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Flashcards in GI Deck (78):
1

Summary of GI pathology?

Upper GI: Oesophageal/Stomach/SI pathology

Lower GI: Diverticular/IBD, Polyps, Adenoma, CRC,

Infective GE
Intra-abdominal infections
Nutritional support in trauma

2

What is the most common cause of oesophagitis?

Gastro-oesophageal reflux

(infection if immunocomp/ corrosives)

3

State 5 risk factors for reflex oesophagitis.

Male
Caucasion
Overweight
Defective LES
Hiatus heria
Increased intra-abdo pressure

4

Ulceration/Haemorrhage/Perforation/Strictures are possible complications of long-standing reflux oesophagitis.

What is another one which is a pre-malignant condition?

BARRETT'S OESOPHAGUS

5

What are the risk factors for Barrett's oesophagus?

Same as reflex oesophagitis

6

State the histiological changes in Barrett's oesophagus.

Glandular metaplasia

(sq --> columnar)

7

Those wth Barrett's oesophagus require regular endoscopic surviellance. For what?

ADENOCARCINOMA

8

What are the 2 types of Oesophageal cancer?

Adenocarcinoma - from Barrett's

Squamous Carcinoma - from native cells (middle/lower 1/3)

9

Which Oesophageal cancer has the same risk factors as Barrett's/reflex oesophagitis?

Adenocarcinoma

10

Risk factors for Squamous carcinoma?

Smoking
Alcohol
Thermal injury
HPV
Male
Black

11

The 2 oesophageal cancers have the same macroscopic appearence. Describe these.

Strictures
Ulcerated
Fungating
Polypoidal

12

Causes of Chronic gastritis?

ABC: Autoimmune, Bacterial (H.pylori), Chemical injury

NSAIDs
Bile reflux

13

H.pylori is associated with which 2 cancers?

Gastric cancer

MALT Lymphoma

14

What effects does H.pylori have on the stomach?

Chronic inflammation (mucosa)

Glandular atrophy (fibrosis, intestinal metaplasia)

15

What is defined as a localised defect extending to the submucosa +

Peptic ulcer

16

Name 5 causes of peptic ulcers

H.PYLORI
Smoking
NSAIDs
Hyperacidity
Duodenl-gastro reflux

17

Is duodenal or gastric ulcer more common?

What is it always almost caused by?

Duodenal

H.PYLORI

18

Complications of peptic ulcers?

Haemorrhage
Perforation
Penetrate adjacent organs
Stricturing (hour-glass deforming --> reflux)

19

The most common type of gastric cancer is MALT lymphoma. T/F?

F

ADENOCARCINOMA

20

Adenocarcinoma of the GOJ has the same risk factors as Reflux oesophagitis.

What are the risk factors for Adenocarcinoma of body/antrum?

H.Pylori
Diet
Hypochlrohydria
Bile reflux

21

Gastric cancer in

HDGC

Hereditary diffuse-type

(scattered growth)

22

Other uncommon forms of gastric cancer?

Endocrine tumours
GIST
MALT lymphoma

23

Coeliac D is autoimmune and gliadin induces IL-15 expression --> CD8 IEL activation --> villi atrophy.

T/F?

T

24

Give 4 symptoms of Coeliac D.

Anaemia

Chronic diarrhoea

Bloating (bacteria)

Chronic fatigue (malabsorption)

25

How would you investigate for Coeliac D?

Antibodies

Biopsy

26

If got symptoms despite gluten-free diet, what would this suggest?

Cancer

27

Are diverticula are inward or outward protrusion of mucosa and submucosa?

OUTWARD

28

Diverticula are associated with...?

West
Urban
Elderly
Low fibre

29

Most diverticula present as...?

Other presentations?

Asymptomatic (90%)

Abdo pain
Alternating diarrhoea/constipation

30

Diverticulosis, Perforation, Haemorrhage are examples of what?

Acute complications of diverticula

31

Intestinal obstruction, Fistula, Colitis, Polypoid prolapsing mucosa folds are examples of what?

Chronic complications of diverticulosis

32

IBD is a form of chronic colitis. T/F?

T

33

3 Risk factors for IBD?

Smoking
Oral contraceptive
FH

34

The longer you have UC, the more likely you are to develop CRC. What is neccessary after 10yrs of UC?

Colonoscopy

35

The following features are indicative of which IBD?
-muscoal inflamm
-affects colon- starts in rectum
-continuous disease
-inflammatory polyps

UC

36

Clinical presentation of UC? (4)

Diarrhoea -- urgency
Rectal bleeding
Anorexia --> weight loss
Abdo pain

37

The complications of UC include...? CRC was already mentioned

Toxic megacolon

Haemorrhage

CRC

38

The complication of Crohns are the same as UC. What other ones are there that are not seen in UC?

Fistula
Stricture
Small bowel syndrome --> malabsorption

39

Crohns is transmural/affects any part of GI/ pathcy/ cobblestone appearence. T/F?

T

40

State 5 ways Crohns way present.

