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formative 3b > GI Peer Teaching > Flashcards

GI Peer Teaching Flashcards

1
Q

what is GORD

A

Gastro Oesophageal Reflux Disease

it is where there’s reflux of gastric acid, bile and duodenal contents into the oesophagus

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2
Q

pathophys of GORD

A

it is where the lower oesophageal sphincter is incompetant and leads to gastric acid flowing up into the oesophagus

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3
Q

GORD risk factors

A

male

increased abdominal pressure (e.g. obesity or pregnancy)

smoking

hiatus hernia

gastric acid hypersecretion

high alcohol consumption

hiatus hernia

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4
Q

clinical features of GORD

A

heartburn

relieved by antacids

belching

waterbrach

acid brash

chronic cough

nocturnal asthma

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5
Q

Dx of gord

A

no Ix usually needed - diagnosis usually on clinical findings

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6
Q

management of GORD

A
  • antacids e.g. gaviscon
  • PPIs e.g. lansoprazole
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7
Q

complications of GORD

A

Peptic stricture

barret’s oesophagus (squamous to columnar)

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8
Q

what are peptic ulcers

A
  • they are breaks in epithelial cells which penetrate down to the mucosa
    *
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9
Q

where are gastric ulcers mostly seen

A

in the lesser curve of the stomach

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10
Q

are duodenal or gastric ulcers more common

A

duodenal ulcers are more common than gastric ulcers

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11
Q

what are the two important causes of peptic ulcers

A

Helicobacter Pylori and NSAID use

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12
Q

diagnosis of helicobacter pylori infection

A

urea breath test

serology

stool antigen test

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13
Q

what is the treatment for helicobacter pylori

A

PPI (lansoprazole)

with two antibiotics (Metronidazole and Clarithromycin)

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14
Q

why do NSAIDs cause peptic ulcers

A

they inhibit cyclooxygenase 1 enzyme which is needed for preoduction of prostaglandins

prostaglandins are needed for the production of mucous

this leaves the epithelium unprotected by mucous

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15
Q

what is the component of gluten which causes coeliac

A

gliadin

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16
Q

what happens in coeliac disease

A
  1. gliadin binds to secretory IgA in the mucosal membrane
  2. gliadin IgA is transcytosed to the lamina propria
  3. gliadin binds to tTG and is deaminated
  4. deaminated gliadin is taken up by macrophages and expressed on MHC2
  5. T helper cells release inflammatory cytokines and stimulate B cells
  6. there is then antibody mediated gut damage
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17
Q

coeliac histology findings

A
  1. increased intraepithelial lymphocytes
  2. lamina propria inflammation
  3. villous atrophy
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18
Q

diagnosis of coeliac disease

A
  • patient must be ingesting gluten in their normal diet
    • serology
      • IgA-tTG
    • FBC
      • iron deficiency anaemia
    • Histology
      • villous atrophy
      • increased intraepithelial lymphocytes
      • lamina propria inflammation
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19
Q

what is the prevalence of coeliac disease

A

1% globally

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20
Q

are men or women more affected by coeliac

A

women are slightly more likely to be affected

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21
Q

what is the name of the criteria that the histological findings of coeliac are checked against

A

marsh criteria

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22
Q

what are the symptoms of coeliac

A

bloating

failure to thrive

diarrhoea

dermatitis herpetiformis

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23
Q

what is dermatitis herpeteiformis

A

Dermatitis herpetiformis (DH) is a chronic autoimmune blistering skin condition, characterised by blisters filled with a watery fluid that is intensely itchy.

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24
Q

what triad of things would you see in malabsorption

A

weight loss

steatorrhoea

anaemia

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25
Q

name 5 causes of malabsorption

A
  • poor intake
  • poor intraluminal digestion
    • bacterial overgrowth
    • pancreatic insufficiency
    • poor bile secretion
  • reduced surface area
    • coeliac
    • bowel resection (crohns)
    • extensive parasites (giardia)
  • lymphatic obstruction
    • TB
    • lymphoma
  • lack of digestive enzymes
    • dissaccharide insufficiency causing lactose intolerance
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26
Q

what is crohns

A

it is transmural, granulomatous inflammation affecting any part of the gut

it is due to an inappropriate immune response to the gut flora in a genetically susceptible individual

