9. GI Flashcards
1
Q
what is a mallory weiss tear and what can happen to this tear
A
Tear in oesophagus which can bleed
2
Q
risk factor for mallory weiss tear
A
20-50 year old males
3
Q
causes of mallory weiss tear (3)
A
things that increase intra-abdominal pressure (excessive vomiting, coughing and hiatus hernia)
4
Q
signs and symptoms of mallory weiss tear (3)
A
Haematemesis (blood in vomit)
Melena (black stools due to older blood)
Systemic: Postural hypotension and dizziness
5
Q
investigation for mallory weiss 1 and when should this be done
A
endoscopy within 24 hours
6
Q
treatment steps for mallory weiss 3
A
- resuscitation (ABC)
- treat causes eg if alcohol is causing vomiting then stop alcohol intake
- clip or inject the tear with adrenaline to help it heal
7
Q
key terminology for mallory weiss tear 3
A
‘Continuously retching’
‘Vomit with blood inside’
throwing up before blood
8
Q
what r oesophageal varices
A
Enlarged veins protruding into the oesophagus
9
Q
risk factors for oesophageal varicse 1
A
Past medical history of liver failure/ dysfunction
10
Q
cause of oesophageal varices 1
A
Portal Hypertension
11
Q
signs and symptoms of oesophageal varices 3
A
- Haematemesis (large volumes)
- Abdominal pain
- Shock, hypotension and pallor (due to blood loss)
12
Q
investigations for oesophageal varices 2 (diagnosis, identify cause)
A
Diagnosis: endoscopy
doppler ultrasonography/ MRI to identify portal hypertension
13
Q
treatment for oesophageal varices 3 (1st- 2 things, 2nd)
A
1st line: band ligation
Prophylactic antibiotic therapy
Transjugular intrahepatic portosystemic shunt (TIPS) if irresponsive to first line treatment
14
Q
complication of oesophageal varices 1
A
Can lead to severe variceal bleeding
15
Q
key terminology for oesophageal varices 1
A
coughing up A LOT of blood
16
Q
what is achalasia (2)
A
Degeneration ganglions of myenteric plexus= LOS not relaxing properly
17
Q
risk factor for achalasia 1
A
elderly
18
Q
pathophysiology of achalasia 2
A
- LOS cannot relax
- This prevents food and drink going into the stomach
19
Q
signs and symptoms of achalasia 3
A
Dysphagia- cannot swallow liquids OR solids
Heartburn (as contents of the stomach can travel up into the oesophagus and cannot go back down)
Regurgitation of food/ drink
20
Q
1st line (and results) and GS for achalasia investigations
A
1st line: barium swallow test with a positive
Birds beak sign
GS: oesophageal manometry
21
Q
what is a positive birds beak sign
A
dilated oesophagus and tight lower oesophageal sphincter
22
Q
treatment for achalasia (3
A
Lifestyle changes: smaller and more frequent meals
nitrates/ CBB to relax LOS
Heller myotomy surgery (high success rate)
23
Q
risk of treating achalasia
A
LOS too relaxed= risk of GORD
24
Q
what is GORD and what does it stand for
what causes the reflux
A
LOS relaxation causes reflux of gastric contents into the oesophagus
Gastro-Oesophageal Reflux Disease
LOS relaxation
25
risk factors for GORD 3 and which sex is more likely to get this by how much and why
Increased intraabdominal pressure: obesity and pregnancy
Sliding Hiatus hernia (LOS slides up into chest)
Scleroderma (connective tissue disorder which scars the LOS)
LOS relaxants: Caffeine Alcohol
Males x2 risk than females (eostrogen is protective)
26
signs and symptoms 2 of GORD including 3 red flags and 3 extra-oesophageal signs GORD
1. Heartburn (main symptom) which is exacerbated when lying down as reflux more easily occurs
2. Dyspepsia
3. Extra-oseophageal signs: cough, asthma, dental erosion (due to acid eroding teeth)
