the epidemiology of mallory-weiss tears?

A
  • most common in males

- mainly 20-50 years old

178
Q

what are the risk factors for mallory weiss tears?

A
  • alcoholism
  • forceful vomiting
  • eating disorders
  • NSAID abuse
  • male
  • chronic cough
179
Q

what are the clinical features of mallory-weiss tears?

A
  • vomiting
  • haematemesis after vomiting
  • retching
  • postural hypotension
  • dizziness
180
Q

what are the investigations for mallory-weiss tears?

A

Rockall score (assess blood loss: <3 = low risk)
FBC, U&E, coag studies, group & save
ECG & cardiac enzymes

endoscopy to confirm tear

181
Q

what is the treatment for mallory weiss tears?

A
  • ABCDE
  • Terlipressin + Urgent Endoscopy
  • Rockall Score + Inpatient Observation
  • Banding/clipping, adrenaline, thermocoag
182
Q

what are oesophageal varices?

A

Abnormal, enlarged veins in the oesophagus, that develop when normal blood flow to the liver is blocked by a clot / scar tissue

183
Q

where do varices tend to occur?

A
  • gastroesophageal junction
  • rectum
  • left renal vein
  • diaphragm
  • anterior abdominal wall
184
Q

when do gastroesophageal varices tend to rupture?

A

when blood pressure in portal vein exceeds 12mmHg

185
Q

what is the epidemiology of gastroesophageal varices?

A
  • 90% of patients with cirrhosis develop varices over 10 years - 1/3 will bleed
  • bleeding likely in large varices
  • varices tend to develop in lower oesophagus and gastric cardia
186
Q

what are the main causes of gastroesophageal varices?

A
  • alcoholism
  • viral cirrhosis
  • portal hypertension
187
Q

what are the risk factors for gastroesophageal varices?

A
  • cirrhosis
  • portal hypertension
  • schistosomiasis infection
  • alcoholism
188
Q

what is the pathophysiology of gastroesophageal varices?

A
  • liver injury causes increased resistance to flow -> portal hypertension
  • hyperdynamic circulation -> formation of collaterals between portal and systemic systems
  • pressure >10mmHg start to bleed (rupture >12mmHg)
189
Q

what is the clinical presentation of gastroesophageal varices?

A
  • haematemesis/melena
  • abdominal pain (epigastric)
  • shock (if major blood loss)
  • fresh rectal bleeding
  • hypotension and tachycardia
  • pallor
  • splenomegaly
  • ascites
  • hyponatraemia
  • signs of chronic liver damage (jaundice, increased bruising)
190
Q

what investigations should be undertaken for gastroesophageal varices?

A
  1. Urgent endoscopy
  2. FBC, U&E, clotting (INR), LFTs, group & save
  3. CXR / ascitic tap / further Ix for PHT
191
Q

what is the treatment for gastroesophageal varices?

A
  • ABCDE
  • Rockfall Score (Prediction of Rebleeding and Mortality)
  • Bleeding Varices - Terlipressin + Prophylactic Antibiotics (Ciprofloaxcin), Balloon tamponade (Sengstaken-Blakemore tube), Endoscopic Banding, TIPS
  • Bleed Prevention - BB + Endoscopic Banding. Cirrhosis = screening endoscopy
192
Q

how can gastroesophageal varices be prevented?

A
  • PROPRANOLOL - reduce resting pulse rate to decrease portal pressure
  • variceal banding
  • liver transplant
193
Q

what is IBS?

A

a mixed group of abdominal symptoms for which no organic cause can be found

194
Q

what is the epidemiology of IBS?

A
  • age of onset is under 40
  • females>males
  • 1/5 western world experience symptoms
195
Q

what are the 3 different types of IBS?

A
  • IBS-C with constipation
  • IBS-D with diarrhoea
  • IBS-M with constipation and diarrhoea
196
Q

what are the risk factors for IBS?

A
  • previous severe diarrhoea
  • female
  • high hypochondriac anxiety and neurotic score at time of illness
197
Q

what are the causes of IBS?

A 
depression, 
anxiety, 
stress, 
trauma, 
abuse
GI infection
eating disorders
198
Q

what is the pathophysiology of IBS?

A

dysfunction in brain-gut axis results in disorder of intestinal mobility and/or enhanced perception

199
Q

what are the extra-intestinal symptoms of IBS?

