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GI Flashcards

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1
Q

What is IBS?

A

‘Functional’ chronic bowel disorder
>3 months GI symptoms with no underlying cause-everything else ruled out

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2
Q

Name some IBS triggers

A

Related to psychology:
Stress
Anxiety
Drugs
Poor diet

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3
Q

Describe the symptoms of IBS

A

Abdominal pain and bloating, relieved from defacation
Altered stool form/frequency

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4
Q

How is IBS diagnosed?

A

Exclusion diagnosis
Serology(coeliac)
Fecal calprotectin(IBD)
ESR, CRP, cultures(infections)

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5
Q

Describe the treatment for IBS

A

Conservative: patient education and reassurance, e.g. more fibre
Moderate:
IBS-C-laxatives(senna)
IBS-D antimotility drug(loperimide)
Severe: TCA(amitriptyline)+consider referral

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6
Q

What are the 3 types of IBS

A

IBS-C: mostly constipation
IBS-D: mostly diarrhea
IBS-M: alternating/mixed C/D

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7
Q

What is GORD?

A

Gastric reflux due into oesophagus due to decreased pressure across the lower oesophageal sphincter->oesophagitis

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8
Q

Name some causes of GORD

A

Increased intraabdominal pressure: pregnancy, obesity
Hiatal hernia: LOS sliders up through oesophagus-mostly sliding type
Drugs like anti muscarinincs
Scleroderma: scarring of LOS

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9
Q

Describe the pathophysiology of GORD

A

Decreased LOS pressure->more potential for passage of acid upwards

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10
Q

Describe the symptoms of GORD

A

Heartburn-retrosternal burning chest pain
Chronic cough
Nocturnal asthma
Dysphagia
Symptoms worse at night

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11
Q

What are the red flag symptoms of GORD

A

Dysphagia
Haematemesis
Weight loss

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12
Q

Describe the diagnosis of GORD

A

If no red flag symptoms:
Clinical diagnosis-straight to treatment
If red flag symptoms:
Endoscopy: oesophagitis/Barret’s oesophagus
Oesophageal manometry: Measure LOS pressure and monitor gastric pH

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13
Q

Describe the treatment of GORD

A

Conservative: lifestyle changes(smaller meals, not just before bed)
Pharmacological: PPI’s or H2RA if CI
Antacids-SE: diarrhoea
Alginates-gaviscon
Surgical: Surgical tightening of LOS

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14
Q

Describe the surgical treatment of GORD

A

Tightening of LOS
Nissen fundoplication: wrap fundus around LOS externally to increase pressure across it

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15
Q

Name 2 complications of GORD

A

Oesophageal strictures
Barrets oesophagus

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16
Q

Describe the presentation and treatment of oesophageal strictures

A

Usually 60+ patients with progressively worsening dysphagia
Treatment: endoscopic oesophageal dilation and PPI

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17
Q

What percentage of GORD patients develop Barrets?

A

10%

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18
Q

Which hernia is always involved with Barrets oesophagus?

A

Hiatal hernia

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19
Q

What is Barrets oesophagus?

A

Metaplasia
Stratified squamous epithelium->simple columnar

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20
Q

What does Barrets increase the risk of?

A

Adenocarcinoma

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21
Q

Describe the typical presentation of a patient with Barrets oesophagus

A

Middle-aged caucasian male with a history of GORD and progressively worsening dysphagia

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22
Q

Describe the progression of normal esophagus to adenocarcinoma

A

Normal->metaplasia(Barret’s)->dysplasia(adenocarcinoma)

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23
Q

How is Barret’s diagnosed?

A

Biopsy

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24
Q

What is a Mallory Weiss tear?

