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GI conditions Flashcards

1
Q

Crohn’s Disease: Pathology

A
  • Affects any part of GI tract mouth → anus (mostly terminal ileum and proximal colon)
  • Inflammation in all bowel wall layers
  • Patches of inflammation (non-continuous, skip lesions)
  • Granulomas inflammation
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2
Q

Crohn’s Disease: Risk Factors (5)

A
  • Family history
  • More genetic than UC
  • Smoking increases risk
  • NSAIDs exacerbate
  • Stress and depression trigger flares
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3
Q

Crohn’s Disease: Epidemiology

A
  • More common in western world
  • Affects females more than males
  • Presents 20-40 years
  • Lower incidence than UC
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4
Q

Crohn’s Disease: Symptoms (3)

A
  • Small bowel - right lower quadrant abdo pain, weight loss, malabsorption, severe can mimick appendicitis
  • Colon - bloody diarrhoea, pain on defecation
  • Oral aphthous ulcers
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5
Q

Crohn’s Disease: Complications (7)

A
  • Malabsorption
  • Small bowel obstruction
  • Bowel perforation
  • Abscesses
  • Colorectal cancer
  • Anaemia
  • Sclerosing cholangitis
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6
Q

Crohn’s Disease: Investigations (5)

A
  • Bloods - raised WCC, raised platelets, raised CRP & ESR
  • Anaemia - normocytic, iron, folate or B12 deficiency
  • pANCA negative
  • Hypoalbuminemia when severe
  • Colonoscopy - gold standard, granulomatous transmural inflammation
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7
Q

Crohn’s Disease: Treatment (7)

A
  • Oral prednisolone - glucocorticoid steroid, first line
  • IV hydrocortisone - stronger steroid, in severe cases
  • Smoking cessation
  • Treat deficiencies
  • Anti-TNF antiBodies - if not responsive to steroids (infliximab, adalimumab)
  • Azathioprine - maintains remission
  • Surgery - 80% need it
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8
Q

Ulcerative Colitis: Description

A

Inappropriate immune response against (possibly abnormal) colonic flora in genetically susceptible individuals

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9
Q

Ulcerative Colitis: Pathology

A
  • Only affects colon (rectum → ileocaecal valve)
  • Total continuous inflammation with ulcers and pseudo-polyps when severe
  • Only mucosa inflamed
  • Crypt abscesses
  • Depleted goblet cells
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10
Q

Ulcerative Colitis: Risk Factors (3)

A
  • Family history
  • NSAIDs
  • Stress and depression (triggers flares)
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11
Q

Ulcerative Colitis: Epidemiology

A
  • More common in western world
  • Presentation 20-40 years
  • More common than Crohn’s
  • Smoking is a protective factor!
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12
Q

Ulcerative Colitis: Symptoms (7)

A
  • Abdo pain/cramps - lower left quadrant
  • Episodic or chronic diarrhoea (blood and mucus)
  • Fever
  • Anorexia
  • Malaise
  • Weight loss
  • Clubbing
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13
Q

Ulcerative Colitis: Complications (5)

A
  • Colon - bleeding, perforation, colorectal cancer
  • Skin - erythema nodosum (symmetrical shin bumps), pyoderma gangrenosum (painful ulcers on skin)
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14
Q

Ulcerative Colitis: Investigations (5)

A
  • Blood tests - raised WCC, raised platelets, raised CRP (c-reactive protein) and ESR (erythrocyte sedimentation rate)
  • Colonoscopy - gold standard, sigmoidoscopy is diagnostic
  • Anaemia - normocytic
  • Hypoalbuminemia - when severe
  • pANCA - antibody often positive in UC and never in Crohn’s
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15
Q

Ulcerative Colitis: Treatment (3)

A
  • 5-aminosalicyclic acid (5-ASA) - oral is first line, also can be suppository. Sulfasalazine! (mesalazine, olsalazine)
  • Prednisolone - glucocorticoid steroid, second line not responding to 5-ASA or severe cases
  • Colectomy - severe cases with no response to treatment. Ileoanal anastomosis (remove colon and attach ileum and anus) or ileostomy (stoma)
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16
Q