4. Red flags: dysphagia, weight loss, haematemesis
27
investigations for GORD 2
1. GS and diagnostic: 24 hour pH monitoring (abnormal if pH <4 more than 4% of the time)
2. Endoscopy to look for Barrett’s, especially in those with chronic heartburn symptoms
28
treatment for GORD 2
1st line: PPI
Lifestyle changes: smaller meals, avoid food from 3 hours before bed
29
1 complication for GORD and show the disease pathway
Gastric adenocarcinoma
GORD-> barretts-> oesophageal adenocarcinoma
30
what is barretts oesophagus and where does this occur
Metaplasia from stratified squamous to simple columnar epithelium
Has to occur within 1cm of the gastro-oesophageal junction
31
epidemiology of barretts 3
middle aged
caucasian
males
32
investigation of barretts
Endoscopy with biopsy which should show metaplasia within 1cm of the GOJ
33
treatment for barretts 2
PPI
Regular Endoscopic surveillance (risk of cancer)
34
complication of barretts
Premalignant to oesophageal adenocarcinoma
35
what is gastritis
Inflammation of gastric mucosal lining
36
causes of gastritis 5
H. pylori
NSAIDs
alcohol
mucosal ischaemia
autoimmune (due to autoantibodies against gastric cells)
h, n, m, 2xa- HakuNa MaAatA
37
signs and symptoms of gastritis 5
Dyspepsia (indigestion)
Epigastric pain with diarrhoea
Nausea and vomiting
Early satiety
38
investigations for gastritis (1st line, GS)
For H Pylori suspected cause: stool antigen test and urea breath test
GS: endoscopy with biopsy
39
treatment for gastritis 3
For H. Pylori give triple therapy (1 PPI and 2 antibiotics eg omeprazole, clarithromycin and amoxicillin)
For autoimmune cause: IM Vit B12
For alcohol/ NSAID cause, cease them
40
3 complications of gastritis
1. peptic ulcer disease
2. gastric adenocarcinoma
3. anaemia/ bleeding
41
name the disease pathway 3 involving gastritis
gastritis → peptic ulcer → gastric adenocarcinoma
42
define IBS 3
Chronic functional bowel disorder characterised by abdominal pain and change in bowel habits
43
3 risk factors for IBS
Stress/ anxiety
Female
Younger age (peak at 20-30 year olds)
44
cause of IBS 2
No single cause
contributions from food hypersensitivity
45
signs and symptoms of IBS 3
Abdominal pain and bloating relieved from defecation/ flatulence
Altered stool consistently and frequency
Symptoms worse postprandial
46
what is the general investigation aim for IBS
Process of exclusion of other conditions
47
4 investigations for IBS
Exclude coeliacs with serology (anti-tTG or anti-EMA)
Exclude IBD with faecal calprotectin
Exclude infections with ESR/CRP/ blood cultures
Exclude colorectal cancer with colonoscopy
48
diagnosis checklist for IBS 3
Diagnosis checklist=
1. recurrent abdominal pain for at least 1 day weekly for past 3 months
2. symptoms from 6 months ago
3. one of the following
-Symptoms relieved by defecation
-Change in bowel appearance
-Change in bowel frequency
49
3 categories of treatment for IBS
conservative, mild and severe
50
conservative treatment for IBS 2
Reassure patient
Advise to avoid trigger foods eg caffeine/ alcohol and short chain carbohydrate
51
mild treatment of IBS 2
Anti mobility eg Loperamide for diarrhoea
Laxatives eg Senna for constipation
52
severe treatment of IBS 3
Tricyclic antidepressants eg amitriptyline
CBT
GI referral
53
differentials of IBS 4
IBD
coeliacs
GI infection
lactose intolerance
54
what is coeliacs, what type of reaction is it and what is it mediated by
Autoimmune type 4 hypersensitivity to gluten (mediated by T cells)
55
risk factors for coeliacs 2
Other autoimmune conditions eg DM