A

Linear lower oesophageal mucosal tear due to sudden increase in intra-abdominal pressure

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25
Describe the typical presentation of someone with a Mallory Weiss tear
Young male with acute history of retching (e.g. after night out) that eventually causes haematemesis
26
Name some risk factors for developing a Mallory Weiss tear?
Alcohol Chronic cough Bullemia Hyperemesis gravidarum No history of liver disease and pulmonary hypertension
27
What is hyperemesis gravidarum?
Pregnancy complication: severe nausea and vomiting-> weight loss, dehydration
28
What is a differential diagnosis for Mallory Weiss tear and how can you distinguish between them?
Haematemesis + portal hypertension/liver disease->Oesophageal varices rupture Haematemesis + no liver history + retching history-> Mallory Weiss tear
29
Describe the symptoms of a Mallory Weiss tear
Haematemesis (after retching/vomiting history) Hypotension if severe
30
What scoring system is used to assess the severity of upper GI bleeds?
Rockall score
31
How would you diagnose a Mallory Weiss tear?
OGD (endoscopy)
32
How is a Mallory Weiss tear treated?
Most heal spontaneously within 24 hours
33
What is peptic ulcer disease?
Punched out holes in either stomach or duodenum
34
What are the 2 types of PUD and which is more common?
Gastric-less common Dudoenal-most common
35
Where are gastric ulcers found?
Most in lesser curve of the stomach
36
Name some causes of gastric ulcers
H. Pylori NSAID's Zollinger Ellison syndrome
37
What is Zollinger-Ellison syndrome?
Triad of: -Pancreatic tumor -Gastric acid hypersecretion -Widespread peptic ulcers
38
Describe the symptoms of gastric ulcers.
Epigastric pain -Worse on eating -Better between meals and with antacids -Typically weight loss
39
Name some red flags for PUD
>55 Haematemesis/melaena Anaemia Dysphagia
40
Describe the diagnosis of gastric ulcers
If no red flags: -C-urea breath test and stool antigen test If red flags: -Urgent endoscopy and biopsy
41
Where are duodenal ulcers mostly found?
D1/D2 posterior wall
42
Name some causes of duodenal ulcers
H. Pylori-MOST COMMON NSAID's Zollinger Ellison syndrome
43
Describe the symptoms of duodenal ulcers
Epigastric pain -Worse between meals -Better with food -Typically weight gain
44
Describe the diagnosis of duodenal ulcers
If no red flags: -Urea breath test -Stool antigen test If red flags: Urgent endoscopy + biopsy
45
What would you expect to see on the biopsy if the patient has a duodenal ulcer
Brunner's gland hypertrophy->more mucus production
46
What is important to check to avoid false negatives when testing for H.pylori
If testing for H.Pylori, patient must be off PPI's for >2 weeks
47
Describe the treatment for PUD
Stop NSAID's If H.pylori->triple therapy: CAP-clarithromycin, amoxicillin and PPI If PU found, rescope 6-8 weeks later
48
Name a complication of peptic ulcers
Bleeding from ruptured left gastric artery Less common
49
Name a complication of duodenal ulcers
Bleeding from ruptured gastroduodenal artery Very common
50
Name the 9 regions of the abdomen
Right hypochondriac-epigastric region-left hypochondriac Right lumbar-umbilical region-left lumbar Right iliac-hypogastric region-left iliac
51
What are the 2 main signs of an upper GI bleed?
Haematemesis(vomiting fresh blood) Melena ('digested' blood-black stools)
52
What is the main sign of a lower GI bleed?
Haematochezia (fresh red blood in stools)
53
What are the red flag GI signs?
ALARMS Anaemia Loss of weight Anorexia (loss of appetite) Recent onset of progressive symptoms Masses/melena or bleeding form any part of GI tract Swallowing difficulties +>55 years
54
Which conditions are associated with haematemesis?
Mallory Weiss Oesophageal varices Oesophageal cancer
55
Which GI conditions are associated with dysphagia?
Achalasia Oesophageal cancer Zenker's diverticulum Systemic sclerosis Strictures
56
Which GI conditions are associated with pain
Mallory Weiss Oesophageal varices GORD
57