IBS: Definition

A

Mixed group of abdominal symptoms with no organic cause

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17
Q

IBS: Epidemiology

A
  • Onset <40 years
  • More females
  • 20% of western world
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18
Q

IBS: Risk Factors (3)

A
  • GI infections
  • Stress
  • Eating disorders
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19
Q

IBS: Types

A
  • IBS-C - with constipation
  • IBS-D - with diarrhoea
  • IBS-M - mixed
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20
Q

IBS: Symptoms (3)

A
  • Abdominal pain
  • Bloating
  • Change in bowel habit
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21
Q

IBS: Diagnostic criteria

A
  • Abdominal pain with at least 2 of:
  • Relieved by defecation
  • Altered stool form
  • Altered bowel frequency
  • For at least 6 months
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22
Q

IBS: Investigations (2)

A
  • Rule out differentials
  • Bloods - anaemia, inflammation, coeliac
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23
Q

IBS: Treatment (6)

A
  • Dietary modification (determine trigger foods)
  • Soluble fibre not insoluble fibre
  • Antispasmodics - for pain/bloating in moderate
  • Loperamide (Imodium) - for diarrhoea
  • Laxatives - for constipation
  • Can use antidepressants when severe - dampen gut sensitivity
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24
Q

Coeliac: Description

A
  • Inflammation of the mucosa of the upper small bowel in response to gluten
  • Autoimmune - T cell mediated
  • Intolerance to Prolamin causes villous atrophy (villi erode away) → malabsorption
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25
Coeliac: Epidemiology
- 1% of UK population (only 25% diagnosed) - HLA-DQ2 and HLA-DQ8 gene associations
26
Coeliac: Risk Factors (2)
- Other autoimmune diseases (T1DM, autoimmune thyroid disease, Sjogren’s syndrome, Addison’s disease) - IgA deficiency
27
Coeliac: Pathology
a-Gliadin resistant to digestion → passes through damaged epithelial wall into cells → deaminated by tissue transglutaminase → antigen-presenting cells activate gluten sensitive CD4 T cells → inflammatory cascade → villous atrophy and crypt hyperplasia (elongated intestinal grooves)
28
Coeliac: Symptoms (8)
- Weight loss (malabsorption) - Fatigue (malabsorption) - Staetorrhoea (floating stool due to unabsorbed fat) - Anaemia - D&V - Abdo pain - Mouth ulcers - Dermatitis herpetiformis (deposition of IgA in skin causing raised red pathces)
29
Coeliac: Investigations (4)
- Serum antibody testing - first line, IgA tissue transglutaminase (tTG) - Duodenal biopsy - gold standard, endoscopically will show villous atrophy, crypt hyperplasia and increased epithelial WBCs - FBC - anaemias - Genetic testing - HLA-DQ2 & HLA-DQ8
30
Coeliac: Treatment (2)
- Gluten free diet - Treat vitamin deficiencies
31
Coeliac: Complication
Hyposplenism - give vaccination against pneumococcal infection
32
GORD: Pathology
Reduced tone of lower oesophageal sphincter → increase in transient relaxations → reflux of gastric acid, pepsin, bile and duodenal contents to oesophagus
33
GORD: Causes (6)
- Obesity - Hiatus hernia - LOS hypotension - Loss of oesophageal peristaltic function - Over eating - Systemic sclerosis
34
GORD: Risk Factors (4)
- Obesity - Male - Pregnancy - Smoking
35
GORD: Symptoms (6)
- Heart burn - burning chest pain, made worse by lying down - Odynophagia - painful swallowing - Hoarse throat - Wheezing - Nocturnal asthma - Acidic taste in mouth
36
GORD: Differential Diagnosis (4)
- Coronary artery disease - Biliary colic - Peptic ulcer - Malignancy
37
GORD: Investigations (2)
