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GI Flashcards

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1
Q

What is inflammatory bowel disease (IBD)

A

Umbrella term for 2 main diseases causing inflammation of the GI tract
* Ulcerative Colitis (UC)
* Crohn’s disease

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2
Q

Define UC

A

Autoimmune condition causing excessive inflammation of mucosa in the colon

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3
Q

Describe the inflammation in UC

A
  • Starts from rectum
  • Continuous inflammation
  • Confined to superficial mucosa
  • Only affects colon/rectum
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4
Q

How does smoking affect UC

A

Smoking is protective in UC
I.e smoking is associated with a lower risk of having UC

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5
Q

RFs of UC

A
  • NSAIDs
  • FHx
  • Jewish
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6
Q

Give 4 factors that may trigger a flare in UC

A

stress
medications: NSAIDs, antibiotics
cessation of smoking

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7
Q

Signs and symptoms of UC

A
  • Abdo pain usually in left lower quadrant
  • Blood and mucous in stool
  • Bloody diarrhoea
  • Tenesmus - needing to pass stool even tho bowels are empty
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8
Q

Which gene is UC associated with

A

HLA B27 gene

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9
Q

What type of UC has inflammation in the entire bowel

A

pancolitis

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10
Q

Describe the investigation of UC

A
  • GS: Colonoscopy + biopsy
    Depletion of goblet cells
    No inflammation beyond mucosa
    Crypt abscesses
  • Faecal calprotectin stool test - +ve (non-specific)
  • pANCA (perinuclear anti-neutrophilic cytoplasmic Ab) - +ve
  • CRP/ESR - inflammation and active disease
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11
Q

When is faecal calprotectin released

A

Released by the intestines when inflamed

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12
Q

Treatment of mild/ moderate UC

A
  1. topial rectal Aminosalicylate (mesalazine)
  2. if remission not achieved within 4 weeks, add on oral aminosalicylate
  3. add on topical/ oral Corticosteroids (prednisolone)
    - stop topical treatment in proctosigmoiditis and left-sided ulcerative colitis
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13
Q

Treatment for severe UC

A

Should be treated in hospital
1. IV steroid - e.g. hydrocortisone
2. No improvement after 72hrs: consider adding IV ciclosporin or consider surgery

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14
Q

What is the gold standard treatment of UC

A

Colectomy = curative

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15
Q

How is remission maintained in UC

A

proctitis and proctosigmoiditis:
* topical (rectal) aminosalicylate alone OR
* oral aminosalicylate plus a topical (rectal) aminosalicylate OR
* oral aminosalicylate by itself
left-sided and extensive ulcerative colitis:
* low maintenance dose of an oral aminosalicylate
severe relapse or >=2 exacerbations in the past year:
* oral azathioprine or oral mercaptopurine

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16
Q

Describe the histological features of inflammation in Crohn’s

A
  • Transmural
  • Granulomatous (skip lesions)
  • Affects any part of the GI tracts
  • inflammation in all layers from mucosa to serosa
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17
Q

What is the most common site affected by Crohn’s disease

A

terminal ileum

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18
Q

How does smoking affect Crohn’s

A

Doubles risk of developing Crohn’s

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19
Q

Signs and symptoms of Crohn’s

A
  • Abdo pain usually in right lower quadrant (ileum)
  • diarrhoea usually non bloody
  • Malabsorption - weight loss, fatigue
  • Mouth ulcers
  • perianal disease
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20
Q

Explain the pathophysiology of Crohn’s

A
  • Faulty GI epithelium = pathogen invasion
  • Exaggerated inflammatory response
  • Formation of granuloma and destruction of GI tissues
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21
Q

Describe the investigation of Crohn’s

A
  • Endoscopy and colonoscopy: skip lesions, cobblestone appearance
  • Biopsy: Transmural inflammation with granulomas
  • pANCA: -ve
  • Raised faecal calprotectin
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22
Q

Features suggestive of Crohn’s on small bowel enema

A

strictures: ‘Kantor’s string sign’
proximal bowel dilation
‘rose thorn’ ulcers
fistulae

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23
Q

How is remission induced in Crohn’s

A
  1. glucocorticoids (oral, topical or intravenous)
    * Oral prednisolone
    * IV hydrocortisone
    * Oral budesonide as alternative
  2. 5-ASA drugs (e.g. mesalazine)
  3. Azathioprine, mercaptopurine or methotrexate may be used as an add-on medication
  4. Infliximab is used in refractory disease and fistulating Crohn’s
    * metronidazole for isolated peri-anal disease
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24
Q

