Gastro-Intestinal Flashcards
What test do you use to investigate H.pylori ?
- Helicobacter pylori urea breath test
- H pylori faecal antigen test
- FBC - Show Leukocytosis and reduced haemoglobin and haematocrit.
When would you refer a patient with dyspepsia and acute gastrointestinal bleeding? and What is the gold standard diagnostic test for peptic ulcer disease?
Immediately and Endoscopy
what is the first line diagnostic test for Peptic ulcer disease with h.pylori
Histology and/or urease testing (rapid urease test) or Stool antigen test.
What test is used to confirm successful eradication of H.pylori
Carbon-13 urea breath test 6 to 8 weeks after starting treatment
Is there an investigation available for diagnosing iBS?
NO
What is a) the first line investigation and b) the diagnostic of coeliac disease?
Serology - IGA tissue transglutaminase antibody and total IgA - THIS IS NOT DIAGNOSTIC.
Endoscopic intestinal biopsy - Diagnostic.
Diverticular disease is confirmed by:
Endoscopy, colonoscopy, or CT Colonography.
When do you use a stool culture and sensitivity test for Infectious diarrhoea
Diarrhoea has not resolved by day 7
travelled abroad - 3 specimiens for ova/cysts and parasites (2-3 days apart)
All children under age 5 years - who are at risk of shiga toxin-producing e.coli)
contact with an affected person.
What condition causes: Sudden-onset, constant, severe pain in the upper right quadrant, lasting several hours. It can radiate to the back, referred pain in the shoulder or interscapular region.
Acute Pancreatitis
Confirmatory test for acute Cholecystitis?
Abdominal ultrasound
Whats the key difference in symptoms between bacterial gastroenteritis and viral?
Bloody diarrhoea and fevers - Bacterial
Watery diarrhoea - Viral
How long do you suffer from Gastroenteritis
2-7 days (usually self resolves after 2-3 days).
what is a serious complication of gastroenteritis?
Dehydration (noted by increase na+ and creatinine in blood test) + pale motteled skin, hypotension, reduced skin turgor.
Do you give antibiotics for gastroenteritis?
No - not usually. just practice hygiene do not go to public places until 48 hours after the last vomiting/diarrhoea episode Oral hydration and fruit juice sips introduce normal diet slowly.
Whats the difference between gastroenteritis and gastritis?
Gastroenteritis - Watery diarrhoea, nausea and vomiting (Gastric irritation and small intestine irriation.
Gastritis - errosion or non errosive irritation of the stomach mucosa - Leads to dyspepsia and epigastric pain.
When asking history question for gastroenteritis what is important?
Drugs history - Antibiotic use, or PPI treatment
Travel history - Foreign non western countries.
What timeframe is considered chronic diarrhoea?
> 4 weeks
what timeframe is considered acute diorrhoea?
< 4 weeks. less than,
Whats the difference between organic and functional diarrhoea?
Organic - bloody, fevers, wakes you up at night, does not resolve on fasting, weight loss and severe abdominal cramps, nocturnal diarrhoeah (IBD, Coeliac disease, pancreatitis) large volume
Functional - triggered by stress, relieved on fasting, no weight loss, (examples - IBS, Lactose intolerance, food allergies, alcohol/drugs) small volume
Whats the difference between diarrhoea from the small bowel vs large bowel?
Small intestine - yellow/gray - low frequency but high load
Large bowel - bloody/mucus - high frequency but low load
Causes of chronic diarrhoea?
Coeliac (can occur when older)
IBD
IBS
Colorectal cancer
Causes of bloody acute diarrhoea?
Bacterial - Campylobacter jejuni (this is most common isolated in gp), Shigella, E.coli, C.diff, Salmonella
Viral - Cytomegolovirus
Parasites- Schistosomiasis
Most common infectious causes of acute diarrhoea?
Sapovirus
noravirus
rotavirus
Campylobacter infection
What are the time differences for viral, bacterial and protoza based diarrhoea?
Viral diarrhoea lasts around 2–3 days.
Untreated bacterial diarrhoea has a duration of around 3–7 days.
Protozoal diarrhoea can be present for weeks to months without treatment.
types of diarrhoea caused by protozoa that can cause chronic diarrhoea?
Entamoeba histolytica, Giardia intestinalis and Cryptosporidium
What is IBS?
Irritable bowel syndrome -
Diagnosis of exclusion
RF of IBS?
Age 20-30 years
sex - female
Gastroenteritis
STRESS!
Criteria of IBS?
