Gastro Flashcards
1
Q
Achalasia signs and symptoms
A
Dysphagia of solid and liquid
Regurgitation
Weight loss
2
Q
Achalasia investigations
A
Gold standard: high res oesophageal manometry
Upper GI endoscopy
Barium swallow
3
Q
Achalasia management
A
Medical:
CCB and nitrates
Surgical:
Heller cardiomyotomy
4
Q
GORD signs and symptoms
A
Heartburn after meals
Acid regurgitation -> sour taste
Chronic cough or nocturnal asthma
Waterbrash(increased salivation)
5
Q
GORD investigations
A
Resolution of symptoms after 8 week PPI trial
OGD->ulcerations
Oesophageal manometry with pH monitoring
H. Pylori breath/stool test
6
Q
GORD management
A
Lifestyle:
Weight loss
Smoking cessation
Avoid trigger foods
Medical:
PPI
H2 antagonist
Antacids
Surgical:
Nissen fundoplication
7
Q
PUD signs and symptoms
A
H. Pylori
NSAID use
Epigastric pain
Gastric->pain after meals
Duodenal->pain hours later
Nausea, vomiting
Mild weight loss
8
Q
PUD investigations
A
Gold standard: upper GI endoscopy
H. Pylori test: urea breath, stool antigen
Serum fasting gastrin level
9
Q
PUD management
A
Lifestyle:
Smoking cessation
Alcohol cessation
H. Pylori +:
PPI + amoxicillin + clarithromycin/metronidazole
H. Pylori -:
Stop drug that causes ulcer
4-8 weeks PPI
10
Q
Hiatus hernia signs and symptoms
A
Sliding(80%), rolling(20%)
Most asymptomatic
GORD
11
Q
Hiatus hernia investigations
A
Gold standard: upper GI endoscopy
CXR->retro cardiac bubble
12
Q
Hiatus hernia management
A
Conservative:
Weight loss
PPI
Surgical:
Hernia pushed back and stomach wrapped around it
13
Q
Barrett’s oesophagus signs and symptoms
A
GORD presentation
14
Q
Barrett’s oesophagus investigations
A
Gold standard: upper GI endoscopy with biopsy
15
Q
Barrett’s oesophagus management
A
Non-dysplastic:
Maximise PPI therapy
Monitoring
Therapeutic intervention:
Radio frequency ablation
Endoscopic mucosal resection of nodular growth
16
Q
Oesophageal cancer signs and symptoms
A
Dysphagia->first solid, then liquid
Rapid weight loss
Hoarseness if RLN pressed
17
Q
Oesophageal cancer investigations
A
Gold standard: upper GI endoscopy
Upper 2/3->SCC
Lower 1/3->adenocarcinoma
CT/MRI for staging
18
Q
Oesophageal cancer management
A
Curative: Oesophagectomy
Palliative: chemo + steroids(dexamethasone) + stent
19
Q
Gastric cancer signs and symptoms
A
H. Pylori
Pernicious anaemia
Smoking
High salt diet
Dyspepsia
Lymphadenopathy (Virchow’s node)
Anaemia
Loss of weight/appetite
Abdominal mass
Recent onset of progressive symptoms
Malaena/haematemesis
Swallowing difficulty
55 years old
20
Q
Gastric cancer investigations
A
Gold standard: upper GI endoscopy with biopsy->signet ring cells
CT/MRI for staging
21
Q
Gastric cancer management
A
OGJ: oesophageogastrectomy
Close to OGJ: total gastrectomy
Far from OGJ: subtotal gastrectomy
22
Q
Mallory Weiss tear signs and symptoms
A
Haematemesis
Lightheaded
Postural hypotension
Alcoholic/bulimic
23
Q
Mallory Weiss tear investigations
A
Gold standard: upper GI endoscopy
Rockall score
Glasgow-Blatchford score
FBC
urea
CXR
24
Q
Mallory Weiss tear management
A
1st line:
With endoscopy, inject adrenaline or conduct band ligation to stop bleeding
Adjunct:
PPI