How is remission maintained in Crohn’s

A
  • stop smoking
  • 1st line: azathioprine or mercaptopurine (+TPMT activity should be assessed before starting)
  • 2nd line: methotrexate
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25
What is the investigation of choice for suspected perianal fistulae in Crohn's
MRI
26
Describe the role of surgery in Crohn's disease
* ileocaecal resection * segmental small bowel resections * perianal abscess: incision and drainage
27
What are some complications of Crohn's
* Fistula - abnormal open connection * Fissures - crack in the lining * Strictures - narrowing due to thickened wall * anaemia
28
Signs of extraintestinal IBD
* Ankylosing spondylitis - inflamed spine * Pyoderma gangrenosum - painful skin ulcers * Uveitis - mc in UC * Erythema nodosum - swollen fat under skin = dark bumps/ patches * primary Sclerosing cholangitis - much mc in UC * Pyoderma gangrenosum * Clubbing * arthritis - mc
29
Define irritable bowel syndrome
A chronic functional bowel disorder * no identifiable organic disease underlying the symptoms
30
RFs of IBS
* Female * Younger age (20-30) * Anxiety * PTSD
31
What are the 3 main types of IBS
* IBS-C = constipation * IBS-D = diarrhoea * IBS-M = Alternated between C and D
32
Signs and symptoms of IBS
* Abdominal pain - relieved from defecation * Bloating * Change in bowel habit * Symptoms are worse after eating
33
Describe the investigation and diagnosis of IBS
Rule out differentials: * Faecal calprotectin -ve to exclude IBD * -ve coeliac disease serology * Normal FBC, ESR & CRP Diagnosis: * Recurrent abdo pain at least once a week for last 3 months
34
Describe the conservative management of IBS
* Patient education * Low FODMAP diet * Limit caffeine and alcohol
35
What are FODMAPs
Short-chain carbs that are poorly absorbed in the GIT: Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols
36
Describe the medical management of IBS
* Diarrhoea - loperamide * Constipation - laxatives (avoid lactulose due to bloating) * Antispasmodic for cramps - hyoscine butylbromide * Tricyclic antidepressants - amitriptyline
37
What is coeliac disease
Autoimmune condition where exposure to gluten causes mucosal inflammation in the small bowel
38
Name the 2 main autoantibodies associated with coeliac disease
* Anti -tissue transglutaminase (anti-TTG) * Anti-endomysial (anti-EMA)
39
What 2 genes are associated with coeliac diseae
* HLA-DQ2 (90%) * HLA-DQ8
40
Explain the pathophysiology of coeliac disease
* Auto-antibodies (anti-TTG and anti-EMA) are created in response to exposure to gluten * These target epithelial cells of the SI and lead to inflammation
41
How does inflammation affect the small intestine in coeliac disease
* Affects particularly the jejunum * Villous atrophy * Crypt hyperplasia
42
What type of antibodies are anti-TTG and anti-EMA
IgA
43
Signs and symptoms of coeliac disease
* Dermatitis herpetiformis - itchy blistering skin rash caused by IgA deposition in dermis * Diarrhoea and recurrent abdo pain * Failure to thrive in kids * Anaemia secondary to iron, folate or B12 deficiency * Weight loss and fatigue
44
Describe the investigation and diagnosis of coeliac disease
Investigations must be carried out while patient remains on a diet containing gluten * Check for total IgA levels to exclude deficiency * 1st line: raised anti-TTG * 2nd: raised anti-EMA * GS: Endoscopy and duodenal biopsy: crypt hyperplasia, villous atrophy and intraepithelial lymphocytes
45
Why is it important to test for total IgA levels in coeliac disease
* anti-TTG and anti-EMA are IgA * If the patient has an IgA deficiency then the coeliac test will give a false negative
46
How is coeliac disease treated
Lifelong gluten-free diet
47
Name 4 autoimmune conditions associated with coeliac disease
* T1DM * Hashimoto's thyroiditis * Primary sclerosing cholangitis * Autoimmune hepatitis
48
Give 5 complications of untreated coeliac disease
* Vitamin deficiency * Anaemia - Fe, folate, B12 * Osteoporosis / osteomalacia * Lactose intolerance * Hyposplenism
49
What is tropical sprue
