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GI Flashcards

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1
Q

What is IBD

A

Umbrella term for chronic systemic diseases involving inflammation of intestine
- Immune respose against gut/colonic flora

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2
Q

What is Crhons’s disease

A

Inflammation of GI tract anywhere from mouth to anus

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3
Q

Macroscopic changes in Crohns (4)

A
  • Inflamm of GI tract
  • Skip lesions
  • Cobblestone apperance
  • Deep uclers in mucosa
  • oral and perianal disease
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4
Q

Microscopic changes (4)

A
  • Transmural inflamm
  • Granuloma
  • Increase chronic inflamm cells
  • Increase goblet cells
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5
Q

Crohns presentation

A

sx

  • Diarrhoea - bleeding + pain
  • abdo pain
  • weight loss
  • fatigue
  • fever
  • Malasie

signs

  • abdo tenderness
  • anal strictures
  • fistulae
  • clubbing
  • perianal abscess
  • skin, eye + joint issues
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6
Q

Crohns investigations

A
  • FBC:
    Normochromic, normocytic anaemia - malabsorption
    Fe/B12/folate deficiency
  • Stool sample
  • C.diff/campylobacter
  • faecal calprotectin
  • Barium swallow
    cobblestone apperance
  • GOLD
    colonoscopy + biopsy
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7
Q

Crohns - advice and assessments prior to tx

A
  • stop smoking

- assess risk of osteoperosis

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8
Q

Crohns tx

A
  1. Induce remission
    - Oral corticosteroids - Prednisolone
  2. If no impovement add Anti-TNF antibodies
    - Influximab
  3. Maintain remission
    - Azathioprine
    - Methotrexate
  4. surgery
    - at worst affected areas
    - tx complications
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9
Q

Crohns severe flare ups tx

A

IV hydrocortisone

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10
Q

Crohns complications

A
  • Stricture
  • Colorectal cancer
  • Fistulae
  • Aneamia
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11
Q

Ulcerative colitis defenition

A

inflamm disorder of colonic mucosa - never affects proximal to ileocecal valve

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12
Q

UC macroscopic

A
  • continuous inflamm
  • ulcers
  • pseudo-polyps
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13
Q

UC microscopic

A
  • mucosal inflamm
  • no granuloma
  • depleted goblet cells
  • crypt abscesses
  • backwash ileutis –> villous atrophy
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14
Q

UC presentation

A

sx

  • Pain in LLQ
  • Diarrhoea - blood + mucous
  • Abdo discomfort
  • Tenesmus
signs 
acute:
fever/tachy/tender
- extra intestinal signs 
- clubbing 
- erythema nodosum
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15
Q

UC investigations

A
  • stool sample
    R/O infectious causes
- Bloods
FBC:
*anaemia
* raised ESR/CRP
*pANCA +ve
*faecal calprotectin
  • Barium swallow
  • GOLD
    colonsocopy + mucosal biopsy
    loss of haustrations
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16
Q

UC severity index

A

Truelove and Witt’s

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17
Q

UC tx

A 
Induce remission 
1. mild - Aminosalicylate 
    1st - Mesalazine/Sulfasalazine 
if no response:
- prednisolone

Maintain remission

  • Mesalazine
  • azathioprine
Sever disease:
infliximab 
PR steroids 
surgery 
IV hydrocortisone
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18
Q

UC surgery

A

Panproctocolectomy - remove colon and rectum

  • Permanent iliostomy
  • Ileo-anal anastamosis (j-pouch)
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19
Q

UC complications

A

Toxic dilatation
perforation
CRC
PSC

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20
Q

Extraintestinal signs of IBD

  • eyes
  • Joints
  • skin
  • liver
  • renal
A
  • uveitis/ conjunctivitis
  • Arthralgia
    Ankolysing spondy
    small joint arthiritis
  • Eryhtema nodosum
    Pyoderma gangrenosum
  • Fatty liver
    PSC
    Chronic hepatitis + Cirrhosis
  • Oxalate stones (small bowel)
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21
Q