Anti-emetic
2nd line:
Sengstaken-Blakemore tube
25
Colorectal cancer signs and symptoms
Change in bowel habit
PR bleeding
Weight loss(FLAWS)
Anaemia features
Palpable abdominal mass(late)
Lymphadenopathy(late)
26
Colorectal cancer investigations
FBC->anaemia
LFT->metastasis
Colonoscopy + biopsy(diagnostic)
Double contrast barium enema
CT to check for met
27
Colorectal cancer management
Surgical excision
Chemo/radiotherapy
28
Colorectal cancer screening
faecal immunochemical test(FIT)
Rigid sigmoidoscopy
29
Crohn’s signs and symptoms
Crampy abdominal pain(RLQ)
Diarrhoea(blood, mucus, pus)
Peri anal lesions
Fatigue
Weight loss
Painful oral lesions
Skin lesions: erythema nodosum, pyoderma gangrenosum
30
Crohn’s investigations
FBC, iron, B12, folate, CRP, ESR
Faecal calprotectin test
AXR: bowel dilation
CT: bowel wall thickening
Colonoscopy+biopsy: cobblestone appearance, skip lesions, ulcers
Histology: transmural, non-caseating granulomas
Barium enema+X-ray: string sign of Kantor, rose thorn ulcers
31
Crohn’s management
Smoking cessation
1. Steroids(prednisolone/budesonide)
2. Mesalazine(5-ASA)
3. Immunomodulator(azathioprine/methotrexate)
4. Infliximab if fistula
5. Surgery if obstructed
Maintain remission:
1st: Azathioprine
2nd: Methotrexate
3rd: Surgery
32
UC signs and symptoms
HLA B27
Bloody diarrhoea
Rectal bleeding + mucus
Abdominal pain
Weight loss
Ankylosing spondylitis
Anaemia
33
UC investigations
FBC, LFT, CRP, ESR
Stool sample: raised faecal calprotectin
pANCA
AXR: dilation, thumbprinting
Barium enema X-ray: lead pipe appearance
Colonoscopy+biopsy: continuous ulcers
34
UC management
Induce remission:
Rectal aminosalicylate(1st)
Oral aminosalicylate(2nd)
Hydrocortisone(3rd)
Ciclosporin(4th), don’t use if hypertension/renal problem
Maintain remission:
Mild - PR/oral Mesalazine
Moderate/Severe - Azathioprine and/or Inflixamab
Total colectomy is curative
35
UC complications
Toxic mega colon
Primary sclerosing cholangitis
Colorectal adenocarcinoma
36
Coeliac disease signs and symptoms
Other autoimmune diseases
IgA deficiency
Diarrhoea
Weight loss
Abdominal pain/discomfort
Fatigue
Dermatitis herpetiformis
37
Coeliac disease investigations
IgA tTG
Endomysial antibody
OGD+biopsy(gold standard): villous atrophy, crypt hyperplasia
DEXA scan(osteopenia is associated)
38
Coeliac disease management
Gluten free diet
Vitamin+mineral supplements
39
IBS presentation
6 month history:
Abdo pain/discomfort
Bloating
Change in bowel habit
Diarrhoea/constipation->stool consistency altered
Defecation relieves abdo discomfort
40
IBS investigations
Diagnosis of exclusion
FBC(CRC), ESR, CRP(IBD)
Anti-tTG(coeliac)
41
IBS management
Lifestyle:
Fibre
Avoid caffeine, lactose
Stress management
Education
Medical:
Constipation -> laxative
Diarrhoea -> loperamide
Cramps -> antispasmodics
42
Haemorrhoids signs and symptoms
Bright red painless bleeding during defecation
Can be painful
Anal pruritus
Palpable mass
43
Haemorrhoids investigations
Gold standard: anoscopic examination
44
Haemorrhoids management
Conservative:
Fibre + Fluids
Grade 1: topical corticosteroids
Grade 2/3: rubber band ligation
Grade 4: surgical haemorrhoidectomy
