- abdominal pain or discomfort that is either relieved by defecation or associated with altered bowel frequency or stool form - altered stool passage - Abdominal bloating (more common in women than men), distension, tension or hardness - Symptoms made worse by eating - Passage of mucus

GI Flashcards by Darcie Furniss

describe what would be seen on colonoscopy and biopsy for someone with Crohn’s disease

GALS:
- Granuloma
- All
- Layers and levels - transmural, mouth to anus
- Skip lesions
also
- deep ulcers and fissures: “cobblestone mucosa”
- goblet cells present

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what is the first line investigation for Coeliac disease?

IgA tissue transglutaminase or IgA endomysial antibody (anti-tTGA or EMA)

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coughing in oesophageal cancer indicates the mass is where?

upper third of oesophagus

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describe the metaplasia in Barrett’s oesophagus

distal oesophageal epithelium metaplases from squamous to columnar

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what is the first line treatment for a peptic ulcer?

PPI + amoxicillin + clarithromycin / metronidazole

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which cells do PPIs act on?

parietal cells

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name 5 types of diarrhoea

inflammatory, secretory, osmotic, exudative, dysentery

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What symptoms or history points would lead you to think of inflammatory diarrhoea?

painful abdomen
severe diarrhoea (watery)
fever
tenesmus

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What clinical tool would you use to classify faeces?

bristol stool chart

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List 4 symptoms of small bowel obstruction

abdominal distension
abdominal pain
nausea / vomiting
constipation

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What would your initial supportive management be in small bowel obstruction?

‘Drip and suck’ management:
- Make the patient nil-by-mouth (NBM)
- Insert a nasogastric tube to decompress the bowel (‘suck’)
- Start IV fluids and correct any electrolyte disturbances (‘drip’)
- Urinary catheter and fluid balance
- Analgesia as required
- suitable anti-emetics

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what complication of SBO would lead to emergency surgery?

bowel ischaemia or strangulation

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4 causes of gastritis?

autoimmune
NSAIDs
alcohol abuse
bile reflux
mucosal ischaemia

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What investigations would you use if you suspect an infective cause of gastritis?

urea breath test, faecal antigen test

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differentials for gastritis?

peptic ulcer, GORD, gastric lymphoma/carcinoma

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Name 4 clinical features of haemorrhoids

bright red blood in stools, pain on defecation, pruritis ani, mucus discharge

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Briefly describe the pathophysiology of haemorrhoids

swelling and inflammation of veins in rectum and anus

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Describe the two types of haemorrhoids

Internal haemorrhoids:
- arise internally
- are painless covered in mucus
- can also prolapse
External haemorrhoids
- Form at the anal opening
- painful
- covered with skin.

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Give 5 non-surgical and 3 surgical treatment of haemorrhoids

Non-surgical:
- Stool softeners
- High fibre diet
- adequate fluid intake
- Analgesia
- Topical hydrocortisone.
Surgical:
- Band ligation
- haemorrhoidectomy
- Sclerotherapy (shrinking veins till absorbed by body)

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symptoms of IBS?

abdominal pain or discomfort that is either relieved by defecation or associated with altered bowel frequency or stool form
altered stool passage
Abdominal bloating (more common in women than men), distension, tension or hardness
Symptoms made worse by eating
Passage of mucus

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List 5 causes of acute diarrhoea

Antibiotic associated diarrhoea - eg cephalosporins / clindamycin associated with C. difficile infections
Parasitic cause (e.g. Giardia Lamblia)
Bacterial cause (e.g. Salmonella from food poisoning / Campylobacter infection from puppies in small children
Viral cause (e.g. Rotavirus - affects nearly all kids by age 4 / Norovirus - associated with cruise ships
Drugs eg allopurinol / NSAIDs / PPIs etc
Constipation with ‘overflow’ diarrhoea
Anxiety
Food allergy
Early sign of a chronic condition such as IBS / IBD

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Name 2 non-invasive tests for H.pylori infection

C-urea /13C breath test (1st line)
Blood/serological testing / IgG antibody detection
Stool antigen test

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list 4 complications of diverticulitis

Large bowel perforation / obstruction
Fistula formation
Bleeding
Mucosal inflammation (Can mimic Crohn’s disease on endoscopy)

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List 5 risk factors for oesophageal cancer

Alcohol, Smoking tobacco, Obesity, GORD, Achalasia

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What is the first line drug used to treat haematemesis from ruptured oesophageal varices and what should be used if contraindicated?

- IV Terlipressin acts as a vasodilator to control variceal bleeding. - If contraindicated (e.g. in IHD) -> IV somatostatin

gold standard exam for appendicitis?

5 differentials of appendicitis?

