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Y3 > Gastro > Flashcards

Gastro Flashcards

1
Q

Achalasia signs and symptoms

A

Dysphagia of solid and liquid
Regurgitation
Weight loss

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2
Q

Achalasia investigations

A

Gold standard: high res oesophageal manometry
Upper GI endoscopy
Barium swallow

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3
Q

Achalasia management

A

Medical:
CCB and nitrates

Surgical:
Heller cardiomyotomy

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4
Q

GORD signs and symptoms

A

Heartburn after meals
Acid regurgitation -> sour taste
Chronic cough or nocturnal asthma
Waterbrash(increased salivation)

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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

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6
Q

GORD management

A

Lifestyle:
Weight loss
Smoking cessation
Avoid trigger foods

Medical:
PPI
H2 antagonist
Antacids

Surgical:
Nissen fundoplication

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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

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8
Q

PUD investigations

A

Gold standard: upper GI endoscopy

H. Pylori test: urea breath, stool antigen
Serum fasting gastrin level

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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

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10
Q

Hiatus hernia signs and symptoms

A

Sliding(80%), rolling(20%)
Most asymptomatic
GORD

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11
Q

Hiatus hernia investigations

A

Gold standard: upper GI endoscopy
CXR->retro cardiac bubble

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12
Q

Hiatus hernia management

A

Conservative:
Weight loss
PPI

Surgical:
Hernia pushed back and stomach wrapped around it

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13
Q

Barrett’s oesophagus signs and symptoms

A

GORD presentation

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14
Q

Barrett’s oesophagus investigations

A

Gold standard: upper GI endoscopy with biopsy

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15
Q

Barrett’s oesophagus management

A

Non-dysplastic:
Maximise PPI therapy
Monitoring

Therapeutic intervention:
Radio frequency ablation
Endoscopic mucosal resection of nodular growth

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16
Q

Oesophageal cancer signs and symptoms

A

Dysphagia->first solid, then liquid
Rapid weight loss
Hoarseness if RLN pressed

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17
Q

Oesophageal cancer investigations

A

Gold standard: upper GI endoscopy
Upper 2/3->SCC
Lower 1/3->adenocarcinoma
CT/MRI for staging

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18
Q

Oesophageal cancer management

A

Curative: Oesophagectomy

Palliative: chemo + steroids(dexamethasone) + stent

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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

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20
Q

Gastric cancer investigations

A

Gold standard: upper GI endoscopy with biopsy->signet ring cells
CT/MRI for staging

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21
Q

Gastric cancer management

A

OGJ: oesophageogastrectomy
Close to OGJ: total gastrectomy
Far from OGJ: subtotal gastrectomy

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22
Q

Mallory Weiss tear signs and symptoms

A

Haematemesis
Lightheaded
Postural hypotension
Alcoholic/bulimic

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23
Q

Mallory Weiss tear investigations

A

Gold standard: upper GI endoscopy
Rockall score
Glasgow-Blatchford score
FBC
urea
CXR

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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

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25
Q

Colorectal cancer signs and symptoms

A

Change in bowel habit
PR bleeding
Weight loss(FLAWS)
Anaemia features
Palpable abdominal mass(late)
Lymphadenopathy(late)

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26
Q

Colorectal cancer investigations

A

FBC->anaemia
LFT->metastasis
Colonoscopy + biopsy(diagnostic)
Double contrast barium enema
CT to check for met

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27
Q

Colorectal cancer management

A

Surgical excision
Chemo/radiotherapy

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28
Q

Colorectal cancer screening

A

faecal immunochemical test(FIT)
Rigid sigmoidoscopy

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29
Q

Crohn’s signs and symptoms

A

Crampy abdominal pain(RLQ)
Diarrhoea(blood, mucus, pus)
Peri anal lesions
Fatigue
Weight loss
Painful oral lesions
Skin lesions: erythema nodosum, pyoderma gangrenosum

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30
Q

Crohn’s investigations

A

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

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31
Q

Crohn’s management

A

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

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32
Q

UC signs and symptoms

A

HLA B27
Bloody diarrhoea
Rectal bleeding + mucus
Abdominal pain
Weight loss
Ankylosing spondylitis
Anaemia

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33
Q

UC investigations

A

FBC, LFT, CRP, ESR
Stool sample: raised faecal calprotectin
pANCA
AXR: dilation, thumbprinting
Barium enema X-ray: lead pipe appearance
Colonoscopy+biopsy: continuous ulcers

