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YEAR 1 > GI theory > Flashcards

GI theory Flashcards

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1
Q

barrett’s oesophagus

A

complication of reflux
metaplasia of oesophagus mucosa -> intestinal

increased risk of dysplasia / neoplasia

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2
Q

eosinophilic oesophagus

A

allergic oesophagitis
Fx of allergies / asthma

feline looking oesophagus
treat w/ steroids / montelukast

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3
Q

benign oesophageal tumours

A

RARE
squamous papilloma (HPV)
leiomyomas - SM

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4
Q

malignant oesophageal tumours

A

squamous cell carcinoma (upper 2/3)
adenocarcinoma (lower 1/3, reflux risk)

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5
Q

peptic ulcer formation

A

increased acid production + failure of mucosal defence

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6
Q

benign gastric tumours

A

hyperplastic polyps
cystic fundic gland polyps

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7
Q

malignant gastric tumours

A

adenocarcinoma (H. pylori - intestinal / diffuse type)
lymphoma (maltoma - also H. pylori)
gastrointestinal stromal tumour (GIST) - gut pacemaker cells

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8
Q

coeliac histology

A

loss of villous height
intra-epithelial lymphocytes

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9
Q

small intestine tumours

A

primary RARE
lymphoma (maltoma / enteropathy associated T cell lymphoma - coeliac)
carcinoma (crohn’s / coeliac assoc)

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10
Q

appendix tumours

A

neuroendocrine neoplasm (most common)
LAMN / HAMN

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11
Q

oral tumours

A

squamous cell carcinoma (most common)
salivary gland tumour
lymphoma

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12
Q

oral malignancy signs

A

white patches
red patches
ulceration (painless)
lumps / swelling

floor of mouth + lateral tongue - HIGH RISK

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13
Q

intestinal failure defintion

A

inability to maintain adequate nutrition / fluid stasis via intestines

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14
Q

intestinal failure types

A

type 1 - short-term (surgical ileus, crit illness, vomiting)
self-limiting (+ fluids)

type 2 - medium (post surgery awaiting reconstruction)
PN support

type 3 - chronic (short bowel, crohn’s etc)
home PN, transplant

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15
Q

functional dyspepsia

A

bothersome indigestions symptoms + no evidence of structural disease

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16
Q

dyspepsia types

A

epigastric pain syndrome
- epigastric pain / burning

post-prandial distress syndrome
- postprandial fullness / early satiation

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17
Q

dyspepsia RF

A

younger, female, IBS, psychological comorbid, enteric infection, high BMI, NSAIDs, H. pylori

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18
Q

zollinger ellison syndrome

A

tumour in head of pancreas / duodenum -> increased stomach acid production -> peptic ulcer

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19
Q

outcomes of H. pylori infection

A

increased acid -> no atrophy -> ulcer

decreased acid -> atrophy -> gastric cancer

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20
Q

anaemia definition

A

reduced total RBC mass

Hb concentration
haematocrit (proportion)

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21
Q

mean corpuscular volume (MCV)

A

average volume of RBC

microcytic = low MCV, lack of iron
macrocytic = high MCV, lack of folic acid / B12

normal MCV - anaemia of chronic disease

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22
Q

B12 absorption

A

2 steps - gastric + small intestine

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23
Q

folic acid absorption

A

duodenum
(deficiency = will’s disease)

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24
Q

iron absorption

A

ferric form (eaten) -> ferrous form (ascorbic acid in gastric) -> soluble iron-ascorbate chelate -> absorption in duo / upper jejunum

