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GI Flashcards

1
Q

what causes GORD?

A

reflux of gastric contents back into oesophagus/prolonged contact with mucosa. Due to;

  • reduced tone in LOS and transient relaxations
  • increased mucosal sensitivity to gastric acid
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2
Q

Predisposing factors to GORD?

A

obesity, pregnancy, systemic sclerosis

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3
Q

Features of GORD?

A

heart burn, regurgitation, cough and nocturnal asthma, hoarse voice

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4
Q

Red flags of GORD?

A

weight loss, dysphagia, haematemesis, anaemia

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5
Q

Ix for GORD?

A

OGD, 24hr pH monitoring

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6
Q

Mx of GORD? + name 2 medications and their classes

A
  1. lifestyle - lose weight, avoid alcohol, avoid aggravating foods, stop smoking
    PPI e.g. omeprazole
    H2 receptor antagonist e.g. Ranitidine
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7
Q

Complications of GORD - name 2

A

strictures, barrret’s oesophagus

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8
Q

what is the histological change in barretts oesophagus?

A

squamous –> columnar epithelium

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9
Q

what is alchalasia?

A

oesophageal peristalisis - failure of the LOS to relax which impairs oesophageal emptying

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10
Q

name some Ix for oesophageal issues?

A

Barium swallow - shows the dilation of the oesophagus and the peristalisis
oesophageal manometry
OGD
CXR

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11
Q

what is a hiatus hernia?

A

when part of the stomach herniates through the oesophageal hiatus of the diaphragm

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12
Q

Main RF for malignancy in the lower 1/3 of the oesophagus?

A

Barrett’s oesophagus - adenocarcenoma (lower 1/3)

SCC occurs in the middle 1/3 - RF = smoking/alcohol

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13
Q

what is H.Pylori?

A

gram -ve urease producing bacteria found in the gastric antrum

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14
Q

which diseases is H.Pylori associated with?

A

chronic gastritis, peptic ulcer disease, gastric cancer, gastric B cell lymphoma

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15
Q

name 2 methods of non-invasive and invasive testing for H.Pylori?

A

NON INVASIVE - urea breath test, stool antigen test, serology
INVASIVE - endoscopic gastric mucosal biopsy (test for urease and then test histology)

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16
Q

Which Abx are given to eradicate H.Pylori?

A

omeprazole + metronidazole + clarithromycin

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17
Q

Name some causes of peptic ulcers

A

H.Pylori, NSAIDS, crohns

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18
Q

How do duodenal ulcers and gastric ulcer features differ?

A

DU - pain when pt is hungry

GU - pain when pt is eating

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19
Q

Name some complications of gastric ulcers?

A

Perforation –> painless haemorrhage

gastric outlet obstruction

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20
Q

Red flags with gastric ulcer symptoms?

A

pain similar to peptic ulcer
+ nausea, anorexia, weight loss
mets –> ascites and hepatomegaly

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21
Q

Name the two presentations of upper GI bleeding?

A 
haematemesis = vomit blood
malaena = passage of black tar stools
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22
Q

Mx for an upper GI bleed?

A

IMMEDIATE - FBC/UE/LFT/clotting. group and save, cross match 4 units, start IV fluids

  • stop NSAIDS/warfarin/aspirin
  • give PPI to high risk patients
  • consider ABX
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23
Q

Name some causes of upper GI bleeding

A

mallory weiss tear, previous ulcer, varices, gastric carcinoma

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24
Q

Causes of lower GI bleeding (small intestine/colon)