A
  • painful periods
  • urinary frequency, urgency, nocturia, incomplete bladder emptying
  • back pain and joint hypermobility
  • fatigue
200
Q

what is the clinical presentation of IBS?

A

ABC

  • A = abdominal pain/discomfort - relieved by defecation
  • B = bloating
  • C = change in bowel habit

2 or more of following

  • urgency
  • incomplete evacuation
  • abdominal bloating/distention
  • mucous in stool
  • worsening of symptoms after food
201
Q

what are the red flag symptoms for GI cancers?

A
  • unexplained weight loss
  • PR bleeding/blood in stool
  • family history of bowel or ovarian cancer
202
Q

what investigations should be undertaken for IBS?

A

diagnosis is made by ruling out differentials

  • bloods
    • FBC
    • ESR and CRP
  • coeliac serology
  • faecal calprotectin
  • colonoscopy
203
Q

what is the rome III diagnostic criteria for IBS?

A
  • recurrent abdominal pain at least 3 days a month in last 3 months
  • associated with 2 of following:
    • onset associated with change in frequency of stool
    • onset associated with change in form (appearance) of stool
204
Q

what is the management of IBS?

A
  • dietary/lifestyle modification = avoid alcohol, caffeine and fizzy drinks, small frequent meals, FODMAP diet
  • antispasmodics - MEBERVERINE or BUSCOPAN
  • laxatives - MOVICOL
  • antimotility agents - LOPERAMIDE
  • if no better try tricyclic antidepressants AMITRIPTYLINE - warn about drowsiness
205
Q

what should be considered if you see atrial fibrillation and abdominal pain?

A

mesenteric ischaemia

206
Q

what is the definition of acute diarrhoea?

A

diarrhoea lasting less than 2 weeks

207
Q

what is the definition of chronic diarrhoea?

A

diarrhoea lasting more than 2 weeks

208
Q

what are the causes of diarrhoea?

A
  • viral (majority)
    - in children = rotavirus
    - in adults = norovirus
  • bacterial
    - Campylobacter jejuni
    - E.coli
    - Salmonella
    - Shigella
  • parasitic
    - Giardia lamblia
    - Entamoeba histolyitca
    - Cryptosporidium
209
Q

what is the management for diarrhoea?

A
  • treat underlying causes
  • bacterial treated with METRONIDAZOLE- oral rehydration therapy
  • anti-emetics - METOCLOPRAMIDE
  • anti-motility agents - LOPERAMIDE
210
Q

what are the effects of helicobacter pylori?

A
  • inflammation
  • antral gastritis
  • gastric cancer
  • peptic ulcers
211
Q

what is the treatment for helicobacter pylori infection?

A

triple therapy

  • PPI - LANSOPRAZOLE / OMEPRAZOLE
  • 2 of the following: METRONIDAZOLE, CLARITHROMYCIN , AMOXICILLIN, TETRACYCLINE, BISMUTH
212
Q

what are the investigations for H.pylori infection?

A

urea breath test

stool antigen test

213
Q

what is the epidemiology of gastric cancer?

A

● 4th most common cancer worldwide
● Second leading cause of cancer-related mortality
● Incidence increases with age
● Men > women
● More common in Japan and Chile, less common in USA
● 10% 5yr survival

214
Q

what is lynch syndrome?

A

hereditary non-polyposis colon cancer

autosomal dominant condition caused by mutation in hMSH1 or hMSH2 genes, in highly repeated short DNA sequences

215
Q

what is the effect of lynch syndrome?

A

polyps form in the colon and rapidly progress to colon cancer

216
Q

what is diverticulosis?

A

presence of diverticulum

217
Q

what is diverticular disease?

A

diverticula are symptomatic

218
Q

what is diverticulitis?

A

inflammation of diverticulum

219
Q

what is the clinical presentation of diverticulitis?

A
  • febrile
  • tachycardia
  • tenderness, guarding and rigidity on left side
  • palpable tender mass sometimes felt in left iliac fossa
220
Q

what are the investigations for diverticulitis?

A

Bloods - Raised WCC, ESR & CRP
Pregnancy test in women of childbearing age
Stool culture
Imaging - Erect CXR, AXR and CT

Imaging May Show
Pneumoperitoneum 
Dilated Bowel Loops
Obstruction
Abscess
221
Q

what is the management for diverticulitis?