Genetic (HLA-DQ2 or HLA-DQ8)
56
pathophysiology for coeliacs 5
Gluten broken down to gliadin
Gliadin binds to IgA= immune response
Autoantibodies anti-tTG and anti-EMI produced to this
These antibodies attack SI epithelial cells
This causes villous atrophy, crypt hyperplasia, intraepithelial lymphocytes
57
signs and symptoms of coeliacs 5
1. Dermatitis herpetiformis (characteristic of coeliacs)- rash on knees, and elbows from IgA deposition near skin
2. Diarrhoea
3. Steatorrhea, Osteopenia, secondary anaemia and weight loss (due to malabsorption)
4. Children= failure to thrive
5. Angular stomatatitis (mouth ulcers)
58
investigations for coeliacs (1st, 2nd, GS)
1st line: serology
=anti-tTG antibodies (most specific)
AND Increase in total IgA (but risk of false +)
2nd line: serology
=anti-EMA antibodies (less reliable)
GS/ Diagnostic
=Duodenal biopsy showing crypt hyperplasia, villous atrophy and epithelial lymphocyte infiltration
59
treatment for coeliacs
gluten free diet for rest of life
60
compare the location of UC vs Crohns
UC- large colon
Crohns- anywhere in the GI tract
61
compare the pattern of inflammation UC vs Crohns
UC: continuous inflamed areas
CD: patches of inflammation called skip lesions
62
compare the location of pain UC vs Crohns
UC: typically in the lower left abdomen (uLcerative)
CD: typically in the lower right abdomen (cRohns)
63
compare the depth penetration in UC vs Crohns
UC: inflammation only of inner mucosal lining
CD: transmural inflammation (all layers)
64
compare bleeding in UC vs Crohns
UC: common during bowel movements, red stool
CD: uncommon in stool
65
what r the common risk factors for UC and Crohns 3
family history
NSAIDs
stress/ depression
66
unique risk factor to UC 1
HLA B27 gene
67
unique risk factor to Crohns 2
smoking
linked to NOD-2 mutation
68
what condition is smoking protective in
UC
69
signs and symptoms of UC 3
Lower left quadrant abdominal pain
Tenesmus
Blood mucosal watery diarrhoea
70
what is a extra-intestinal condition linked to UC 1
90% of UC patients have PSC
71
signs and symptoms of crohns 3
right lower quadrant abdominal pain
melena
signs of malabsorption: diarrhoea, weight loss, steatorrhea
72
extra intestinal signs of UC AND crohns 2
erythema nodosum and uveitis
73
what is a extra-intestinal condition linked to crohns 1
mouth ulcers
74
general investigation for IBD 4
inflammation: CRP/ESR/WCC
malabsorption: iron/ folate/ vit B
IBD marker: faecal calprotectin stool test (+ result)
GS: colonoscopy/ endoscopy with biopsy
75
what blood test differentiate between UC and crohns and what is the result for each
pANCA
+ for UC and - for Crohns
76
What is GS diagnostic for ulcerative colitis and 3 results
UC= colonoscopy with biopsy
-> continuous, leadpipe sign
-> mucosal inflammation
-> CRYPT HYPERPLASIA
77
What is GS diagnostic for crohns and 4 results
Crohns= endosocpy with biopsy
-> skip lesions
->cobblestoning
->transmural inflammation
->non- caseating granulomas
78
what is the treatment for mild IBD symptoms 2
Mesalazine and prednisolone
79
what is the treatment for mod/ severe IBD symptoms 2
Hydrocortisone
TNF alpha inhibitor eg infliximab
80
what is the GS treatment for UC and why is this not GS in crohns
Colectomy surgery (curative)
not curative in crohns
81
what maintains remission in UC vs crohns
UC= mesalazine
crohns= azathioprine
82
complication of UC 1
Toxic megacolon
83
complication of crohns 4
fistula
strictures
abscesses
small bowel obstruction
FASS
84
what is more common a small or large bowel obstruction?
