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GASTROINTESTINAL > CORE CONDITIONS > Flashcards

CORE CONDITIONS Flashcards

1
Q

GORD: Description

A

When acid travels out of the stomach into the oesophagus damaging the endothelium which is not designed to be resistant to acid.

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2
Q

GORD: Epithelial patterns

A

Normal endothelium of oesophagus is STRATIFIED SQUAMOUS

In stomach this becomes COLUMNAR + GOBLET CELLS

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3
Q

GORD: Complications

A

If GORD is persistent the oesophagus undergoes adaptive change in epithelium to become resistant to acid. Changes from strat. squamous to columnar - BARRET’S OESOPHAGUS.
METAPLASIA

ALSO: ulceration, malignancy neoplasm

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4
Q

GORD: Aetiology/RFs

A

Obesity as well as long-term exposure to spicy or fatty foods and alcohol.

Hiatal hernia
LOS incompetence 
Slow draining from the stomach 
Smoking 
Pregnancy 
H. Pylori 
NSAID overuse
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5
Q

GORD: Presentations (signs and symptoms)

A

Central chest pain in vertical line. Sharp pain brought on by eating and worse when lying flat

  • Heartburn
  • Over salivation
  • Metallic or unusual taste in mouth
  • Vomiting
  • Dysphagia
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6
Q

GORD: Management

A

PPIs (omeprazole, lansoprazole)
Sitting up
Antacids (Calcium carbonate)

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7
Q

Peptic Ulcer: Description

A

Either DUODENAL (more common) or gastric. Small areas of break down in the epithelium

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8
Q

Peptic Ulcer: Aetiology/RFs

A

Stomach in constant homeostatic acid balance.
ACID FACTORS: acid, pepsin, h. pylori, bile
ANTACID FACTORS: mucus, bicarbonate and cell turnover). Ulcers occur when this is imbalances and corrosion occurs
RF: H. pylori, NSAIDs, steroids, SSRIs, Blood group O, Smoking, Stress, Aggravating Foods, Alcohol

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9
Q

Peptic Ulcer: Presentation (signs and symptoms)

A 
Epigastric pain (before meals or at night) relieved by drinking milk
Epigastric tenderness
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10
Q

Peptic Ulcer: Investigations and Dx

A

Endoscopy confirms
>55yo presenting with epigastric tenderness ALWAYS send for endoscopy because high risk for neoplasm
Biopsy can also test for H.pylori

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11
Q

Peptic Ulcer: Complications

A

Bleed, Perforate, malignant transformation, decrease gastric outflow

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12
Q

Peptic Ulcer: Management

A

IF H.PYLOR POSITIVE: Full dose PPI, Amoxicillin OR metronidazole
Clarithromycin
Avoid RFs

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13
Q

Oesophageal Carcinoma: Description

A

Malignancy. 20% in upper part, 50% in middle and 30% in lower 1/3
Either SQUAMOUS CELL (if proximal) or ADENOCARCINOMAS (distal)

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14
Q

Oesophageal Carcinoma: Epi

A

More common in middle eastern countries (diet?)

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15
Q

Oesophageal Carcinoma: Aetiology and RFs

A 
Diet
Reflux + Barret's
Smoking 
Alcohol
Achalasia (failure of LOS to open fully)
Plummer-Vinson syndrome (difficulty swallowing with iron def. anaemia and glossitis)
>55yo
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16
Q

Oesophageal Carcinoma: Presentation (signs and sx)

A 
Dysphagia
Weight loss
Reflux (chest pain)
Hoarseness (upper 1/3)
Cough (upper 1/3)

Always ask about red flag symptoms so as to differentiate from reflux

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17
Q

Oesophageal Carcinoma: Ix and Dx

A

Endoscopy + Biopsy

CT/MRI for staging

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18
Q

Oesophageal Carcinoma: Management

A

Radiotherapeutic oesophagectomy for mild disease.

