even more GI Flashcards
severe epigastric pain that radiates to back- after having a few too many drinks the night before
-next step in management after taken serum amylase
acute pancreatitis
- fluid resuscitation as many patietns with acute pancreatitis develop systemic inflammatory response syndrome (SIRS) which can lead to multiple organ dysfunction (MODS)
Supportive measures such as fluid resuscitation and oxygen supplementation are the mainstay of the treatment for acute pancreatitis
cullens sign is
bruising around the umbillicus from acute pancreatitis or an ectopic pregnancy
mcburneys sign is
pain over mcburneys point seen in acute appendicitis
troisers sign is
presence of virchows node in the left supraclavicular fossa and is a marker for gastric cancer
Hearburn (retrosternal discomfort after eating and on lying down), acid taste in mouth (acid brash), excessive salivation (waterbrash), difficulty swallowing and nocturnal asthma
Reflux oesophagitis (GORD)
Is gord associated with tight clothes
yes
- progressively worsening swallowing over several years
- troubled by regurgiation of undigested food and halitosis(bad breath)
- suffers fits of coughing on lying flat
achalasia
- leads to regurg of undigested foods and halitosis
- tends to present in middle aged women
CXR- wide mediastinum and shadow behind the heart, with a fluid level
achalasia
furthere confirmation of achalasia after xray
barium swallow or oesophagoduodenoscopy
treatment of mild and severe achalasia
mild- nitates and anticholinergic medications
severe- surgical (Heller’s operation)
loss of the myenteric plexus and failure of relaxation of the lower circular muscles
achalasia
- food sticking in back of throat
- pale, spoon shaped nails, smooth tongue and angular cheilitis
Plummer vinson syndrome
Endoscopy or barium meal shows friable web across the anterior oesophageal lumen
-caused by hyperplasia and hyperkeratosis of the oesophageal mucosa
plummer vinson syndrome
is plummer vinson syndrome pre malignant and should be biopsied
yes
plummer vinson syndrome consists of
iron deficiency anaemia, glossitis, angular cheilitis, dysphagia
difficulty swallowing, first mouthful easy to swallw and then increasingly difficulty and neck swelling
Pharyngeal pouch
enlargement of the left atrium, double cardiac silhouette, straightening of the left border of the heart and horizontal left bronchus
left atrial hypertrophy
mitral stenosis associated with
large left atrium
Budd chairi syndrome classicaly presents with
abdo pain, ascites and hepatomegaly
obstruction of IVC causes
venous collaterals in the back with upward direction flow and bipedal oedema
-hypopigmented patches on skin, weight loss, loose stools, oligomenorrhoea(infrequent menstrual periods), finger swelling, fine tremor, resting tachycardia, warm peripheries
Thyrotoxicosis
soft tissue swelling on fingers that resembles clubbing, bulging eyes, raised waxy lesions on shins
(classical triad)
graves disease
16y/o boy with malaise, weight loss, polydipsia(abnormal thirst)
-raised blood glucose
Type 1 diabetes
evidence of liver function test that drinking excessive amounts:
macrocytic anaemia, low urea and sodium levels, deranged LFTs and elevated INR
AST:ALT ratio greater than 2 suggests
alcoholic hepatitis
-wise to prescribe vitamin supplements particularly thiamine
what do these suggest: ascites, hepatomegaly, multiple pulmonary metastases
malignancy
weight loss, anorexia, swellin gof abdo, pleural effusion, hepatomegaly, multiple opacities throughout lung fields
51y/o women
ovarian cancer
is suspect ovarian cancer what invesigations:
CA-125 blood test and pelvic ultrasound to calculate risk of malignancy. (RMI)
Ct scan of abdomen and pelvis will allow for staging
- If RMI and CT suggest ovarian cancer, diagnosis can be confirmed by histology from tissue obtained during laparotomy
most common primary liver tumour
hepatocellular carcinoma
in 60% of patients raised alpha fetoprotein in
Hepatocellular carcinoma
Ultrasound- focal lesions(filling defects) and may show involvement of the portal vein
hepatocellular carcinoma
examination may reveal hepatomegaly or right hypochondrial mass
hepatocellular carcinoma
penicillamine (treatment for wilsons disease) is associated with
membranous nephropathy
diffuse proliferative glomerulonephritis is associated with
SLE
barium study of – shows birds peak on lower oesophagus while manometry reveals abnormally high oesophageal sphincter tone that fails to relax on swallowing
oesophgeal achalasia
reduced secretion of - is linked to the development of achalasia
nitric oxide
patient is most likely prescribed an opiate like codeine phosphate to manage pain from osteoarthritic knee joint. Opiates like codeine phosphate cause well known to cause
constipation
what should be co presrcibed when prescribe an opiate (deal with pain)
laxative such as senna
raised bilirubin and ALP suggests may have
cholecystitis or cholangitis
what would confirm if its a biliary problem
ultrasound scan
is suspect pneumonia by lung consolidation but have raised bilirubin and ALP, do — to rule out biliary problem
ultrasound scan
-symptomatic anaemia (PALE), chronic diarrhoea, had glossitis with decreased vitamin b12 level and increased folate
suggestive of Small Intestine Bacterial overgrowth
- definitive treatment =antibiotics!
