Deck 3 - GI Flashcards
Q. Name 3 causes of pancreatitis
A. Gallstones (60%) (2:1 cause in UK) B. Alcohol (30%) C. Hyperlipidaemia D. Direct damage (trauma/ ERCP) E. Idiopathic F. Toxic a. Drugs – azothioprine/ diuretics/ steroids/ NSAIDS b. Infection – viral c. Venom – scorpion stings (Trinidad)
Q. What is released in pancreatitis?
A. Inflammatory cytokines (TNF alpha, IL2, IL4 and pancreatic enzymes –trypsin/lipase etc)
Q. Name four clinical features of acute pancreatitis
A. Severe epigastric pain radiating into back
B. Asscociated anorexia, nausea and vomitting
C. Fever, dehydration, hypotension, tachycardic – SEPTIC SHOCK
D. Abdominal guarding on examination
E. In appox 1-3% Haemorragic Pancreatitis
a. Grey-Turner’s sign
i. Left flank ecchymosis
b. Cullen’s sign
i. Periumbilical ecchymosis
F. (GET SMASHED: (causes) G(all stones), E (thanol), T(Rauma), S(teroids), M (umps), A (utoimmune), S(corpion stings, H(yperlipidaemia), E(RCP), D(rugs)
Q. Name 2 features of the abbreviated Glasgow scoring system used to predict severity and prognosis of pancreatitis
A. P.A.N.C.R.E.A.S., score > 3 needs ITU support B. PaO2 < 8kPa C. Age > 55 years D. Neutrophils > 15 x 109 E. Calcium < 2mmol/l F. Raised urea > 15mmol/l G. Elevated enzymes LDH > 200IU/l or AST > 600IU/L H. Albumin < 32g/l I. Sugar – serum glucose > 15mmol/l
Q. What occurs in chronic pancreatitis?
A. The underlying mechanism of chronic pancreatitis is unclear the end result is pancreatic fibrosis which can take several years to develop.
A. Chronic pancreatitis is the result of chronic inflammation of the pancreas which results in irreversible damage.
B. S&S : Severe abdo pain (upper, radiates to back, aggravated by eating - epigastric), nausea/vomiting, decreased appetite, endocrine: malabsorption with weight loss –diarrhoea/steatorrhea, protein deficiency, exocrine dysfunction - diabetes mellitus
Q. Name two features of critical ischaemia, describe the effects that may be seen in the most affected regions
A. Pain at rest (nocturnal), blood supply barely adequate to allow basal metabolism
B. Affects remote regions – toe?
C. Acute limb ischemia – pain, pale, paralysis, paraesthesia, perishing cold, pulseless
Q. Name two features of intermittent ischaemia, describe the effects that may be seen in the most affected regions
A. Moderate ischaemia, anaerobic metabolism occurs when o2 demand exceeds supply (exercise), lactic acid is formed = pain, resolves at risk
Q. Name two features of PVD, describe the effects that may be seen in the most affected regions
A. Intermittent claudication (muscle cramps on walking – calf, thigh, buttock)
B. Critical leg ischaemia – pain at rest, ulceration, gangrene
Q. Name 3 of the 6Ps of acute ischaemia
A. 6 Ps – pain, pallor, perishing cold, pulseless, paraesthesia, paralysis: symptoms depend on speed and completeness “gradient” of ischemia
Q. What causes IBS, how is it diagnosed?
A. Irritable bowel syndrome, syndrome of exclusion
B. ? Unknown aetiology – related to brain:gut axis?
a. Acute stress activates hypothalamo-pituitary axis and sympathetic NS
b. Brain may influence transmission of Nociceptive information and activation of visceral reflexes through descending inhibitory and excitatory pathways that terminate within dorsal horn at secondary sensory neuron
C. Triggers: Multifactorial… early life? Emotional/Psychology trauma, abuse, stress (work, family), personality traits (anxiety), abnormal gut flora, food/diet
Q. Describe the clinical presentation of IBS, what are the four types?
A. Recurrent abdo pain at least 1/7 in 3/12
B. Associated with 2 or more
1. Related to defecation
2. Associated with change in frequency
3. Associated with change in form
Supporting: abdo pain relieved by defaecation or CBH + at least 2 of the following
• Altered stool passage (straining, urgency, incomplete evacuation)
• Bloating
• Symptoms worsened by eating
• Mucus in stool
• Other common features: lethargy, nausea, back ache, bladder symptoms
• Types of IBS: constipated, diarrhea, mixed, non-classical
- Q. Name two “alarm features” in a history that may point to colon cancer (IBS context)
A. Weight loss, (short history), >50yrs, nocturnal symptoms, male sex, family history of colon, rectal bleeding
- Q. What stool investigation is specific to inflammatory bowel disease?
A. Faecal calprotectin: indicates migration of neutrophils into intestinal mucosa = inflammation
- Q. Describe management of IBD
A. Pain treatment
B. Pharmacotherapy:
a. antispasmodics (PRN mebeverine, buscopan),
b. constipation: laxatives (movicol), linaclotide (reduces activation of colonic sensory neurons reducing pain, increases gut motility)
c. for diarrhoea: antimotility agents (loperamide – alters neuronal activity of intestinal motility)
d. Second line: tricyclic antidepressants, SSRIs
C. Psych treatment
a. CBT, hypnotherapy
D. Education
E. Reassurance
F. Dietary modification: regular small frequent meals, plenty of fluids, reduce insoluble fibre intake, increase soluble fibre intake (low FODMAP diet)