45
Haemorrhoids complication and management
Thrombosed haemorrhoid: significant pain and tender lump
<72 hours: refer for excision
Stool softener, ice pack, analgesia->resolve in 10 days
46
Rectal prolapse signs and symptoms
Obese
Natural birth/surgery/trauma
Chronic constipation
Painless mass protruding following defecation
Mucous discharge
Incontinence
47
Rectal prolapse investigations
Clinical diagnosis
Ask patient to strain to elicit prolapse
48
Rectal prolapse management
DeLormes procedure
49
Anal fissure signs and symptoms
Hard stool or constipation
Pregnancy
Opiates
Pain on defecation
Fresh blood when wiping
50
Anal fissure investigations
Clinical diagnosis
51
Anal fissure management
Conservative:
Fibre
Increase fluid intake
CCB
Analgesia:
Topical GTN
Topical NSAID
Chronic:
Botox injection
Sphincterectomy
52
Anal fistula signs and symptoms
Frequent anal abscesses
Pain and swelling around anus
Foul drainage in underwear
53
Anal fistula investigations
Opening in skin around anus
Anoscope/rectoscope
54
Anal fistula management
Fistulotomy
Seton
55
Anal abscess signs and symptoms
Perianal pain not related to defecation
Perianal swelling/tenderness
56
Anal abscess investigations
Clinical examination
Visualise abscess
CT/MRI to visualise abscess
57
Anal abscess management
Surgical drainage of abscess
Fistulotomy if fistula present
58
Pilonidal sinus signs and symptoms
Young Male
Sacrococcygeal discharge, pain, swelling
59
Pilonidal sinus investigations
Clinical diagnosis
60
Pilonidal sinus management
Surgical excision of sinus+cyst
Antibiotics
Hair removal
Local hygiene advice
61
Hepatitis signs and symptoms
RUQ pain
Jaundice
Hepatomegaly
Fatigue
Dark urine
62
Alcoholic hepatitis investigations
FBC: macrocytic anaemia
LFT: AST/ALT ratio >2, high BR, low albumin
Clotting: high PT means severe
Hepatic USS
Liver biopsy: Mallory bodies->hepatitis
63
Alcoholic hepatitis management
Alcohol abstinence
Nutrition: vit esp B1
Weight loss
Stop smoking
Steroids if severe
64
NAFLD investigations and risk factors
Obesity
T2DM
Hypertension
LFT: AST/ALT ratio <1
65
NAFLD management
Diet, exercise
Control risk factors: glucose, statin
66
Viral Hep A&E method of infection and management
Faecal oral route(sex/contaminated water)
Supportive management
Avoid alcohol/paracetamol
67
Viral Hep B/C/D
C is chronic
B is acute and associated with polyarteritis nodosa (aneurysms) -> pred + immunosuppressant
D is coinfection of B and increases risk of liver failure
Supportive management, antiviral
68
Liver cirrhosis signs and symptoms
Finger clubbing
Spider naevi
Gynaecomastia
Palmar erythema
Hepatomegaly
Jaundice
Portal hypertension: ascites, caput medusae
Oesophageal varices: haematemesis
69
Liver cirrhosis investigations
LFT: AST>ALT
Liver USS
Coagulation screen
FBC
CRP
70
Liver cirrhosis management
Treat underlying
Avoid hepatotoxic drugs
Encephalopathy:
Protein restrict
Phosphate enema/lactulose
Avoid sedation
Ascites:
Sodium restrict
Diuretics
Spontaneous bacterial peritonitis:
Cefuroxime + metronidazole
Varices:
Primary prophylaxis->BB
Ruptured->haematemesis->ABCDE, terlipressin
71