small
85
causes and percentages of small bowel obstruction 3
75% adhesions (due to previous abdominal/ gynae surgeries)
10% hernias
Crohn’s strictures
86
causes and percentages of large bowel obstruction 3
90% malignancy ie colorectal cancer
5% sigmoid volvus (coffee bean appearance on abdominal X-ray)
Intussusception (bowel folds within itself in children)
87
signs and symptoms of small bowel obstruction
Colicky abdominal pain
Mild abdominal distension
Vomiting first then constipation
Tinkling bowel sounds
88
signs and symptoms of large bowel obstruction
Continuous abdominal pain
Severe abdominal distension
Constipation first then vomiting
Absent bowel sounds
89
investigations for obstruction of small, large and pseudo obstruction of the bowel (1st, GS)
1st=
-> abdominal X-ray
-> diagnosis: dilation of SI over 3cm, LI over 6cm or caecum over 9cm
GS:
-> CT abdomen and pelvis with contrast
90
treatment for stable patients with small/ large bowel obstruction 3 and what is this management approach called
-> IV cannula for fluid resuscitation
-> NG feeding tube
-> analgesia, antiemetics, antibiotics
drip and suck
91
treatment for unstable patients with small/ large bowel obstruction 2
surgery (resections/ laparotomy)- depends on cause and location
92
what is pseudo obstruction
Colonic dilation with no mechanical obstruction
93
causes of pseudo obstruction 2 and what is the main cause
Post operation (main cause)
neurological conditions eg MS/ parkinsons
94
treatment for pseudo obstruction 2
Same as small and large bowel obstruction PLUS
IV neostigmine (relieved acute pseudo obstruction)
95
complication of pseudoobstruction 2
Bowel ischaemia and perforation
96
what is diarrhoea definition
3 or more watery stools passed a day
97
classify acute, subacute and chronic time periods
Acute if under 14 days
Subacute if 14-28 days
Chronic if over 28 days
98
4 general causes of diarrhoea
1. IBD/IBS
2. coeliac
3. HYPERTHRYOIDISM
4. infection
99
what 3 subclassifications in diarrhoea caused by infection and give examples for each (2, 5,1)
viral: rotavirus in kids and nororvirus in adults
bacterial: C. diff, C. jejuni, E.coli, shigella, salmonella
helminth (giardia lambda)
100
main cause of diarrhoea
viruses
101
signs and symptoms of diarrhoea 3
vomiting
abdominal cramps
watery stools 3+ times a day
102
what suggests a bacterial cause of diarrhoea 2
dysentery (blood in diarrhoea)
previous antibiotic use= campylobacter
103
what suggests there is a infectious cause behind diarrhoea 1
acute history
104
what suggests a viral cause for diarrhoea 4
muscle pain, fatigue, headache, fever (all complications a nurse tells u before a vaccination)
105
what three main tests can be done for diarrhoea
blood tests
PCR
stool culture
106
what is PCR test for in diarrhoea testing for 3
for viruses, C. diff or campylobacter
107
what is stool culture test for diarrhoea testing for 2
bacteria or parasites
108
what can be investigated in blood tests for diarrhoea and what do they point towards (3)
-> increased ESR/ CRP= infectious cause
-> increased eosinophils= parasitic
-> increased ESR/CRP and anaemia= Crohns, UC, cancer
109
treatment for diarrhoea 3 step approach
1. Oral rehydration
2. Treat underlying cause
3. Medicine for symptoms:
-> antiemetics eg metoclopramide
-> antimotility eg loperamide
110
what two conditions does bowel ischaemia involve and which is more common out of the two
ischaemic colitis and mesenteric ischaemia
ischaemic colitis
111
what is ischaemic colitis and what does this typically affect and why
Ischaemia of colonic arterial supply due to hypoperfusion
splenic flexure as this is most distal
112
signs and symptoms of ischaemic colitis 3
Left lower quadrant abdominal pain (colicky, worse postprandial)
Bright blood stool
Signs of hypovolemic shock (pallor, weak and rapid pulse)
113
investigations for ischaemic colitis 1st, 2nd GS and what is the condition for the GS
1st line: General investigation with physical exam and rule out causes with full bloods, ECG and LFT