Prognosis generally poor

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19
Q

Gastric Carcinoma: Description

A

Almost always adenocarcinoma found in middle stomach. V hard to detect and hence have poor prognosis.
incidence approx 23/100,000

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20
Q

Gastric Carcinoma: Aetiology and RF

A 
Pernicious Anaemia 
Blood group A 
H. pylori 
Atrophic gastritis 
Adenomatous polyps 
Lower social class 
Smoking 
Diet
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21
Q

Gastric Carcinoma: Presentation (signs and symptoms)

A 
Dyspepsia (reflux, chest pain)
Weight loss 
Vomiting +/- blood 
Dysphagia 
Anaemia 
Epigastric mass on palpation (poor prognostic sign)
Hepatomegaly 
Jaundice 
Ascites
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22
Q

Gastric Carcinoma: Ix and Dx

A

Gastroscopy and biopsy
CT/MRI staging
Cytology

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23
Q

Gastric Carcinoma: Management

A

Surgical resection or total gastrectomy
COMBO CHEMO: 5-flouroouracil)
HER-2 receptor is found in some tumours they have a slightly better prognosis because they respond better to TRASTUZUMAB

Overall 5 year survival is <10%

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24
Q

Colorectal Carcinoma: Description

A

Usually an adenocarcinoma

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25
Q

Colorectal Carcinoma: Epi

A

3rd most common cancer in the UK (after lung and breast) and the 2nd biggest cancer killer

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26
Q

Colorectal Carcinoma: Aetiology and RFs

A 
Polyps
IBD
Genetic predisposition(FAP and HNPCC)
Diet (low in finer and high in red and processed meat)
Alcohol
Smoking
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27
Q

Colorectal Carcinoma: Presentations (Signs and symptoms)

A

Depends on site:
L-SIDED: Blood or mucus in stool, palpable mass on PR
Changes in bowel habit
Weight loss
Tenesmus (feeling of incomplete defecation)
RIGHT-SIDED: more severe weight loss, anaemia, abode pain, obstruction less likely

GENERAL: Abdo mass, perforation, haemorrhage, fistulas

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28
Q

Colorectal Carcinoma: Ix and Dx

A 
BLOOD: FBC (Hb MICROCYTIC ANAEMIA)
Faecal occult blood 
Sigmoidoscopy
Colonoscopy
Barium Enema 
LFT 
CT/MRI
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29
Q

Colorectal Carcinoma: Staging

A

DUKE’S STAGING + 5 year survival
A. Limited to muscularis propria = 93%
B. Extension through muscularis propria = 77%
C. Involvement of regional lymph nodes = 48%
D. Distant metastases = 6.6%

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30
Q

Colorectal Carcinoma: Management

A

Surgical Resection
Chemotherapy
Radiotherapy

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31
Q

Pancreatic Carcinoma: Description

A

Adenocarcinoma. Mostly arise in pancreatic head and metastasis early and easily

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32
Q

Pancreatic Carcinoma: Epi

A

approx. 2% malignancies. V bad prognosis, causes around 6,500 deaths p.a.

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33
Q

Pancreatic Carcinoma: Aetiology and RF

A 
Smoking 
ALCOHOL
DM 
Large waist circumference 
Chronic pancreatitis 
95% have KRAS2 gene
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34
Q

Pancreatic Carcinoma: Presentations (Signs and symptoms)

A

HEAD: painless, obstructive jaundice
TAIL: epigastric pain
GENERAL: weight loss, anorexia, diabetes, acute pancreatitis, thrombophlebitis migrant (vein in arm or leg becomes swollen), hypercalcaemia, portal hypertension
SIGNS: jaundice, palpable gall bladder, epigastric mass, hepatosplenomegaly, lymphadenopathy, ascites

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35
Q

Pancreatic Carcinoma: Ix and Dx

A

BLOOD: cholestatis jaundice is non-specific but a good marker for prognosis
IMAGING: CT and USS can help get a specific location and guide a biopsy