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25
causes of anaemia
dietary (rare) malabsorption (lack of acid / small bowel disease) blood loss (GI bleeding)
26
glasgow-blatchford score
identifies low risk GI bleeds
27
acute upper GI bleeding
cautery, clips, pro-coag spray interventional radiology / surgery
28
acute lower GI bleeding
majority self-limiting transfusion most commonly needed
29
barrett's treatments
radiofrequency ablation endoscopic mucosal resection (EMR)
30
achlasia
failure for LOS to relax + absent peristalsis
31
types of oesophageal dysmotility
distal oesophageal spasm (DES) jackhammer oesophagus absent peristalsis dysphagia, retrosternal pain, reflux
32
cyclical vomiting syndrome
functional recurrent episodes of N+V
33
somatic symptom disorder
mental illness distressing bodily Sx
34
factious disorder
(munchausen's') malingering for psychological gain
35
crohn's complications
malabsorption fistulas anal disease intractable disease bowel obstruction amyloidosis
36
UC complications
intractable disease toxic megacolon CRC blood loss electrolyte imbalance extra GI manifestations
37
crohn's vs UC
anywhere skip lesions thickened bowel + strictures transmural inflamm granulomas fistulae colon + rectum mucosal ulceration + thin walls superficial inflamm high cancer risk extra GI common
38
polyp styles
pedunculated - bros OUT sessile - texture pad core flat - also exists ??
39
colon adenoma
MUST be removed
40
inherited CRC
HNPCC + FAP
41
pseudomembranous colitis
abx induced patchy yellow membranous exudate on mucosal surface
42
collagenous colitis
thickened basal lamina patchy disease
43
lymphocytic colitis
raised intraepithelial lymphocytes
44
severity judge for UC
severe = >6 bloody stools / 24h + 1 or more of: 1. fever 2. tachycardia 3. anaemia 4. elevated CRP
45
haemorrhoid grades
1. bleeding, not out 2. bleeding, in and out 3. bleeding, push back in 4. bleeding, always out
46
seton stitch
keeps fistulae open
47
ogilvie's syndrome
acute dilation of the colon in absence of colonic obstruction hip replacement / CABG / pneumonia / elderly
48
hernia classification
hiatal - into thorax internal - within abdomen external - outside abdomen
49
divarification of recti
NOT a hernia thinning budge of linea alba
50
hernia types
1. spigelian - linea semilunaris 2. incisional - failure of fascia to fully restore strength in surgical wound 3. parastomal - type of ^ 4. obturator - through hip bone
51
hernia complications
1. irreducible - cant get it back in 2. obstructed - bowel loop non-functioning 3. strangulation - bowel loop ischaemic
52
space of Disse
between hepatocytes + sinusoids
53
liver metabolism
1. fasting = glycogen breakdown + gluconeogenesis 2. feeding = glycogen deposits 3. lipids = chylomicrons (digested in bile) 4. proteins = via CAC 5. ammonia = converted to urea
54
cirrhosis mech
1. chronic inflamm damaged hepatocytes 2. hepatic stellate cells activated (space of Disse) 3. increase fibrosis 4. cirrhosis!
55
hazardous vs harmful drinking
14 - 35 (women) 14 - 50 (men) 35+ (women) 50+ (men)
56
HBV bloods
1. HBsAg - infection present 2. HBeAg - high viral replication 3. HBsAb - infection clearance / immunity (vaccine) 4. HBeAb - reduced viral replication 5. HBcAb - previous infection (NOT vaccine)
57
HBV stages
1. immune tolerant +HBeAg, yes HBV DNA, normal ALT, highly contagious 2. immune reactant +HBeAg, yes HBV DNA, raised ALT 3. inactive carrier -HBeAg, +HBeAb, lower HBV DNA, normal ALT 4. chronic hep B -HBeAg, +HBeAb, high HBV DNA, raised ALT 5. occult infection -HBsAg, +HBcAb / HBsAb, normal ALT, low HBV DNA
58
TIPSS
contraindicated in hepatic encephalopathy
59
ascites mech
1. portal HTN 2. splanchnic dilation (NO) 3. SVR + MAP decrease 4. RAAS activated -> sodium + water retention (RAAS can also be decrease in albumin)
60
spontaneous bacterial peritonitis (SBP)
complication of (decompensated) ascites bacteria in ascitic fluid raised neutrophils on tap broad spec abx
61
liver transplant
UKELD <49 to be eligible BSG / BASL bundle first 24h post