effective antibiotics in SIBO
metronidazole, ciprofloxacin, co-amoxiclav, rifaximin
— results from ingestion of seafood
Ciguatera toxicity
treatment -conservative
describe geographic tongue
recurrent episodes of tongue soreness by spicey/ acidic foods
depapillation of tongue
affects 2-3% of population
often asymptomatic
no association with oral cancer
most common oral malignancy
squamous cell carcinoma
ulcer on lateral border of tongue/ floor of mouth - had for months, is a smoker
squamous cell carcinoma
pruritic rash affecting wrists and shins and oral soreness. white striae and ulceration
lichen planus- stress is a risk factor - affects skin and mucous memebranes
skin- red papules that may have white on them
oral- painless white streaks or painful ulcers and erosions
iron deficiency initially presents with
angular stomatatitis and smooth, red sore and depapillated tongue
corticoteriod use associated with oral candiasis (__)
thrush
treatment for oral candiasis
mild- topical miconazole gel
severe- oral fluconazole
-rinsing mouth after using inhaler should help prevent this in future
high urine 5. hydroxyindoleacetic acid content diagnosis of
carcinoid syndrome
carcinoid syndrome relates to carcinoid tumour that releases
serotonin
symptoms of carcinoid syndrome
flushing, diarrhoea, bronchospasm- can develop right sided heart failure
young man, gait was unsteady, could not see, low comprehension, seemed drunk but not had any alcohol, pooed alot that smelt
low calcium and phosphate levels
Vitamin D deficiency - ataxia, steatorrhoea, cognitive decline, visual problems
if got vitamin D deficiency give dose of vitamin
E ???
vitamine B deficiency most commonly occurs in
malnourished patietns with a significatn alcohol history
patient had progressive forgetfullness, has hepatomegaly and ascites adn now has cirrhosis . what test would suspect diagnossi
low serum ceurolplasmin
or low serum copper, urinary copper over last 24hrs raised
liver biopsy is confirmatory
as suffering from wilsons disease progressing to cirrhosis
treatment of wilsons disease now causing cirrhosis
Penicillamine
AST:ALT ratio is often measured to distinguish between
alcoholic and viral hepatitis
—- is greater than AST in viral hepatitis whereas in alcoholic hepatitis ___ is greater than ALT
ALT
AST
alpha 1 antitrypsin leads to
panacinar emphysema in the lungs and periodic acid schiff (PAS)- positive globules in the liver
- can increase risk of hepatocellualar carcinoma
alpha fetoprotein is a marker for
hepatocellular carcinoma
anti smooth muslce antibodies are indicative of
autoimmune hepatitis
signs of iron overload( haemochromatosis)
arthralgia and erectile dysfunction
intervention if got villous atrophy
gluten free diet- coeliac!
ive got coeliac disease and not avoiding gluten then may gt
persistance of rsh, diarrhoea, and may increase risk of small bowel lymphoma
budd chairi syndrome triad
abdo pain, tender hepatomegaly, ascites
once blood test reveal hep c positive what test next?