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36
Q

Pancreatic Carcinoma: Management

A

Most cases have already metastasised on presentation and so are poor candidates for surgery. Could try:
Pancreatic-duodectomy (Whipple’s)
Tail excision

5 year survival is 3%

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37
Q

Ascites: Description

A

Collection of >25mL fluid in peritoneal space. Good indicator of liver disease because suggests hypoalbuminaemia. Albumin is key transport protein (unconj. bili) hence associated jaundice. Also contributes to osmotic pressure in blood.
Less albumin, less osmotic draw into blood so cells swell with fluid

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38
Q

Ascites: Aetiology and RF

A

Chronic Liver Disease

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39
Q

Ascites: Presentations (Signs and symptoms)

A

SHIFTING DULLNESS. Percuss from centre working laterally until percussion note is dull. Then get them to lie on opposite side and stay there for 30s-1min and repeat. Dullness should have shifted.
If large might impact breathing. Presents alongside:
- Spider naevi
- Leg swelling and bruising
- Haemtemesis
- Gynecomastia
- Encephalopathy

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40
Q

Ascites: Management

A

DIURETICS and treat cause.
SPIRONOLACTONE and then a loop diuretic such as furosemide.
Don’t use spironolactone if patient already has gynecomastia

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41
Q

Coeliac Disease: Description

A

Aversion and intolerance to gluten (gliadin = metabolite of gluten). AI reaction when the body starts to destroy intestinal epithelium (VILLOUS ATROPHY)

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42
Q

Coeliac Disease: Aetiology and RF

A

Almost all people with coeliac share alleles (HLA-DQ2 and HLA-DQ8)
FH++

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43
Q

Coeliac Disease: Presentations (signs and symptoms)

A 
Weight loss
Diarrhoea 
Blood in stool
Smelly stools/steatorrhoea
Abdo pain and bloating following ingestion of gluten 
Vomiting 
Aphthous ulcers (mouth)
Fatigue 
Weakness
Failure to thrive
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44
Q

Coeliac Disease: Ix and Dx

A

MALABSORPTION:

  • Reduce Hb
  • Reduced B12
  • Reduced Ferritin
  • Alpha-Gliadin
  • Anti-Transglutaminase Antibodies
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45
Q

Coeliac Disease: Management

A

LIFELONG avoidance of gluten and treatment of any vitamin deficiencies and anaemia

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46
Q

Upper GI Bleed: Presentation

A

Bleeding can present in many ways depending on level:

  • HAEMATEMESIS: vomiting blood, might be bright red or dark and coffee ground depending on level. Bright red suggests a MALLOR-WEISS TEAR. Coffee ground suggests blood has come from further down
  • MALAENA: dark, pungent stools. Bleed in the upper GI system. Blood digested
  • ANAEMIA: common P/C
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47
Q

Upper GI Bleed: Important Fx in Hx

A
  • PMH of dyspepsia or ulcer
  • Any known liver disease
  • Duration of sx
  • Recent weight loss?
  • Co-morbidities
  • Difficulty swallowing
  • Changes in bowel habits
48
Q

Upper GI Bleed: Complication

A

Always look out for signs of SHOCK (hypovolaemic)

  • Peripheral shut down (cool/clammy and long CRT)
  • Decreased GCS
  • Poor urine output
  • Tachycardia
  • Systolic BP <100mmHg
49
Q

Upper GI Bleed: Causes

A
  • Peptic ulcer rupture
  • Oesophageal varices
  • Gastritis
  • NSAID use
  • Oesophagitis
  • Duodenitis
  • Malignancy
  • Bleeding disorders
  • Meckel’s diverticulum
  • Peutz-Jehger’s syndrome
50
Q

Upper GI Bleed: Acute Management

A
  • Insert 2 large-bore cannulas and take blood (FBC) U&E, LFT, Clotting and Group and Save
  • Give IV fluids. 0.9& glucose or haartman’s 500mL over 10-15min
  • Insert catheter to monitor urine output
  • CXR, ECG and ABG
  • Transfuse with cross-matched blood ASAP
  • Consider highest dose omeprazole
  • Urgent endoscopy
51
Q