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27
Q

what is the macroscopic appearance of crohns

A

skip lesions, cobblestone appearance

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28
Q

which mutation increases risk of crohns

A

NOD2 on chromosome 16

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29
Q

what is the prevalence of crohns

A

1-2%

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30
Q

in crohns and ulcerative colitis does smoking increase or decrease risk

A

in crohns smoking increases risk a lot

in ulcerative colitis smoking is protective

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31
Q

what are the symptoms of crohns

A

diarrhoea

abdo pain

weightloss/failure to thrive

systemic symptoms of fever, fatigue, malaise and anorexia

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32
Q

5 signs of crohns

A

bowel ulceration

abdo tenderness/mass

anal strictures

perianal abscess/fistulae/skin tags

clubbing of fingernails

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33
Q

what is the macroscopic appearance of crohns disease

A

skip lesions

cobblestone appearance

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34
Q

what is the microscopic appearance of crohns disease

A

transmural

granulomatous

goblet cells present

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35
Q

how is crohns diagnosed

A

colonoscopy and biopsy looking for macroscopic and miscroscopic changes

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36
Q

which part of the gut is most commonly affected by crohns

A

terminal ileum but can affect anywhere mouth to anus

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37
Q

in crohns is there blood and excess mucus in the stool

A

no

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38
Q

crohns risk factors

A

smoking

female

mutation on NOD2 on chromosome 16

chronic stress

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39
Q

Ix for crohns

A

Dx relies on colonoscopy and biopsy

stool sample has to be done to rule out infectious causes

FBC - raised ESR and CRP, low Hb due to anaemia

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40
Q

crohns management

A

oral corticosteroids

IV hydrocortisone in severe flare ups

anti-TNF antibodies (infliximab) if no improvement

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41
Q

what should you add to someone’s crohns management if they have frequenct exacerbations

A

azathioprine or methotrexate

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42
Q

what do you get from B12 deficiency

A

glossitis

lemon tinged skin (due to pallor and jaundice at same time)

neuro symptoms

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43
Q

what is ulcerative colitis

A

it is a relapsing remitting inflammatory disorder of the colonic mucosa

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44
Q

what is the macroscopic appearance of ulcerative colitis

A

continuous inflammation with ulcers and pseudo polyps

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45
Q

what is the microscopic appearance of ulcerative colitis

A

mucosal inflammation, no granulomas, depleted goblet cells and increased crypt abscesses

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46
Q

symptoms of ulcerative colitis

A

pain typically in the lower left quadrant

diarrhoea with blood and mucus

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47
Q

signs of ulcerative colitis

A

fever

clubbing

erythema nodusum

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48
Q

what is the cause of ulcerative colitis

A
  • Inappropriate immune response against colonic flora in genetically susceptible individuals
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49
Q

is the inflammation transmural in ulcerative colitis and crohns

A

in crohn’s it’s transmural

in ulcerative colitis it’s usually not

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50
Q

what is the prevalence of ulcerative colitis

A

1-2%

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51
Q

what age are people when they usually present with ulcerative colitis

A

they are usually 20-40yrs old

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52
Q

what Ix would you do for ulcerative colitis

A

FBC:

  • high ESR and CRP

pANCA may be present in serology

Stool sample M,C&S must be done to rule out infectious diseases

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53
Q

management of ulcerative colitis

A

sulfasalazine

add oral prednisolone if there’s no response

if they still have disease you can use infliximab (anti TNF alpha)

colectomy is indicated if they have severe UC and are not responding to treatment

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54
Q

fill in this table

A
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55
Q

what is IBS

A

irritable bowel syndrome is a group of abdominal symptoms for which no organic cause can be found

