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Year 2 revision > GI pathology 1 > Flashcards

GI pathology 1 Flashcards

1
Q

What is GORD?

A

Gastro-oesophageal reflux disease

Causes by reflux of stomach contents.

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2
Q

Causes of GORD

A
  • Lower oesophageal sphincter hypotension
  • Hiatus hernia
  • Oesophageal dysmotility
  • Obesity
  • Gastric acid hypersecretion
  • Delayed gastric emptying
  • Smoking, alcohol
  • Pregnancy
  • Drugs (tricyclics, anticholinergics, nitrates)
  • Helicobacter pylori
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3
Q

Symptoms of GORD

A
  • Oesophageal
    • Heartburn
    • Belching
    • Acid brash (acid or bile regurgitation)
    • Waterbrash (mouth fills with saliva)
    • Odynophagia
  • Extra-oesphageal
    • Nocturnal asthma
    • Chronic cough
    • Laryngitis
    • Sinusitis
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4
Q

What is heartburn?

A

Burning, retrosternal discomfort after meals, lying, stooping or straining, relieved by antacids.

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5
Q

Complications of GORD

A
  • Oesophagitis
  • Ulcers
  • Benign stricture
  • Iron deficiency
  • GORD may lead to Barrett’s oesophagus
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6
Q

What is Barett’s oesophagus?

A

Distal oesophagus undergoes metaplasia from squamous to columnar cells.

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7
Q

Treatment of GORD

A
  • Lifestyle
    • Weight loss
    • Smoking cessation
    • Reduce alcohol / acidic foods / spicy foods / fizzy drinks / caffeine
    • Avoid eating 3 hours before bed
  • Drugs
    • Antacids
    • Add a PPI
    • For refractory symptoms add a H2 blocker and/or try twice daily PPI
  • Surgery
    • to increase resting lower oesophageal sphincter pressure
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8
Q

What should be suspected if patient presents with diarrhoea and weight loss or anaemia?

A

Coeliac disease

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9
Q

Pathophysiology of coeliac disease

A

T-cell response to gluten in the small bowel causes villous atrophy and malabsorption

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10
Q

Presentation of coeliac disease

A
  • Steatorrhoea
  • Diarrhoea
  • Abdominal pain
  • Bloating
  • Nausea and vomiting
  • Apthous ulcers
  • Angular stomatitis
  • ↓weight
  • Fatigue
  • Weakness
  • Osteomalacia
  • Failure to thrive (children)
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11
Q

Coeliac disease diagnosis

A
  • ↓Hb, ↑RCDW, ↓B12, ↓ferritin
  • antibodies: anti transglutaminase (it is an IgA antibody so check IgA levels to exclude subclass deficiency)
  • where serology positive or high index of suspicion proceed to duodenal biopsy while on a gluten containing diet
    • expect subtotal villous atrophy, ↑intraepithelial WBCs and crypt hyperplasia
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12
Q

Treatment of coeliac disease

A

Lifelong gluten free diet

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13
Q

What is irritable bowel syndrome?

A

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

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14
Q

Diagnosis of IBS

A

Only diagnose IBS if recurrent abdominal pain associated with at least 2 of:

  • relief by defecation
  • altered stool form
  • altered bowel frequency

Symptoms are chronic (more than 6 months) and exacerbated by stress, menstruation or gastroenteritis (post infectious IBS)

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15
Q

IBS - you should think of other diagnosis if:

A
  • age >60
  • history <6 months,
  • anorexia, ↓weight
  • waking at night with pain/diarrhoea
  • mouth ulcers
  • abnormal CRP, ESR
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16
Q

Treatment for IBS - constipation

A
  • Ensure adequate water and fibre intake and promote physical activity
  • Simple laxatives
17
Q

Treatment for IBS - diarrhoea

A
  • Avoid sorbitol sweetners, alcohol, and caffeine
  • Reduce dietry fibre intake
  • Encourage patients to identify their own trigger foods
  • Try a bulking agent +/- loperamide 2mg after each loose stool
18
Q

Treatment for IBS - colic/bloating

A
  • oral antispasmodics
  • probiotics
  • low FODMAP diet
19
Q

Treatment for IBS - psychological symptoms / visceral pain

A
  • CBT
  • Tricyclics eg amitriptyline - low dose
20
Q

Symptoms of chronic pancreatitis

A
  • epigastric pain that bores through to the back, relieved by sitting forward or hot water bottles
  • bloating
  • steatorrhoea
  • ↓weight
  • brittle diabetes

Symptoms relapse and worsen

21
Q

Causes of chronic pancreatitis

A
  • Alcohol
  • Smoking
  • Autoimmune
  • Cystic fibrosis
  • Haemachromatosis
  • Pancreatic duct obstruction
  • Congenital
22
Q

Tests for chronic pancreatitis

A
  • Ultrasound +/- CT
  • pancreatic calcifications confirm the diagnosis
23
Q

Chronic pancreatitis treatment

A
  • drugs
    • analgesia
    • lipase
    • fat soluble vitamins
  • diet
    • no alcohol
    • low fat may help
  • surgery
    • for unremitting pain, narcotic abuse or ↓weight
      • pancreatectectomy
      • pancreaticojejunostomy
24
Q

Carcinoma of the pancreas typical patient

A

Male > 70yrs old

25
Q

Carcinoma of the pancreas risk factors

A
  • smoking
  • alcohol
  • carcinogens
  • diabetes mellitus
  • chronic pancreatitis
  • ↑ waist circumference
  • diet high in fat, red meat and processed meat
26
Q

Where on the pancreas does carcinoma arise?

A
  • 60% pancreatic head
  • 25% body
  • 15% tail
27
Q

Carcinoma of the pancreas symptoms

A
  • Tumours in the head of the pancreas
    • painless obstructive jaundice
  • Tumours in the body and tail of the pancreas
    • 75% present with epigastric pain
  • Either may cause
    • anorexia
    • weight loss
    • diabetes
    • acute pancreatitis
28
Q

Carcinoma of the pancreas signs

A
  • jaundice + palpable gall bladder
  • epigastric mass
  • hepatomegaly
  • splenomegaly
  • lymphadenopathy
  • ascites
29
Q

Carcinoma of the pancreas investigations

A
  • blood
    • cholestatic jaundice
    • ↑CA 19-9 is non-specific but helps assess prognosis
  • imaging
    • US or CT
      • can show a pancreatic mass +/- dilated biliary tree +/- hepatic metastases
    • ECRP/MCRP (Endoscopic retrograde cholangiopancreatography / magnetic resonance cholangiopancreatography)
    • EUS (endoscopic sonography)
30
Q

Carcinoma of the pancreas treatment

A
  • Surgical resection - pancreatoduodenectomy
    • only when no distant metastasis and vascular invasion still at at minimum
  • Laparoscopic excision
  • Post-op chemotherapy
    • delays disease progression
  • Endoscopic or percutaneous stent insertion
    • may help jaundice and anorexia
  • Large doses of opiates and radiotherapy
    • to treat disabeling pain
31
Q

Carcinoma of the pancreas prognosis

A
  • Often dismal
  • Mean survival < 6 months
  • 5 year survival 3%

Year 2 revision (15 decks)

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