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GI Tract Flashcards

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1
Q

Mechanism of h2 receptor antagonists and examples

A

Decrease acid production by preventing histamine activation of acid production
(Limited benefit as alternative pathways still open- acetylcholine and gastrin)

Cimetidine- many drug interactions
Ranitidine- safer for clinical use

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2
Q

3 proton pump inhibitors

A

Omeprazole
Pantoprazole
Lansoprazole

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3
Q

Name 3 upper GI oral diseases

A

Recurrent oral ulceration
Lichen planus
Orofacial granulomatosis

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4
Q

Name 3 upper GI oesophageal disorders

A

Dysphagia
Dysmotility disorders
GORD (gastro oesophageal reflux disease)

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5
Q

3 mains causes of GORD

A

Defective lower oesophageal sphincter
Impaired lower clearing
Impaired gastric emptying

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6
Q

3 effects of GORD

A

Ulceration
Inflammation
Metaplasia (abnormal change in nature of tissue)

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7
Q

4 signs/symptoms of GORD and their causes

A

Epigastric burning
- worse lying down, bending over, pregnant

Dysphagia

  • oesophagitis (inflammation of oesophagus)
  • stricture (fibrosis and scarring narrow oesophagus)
  • dysmotiity

GI bleeding

Severe pain

  • mimics MI
  • oesophageal muscle spasm
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8
Q

Define Barretts oesophagus

A

Recurrent acid reflux into lower part of oesophagus resulting in metaplasia of oesophagus lining into gastric type mucosa

  • protects mucosa from damage
  • increased risk of carcinoma
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9
Q

Define Hiatus Hernia

A

Part of stomach protrudes through diaphragm opening (hiatus) into thorax

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10
Q

5 ways to manage GORD

A

Stop smoking- improves sphincter (increased muscular tone)
Lose weight and avoid triggering activities
Antacids
H2 blockers and PPIs
Improve GI motility and gastric emptying

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11
Q

2 functions of medicines used in upper GI tract

Examples

A

Eliminate formed acids
-antacids

Reduce acid secretion

  • H2 receptor blockers
  • proton pump inhibitors
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12
Q

Where can peptic ulcer disease (PUD) occur?

A

Any acid affected site

- oesophagus, stomach, duodenum

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13
Q

3 causes of PUD

A

Drugs (NSAIDs, steroids)
Excessive acid
Decreased protective barrier (usually H. Pylori involvement)

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14
Q

Signs/symptoms of PUD

A 
Asymptomatic 
Epigastric burning
- worse before/just after meal
- worse at night
- relieved by food, alkali and vomiting
Usually no physical signs (only when complications e.g. Bleeding)
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15
Q

4 investigations for PUD

A

Endoscopy
Radiology (barium meal)
Anaemia (FBC, FOB)
Test for H. Pylori

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16
Q

4 local complications of PUD

A

Perforation
Haemorrhage
Stricture
Malignancy

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17
Q

Systemic complication of PUD

A

Anaemia

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18
Q

4 treatments for PUD if it is a reversible problem, H. Pylori present

A

Stop smoking
Small, regular meals
Eradication therapy
Ulcer healing drugs

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19
Q

3 PUD treatments if there is stricture, acute bleeding, perforation or malignancy

A

Endoscope
Surgical and repair (gastrectomy- whole or part of stomach removed)
Vagotomy (cutting of branches of vagus nerve)

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20
Q

2 ways medication can treat PUD and examples

A
  1. Reduce acid secretion
    - h2 receptor blockers
    - protein pump inhibitors
  2. Improve mucosal barrier- eliminate H. Pylori- inhibit prostaglandin removal (involved in mucous production)
    : Reduce NSAID and steroid use
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21
Q

What is triple therapy?

