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GI Flashcards

1
Q

What is meant by the term inflammatory bowel disease?

A

Umbrella term:

  • Crohn’s disease
  • Ulcerative colitis
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2
Q

What is Crohn’s disease?

A

Transmural, granulomatous inflammation affecting any part of the gut (mouth to anus)

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3
Q

Describe the macroscopic and microscopic features of Crohn’s disease

A

Macroscopic:
- Skip lesions (‘cobblestone’ appearance)

Microscopic:

  • Transmural
  • Granulomas
  • Goblet cells present
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4
Q

What are the symptoms and signs of Crohn’s disease?

A

Symptoms:

  • Diarrhoea
  • RLQ abdominal pain
  • Weight loss
  • Fatigue

Signs:

  • Mouth ulcers
  • Anaemia
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5
Q

Describe the investigation of Crohn’s disease

A

Bloods:

  • FBC may show anaemia
  • ESR/CRP raised

Stool sample to rule out infection

Colonoscopy and biopsy = DIAGNOSTIC

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6
Q

Describe the pharmacological management of Crohn’s disease

A
  • Oral corticosteroid, e.g. prednisolone
  • IV hydrocortisone in severe flare-ups
  • Add anti-TNF antibodies (e.g. Infliximab) or DMARD (e.g. sulfasalazine, methotrexate) in severe disease
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7
Q

What is ulcerative colitis?

A

Inflammatory condition affecting the colon mucosa ONLY!

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8
Q

Describe the macroscopic and microscopic features of ulcerative colitis

A

Macroscopic:

  • Continuous lesion (no skip lesions)
  • Ulcers

Microscopic:

  • Mucosa ONLY
  • No granulomas
  • Goblet cell depletion
  • Crypt abscesses
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9
Q

Describe the symptoms and signs of ulcerative colitis

A

Symptoms:

  • Diarrhoea WITH BLOOD/MUCUS
  • LLQ abdominal pain

Signs:

  • Fever
  • Erythema nodusum
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10
Q

Describe the investigation of ulcerative colitis

A

Bloods:

  • ESR/CRP raised
  • Autoantibody screen for pANCA (perinuclear anti-neutrophil cytoplasmic antibodies)

Stool sample to rule out infection

Colonoscopy and biopsy = DIAGNOSTIC

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11
Q

Describe the pharmacological management of ulcerative colitis

A
  • DMARD, e.g. Sulfasalazine

- Add oral prednisolone if necessary

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12
Q

Describe the interventional management of ulcerative colitis

A

Colectomy

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13
Q

What is irritable bowel syndrome?

A

A group of abdominal symptoms for which no organic cause can be found

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14
Q

Describe the symptoms of irritable bowel syndrome

A
  • Abdominal pain relieved by defecating
  • Bloating
  • Alternating bowel habits (constipation, diarrhoea)
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15
Q

Describe the investigation of irritable bowel syndrome

A

Diagnosis is made after ruling out differentials (i.e. Crohn’s disease, ulcerative colitis, Coeliac disease etc.)

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16
Q

Describe the pharmacological management of irritable bowel syndrome

A
  • For pain/bloating: anti-spasmodic, e.g. buscopan
  • For diarrhoea: anti-motility agent, e.g. loperamide
  • For constipation: laxative, e.g. senna
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17
Q

What is GORD? Describe its pathophysiology

A

GORD = gastro-oesophageal reflux disease

Reflux of gastric contents into the oesophagus due to relaxation of the lower oesophageal sphincter independently of swallowing

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18
Q

What are the risk factors for GORD?

A
  • Male
  • Increased abdominal pressure, e.g.obesity, pregnancy
  • Smoking
  • Hiatus hernia
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19
Q

What is the main symptom of GORD?

A

Heartburn

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20
Q

Describe the pharmacological management of GORD

A
  • Anatacids, e.g. gaviscon
  • H2 blockers, e.g. ranitidine
  • PPIs, e.g. lansoprazole
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21
Q

How do PPIs work?

A

PPIs inhibit release of hydrogen ions into the stomach, so inhibit production of gastric acid

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22
Q

What is a peptic ulcer?

A

A break in the epithelial lining penetrating down to the mucosa (in the stomach/first part of the duodenum)

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23
Q

What are the causes of peptic ulcers?