What are oesophageal varices?
Enlarged veins that protrude into the oesophagus
58
Name the cause of oesophageal varices
Hypertension in portal venous system due to liver issues
59
Name some symptoms of oesophageal varices
Rupture and lead to: -Haematemesis -Abdominal pain -Systemic: shock, hypotension, pallor
60
How are oesophageal varices diagnosed?
Endoscopy
61
Describe the treatment of oesophageal varices during an acute bleed
ABCDE Vasopressin (terlipressin) for vasoconstriction Bleeding abnormalities: vitamin K Surgery: endoscopic variceal band ligation within 24 hours
62
Describe the treatment of oesophageal varices without bleeding
Beta-blocker (propanolol) Endoscopic variceal band ligation
63
How does H pylori cause ulcers?
Secretes urease->urea is converted to ammonium which is toxic to gastric mucosa-> decreased mucus + increased inflammation->increased acid production
64
How do NSAIDs cause ulcers?
Inhibit COX pathway->inhibitin prostaglandin secretion-> decrease in gastric mucosa-> ulcer
65
What is gastritis?
Mucosal inflammation and injury
66
Name some causes of gastritis
Autoimmune H.pylori NSAID's Mucosal ischemia Campylobacter
67
Which autoimmune conditions are associated with gastritis?
Pernicious anaemia Anti IF antibodies
68
How do NSAID's cause gastritis?
Cause gastropathy: injury without inflammation
69
Describe the symptoms of gastritis
Epigastric pain Diarrhoea Nausea and vomiting Indigestion
70
How is gastritis diagnosed?
If H.pylori suspected: -Stool antigen test/urea breath test Gold standard: endoscopy and biopsy
71
How is gastritis caused by H pylori treated?
Triple CAP therapy Clarithromycin, amoxicillin, PPI
72
Which part of the stomach does autoimmune gastritis affect and what does this cause?
Fundic portion Causes atrophy of parietal cells
73
Name a complication of gastritis
PUD
74
Describe the effect of H pylori in the stomach
1)Decreases somatostatin 2)Decreases luminal HCO3- 3)Secretes urease-toxic NH3 4)Increases gastrin release
75
What is appendicitis?
Inflammation of the appendix, usually due to lumen obstruction
76
What age range is appendicitis most commonly found in?
10-20
77
Name the causes of appendicitis
Faecolith(hard solid faeces) Lymphoid hyperplasia Filarial worms
78
How does appendicitis become a surgical emergency?
Blockage can become infected with E.Coli Blockage causes an increased pressure inside the appendix->increased rupture risk Can lead to spontaneous bacterial peritonitis
79
Describe the symptoms of appendicitis
Umbilical pain which localises to McBurneys point Rebound tenderness Abdominal guarding Pyrexia Rosving's sign(Press on LLQ causes RLQ pain) Pain on internal rotation of thigh Pain when lying on side and extending right leg
80
Where is McBurneys point?
2/3 the distance from the navel to the right anterior superior iliac spine
81
Name a complicatino of appendicitis
SBP, periappendical abscess
82
How is appendicitis diagnosed?
CT abdomen and pelvis
83
Name a differential diagnosis for appendicitis and how you would rule this out
Ectopic pregnancy Pregnancy test to rule out
84
Describe the treatment for appendicitis
Antibiotics then appendectomy(laparoscopic) Must drain abscesses
85
Describe the management of periappendical abscesses
Must be drained, then given intra-abscess antibiotics Resistant to systemic antibiotics as walled off bacterial collection
86
What is diverticular disease?
Outpouching of colonic mucosa
87
What is the difference between diverticular disease and diverticulosis?
Diverticular disease: symptomatic outpouch Diverticulosis: Asymptomatic outpuch
88
What is a diverticulum?
An outpouching at perforating artery sites
89
What is diverticulitis?
Inflammation of the outpouch: infection
90
Are most diverticular symptomatic or asymptomatic?
95% diverticula-asymptomatic Only 5%->diverticular disease
91
What is Meckel's diverticulum?
Paediatric disorder Failure of obliteration of the vitelline duct
92
Describe the signs and symptoms of Meckels diverticulum