62
hepatorenal syndrome
same mech as ascites, renal vasoconstriction instead of Na retention Dx of exclusion
63
endocrine pancreas
islets of langerhans 1. blood glucose up 2. increased diffusion into cell (GLUT2) 3. aerobic resp 4. ATP/ADP ratio increase 5. ATP-K+ channels CLOSE 6. voltage-gated Ca2+ open 7. intracellular Ca2+ triggers insulin release
64
exocrine pancreas
duct cells - HCO3- out acinar cells - enzymes 1. cephalic - vagal stim (AC) 2. gastric - gastric distension -> vagovagal reflex / parasymth (AC/DC) 3. intestinal - (acid in duo -> secretin from S -> NaHCO3 from DC / pat + protein in deo -> CCK from I -> enzymes from AC)
65
ALT 50-200
MASLD, chronic viral hep autoimmune hep, haemochromatosis, wilson's, a1 anti-trypsin
66
ALT 1000s
viral hep, shock liver, paracetamol overdose, autoimmune hep, budd-chiari
67
ALT >3000
drugs (paracetamol) or ischaemia
68
ALT / AST ratio
usually ALT >AST ALT < AST - fibrosis AST 2x ALT - alcoholic
69
gen ALT / AST
AST can be normal in HCV / fatty liver ALT rarely >3x normal in alcoholic ALT raised in acute biliary obstruction
70
autoimmune markers
antinuclear (ANA) anti SM (ASMA) anti liver/kidney microsomal (anti-LKM1) antimitochondrial (AMA)
71
GGT
also raised in fatty liver / alcohol related
72
cholestatic LFTs
USS yes dilation -> malignancy (painless) or gallstones (colicky). MCRP Ix no dilation -> PBC (AMA+), seronegative PBC (AMA-, MCRP rule out ->), PSC (MCRP)
73
drug induced LFTs
hepatic (isoniazid / phenytoin / methyldopa) cholestatic (augmentin / ocpill / androgens) steatosis (TPN / methotrexate)
74
cirrhosis pathology
bands of fibrosis separating regenerative nodules (hepatocytes)
75
fatty liver / alcoholic hep / fibrosis pathology
FL - fat vacuoles clear in hepatocytes AH - fat vacuoles, hepatocyte necrosis, neutrophils fibrosis - collagen deposits
76
HAV / acute pathology
individual cell necrosis
77
HBV / HCV / chronic pathology
dense portal drone inflammation + fibrosis
78
PBC / autoimmune hep / PSC pathology
PBC - granulomas + bile duct loss AH - chronic hep pattern PSC - periductal fibrosis (onion skin), duct destruction
79
acute liver disease / failure definition
disease - insult to (normal) liver causing damage - <6m FAILURE - ^ + encephalopathy + prolonged coag
80
benign liver masses
1. haemangioma most common 2. focal nodular hyperplasia hyperplastic resp to abnormal arterial flow 3. hepatic adenoma 7. liver abscesses
81
hepatic cysts
4. simple cyst 5. hydatid cyst tapeworms 6. polycystic liver disease a) von meyenburg complexes dilated cystic bile ducts b) PCLD c) ADPKD
82
malignant liver tumours
1. HCC - most common 2. fibro-lamellar carcinoma young patients, not cirrhosis 3. metastases
83
types of gallstone
1. cholesterol 2. pigment 3. calcium 4. mixed
84
complications of gallstones
1. biliary colic 2. cholecystitis (acute / chronic) 3. gallbladder mucocele 4. gallbladder empyema - carcinoma - 5. choleclocholithiasis 6. ascending cholangitis - obstructive jaundice - 7. gallstone ileus 8. pancreatitis (acute / chronic)
85
pancreatitis pathology
fat necrosis chronic = fibrosis
86
parasites
1. cryptosporidium food / shellfish 2. giardia lamblia pools / lakes / rivers etc 3. entamoeba histolytica
87
bacteria
1. campylobacter (chicken) 2. salmonella (foodborne) 3. E.coli (0157 (HU syn) / shiga-toxin) 4. listeria (IM compromised / pregnancy)
88
normal flora
mouth - viridans strep, neisseria sp. candidia sp, staph jejunum - coliforms + anaerobes (small numbers) colon - coliforms + anaerobes + enterococcus faecalis (large numbers)
89
bloody causes
1. shigella 2. E.coli 3. salmonella 4. campylobacter 5. parasites
90
malnutrition management
1. food first 2. oral supplements (shakes etc) 3. ETF 4. PN
91
refeeding syndrome
rapid refeeding (EN or PN) hypo- (kalaemia / phosphataemia / magnesaemia), altered glucose metabolism, fluid overload arrythmias, altered conciousness, seizures, resp failure, CV collapse, death

YEAR 1 (11 decks)

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