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56
Q

what are the risk factors of IBS

A

stress

being female

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57
Q

what are the symptoms of irritable bowel syndrome

A

abdominal pain relieved by defacating

bloating

alternating bowel habits

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58
Q

medical management of IBS

A
  • pain and bloating: buscopan
  • for constipation: laxative like senna
  • for diarrhoea: anti motility like loperamide
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59
Q

what is the prevalence of irritable bowel syndrome

A

10-20%

60
Q

lifestyle advice for IBS

A

adequate water

reduce/increase fibre

encourage them to find trigger foods

low FODMAP diet

61
Q

what is the aim of the Ix if you suspec IBS

A

to rule out other pathology

62
Q

what are the risk factors for infective diarrhoea

A

foreign travel

poor hygeine

overcrowding

new or different foods

63
Q

is infective diarrhoea more commonly bacterial, viral or parasitic

A

mostly viral

sometimes bacterial

occasionally parasitic

64
Q

what are the 3 most common viral causes of infective diarrhoa

A
  • rotavirus in children
  • norovirus
  • adenovirus
65
Q

what are 4 common causes of bacterial diarrhoea

A

campylobacter jejuni

e.coli

salmonella

shigella

66
Q

name two parasitic causes of infective diarrhoea

A

giardia lamblia

cryptosporidium

67
Q

which are the 4 antibiotics which may cause a C.diff infection

A

cephalosporins

coamoxiclav

ciprofloxacin

clindamycin

68
Q

what finding in stool may be suggestive of a bacterial infection

A

blood

69
Q

treatment for infectious diarrhoea

A

rehydration

antibiotics

antimotility (loperamide)

70
Q

what would be your findings on auscultation of the bowel if there was obstruction

A

tinkling bowel sounds

71
Q

main features of bowel obstruction

A

colic pain occurs early but goes with long-standing obstruction

vomiting

nausea

anorexia

distension

constipation may be absolute (no flatus)

tinkling sounds on auscultation

72
Q

how can you tell if it’s small or large bowel obstruction

A

small bowel: vomiting occurs early, distention is less and pain is higher

AXR

73
Q

what is ileus

A

it is functional obstruction from decreased bowel motility

bowel sounds will be absent

74
Q

what is paralytic ileus and what does it commonly follow

A
  • adynamic bowel due to the absence of normal peristaltic contractions. Often follows abdo surgery or spinal injury.
75
Q

what is a simple obstruction

A
  • one obstructing point and no vascular compromise
76
Q

what is a closed loop obstruction

A

forming a loop of grossly distended bowel at risk of perforation

77
Q

what is a strangulated obstruction

A
  • blood supply is compromised and the patient is iller than you would expect.
  • Pain is sharper, more constant and localised.
  • Peritonism is the cardinal sign.
  • 100% mortality if untreated
78
Q

causes of small bowel obstruction

A

adhesions

hernias

79
Q

causes of large bowel obstruction

A

colon cancer

constipation

diverticular disease

volvolus

80
Q

what is a hernia

A

it is a protrusion of an organ or tissue out of the body cavity in which it normally lies

81
Q

causes of hernias

A

muscle weakness (age and trauma)

body strain (constipation, heavy lifting, pregnancy and chronic cough)

82
Q

what is an inguinal hernia

A

it is a protrusion of abdominal cavity through the inguinal canal

83
Q

what is the difference between a direct and an indirect inguinal hernia

A

direct protrudes directly into the inguinal canal medial to the inferior epigastric vessels

indirect protrudes through the internal inguinal rind lateral to the inferior epigastric vessels

84
Q

what is a hiatus hernia

A

it is where part of the stomach herniates through the oesophageal hiatus of the diaphragm

85
Q

what is the difference between a sliding and rolling hiatus hernia - which is more common

A

SLIDING: Oesophageal-gastric junction slides through the hiatus and lies above the diaphragm no symptoms other than reflux

ROLLING: uncommon - the gastric fundus rolls up through the haitus alongside the oesophagus. the gastro-oesophageal junction remains below the diaphragm. can be treated with surgery

86
Q

DDx of GORD

A

oesophagitis

duodenal or gastric ulcers

cardiac disease

MSK - costochondritis

87
Q

lifestyle advice in GORD

A
  • weight loss
  • smaller meals
  • smoking cessation
  • reduce intake of
    • citrus fruit
    • alcohol
    • spicy food
    • caffeine
    • onions
  • avoid eating <3hrs before bed
88
Q

Surgical treatment for GORD

A
  • Fundoplication: twist in the top of the stomach
    • Wrap the fundus around the top of the oesophagus giving an extra sphincter
  • This would aim to increase lower oesophageal sphincter pressure
  • Only consider in severe GORD if drugs are not working
89
Q