Rule of 2's: 2 years old 2 inches long 2 ft from ileocaecal valve (umbilical)
93
How is Meckel's diverticulum diagnosed?
Technetium scan
94
Name some risk factors for diverticular disease
Connective tissue disorders: Marfans, EDS Ageing Increased colon pressure: COPD, chronic cough, age
95
Describe the symptoms of diverticular disease
Triad: -LLQ pain -Constipation -Fresh rectal bleeding
96
How is diverticular disease diagnosed?
CT abdomen/pelvis with contrast
97
Describe the treatment for diverticulosis
Nothing: watch and wait
98
Describe the treatment for diverticular disease
Bulk forming laxatives GS: surgery
99
Describe the treatment for diverticulitis
Antibiotics(co-amoxciclav) + paracetemol IV fluid + liquid food, rarely surgery
100
What kind of obstruction is an intestinal obstruction?
Mechanical bowel obstruction
101
Which areas of the bowel can be obstructed?
Small bowel: 60-75% Large bowel: 25-40%
102
Name some causes of a small bowel obstruction
Adhesions: often surgical Crohn's Strangulating hernias Malignancy
103
What is the most common cause of small bowel obstructions?
Adhesions
104
Name the symptoms of a small bowel obstruction
First vomiting, then constipation Mild abdominal distention and pain Tinkling bowel sounds (hyperresonant bowel sounds)
105
How do you diagnose bowel obstructions?
1st line: CXR-dilated bowel loops + transluminal gas shadows GS: CT abdomen
106
What CXR findings indicated bowel obstructions?
Dilated bowel loops Transluminal fluid-gas shadows LBO: Coffee bean sign
107
Describe the treatment for bowel obstructions
Fluid resus NG tube Antiemetics and analgesia Antibiotics: reduce sepsis risk Surgery as last resort
108
Name the causes of a large bowel obstruction
Malignancy-90% Volvulus Intussusception
109
What is the most common cause of LBo's?
Malignancy
110
What is a volvulus?
Abnormal twisting of the intestine Mostly affects sigmoid colon Found in children
111
What is intussusception?
Bowel telescopes in on itself Most common in children
112
What is pseudo-obstruction?
No mechanical obstruction, often a result of post-op state E.g. opiate induced paralytic ulcers
113
What is Hirschprung's disease?
Congenital malformation: born without a colon nerve supply-can't poo properly and often leads to LBO
114
What counts as diarrhoea?
>3 watery stools a day:level 5-7 on Bristol stool chart
115
How long does acute diarrhoea last for?
<14 days
116
How long does subacute diarrhoea last for?
14-28 days
117
How long does chronic diarrhoea last for?
>28 days
118
What are the different types of diarrhoes?
-Watery -Secretory -Osmotic -Functional (IBS) -Steatorrhoea -Inflammatory
119
What does bloody diarrhoea indicate?
Dysentery E.g. amoebic dysentery E.Coli/salmonella/shigella
120
Name some non-infective causes of diarrhoea
IBD Coeliac Hyperthyroidism Inflammation/malignancy
121
Describe the infective causes of diarrhoea
Viral: rotavirus(kids), norovirus(adults) Bacterial: C.diff, Campylobacter, E.Coli, salmonella, shigella, cholera Worms Antibiotics (increases risk of C diff infections) Giardias + amoeba
122
What is the most common cause of infective diarrhoea?
Viral
123
What is the most common cause of bacterial diarrhoea?
Campylobacter
124
Which antibiotics increase the risk of C.diff infection and therefore diarrhoea?
4C's Clarhythromycin Co-amoxciclav Ciprofloxacin Cephalosporin
125
What is the most likely cause of diarrhoea in a child under 3?
Rotavirus
126
What is the most likely cause of diarrhoea in a patient on antibiotics?
C.diff
127
What is the most likely cause of diarrhoea in a patient with Guillian Barre?
Campylobacter
128
What is the main difference in symptoms between infective and non-infective diarrhoea?
Infective: acute, often travellers Non-infective: Longer history
129
Describe the treatmetn of diarrhoea
Depends on the cause Viral-most common-self limiting
130
What complications can arise from diarrhoea?
Dehydration and electrolyte loss Treat with fluids, dioralyte
131
What are the 2 types of oesophageal cancer?
