Abdo/ GI Flashcards
GORD
Epidemiology
1in4 adults experience heartburn
Men > women
GORD
Causes
Lifestyle: Alcohol, smoking, obesity, stress, coffee, chocolate
Organic: Increased abdo pressure (pregnancy)
Decreased gastric emptying
Inadequate cardiac sphincter (Nitrates, Ca channel blockers, tricyclics)
GORD
Symptoms
Heartburn - worse after meals and lying down Cough Retrosternal discomfort Bad breath Tooth decay Chest pain
GORD
Investigations
Endoscopy pH monitoring (see if acidic pH in oesophagus matches symptoms) Barium swallow - Hiatus hernia
GORD
Management
Lifestyle: Weight loss, upright bed, smoking cessation, smaller meals, less alcohol
PPI
H2 receptor antagonist for quick onset or persistent symptoms
GORD
Red Flags
Late onset dyspepsia
Dyspepsia with jaundice, pernicious anaemia or mass
Weight loss, anaemia, vomiting
Peptic Ulcer
Epidemiology
1in10 people get one in a lifetime
Men > women
More common in voer 60s
Duodenal ulcer more common than gastric
Peptic ulcer
Causes
NSAIDs
H. pylori
Other: smoking, stress, alcohol, steroids, genetics
Peptic ulcer
Risk Factors
Smoking
Stress
Alcohol
Genetics - type O blood
Peptic ulcer
Symptoms
Gnawing epigastric pain, relieved by eating and can wake in night Indigestion Lack of appetite Oral flatulence Bloating
Peptic Ulcer
Red flags
Melena
Haemetemesis
Coffee ground stool
Acute abdomen
Peptic ulcer
ALARMS
Anaemia Loss of weight Anorexia Recent symptoms Melena/ haemetemesis Swallowing difficulty
Peptic ulcer
Investigations
Endoscopy if ALARMS
H. pylori test - urea breath or stool antigen
Biopsy if not NSAID or H. pylori
Peptic ulcer
Management
H. pylori - PPI, Antibiotics (amoxicillin, clarythromycin, metronidazole) then test eradication
NSAID - Stop NSAID, PPI
Check bleeding with Rockall or Glasgow-Blatchford score
Stop smoking and taking NSAIDs
Upper GI Bleed
Epidemiology
100/100,000 per year
10% mortality
Upper GI bleed
Common causes
Peptic ulcer Mallory-Weiss tear Gastritis Oesophageal varices Malignancy Oesophagitis
Upper GI bleed
Rare causes
Pancreatic pseudocyst
Ehler’s Danlos
Haemobilia
Upper GI bleed
Risk factors for rebleeding
Shock on admission
60+
Coagulopathy
Cardiovascular disease
Upper GI Bleed
Symptoms
Melena Coffee ground stool Haemetemesis (Fresh PR bleeding indicates massive bleed) Dizziness
Upper GI Bleed
Signs
Shock
Anaemic
Hypotensive
Dehydration
What is Boerhaave’s syndrome?
Oesophageal tear due to vomiting
Upper GI bleed
Investigations
Urea: creatinine ratio (30+ means increased risk)
CT - Pancreatitis, cholecystitis, liver disease
PR and abdo exam
Cross Match blood for transfusion
Upper GI bleed
Management
Manage fluid loss
Varices - band
Non-variceal - mechanical/ thermal coagulation
O2 face mask