Lifetime risk of appendicitis

A

6%

90
Q

what age does appendicitis usually occur

A

10-20

91
Q

what is the pathophysiology of appendicitis

A

gut organisms invade the appendix wall after lumen obstruction by lymphoid hyperplasia, faecal pellets or filarial worms

this leads to oedema, ischaemic necrosis and perforation

92
Q

Roysing’s sign

A

pain is more in the RIF than the LIF when LIF is palpated

93
Q

Ix for appendicitis

A
  • Bloods
    • CRP
    • ESR may not have developed yet
  • CT
    • useful if diagnosis unclear and reduces -ve appendectomy rate
94
Q

appendicitis presentation

A

fever

pain (mcburney’s point)

anorexia

peritonism with guarding

comiting

95
Q

what is peritonitis

A

it is inflammation of the peritoneum due to entry of blood, air, bacteria or GI contents

96
Q

symptoms of peritonitis

A

dull pain that becomes sharp

pain worse on coughing or moving

systemic symptoms and they are generally unwell

97
Q

name 6 causes of peritonitis

A
  • AEIOU
    • appendicitis
    • ectopic pregnancy
    • infection
    • obstruction
    • ulcer
  • peritoneal dialysis
98
Q

differentials for appendicitis

A

ectopic pregnancy (do preg test)

UTI (test urine)

diverticulitis

cholecystitis

99
Q

how does ectopic pregnancy present

A

low abdo pain

sudden onset

tachycardia

low bp

100
Q

what are the investigations for peritonitis

A
  • clinical examination
  • AXR
  • FBC
  • U&E
  • LFT
  • Ascitic tap
101
Q

what is pancreatitis

A

it is inflammation of the pancreas which may lead to pancreatic enzymes damaging the pancreas and nearby blood vessels

102
Q

what is the presentation of pancreatitis

A

nausea and vomiting

epigastric pain radiationg to back (relieved by sitting forwards)

Cullen’s sign

Grey Turner’s sign

103
Q

what are the causes of pancreatitis

A
  • IGETSMASHED
    • Idiopathic
    • Gallstones
    • Ethnol (alcohol)
    • Trauma
    • Steroids
    • Malignancy
    • Autoimmune
    • Scorpion sting
    • Hypercalcaemia
    • ERCP
    • Drugs
104
Q

what are cullen’s and grey turner’s sign? what do they indicate

A

cullen’s: bruising around umbilicus

grey turner’s: bruising around the flanks

both indicate acute pancreatitis

105
Q

what are the Ix for pancreatitis and what do they show

A

high amylase

high lipase

AXR

CT chest/abdo

106
Q

management of pancreatitis

A

IV fluids and maintain electrolyte balance

pain relief

maybe bowel rest

107
Q

what is the cause of ischaemic colitis

A

low flow in the inferior mesenteric artery

108
Q

how does ischaemia colitis present

A

left iliac fossa pain

bloody diarrhoea

109
Q

how do you diagnose ischaemic colitis

A

colonoscopy

110
Q

what is the cause of acute mesenteric ischaemia

A

low flow in the superior mesenteric artery

111
Q

what is the presentation of acute mesenteric ischaemia

A

acute severe abdo pain that is out of proportion with signs

patient is sicker than they look

rapud hypovolaemia –> shock

112
Q

diagnosis of acute mesenteric ischaemia

A

metabolic acidosis and high lactate

often made on exploratory laparotomy

113
Q

management of acute mesenteric ischaemia

A

surgery to remove the dead bowel

fluid resus

antibiotics

thrombolytics infused locally by catheter if thrombosis is identified by arteriography

114
Q

if someone has AF and abdo pain you should always think of what?