Chronic malabsorption syndrome associated with tropical travel (SEA, Caribbean)
50
How does a duodenal biopsy differ in tropical sprue vs coeliac disease
* TS - incomplete villous atrophy * CD - complete villous atrophy
51
Tx for tropical sprue
Ab - tetracycline
52
What is gastro-oesophageal reflux disease
Reflux of gastric acid from the stomach into the oesophagus due to lower oesophageal sphincter (LOS) relaxing
53
6 Risk factors of GORD
* Obesity * Pregnancy * Hiatus hernias * Smoking * NSAIDs * Male
54
What is a hiatus hernia
Where part of your stomach moves up into your chest through an opening (hiatus) in the diaphragm
55
Signs and symptoms of GORD
* Heartburn - worse lying down * Acid regurgitation * Epigastric/ retrosternal pain * Dyspepsia - indigestion * Nocturnal cough
56
Give 5 red flag symptoms that you might detect when taking a history from someone with dyspepsia
* Anaemia * Weight loss * Dysphagia * Upper abdominal pain * Nausea and vomiting
57
Describe the investigation and diagnosis of GORD
* Endoscopy * Manometry - rule out motility disorder and monitor gastric acid pH
58
Criteria for the 2 week endoscopy referral
* When patient displays red flag signs * Over 55 (exc dysphagia = any age )
59
Describe the conservative management of GORD
* Lose weight * Reduce caffeine and alcohol intake * Smoking cessation * Smaller, lighter meals * Avoid heavy meals 3-4h before bed
60
Describe the medical treatment of GORD
* Acid neutralising meds - Gaviscon * Proton pump inhibitors (PPI) - lansoprazole * H2 antagonist - famotidine
61
How do proton pump inhibitors work and how should they be taken
* Inhibit gastric secretion by blocking H+/K+ ATPase in parietal cells * Best taken on an empty stomach once daily 30 mins before first meal
62
What is last resort treatment of GORD
* Nissen fundoplication - tying fundus of stomach around lower oesophagus to narrow LOS
63
3 complications of GORD
Barrett's oesophagus oesophagitis ulcers
64
What is barret's oesophagus
*Constant acid reflux results in metaplasia of the LOS from a stratified squamous to a simple columnar epithelium
65
Why is barrett's considered premalignant
* Associated with increased risk (3-5%) of developing oesophageal adenocarcinoma * Metaplasia - dysplasia - adenocarcinoma
66
Diagnosis of Barret's
Biopsy and endoscopy - metaplasia >1cm above gastro-oesophageal junction
67
Treatment of Barret's
PPI Endoscopic monitoring
68
What are the 2 types of peptic ulcer
* Gastric - stomach * Duodenal - mc
69
Explain the pathophysiology of peptic ulcer disease
* There is a protective layer in the stomach comprised of mucus and bicarbonate secreted by the stomach mucosa * Stomach mucosa is prone to ulceration from breakdown of this protective layer and an increase in stomach acid
70
What causes PUD
* Helicobacter pylori * NSAIDs
71
State 5 things that can cause increased stomach acid
* Stress * Alcohol * Caffeine * Smoking * Spicy food
72
How does PUD present
* Dyspepsia * Epigastric pain * Haematemesis (vomit blood) and melena
73
Which type of ulcer presents with epigastric pain that gets better after eating
Duodenal
74
Which type of ulcer presents with epigastric pain that gets worse after eating
Gastric
75
Why are duodenal ulcers less painful after eating
* Pyloric sphincter closes during digestion which prevents acid from getting into the duodenum
76
Investigation of PUD
* Endoscopy and biopsy * H.pylori tests
77
Treatment of PUD
* Stop NSAIDs * H.pylori: Triple therapy = clarithromycin, amoxicillin and PPI
78
Complication of PUD
* Gastric - ruptured left gastric artery * Duodenal - ruptured gastroduodenal artery
79
Define gastritis
Inflammation of the stomach mucosal lining
80
List some causes of gastritis
* H.pylori * autoimmune gastritis - related to pernicious anaemia and anti-IF Abs * NSAIDs - COX inhibitor * Stress
81
What does a COX inhibitor do
Inhibits cyclooxygenase which inhibits prostaglandin synthesis = less mucous secretion
82
Signs and symptoms of gastritis
* Dyspepsia * Epigastric pain * Diarrhoea
83
Describe the investigation and diagnosis of gastritis
