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Phase 2A revision > GI to work on > Flashcards

GI to work on Flashcards

1
Q

Give 2 common causes of large bowel obstruction

A
  1. Colorectal malignancy - most common in UK

2. Volvulus - more common in Africa

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2
Q

Give 5 risk factors for colorectal cancer

A
  1. Increasing age
  2. Family history
  3. Western diet - saturated animal fat, red meat consumption, low fibre, high sugar
  4. Alcohol
  5. Smoking
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3
Q

Give 4 signs of rectal carcinoma

A
  • rectal bleeding and mucus
  • when cancer grows there will be thinner stools and tenesmus (cramping rectal pain)
  1. Abdominal mass
  2. Perforation
  3. Haemorrhage
  4. Fistulae
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4
Q

Explain Dukes staging and prognosis

A 
A = limited to muscularis mucosae = 95% 5-year survival 
B = extension through muscularis mucosae (not lymph) = 75% 5-year survival 
C = involvement of regional lymph nodes = 35% 5-year survival 
D = distant metastases = 25% 5-year survival
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5
Q

How do you treat H. pylori?

A

Triple therapy:
Normal –> amoxicillin, omeprazole and clarithromycin/metronidazole

Penicillin resistance –> clarithromycin, omeprazole and metronidazole

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6
Q

Give 3 symptoms of peptic ulcers

A
  1. recurrent burning epigastric pain
  2. pain relieved by antacids and is worse when hungry
  3. pain occurs at night
  4. nausea
  5. anorexia and weight loss
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7
Q

Give 5 broad causes of malabsorption

A
  1. Defective intraluminal digestion
  2. Insufficient absorptive area
  3. Lack of digestive enzymes
  4. Defective epithelial transport
  5. Lymphatic obstruction
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8
Q

Malabsorption: what can cause defective intraluminal digestion?

A
  1. Pancreatic insufficiency due to pancreatitis/CF - lack of digestive enzymes
  2. Defective bile secretion due to biliary obstruction or ileal resection
  3. Bacterial overgrowth
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9
Q

give 3 microscopic features that will be seen in ulcerative colitis

A
  1. Crypt abscess
  2. goblet cell depletion
  3. mucosal inflammation - does not go deeper
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10
Q

Name 3 causes of IBD

A
  1. Genetic
  2. Stress/depression
  3. Inappropriate immune response
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11
Q

Give 4 signs and symptoms of Ulcerative colitis

A
  1. Episodic/chronic diarrhoea +/- blood/ mucus
  2. Abdominal pain - left lower quadrant
  3. Systemic - fever, malaise, anorexia, weight loss
  4. Clubbing
  5. Erythema nodosum
  6. Amyloidosis
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12
Q

Give 4 signs and symptoms of Crohn’s disease

A
  1. Diarrhoea - urgency
  2. Abdominal pain
  3. Systemic - weight loss, fatigue, fever, malaise
  4. Bowel ulceration
  5. Anal fistulae/stricture
  6. Clubbing
  7. Skin/joint/eye problems
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13
Q

What investigations might you do in someone with IBD?

A
  1. Bloods - FBC, ESR, CRP
  2. Faecal calprotectin - shows inflammation but is not specific for IBD
  3. Flexible sigmoidoscopy
  4. Colonoscopy - biopsy to confirm
  5. examination
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14
Q

What is the treatment for Crohn’s disease?

A
  • Smoking cessation
  • 1st line = Corticosteroids - BUDESONIDE (controlled release) or ORAL PREDNISOLONE (for severe attacks)
  • Surgical resection - only minimal
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15
Q

What are the complications for Ulcerative colitis?

A
  1. Colon –> blood loss, colorectal cancer, toxic dilatation
  2. Arthritis
  3. Iritis, episcleritis
  4. Fatty liver and primary sclerosing cholangitis
  5. Erythema nodosum
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16
Q

Give 5 complications of Crohn’s

A

PERFORATION AND BLEEDING = MAJOR

  1. Malabsorption
  2. Obstruction –> toxic dilatation
  3. Fistula/abscess formation
  4. Anal skin tag/fissures/fistula
  5. Neoplasia
  6. Amyloidosis
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17
Q