Biliary colic/cholecystitis/cholangitis signs and symptoms
Biliary colic:
RUQ pain
May have jaundice
Acute cholecystitis:
RUQ pain
Fever
NO jaundice
Ascending cholangitis:
Charcot’s triad->fever, jaundice, RUQ pain
72
Biliary colic/cholecystitis/cholangitis investigations
FBC: WCC raised if infection
LFT: may be raised
USS(diagnostic): acoustic shadow, wall thickening, CBD dilated
73
Biliary colic/cholecystitis/cholangitis management
Analgesia
Fluid resuscitation
Antibiotics if infection
Cholangitis: ERCP
Cholecystitis/biliary colic: Laparoscopic cholecystectomy(definitive), elective if BC
74
Pancreatic cancer signs and symptoms
Painless jaundice, Weight loss->Pancreatic cancer until proven otherwise
Palpable gall bladder
FLAWS
Steatorrhoea
Diabetes
Trossaeu sign
75
Pancreatic cancer investigations
Gold standard: ERCP + biopsy
CA19-9, AFP, CEA
USS
CT CAP for staging
76
Pancreatic cancer management
<3cm: Whipple’s resection + adjuvant chemo
>3cm: Percutaneous/endoscopic biliary stent insertion
77
Cholangiocarcinoma signs and symptoms
Virchow’s node
Sister Mary Joseph node
FLAWS
RUQ pain
Extrahepatic: jaundice, palpable gall bladder
78
Cholangiocarcinoma investigations
Gold standard: ERCP + biopsy
LFT
Clotting study
CA19-9
USS
MRCP
79
Cholangiocarcinoma management
Localised tumour: cholecystectomy
Intrahepatic: partial hepatectomy
Distal CBD: whipple’s procedure
Adjuvant chemo/radiotherapy
80
HCC signs and symptoms
Weight loss
Hepatomegaly
Jaundice
Liver failure
81
HCC investigations
Screening for high risk groups
Bloods: aFP tumour marker
USS, CT
82
HCC management
Early:
Non-cirrhotic -> resection
Cirrhotic -> transplant
Unsuitable for surgery:
Percutaneous ethanol injection for peripheral lesion
Sorafenib(multikinase inhibitor)
83
PBC/PSC signs and symptoms
Pruritus
Lethargy
Obstructive jaundice
Spider naevi
Xanthelasma
Hepatosplenomegaly
84
PBC/PSC investigations
Bloods: Anti-mitochondrial antibodies (PBC), pANCA (PSC)
Ultrasound
LFT: high ALP, GGT, BR
ERCP/MRCP: bead on a string appearance (PSC)
Biopsy: onion skin fibrosis (PSC)
85
PBC/PSC management
Cholestyramine for pruritus
Vit A, D, E, K supplements
Ursodeoxycholic acid (bile salt replacement)
Liver transplant if BR>100
Steroids/methotrexate/ciclosporin
Screen for Cholangiocarcinoma, CA19-9
86
Wilson’s disease signs and symptoms
Neuro: basal ganglia degeneration->Parkinsonism, speech impairment
Eyes: kayser-fleischer rings
Liver: hepatitis and cirrhosis
87
Wilson’s disease investigations
Slit lamp examination of eye
Bloods: LFT, low serum caeruloplasmin, high free copper
Urinalysis: high urine copper
Genetic testing
Liver biopsy
88
Wilson’s disease management
Copper chelation with penicillamine
89
Haemochromatosis signs and symptoms
Erectile dysfunction
Tan
Lethargy
Diabetes
Arthralgia
90
Haemochromatosis investigations
High transferrin
Transferrin sat >45%
LFT: raised ALT, AST
Normal FBC
Genetic testing
Liver biopsy
91
Haemochromatosis management
Avoid exogenous iron, vit C, alcohol
Analgesia if needed
Regular venesection
92
AI hepatitis management
Prednisolone(steroid)
Azathioprine(immunosuppressant)
93
What is AI hepatitis associated with
Hypothyroidism