IBD Crohn’s: Description

A 
Inflammation of digestive tract (mouth to anus) FULL THICKNESS (transmural). Terminal ileum and proximal colon most likely to be affected.
SKIP LESIONS (not continuous inflammation)
52
Q

IBD Crohn’s: Epi

A

1/1000. More common in caucasian

53
Q

IBD Crohn’s: Aetiology and RFs

A

Familial link with mutations NOD2, CARD15
Smoking increases risk
NSAIDs increase risk

54
Q

IBD Crohn’s: Presentation (signs and symptoms)

A

Common age of first presentation 20-40:

  • urgency of defecation and diarrhoea
  • abdo pain
  • weight loss and anorexia
  • fever and vomiting
  • malaise
  • aphthous ulcers
  • abdo tenderness and mass
  • peri-anal abscesses
  • clubbing
  • skin, joint and eye problems
55
Q

IBD Crohn’s: Ix and Dx

A

BLOODS: (FBC, U&E, ESR, CRP, LFT, INR, Ferritin, B12 and folate)
STOOL SAMPLE: Exclude infection
COLONOSCOPY and rectal biopsy
ENEMA

56
Q

IBD Crohn’s: Management

A

In mild attacks: Prednisolone 30mg PO for 1 week
In severe attacks: High dose hydrocortisone + metronidazole (in extensive peri-anal disease)
Consider INFLIXIMAB

57
Q

IBD UC: Description

A

Inflammation exclusively in large bowel. Most commonly in rectum and L-side descending colon
Inflammation is just inner layer of gut but IS CONTINUOUS. May be polyps or pseudo-polyps.

58
Q

IBD UC: Epi

A

Slightly more common than crohn’s. 1-2/1000 F>M

59
Q

IBD UC: Aetiology and RFs

A

Again largely unknown. Familial link and AI component

  • smoking is PROTECTIVE and disease more prevalent among non-smokers
  • disease relapses when people stop smoking
60
Q

IBD UC: Presentation (signs and symptoms)

A 
episodic and crampy diarrhoea +/- blood or mucus
Clubbing 
Erythema nodosum (red lumps under skin)
Pyoderma gangrenosum
Conjunctivitis 
Episcleritis 
Iritis 
Large joint arthritis 
Sacroilitis 
Ankylosing spondylitis
61
Q

IBD UC: Ix and Dx

A

BLOODS: FBC, ESR, CRP, U&E, LFT, Cultures
STOOL: Exclude infection
AXR: no faecal shadows, mucosal thickening
ERECT CXR: might see bowel perf
COLONOSCOPY: confirm and show extent

62
Q

IBD UC: Management

A

SULFASALAZINE: induces remission. Consider prednisolone for inflammation
If more severe then replace prednisolone with hydrocortisone.

63
Q

IBS: Description

A

Diagnosis of exclusion for persistent abdominal symptoms for which no organic cause can be found.

64
Q

IBS: Epi

A

10-20%. Usually in people <40. Young adult females are high risk group.

65
Q

IBS: Aetiology and Risk Factors

A

No organic cause of IBS. Could be due to hyper-motility of the bowel and over-reaction of the visceral gut response (the brain of the gut)
Slight familial pattern

66
Q

IBS: Presentation (signs and symptoms)

A 
Cramping abdominal pain which is relieved by defecating.
Change in frequency or consistency of stools.
High urgency to defecate
- Bloating 
- Mucus on PR or stools 
- Nausea 
- Made worse by certain foods
- Bladder symptoms 
- Backache
67
Q

IBS: Ix and Dx

A

PR
Colonoscopy and biopsy (consider in higher risk groups e.g. >50y +PMH cancer, or if red flag sx)
BLOODS: coeliac serology