Describe the pathophysiology of Coeliac disease

A
  1. Gliadin from gluten deaminated by tissue transglutaminase –> increases immunogenicity
  2. Gliadin recognised by HLA-DQ2 receptor on APC –> inflammatory response
  3. Plasma cells produce anti-gliadin and tissue transglutaminase –> T cell/cytokine activated
  4. Villous atrophy and crypt hyperplasia –> malabsorption
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18
Q

Give 5 symptoms of Coeliac disease

A
  1. Diarrhoea and steatorrhoea (stinking/fatty)
  2. Weight loss
  3. Irritable bowel
  4. Iron deficiency anaemia
  5. Osteomalacia
  6. Fatigue
  7. abdominal pain
  8. angular stomatitis
  9. dermatitis herpetiform
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19
Q

What 3 histological features are needed in order to make a diagnosis of coeliac disease?

A
  1. Raised intraepithelial lymphocytes
  2. Crypt hyperplasia
  3. Villous atrophy
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20
Q

What part of the bowel is mostly affected in coeliac disease?

A

Proximal small bowel (duodenum)

mean B12, folate and iron cannot be absorbed = anaemia

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21
Q

Give 3 complications of Coeliac disease

A
  1. Osteoporosis
  2. Anaemia
  3. Increased risk of GI tumours
  4. secondary lactose intolerance
  5. T-cell lymphoma
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22
Q

Give 3 causes of squamous cell carcinoma

A
  1. Smoking
  2. Alcohol
  3. Poor diet/obesity
  4. coeliac disease
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23
Q

Give 5 symptoms of oesophageal carcinoma

A
  1. progressive dysphagia
  2. Weight loss
  3. Heartburn
  4. Haematemesis
  5. Anorexia
  6. Pain
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24
Q

Give 3 causes of gastric cancer

A
  1. Smoked foods
  2. Pickles
  3. H. pylori infection
  4. Pernicious anaemia
  5. Gastritis
  6. family history
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25
Q

Describe how gastric cancer can develop from normal gastric mucosa

A

Smoked/pickled food diet leads to intestinal metaplasia of normal gastric mucosa
Several genetic changes lead to dysplasia and then eventually intra-mucosal and invasive carcinoma

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26
Q

Give 3 symptoms and signs of gastric cancer

A
  1. Weight loss
  2. Anaemia (pernicious)
  3. nausea and Vomiting
  4. Dyspepsia and dysphasia
  5. palpable epigastric mass
  6. Hepatomegaly, jaundice and ascites
  7. Enlarged supraclavicular nodes
  8. epigastric pain
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27
Q

What investigations might you do in someone who you suspect has gastric cancer?

A
  1. gastroscopy - biopsy
  2. endoscopic USS - depth of invasion
  3. CT /MRI /PET
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28
Q

what are the red flag signs for upper GI cancer?

A

For people with an upper abdominal mass consistent with stomach cancer:

  • Dysphagia of any age
  • Aged ≥ 55yr + weight loss with any of the following:
  • Upper abdominal pain/(or)
  • Reflux/ (or)
  • Dyspepsia
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29
Q

Give 3 causes of appendicitis

A
  1. Faecolith
  2. Lymphoid hyperplasia
  3. Filarial worms
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30
Q

What investigations might be done in a patient you suspect has appendicitis?

A
  • Blood tests = raised WCC,
  • CRP, ESR
  • USS
  • CT - gold standard
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31
Q

Give 2 complications of appendicitis

A
  1. Ruptured appendix –> peritonitis
  2. Appendix mass
  3. Appendix abscess
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32
Q

Give 3 causes of Gastro-oesophageal reflux disease (GORD)

A
  1. Hiatus hernia - sliding or rolling hiatus
  2. Smoking
  3. Obesity
  4. Alcohol
  5. pregnancy
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33
Q

Describe the pathophysiology of GORD

A

Lower oesophageal sphincter dysfunction –> reflux of gastric contents –> oesophagitis

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34
Q

Name 3 oesophageal symptoms of GORD

A
  1. Heartburn - retrosternal chest pain, after meals, worse when lying down, relieved by antacids
  2. Bleching
  3. Food/acid and water brash
  4. Odynophagia - (painful swallowing)
  5. Dysphagia - (difficulty swallowing)
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35
Q

Name 3 extra oesophageal symptoms of GORD

A
  1. Nocturnal asthma
  2. Chronic cough
  3. Laryngitis
  4. Sinusitis
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36
Q

What investigations are done for someone you suspect has GORD?