A

bowel/mesentry ischaemia

115
Q

what is intestinal angina

A

chronic mesenteric ischaemia

116
Q

how does chronic mesenteric ischaemia present

A
  • triad
    1. severe, colicky, post-prandial abdo pain
    2. weightloss because eating hurts
    3. upper abdo bruit
  • also
    • bleeding PR
    • malabsorption
    • N&V
117
Q

causes of chronic mesenteric ischaemia

A

typically due to a low flow state due to atherosclerotic disease in all mesenteric arteries

118
Q

treatment for ischaemic colitis

A

conservative with fluid replacement and antibiotics

119
Q

is stomach carcinoma more common in men or women

A

men

120
Q

what are 4 risk factors for stomach carcinoma

A

pernicious anaemia

H. pylori

atrophic gastritis

smoking

121
Q

symptoms of gastric carcinoma

A
  • non specific
  • dyspepsia
  • weightloss
  • vomiting
  • anaemia
122
Q

what are the Ix for stomach carcinoma

A

gastroscopy with multiple biopsies

CT/MRI for staging

cytology of peritoneal wash can help discover peritoneal mets

123
Q

risk factors for oesophageal cancer

A

alcohol excess

smoking

achalasia

reflux oesophagitis

obesity

drinking very hot drinks

124
Q
A
125
Q

are men or women more commonly affected by oesophageal cancer

A

men much more commonly

126
Q

what is diverticulitis

A

A GI diverticulum is an outpouching in the gut wall. These usually occur at the sites of entry of perforating arteries. Diverticulitis refers to inflammation of a diverticulum

127
Q

where does most diverticulitis occur

A

95% in the sigmoid colon

128
Q

what is diverticulosis

A

this is the presence of diverticula but they are not inflamed

129
Q

what is the presentation of diverticulitis

A

pyrexia

high white cell coult

high ESR/CRP

a tender colon

localised or generalised peritonism

130
Q

what is the treatment for diverticulitis

A

Mild: bowel rest (fluids only) and antibiotics

surgery indicated if there’s any peritonitis

131
Q

complications of diverticulitis

A
  • perforation: ileus, peritonitis and shock
    • this has high mortality and requires an emergency laperotomy
  • haemorrhage: can cause a big, sudden, painless rectal bleed
    • needs colonic haemostasis ± colonic resection
132
Q

what is a mallory weiss tear

A
  • Persistent vomiting/retching causes haematemesis via an oesophageal mucosal tear
133
Q

what is a pilonidal sinus and how does it happen

A
  • Obstruction of natal cleft hair follicles ~6cm above the anus
  • Ingrowth of hair excites a foreign body reaction
  • There may be fowl smelling discharge
  • Much more common in men
  • There may be fowl smelling discharge
134
Q

what is an anal fistula

A

it communicates between the skin and the anal/rectal canal

135
Q

causes of anal fistulae

A

crohn’s

diverticulitis

rectal carcinoma

idiopathic

136
Q

what are haemorrhoids

A

They are disrupted and dilated anal cushions

anal cushions are the masses of spongy vascular tissue that contribute to anal closure

137
Q

causes of piles

A

straining

pregnancy

congestion from a pelvic tumour

138
Q

symptoms of piles

A

bright red rectal bleeding on tissue or after defication

may coat stools

mucous discharge

pruritis ani

139
Q

what should you do for all rectal bleeding?

A

abdominal exam

PR exam

colonoscopy to exclude malignancy if >50yrs old

140
Q

predisposing factors to colorectal cancer

A

IBD
genetic (FAP and HNPCC)

low fibre and high processed meat diet

high alcohol consumption

smoking

141
Q

two syndromes that cause colon cancer

A

lynch syndrome (HNPCC)

FAP

142
Q

what is lynch syndrome

A
  • causes 1-3% of colorectal cancer
  • AD inheritance due to mutations in MMR genes
  • lifetime risk is 80%
  • also increased risk of
    • endometrial
    • ovarian
    • stomach
143
Q

what is FAP

A
  • Familial adenomatous polyposis
    • mutations in APC TSG
    • causes <1% colon cancer
    • penetrance is 100% by 50
144
Q

what are DUKES A,B and C

A
  • Colon cancer staging
    • A: limited to muscularis mucosae
    • B: extended beyond muscularis mucosae
    • C: involvement of regional lymph nodes
    • D: distant metastatic spread
145
Q

management of colon cancer

A
  • surgery
  • radiotherapy
  • biologics
    • bevacizumab (anti-VEGF)
146
Q

what is the microscopic appearance of crohns

A

transmural granulomas - goblet cells present

formative 3b (18 decks)

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