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Flashcards in GI Deck (20):
1

Hirschsprungs disease

No ganglion cells in myenteric plexus.
Obstruction in babies.
RET proto-oncogene Cr10+, assoc with Down's.
Hypertrophied nerve fibres, no ganglia.
Tx: resect affected (constricted) segment.

2

Mechanical lower GI diseases

All obstruction:
- Constipation
- Diverticular disease
(Meckel's = "true", all layers, before 2yo. rule of 2s)
- Adhersions, external masses, herniation
- Intussusception, volvulus (small bowel in small children, sigmoid in ederly)

3

Diverticular disease

V common due to low fibre diet, high pressure.
90% in left colon.
Often ASx, ?PR bleed.
Complications: diverticulitis, perf, fistula, obstruction.

4

Inflammatory Bowel Disease

20s, White, Unknown aetiology.
Extra-GI:
- Malabsorption: Fe def, stomatitis;
- Eyes: Uveitis, conjunctivitis;
- Skin: pyoderma gangrenosum, erythema nodosum (tender);
- Joints
- Liver: pericholangitis, PSC.

5

Crohn's disease

Smoking makes it worse.
Whole GI tract, whole thickness (transmural), skip lesions, Cobblestone. Aphthous ulcer, rosethorn ulcers. Non-caseating granulomata.
Intermittent diarrhoea (no blood), fever, pain.
Strictures, fitulae, abscesses, perforation.
Ix: CRP, ESR, Barium contrast, Endoscopy.
Mx: Pred / IV hydrocortisone / metronidazole. ?immunosupressors.

6

Ulverative Colitis

Starts in rectum, spreads continuously, doesn't reach small bowel (unless backwash ileitis). Superficial, no structural problems other than pseudopolyps.
Bloody diarrhoea. mucus, pain relieved by defaecation.
Sever haemorrhage, toxic megacolon, ?adenoCa.
Ix: rectal biopsy, AXR, stool culture.
Tx: Pred + mesalazine.

7

Carcinoid syndrome

Diverse group of tumours of enterochromaffin cell origin. Usually bowel.
Produce Serotonin, so get carcinoid syndrome.
Bronchoconstriction, flushing, diarrhoea.
Ix: 24hr urine 5-HIAA.
Tx: Octreotide.

8

Adenoma of colon / rectum

Benign dysplasia, may become adenoCa.
50% >50yo have them, mainly asymptomatic.
Malingnancy RF: large, dysplastic, villous.

9

Peutz-Jeghers syndrome

Dominant, LKB1.
Multiple GI polyps, freckles around mouth, palms and soles.
More intussusception and malignancy, so watch GI tract.

10

Colon cancer

98% adenoCa. 60-79yo. (Familial if

11

Duke's staging

Colon cancer.
A : mucosa (>95% % year survival)
B1 : muscularis propria
B2: transmural
C1 : muscularis propria + LN
C2: transmural + LN
D : distant metastases (

12

GORD

Commonest cause of oesophagitis.
Ulceration, haemorrhage, Barrett's, stricture, perforation.
Los Angeles classification.
Tx: weight, stop smoking, PPIs.

13

Barrett's oesophagus

After chronic GORD, columnar epithelium moves up.
10% symptomatic GORD become this.
30x risk of adenoCa.
Tx: endoscopic resection.

14

Oesophageal adenoCa

Common.
RF: smoking, obesity, radiotherapy, male.
Usually distal 1/3 because assoc with Barrett's.

15

Squamous cell oesophageal Ca

Much rarer.
RF: Alcohol, smoking, Afrocab, achalasia of cardia, Plummer-Vinson syndrome, nutritional def, HPV.
Middle 1/3.
Progressive dysphagia, odynophagia, anorexia, weight loss.
Rapid growth, early spread, palliate.

16

Gastritis

Acute (neut): insult - aspirin, NSAIDs, bleach, burns.
Chronic (lymphocytes): H pyori, autoimm, alcohol, smoking.
Can give ulcers, or intestinal metaplasia then dysplasia then cancer.

17

Gastric ulcer

After antral gastritis (H pylori).
Epigastric pain worse with food.
RF: H pylori, smoking, NSAIDs, stress, elderly.
Punched out lesion with rolled margins.
Iron deficiency anaemia, perf, malignancy.

18

Gatric lymphoma

H pylori again!
#Haem
PPI, clarithromycin, amoxicillin.

19

Duodenal ulcer

4x more common than gastric.
Pain, worse at night, *better* with food and milk.
Younger adults.
Same RF: H pylori, smoking, NSAIDs, steroids.
Same complications: IDA and perf.

20

Coeliac disease

Autoimmune.
Gluten intolerance, villous atrophy, malabsorption.
Irish women.
Sx: steatorrhea, pain, bloating, N+V, weight loss/FTT, fatigue, IDA, rash (dermatitis hepatitis).
Tests: anti-endomysial, anti-TTG.
Best Ix: duodenal biopsy - villous atrophy.
Tx: gluten free diet.
10% progress to duodenal T-cell lymphoma if not treated.