Fludrocortisone

A

Increase mineralocorticoid

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22
Q

Hydrocortisone

A

Mineral and glucocorticoid

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23
Q

Prednisolone

A

Increase glucocorticoid

Decrease Mineralocorticoid

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24
Q

Glucocorticoid S/E

A 
weight gain
impaired glucose regualtion
galucoma 
neutrophilia 
cushings
osteoperosis 
immunosuppression
depression
insomnia
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25
Which carcinogen increases risk of oespohageal + gastric cancers
Nitrosamines
26
Irritable bowel syndrome defenition + RF
-Functional bowel disorder - mixed group of abdo sx with no organic cause ``` Female stress hamily hx of IBS young mental health issues ```
27
3 types of IBS
IBS - C IBS - D IBS - M
28
IBS triggers
stress hormones GI infections Food - wheat/milk/beans/citrus fruits
29
When should you consider IBS
- abdo pain/discomfort - bloating - change in bowel habit
30
IBS presentation
- C/D/M - urgency - incomplete evacuation - Mucous PR - nausea
31
what makes IBS worse
stress gastroentirits menstruation
32
IBS investigations
``` diagnosis of exculsion - Bloods FBC Coelaic- Anti-TTG IBD markers - Stool sample - conoscopy ```
33
IBS differential
IBS-D --> lactose intolerant coeliac IBD CRC
34
cireria for IBS diagnosis
Abdo pain: - relieved by defication - assosc w/ change in bowel habit or frequency 2 or more of: - mucous PR - worsening of sx after eating - bloating - emergency evacuation
35
IBS tx | - diet and lifestyle
``` Avoid trigger foods high fibre foods fluids avoid caffine + fizzy drinks small frequent meals enough sleep low FODMAP diet - apple/ cows milk/baked beans ```
36
IBS tx - pain - diarrhoea - constipation - 2nd line - 3rd line
- Pain - Buscapan (antispasmodic) - Diarrhoea - Loperamide - Constipation - Linaclotide * avoid lactulose - bloating - Amitryptaline * DROWSY - SSRI antidepressants Citalopram - CBT
37
What is coeliac disease
systemic AI disease triggered by exposure to gluten
38
Risk factors for coeliac
HLA-DQ2/8 assosc FHx Other AI diseases Irish
39
Coeliac causative molecule
Gliadin
40
Coeliac presentation
``` sx- abdo pain bloating diarrhoea mouth ulcers fatigue weight loss ``` signs - steattorhea - anaemia - dermatitis hepatiformis - failure to thrive - osteomalacia
41
Coeliac macroscopic signs
- reduced duodenal folding | - scalloping
42
What other disease should you test when a new diagnosis of coeliac is found
T1DM
43
Coeliac endocopy and intestinal biopsy results
Villous atrophy crypt hyerplasia intraepithelial lymphocytes
44
When is serology only accurate in coeliacs
If a gluten containing diet is followed >6weeks before testing
45
Coeliac investigations
- Check total IgA Ab levels to exclude IgA deficeincy Serology - IgA tissue transglutaminase Ab (first choice) - IgA endomysial Ab Endoscopy and biopsy DEXA Bloods: FBC/B12/Folate
46
Complications of coeliac
``` Vitmain deficiency Anaemia Osteoperosis Ulcerative jejunitits Non-Hodking lymphoma malignancy risk - small bowel/oesophageal - 2x increase risk subfertility Dermatitis hepatiformis ```
47
Coeliac tx
Lifelong gluten free diet | DEXA scan
48
Differential dx of GORD
CAD biliary colic PUD Malignancy
49
GORD pathophysiology
LOS tone decreases with increase in transient LOS relaxations Increased mucosal sensitivity to gastric acis and decreased oesophageal clearnance of acid
50
GORD predisposing factors
``` Hiatus hernia Pregnancy large meals chronic coughing alcohol smoking Gastric acid hypersecretion slow gastric emptying Drugs - nitrates/tricyclics ```
51
What is GORD
reflux of gastric acid through LOS irritating lining of the oesophagus
52
Epithelial lining of - stomach - oesophagus
- columnar epithelium | - squamous epithelium
53
GORD presentation
- Heartburn * worse when bending/lying * worse w/ alcohol/hot drinks - Belching - bloating - regurgitation - odynophagia - retrosternal pain - hoarse voice
54
GORD extra-oesophageal
Laryngitis sinusitis Nocturnal asthma chronic cough
55
GORD what remits an endoscopy