- Crohn’s disease (causing acute terminal ileitis) - Ectopic pregnancy - UTI - urinalysis - Diverticulitis - Perforated ulcer - Food poisoning

give a brief history of H. Pylori gastritis

worsening epigastric pain, weight loss, no vomiting or diarrhoea, active inflammation on endoscopy/biopsy

describe the differences between SBO and LBO?

SBO - acute - mid abdo pain, colicky to constant pain - early vomiting, may present with constipation - mild - moderate distension LBO - gradual - lower abdo pain, continuous pain - late stage vomiting, marked constipation - severe distension

which condition is associated with ulcerative colitis?

primary sclerosing cholangitis

which antibiotics commonly cause C. difficile toxin?

clindamycin, cephalosporins, quinolones, co-amoxiclav and aminopenicillins

second line investigation for coeliac after blood tests (also is gold standard?)

endoscopy with duodenal biopsy

what is the name of the bowel caner screening home-test kit?

faecal immunochemical test

where in the GI tract do Mallory-Weiss tears occur?

gastro-oesophageal junction

What is the gold standard investigation for diagnosing acute diverticulitis?

contrast CT colonography

What is the commonest cause of oesophageal varices in the UK?

liver cirrhosis

what is the most likely cause of intestinal obstruction following surgery?

intra-abdominal adhesions

what kind of anaemia can colorectal cancer cause?

iron deficiency anaemia

are crypt abcesses seen in UC or CD?

what is diverticulosis?

- condition occurs when small pouches/sacs form and push outward through weak spots in the wall of colon - can be asymptomatic and can lead to diverticulitis

what supplements will be needed after ileo-caecal resection?

vit B12

where are colorectal cancers most commonly found?

rectum

What is a potential complication of a Mallory-Weiss tear?

Substantial blood loss, shock, collapse, haemorrhage

what is the treatment for Mallory-Weiss tear?

Endoscopic haemostasis

Give 3 red flag signs for GORD complications

weight loss, haematemesis, dysphagia

Give 2 causes (not RF) of Gastro-Oesophageal Reflux Disease

- Lower oesophageal sphincter hypotension - Hiatus hernia - Abdominal obesity - Gastric acid hypersecretion - Slow gastric emptying - Drugs e.g. Calcium Channel Blockers, Nitrates or Anti-muscarinic) - Systemic Sclerosis

give 3 non-intestinal symptoms of IBS

painful period, change in urinary symptoms, back pain, fatigue

What is the name of the criteria used to diagnose Irritable Bowel Syndrome?

rome III diagnostic criteria

what class of drug can be given to relieve bloating and the associated pain of IBS?

antispasmodics / anticholinergics

what stimulates mucus secretion?

prostaglandins

what is first line medication management of a H. pylori infection causing gastritis?

clarithromycin, amoxicillin and omeprazole

what is the first line investigation for an abdo obstruction?

abdo XR

does UC have skip lesions?

name 4 causes of diverticulum

- low fibre diet - obesity - NSAIDs - smoking

name 2 things seen on duodenal biopsy in Coeliac?

villous atrophy and crypt hyperplasia

what kind of anaemia is seen in Crohn's disease?

iron and folate deficiency due to malabsorption

name 3 sites where you might see a hernia?

inguinal, femoral, umbilical, incisional

Other than to digest food give 3 functions of the stomach.

- Kill Microbes/Bacteria - Secrete intrinsic factor / enable B12 absorption - Store and/or Mix food - Secrete and active proteases - Produce stomach acid - Regulate emptying into the duodenum

Define malabsorption.

Inadequate absorption of nutrients/food in/by the small intestines

Why do 95% of abdominal aneurysms occur below the renal arteries but above the aortic bifurcation?

naturally contain less elastin in the arterial wall

What area of Virchow’s triangle does an abdominal aortic aneurysm affect

stasis, abnormality in blood flow

What size must an AAA reach to be considered operable?

>5.5cm2

State Laplace’s Law

R=1/r^4

what do most colon cancers develop from?

polyps

what proportion of colon cancers develop in the rectum?

1/3

what is the most common type of carcinoma found in colorectal cancer?

adenocarcinoma

What is the current bowel cancer screening programme?

faecal occult blood test in men/women aged 60-69

What 2 methods can be used to stage CRC?

TNM / duke's staging

coeliac disease: what is the single most likely pathology to be seen on endoscopy?

villous atrophy

give 4 extraintestinal symptoms of UC

Arthritis Conjunctivitis Clubbing (more common in CD) Pyoderma Gangrenosum

e.g. first line drug for diarrhoea in IBS?

loperamide - anti-motility agent

name 3 risk factors for CD

family history, HLA-B27, caucasian, smoking, NSAIDs

describe goblet cells in CD and UC

increased in CD, decreased in UC

Name two other primary investigations / blood markers you may use in the diagnostic process for Crohn’s disease.

- faecal calprotectin - FBC: leukocytosis in a flare up - CRP/ESR - U&Es - colonoscopy and biopsy