A

SI - cancer, UC, meckels diverticulum

Colon - haemmerhoids, fissure, neoplasm, UC/CD, diverticular disease

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25
How do you investigate a lower GI bleed?
resuscitate - fluids/blood Hx and exam protoscopy for anorectal disease sigmoidoscopy
26
What is coeliac disease?
autoimmune condition whcih reacts to the a gliadin portion on the gluten molecule causing an inflammatory cascade
27
What is shown on histology on a patient with coeliac disease?
villous atrophy crypt hyperplasia increased intraepithelial cells
28
Features of coeliac disease?
tired, malaise, steatorrhea, deficiency in B12/folate/iron
29
What Ix do you do for coeliac disease?
Abs - TTG, EMA FBC - anaemia? DXA scan Distal duodenal biopsy
30
Mx for coeliac disease?
gluten free diet, pneumococcal vaccine
31
What is the effect of a resected terminal ileum?
B12 malabsorption --> megaloblastic anaemia | Bile salt malabsorption --> renal oxalate stones
32
what is meckels diverticulum??
diverticulum which is left over from the umbilical cord (60cm from the ileocaecal valve)
33
how can a meckel's diverticulum present?
lower GI bleeding, perforation, inflammation, obstruction
34
causes of intestinal ischaemia?
reduced blood flow - atheroma - embolism - vasculitis - shock
35
how does bowel ischaemia present?
severe abdo pain but with limited findings on examination
36
how do small bowel tumours present?
abdo pain, diarrhoea, anorexia, anaemia, carcinoid features
37
which conditions increase the risk of small bowel tumours?
crohns, coeliac
38
which cells do carcinoid tumours develop from?
enterochromaffin cells (produce serotonin)
39
how does carcinoid syndrome (increased serotonin present)
flushing, wheezing, diarrhoea, abdo pain
40
name a serotonin antagonist?
cyroheptadine
41
what does high 5HIAA in urine make a potential diagnosis?
carcinoid small bowel tumour
42
What causes IBD?
inflammatory condition affecting the bowel. Genetics - stronger for CD, familial aggregation, links with HLAB27 Environment - reduced Rx of UC with smoking, smoking precipitates relapses
43
Features of CD presentation?
``` commonly affects ileocaecal bowel abdo pain and weight loss diarrhoea bleeding/pain on defacation anal tags/fissures/abscesses oral ulcers ```
44
Features of UC presentation?
diarrhoea and blood/mucus urgency tenesmus L lower quadrant pain
45
Histological features of CD?
``` affects oral --> perianal parts of bowel discontinuous lesions deep ulcers/fissure (cobblestone appearance) transmural inflammation granulomas ```
46
Histological features of UC?
``` Colon only affected (begins in rectum then extends up) continuous lesions red mucosa/bleeds easily mucosal inflammation only no granulomata, crypt abscessees ```
47
How do you investigate IBD?
BLOODS - FBC (anaemia, platelets), ESR, CRP, albumin, LFTs | IMAGING - rigid flexible sigmoidoscopy, rectal biopsy, colonoscopy, small bowel imaging, plain XR
48
IBD DD?
infection, ischaemia, radiation, bacteria overgrowth
49
Name some extra-gastrointestinal features of IBD?
EYES - uveitis, episcleritis JOINTS - arthralgia, ankylosing spondylitis, inflammatory back pain SKIN - erythema nodosum LIVER - fatty liver, sclerosing cholangitis, cirrhosis, hepatitis RENAL - oxalate stones
50
How do you induce and maintain remission in UC?
Induce remission - Aminosalicylate/IV steroids | maintain remission - topical aminosalicylate (azathioprine if severe.)
51
How do you induce and maintain remission in CD?
STOP SMOKING induce remission - steroids, enteral feed, infliximab maintain remission - azathioprine/surgery
52
Name some complications of IBD
perforated bowel, strictures, abscesses, fistulae/fissures, colon cancer
53
What is the definition of constipation?
consistent difficulty in defacation. Infrequent passage of stools <3 days/weeks + straining and passage of hard stools with a sensation of incomplete emptying
54
Name some causes of pregnancy