Adenocarcinoma Aquamous cell carcinoma
132
What part of the oesophagus does oesophageal adenocarcinoma affect?
Lower 2/3 of oesophagus
133
Name a risk factor for oesophageal adenocarcinoma
Barrett's oesophagus
134
What part of the oesophagus does oesophageal squamous cell carcinoma affect?
Upper 2/3 of oesophagus
135
Name some risk factors for developing oesophageal squamous cell carcinoma
Smoking Alcohol
136
Describe the symptoms of oesophageal cancer
Presents when advanced: ALARMS Anaemia Loss of weight Anorexia Recent sudden symptom worsening Melenea/haematemesis Swallowing difficulties-progressive
137
What is the most key symptoms suggestive of oesophageal cancer?
Progressive swallowing difficulties
138
Name a differential diagnosis for oesophageal cancer and how you can distinguish between them
Achalasia: non progressive swallowing difficulties Oesophageal cancer: progressive
139
How is oesophageal cancer diagnosed?
OGD(gastroscopy) and biopsy (with barium swallow) CT/PET for staging
140
Describe the treatment for oesophageal cancer
Medically fit: chemo/radio and surgery Unfit: palliative
141
What kind of cancers are most gastric carcinomas?
Adenocaricnomas
142
Describe the stageing of gastric carcinomas
T1: well differentiated-better prognosis: more common T2: Undifferentiated-worse prognosis: typically at proximal stomach
143
Name some causes of gastric cancer
H.pylori Smoking CDH-1 mutation(mutated cadherin gene-80% risk) fHx Pernicious anaemia->AI chronic gastritis
144
Describe the symptoms of gastric cancer
Severe epigastric pain(like gastritis but worse_ Anaemia (Fe deficiency, weight loss, progressive dysphagia Mets signs: jaundice->liver mets Krukenberg tumour->ovarian mets Lymph nodes: Virchow's node: supraclavicular Sister Mary Joseph node: umbilical
145
How is gastric cancer diagnosed?
Gastroscopy and biopsy CT/MRI for staging, PET to ID mets
146
Describe the treatment for gastric cancer
Surgery + 'ECF' chemo regimen, if resectable
147
How common are SI carcinomas and what kind of carcinomas are they?
1% of all GI tumours SI pretty tumour resistant Adenocarcinomas
148
Name some RF's for developing SI carcinoma
Chronic SI disease, e.g. Crohn's, coeliac
149
How is SI carcinoma diagnosed?
Gastroscopy and biopsy CT/MRI for staging, PET for mets
150
How is SI carcinoma treated?
Surgery + 'ECF' chemo regimen
151
What kind of cancer is colorectal cancer?
Adenocarcinoma
152
What is the main precursor for colorectal cancer?
Polyps/adenomas: mostly spontaneous and benign, common with age but can progress to cancers
153
Which 2 inherited conditions massively increase the risk of polyps?
1)Familial adenomatous polyposis(FAP) 2)Hereditary non polyposis colon cancer (HNPCC-lynch syndrome)
154
What is FAP?
Familial adenomatous polyposis Autosomal dominant APC gene mutation->1000s of duodenal polyps Inevitably will get colorectal cancer
155
What is HNPCC?
Hereditary non polyposis colon cancer/Lynch syndrome Autosomal dominant MSH-1/2 mutation->DNA mismatch repair gene Rapidly increases progression from adenoma->adenocarcinoma
156
Name some risk factors for developing colorectal cancer
Familial inherited genetic predisposition Adenomas/polyps Alcohol, smoking, UC
157
Where does colorectal cancer commonly metastasize to?
Liver Lung
158
Where is colorectal cancer mostly found?
Distal colon->sigmoid
159
Describe the symptoms of colorectal cancer
LLQ pain Bloody mucus stools(fresh blood->distal colon, closer to anus) Tenesmus(if rectal involvement)
160
What is tenesmus?
Feeling of needing to pass stools even when bowels are empty
161
How is colorectal cancer diagnosed?
FIT test (faecal occult) Suspected cancer 2 week wait pathway GS: colonoscopy and biopsy
162
What is a FIT test?
Fecal occult Screening test for micro blood particles in feces. Done in all >60 patients with iron deficiency anaemia and change in bowel habits
163
When would patients suspected of having colorectal cancer be referred to the 2 week cancer pathway?