2nd line: CT contrast or angiography
Gold standard: Colonoscopy and biopsy (after patient has recovered to prevent poor healing and stricture formation)
114
treatment for ischaemic colitis if symptomatic 2 and if gangrenous 1
If symptomatic: antibiotic prophylaxis and rehydration
If gangrenous (infection): surgery
115
complications of bowel ischaemia 2 and what can they lead to 1 each
perforation which can lead to spontaneous bacterial peritonitis
Strictures (narrowing) which can cause obstruction
116
what is mesenteric ischaemia
what r the 2 types
Ischemia due to narrowed/ blocked GI blood vessels supplying the small bowel
Can be acute (like an abdominal MI- emergency) or chronic (like abdominal angina)
117
risk factors for bowel ischaemia 3 and one specific to acute mesenteric ischaemia
Same for CV and atherosclerosis eg hypertension, obesity, DM
acute mesenteric isch= A Fib
118
triad of signs and symptoms of mesenteric ischaemia 3
-> central or right iliac fossa severe pain
-> no abdominal signs on exam eg guarding/ rebound tenderness
-> rapid hypovolemic shock
119
what r the two characteristics of upper IG bleeds
haematemesis
melena
120
what r the 2 characteristic of lower GI bleeds
haematochezia
dystentery
121
what r the 7 red flags for GI and what do they point towards
point to cancer
ALARMS55 (anaemia, loss of weight, anorexia, recent symptom onset, melena, dySphagia, older than 55)
122
what is the investigation for dysphagia
endoscopy
123
what is the investigation for bleeds 2
endocsopy/ colonoscopy
124
what is the investigation for anal issues
DRE
125
what is appendicitis
inflammation of the appendix
126
what r the causes of appendicitis 2
infectious microorganisms
blockage of appenditicits
127
pathophysiology of appendicitis (3 steps) and what can this do (3)
obstruction
causes bacterial growth
inflammation of appendix
inflammation can press on nerves, blood vessels and stop secretions
128
signs and symptoms of appendicitis 3
umbilical pain which localises as right iliac fossa pain
nausea and vomiting
pyrexia
129
test investigations for appendicitis (3)
blood test: high WCC, ESR, CRP
CT abdo and pelvis GS
pregnancy test to rule out ectopic pregnancy
130
physical exam investigations for appendicitis 5
1. Roving’s sign (palpation on the left iliac fossa causes pain in the right iliac fossa)
2. psoas sign (right iliac pain on right hip extension)
3. obturator sign (right iliac iliac pain on right hip flexion and internal rotation)
4. guarding
5. rebound tenderness
131
treatment for appendicitis 2 and how is this done 2
antibiotics
appendectomy
laparoscopic or open
132
define diverticulum
outpouching of the colon wall
133
what is diverticula
plural of diverticulum
134
what is diverticular disease
diverticula with symptoms
135
what is diverticulosis
diverticula WITHOUT symptoms
136
what is diverticulitis
when diverticula become inflammed
137
explain the pathophysiology of diverticulitis 2 steps
1. high pressure in colon/ weak wall= diverticula formed
2. inflammation if bacteria/ faecal matter gathers in diverticula
138
risk factors for diverticular disease 4
NSAIDs
obesity
constipation
ageing
139
where do diverculas typically form
sigmoid colon
140
signs and symptoms of diverticular disease 3
left lower quadrant pain
constipation
fresh rectal bleeding
divertiCuLaR
constipation, lower left quadrant pain, rectal bleeding (haematochezia)
141
complication of appendicitis 2
SBO if rupture
periappendiceal abscess
142
what is meckels diverticulum and what type of patients does it affect
paedtriatrics
failure of obliteraiton of vitelline duct
143
investigation for diverticular disease (GS)
CT abdomen and pelvis with contract GS
144
treatment for diverticulosis 1
watch and wait approach
145
treatment for diverticular disease (2, GS)
bulk forming laxative eg isphagula husk and antibiotics
GS= surgery
146
treatment for diverticulitis 3
co-amoxiclav
paracetamol
IV fluid
147
what type of gram bacteria is H pylori
gram - bacteria