*GS: Endoscopy & biopsy - inflammation and atrophy H.pylori: * stool antigen, urea breath test and rapid urease test during endoscopy * Stop PPI for at least 2w before testing/ 4w for Ab
84
Treatment of gastritis
* H.pylori eradication - triply therapy * Autoimmune - IM vitamin B12 * Stop NSAID, alcohol
85
State 3 complications of gastritis
* Peptic ulcers * Bleeding and anaemia * Gastric cancer
86
What is appendicitis
Inflammation of the appendix Surgical emergency
87
At what age range is the peak incidence of appendicitis
10-20 years old
88
Where is the appendix located
McBurney's point - 2/3 from umbilicus
89
Causes of appendicitis
* Faecolith - stony mass of compacted faeces * Lymphoid hyperplasia * Intestinal worms
90
Explain the pathophysiology of appendicitis
* Obstruction in the lumen of the appendix = stasis = bacterial overgrowth = inflammation
91
Signs and symptoms of appendicitis
* Abdo pain starting at umbilical region and migrating to right iliac fossa * Fever * Anorexia
92
Signs of appendicitis on physical examination
* Abdo guarding * Rovising's sign - palpitation on LIF causes pain in RIF * Rebound tenderness * Psoas and obturator sign
93
Investigation and diagnosis of appendicitis
* CT * Ultrasound - used in children and in female patients to exclude ovarian and gynaecological pathology * Pregnancy test * Clinical diagnosis
94
Differential diagnosis of appendicitis
* Ectopic pregnancy * Ruptured ovarian cyst * Meckel's diverticulum
95
How is appendicitis treated
Appendectomy * laparoscopic = fewer risks and faster recovery compared to open surgery
96
Define diverticulum
Outpouching of the colon mucosa Pl= diverticula
97
Define diverticulosis
Presence of diverticula without any symptoms
98
Define diverticular disease
Presence of diverticula with symptoms
99
Define diverticulitis
Inflammation and infection of diverticula
100
Describe the pathophysiology of diverticulitis
High pressures in colon/ weak wall -> Diverticula -> faeces can get trapped here and obstruct the diverticula -> abscess and inflammation -> diverticulitis
101
Give 3 RFs of diverticular disease
* Older people (>50) * Low fibre diet * Use of NSAIDs * Obesity (BMI >30)
102
What part of the bowel is most likely to be affected by diverticulitis
Sigmoid colon
103
Symptoms of diverticular disease
* Left iliac fossa pain * Constipation * abdo bloating * Rectal bleeding
104
Symptoms of diverticulitis
• Same as diverticular disease: Bloating, constipation, LLQ pain + guarding, • ++ fever and diarrhoea
105
Describe the investigation and diagnosis of diverticular disease
* GS: Contrast CT scan * Colonoscopy * raised CRP * FBC - leukocytosis
106
Treatment for diverticulosis
Tx not necessary Dietary and lifestyle changes • gradually increasing fibre • weight loss • Smoking cessation • Exercise
107
Treatment for diverticular disease
* Bulk-forming laxatives (e.g. ispaghula husk) * Paracetamol for abdo pain * Dietary and lifestyle changes
108
Treatment for diverticulitis
* Oral co-amoxiclav * analgesia - paracetamol * Low residue diet - low in fibre and undigested material * Severe: IV fluids, Ab and surgery
109
Give 4 complications of diverticulitis
* Peritonitis * Perforation * Haemorrhage * Obstruction
110
Describe H.pylori
Gram-negative spiral bacteria
111
Describe the pathology of h.pylori
* Decreases somatostatin * Increases luminal gastric acid * Produces ammonia * Decreased bicarbonate secretion
112
What can H.pylori infection cause
* Gastritis * PUD
113
What is Zenker's diverticulum
Outpouching into the pharynx causing food to become stuck there instead of going fully down the oesophagus
114
Signs and symptoms of zenker's diverticulum
* Smelly breath * Regurgitation
115
What type of bacteria is H.pylori
Gram-negative spiral bacteria
116
What are the symptoms of an upper GI bleed
* Melena * Haematemesis * Coffee ground vomit
117
Causes of an upper Gi bleed
* Oesophageal varices * Mallory-Weiss tear * PUD
118
What is a Mallory Weiss tear
Tear in lower oesophagus due to sudden increase in intra-abdominal pressure
119
RFs of MW tear
* Weight lifting * Chronic cough * Bulimia * Food poisoning * Heavy Alcohol use
120