A
  • Diagnosis can be made without investigations
  • Endoscopy (if red flags)
  • Barium swallow
  • 24hr oesophageal pH monitoring
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37
Q

What is the treatment of GORD?

A

conservative

  • stop smoking
  • stop alcohol
  • lose weight
  • change sleep position

medical

  • PPI (omeprazole)
  • H2 receptor antagonist (ranitidine)

surgical
- nissen fundoplication

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38
Q

Describe the multi-factorial pathophysiology of IBS

A

The following factors can all contribute to IBS:

  • Psychological morbidity
  • trauma in early life
  • Abnormal gut motility
  • Genetics
  • Altered gut signalling (visceral hypersensitivity)
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39
Q

Give an example of a differential diagnosis for IBS

A
  1. Coeliac disease
  2. Lactose intolerance
  3. Bile acid malabsorption
  4. IBD
  5. Colorectal cancer
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40
Q

Describe the non pharmacological treatment of IBS

A

Education
Resistance
Dietary modification - reduce caffeine, plenty of fluids, increase fibre intake

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41
Q

A 50-year-old man presents with dysphagia. Which one of the following suggest a benign nature of his disease?

a. Weight loss
b. Dysphagia to solids initially then both solids and liquids
c. Dysphagia to solids and liquids occurring form the start
d. Anaemia
e. Recent onset of symptoms

A

c. Dysphagia to solids and liquids occurring form the start

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42
Q

A 52-year-old lady presents with fatigue and itching. She noticed pale stool and dark urine. She suffers from hypercholesterolaemia and rheumatoid arthritis. She takes simvastatin and cocodamol. Examination revealed jaundice, xanthelasma, spider naevi, and hepatomegaly. Her bloods showed Bili 150, ALP 988, ALT 80, positive AMA and a raised IgM. What is the most likely diagnosis?

a. Simvastatin induced liver injury
b. Primary biliary cirrhosis
c. Gallstones
d. Autoimmune hepatitis
e. Primary sclerosing cholangitis

A

b. Primary biliary cirrhosis

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43
Q

what are the microscopic features of crohns disease?

A
  • transmural inflammation
  • granulomas
  • increase in inflammatory cells
  • goblet cells
  • less crypt abscesses
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44
Q

what are the risk factors for crohn’s disease?

A
  • genetic association - mutation on NOD2 (CARD15) gene on chromosome 16
  • smoking
  • NSAIDs
  • family history
  • chronic stress and depression
  • good hygiene
  • appendicectomy
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45
Q

what are the risk factors for ulcerative colitis?

A
  • family history
  • NSAIDs
  • chronic stress and depression
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46
Q

what are the risk factors for coeliac disease?

A
  • HLA DQ2/DQ8
  • other autoimmune diseases e.g. T1DM, thyroid disease, Sjogren’s
  • IgA deficiency
  • breast feeding
  • age of introduction to gluten into diet
  • rotavirus infection in infancy
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47
Q

what are the risk factors for oesophageal cancer?

A

ABCDEF

  • Achalasia
  • Barret’s oesophagus
  • Corrosive oesophagitis
  • Diverticulitis
  • oEsophageal web
  • Familial
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48
Q

what are the causes of adenocarcinoma of the oesophagus?

A
  • smoking
  • tobacco
  • GORD
  • obesity - increases reflux
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49
Q

what are the complications of GORD?

A
  • peptic stricture

- barrett’s oesophagus

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50
Q

what are the risk factors for mallory weiss tears?

A
  • alcoholism
  • forceful vomiting
  • eating disorders
  • NSAID abuse
  • male
  • chronic cough
51
Q

what are the clinical features of mallory-weiss tears?

A
  • vomiting
  • haematemesis after vomiting
  • retching
  • postural hypotension
  • dizziness
52
Q

what are the investigations for mallory-weiss tears?

A

Rockall score (assess blood loss: <3 = low risk)
FBC, U&E, coag studies, group & save
ECG & cardiac enzymes

endoscopy to confirm tear

53
Q

what is the treatment for mallory weiss tears?

A
  • ABCDE
  • Terlipressin + Urgent Endoscopy
  • Rockall Score + Inpatient Observation
  • Banding/clipping, adrenaline, thermocoag
54
Q

what are oesophageal varices?