148
what does H pylori cause 3
peptic ulcer disease
gastric adenocarcinomas
gastritis
149
investigations for H pylori (1st line, GS) and what is the condition for the 1st line
1 st line- urea breath test/ stool antigen tests
Stop PPI for 2 weeks before testing
GS- Biopsy
150
what is treatment for H pylori 3
clarithromycin
amoxicillin
omeprazole
151
alternative to amoxicillin in H pylori triple treatment 1
metronidazole
152
what r the two types of oesophageal cancer and where do they affect
Adenocarcinoma- lower 1/3 of the oesophagus
Squamous cell carcinoma- upper 2/3 of the oesophagus
153
cause of oesophageal adenocarcinoma 1
Barret’s oesophagus metaplasia
154
cause of oesophageal squamous cell carcinoma 2
smoking
alcohol
155
signs and symptoms of oesophageal cancer
anaemia
loss of weight
anorexia
recent symptoms
melena
swallowing is PROGRESSIVELY worse (solids to liquids)
156
differential to oesophageal cancer 1 and how to tell them apart
achalasia- achalasia unable to swallow both liquids and solids, cancer is progressive so unable to swallow solids then liquids
157
investigation for oesophageal cancer (GS, staging)
GS- endoscopy + biopsy (w/barium)
CT for staging (TNM)
158
treatment for oesophageal cancer (earlier and later stage)
earlier: Surgical resection w/radio/chemotherapy
Later stages- palliative
159
what type of cancers r most gastric cancers
adenocarcinomas
160
what r the two types of gastric carcinomas and explain three differences between the two
T1 and 2
T1- well differentiated better prognosis- Tubular cells on histology
T2- poorly differentiated worse prognosis- Signet ring cells
161
causes of gastric carcinomas 4
H. pylori
Smoking
CDH-1 (Tumour suppressor gene)
Autoimmune chronic gastritis (pernicious anaemia)
162
signs and symptoms of gastric carcinomas 3
Severe epigastric pain (worse than gastritis)
Cancer signs- Weight loss, TATT
ALARMS- progressive dysphagia
163
what r the metastases signs associated with gastric carcinoma 4
Jaundice – liver met
Krukenberg tumour- ovarian met
Lymph node met:
- Virchows node- supraclavicular
- Sister Mary Joseph node- umbilical
164
investigation for gastric carcinoma (2)
Gastroscopy + Biopsy
CT for staging (TNM)
165
treatment for gastric carcinoma
Surgery and chemo
166
what is the requirement for 2 week GI endoscopy referral 2
dysphagia
or over 55 with weight loss and 1/3
1. reflux
2. dyspepsia
3. abdominal pain
167
how common r small bowel carcinomas
Rare
168
risk factor of small bowel carcinomas
Chronic SI disease e.g. Crohn’s, Coeliac
169
investigation 2 and treatment of small bowel carcinoma 2
investigation: gastroscopy + biopsy and CT for staging
treatment: surgery and chemo
same as gastric cancer
170
what is the pathophysiology of large bowel cancer 2
1. spontaneous benign adenomas form
2. these are precursors- develop into cancers
171
two conditions that increase risk of polyps
FAP- familial adenomatous polyposis
HNPCC lynch syndrome- hereditary non-polyposis colorectal cancer
172
what is the gene mutation in FAP and HNPCC
FAP: APC gene mutation
HNPCC: MLH 1 gene mutation
173
how does FAP and HNPCC cause large bowel cancer
FAP: causes 1000s of duodenal polyps to form which inevitably become cancerous
HNPCC: rapidly increases progression of adenoma and makes it cancernous
174
risk factors for large bowel adenoma 5
Gene mutations
Having polyps
Alcohol
smoking
UC
PAGSU (like DK)
175
where does large bowel cancer commonly metastasise to 2
liver and lungs
176
signs and symptoms of large bowel cancer 3
LLQ pain
Blood mucous stools (fresh blood, closer to anus)
Tenesmus
same as UC
177
investigations into large bowel cancer (1st, GS, what happens if 1st comes back +)
FIT TEST (Faecal occult - Screening)- faecal immunochemical test
GS- Colonoscopy + Biopsy
Patients with a positive FIT or suspected colorectal cancer referred for a colonoscopy within 2 weeks
178
treatment for large bowel cancer 3
Surgical resection + chemo/radiotherapy
179