Positive FIT test and symptoms->referred for colonoscopy/biopsy within 2 weeks
164
How is colorectal cancer staged?
TNM system
165
Describe the treatment for colorectal cancer
Surgery is only curative option-if no mets Chemo
166
What is dyspepsia?
Presenting symptom of 'indigestion'
167
Describe the symtpoms of dyspepsia
Early satiation Epigastric pain and reflux Extreme fullness
168
Describe the causes of dyspepsia
Often unknown-'functional' disorders May be related to ulcers, especially gastric
169
What investigations would you do in someone with dyspepsia?
Needs endoscopy to find the underlying cause
170
Describe the virulence of H pylori
Low virulence Commensal in GIT
171
Is H pylori gram positive or negative
Gram negative
172
How does H pylori cause pathological effects?
1)Decreases somatostatin 2)Increases luminal gastric acid (as increases gastrin) 3)Urease->ammonia generation 4)Decreased HCO3- secretion
173
Name some GIT conditions that H pylori can cause
PUD Gastritis Gastric carcinomas
174
How can H.pylori be diagnosed?
Biopsy (stool antigen + C urea breath test often 1st line)
175
How is H pylori treated?
Triple therapy: Clarythromcyin + Amoxcicillin + PPI
176
Is E.Coli gram positive or gram negative?
Gram negative
177
Describe the virulence of E.Coli
Often commensal Some strains/serotypes are very virulent
178
Which E.Coli strains cause watery diarrhoea?
ETEC EAEC EPEC
179
Which E.Coli strains cause blood diarrhoea?
EHEC(H-haemorrhage)
180
Which E.Coli serotpye causes haemolytic uremic syndrome?
Serotype 0157:H7->haemorrhagic diarrhoea + nephritic syndrome
181
Describe the treatment of E.Coli
Often amoxicillin or trimethoprin/nitrofurantoin
182
What conditions does E.Coli commonly cause?
UTI's Diarrhoea in GIT
183
Is C difficile gram positive or negative?
Gram positive spore forming bacteria
184
What can induce C difficile?
Antibiotics: 4C's Ciprofloxacin Co-amoxiclav Cephalosporins Clindamycin
185
What condition does C difficile cause?
Pseudomembranous colitis
186
What is pseudomembranous colitis?
Swelling/inflammation of large intestine due to C difficile overgrowth
187
How can antibiotics lead to severe diarrhoea?
Normal GIT flora killed by C's antibiotics and C.diff replaces these Results in dangerous severe diarrhoea (very watery->high risk of dehydration)
188
What is the treatment for C.difficile?
Stop using C's antibiotics Give vancomycin
189
What is achalasia?
Oesophageal dysmotility(impaired peristalsis) LOS fails to relax Rare and idiopathic
190
Describe the symptoms of achalasia
Non progressive dysphagia(struggle to swallow everything) Chesty substernal pain Food regurgitation Aspiration pneumonia
191
How is achalasia diagnosed?
'Bird beak' on barium swallow Diagnostic: manometry->measure pressure across LOS
192
Describe the treatment of achalasia
Only curative: surgery: balloon stenting Drugs that can help pre-surgery: nifedipine, nitrates
193
What is ischaemic colitis?
Ischaemia of colonic arterial supply->colon inflamed due to hypoperfusion
194
Name some causes of ischaemic colitis
Affecting IMA: Thrombosis (with/without atherogenesis) Emboli Low CO + arrhythmias e.g. shock COCP
195
What are the most common sites affected by ischaemic colitis?
Watershed areas: Splenic flexure(most common) Sigmoid colon + cecum
196
Describe the symptoms of ischaemic colitis
LLQ pain + bright bloody stool With/without signs of hypovolaemic shock
197
How is ischaemic colitis diagnosed?
Colonoscopy + Biopsy Only done after patient fully recovered-prevents stricture formation + normal healing) Rule out other causes: stool sample->H/pylori
198
Describe the treatment of ischamic colitis
Symptomatic: IV fluid and antibiotics (prophylactic) Gangrenous(infarcted colon)->only surgery
199
Name some complications of ischaemic colitis
Perforation->SBP Strictures->obstruction
200
What is mesenteric ischaemia?
Ischaemia of the small intestine
201
What are the 2 types of mesenteric ischaemia?
