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Internal Medicine > Davidson - Alimentary Tract And Pancreatic Disease > Flashcards

Davidson - Alimentary Tract And Pancreatic Disease Flashcards

1
Q

In clinical examination of the GI, what do we examine on hands?

A
  1. Clubbing (in a patient with malabsorption)
  2. Koilonychia
  3. Signs of liver disease
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2
Q

In clinical examination of the GI, what do we examine regarding skin and nutritional status?

A
  1. Muscle bulk

2. Signs of weight loss

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3
Q

What do we generally observe before the clinical examination of the GI?

A
  1. Distressed/in pain?
  2. Fever?
  3. Dehydrated?
  4. Habitus
  5. Skin
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4
Q

What do we observe during the abdominal examination?

A
  1. Distention
  2. Respiratory movements
  3. Scars
  4. Colour
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5
Q

What is the course of clinical examination of the GI?

A

First, observe –> Skin and nutritional status –> Hands –> Head and neck –> Abdominal examination –> Palpate, percuss, auscultate –> Groin for hernia/lymph nodes –> Perineum and rectal for Fistulae/skin tags/haemorrhoids/masses.

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6
Q

What are the possible findings in examination of the RUQ?

A

Hepatomegaly and palpable gallbladder.

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7
Q

What are the possible findings if we examine an epigastric mass?

A
  1. Gastric cancer
  2. Pancreatic cancer
  3. Aortic aneurysm
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8
Q

What are the possible findings when we palpate a LUQ mass?

A

Spleen:
Edge - Can’t get above it - Moves towards right - Iliac fossa - Dull percussion note - Notch.
Kidney:
Rounded - Can get above - Moves down - Resonant to percussion - Ballotable.

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9
Q

What are the possible findings when the abdomen is tender to palpation?

A 
Peritonitis:
1. Guarding and rebound
2. Absent bowel sounds
3. Rigidity
Obstruction 
1. Distended 
2. Tinkling bowel sounds 
3. Visible peristalsis
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10
Q

What are the possible findings when we palpate a left iliac fossa mass?

A
  1. Sigmoid colon cancer
  2. Constipation
  3. Diverticular mass
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11
Q

What are the possible findings when we palpate a suprapubic mass?

A
  1. Bladder
  2. Pregnancy
  3. Fibroids/carcinoma
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12
Q

What are the possible findings when we palpate a right iliac fossa mass?

A
  1. Caecal carcinoma
  2. Crohn
  3. Appendix abscess
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13
Q

What should we keep in mind when we see generalized distention of the abdomen?

A
  1. Fat (obesity)
  2. Fluid (ascites)
  3. Flatus (obstruction/ileus)
  4. Faeces (constipation)
  5. Fetus (pregnancy(
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14
Q

What should we think when we examine the rectum and find anal disease?

A
  1. Tags
  2. Hemorrhoids
  3. Polyps
  4. Crohn disease
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15
Q

What are the possible findings regarding the stool in rectal examination?

A
  1. Consistency

2. Colour - steatorrhoea, bloody/black, faecal occult blood.

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16
Q

What percentage of the population is affected by functional bowel disorders?

A

10-15%.

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17
Q

What is the percentage of the people affected by IBD?

A

1/250

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18
Q

What is the length of the esophagus from the cricoid cartilage to the cardiac orifice of the stomach?

A

25cm.

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19
Q

During fasting, how often does a wave of peristaltic activity passes down?

A

Every 1-2h.

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20
Q

How can we classify the tests available for GI symptoms?

A

Tests of:

  1. Structure
  2. Infection
  3. Function
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21
Q

What is the importance of plain X-rays of the abdomen?

A

Useful for:

  1. Intestinal obstruction
  2. Paralytic ileus
  3. Dilated loops of bowel and fluid levels may be seen.
  4. Also gallstones and renal stones.
  5. Calcified lymph nodes
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22
Q

What may be seen on an CXR regarding the abdomen?

A

Subdiaphragmatic air - diagnosis of suspected perforation.