68
Q

IBS: Management

A

Encourage healthy diet and avoiding aggravating foods (+fiber) avoid lactose and fatty foods, alcohol and fizzy drinks
Hypnosis can be effective

69
Q

Infective Gastroenteritis: Description

A

One particular strain of gut flora takes over. Viral causes have shorter presentations

70
Q

Infective Gastroenteritis: Causative agents

A

Bacterial: Campylobacter, E.coli O157, Clostridium difficile
Viral: rotavirus and norovirus

71
Q

Infective Gastroenteritis: Aetiology and RFs

A

Depends on cause. Spread through FO route

72
Q

Infective Gastroenteritis: Presentations (signs and symptoms)

A
  • Diarrhoea and vomiting
  • Fever, rigors, sweats
  • Anorexia
  • > 2week duration
73
Q

Infective Gastroenteritis: Ix and Dx

A

Stool microscopy/culture might be useful if sx are slightly unusual or lasting a long time

74
Q

Infective Gastroenteritis: Management

A

ORT
Abx only indicated in the very vulnerable (resistance is common)
CHOLERA: tetracycline is good at reducing transmission)
SALMONELLA: ciprofloxacin
SHIGELLA AND CAMPYLOBACTER: ciprofloxacin

75
Q

Pancreatitis (acute): Description

A

inflammation of pancreas caused by auto-digestion of pancreatic parenchyma. Commonly associated with oedema and fluid shifts leading to hypovolaemia

76
Q

Pancreatitis (acute): Aetiology and RFs

A 
ALCOHOLISM (and fatty change)
GET SMASHED
Gall stones 
Ethanol 
Trauma 
Steroids 
Mumps 
Autoimmune 
Scorpion venom 
Hyperlipidaemi, hypothermia or hypercalcaemia 
ERCP and emboli 
Drugs
77
Q

Pancreatitis (acute): Presentation (signs and symptoms)

A 
Severe epigastric pain that is exacerbated by eating and radiates to back
Vomiting 
Tachycardia 
Fever 
Jaundice 
Shock 
Rigid abdomen 
Tenderness 
Peri-umbilical bruising (CULLEN'S)
Flank bruising (GREY-TURNER'S)
78
Q

Pancreatitis (acute): Ix and Dx

A 
BLOODS: amylase and lipase (degree of elevation not necessarily proportional to extent of disease)
ABG, CXR US and CRP
GLASGOW CRITERIA FOR SEVERITY (PANCREAS):
PaO2 <8kPa
Age >55y
Neutrophilic WBC >15x10^9
Calcium <2mmol/L
Renal function: urea>16mmol/L
Enzymes LDH>600, AST>200
Albumin <32g/dL
Sugar: blood glucose >10mmol/L
79
Q

Pancreatitis (acute): Management

A 
NBM (+NG tube)
IV and give lots of 0.9% saline 
Insert catheter and monitor output 
Analgesia (morphine or pethidine)
Record obs hourly
80
Q

Pancreatitis (chronic): Description

A

Inflammation of pancreas but long term. Also caused by auto-digestion and can also have AI component.

81
Q

Pancreatitis (chronic): Aetiology and RFs

A

ALCOHOL
Cystic fibrosis
Familial links
Haemochromatosis

82
Q

Pancreatitis (chronic): Presentations (signs and symptoms)

A 
Epigastric pain radiating to back.
Steatorrhoea 
Weight loss 
Diabetes 
Relapse and remitting pattern
83
Q

Pancreatitis (chronic): Ix and Dx

A

USS diagnostic (+CT)

84
Q

Pancreatitis (chronic): Management

A

Analgesia important
Replacement lipase (Creon)
Replacement fat soluble vitamins: A, D, E and K
Replacement insulin
Low fat diet
Pancreatectomy might be useful for very severe

85
Q

Gall Stones: Description

A

Solidification of the bile in the gall bladder or further down in CBD.
Bile is cholesterol, bile salts and phospholipids in specific amounts. If ratios alter then precipitates form:
BILE PIGMENT STONES (Small and fragile)
CHOLESTEROL STONE (large and often solitary)
MIXED: faceted

86
Q

Gall Stones: Epi

A

8% of those over 40. F>M. 90% asx.