A

Oral/IV Abx - Ciprofloxacin, Metronidazole
Analgesia + liquid diet +/- fluid resus
Surgical Resection - Rare Cases

222
Q

what are the complications of diverticulitis?

A 
● Perforation 
● Fistula formation into the bladder or vagina 
● Intestinal obstruction 
● Bleeding 
● Mucosal inflammation
223
Q

what are the clinical features of volvulus?

A

consistent with bowel obstruction (absolute constipation and distention)
Comes on extremely quickly
Rarely nausea and vomiting

224
Q

what are the investigations for volvulus?

A

abdominal XR - coffee bean sign

225
Q

what is the management for volvulus?

A

rigid sigmoidoscopy and rectal tube

226
Q

what are the biliary complications of crohns disease vs ulcerative colitis?

A

crohn’s = gallstones

ulcerative colitis = primary sclerosing cholangitis

227
Q

what is the appearance of crohn’s and colitis on X rays?

A

crohn’s = string appearance

colitis = lead-pipe sign

228
Q

what are the causes of actue mesenteric ischaemia?

A

thrombus
embolism
non-occlusive

229
Q

what are the investigations for acute mesenteric ischaemia?

A

ABG - raised lactate and acidosis
angiography, doppler ultrasound
CT with contrast

230
Q

what is the physiology of swallowing?

A

Tongue presses against hard palate and forces hard bolus of food into oropharynx
Tongue blocks off mouth and larynx and uvula rise to prevent food from entering lungs
Upper oesophageal sphincter relaxes allowing food to enter oesophagus
Constrictor muscles of the pharynx contract forcing food down
Food moves down by peristalsis
Gastroesophageal sphincter surrounding cardiac orifice opens and food enters stomach

231
Q

what are the causes of dysphagia?

A

Disease of mouth and tongue - tonsillitis
Neuromuscular disorders - bulbar palsy, myasthenia gravis
Esophageal motility - achalasia, scleroderma, DM
Extrinsic pressure - goitre, mediastinal glands
Intrinsic lesion - stricture, pharyngeal pouch

232
Q

what is achalasia?

A

Failure of esophageal smooth muscle to relax resulting in LOS remaining closed

233
Q

what are the clinical features of achalasia?

A

Dysphagia of liquids and solids - solids more than liquids
regurgitation more than reflux
no apparent underlying cause

234
Q

where do pharyngeal pouches occur?

A

Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles

235
Q

what is barrett’s oesophagus?

A

Metaplasia of the lower esophageal mucosa (stratified squamous to columnar epithelium with goblet cells)

236
Q

what are the causes/ risk factors of barrett’s oesophagus?

A 
GORD, 
Male (7:1), 
caucasian, 
FHx, 
Hiatus hernia, 
Obesity, 
Smoking, 
Alcohol
237
Q

what are the clinical features of barrett’s oesophagus?

A

Classic history: middle aged caucasian male with long history GORD & dysphagia

238
Q

what are the investigations for barrett’s oesophagus?

A

OGD + biopsy

239
Q

what is the management for barrett’s oesophagus?

A
  • Lifestyle: weight loss, smoking cessation, reduce alcohol, small reg meals, avoid hot drinks/alcohol/eating <3hrs before bed, avoid certain drugs (nitrates, anticholinergics, TCAs, NSAIDs, K+ salts, alendronate)

Endoscopic Surveillance with Biopsies

High Dose PPI

Dysplasia - Endoscopic Mucosal Resection, Radiofrequency Ablation

Severe: oesophagectomy

240
Q

which are the most common types of oesophageal cancer in the developing and developed world?

A

developing = squamous cell carcinoma

developed = adenocarcinoma

241
Q

where is adenocarcinoma of the oesophagus found?

A

lower 1/3 - near GO junction

242
Q

where is squamous cell carcinoma of the oesophagus found?

A

upper 2/3

243
Q

what are the red flag symptoms for GORD that requires further investigation?

A 
Dysphagia (difficulty swallowing)
> 55yrs
Weight loss
Epigastric pain / reflux
Treatment resistant dyspepsia
Nausea and vomiting
Anaemia
Raised platelets
244
Q

what is the difference in presentation of gastric ulcers vs duodenal ulcers?