Rome criteria IV 1 day a week for 3 months releieved on defecation change in frequency change in FORM of stool
Symptoms of IBS
Abdominal pain IBS with diarrhoea, constipation or MIXED pain relieved on defecation Urgency fluctulence and urgency
Treatment:
- Diet
- High fibre
- No alcohol/caffeine/spicy and fatty foods
- probiotics
- CBT
Bulkforming laxatives - constipation
lopermide - diarrhoea antimotility
Diagnosis of IBS
symptoms persistent for 6 months
Abdominal pain, or
Bloating, or
Change in bowel habit.
change in frequency (increased/decreased)
change in form (lumpy, soft, loose, or watery)
Altered stool passage (straining, urgency, or incomplete evacuation)
worsened by eating
rectal mucus
what Constipation medication should you NOT give for IBS
Lactulose
what are the signs & symptoms of Pancreatitis?
- Sharp Epigastric pain
- radiates to the back or flank
- Vomiting/Diarrhoea
- Alleviated by moving forward or foetal position
- worse on movement
- rebound tenderness
Causes of acute pancreatitis?
I G E T S M A S H E D Gallstones Ethanol - alcohol misuse Trauma Drugs - Steroids, Infection - Mumps, steroids
Diagnosis of Pancreatitis
Abdominal pain Amylase/lipase (3 x upper limit) Imaging ct abdomen/pelvis / ultrasound (can see hypocalcemia - fat breaks down, free fatty acids bind to calcium) Hyperglycemia
What is dyspepsia?
a range of Upper gastric symptoms etc: Bleching, vomiting and nausea, epigastric pain, reflux, heartburn that last for more than 4 weeks.
Post prandial - to do with food
Epigastric syndrome - improved on ingestion
Or both
Red flag symptoms of upper gI cancer?
Hemetemesis Persistant vomiting Dysphagia unintended weight loss Abdominal mass
What are the differentials of Dyspepsia?
GORD Peptic ulcer - h.pylori test Drugs (metformin, nsaids, bisphosphanates) Inferior MI Oesophagitis
What is barrest oesphagous?
Change of squamous cells to transitional columnar epithelial cells
How do you treat dyspepsia?
PPI for 4-8 weeks NO food 3 hours before bed elevate the head avoid spicy foods, coffee and caffeine frequent moderate food weight loss smoking cessatoin
what unusual ways can GORD present?
Asthma, Hoarseness, Dry cough, Dental Erosions
what is treatment of GORD vs Oeosphagitis
4 weeks PPI - oesphagitus
8 weeks PPI - oesphagitus
What are haemorrhoids?
veins - form haemorrhoid plexus in the anal canal. Can have internal haemorrhoids above the dentate or pectinate line. Or external haemorrhoids which is below the line.
What are the symptoms of haemorrhoid
- Bright red streaks of blood
- painful defecation
- painful if external haemorroids
- fullness and pressure, incomplete evacuation
- itching/burning
Treatment of haemmoroids
stages 3 and 4 haemarrhoidectomy topical creams - steroids and local. anaesthetic - used mornign and nigh and after bowel movement good fibre intake, and drinking water patching and keep clean anal region. do not hold onto stool. heavy lifting straining when passing stool
Refer if sever pain.
Stages of haemmorhoids
- they are larger than normal in anal canal
- they protude pass dentate line on straining
- they protude pass dentate line a reduce on manual pressure
4 they remain outside the dentate line and enlarged.
What is pneumonia?
Inflammation, infection of the aveoli sacs
I am an alcoholic - what organism will give me pneumonia?
Klebsiella
I am in college, in barracks, what organism will give me pneumonia, and ENT (pharyngitis symptoms)
Mycoplasma pneumonia
what organism from birds/bat droppings causes pneumonia
Histoplasmosis
What fungal pneumonia is found in HIV
Pneumocystitis jerviccie
What pneumonia is present in copd, asthma, cystic fibrosis patients?
Hemophillus influenza.
what is the most common bacterial pneumonia?
Streptococcas aeures
what bacterial pneumonia is found in HIV patients, or cystic fibrosis. (Bacterial)
Pseudonmas aurgenious
what pneumonia is found in air cons, or water source?
Legionelle - urine test, can also cause nausea and vomiting.
what is common VAP and IV users?
Staph.
What organism comes
Name the pneumonia organism for the following:" Rusty - blood tinged - Green sputum foul smelling Red current jelly
1 - Strep.