``` GI bleed - hamatemisis - melena Weight loss Dysphagia Anaemia ```
56
GORD lifestyle management
Weight loss avoid alcohol + smoking small regular meals raise bed head
57
GORD Tx
Acid neutralising meds - PRN - Gaviscon Antacids - Mg trisiclate mixture PPI - Lansoprazole H2 receptor antagonists - Ranitidine Surgery - Nissen's fundoplication Increases LOS pressure
58
GORD complications
``` - Oesophageal stricture worsening of dysphagia tx: endoscopic dilatation long term PPI ``` ``` -Barret's oesophagus squamous-->columnar Metaplasia Increased goblet cells Pre-malignant for adenocarcinoma tx: PPI ```
59
What is an ulcer
Breach in the mucosa of the stomach or duodenum | Duodenal ulcers more common
60
What arteries cause haemorrorahge after ulcers - Lesser curvature - Duodenal cap posterior wall
L.Gastric artery Gastroduodenal artery
61
Differences between IBD and IBS
Stool: IBS- mucus IBD - bloody IBD: Joint/skin/eye issues Lack of appetite weight loss
62
PUD aetiology
``` H.pylori NSAIDs SSRI's steroids Increased acid: - Alcohol - smoking - caffine - stress ```
63
PUD - NSAIDs MOA
Inhibit COX-1 - decrease prostaglandin synthesis - decreases mucous secretion - mucosa vulnerable
64
PUD presentation
``` Epigastric pain bloating/belching weight loss loss of appetite vomitting melena haematemesis ```
65
Who do you tell the difference between a gastric and duodenal ulcer
Gastric - increase pain when eating Duodenal - improves on eating - nocturnal pain - weight gain
66
H- Pylori PUD
``` Gram -ve bacteria Secreates urease - - Breaksdown urea into NH3 + CO2 - NH3 neutralises acid and protect H.pylori - damage to stomach tissue ```
67
Which 3 chemicals does H.Pylori increase inorder to damage mucous
Gastrin Histamine SST
68
PUD investigations
Pt <55y/o - Stool Ag testing - C13 breath test - serology testing Endoscopy to: All ALARM pts Pt>55y/o
69
Cancer red flag sx
``` ALARMS A - Anaemia L - Loss of weight A Anorexia R - Recurrent onset/progressive sx M - Melena/haematemesis S - swallowing issues Dysphagia ```
70
PUD DD
``` A.cholangitis Cholecystitis Gallstones GORD IBD ```
71
PUD tx
Lifestyle: - Decrease smoking + alcohol - Loose weight - Reduce stress ``` Pharma: - Stop NSAIDs - H pylori eradication: Triple therapy Lansoprazole Metronidazole Amoxicillin ``` - H2 receptor antagnosit Ranitidine Cimetidine
72
PUD complications
``` Haemorrhage --> shock Peritonitis Malignancy Strictures Pyloric stenosis ```
73
Where is Mcburneys point
2/3 of the way between umbilicus and ASIS
74
Appendicitis aetiology
Faecolith obstruction | undigested seed
75
Why does onset of central pain become localised in appendicitis
Visceral nerves irritated then localisation to RIF as parietal nerves become irritated
76
Why referred shoulder pain
Diaphragm irritation | C345
77
Appendicitis presentation
``` Abdo pain Loss of appetite Nausea Diarrhoea Vomitting ``` ``` Signs: - Tender at Mcburneys - Guarding to RIF - Fever - Rovsing's sign palpation on LIF causes pain in RIF ```
78
Appendicitis - signs of peritonitis
- Rebound tenderness | - Percussion tenderness
79
Appendicits investigations
``` - Bloods CRP/ESR - raised WCC - raised - CT (GOLD) - USS Inflammed appendix mass - Pregnancy test Serum bHCG - Urinalysis (Exclude UTI) ```
80
Appendictis DD
- Ectopic pregnancy - Ovarian cysts (rupture) - Meckels diverticulum - Ulcer perforation
81
Appendictis tx
Laproscopic appendectomy - Pre op Abx Metronidaole + Cefuroxime
82
Meckels diverticulum complications
- Ulcer | - Acute inflamm
83
Bowel obstruction - mechanical causes (4)
- Hernia - Intususception - Tumour - Adhesions - Volvus
84
Small bowel obstrucion causes
Post - op adhesions Strangulated hernia Volvulus - kids
85
Large bowel obstruction causes
Malignancy Volvulus Hirschsprung disease Diverticular disease
86
Obstrucion presentation
``` Sx- vomitting absolute constipation colicky --> diffuse abdo pain anorexia ``` ``` signs- Abdo distension tinkling bowel sounds tympanic percussion lack of flatulence ```
87
Distension - small or large bowel obstruction
Less distension in small bowel obstruction
88
Obstruction investigations