94
AI Hepatitis Investigations
Diagnostic: Liver biopsy
ANA, SMA
raised ALT&AST
usually normal ALP
95
Diverticulitis sign and symptoms
Worsening abdominal pain
Constipation
N+V
Fever
Abdominal tenderness
Sometimes mass
96
Diverticulitis investigations
Bloods: FBC, VBG, U&E
Chest abdo x ray
CT abdo pelvis: thick walled mass containing air and fluid
Colonoscopy might cause perforation
97
Diverticulitis management
Rehydration
Nil by mouth
Paracetamol
Co-amoxiclav 500mg TDS 5/7
Follow up CT
Percutaneous drainage
Colonoscopy
98
GI perforation signs and symptoms
Sudden pain with distension
Guarding rigidity, rebound tenderness
N+V
Constipation
Fever, tachycardia, hypotension
Little to no bowel sounds
99
GI perforation investigation
FBC: leukocytosis
High urea, creatinine
VBG: Lactic acidosis
Erect AXR: free subdiaphragmatic air
CT abdo/pelvis: pneumoperitonism
100
GI perforation management
Conservative:
NBM
NG tube
Broad spectrum antibiotics
PPI
Analgesia, anti-emetics
101
Hernia signs and symptoms
Abdominal pain
Cough reflex
Reducible
Strangulated: N+V, unwell
102
Hernia investigations
Erect CXR
Supine AXR
103
Hernia management
Open/lap repair under LA/GA
Shouldice mesh free repair
Lichtenstein mesh repair
104
Hiatus hernia signs and symptoms
Heartburn
SoB
Palpitations
105
Hiatus hernia investigations
Upper GI endoscopy
Manometry
CT
106
Hiatus hernia management
PPI
H2 receptor antagonist
Nissen fundoplication
107
Infective colitis signs and symptoms
Diarrhoea
Abdo pain
Recent antibiotics use (clindamycin/cephalosporin)
May have fever, hypotension
108
Infective colitis investigations
Supine AXR
Stool sample
Blood culture
Consider sigmoidoscopy
109
Infective colitis management
Discontinue current antibiotics
Transfer patient to side room
 IV fluids
Non opiate analgesia
Oral vancomycin (1st)
+ IV metronidazole if severe
110
Bowel obstruction signs and symptoms
Colicky central pain
Vomiting
Constipation
Abdo distension
Dehydration
high pitched bowel sounds
111
Bowel obstruction investigations
Rule out hernia
Strangulating/simple
Bloods: FBC, CRP, lactate, renal profile
Imaging: CXR, AXR, CECT abdo pelvis
112
Bowel obstruction management
IV drip
NG tube
Analgesia
SBO:
Oral gastrogaffin
Sigmoid volvulus:
Rigid sigmoidoscopy
Colon:
Laparotomy, resection, stoma
113
Acute severe colitis management
IV hydrocortisone + rectal hydrocortisone
Monitor FBC, ESR, CRP
After 3 days, inflixamab
After 5 days, colectomy
114
Infectious diarrhoea organisms, diagnosis and management
Cholera, rotavirus, norovirus, E. coli, campylobacter
Stool sample, PCR for virus
Oral rehydration
Vaccine
Azithromycin for campylobacter
115
Peritonitis signs and symptoms
Generalised acute abdominal pain, guarding, rigidity
Rebound tenderness (Blumberg sign)
Cough worsens pain
Fever
Tachycardia
116
Peritonitis investigations
AXR: pneumoperitoneum
Ascites -> paracentesis: >250neutrophil/mcL -> SBP
117
Peritonitis management
IV fluid, analgesia
IV antibiotics: Cephoxitin (cephalosporin)! Co-amoxiclav
Laparotomy except for SBP
118
Jaundice investigations
Bedside:
ECG (can cause bradycardia)
Bloods:
FBC, U&E
LFT
Imaging:
Liver ultrasound