AMI: acute mesenteric ischaemia: acute attack: 'abdominal MI' CMI: chronic mesenteric ischaemia: long lasting over months: 'abdominal angina'
202
Name the causes of mesenteric ischaemia
Affecting SMA: Thrombosis: most common Emboli: often due to AF
203
Describe the symptoms of mesenteric ischaemia
Triad: Central/right iliac fossa acute severe abdominal pain No abdominal signs on exam (no guarding/rebound tenderness etc) Rapid hypovolemic shock
204
How is mesenteric ischaemia diagnosed?
CT angiogram FBC+ABG: persistent metabolic acidosis
205
How is mesenteric ischaemia treated?
Fluid resus, antibiotics, IV heparin to decrease thromboemboli risk Infarcted bowel->surgery
206
Name a complication of mesenteric ichaemia
SBP
207
What are haemorrhoids?
Swollen veins around anus disrupt anal cushions->part of anal cushions prolapse through tight anal passage
208
Name some causes of haemorrhoids
Constipation with increased straining: most common Anal sex
209
What are the 2 types of haemorrhoids?
Internal External
210
What are internal haemorrhoids?
Originate above internal rectal plexus (dentate line) Less painful as has much lower sensory supply->may feel incomplete emptying
211
What are internal haemorrhoids?
Originate below denatate line So painful patients can't sit down
212
Describe the symptoms of haemorrhoids
Bright red fresh PR bleeding Mucusy stool Bulging pain With/wihtout pruritus ani
213
How are haemorrhoids diagnosed?
Digital PR exam for external-may be visible Internal haemorrhoids->proctoscopy
214
How are haemorrhoids treated?
Stool softener Definitive: rubber band ligation
215
What is a perianal abscess?
Walled off collection of stool and bacteria around anus
216
What is the most common cause of a perianal abscess?
Anal sex->anal gland infection
217
Describe the symptoms of a perianal abscess
Pus in stool and constant pain
218
Describe the treatment for a perianal abscess
Surgical removal and drainage (Antibiotics won't work-walles off so resistant to oral antibiotic therapy)
219
What is an anal fistula?
Abnormal 'tracks' form between inside of anus->elsewhere, e.g. subcut skin Typically progresses from perianal abscesses Abscess discharges which aids fistual formation as abscess grows
220
Describe the symptoms of an anal fistula
Bloody, mucusy discharge, often very visible and painful
221
Describe the treatment for an anal fistula
Surgical removal and drainage-with antibiotics if necessary
222
What in an anal fissure?
Tear in the anal skin lining below the dentate line
223
Name the causes of an anal fissure
Hard faeces: most common Also trauma, like childbirth Crohn's/UC
224
Describe the symptoms of an anal fissure
Extreme defacation pain(strong sensory supply) Very itchy bum: pruritus ani Anal bleeding
225
Describe the treatment for an anal fissure
Stool softening: increase fibre and more fluid Topical creams like lidocaine ointment Definitive: surgery(not really used)
226
What is a pilondial sinus?
Hair follicles get stuck in natal cleft Form small tracts->sinuses Get infected->abscesses
227
Name a risk factor for pilondial sinus/abscess
Very hairy
228
Describe the sympotms of a pilondial abscess
Swollen pus filled smelly abscess on bumcrack-visible on exam
229
Describe the treatment for a pilondial abscess
Surgery Hygiene advice
230
What is Zenker's diverticulum also called and what is it?
Pharyngeal pouch Food goes down the pouch instead of totally down oesophagus
231
Describe the symptoms of Zenker's diverticulum
Smelly breath (food accumulates in oesophagus) Regurgitation and aspiration of food
232
What histological finding is associated with CMV
Owl eye colitis
233
How is cytomegalovirus an AIDS defining illness?
Causes owl eye colitis in immunosuppressed patients
234
Name 2 causes of pseudomembranous colitis
C.difficile CMV
235
What is coeliac's disease?
Autoimmune T4 hypersensitivity to gluten
236
What are the 2 main coeliac genes?
HLADQ2 DQ8
237
Describe the apthophysiology of coeliac disease