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34
Q

UC management

A

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

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35
Q

UC complications

A

Toxic mega colon
Primary sclerosing cholangitis
Colorectal adenocarcinoma

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36
Q

Coeliac disease signs and symptoms

A

Other autoimmune diseases
IgA deficiency
Diarrhoea
Weight loss
Abdominal pain/discomfort
Fatigue
Dermatitis herpetiformis

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37
Q

Coeliac disease investigations

A

IgA tTG
Endomysial antibody
OGD+biopsy(gold standard): villous atrophy, crypt hyperplasia
DEXA scan(osteopenia is associated)

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38
Q

Coeliac disease management

A

Gluten free diet
Vitamin+mineral supplements

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39
Q

IBS presentation

A

6 month history:
Abdo pain/discomfort
Bloating
Change in bowel habit
Diarrhoea/constipation->stool consistency altered
Defecation relieves abdo discomfort

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40
Q

IBS investigations

A

Diagnosis of exclusion
FBC(CRC), ESR, CRP(IBD)
Anti-tTG(coeliac)

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41
Q

IBS management

A

Lifestyle:
Fibre
Avoid caffeine, lactose
Stress management
Education

Medical:
Constipation -> laxative
Diarrhoea -> loperamide
Cramps -> antispasmodics

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42
Q

Haemorrhoids signs and symptoms

A

Bright red painless bleeding during defecation
Can be painful
Anal pruritus
Palpable mass

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43
Q

Haemorrhoids investigations

A

Gold standard: anoscopic examination

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44
Q

Haemorrhoids management

A

Conservative:
Fibre + Fluids

Grade 1: topical corticosteroids
Grade 2/3: rubber band ligation
Grade 4: surgical haemorrhoidectomy

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45
Q

Haemorrhoids complication and management

A

Thrombosed haemorrhoid: significant pain and tender lump

<72 hours: refer for excision
Stool softener, ice pack, analgesia->resolve in 10 days

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46
Q

Rectal prolapse signs and symptoms

A

Obese
Natural birth/surgery/trauma
Chronic constipation

Painless mass protruding following defecation
Mucous discharge
Incontinence

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47
Q

Rectal prolapse investigations

A

Clinical diagnosis
Ask patient to strain to elicit prolapse

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48
Q

Rectal prolapse management

A

DeLormes procedure

49
Q

Anal fissure signs and symptoms

A

Hard stool or constipation
Pregnancy
Opiates
Pain on defecation
Fresh blood when wiping

50
Q

Anal fissure investigations

A

Clinical diagnosis

51
Q

Anal fissure management

A

Conservative:
Fibre
Increase fluid intake
CCB

Analgesia:
Topical GTN
Topical NSAID

Chronic:
Botox injection
Sphincterectomy

52
Q

Anal fistula signs and symptoms

A

Frequent anal abscesses
Pain and swelling around anus
Foul drainage in underwear

53
Q

Anal fistula investigations

A

Opening in skin around anus
Anoscope/rectoscope

54
Q

Anal fistula management

A

Fistulotomy
Seton

55
Q

Anal abscess signs and symptoms

A

Perianal pain not related to defecation
Perianal swelling/tenderness

56
Q

Anal abscess investigations

A

Clinical examination
Visualise abscess
CT/MRI to visualise abscess

57
Q

Anal abscess management

A

Surgical drainage of abscess
Fistulotomy if fistula present

58
Q

Pilonidal sinus signs and symptoms

A

Young Male
Sacrococcygeal discharge, pain, swelling

59
Q

Pilonidal sinus investigations

A

Clinical diagnosis

60
Q

Pilonidal sinus management

A

Surgical excision of sinus+cyst
Antibiotics
Hair removal
Local hygiene advice

61
Q

Hepatitis signs and symptoms

A

RUQ pain
Jaundice
Hepatomegaly
Fatigue
Dark urine

62
Q

Alcoholic hepatitis investigations

A

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
Q

Alcoholic hepatitis management

A

Alcohol abstinence
Nutrition: vit esp B1
Weight loss
Stop smoking
Steroids if severe

64
Q

NAFLD investigations and risk factors

A

Obesity
T2DM
Hypertension

LFT: AST/ALT ratio <1

65
Q

NAFLD management

A

Diet, exercise
Control risk factors: glucose, statin

66
Q

Viral Hep A&E method of infection and management

A

Faecal oral route(sex/contaminated water)