``` GENERAL - pregnancy, low fibre, immobile METABOLIC - DM, hypothyroid FUNCTIONAL - IBS DRUGS - opiates NEURO - SC lesion, PD GI - hirschprung, obstruction ```
55
Constipation red flags?
rectal bleeding, anaemia, resent onset, >50, tenesmus
56
What are diverticula?
pouches of mucosa through colonic muscular wall, they form due to increased intracolonic pressure and areas of weakness in the bowel wall
57
RF for formation of diverticula?
age, low fibre diet, obesity, sedentary lifestyle, smoking and NSAIDS
58
Features of diverticular disease?
Lower left quadrant intermittant abdo pain, bloating, constipation and diarrhoea
59
Features of acute diverticulitis?
severe LLQ pain, N&V, constipation or diarrhoea, urinary symptoms, fever
60
Signs of acute diverticulitis on examination?
increased HR, tender LIF, reduced bowel sounds, guarding, rigidity, tenderness
61
Ix for acute diverticulitis?
CXR - perforated and pneumoperitoneum? AXR - dilated bowel loops CT abdo - abscess AVOID COLONOSCOPY - PERFORATION RISK
62
How do you manage acute diverticulitis?
ABx, liquids, analgesia
63
Name two genetic conditions which increase the risk of bowel cancer
FAP, HNPCC
64
What screening would you do for someone with FAP/HNPCC?
FAP - annual colonoscopy to identify polyps and resect | HNPCC - colonoscopy every 1-2 years and extracolonic surveillance
65
Name some risk factors for colon cancer
age, family history, HNPCC, FAP, high animal protein and low fibre diet
66
Features of L and R sided colon cancer?
LEFT - rectal bleeding, stenosis, altered bowel habit, colicky bowel pain RIGHT - anaemia, RIF mass
67
Ix for CRC?
IMAGING - colonoscopy, CT, barium enema BLOODS - FBC, UE, LFT, CEA tumour marker CXR, PET Faecal occult blood test
68
How are the general public screened for CRC?
age 60-74 Faecal occult blood/FIT every 2 years one off flexible sigmoidoscopy
69
How do you investigate IBS?
stool culture, baseline bloods (FBC, ESR, B12, folate, coeliac, TFT)
70
How do you manage IBS?
low FODMAP diet amitryptilline manage any depression/anxiety which is underlying
71
what are some non-GI causes of the acute abdomen presentation?
DKA, MI, pneumonia, IBS
72
what do you want in the history of the acute abdomen?
Abdo/urinary/gynae Hx - ONSET - sudden e.g. perforation/torsion/AAA/ectopic - SITE - e.g. RIF = appendicitis, LLQ = diverticulitis - COLICKY - mechanical flow obstructed (e.g. ureteric calculi, bowel obstruction)
73
what are you looking at on initial examination of an acute abdomen presentation?
shock - ruptured organ? fever peritonitis - tenderness, buarding, ridgidity obstruction - "tinkling bowel sounds"
74
Ix of the acute abdomen?
``` rectal and pelvic exam Bloods - FBC/UE/LFT/amylase urinalysis CXR AXR laparoscopy pregnancy test ```
75
What causes appendicitis?
lumen of the appendix is obstructed by faecocolith
76
Features of acute appendicitis?
central abdo pain which localises to the RIF anorexia, N&V, diarrhoea pyrexial guarding and tenderness
77
Ix for acute appendicitis?
Bloods - WCC, CRP, ESR | US and CT of the abdomen
78
name 2 causes for localised peritonitis
acute appendicitis, cholecystitis
79
What causes generalised peritonitis?
rupture of abdominal viscus, e.g. ulcer
80
Main causes of a small intestine obstruction
adhesions, hernias, crohns, intussuption, extrinsic cancer involvement
81
Main causes of colonic obstruction?
carcinoma of the colon, sigmoid volvulus, diverticular disease
82
Features of a bowel obstrucrion?
bowel above obstruction is dilated colicky abdo pain vomiting (soon in SBO + bilious) Constipation (earlier with LBO)
83
Findings on abdo exam of a bowel obstruction?
distension and tinkling bowel sounds
84
Mx of a SBO and LBO
SBO - NG suction and IV fluids | LBO - surgery
85
Name a cause of functional bowel obstruction and when does it occur?
paralytic ileus - occurs after abdo surgery/opiate use

Finals (21 decks)

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