Gastro conditions Flashcards
When is it appropriate to refer someone for an upper GI endoscopy in relation to suspicions of gastric/oesophageal cancer?
When someone has dysphagia
When someone is over 55 and has new onset dysphagia with weight loss and abdo pain/ reflux/ dyspepsia
What is cholecystitis?
Inflammation of the gallbladder
What is the most common case of cholecytsitis?
Gallstones
What symptoms will someone with gallstones classically present with?
Pain in the RUQ
Palpable mass in RUQ
Positive Murphy’s sign
Signs of inflammation
How do you test for Murphy’s sign, when would you do it and when is it positive?
Palpate under the 9th costal cartilage when you suspect gallbladder pathology
On inspiration, the gallbladder will move down and hit your hand causing the pain to be in pain
Who is most likely to get cholecystitis?
Those in the western world
What is the first line investigation for cholecystitis?
If asymptomatic no investigations are needed
If symptomatic do LFTs and an ultrasound of the biliary tree
If nothing is found on ultrasound and you still suspect gallstones due to a widened biliary tree or deranged LFTs do an MRCP
If MRCP is not conclusive you can do and EUS
How is cholecystitis managed?
If the patient is waiting for treatment tell them to avoid foods that trigger their symptoms
Do a laparoscopic cholecystectomy and then a clearance of the bile duct
What are some risks for acute cholecystitis?
Having existing gallstones
Having previous episodes of RUQ pain
When someone has gallstones when will their pain characteristically come on?
After fatty meals
What is cholangitis?
Inflammation of the biliary tree
What is the difference between cholecystitis and cholangitis?
Cholecystitis= inflammation of the gallbladder Cholangitis= inflammation of the biliary tree
What is pancreatitis?
Inflammation of the pancreas
What symptoms will someone with acute pancreatitis present with?
Deep boring pain in the epigastric pain that localises to the LUQ, radiates to the back, is persistent, alleviated by sitting forward or lying on their side, takes 10-20 mins to reach maximal intensity Vomiting Jaundice Grey Cullens or Turner's sign Fever Tachycardia
What is Grey Cullens and Turner’s sign? When would you see it?
Bruising around the flank and umbilicus
Seen in pancreatitis
What is pain in acute pancreatitis characteristically like?
Starts in epigastric region
Localises to LUQ
Takes 10-20 mins to reach maximal intensity
Deep and boring
Radiates to back
Alleviated by sitting forwards or lying on the side
Constant
How will a patient with acute pancreatitis lie?
Sometimes very still and on their side
What are the first line investigations for acute pancreatitis?
LFTs, bloods, serum amylase and lipase
Ultrasound pancreas if you suspect gallstones
MRI if there is persistent organ failure
What are risk factors for pancreatitis?
Alcohol use
How is pancreatitis managed?
ABC first
Fluid resus
Supportive treatments like oxygen, analgesia, enteral feeding if they are unable to eat
Treat the causes eg remove gallstones surgically if thats the cause
What are complications of acute pancreatitis?
ARDs
Systemic complications eg sepsis, shock, renal failure
Necrosis of the pancreas, formation of a pseudocyst or abcess etc
What is it important to note if the suspected cause of pancreatitis is gallstones?
They may not be visible on ultrasound if there is inflammation so you may have to wait for a few days
What is an anal fissure?
A split in the skin in the distal anal canal
What symptoms will someone with anal fissures classically present with?
A tearing pain in the anus on defecation
Burning sensation that lasts 1-2 hours after defecation
Anal spasm
Blood in the stool or when wiping
Who is most likely to get anal fissures?
Young adults
Pregnant women
What are some causes of anal fissures?
Cancer STI Pregnancy IBD Poor toileting Opiate analgesia use
What is the first line investigation for anal fissure?
None- diagnosis can be clinical and after examination (get them to lie on their side and spread their buttocks but note you may not be able to see it if its superficial or if there is anal spasm)
How are anal fissures managed?
If they are constipated treat the constipation
If stool is normal advise a high fibre diet and lots of fluid intake
If not healed in a week offer rectal GTN ointment
If pain is severe offer analgesia or anaesthetics
If you suspect cancer or if its atypical looking, refer to the relevant specialist
What are complications of anal fissures?
Chronic fissure
Recurrence
Incontinence after surgery
What is coeliac disease?
An autoimmune disorder wherein there is a reaction to dietary gluten peptides that results in villous atrophy and increased lymphocytes etc
What symptoms would someone with coeliac disease classically present with?
Abdominal pain/discomfort/distention Bloating Unexplained weight loss Unexplained anaemia, B12/folate deficiency Faltering growth Mouth ulcers
What are risk factors for coeliac disease?
Genetic/having a first degree relative with it
Having an autoimmune thyroid disorder
Having type 1 diabetes
Who is more likely to get coeliac disease?
Women
Those with a first degree relative
People in Europe/US
What is the first line investigation for coeliac disease?
Serology- first screen for IgA ttg (they must be eating a diet with gluten in it for 6 weeks leading up to it)
If positive refer to specialist for endoscopy so that it can be confirmed and ruled out
What must be done in prep for serology for coeliac disease?
The patient must eat gluten at least in one meal for 6 weeks leading up to the test
How is coeliac disease managed?
Refer to a dietician who will teach them about what contains gluten and what doesn’t, how to avoid contamination, food labelling etc
Also offer annual review to check height/weight, review symptoms, check adherence to diet etc
What are haemorrhoids?
Naturally occuring vascular tissue in the distal anal canal that becomes pathological
What are the 2 types of haemorrhoids and how do they differ?
Internal= lie proximal to the dentate line in the anal canal External= lie distal to the dentate line in the anal canal
What symptoms will someone with haemorrhoids classically present with?
Perianal pain or discomfort
Bleeding from the anus- in the stool or on wiping
What are some risk factors for developing haemorrhoids?
Constipation
Pregnancy
Age 45-65
Presence of a space occupying lesion