Supportive management
Avoid alcohol/paracetamol

67
Q

Viral Hep B/C/D

A

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
Q

Liver cirrhosis signs and symptoms

A

Finger clubbing
Spider naevi
Gynaecomastia
Palmar erythema
Hepatomegaly
Jaundice
Portal hypertension: ascites, caput medusae
Oesophageal varices: haematemesis

69
Q

Liver cirrhosis investigations

A

LFT: AST>ALT
Liver USS
Coagulation screen
FBC
CRP

70
Q

Liver cirrhosis management

A

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
Q

Biliary colic/cholecystitis/cholangitis signs and symptoms

A

Biliary colic:
RUQ pain
May have jaundice

Acute cholecystitis:
RUQ pain
Fever
NO jaundice

Ascending cholangitis:
Charcot’s triad->fever, jaundice, RUQ pain

72
Q

Biliary colic/cholecystitis/cholangitis investigations

A

FBC: WCC raised if infection
LFT: may be raised
USS(diagnostic): acoustic shadow, wall thickening, CBD dilated

73
Q

Biliary colic/cholecystitis/cholangitis management

A

Analgesia
Fluid resuscitation
Antibiotics if infection

Cholangitis: ERCP

Cholecystitis/biliary colic: Laparoscopic cholecystectomy(definitive), elective if BC

74
Q

Pancreatic cancer signs and symptoms

A

Painless jaundice, Weight loss->Pancreatic cancer until proven otherwise

Palpable gall bladder
FLAWS
Steatorrhoea
Diabetes
Trossaeu sign

75
Q

Pancreatic cancer investigations

A

Gold standard: ERCP + biopsy
CA19-9, AFP, CEA
USS
CT CAP for staging

76
Q

Pancreatic cancer management

A

<3cm: Whipple’s resection + adjuvant chemo

> 3cm: Percutaneous/endoscopic biliary stent insertion

77
Q

Cholangiocarcinoma signs and symptoms

A

Virchow’s node
Sister Mary Joseph node
FLAWS
RUQ pain
Extrahepatic: jaundice, palpable gall bladder

78
Q

Cholangiocarcinoma investigations

A

Gold standard: ERCP + biopsy
LFT
Clotting study
CA19-9
USS
MRCP

79
Q

Cholangiocarcinoma management

A

Localised tumour: cholecystectomy
Intrahepatic: partial hepatectomy
Distal CBD: whipple’s procedure
Adjuvant chemo/radiotherapy

80
Q

HCC signs and symptoms

A

Weight loss
Hepatomegaly
Jaundice
Liver failure

81
Q

HCC investigations

A

Screening for high risk groups
Bloods: aFP tumour marker
USS, CT

82
Q

HCC management

A

Early:
Non-cirrhotic -> resection
Cirrhotic -> transplant

Unsuitable for surgery:
Percutaneous ethanol injection for peripheral lesion
Sorafenib(multikinase inhibitor)

83
Q

PBC/PSC signs and symptoms

A

Pruritus
Lethargy
Obstructive jaundice
Spider naevi
Xanthelasma
Hepatosplenomegaly

84
Q

PBC/PSC investigations

A

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
Q

PBC/PSC management

A

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
Q

Wilson’s disease signs and symptoms

A

Neuro: basal ganglia degeneration->Parkinsonism, speech impairment
Eyes: kayser-fleischer rings
Liver: hepatitis and cirrhosis

87
Q

Wilson’s disease investigations

A

Slit lamp examination of eye
Bloods: LFT, low serum caeruloplasmin, high free copper
Urinalysis: high urine copper
Genetic testing
Liver biopsy

88
Q

Wilson’s disease management

A

Copper chelation with penicillamine

89
Q

Haemochromatosis signs and symptoms

A

Erectile dysfunction
Tan
Lethargy
Diabetes
Arthralgia

90
Q

Haemochromatosis investigations

A

High transferrin
Transferrin sat >45%
LFT: raised ALT, AST
Normal FBC
Genetic testing
Liver biopsy

91
Q

Haemochromatosis management

A

Avoid exogenous iron, vit C, alcohol
Analgesia if needed
Regular venesection

92
Q

AI hepatitis management

A

Prednisolone(steroid)
Azathioprine(immunosuppressant)