Prolamins in gluten(alpha gliadin) binds to IgA then interacts with ttG->immunogenic Results in formation of: High IgA IgA anti-ttG EMA antibodies
238
What does tTG stand for?
Tissue transglutaminase
239
What conditions are associated with coeliac disease?
Thyroid disorders Addison's
240
Describe the symptoms of coeliac disease
Malabsorption: Haematinic deficiency->anaemia Steatorrhoea Diarrhoea Osteopenia Weight loss and failure to thrive Dermatitis herpetiformis
241
What is dermatitis herpetiformis?
Papular rash on knees due to IgA skin deposition
242
How is coeliac diagnosed?
Only work if a patient is consistenly eating gluten: Serology: anti-ttG(most specific) Increased total IgA-> may get false negative in IgA deficient patients High EMA Duodenal biopsy: crypt hyperplasia and villous atrophy(and epithelial lymphocyte infiltration)
243
Describe the treatment for coeliac disease
Stop eating gluten Replace vitamins and mineral deficiency Monitor osteoporosis with DEXA scans
244
What is tropical sprue?
Enteropathy associated with tropical travel Produces similar biopsy to coeliac
245
What is the treatment for tropical sprue?
Often responds to antibiotics like tetracycline
246
Name a Ddx for coeliac disease
Tropical sprue
247
What groups are associated with IBD?
MC in Jews Associated with HLAB27(seronegative spondylarthropathy) Bimodal age: 15-20, 55+
248
Describe the pathophysiology of Crohn's
NOD-2 mutation and enteric bacteria cause immune mediated response(T cells) -TNF alpha IL1, IL6
249
Where does Crohn's disease affect?
Whole GIT Especially termianl ileum and proximal colon-usually spares rectum
250
Name some risk factors for developing Crohn's
fHx Jewish Smoking(2 x likely)
251
What kind of inflammation is associated with Crohn's?
Transmural (all 4 layers)
252
Describe the intestinal symptoms of Crohn's
Pain in RLQ Malabsorption as SI infected -B12/folate/Fe deficiency -Gallstones/kideny stones -Watery diarrhoea
253
Name some extra intestinal symtpoms of Crohn's
Apthous mouth ulcers Uveitus/Episcleritis Erythema nodosum/pyoderma gangrenosum Spondyloarthritis-SPINEACHE
254
How is Crohn's diagnosed?
Negative pANCA, might be be ASCA positive High faecal calprotectin Biopsy and endoscopy/XR Endoscopy: skip lesions, cobblestoning, strictures(string sign) Biopsy: transmural inflammation with non caseating granulomas
255
Describe the treatment for Crohn's
For flares: sulfasalazine(PR) and orednisolone For remission: Azathioprine, methotrexate Biologics: anti TNFa: infliximab, IL12+23 inhibitor: ustekenumab
256
Why isn't surgery curative for Crohn's?
Entire bowel can be affected: cutting out one part can cause other parts to flare up
257
Name some complicatiions of Crohn's
Fistula Strictures Abscesses Small bowel obstruction
258
Describe the pathophysiology of UC
AI colitis, associated with HLAB27 gene and pANCA
259
Where does UC affect?
Colon only Starts at rectum(proctitis)->sigmoid->proximal colon
260
Name some risk factors for developing UC
fHx Jewish Smoking is protective!
261
Describe the inflammation associated with UC
Confined to mucosa
262
Describe the intestinal symptoms of UC
Pain in LLQ and tenesmus Bloody mucusy water diarrhoea
263
Describe the extraintestinal symtpoms of UC
Uveitus/episcleritis Pyodema gangrenosum/erythema nodusum Spondylarthropathy: SPINEACHE PSC: 90% UC patients have PSC
264
How is UC diagnosed?
pANCA positive High faecal calprotectin Colonoscopy: continuous inflammation CXR: 'lead pipe sign' Biopsy: Mucosal inflammation with crypt hyperplasia
265
What scoring system is used to assess UC severity?
Truelove and Witts
266
Describe the treatment of UC
Flares: sulfasalazine and pred Remission: azathioprine, methotrexate, ciclosporin Biologics: anti TNFa: infliximab Surgery: total/partial colectomy: curative
267
Name a complication of UC
Toxic megacolon Most common complication causing UC death
268
Describe the gastric acid production in the parietal cells
H2O+CO2->H2CO30>HCO3-(blood)+H+(C-->HCl

Phase 2a med mine (11 decks)

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