A

gastric ulcers = epigastric pain worse after eating, eased by antacids. haematemesis, weight loss, heart burn

duodenal ulcers = epigastric pain before meals and at night, relieved by eating or milk. melaena, weight gain

245
Q

which drugs can cause gastric/duodenal ulcers?

A

NSAIDS
SSRI
corticosteroids
bisphosphonates

246
Q

what are the causes/risk factors of gastritis?

A 
autoimmune disease
H.pylori
bile reflux
NSAIDS
stress
247
Q

what is meckel’s diverticulum?

A

Common Congenital Abnormality of GI Tract

248
Q

what will imaging show in diverticulitis?

A 
Imaging May Show
Pneumoperitoneum 
Dilated Bowel Loops
Obstruction
Abscess
249
Q

what are the causes/risk factors of diverticular disease?

A

low fibre diet
obesity
age >40

250
Q

what is the clinical presentation of diverticular disease?

A

Altered Bowel Habit
Abdominal Pain
Bleeding PR

251
Q

what are the investigations for diverticular disease?

A

CT (Acute)

Colonoscopy

252
Q

what is the management for diverticular disease?

A

High Fibre Diet and Fluids +/- Laxatives

Surgery

253
Q

what are the 2 different types of gastric cancer?

A

type 1 = intestinal / differentiated (70-80%) - found in antrum and lesser curvature
type 2 = diffuse / undifferentiated (20%) - found elsewhere

254
Q

what are the following features for crohns and ulcerative colitis?

  • location
  • inflammatory pattern
  • layers affected
  • granuloma
  • crypt abscesses
  • goblet cells
A

location

  • crohns = any part of GI tract
  • UC = colon only

inflammatory pattern

  • crohns = skip lesions (cobblestone appearance)
  • UC = continuous

layers affected

  • crohns = transmural
  • UC = mucosal

granulomas

  • crohns = granulomas
  • UC = no gramulomas

crypt abscesses

  • crohns = present
  • UC = present

goblet cells

  • crohns = present
  • UC = depletion
255
Q

what are the non-infectious causes of diarrhoea?

A

IBS
IBD - crohns, ulcerative colitis
bowel cancer

256
Q

what are the causes of diarrhoea that are not related to disease or infection?

A
  • stress
  • medication related
  • toxin ingestion
257
Q

which HLA is associated with coeliac disease?

A

HLA DQ2/DQ8

258
Q

what is the difference in presentation of internal and external haemorrhoids?

A

internal = painless bleeding with bowel movements

external = pain and discomfort

259
Q

what is the prevention for diverticulitis?

A

Regular exercise, avoid smoking, high-fibre diet, drink plenty of water

260
Q

what is the clinical presentation of c.diff?

A
  • watery diarrhoea with mucus/blood
  • abdominal distention, cramps
  • malaise
  • fever
261
Q

what is the treatment for c.diff?

A

1st line = vancomycin orally for 10 days

262
Q

what is a pilonidal sinus?

A

abnormal pocket in the skin near the tailbone containing hair and skin debris

263
Q

what is mesenteric ischaemia?

A

narrowed/blocked arteries restrict blood flow to small intestine

264
Q

what is ischaemic colitis?

A

temporary restriction of blood supply to the large intestine due to vasoconstriction or low pressure flow

265
Q

what are the risk factors for ischaemic colitis?

A
  • age >60
  • sex F>M
  • factor V Leiden
  • high cholesterol
  • reduced blood flow - HF, low BP, shock, DM, RA
  • previous abdominal surgery
  • heavy exercise
  • surgery on aorta
266
Q

what are the complications of ischaemic colitis?

A
  • sepsis
  • bowel necrosis
  • death
  • fear of eating
  • unintentional weight loss
267
Q

what are the investigations for ischaemic colitis?

A

CT abdomen - rule out IBD
colonoscopy
stool culture

268
Q

how would you treat mesenteric ischaemia?

A

surgical - stent

269
Q

how would you treat ischaemic colitis?

A
  • bowel resection due to necrosis

- surgically repair hole

270
Q

what causes dark stools in oesophageal varices?

A

The bleeding varices can result in swallowing large amounts of blood, which causes black, tarry stools

also known as melaena

Phase 2A revision (38 decks)

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