93
Q

What is AI hepatitis associated with

A

Hypothyroidism

94
Q

AI Hepatitis Investigations

A

Diagnostic: Liver biopsy
ANA, SMA

raised ALT&AST
usually normal ALP

95
Q

Diverticulitis sign and symptoms

A

Worsening abdominal pain
Constipation
N+V
Fever
Abdominal tenderness
Sometimes mass

96
Q

Diverticulitis investigations

A

Bloods: FBC, VBG, U&E
Chest abdo x ray
CT abdo pelvis: thick walled mass containing air and fluid
Colonoscopy might cause perforation

97
Q

Diverticulitis management

A

Rehydration
Nil by mouth
Paracetamol
Co-amoxiclav 500mg TDS 5/7
Follow up CT
Percutaneous drainage
Colonoscopy

98
Q

GI perforation signs and symptoms

A

Sudden pain with distension
Guarding rigidity, rebound tenderness
N+V
Constipation
Fever, tachycardia, hypotension
Little to no bowel sounds

99
Q

GI perforation investigation

A

FBC: leukocytosis
High urea, creatinine
VBG: Lactic acidosis
Erect AXR: free subdiaphragmatic air
CT abdo/pelvis: pneumoperitonism

100
Q

GI perforation management

A

Conservative:
NBM
NG tube
Broad spectrum antibiotics
PPI
Analgesia, anti-emetics

101
Q

Hernia signs and symptoms

A

Abdominal pain
Cough reflex
Reducible
Strangulated: N+V, unwell

102
Q

Hernia investigations

A

Erect CXR
Supine AXR

103
Q

Hernia management

A

Open/lap repair under LA/GA
Shouldice mesh free repair
Lichtenstein mesh repair

104
Q

Hiatus hernia signs and symptoms

A

Heartburn
SoB
Palpitations

105
Q

Hiatus hernia investigations

A

Upper GI endoscopy

Manometry
CT

106
Q

Hiatus hernia management

A

PPI
H2 receptor antagonist
Nissen fundoplication

107
Q

Infective colitis signs and symptoms

A

Diarrhoea
Abdo pain
Recent antibiotics use (clindamycin/cephalosporin)
May have fever, hypotension

108
Q

Infective colitis investigations

A

Supine AXR
Stool sample
Blood culture
Consider sigmoidoscopy

109
Q

Infective colitis management

A

Discontinue current antibiotics
Transfer patient to side room
 IV fluids
Non opiate analgesia
Oral vancomycin (1st)
+ IV metronidazole if severe

110
Q

Bowel obstruction signs and symptoms

A

Colicky central pain
Vomiting
Constipation
Abdo distension
Dehydration
high pitched bowel sounds

111
Q

Bowel obstruction investigations

A

Rule out hernia
Strangulating/simple
Bloods: FBC, CRP, lactate, renal profile
Imaging: CXR, AXR, CECT abdo pelvis

112
Q

Bowel obstruction management

A

IV drip
NG tube
Analgesia

SBO:
Oral gastrogaffin

Sigmoid volvulus:
Rigid sigmoidoscopy

Colon:
Laparotomy, resection, stoma

113
Q

Acute severe colitis management

A

IV hydrocortisone + rectal hydrocortisone
Monitor FBC, ESR, CRP
After 3 days, inflixamab
After 5 days, colectomy

114
Q

Infectious diarrhoea organisms, diagnosis and management

A

Cholera, rotavirus, norovirus, E. coli, campylobacter

Stool sample, PCR for virus

Oral rehydration
Vaccine
Azithromycin for campylobacter

115
Q

Peritonitis signs and symptoms

A

Generalised acute abdominal pain, guarding, rigidity
Rebound tenderness (Blumberg sign)
Cough worsens pain
Fever
Tachycardia

116
Q

Peritonitis investigations

A

AXR: pneumoperitoneum
Ascites -> paracentesis: >250neutrophil/mcL -> SBP

117
Q

Peritonitis management

A

IV fluid, analgesia
IV antibiotics: Cephoxitin (cephalosporin)! Co-amoxiclav
Laparotomy except for SBP

118
Q

Jaundice investigations

A

Bedside:
ECG (can cause bradycardia)

Bloods:
FBC, U&E
LFT

Imaging:
Liver ultrasound

Y3 (9 decks)

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