Hep C genotype - guides length and type of treatment
treatment of hyperkalaemia
calcium gluconate should be given immediately - to reduce risk of arrythmias - does not iteself reduce potassium
insulin and dexrtrose corrects potassium levels
in achalasia what tests can exclude carcinoma
oesophagoscopy and CT scan
treatment of achalasia
dialtion of the sphincter either using Botox or balloon dilatation. if this fails, surgical management is an option
barium swallow — gives a picute of stenosis
oesophageal webs
corkscrew
oesophageal spasm
sign that peritonitis is not localised
absent bowel sounds
board like abdomen suggest
generalised peritonitis
erythema nodosun is extra manifestation of crohns or uc but not palmar erythema!
barrets oesophagus associated with –malignancy
oesophageal
achalasia is particulary associated with
squamous cell carcinoma
intermittent bloating and diarrhoea in young patient w everything else normal
irritable bowel syndrome
stool shows- trophozoites and cysts
- symptoms- diarrhoea, offensive bowel gas, steatorrhoea, abdo cramps and bloating
Giardiasis
giardiasis treated with
metronidazole
mimics coeliac (villous atrophy) and occurs after travellers of south east asia and caribean.
tropical sprue
what leads to catastrophic haematemesis
oesophageal varices! not mallory weiss tear-prolonged vomitting causing bright red haematemesis
prescence of caput medusae suggests
portal hypertension
treatment for NAFLD
no current medications but weight loss is the mainstay treatment
mildly raised ALP and aminotransferases. obesity and type 2 diabetes. Does not drink alcohol. Hepatomegaly.
NAFLD
azathioprine is used in
autoimmune hepatitis
before starting azithiprine, what should be testes for
Thiopurine methyltransferase (TPMT) acitivty
severe itching, mild jaundice
primary biliary cholangitis!!!
psc is different to pbs
psc is more common in men and anti mitocchondrial antibody is negative and p-anca is positive
ANA, anti smooth muscle antibody, LKM are elevated in
autoimmune hepatitis
common presentation of coeliac disease
vague abdo pain, bloating, diarrhoea, delayed puberty, anaemia if frquently present
first line invstigation for coeliac disease
serological blood tests
definitive diagnosis of coeliac disease
distal duodenal biopsy showing partial or complete villous atrophy, crypt hypertrophy,
crohns differ from coeliac
crohns have bloody diarrhoea but with MUCUS, more severe abdo pain and more acutely unwell
crypts abscess is typical for
UC
crohns or uc –terminal ileum involement, apthous stomatits , non caseating granulomata, stricturing of bowel wall
crohns
absence of bilirubin inn the uterine
gilberts syndrome
diagnosis of tropical sprue
small intestinal biopsy
been in india and has diarrhoea and had diarrhoeain india what test
small intestinal biopsy - determine between giardia or tropical sprue
risk factors for ascending cholangitis
biliary stent and ERCP
asecding cholangitis is most often caused by gram negative rods such as
e.coli, klebsiella and enterobacter
rigors can be caused by
ascending cholangitis
triad of gastrinoma
recurrent peptic ulcer disease, watery diarrhoea and weight loss
–is useful in treatment of gastrinoma
octreotide
first line diuretic in treatment of ascites secondary to liver cirrhosis
spironolactone
average recommended calorie intake for men
2500
and 2000 for women
one unit of alcohol is equivalent to
10ml of alcohol
one pint of beer at 5% is how may units
3
how often should colonscopies be done in patietns with UC thats well controlled
every 5 years
what is associated with coeliac disease
iron deficineciy
small intestine villous atrophy upon exposure to gliadin( in wheat and grain)
coeliac disease
abdominal aortic aneurysm is diagnosed when abdominal aorta has diameter greater than
3cm
management if asymptomatic with multiple gallstones
nothing
symptomatic gallstone disease presents with
colicky right upper quadrant pain that is typically worse after eating fatty foods
tenderness over mcburneys point
appendicitis
mcburneys point is the landmark for – in most people
appendix