Bloody diarrhoea
Colicky abdo pain
Palpable abdo mass
Mouth ulcers
Anorexia

Peri-anal D
Fever

41

Name systems in the body which may show extra IBD-mainfestations.

(inflammatory)

Hepatic
Renal
Skeletal
Haematological
Mucocutaneous

42

Colorectal polyps are an outward mucosal protrusion. T/F?

F

INWARD

43

What is the term for the common non-neoplastic polyps that are benign unless LARGE & RIGHT-SIDED?

Hyperplastic

44

Name the 2 non-neoplastic polyps that present in youth and ass with cancers

Juvenille polyps (malignanrt potential)

Peutz-Jeghers syndrome (predisposes to many cancers)

45

The neoplastic benign polyp is called adenoma. Is it a precursor of CRC?

YES

46

What type of cancer is CRC generally?

Adenocarcinoma ~95%

47

Risk factors for CRC?

Diet
Obesity
IBD
Alcohol
NSAIDs
HRT
FH
Adenoma
pelvic radiation
Schistosomiasis

48

Are most CRC related to FH or sporadic?

Sporadic ~ 75%


(FH ~20%)

49

Which inhertied conditions increase your risk of CRC?
Which one also increases risk for other cancers?

HNPCC*
FAP 100%

50

Where does CRC tend to spread to?

Liver
Lung

51

State the staging system for CRC.

Dukes
A: confined to wall
B: invading wall
C: regional LN
D: distant mets

52

What mode of infection is common in Infectious Gastroenteritis (GE)

Food/water-bourne

53

Common viral causes of GE include Rotavirus/Norovirus. What about bacteria?

Salmonella
E.Coli
Campylobactera
V.cholerae
C.dif

54

Presenting complaint of GE are SUDDEN non-specific GI symptoms. Complications?

Dehydration
Renal dysfunction
Toxic megacolon
GBS
HUS

55

What SHOULDN'T you give to treat GE?

ANTIBIOTICS
(except in young/old/immunocomp)

bacteria dying will release toxins --> worse

56

The Winter-vomiting disease = Norovirus. What is the classic presentation?

Treatment?

Diarrhoea
Projectile vomiting
24-48hr illness

Supportive

57

Which strain of E.Coli releases shinga toxin causing diarrhoea + dehydration?

E.Coli 0157

58

Complication of E.Col 0157 GE?

HUS

Shinga toxin acts on RBC

59

Antibiotic-associated diarrhoea can occur up to how long after treatment?

2 months

60

C.dif is common in >60s / taken borad spectrum antibiotics.

Whats the treatment?

Oral Metronidazole/Vancomycin!

Faecal transplants

61

State 2 sources of intra-abdominal infections.

GI tract
Blood

62

What are the 3 mechanisms of how an intra-abdo infection can occur?

1. Translocation across wall
(Perforated Appendix/Diverticulum)

2. Translocation across lumen
(hepatobiliary)

3. Translocation from extra-intestinal source
(blood, trauma)

63

Cholecystitis = ?

Causes?

= inflammation of GB wall

Obstruction of cystic duct (GALL STONES, malignancy, worms, ERCP)

64

How does cholecystitis present?

RUQ pain
Fever
Mild jaundice

65

Complication and treatment of cholecystitis?

Empyema of GB

Remove pus

66

Cholangitis = ?

Causes?
Presentation?

= Inflammation of biliary tree

Same as cholecystitis

67

Intraperitoneal abscesses can be caused by...?

Perforation
Cholecystitis/Cholangitis
Ischaemia
Pancreatitis
Anastomatic leak

68

Is the presentation oof intra-peritoneal abscesses specific or non-specific?

Non-specific

Sweating
Anorexia
High fever

69

State the locations where intra-peritoneal abscesses occur.

Subphrenic
Subheaptic
Paracolic
Pelvic

70

How would you investigate intra-abdominal infections?

Bloods: FBC, CRP, LFTs

Imaging: CXR, USS, Abdo CT

Microbiological: microscopy, culture, sensitivity testing

71

Intra-abdominal infections are treated diff for > 65s and

Start:
Cefuroxime + Metronidazole 65s

72

What are the 3 phases post-trauma?

Phase 1: Clinical shock

Phase 2: Catabolic state

Phase 3: Anabolic state

73

What is the amrker for tissue hypoxia?

LACTATE

74

When is a patient most vulnerable of refeeding syndrome?

What is it?

IN ANABOLIC PHASE

If feed too quickly from malnourishment --> increased uptake into cells --> ions decrease in blood (when already low) --> CARDIAC ARREST

75

Manifestation of refeeding syndrome after tests?

Decreased K/Mg/Pi, Thiame

Salt/H20 retetion --> oedema

76

The term for inflammation of the large intestine due to C.dif overgrowth?

Complication of antibitoic therapy.

Pseudomembranous colitis

77

What is the term for inflammation of the ascites fluid?

Spontaneous Bacterial Peritonitis

78

~10 days post-trauma patients are at risk of what respiratory syndrome?

ARDS