A

Abnormal, enlarged veins in the oesophagus, that develop when normal blood flow to the liver is blocked by a clot / scar tissue

55
Q

when do gastroesophageal varices tend to rupture?

A

when blood pressure in portal vein exceeds 12mmHg

56
Q

what are the main causes of gastroesophageal varices?

A
  • alcoholism
  • viral cirrhosis
  • portal hypertension
57
Q

what are the risk factors for gastroesophageal varices?

A
  • cirrhosis
  • portal hypertension
  • schistosomiasis infection
  • alcoholism
58
Q

what is the pathophysiology of gastroesophageal varices?

A
  • liver injury causes increased resistance to flow -> portal hypertension
  • hyperdynamic circulation -> formation of collaterals between portal and systemic systems
  • pressure >10mmHg start to bleed (rupture >12mmHg)
59
Q

what is the clinical presentation of gastroesophageal varices?

A
  • haematemesis/melena
  • abdominal pain (epigastric)
  • shock (if major blood loss)
  • fresh rectal bleeding
  • hypotension and tachycardia
  • pallor
  • splenomegaly
  • ascites
  • hyponatraemia
  • signs of chronic liver damage (jaundice, increased bruising)
60
Q

what investigations should be undertaken for gastroesophageal varices?

A
  1. Urgent endoscopy
  2. FBC, U&E, clotting (INR), LFTs, group & save
  3. CXR / ascitic tap / further Ix for PHT
61
Q

what is the treatment for gastroesophageal varices?

A
  • ABCDE
  • Rockfall Score (Prediction of Rebleeding and Mortality)
  • Bleeding Varices - Terlipressin + Prophylactic Antibiotics (Ciprofloaxcin), Balloon tamponade (Sengstaken-Blakemore tube), Endoscopic Banding, TIPS
  • Bleed Prevention - BB + Endoscopic Banding. Cirrhosis = screening endoscopy
62
Q

how can gastroesophageal varices be prevented?

A
  • PROPRANOLOL - reduce resting pulse rate to decrease portal pressure
  • variceal banding
  • liver transplant
63
Q

what are the risk factors for IBS?

A
  • previous severe diarrhoea
  • female
  • high hypochondriac anxiety and neurotic score at time of illness
64
Q

what are the causes of IBS?

A 
depression, 
anxiety, 
stress, 
trauma, 
abuse
GI infection
eating disorders
65
Q

what is the pathophysiology of IBS?

A

dysfunction in brain-gut axis results in disorder of intestinal mobility and/or enhanced perception

66
Q

what are the extra-intestinal symptoms of IBS?

A
  • painful periods
  • urinary frequency, urgency, nocturia, incomplete bladder emptying
  • back pain and joint hypermobility
  • fatigue
67
Q

what is the clinical presentation of IBS?

A

ABC

  • A = abdominal pain/discomfort - relieved by defecation
  • B = bloating
  • C = change in bowel habit

2 or more of following

  • urgency
  • incomplete evacuation
  • abdominal bloating/distention
  • mucous in stool
  • worsening of symptoms after food
68
Q

what are the red flag symptoms for GI cancers?

A
  • unexplained weight loss
  • PR bleeding/blood in stool
  • family history of bowel or ovarian cancer
69
Q

what investigations should be undertaken for IBS?

A

diagnosis is made by ruling out differentials

  • bloods
    • FBC
    • ESR and CRP
  • coeliac serology
  • faecal calprotectin
  • colonoscopy
70
Q

what is the rome III diagnostic criteria for IBS?

A
  • recurrent abdominal pain at least 3 days a month in last 3 months
  • associated with 2 of following:
    • onset associated with change in frequency of stool
    • onset associated with change in form (appearance) of stool
71
Q

what should be considered if you see atrial fibrillation and abdominal pain?

A

mesenteric ischaemia

72
Q

what is the definition of acute diarrhoea?

A

diarrhoea lasting less than 2 weeks

73
Q

what is the definition of chronic diarrhoea?

A

diarrhoea lasting more than 2 weeks

74
Q

what are the causes of diarrhoea?