- Symptoms usually diagnostic (red flags: weight loss, haematemesis, dysphagia) - Oesophago-gastro-duodenoscopy - shows if there is oesophagitis or hiatus hernia
38
GORD: Treatment (5)
- Lifestyle changes - weight loss, smoking cessation, small meals - Antacids (gaviscon) - Proton Pump Inhibitors - inhibit gastric hydrogen release, preventing the production of gastric acid (lansoprazole, omeprazole) - H2 receptor antagonists - block histamine receptors on parietal cells, reducing acid release (cimetidine) - Surgery
39
GORD: Complications (2)
- Barret’s Oesophagus - oesophageal epithelial metaplasia from squamous to columnar. Can progress to oesophageal cancer - Peptic stricture - inflammation of oesophagus → narrowing and stricture
40
Oesophageal Cancer: Epidemiology
- 6th most common - Squamous cell carcinomas are in the middle third (40%) and upper third (15%) - Adenocarcinomas are in lower third and stomach cardia (45%) - More males, presents age 60-70
41
Oesophageal Cancer: Causes (8)
- Squamous: - Alcohol abuse - Smoking - Obesity - Low fruit and veg consumption - Adenocarcinoma - GORD - Smoking - Obesity - Barrett’s oesophagus is the biggest risk factor
42
Oesophageal Cancer: Risk Factors (5)
- Smoking - Alcohol - Obesity - Barrett’s oesophagus - Achalasia (disorder of reduced peristalsis)
43
Oesophageal Cancer: Pathology
Oesophageal epithelium undergoes metaplasia from squamous to columnar glandular (like stomach)
44
Oesophageal Cancer: Symptoms (4)
- Pain - Dysphagia - starts just with solids then liquids become painful, liquid pain at first indicates benign - Anorexia - Weight loss
45
Oesophageal Cancer: Investigations (3)
- Oesophagoscopy with biopsy - Barium swallow - to see strictures - CT/MRI/PET for tumour staging
46
Oesophageal Cancer: Treatments (3)
- Surgery - Chemo/radiotherapy - Palliative care
47
Oesophageal Cancer: Leiomyomas description
Benign smooth muscle tumours arising from oesophageal wall. Intact, well encapsulated and within overlying mucosa, slow growing
48
Gastric Cancer: Epidemiology
- Eastern Europe and Asia - Unknown cause - More males - Falling incidence
49
Gastric Cancer: Symptoms (6)
- Epigastric pain - constant and severe - N&V - Weight loss - Dysphagia - Anaemia - from blood loss - Jaundice - liver metastasis
50
Gastric Cancer: Investigations (3)
- Gastroscopy with biopsy - Endoscopic ultrasound - CT/MRI/PET
51
Gastric Cancer: Treatment (2)
- Nutritional support - Surgery with chemo
52
Colorectal Cancer: Epidemiology
- 3rd most common cancer worldwide - Mostly in distal colon - More males - Usually >60 years
53
Colorectal Cancer: Risk Factors (3)
- Increasing age - Family history - Genetic predisposition
54
Colorectal Cancer: Pathology
- Normal epithelium → adenoma → colorectal adenocarcinoma → metastatic colorectal adenocarcinoma (almost always adenocarcinoma) - Spreads by direct infiltration through the bowel wall then spread to lymphatic and blood vessels and metastasise to liver and lung
55
Colorectal Cancer: Staging
Duke stage: - A - just in mucosa, 95% 5 year survival - B - into submucosa, 75% 5 year survival - C - invaded nearby lymph nodes, 35% 5 year survival - D - metastasised, 25% 5 year survival
56
Colorectal Cancer: Symptoms (4)
- **Right-sided carcinoma** - asymptomatic, iron deficiency, mass, weight loss, abdominal pain - **Left-sided and sigmoid carcinoma** - change in bowel habit, blood and mucus in stools, alternated constipation and diarrhoea - **Rectal carcinoma** - rectal bleeding and mucus, cramping rectal pain and thinner stools as it grows - **Emergency (obstruction)** - absolute constipation, colicky abdominal pain, abdominal distension, vomiting stool
57