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23
Q

What are the indications and major uses of barium shallow/meal?

A
  1. Motility disorders (achalasia and gastroparesis).

2. Perforation or fistula (non-ionic contrast).

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24
Q

What are the indications and major uses of Barium follow-through?

A
  1. Diarrhea and abdominal pain of small bowel origin.
  2. Possible obstruction by strictures.
  3. Suspected malabsorption.
  4. Crohn’s disease assessment.
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25
Q

What are the indications and major uses of barium enema?

A
  1. Altered bowel habit
  2. Evaluation of strictures or diverticular disease
  3. Megacolon
  4. Chronic constipation
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26
Q

What are the limitations of barium shallow-meal?

A
  1. Risk of aspiration
  2. Poor mucosal detail
  3. Low sensitivity for early cancer
  4. Inability to biopsy
27
Q

What are the limitations of barium follow-through?

A
  1. Time consuming
  2. Radiation exposure
  3. Relative insensitivity
28
Q

What are the limitations of barium enema?

A
  1. Difficult in frail or incontinent patients.
  2. Sigmoidoscopy needed to see rectum.
  3. Low sensitivity for lesions <1cm.
29
Q

What are the indications and major uses of ultrasound?

A
  1. Abdominal masses
  2. Organomegaly
  3. Ascites
  4. Biliary tract dilatation
  5. Gallstones
  6. Guided biopsy lesions
  7. Small bowel imaging
30
Q

What are the limitations of ultrasound?

A
  1. Low sensitivity for small lesions.
  2. Little functional information
  3. Operator-dependent
  4. Gas and obesity may obscure view
31
Q

What are the indications and major uses of CT in GI imaging?

A
  1. Assess pancreatic disease
  2. Hepatic tumor deposits
  3. CT colonography (virtual colonoscopy)
  4. Tumor staging
  5. Assess lesion vascularity
  6. Abscesses and collections
32
Q

What are the limitations of CT in GI imaging?

A
  1. Cost

2. Radiation dose

33
Q

What are the indications and uses of MRI in GI imaging?

A
  1. Hepatic tumor staging
  2. MRCP
  3. Pelvic and perianal disease
  4. Crohn’s Fistulae
  5. Small bowel visualization
34
Q

What are the limitations of MRI in GI imaging?

A
  1. Claustrophobic patients

2. Contra in presence of metallic prostheses, cardiac pacemaker, cochlear implants.

35
Q

What are the indications and major uses of CT-PET in GI imaging?

A
  1. Detection of metastases not seen in US or CT.

2. Images can be fused with CT to form composite image.

36
Q

How many hours must the patient be fast for an upper GI endoscopy?

A

At least 4 hrs.

37
Q

What sedation do we use in upper GI endoscopy?

A

Light IV benzodiazepine sedation or local anesthetic throat spray.

38
Q

How can we control bleeding endoscopically?

A
  1. Injection sclerotherapy
  2. Diathermy
  3. Variceal ligation
  4. Laser therapy
  5. Endoscopic clipping
39
Q

How can we treat tumours endoscopically?

A
  1. Laser therapy
  2. Polypectomy
  3. Photodynamic therapy/ Radiofrequency ablation
  4. Endoscopic mucosal resection
40
Q

How can we treat strictures endoscopically?

A
  1. Stent insertion
  2. Balloon dilatation
  3. Bouginage
41
Q

How can we manage biliary and pancreatic disease endoscopically?

A
  1. Sphincterotomy
  2. Basket retrieval
  3. Stent insertion
  4. Pseudocyst drainage
42
Q

Mention some indications for Upper GI endoscopy?

A
  1. Dyspepsia over 55yrs of age or with alarm symptoms.
  2. Atypical chest pain
  3. Dysphagia
  4. Vomiting
  5. Weight loss
  6. Acute or chronic GI bleeding
  7. Screening for esophageal varices in patients with chronic liver disease.
  8. Abnormal CT or barium meal
  9. Duodenal biopsies in the investigation of malabsorption.
  10. Therapeutic purposes.
43
Q

Mention some contraindications of upper GI endoscopy?