A
  • viral (majority)
    - in children = rotavirus
    - in adults = norovirus
  • bacterial
    - Campylobacter jejuni
    - E.coli
    - Salmonella
    - Shigella
  • parasitic
    - Giardia lamblia
    - Entamoeba histolyitca
    - Cryptosporidium
75
Q

what is the management for diarrhoea?

A
  • treat underlying causes
  • bacterial treated with METRONIDAZOLE
  • oral rehydration therapy
  • anti-emetics - METOCLOPRAMIDE
  • anti-motility agents - LOPERAMIDE
76
Q

what are the effects of helicobacter pylori?

A
  • inflammation
  • antral gastritis
  • gastric cancer
  • peptic ulcers
77
Q

what is lynch syndrome?

A

hereditary non-polyposis colon cancer

autosomal dominant condition caused by mutation in hMSH1 or hMSH2 genes, in highly repeated short DNA sequences

78
Q

what is the effect of lynch syndrome?

A

polyps form in the colon and rapidly progress to colon cancer

79
Q

what is diverticulosis?

A

presence of diverticulum

80
Q

what is diverticular disease?

A

diverticula are symptomatic

81
Q

what is diverticulitis?

A

inflammation of diverticulum

82
Q

what is the clinical presentation of diverticulitis?

A
  • febrile
  • tachycardia
  • tenderness, guarding and rigidity on left side
  • palpable tender mass sometimes felt in left iliac fossa
83
Q

what are the investigations for diverticulitis?

A

Bloods - Raised WCC, ESR & CRP
Pregnancy test in women of childbearing age
Stool culture
Imaging - Erect CXR, AXR and CT

Imaging May Show
Pneumoperitoneum 
Dilated Bowel Loops
Obstruction
Abscess
84
Q

what is the management for diverticulitis?

A

Oral/IV Abx - Ciprofloxacin, Metronidazole
Analgesia + liquid diet +/- fluid resus
Surgical Resection - Rare Cases

85
Q

what are the complications of diverticulitis?

A 
● Perforation 
● Fistula formation into the bladder or vagina 
● Intestinal obstruction 
● Bleeding 
● Mucosal inflammation
86
Q

what are the clinical features of volvulus?

A

consistent with bowel obstruction (absolute constipation and distention)
Comes on extremely quickly
Rarely nausea and vomiting

87
Q

what are the investigations for volvulus?

A

abdominal XR - coffee bean sign

88
Q

what is the management for volvulus?

A

rigid sigmoidoscopy and rectal tube

89
Q

what are the biliary complications of crohns disease vs ulcerative colitis?

A

crohn’s = gallstones

ulcerative colitis = primary sclerosing cholangitis

90
Q

what are the causes of actue mesenteric ischaemia?

A

thrombus
embolism
non-occlusive

91
Q

what are the investigations for acute mesenteric ischaemia?

A

ABG - raised lactate and acidosis
angiography, doppler ultrasound
CT with contrast

92
Q

what are the causes of dysphagia?

A

Disease of mouth and tongue - tonsillitis
Neuromuscular disorders - bulbar palsy, myasthenia gravis
Esophageal motility - achalasia, scleroderma, DM
Extrinsic pressure - goitre, mediastinal glands
Intrinsic lesion - stricture, pharyngeal pouch

93
Q

what are the clinical features of achalasia?

A

Dysphagia of liquids and solids - solids more than liquids
regurgitation more than reflux
no apparent underlying cause

94
Q

where do pharyngeal pouches occur?

A

Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles

95
Q

what are the causes/ risk factors of barrett’s oesophagus?

A 
GORD, 
Male (7:1), 
caucasian, 
FHx, 
Hiatus hernia, 
Obesity, 
Smoking, 
Alcohol
96
Q

what is the management for barrett’s oesophagus?

A
  • Lifestyle: weight loss, smoking cessation, reduce alcohol, small reg meals, avoid hot drinks/alcohol/eating <3hrs before bed, avoid certain drugs (nitrates, anticholinergics, TCAs, NSAIDs, K+ salts, alendronate)

Endoscopic Surveillance with Biopsies

High Dose PPI

Dysplasia - Endoscopic Mucosal Resection, Radiofrequency Ablation

Severe: oesophagectomy

97
Q

what are the red flag symptoms for GORD that requires further investigation?

A 
Dysphagia (difficulty swallowing)
> 55yrs
Weight loss
Epigastric pain / reflux
Treatment resistant dyspepsia
Nausea and vomiting
Anaemia
Raised platelets
98
Q

what is the difference in presentation of gastric ulcers vs duodenal ulcers?