Higher risk of sx if smoker and have children

87
Q

Gall Stones: Aetiology and RF

A

Fat, Female, Fertile, Forty, Fair

Associated with cholecystitis

88
Q

Gall Stones: Presentations (Signs and symptoms)

A

Pain in epigastric region or RUQ.
- Pain is severe and continuous in acute cholecystitis
- Pain is colicky in chronic cholecystitis
ACUTE: vomiting, fever, local peritonism, GB mass, obstructive jaundice and cholangitis
MURPHY’S SIGN
CHRONIC: colicky pain as well as flatulence, distension and discomfort, nausea and fat intolerance
BILIARY COLIC

89
Q

Gall Stones: Ix and Dx

A

Elevated WCC. USS (thickened wall of GB and CBD)

90
Q

Gall Stones: Management

A

NBM and die cefuroxime for acute GS. Consider a cholecystectomy
CHRONIC: cholecystectomy.

91
Q

Appendicitis: Description

A

Acute inflammation of the vermiform appendix usually secondary to infection

92
Q

Appendicitis: Epi

A

Lifetime incidence of 6%. Most common ages of presentation 10-20y

93
Q

Appendicitis: Aetiology and Risk Factors

A

Idiopathic. Bowel contents become static in the vermiform appendix and the overgrowth of bacteria less to inflammation. There is also a surrounding oedema due to the bacteria which can cause necrotic ischaemia and perforation.

94
Q

Appendicitis: Presentation (signs and symptoms)

A

Acute, intense pain in the RIF. Pain starting in the umbilicus moves to the RIF when the appendix becomes so inflamed as to touch the overlying peritoneum.
Vomiting +++
Guarding and rebound tenderness at McBurney’s point (1/2 between ASIS and umbilicus)
Changes in bowel habits
Tachycardia, fever and furred tongue
Might not always have pain.

95
Q

Appendicitis: Ix and Dx

A

USS

BLOODS: FBC, CPR, ESR and WCC

96
Q

Appendicitis: Differentials

A 
Ectopic pregnancy
UTI
Mesenteric adenines 
Cholecystitis 
Diverticulitis 
Crohn's disease 
Perforated ulcer 
Food poisoning or acute GIitis 
Merkel's diverticulum
97
Q

Appendicitis: Management

A

Laparoscopic appendicectomy WITH METRONIDAZOLE AND CEFUROXIME
Take Special care in pregnant women

98
Q

Bowel Obstruction: Description

A

Blockage in the bowel: can be partial or full and happen for many reasons.
Complete absence of peristaltic contraction = paralytic ileus

99
Q

Bowel Obstruction: Aetiology and Risk Factors

A

Likely causes depend on where the blockage is:
SMALL BOWEL: adhesions (sticking together of the bowel wall), Hernias
LARGE BOWEL: colon carcinoma, constipation, diverticular disease, volvulus (bowel twisting round itself. Can be very serious if the mesenteric blood supply is compromised)
RARER: Crohn’s, Gallstone ileus, intussusception, TB, foreign body
PSEUDO-OBSTRUCTIONS (can be caused by surgery)

100
Q

Bowel Obstruction: Presentation (signs and symptoms)

A

FOUR KEY SIGNS:

  • Vomiting (projectile and copious. Can also be faecal vomiting)
  • Colicky pain (long term obstruction might not have pain)
  • Constipation or absence of defecation
  • Distension

TINKLING bowel sounds

101
Q

Bowel Obstruction: Ix and Dx

A

Important to try and decide where you think the bowel is before you investigate.
(Small bowel vomiting will be more prominent, large bowel pain and distension more so)
Endoscopy
AXR (gas in the small bowel)
PR

102
Q

Bowel Obstruction: Ileus

A

Ileus is a functional disfunction or mechanical disfunction. Less or no pain and less or no bowel sounds

103
Q

Bowel Obstruction: Volvulus

A

Potentially fatal if the bowel becomes ischaemic and necrotic.
SIMPLE: one obstruction point and no valvular compromise
CLOSED LOOP: obstruction at two points forming loop which is grossly distended and at higher risk of perf
STRANGULATED: blood supply compromised. Sharp localised pain - might have peritonism.