- Abdo CT - GOLD excludes perforation bowel dilatation bowel wall thickening - AXR dilated bowel loops kidney bean - volvus - Bloods WCC raised
89
Obstruction tx
``` NG tube IV fluids Analgesics Abx Surgery ```
90
What is an adhesion
sticking together of abdo structures through fibrous adhesions - bowel loops - omentum common post-op
91
What is a volvus
``` occurs at part of bowel with mesentery - sigmoid colon - caecum cuts off blood supply coffe bean sign ```
92
What is an intussusception
``` telescopping of bowel causing obstruction - ileocecal valve into caecum can cause: perforation strangulation ```
93
Bowel obstruction abdo X-ray bowel measurements warning
SB > 3cm wide LB > 6cm wide Caecum/sigmoid >9cm
94
What is diverticular disease
Asymptomatic diverticula - outpouchings of bowel wall
95
Site for diverticula
Sigmoid - narrowes part so highest pressure - site where B.V penetrates colon wall - weakest point
96
Types of diverticula
True - CONGENITAL ALL layers involved in outpouching Flase - ACQUIRED Only mucosa and submucosa involved in outpouching - muscle layer remains
97
Diverticula patho
Low fibre diet increases intra-colonic pressure herniation at weak site
98
Acute diverticulisis cause and complications
- faecolith obstruction leading to stagnation + bacterial multiplication ``` - complications: perforation abscess formation fistulae haemorrhage acute perotinitis - generalised ```
99
Acute diverticulitus presentation
``` sx- LIF pain Altered bowel habits - erratic Nausea flatulence Fever ``` ``` Signs- Tenderness guarding Ferbile tachycardic palpable tender mass ```
100
Divertivular disease investigations
colonscopy - colonic wall thickening - divertiula
101
A. diverticulits investigations
CT abdo - GOLD Barium enema Abdo X-ray - No colnocoscopy due to perforation risk
102
Diverticular disease tx
High fibre diet Mebeverine - ant-spasmodic Relaxes SM
103
A.diverticulitis tx
``` fluids SM relaxants - diazepam Abx: Ciprofloxacin Metronidazole ``` Surgery - degree of infective complications indicates requirements
104
Chronic inflammation cell infiltrates
Mononuclear cells - monocytes Lymphocytes Plasma cells Macrophages
105
Causes of gastritis
``` H- pylori chronic alcohol NSAIDs AI gastritis Herpes simplex CMV ```
106
What is AI gastritis
Ab against parietal cells - Atrophic gastritis - IF deficiency --> Prenicious anaemia - 3x risk adenocarcinoma
107
Gastritis presentation
``` N + V Abdo bloating Haematemsis Melena Indigestion Epigastric pain ```
108
Gastritis DD
PUD GORD Gastric lymphoma Non ulcer dyspepsia
109
Gastritis investigations
- Upper GI endoscopy + biopsy Red,irritated + inflammed mucosa If H-pylori suspected: - C-urea breath test - Stool Ag test
110
Gastritis tx
Avoid: alcohol NSAIDs Citrus fruits - Educate Pts - H-pylori eradication
111
Oesophageal cancer location
Upper 2/3 = Squamous cell Lower 1/3 = Adenocarcinoma
112
How does H-pylor infection lead to cancer
- Persistent infection - Chronic gastritis - Atrophic gastrits - Pre malignant intestinal metaplasia - Dysplasia - advanced gastric cancer
113
Peritonitis causes
``` A - Appendicitis E - ectopic pregnancy I - TB infection O - Obstruction U - ulcer ``` Peritoneal dialysis
114
4 types of gastric cancers
``` Adenocarcinoma - Diffuse - Intestinal Lymphoma Carcinoid tumour - G cells Leiomyosarcoma - SM ```
115
Gastric cancer epidemiology
Japan/China | Male
116
3 types of bowel ischaemia
Acute mesenteric Chronic mesenteric Ischaemic colitis - chronic colonic ischaemia
117
Watershed areas of colon
Spenic fexure | Caecum
118
When should you suspect mesenteric ischaemia
Atrial fibrillation + Abdo pain
119
Foregut blood supply
Coelaic artery
120
Midgut blood supply
S. mesenteric artery
121
Hindgut blood supply
Inferior mesenteric artery
122
Acute mesenteric ischaemia causes
Thrombosis - common Thromboembolism - from AF SMV - Thrombosis Non occlusive - LOW BP - low CO after MI
123
Bowel ischaemia presentation
- Acute severe abdo pain - No abdo signs - Diarrhoea - Vomitting - Weight loss - Hypovolaemia - Melaena
124
Bowel ischaemia investigations
Bloods: - High lactate (Metabolic acidosis) X-ray - GOLD - Gass less abdo Laparotomy - find necrotic bowel