Colorectal Cancer: Differential Diagnosis (6)
- Haemorrhoids - Anal fissure - Anal prolapse - IBD - Ischaemic colitis - Meckel’s diverticulum
58
Colorectal Cancer: Investigations (3)
- Colonoscopy - gold standard - Digital Rectal exam - detects less than half - Double contrast barium enema
59
Colorectal Cancer: Management (4)
- Surgery - Endoscopic stenting - Radiotherapy - Chemo
60
Small Intestinal Cancer: Epidemiology
- 1% of all malignancies - Adenocarcinomas mostly
61
Small Intestinal Cancer: Risk Factors (3)
- Family history - Coeliac - Crohn’s
62
Small Intestinal Cancer: Symptoms (6)
- Abdo pain - Diarrhoea - Weight loss - Anorexia - Anaemia - Palpable mass
63
Small Intestinal Cancer: Investigations (3)
- Ultrasound - Endoscopic biopsy - CT/MRI
64
Small Intestinal Cancer: Treatment (2)
- Surgery - Radiotherapy
65
Peptic Ulcer: Epidemiology
- More elderly - More in developing countries (due to h. Pylori) - Duodenal ulcers are more common than gastric ulcers
66
Peptic Ulcer: Causes (6)
- **H. Pylori** - most common. Lives in gastric mucus and secretes urease → urea in stomach splits to CO2 and ammonia → ammonia + H+ = ammonium → damage gastric epithelium → inflammation reducing mucosal defence - **NSAIDs** - COX-1 inhibited → reduced prostaglandin synthesis → reduced mucus secretion → reduced mucosal defence - **Mucosal Ischaemia** - stomach cells have insufficient blood supply → necrosis → reduced mucin production → gastric acid attacks cells → ulcer. Treat with H2 blocker - **Increased acid** - overwhelms mucosal defence → acid attacks mucosal cells → cell death → ulcers. Increased by stress. Treat with PPI and H2 blocker - **Bile reflux** - duodeno-gastric reflux → regurgitated bile strips away mucus layer → reduced mucosal defence - **Alcohol**
67
Peptic Ulcer: Symptoms (9)
- Burning epigastric pain - Bloating - Vomiting - Haematemesis - Dyspepsia (indigestion) - Nausea - Gastric ulcers are painful when hungry, eating, at night - Duodenal ulcers are painful after meals, relieved by eating - Cancer red flags: unexplained weight loss, anaemia, GI bleeding, dysphagia, mass
68
Peptic Ulcer: Investigations (4)
- Endoscopy with biopsy - urease test and histology - Stool antigen test - for H. Pylori - Urea breath test - Blood test for IgG antibodies
69
Peptic Ulcer: Treatment (6)
- Lifestyle - smoking cessation, reduce stress, drink less - Stop NSAIDs - Antibiotics for H. Pylori - CAP (clarithromycin, amoxicillin, PPI) - PPIs - lansoprazole, omeprazole - H2 antagonists - reduces acid release (cimetidine) - Surgery
70
Peptic Ulcer: Complications (5)
- Haemorrhage (ulcers hiting artery) - Perforation - Obstruction - Peritonitis - Acute pancreatitis
71
Appendicitis: Pathology
- Appendix at McBurney’s point - 2/3rds from umbilicus to anterior superior iliac spine - Appendix obstruction → invasion of gut organisms → inflammation → necrosis → perforation
72
Appendicitis: Epidemiology
Incidence between 10-20 yrs
73
Appendicitis: Causes (5)
- Faecoliths (stool forming solid stones) - most common - Bezoars/metastases - least common - Trauma - Intestinal worms - Lymphoid hyperplasia
74
Appendicitis: Symptoms (5)
- Early pain around umbilicus that migrates to right iliac fossa - Guarding - involuntary muscle contraction when pressing abdomen - Fever - N&V - Anorexia
75
Appendicitis: Investigations (3)
- CT - gold standard, sensitive and specific - Bloods - raised WCC, raised CRP & ESR - Pregnancy test to exclude ectopic pregnancy
76
Appendicitis: Treatment (2)
- Appendicectomy - gold standard, laparoscopic - IV antibiotics and fluids - pre and post operative
77
Appendicitis: Complications (3)
- Perforation - Adhesions - Appendiceal abscess
78
Bowel Obstruction: Description