A

gastric ulcers = epigastric pain worse after eating, eased by antacids. haematemesis, weight loss, heart burn

duodenal ulcers = epigastric pain before meals and at night, relieved by eating or milk. melaena, weight gain

99
Q

which drugs can cause gastric/duodenal ulcers?

A

NSAIDS
SSRI
corticosteroids
bisphosphonates

100
Q

what are the causes/risk factors of gastritis?

A 
autoimmune disease
H.pylori
bile reflux
NSAIDS
stress
101
Q

what will imaging show in diverticulitis?

A 
Imaging May Show
Pneumoperitoneum 
Dilated Bowel Loops
Obstruction
Abscess
102
Q

what are the causes/risk factors of diverticular disease?

A

low fibre diet
obesity
age >40

103
Q

what is the clinical presentation of diverticular disease?

A

Altered Bowel Habit
Abdominal Pain
Bleeding PR

104
Q

what are the investigations for diverticular disease?

A

CT (Acute)

Colonoscopy

105
Q

what is the management for diverticular disease?

A

High Fibre Diet and Fluids +/- Laxatives

Surgery

106
Q

what are the 2 different types of gastric cancer?

A

type 1 = intestinal / differentiated (70-80%) - found in antrum and lesser curvature
type 2 = diffuse / undifferentiated (20%) - found elsewhere

107
Q

what are the following features for crohns and ulcerative colitis?

  • location
  • inflammatory pattern
  • layers affected
  • granuloma
  • crypt abscesses
  • goblet cells
A

location

  • crohns = any part of GI tract
  • UC = colon only

inflammatory pattern

  • crohns = skip lesions (cobblestone appearance)
  • UC = continuous

layers affected

  • crohns = transmural
  • UC = mucosal

granulomas

  • crohns = granulomas
  • UC = no gramulomas

crypt abscesses

  • crohns = present
  • UC = present

goblet cells

  • crohns = present
  • UC = depletion
108
Q

what are the non-infectious causes of diarrhoea?

A

IBS
IBD - crohns, ulcerative colitis
bowel cancer

109
Q

what are the causes of diarrhoea that are not related to disease or infection?

A
  • stress
  • medication related
  • toxin ingestion
110
Q

which HLA is associated with coeliac disease?

A

HLA DQ2/DQ8

111
Q

what is the difference in presentation of internal and external haemorrhoids?

A

internal = painless bleeding with bowel movements

external = pain and discomfort

112
Q

what is the prevention for diverticulitis?

A

Regular exercise, avoid smoking, high-fibre diet, drink plenty of water

113
Q

what is the clinical presentation of c.diff?

A
  • watery diarrhoea with mucus/blood
  • abdominal distention, cramps
  • malaise
  • fever
114
Q

what is the treatment for c.diff?

A

1st line = vancomycin orally for 10 days

115
Q

what is a pilonidal sinus?

A

abnormal pocket in the skin near the tailbone containing hair and skin debris

116
Q

what is mesenteric ischaemia?

A

temporary restriction of blood supply to the large intestine due to vasoconstriction or low pressure flow

117
Q

what are the risk factors for ischaemic colitis?

A
  • age >60
  • sex F>M
  • factor V Leiden
  • high cholesterol
  • reduced blood flow - HF, low BP, shock, DM, RA
  • previous abdominal surgery
  • heavy exercise
  • surgery on aorta
118
Q

what are the complications of ischaemic colitis?

A
  • sepsis
  • bowel necrosis
  • death
  • fear of eating
  • unintentional weight loss
119
Q

what are the investigations for ischaemic colitis?

A

CT abdomen - rule out IBD
colonoscopy
stool culture

120
Q

how would you treat mesenteric ischaemia?

A

surgical - stent

121
Q

how would you treat ischaemic colitis?

A
  • bowel resection due to necrosis

- surgically repair hole

122
Q

what is the treatment for ulcerative colitis

A
  • Aminosalicylates
  • 5-ASA (SULFASALAZINE)
  • PREDNISOLONE
  • HYDROCORTISONE
  • Surgical resection
123
Q

What is the surgical management for GORD?

A

Nissen fundoplication

Phase 2A revision (38 decks)

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