Who is a MW tear usually seen in
* Age 20-50 * Male
121
Signs and symptoms of MW tear
* Haematemesis * Melena * Hypotension (if severe) * Dizziness
122
Investigation of a MW tear
* Upper GI endoscopy - tear/laceration * FBC, LFT, U+E
123
Treatment for MW tear
* Most spontaneously heal within 24h * Lifestyle: reduce alcohol, CBT for bulimia
124
What is oesophageal varices
Enlarged/ dilated collateral veins in the lining of the oesophagus (submucosa)
125
Causes of oesophageal varices
* Cirrhosis of liver * HTN in portal venous system
126
Signs and symptoms of oesophageal varices
* Haematemesis and melena * Abdo pain * Sx of LD: ascites, jaundice, encephalopathy * hypotension * pallor
127
4 investigations of oesophageal varices
* Gastroscopy - dilated veins in lower oesophagus * FBC - microcytic anaemia * Elevated urea and creatinine
128
When are oesophageal varices considered an emergency
when the vein ruptures this causes large amounts of bleeding
129
Treatment for oesophageal varices with an acute bleed
* ABCDE and IV fluids * Terlipressin or somatostatin analogue (octreotide) if CI * Vit K for bleeding abnormality * Surgery: endoscopic variceal band ligation within 24h
130
Treatment for oesophageal varices without a bleed
* Non-selective beta blocker (propanolol) * Annual endoscopy * Surgery
131
What is bowel obstruction
Mechanical interruption of passage through the bowel
132
What type of bowel obstruction is most common
Small bowel obstruction (60-75%)
133
Give 4 causes of small bowel obstruction (SBO)
* Adhesions ( 75% & often surgical) * Crohn's * Hernias * Malignancy
134
What are the signs and symptoms of SBO
* Vomiting (may contain faeces) first then constipation * abdo distension and pain * Tinkling bowel sounds * Tachycardia and hypotension
135
Give 4 causes of large bowel obstruction (LBO)
* Malignancy (90%) * Sigmoid volvulus (twists around itself- coffee bean appearance) * Diverticulitis * Intussusception (more common in children) is when the bowel fold within itself
136
Signs and symptoms of LBO
* Constipation first then vomiting * Intermittent abdo pain * Severe distension (RLQ)
137
Describe the investigation of bowel obstruction
Abdo XRay: * dilated bowel loops * SBO: >3CM & coiled spring appearance * LBO: >6CM & coffee bean sign if sigmoid volvulus GS: CT abdo * FBC - leukocytosis and neutrophilia * Raised CRP
138
Describe the treatment of bowel obstruction
* IV cannula - fluid resuscitation * Nasogastric tube to decompress stomach (Nil by mouth) * Analgesia and Antiemetics (N+V) - Metoclopramide * Surgery as last resort
139
What is pseudo-obstruction
Colonic dilation with no mechanical obstruction
140
Causes of pseudo-obstruction
Post-operative (paralytic ileus ) * Meds - opioids, CCB * Recent trauma/ surgery
141
Treatment for pseudo-obstruction
IV neostigmine
142
What is diarrhoea
Abnormal passage of 3+ watery stools daily
143
Give 3 types of diarrhoea
* Watery * Inflammatory * Dysentery - bloody
144
Causes of diarrhoea
* Most commonly viral * Non-infective : Coeliac, hyperthyroid, IBD * Bacterial infection * Ab * Parasitic infection
145
What is the leading cause of diarrhoea in children (<3)
Rotavirus
146
Which virus is the mc cause of diarrhoea in adults
Norovirus - winter vomiting
147
Where is norovirus commonly spread
Cruise ships Hospitals Restaurants
148
Give 4 bacteria which commonly cause diarrhoea
* Campylobacter jejuni - mc bacterial cause * E.coli * Salmonella * Shigella
149
How can antibiotics cause diarrhoea
Ab can interfere with bacteria balance in the bowel * Can cause clostridium difficile bacteria to multiply and produce toxins = diarrhoea
150
Name 4 Abx that increase risk of C. difficile infection
* Co-amoxiclav * Ciprofloxacin * Cephalosporins * Clindamycin
151
What is the most common parasitic cause of diarrhoea
Giardia lamblia
152
Signs and symptoms of diarrhoea
Dependant on cause * Bloody stool - hints bacterial * Viral cause - fever, fatigue, headache etc * Non-infective - longer Hx
153
How is diarrhoea diagnosed
* Stool culture * PCR - virus and bacteria * Increased ESR/CRP = infection * Increased eosinophils = parasite * High ESR/CRP + anaemia = IBD