Arrest of the onward propulsion of intestinal contents
79
Small Bowel Obstruction: Epidemiology, Causes, Pathology
- Most common - 60-75% - **Causes** - adhesions (60%, previous abdo surgery or infetions), hernias, malignancy, Crohn’s - **Pathology** - obstruction → distension above the blockage → increased pressure on blood vessels in bowel wall → ischaemia and necrosis → perforation
80
Small Bowel Obstruction: Symptoms, Investigations, Treatment
- **Symptoms** - pain (on and off, higher than LBO), vomiting (begins earlier than in LBO), increased bowel sounds (tinkling) - **Investigations** - Abdominal x-ray (first line, shows gas shadows), Non-contrast CT (gold standard, localises obstruction) - **Treatment** - aggressive fluid resuscitation and decompression (drip and suck), analgesia, anti-emetics, antibiotics, surgery (laparotomy)
81
Large Bowel Obstruction: Causes, Symptoms, Investigations, Treatment
- **Causes** - malignancy (90%), volvulus (rotation of bowel on mesenteric axis → ischaemia and necrosis), Crohn’s - **Symptoms** - abdo pain (less localised than SBO and lower), more abdominal distension (swollen), vomiting later than SBO, constipation earlier than SBO - **Investigations** - abdo x-ray (1st line, gas shadows and distension), CT (gold standard) - **Treatment** - drip and suck
82
Pseudo-Obstruction: Presentation, Causes, Treatment
- Presents identically to LBO or SBO - Causes - Trauma, post-operative (paralytic ileus), drugs (opiates) - Treat underlying problem
83
Acute Mesenteric Ischaemia: Location, Causes, Symptoms
- Affects small bowel - Causes: Superior mesenteric artery (SMA) thrombosis or SMA embolism due to AF. Mesenteric vein thrombosis (less common, in young patients in hypercoaguble states) - Symptoms: acute severe abdo pain, no tenderness/ guarding/ distension, rapid hypovolaemic shock
84
Acute Mesenteric Ischaemia: Investigations, Treatment, Complications
- Investigations: bloods, abdo x-ray (rule out bowel obstruction), laparoscopy, CT angiography (non-invasive, detects blockages) - Treatment: fluid resuscitation, antibiotics, IV Heparin (reduce clotting), surgery - Complications: sepsis, peritonitis
85
Chronic mesenteric Ischaemia: Description
- Affects small bowel - Same as AMI but symptoms are less severe and last longer
86
Ischaemic Colitis: Location, Causes, Symptoms
- Affects large bowel - Causes: thrombosis, emboli, low flow states - Symptoms: sudden onset left iliac fossa pain, bright red blood in stools, hypovolaemic shock
87
Ischaemic Colitis: Investigations, Treatment
- Investigations: urgent CT (rule out perforation), sigmoidoscopy (shows epithelial cell apoptosis), colonoscopy (gold standard, only after recovery, excludes strictures and confirm mucosal healing) - Treatment: symptomatic treatment, fluids, antibiotics
88
Diverticular Disease: Diverticulosis defintion
Presence of diverticula - pouches of mucosa extrude through the colonic muscular wall
89
Diverticular Disease: Diverticulitis definition
Inflammation from faeces blocking the neck of the diverticulum
90
Diverticular Disease: Meckel's Diverticulum definition
A congenital condition that is present in around 2% of the population. Typically children present with symptoms around the age of 2. A small number of these will go on to develop diverticulitis, which in children presents very similar to appendicitis. Test show ectopic ileal, gastric or pancreatic mucosa
91
Diverticular Disease: Epidemiology
- Affects 50% of population over 50 - Unknown cause
92
Diverticular Disease: Symptoms (4)
- Mostly asymptomatic - Pain - Constipation - Bleeding
93
Diverticular Disease: Investigation
CT
94
Diverticular Disease: Treatment (2)