what r the 2 types of peptic ulcers classified under peptic ulcer disease, which is most common
gastric and duodenal
most common= duodenal
180
where r gastric ulcers found 1
Lesser curvature of the stomach
181
4 causes of gastric and duodenal ulcer
Gastritis
H. pylori
NSAIDs
Zollinger-Ellison syndrome- tumour that secretes high amounts of gastrin leading to hypersecretion of HCL
182
signs and symptoms of gastric ulcers 4
Epigastric pain- WORSE ON EATING
Dyspepsia
Perforation of the L. gastric artery- melaena and haematemesis
183
what r the investigations for gastric and duodenal ulcers
1. if red flags then GS= urgent endoscopy with biopsy
2. if no red flags then H pylori test (urea breath and stool antigen)
184
what is the condition for testing for H pylori with stool antigen/ urea breath test and why
has to be off PPI for 2 weeks prior to reduce false positive
185
treatment for gastric and duodenal ulcers 1 and what is the specific treatment if peptic ulcer disease is found 1
1. treat causes eg stop NSAIDs/ H pylori treatment
2. if peptic ulcer disease found then rescope 6-8 weeks later
186
acute complication of gastric ulcer
Bleeding due to ruptured left Gastric artery
187
where r duodenal ulcers found 2
D1/D2 posterior wall
188
signs and symptoms of duodenal ulcers 4
Epigastric pain- BETTER AFTER EATING
Dyspepsia
Perforation of gastroduodenal artery- melaena and haematochezia
189
what r haemorrhoids
enlarged veins around anus
190
3 causes of haemorrhoids and main cause
MC: constipation
anal sex
pregnancy
191
grades of haemorrhoids 4
1. No prolapse
2. Prolapse when straining and return on relaxation
3. Prolapse when straining and can be manually pushed back in
4. Prolapse permanently
192
signs and symptoms of haemorrhoids 2
haematachezia
Puritis anus
193
investigations of haemorrhoids for internal and external prolapses (1,1)
External prolapsed- PR
Internal prolapsed- proctoscopy
194
conservative treatment for haemorrhoids 4
topical treatment
IV fluid, fibre and laxatives for constipation
195
haemorrhoid treatment 1st and 2nd grade 1
rubber band ligation
196
haemorrhoid treatment 3rd and 4th grade
haemorrhoidectomy
197
what is a perianal abscess
Infection in anorectal tissue
198
causes of perianal abscess 3
anal trauma (anal sex-> oral gland infection)
Crohn’s
ANAL fistula
199
signs and symptoms of perianal abscess 2
Perianal pain
pus in stool
200
treatment for perianal abscess 2
Surgical removal and drainage
201
what is anal fistula
Abnormal ‘passage’ form between the epithelial surface of the anal canal and skin
202
causes of anal fistula 2
Perianal abscesses
Crohn’s disease
203
signs and symptoms of anal fistula 3
Throbbing pain worse on sitting
Blood mucous in stool
Puritis
204
treatment for anal fistula 2
Surgery
Treat with antibiotics if infected
205
what is an anal fissure
Tear in anal skin lining below dentate line
206
causes of anal fissure3
Constipation (MC)
Anal trauma
Crohn’s and UC
207
signs and symptoms of anal fissure 2
Extreme pain on defecation
Anal bleeding
208
treatment for anal fissure 2
Stool softening- increase Fibre and fluids
209
what is a pilonidal sinus/ abscess- pathophysiology
Hair follicles get stuck in natal cleft (bumcrack) which form sinuses and can get infected to form abscesses
210
risk factor for pilonidal sinus/ abscess 1
hairy people
211
signs and symptoms of pilonidal sinus/ abscess
swollen pus filled smelly abscess on bumcrack
viable on exam
212
treatment for pilonidal sinus/ abscess 2
Surgery and hygiene advice
213
what is Pseudomembranous colitis
Inflammation of the colon due to overgrowth of C. difficile and a recent history of antibiotic use
214
causes of Pseudomembranous colitis 4
Clindamycin (see linda my sin)
CIPROFLOXACIN
Cephalosporins
Penicillin
215
pathophysiology of Pseudomembranous colitis
Normal GIT flora is killed by Abx and C. difficile is replaced
216
signs and symptoms of Pseudomembranous colitis 1
Severe infectious diarrhoea
217
treatment of pseudomembranous colitis 3
Stop using C’s Abx
Give metronidazole, vancomycin