125
Bowel ischaemia tx
``` Fluids Abx - IV gentamicin + metronidazole Heparin/anticoag Surgery ```
126
Bowel ischaemia complications
Perforation --> Septic peritonitis Gangrene Systemic inflamm response syndrome --> Multi organ failure Scarring and narrowing of intestines
127
Bowel ischaemia RF
``` Atherosclerosis >50y/o smoking COPD Arrhythmia Clotting disorder ```
128
Ischaemic colitis RF
``` Contraceptive pill Thrombophilia - Hypercoagulability Vasculitis - BF restriciton ```
129
Ischaemic colitis presentation
Abdo pain Rectal bleeding diarrhoea Shock
130
Shock signs
``` Pale Sweaty Rapid pulse Decreased urine confusion ```
131
Ischaemic colitis investigations
Colonoscopy + Biopsy - Exclure stricture formation at site Flexible sigmoidoscopy CT - excludes perforation
132
Ischaemic colitis tx
Fluids | Abx
133
Oesophageal cancer aetiology
``` Alcohol Achalasia Smoking Obesity Barret's oesophagus ```
134
Oesophageal cancer protective factors
Fibre Caretnoids Folate Vit C
135
Oesophageal cancer presentation
``` Dysphagia Weight loss Vomiting Loss of appetite Pain ``` Squamous cell - hoarse voice - cough
136
Oesophageal cancer investigations
Endoscopy and biopsy Barium swallow - strictures CT - Staging
137
Oesophageal cancer + dysphagia tx
Surgical resection Neoadjuvant chemo Dyshpagia tx - Endoscopic stent insertion to restore patency
138
RF for SI tumours
Chrons | Coeliac disease
139
SI tumour types
Adenocarcinoma - common | Non - Hodgkin's lymphoma
140
Small intestine tumour presentation
``` Pain Diarrhoea Anorexia Weight loss Anaemia Palpable mass ```
141
Chronic mesenteric ischaemia causes
Atherosclerosis
142
Most common colorectal cancer
Adenocarcinoma | - Cells lining colonic crypts
143
2 inherited causes of colon cancer
FAP - Familial adenomatous polyposis HNPCC - Heriditary nonpolyposis colon cancer Lynch syndrome
144
What is Familial adenomatous polyposis
- AD condition - Genetic variability in APC gene - Abonrmailty in APC causes beta catenin to build up beta catenin causes upregualtion of proliferation in the epithelium - >100 polyps develp - 100% lifetime risk of CRC
145
Process of polyps becoming cancerous
- Cells divide faster than usual - Polyps TSG mutations -Adenocarcinoma Malignant evolution of polyps
146
CRC risk factors
``` Age Low fibre diet Smoking Red meat high diet Alcohol Family hx obesity Male Ulcerative colitis ```
147
What is a polyp
Abnormal growth of tissue projecting into intestinal lumen from normally flat muscosal surface Most polyps are adenomas (precursors for most colorectal lesions)
148
CRC presentation - general
``` Change in bowel habit - More loose and frequent stools Weight loss PR bleeding Tenesmus Iron deficiency anaemia ```
149
CRC specific presentation
``` Asceding bowel Grow outwards - pain RIF - No bowel obstruction - Ulceration and bleeding ``` ``` Desceding bowel Ring shaped infiltratign mass - Bowel obstruction - Colicky abdo pain - Bloody stools - Altered bowel habits ```
150
CRC differential diagnosis
Haemorrhoids Diverticular disease IBD Ischaemic colitis
151
CRC investigations
Colonoscopy + Biopsy - GOLD - risk of perforation CT Colonography Barium enema - No sedation required - avoid perforation risk - Apple core sign Bloods - FBC - microcytic anaemia Staging CT
152
What test is used in population screening tests for CRC
Faecal occult blood test
153
Tumour marker for CRC
CEA - Carcinomembryonic Ag | - Only useful for CRC recurrence
154
What classification system is used for CRC staging
Dukes classification
155
Descibe the Dukes classification
A - Limited to muscularis mucosa B - Extension through muscularis mucosa (muscle of bowel wall) C - LN involvement D - metastatic
156
CRC management
Surgery - End to end anastamosis of bowel - only indicated if no mets - post op chemo Endoscopic stenting - palliation in malignant obstruction Chemo Radio
157
What is an anterior resection surgery removing
Tumours of low sigmoid colon or higher rectum
158
3 cancer screening programmes in UK
Breast Bowel Cervical

Phase 2a (11 decks)

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