A
  1. Severe shock
  2. Recent MI, arrhythmia, unstable angina
  3. Severe respiratory disease
  4. Atlantoaxial subluxation
  5. Possible visceral perforation
44
Q

Mention some complications of upper GI endoscopy.

A
  1. Cardiorespiratory depression due to sedation.
  2. Aspiration pneumonia
  3. Perforation
45
Q

What are the indications for wireless capsule endoscopy?

A
  1. Obscure GI bleeding
  2. Small bowel Crohn’s disease
  3. Assessment of celiac disease and its complications
  4. Screening and surveillance in familial polyposis syndromes.
46
Q

What are the contraindications of wireless capsule endoscopy?

A
  1. Known or suspected small bowel stricture (risk of capsule retention).
  2. Caution in people with pacemakers or implantable defibrillators.
47
Q

Mention a complication of wireless capsule endoscopy.

A

Capsule retention (<1%).

48
Q

What are the diagnostic indications of double ballon enteroscopy?

A
  1. Obscure GI bleeding
  2. Malabsorption or unexplained diarrhea
  3. Suspicious radiological findings
  4. Suspected small bowel tumors
  5. Surveillance of polyposis syndromes
49
Q

What are the therapeutic indications of double balloon enteroscopy?

A
  1. Coagulation/diathermy of bleeding lesions.

2. Jejunostomy placement.

50
Q

What are the contraindications of double balloon enteroscopy?

A

Same as for upper GI endoscopy.

51
Q

What are the indications for colonoscopy?

A
  1. Suspected inflammatory bowel disease.
  2. Chronic diarrhea
  3. Altered bowel habit
  4. Rectal bleeding or iron def. anemia
  5. Assessment of abnormal CT colonogram or barium enema.
  6. Colorectal cancer screening.
  7. Colorectal adenoma and carcinoma follow-up.
  8. Therapeutic procedures
52
Q

What are the contraindications of colonoscopy?

A
  1. Acute severe ulcerative colitis –> Prefer unprepared flexible sigmoidoscopy.
  2. Upper GI endoscopy.
53
Q

What are the possible complications of colonoscopy?

A
  1. Cardiorespiratory depression due to sedation.
  2. Perforation.
  3. Bleeding following polypectomy.
54
Q

Where is colonoscopy NOT useful?

A

In the investigation of constipation.

55
Q

What is the tolerance of endoscopy in old age?

A

Endoscopic procedures are generally well tolerated, even in very old people.

56
Q

What are the side effects from sedation for endoscopy in old age people?

A

Older people are more sensitive, and respiratory depression, hypotension and prolonged recovery are more common.

57
Q

What antiperistaltic agents are preferred for endoscopy in old age?

A

Hyoscine should be avoided in those with glaucoma - can also cause tachyarrhythmia.
Glucagon is preferred if an antiperistaltic agent is needed.

58
Q

What is very sensitive in detecting mucosal inflammation?

A

Fecal calprotectin.

59
Q

Mention some reasons for biopsy or cytological examination.

A
  1. Suspected malignant lesions.
  2. Assessment of mucosal abnormalities.
  3. Diagnosis of infection (Candida, H.pylori, G.lamblia)
  4. Analysis of genetic mutations.
60
Q

What can give useful information about esophageal motility?

A

A barium shallow.

61
Q

What procedure is of value in diagnosing cases of GERD, achalasia, and non-cardiac chest pain?

A

Esophageal manometry, often in conjuction with 24h pH measurement.

62
Q

What is the test for lactose absorption?

A

Lactose H2 breath test.

63
Q

What is the test for bile acids absorption?

A

SeHCAT test.

64
Q

In clinical examination of the GI tract, what do we examine in the head and neck?

A
  1. Pallor
  2. Jaundice
  3. Angular stomatitis
  4. Glossitis
  5. Parotid enlargement
  6. Mouth ulcers
  7. Dentition
  8. Lymphadenopathy (Virchow’s gland in gastric cancer)

Internal Medicine (106 decks)

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