A

Eliminates helicobacter pyloris

Two week course of:
2 antibiotics (amoxycillin and metronidazole)
Protein pump inhibitor (omeprazole)

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22
Q

3 lower GI diseases that affect the small bowel

A

Pernicious anaemia
Coeliac disease
Crohn’s disease

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23
Q

Where does Crohn’s occur?

A

Anywhere on GI tract

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24
Q

4 clinical presentations of Crohn’s

A

Discontinuous ‘skip’ lesions
Some rectal involvement (50%)
Transmural- penetrates full thickness of wall
Cobblestone appearance

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25
6 symptoms of Crohn's and where in GI tract they occur
Colon area: Diarrhoea Abdominal pain PR bleeding (rectal) Small bowel: Intestinal obstruction Malabsorption Mouth: Orofacial granulomatosis
26
4 treatments for Crohn's
``` Systemic steroids e.g. Prednisolone Local steroids Anti inflammatory drugs Palliative - remove obstructed bowel segments drain abscesses ```
27
2 microscopic features of Crohn's
Granulomatous | Oedematous (fluid retention)
28
Site of ulcerative colitis
Colon (large intestine)
29
3 clinical presentations of UC
Continuous Rectum always involved Mucosal inflammation and swelling
30
3 UC symptoms
Diarrhoea Abdominal pain PR bleeding
31
4 treatments of UC
Systemic steroids e.g. Prednisolone Local steroids Anti inflammatory e.g. Sulphasalazine Surgery- colectomy (remove part causing disease)
32
6 clinical features of orofacial granulomatosis
``` Lip swelling Angular cheilitis Cobblestoning Gingivitis Ulceration Microscopic granulomas ```
33
Define pernicious anaemia
Inability to absorb vitamin B12 | Receptors only in terminal ileum
34
Cause of pernicious anaemia
Failure to produce intrinsic factor, which is needed to absorb vitamin B12
35
3 causes of Vit b12 deficiency
Pernicious anaemia Low dietary intake Disease of terminal ileum (Crohn's disease)
36
Define coeliac disease
Sensitivity to α-gliaden component of gluten
37
8 symptoms of coeliac disease
``` Weight loss Lassitude (lack of energy) Weakness Abdominal pain/swelling Diarrhoea Aphthae (small ulcer)/glossitis (inflammation of tongue) Steatorrhoea (fatty stools) Dysphagia ```
38
Effect of gluten free diet on coeliac disease
Reversal of jejunal atrophy (malabsorption goes away) Improved well being Decreased risk of lymphoma
39
Symptoms of colonic carcinoma
None Anaemia Rectal blood loss
40
4 ways to screen for colonic carcinoma
``` FOB (faecal occult blood test) - all over 50s invited Barium enema Endoscopy CT/MRI scan ```
41
Aetiology of colonic carcinoma (9)
``` Diet: Decreased fibre Increased fat Increased meat Decreased veg ``` ``` Smoking Lack of exercise Genetics Ulcerative colitis Intestinal polyps ```
42
What causes most colonic carcinomas
Arise in polyps Most will bleed due to irritation and trauma Usually takes 5 yeRs to progress to malignancy
43
3 treatments for colonic carcinoma
Surgery Radiotherapy Chemotherapy
44
3 ways to diagnose helicobacter pylori
Endoscopy and biopsy Breath test Serology
45
Define gastroenteritis
A non-specific term for various pathological states of the GI tract
46
Primary manifestation of gastroenteritis and possible accompanying symptoms
Diarrhoea Nausea Vomiting Abdominal pain
47
5 key viral symptoms of gastroenteritis
``` Abdominal cramps Vomiting Profuse WATERY stools Fever Headaches ```
48
4 key bacterial dysentery symptoms of gastroenteritis
Small volume stools Fever BLOODY mucoid stools Supra pubic pain
49
Define norovirus and how it's transmitted
Highly contagious non-enveloped ss RNA virus Transmitted faecal to oral route
50
Clinical features of norovirus