104
Q

Bowel Obstruction: Management

A

Surgery
NBM: NG tube and IV fluids
Analgesia and bloods: FBC, amylase, U&Es, Erect CXR and catheterise
AXR and CXR and maybe CT

105
Q

Inguinal Hernia: Description

A

Most common type (in men), weakness in inguinal canal
DIRECT: weakness in posterior inguinal canal wall (most likely at HESSELBACH’S TRIANGLE)
INDIRECT: entered at deep ring and travels the length : more likely to protrude into scrotum

106
Q

Inguinal Hernia: Aetiologies and Risk Factors

A

M»F
Chronic cough, heavy lifting, constipation, previous abdominal surgeries
Anything that raises the INTRA-ABDOMINAL PRESSURE

107
Q

Inguinal Hernia: Presentation (Signs and symptoms)

A

Large, reducible, soft mass in the scrotum or groin. Move when patient coughs
Examine when standing and lying
Determine between direct and indirect by occluding deep ring and asking to cough

108
Q

Inguinal Hernia: Ix and Dx

A

USS can be useful but diagnosis can be made clinically

109
Q

Inguinal Hernia: Management

A

Surgical repair (not always necessary to intervene)
Advise healthy lifestyle and 2-4 weeks off work following surgery
10 weeks convalescence following surgery

110
Q

Femoral hernia: Description

A

Most common type in women. Protrusions in the femoral canal and can appear above or below the inguinal ligament. More likely to be strangulated

111
Q

Femoral hernia: Presentations (signs and symptoms)

A

Reducible mass in upper, inner 1/3 of the thigh.

Differentials include lymphadenopathy in CLOQUET’S node (femoral node). Could also be femoral artery aneurysm

112
Q

Bowel Perforation: Description

A

Hole in the wall of the bowel. Common precursor is peptic ulcer

113
Q

Bowel Perforation: Presentation (signs and symptoms)

A

Acute and severe abdominal pain. Initially focal then diffuse (PERITONITIS). Person might not be moving or talking because their abdomen hurts so much. Be wary of sepsis and tachycardia.

114
Q

Bowel Perforation: Ix and Dx

A

erect CXR. Air will collect under one of the hemi-diaphragms (Pneumoperitoneum)

115
Q

Bowel Perforation: Management

A

Always surgical

Peritoneal wash

116
Q

Viral Hepatitis: Hep A

A

RNA virus.
FO route of transmission (shellfish)
Endemic in Africa and S America (Hx of TRAVEL)
Incubation: 2-6weeks
Sx: fever, malaise, anorexia, nausea, arthralgia THEN jaundice, hepatosplenomegaly and adenopathy
Tests: AST and ALT rise 22-40days after exposure. ALT can be v high. Returns to normal after 5-20weeks.
IgM detectable at day 25.
IgG detectable FOR LIFE
Usually self-liming and not serious
NO RISK OF CHRONICITY
Can be immunised - recommended for all children >12/12.

117
Q

Viral Hepatitis: Hep B

A

DNA.
Blood-Borne (IVDU, blood products, sex and direct contact)
Incubation: 1-6months
Signs: fever, malaise, anorexia, weight loss, arthralgia, urticaria
Tests: surface antigen present 1-6months after exposure. If surface antigen persists for 6 months after then person is carrier (5-10%)
PROG: Becomes chronic 10% time. Treat with interferon, avoid alcohol and immunise sexual contacts

GASTROINTESTINAL (1 decks)

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