A

Helicobacter pylori infection

NSAID use

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24
Q

Describe the investigation of helicobacter pylori infection

A
  • Urea breath test
  • Stool antigen test
  • Serology
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25
Describe the pharmacological management of helicobacter pylori infection
- PPI, e.g. lansoprazole | - 2 Abx (clarithromycin and metronidazole)
26
How do NSAIDs cause peptic ulcers?
NSAIDs inhibit cylooxygenase 1, which inhibits the production of prostaglandins which are needed for mucus production (this leads to mucosal damage)
27
What is Coeliac disease?
Gluten intolerance
28
Describe the investigation of Coeliac disease
Bloods: Autoantibody screen for IgA tissue transglutaminase (tTG) antibody and IgA anti-endomysial antibody (anti-EMA) - MUST HAVE GLUTEN IN DIET WHEN TESTING FOR ANTIBODIES Duodenal biopsy is diagnostic
29
What are the symptoms and signs of Coeliac disease?
Symptoms: - Diarrhoea - Abdominal pain/bloating - Fatigue - Weight loss Signs: - Anaemia - Dermatitis herpetiformis
30
Describe the conservative management of Coeliac disease
Remove gluten from diet
31
What are the 3 major symptoms/signs of malabsorption?
Weight loss, steatorrhoea and anameia
32
What is appendicitis?
Inflammation of the appendix
33
Describe the symptoms an signs of appendicitis
Symptoms: - Acute pain starting around umbilicus migrating to RIF - Nausea, vomiting - Fever Signs: - Abdominal guarding
34
Describe the interventional management of appendicitis
Apendicectomy
35
What is peritonitis?
Inflammation of the peritoneum due to entry of blood, air, bacteria or GI contents (either faeces or bile)
36
What are the symptoms of peritonitis?
Symptoms: - Dull pain that becomes sharp - Pain worse on coughing/moving Signs: - Abdominal guarding
37
What are the causes of peritonitis?
AEIOU and P ``` A - appendicitis/ascites E - ectopic pregnancy I - infection with TB O - obstruction U - ulcer and P - peritoneal dialysis ```
38
Describe the investigation of peritonitis
- Ascitic tap: high neutrophil count | - AXR: dilated bowel, gas under diaphragm
39
Describe the pharmacological management of peritonitis
IV Cefotaxime and Metronidazole
40
What is ischaemic colitis?
Reduced blood supply to the colon
41
What is mesenteric ischaemia?
Reduced blood supply to the small bowel
42
What is the main cause of ischaemic colitis/mesenteric ischaemia?
Atherosclerosis
43
Describe the management of ischaemic colitis/mesenteric ischaemia
Conservative: - Modification of risk factors (atherosclerosis) Interventional: - Resection of ischaemic/dead bowel - Stenting - Mesenteric artery bypass graft
44
What is a Mallory-Weiss syndrome?
Bleeding and other symptoms caused by a tear in the mucous membrane of part of the upper GI tract (oesophagus,stomach and first part of the duodenum)
45
Give the 2 most common sites for a Mallory-Weiss tear
- Gastro-oesophageal junction | - Upper part of the stomach
46
What causes Mallory-Weiss tear(s)?
Persistent retching/vomiting
47
What are the symptoms of Mallory-Weiss syndrome?
- Bringing up blood after retching/vomiting - Epigastric abdominal pain - Black, tarry stools
48
Describe the investigation of Mallory-Weiss syndrome
Gastroscopy
49
Describe the management of a Mallory-Weiss tear
Usually the tear heals by itself | PPIs may be given to help the tear heal
50
What is a hernia? | Give some examples of types of hernia
Protrusion of an organ or tissue outside of the cavity in which it normally lies Inguinal hernia Hiatus hernia Umbilical hernia Incisional hernia
51
What causes a hernia?
- Muscle weakness (trauma, age) | - Abdominal strain (pregnancy, chronic cough, constipation)
52
What is an inguinal hernia?
Protrusion of abdominal cavity contents through the inguinal canal
53
What is a hiatus hernia?
Protrusion of part of the stomach though the oesophageal hiatus of the diaphragm
54
What is gastritis?
Inflammation of the lining of the stomach
55
What causes gastritis?
- Helicobacter pylori infection | - NSAID use
56
What is diverticulitis?
- Diverticula are outpouchings which develop in the lining of the intestine as we age - Inflammation of these diverticula = diverticulitis
57
Describe the investigation of diverticulitis
Colonoscopy
58
Describe the management of diverticulitis
Conservative: - High fibre diet Pharmacological: - Paracetamol
59
What is pancreatitis?
Destruction of pancreas by pancreatic enzymes
60
What are the main causes of pancreatitis?
Gallstones Alcohol Steroids Trauma, e.g. ERCP
61
Describe the symptoms and signs of pancreatitis
Symptoms: - Epigastric pain radiating to back (relieved by sitting forward) Signs: - Cullen's/Grey Turner's sign (bruising around umbilicus/flanks)
62
Describe the investigation of pancreatitis
Bloods: | - High amylase/lipase
63
Describe the management of pancreatitis
Supportive - e.g. IV fluids | Analgesia
64
What are the causes of intestinal obstruction?
- Tumour - Adhesions - Volvulus - Crohn's - Diverticulitis
65
On abdominal examination, tympanic bowel sounds suggest what?
Air/gas

Phase 2a (16 decks)

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