154
Treatment for diarrhoea
Dependent on cause * Oral rehydration * Viral: self-limiting Meds for symptoms * Antimotility - loperamide * Antiemetics
155
What are the 2 types of oesophageal cancer
* Adenocarcinoma * Squamous cell carcinoma
156
Which oesophageal cancer is found in the lower 1/3 of the oesophagus
Adenocarcinoma
157
Where in the oesophagus are squamous cell carcinomas found
Upper 2/3 of oesophagus
158
RFs of adenocarcinoma of the oesophagus
* Barrett's oesophagus * GORD * Hernias * Caucasian
159
RFs of SSC of the oesophagus
* Smoking * Alcohol * BAME
160
Signs and symptoms of oesophageal cancer
* Progressive dysphagia ( solids-liquids) * Anaemia * Weight loss * Anorexia * Hoarse voice * RED FLAGS: ALARMS
161
What would be the likely diagnosis of non-progressive dysphagia
Achalasia
162
Describe the investigation of oesophageal cancer
* Upper GI endoscopy and biopsy * CT/MRI for tumour staging
163
Treatment of oesophageal cancer
* Surgery with adjuvant chemo/radiotherapy * Palliative care
164
Describe the histological differences between type 1 & type 2 gastric cancers
Type 1: * well differentiated * tubular Type 2 * Poorly differentiated * Signet ring cells
165
Which type of gastric cancer has a worse prognosis and why
Type 2 has a worse prognosis as it is highly metastatic and has rapid progression
166
RFs of gastric cancer
* Age 50-70 * Male * H.pylori infection * Pernicious anaemia * Smoking * FHx
167
Signs and symptoms of gastric cancer
* Severe epigastric pain * Weight loss * Progressive dysphagia * N+V
168
Describe the investigation of gastric cancer
* Gastroscopy and biopsy * CT/MRI for staging
169
Treatment for gastric cancer
* Surgery and chemo/radio * Palliative care
170
How common are small bowel cancers
Very rare
171
What are bowel polyps
small growths on the inner lining of colon or rectum
172
What are the 2 inherited conditions that greatly increase risk of colorectal cancer
Familial adenomatous polyposis * Auto dom AP coli gene mutation = many duodenal polyps * 93% risk of colorectal cancer Hereditary nonpolyposis colorectal cancer (lynch syndrome) * Auto dom mutation * Rapidly increases progression of adenoma to adenocarcinoma
173
RFs of colorectal cancer
* Alcohol/ smoking * Genetic predisposition - FAP and lynch * Increasing age * IBD * obesity
174
Presentation of colorectal cancer
* Blood and mucous in stool * Rectal bleeding and mass * Weight loss * Change in bowel habit * Anaemia * abdo pain
175
Describe the referral for suspected bowel cancer
2 week referral if: * Over 40 with abdo pain and unexplained weight loss * Over 50 with unexplained rectal bleeding * Over 60 with change in bowel habit or Fe deficiency anaemia
176
Describe the investigation of colorectal cancer
* GS: Colonoscopy and biopsy - ulcerating lesions * FIT (faecal immunochemical) and faecal occult blood * CT chest, abdo and pelvis - colonic wall thickening, enlarged lymph nodes * double-contrast barium enema - characteristic "apple core" lesion
177
How is bowel cancer screened
* Age 60-74 * Every 2 years * FIT
178
Where is bowel cancer most common
Distal colon (sigmoid and rectum)
179
Treatment for colorectal cancer
* Surgery - incision or resection * Chemo - fluorouracil/folinic acid with oxaliplatin
180
What is achalasia
* Rare idiopathic swallowing disorder of the oesophagus resulting in impaired peristalsis * LOS fails to relax
181
Signs and symptoms of dysphagia
* Non-progressive dysphagia (both liquids and solids) * Substernal heart burn * Food regurgitation > aspiration pneumonia
182
Describe the investigation of achalasia
* Barium swallow = beard beak LOS * GS: manometry Loss of peristalsis Increased lower sphincter tone Inadequate relaxation of lower sphincter * Endoscopy
183
Describe the treatment of achalasia
* Surgery: cardiomyotomy * Botox (botulinum toxin) - relax LOS * Meds: nitrates/ nifedipine can help relax LOS * Balloon dilatation
184
What is a complication of cardiomyotomy
Could lead to GORD
185
What is ischaemic colitis
* Ischaemia of colonic arterial supply * Colon inflammation due to hypoperfusion