Abrupt onset of vomiting and watery diarrhoea | +/- Fever and abdominal pain
51
Management of norovirus
Correct fluid/electrolyte balance
52
3 types of salmonella
Gastroenteritis Enteric Fever (typhoid) Bacteraemia
53
4 symptoms of salmonella
Cramps Watery or bloody diarrhoea Fever, sometimes vomiting Lasts 1-4 days
54
2 treatments for salmonella
Supportive (IV hydration) | Antibiotics
55
Define clostridium difficile
Gram positive, spore forming, anaerobic bacillus | Carried by domestic animals
56
4 treatments for C. Diff
Oral rehydration Antibiotics Colectomy Faecal transplants
57
Ways to prevent C. Diff infection
No vaccine ``` Food hygiene Decrease likelihood of contamination - adequate food and storage - segregation - licensed premises ```
58
3 ways to prevent GI infections
Safe food handling and hand washing Infection control Surveillance
59
Name 4 liver issues
Viral liver disease Jaundice Cirrhosis Liver failure
60
Define jaundice
Accumulation of bilirubin in the skin due to excess bilirubin in blood
61
What is conjugated bilirubin
Soluble bilirubin
62
Define pre-hepatic jaundice
Jaundice due to factors before liver metabolism
63
What usually causes pre-hepatic jaundice and give 3 examples
Usually excessive quantities of RBC breakdown products - haemolytic anaemia (RBC destruction) - post transfusion (bad match) - neonatal (maternal RBC induced)
64
What causes jaundice in haemolysis
Increased bilirubin production beyond livers capacity to conjugate it
65
What causes jaundice in Gilberts disease
Decreased bilirubin uptake by liver cells
66
What causes hepatic jaundice
Due to 'liver failure' - cirrhosis - drug induced liver dysfunction Prevents metabolism of RBC breakdown products
67
How does secretion failure cause jaundice
Defective secretion of conjugated bilirubin from liver cells (e.g. Back into bloodstream)
68
Define canaliculus
Channels in liver that transport bile to gall bladder
69
What causes post-hepatic jaundice
Obstruction to bile outflow
70
Clinical feature of jaundice
Conjugated bilirubin is excreted in urine and faeces - colour changes - pale stool and dark urine suggest POST HEPATIC cause (conjugated bilirubin) - normal urine and faeces in HAEMOLYTICS (excess bilirubin unconjugated)
71
Define acute cholecystits
Inflammation of gall bladder
72
4 gall bladder symptoms
Pain in SHOULDER tip Abdominal pain right side- radiates to back Pain brought on by eating fatty food- stimulates bile release by contraction of gall bladder Usually gall stones
73
5 population traits for gallstone
``` Fair Fertile Female Fat Forty ```
74
3 ways jaundice patients are imaged
Ultrasound- detects dilated bile channels within liver Plain radiographs- show RADIOPAQUE gall stones ERCP- endoscopic retrograde cholangio pancreatography
75
Management of prehepatic jaundice
Identify and treat cause
76
Management of post hepatic jaundice
Remove obstruction - gall stones via ERCP/ ultrasound - force channel open with stent
77
3 ways to prevent gall stone recurrence
``` Remove gall bladder (cholecystectomy) Prevent build up of bile acid - ursodeoxycholic acid - low calorie, low cholesterol diet Prevent bile acid reabsorption from GIT ```
78
Define kernicterus
Brain damage from bilirubin build up in new born
79
Define cirrhosis
Mixed picture of damage, fibrosis and regeneration of liver structure
80
6 causes of cirrhosis
``` Alcohol Primary biliary cirrhosis Viral disease- chronic active hepatitis Autoimmune chronic hepatitis Haemochromatosis (excessive absorption and storage of iron) CF ```
81
5 signs/symptoms of cirrhosis
``` Acute bleed Jaundice Oedema and ascite (abdominal fluid) Encephalopathy (toxic substances affect brain) Spider naevi, palmar erythema ```

BAMS (9 decks)

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