- Antibiotics - Surgery in rare cases of frequent attacks or complications
95
Gastritis: Description
Inflammation of the stomach lining that is associated with mucosal injury
96
Gastritis: Pathology
- **H. Pylori** - lives in gastric mucus and secretes ureas → splits stomach urea into CO2 and ammonia → ammonia + H+ = ammonium → damages gastric epithelium → inflammation - **Autoimmune gastritis** - affects fundus and body of stomach → atrophic gastritis and loss of parietal cells → IF deficiency → pernicious anaemia - **Aspirin and NSAIDs** - inhibits prostaglandins by inhibiting COX-1 → reduces mucus production
97
Gastritis: Causes (9)
- H. Pylori - most common - Autoimmune - Viruses (CMV and HSV) - Duodenogastric reflux - Crohn’s - Mucosal Ischaemia - Increased acid - Aspirin and NSAIDs - Alcohol
98
Gastritis: Symptoms (6)
- Epigastric pain - N&V - Indigestion - Loss of appetite - Abdominal bloating - Haematemesis
99
Gastritis: Differential Diagnosis (5)
- Peptic ulcers - GORD - Non-ulcer dyspepsia - Gastric lymphoma - Gastric carcinoma
100
Gastritis: Investigations (4)
- Endoscopy - Biopsy and histology - H. Pylori urea breath test - H. Pylori stool antigen test
101
Gastritis: Treatment (3)
- CAP - clarithromycin, amoxicillin, PPI - H2 antagonists - ranitidine, cimetidine - Prevention - PPIs with NSAIDS
102
Mallory-Weiss Tear: Epidemiology
- More males - Aged 20-50
103
Mallory-Weiss Tear: Risk Factors (4)
- Alcoholism - Bulimia - Male - NSAID abuse
104
Mallory-Weiss Tear: Pathology
Vomiting/ coughing/ retching increases intra-abdominal pressure → forces stomach contents into oesophagus → dilation and tearing
105
Mallory-Weiss Tear: Symptoms (6)
- Vomiting - Abdominal pain - Haematemesis (vomiting blood) - Postural hypotension (low BP after standing up) - Dizziness - Melena (black stools)
106
Mallory-Weiss Tear: Differential Diagnosis (4)
- Gastroenteritis - Peptic Ulcer - Cancer - Oesophageal Varices
107
Mallory-Weiss Tear: Investigation
Endoscopy
108
Mallory-Weiss Tear: Treatment
- Mostly heal in 24 hrs - Surgery if not healing
109
Haemorrhoids: Description, types, investigation, treatment
- Vascular mucosal cushions function to maintain anal continence. When they enlarge, the vessels are brought closer to abrasion and can bleed into the anus. - Can be internal (above dentate line) or external (below) - Internal: Painless. 1st degree: Do not prolapse. 2nd degree: Prolapse on straining, spontaneous reduction 3rd degree: Prolapse on straining, manual reduction 4th degree: Permanently prolapse, no reduction. - External: Painful and itchy. Visible on external examination. Can also have internal - Investigation: Digital Rectal Exam (DRE) - Treatment: increase fluid and fibre, analgesia, rubber band ligation, haemorrhoidectomy
110
Anorectal Abscess: Risk Factors, Pathology, Symptoms, Investigation, Treatment
- Risk Factors: male, DM, STI, IBD, immunocompromised - Infection of anal sinus → inflammation → abscess - Symptoms: hard, tender perianal lump, fever, constipation, pus discharge - Investigation: DRE - Treatment: Surgical drainage, analgesia
111
Fissure-in-ano: Description, Symptoms, Treatment
- Tear in the mucosa of the anal canal under pressure of defecation - Symptoms: pain on defecation, bright red blood in stool - Treatment: simple pain relief, warm bath
112
Pilonidal Sinus: Description, Epidemiology, Treatment
- Ingrowth of hair excites a foreign body reaction and causes abscess with foul smelling discharge, pain, redness, swelling - Most common in obese caucasian males - Treatment: excision of sinus tract and cover with skin flap if infected. Leave if asymptomatic

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