186
What are the mc sites affected by ischaemic colitis
1. Splenic flexure 2. Sigmoid colon + cecum
187
Signs and symptoms of ischaemic colitis
* LLQ pain * Bright bloody stool * Hypovolemic shock - pallor, weak rapid pulse
188
Causes of ischaemic colitis
* Atrial fibrillation * Thrombosis (mc) * Emboli
189
Describe the investigation of ischaemic colitis
* GS: Colonoscopy and biopsy * contrast CT angiography - bowel dilation * abdo X-RAY - thumbprinting
190
Describe the treatment of ischaemic colitis
* Symptomatic - IV fluid and Ab * Infarcted colon - surgery
191
What is mesenteric ischaemia
Decreased/ blocked flow to small intestines * Can be acute or chronic
192
Causes of mesenteric ischaemia
* Thrombosis * AF * Hernia
193
Signs and symptoms of mesenteric ischaemia
* Severe central colicky abdo pain * Rapid hypovolemic shock * Abdo bruit (swishing sound) * N+V
194
Describe the diagnosis of mesenteric ischaemia
* CT angiography - bowel wall thickening, occlusion * FBC and ABG = persistent metabolic acidosis, leukocytosis
195
Treatment for mesenteric ischaemia
* Ab - ceftriaxone and metronidazole * IV fluids * IV heparin * Surgery
196
What type of bacteria is C.difficile
Gram positive spore forming bacteria
197
What is pseudomembranous colitis
Inflammation of the colon due to overgrowth of clostridium difficile and a recent history of Ab use
198
Explain the pathophysiology of C.diff infection
* C.diff often live harmlessly as normal gut flora keep it under control * Certain Ab interfere with this balance by killing normal gut flora * C.diff no longer under control
199
Signs and symptoms of pseudomembranous colitis
* Watery diarrhoea * Severe dehydration
200
Describe the investigation of pseudomembranous colitis
* Blood test = leucocytosis * Stool sample * abdo XRay/ CT = colonic dilatation
201
Describe the treatment of pseudomembranous colitis
* Stop causative Ab * Give Vancomycin * Hydration and electrolyte replacement * Infection control - hand hygiene
202
Define haemorrhoids (piles)
Swollen veins found inside or around anus that disrupt anal cushions
203
Causes of piles
* Constipation with a lot of straining * Anal sex * Heavy lifting * Pregnacy
204
Describe internal piles
* Originate above dentate line * Less painful as it has a much lower sensory supply * May feel incomplete emptying * They can prolapse * covered in mucus
205
Describe external piles
* Originate below dentate line - anal opening * covered with skin * So painful patients can't sit down
206
Signs and symptoms of piles
* Bright red bleeding on wiping * Itching * Lump around/ inside anus
207
Describe the investigation of piles
* Digital rectal exam for external * Proctoscopy for internal
208
Describe the treatment of piles
* Conservative: stool softener, high fibre, increased fluids * Surgical: Rubber band ligation , Haemorrhoidectomy
209
What is an anal fistula
Abnormal open connection between anal canal and the skin near the anus
210
Causes of an anal fistula
* Perianal abscess (70%) * Chron's ulcerations
211
Describe the signs and symptoms of an anal fistula
* Blood and mucous in stool * Pruritus ani * Throbbing pain
212
Treatment of an anal fistula
* Surgical removal and drainage * Ab if infected
213
What is an anal fissure
Tear in anal canal below the dentate line
214
Causes of an anal fissure
* Constipation * Anal trauma (childbirth) * Chron's/UC (rare)
215
Signs and symptoms of an anal fissure
* Extreme defecation pain * Anal bleeding * Pruritus ani
216
How is an anal fissure treated
* More fibre and fluids * Topical creams
217
What is a perianal abscess
Pus filled lump near anus
218
Causes of perianal abscess
* Anal fistula * Anal trauma
219
Signs and symptoms of a perianal abscess
* Pus in stool * Perianal pain and swelling
220
Treatment for a perianal abscess
Surgery and drainage
221
What is a pilonidal sinus/abscess
Ingrown hair in the natal crack which form sinuses and gets infected (abscesses)
222
Treatment for pilonidal sinus/abscess
* Hygiene advice * Abx

2a - SBCS (9 decks)

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