- h.inflenza, pseudonomas
- Anaerobes
- klebsiella
would you see chest x-ray changes in acute bronchitis?
NO
Should you treat acute bronchitis?
NO - viral, self limiting 3-4 weeks.
can use honey, over the counter cough suppressants
Which condition do you give antibiotics to?
Acute bronchitis
or
pneumonia?
Pneumonia
What antibitoics first line do you give for CAP
First choice oral antibiotic is amoxicillin 500 mg three times a day for 5 days
Patient should get better within 3 days if not then seek help
whats the timescale for CAP
1 week fever reduced
4 weeks chest pain and sputum production
6 weeks - cough and breathlessness resolved
3 months - Symptoms resolved but fatigued
6 months - all better
AN 18 year old boy has swollen parotid salivary glands, epididyorchitis and haematuria? what does he have?
MUMPS- other symptoms can be glomerulonephritis. orchitis epididymitis meningitis encephalitis pancreatitis myocarditis
Is there a treatment for MUMPS?
no
patient keeps isolated 5 days after onset of symptoms.
Mumps is infectious 1 -2 days before onset of symptoms.
How are mumps spread?
Respiratory droplets.
how do you diagnose mumps
igm antibodies
prodromal fever, malasise, athralgia, headaches leads to what condition that causes parotitis?
MUMPS
Koplik spots also known a Enathems are seen in what condition?
Measels - red spots with white or bluish centre
Prodromal - cough, conjuntivitis, coryza leads to what condition?
Measels
Where does the rash exanthem begin in measels?
cephalocaudal- (head, behind ears to feet rash)
what complications can measels causE?
Ottitis media
pneumonitis
Convulsions, encephalitis, seziures. ]’.
whats is rubeola also known as?
Measels
What symptoms do you get with rubella
post auricular lymphadenopathy
fever
trunkal rash
last 3 days- rubella gets better after a week
arthritis
HIGHLY TETRAGENIC - causes eye, heart problems.
Rubella is from what virus family
TOGAvirus
Rubella must always be excluded in which group of patients?
Pregnancy
Feeling hopeless/worthless
and loss of interest
are what two core symptoms of what condition?
Depression
how many symptoms do you need for how long to diagnoise depression!?
2 core symptoms, with atleast 5 of the following for 2 weeks.
- change in appetite
- psychomotor change - agitation or slow movements
- fatigue/tired
- Concentration/memory problems
- suicide thoughts/tendencies
- changes in sleep
what is subthreshold depression?
2 core symptoms - hopelesness and anhedonia
with none of the other symptoms.
what is mild depression? vs moderate and severe depression?
Mild - 2 core symptoms - hopelessness and anehdonia, but less that 5 other symptoms
moderate - more than 5 and effecting daily living
severe - allt he time
what is dysthymia?
Depression lasting longer than 2 years
what is seasonal affective disorder?
depression during winter, remitting in spring.
what is the difference between moderate and severe depression?
In severe you can get psychomotor symptoms.
Treatment of depression?
CBT! - low intensity CBT - self directed and guided by computer, group physical activity
Group therapy - for mild to moderate
high intensity - indivdual CBT, behavrioural therapy and couple therapy
psychodynamic therapy and counselling
SSRI = setraline, fluoxetine, paroxetine
Crisis resolution and home treatment services
what is the definition of bipolar 1 disorder?
Manic episodes for more than 1 week - DIGFAST
Distractibility I Grandiose Flight of ideas agitation sleep deprived Talks fast
what is the definition of biopolar II
Hypomania - without hallucinations and delusions last for 4 days only + depression
what is a bipolar disorder and how is it treated
FLUCTUATING between depression and Mania (lithium)
What symptoms you experience with acute stress?
Anxiety, Palpitations, nausea, dizziness, sweating, clammy, pale, chest pain, headaches, tummy pain and breathing difficulties
What can you offer for acute stress?
CBT - a type of talking therapy
Beta blocker - for palpitations (but it can cause more dizziness)
Diazepam– although not used often anymore
How many causes of hypotension is there?
4
Hypovolemic - haemorrhage or non haemorrhage - GI bleeds, trauma, or Ectopic pregnancy + Aortic aneurysm, diorrhea, vomiting, sweating, diuretics.
Cardiogenic - Cardiac out put reduction - HF, ACS, Valvular disease, arrhythmia.
Decreased peripheral vasoconstriction and increased permeability - Sepsis /anaphylaxis
Obstruction - prevention of venous return i.e PE, cardiac tamponade or tension pneumothorax.