Gastroenterology Flashcards
Red flags of abdominal pain
Persistent or bilious vomiting
Severe chronic diarrhoea
Fever
Rectal bleeding
Weight loss
Dysphagia
Night time pain
Abdominal tenderness
History of constipation
Less than 3 stools a week
Hard stool thats difficult to pass
Rabbit dropping stools
Straining and painful passage
Abdominal pain
Abnormal posture - retentive posturing
Rectal bleeding
Faecal impaction - overflow soiling
Incontinence of loose smelly stools
Hard stools palpable
Loss of the sensation of needing to open bowels
Red flags of constipation
Not passing meconium
Neurological signs
Vomiting
Ribbon stool
Abnormal anus
Abnormal lower back or buttocks
Failure to thrive
Acute severe abdominal pain and bloating
Management of constipation
Lifestyle management
Reverse contributing factors
Laxatives - movicol!
Encourage appropriate toilet behaviour
Define gastro oesophageal refulx disorder
Where contents of the stomach reflux through the lower oesophageal spincter into the oesophagus throat or mouth
Presentation of reflux
Normal after large feeds
Chronic cough
Hoarse cry
Distress, crying or unsettled after feeding
Reluctance to feed
Pneumonia
Poor weight gain
Red flags of reflux
Not keeping anything down
Projectile or forceful vomiting
Bile stained
Haematemesis
Abdominal distension
Reduced consciousness, bulging fontanelle or neuro signs
Respiratory symptoms
Blood in stool
Signs of infection
Rash, angioedema
Apnoeas
Management of reflux
Small frequent meals
Burping regularly
Not overfeeding
Keep upright after feed
Gaviscon
Thickened milk
PPIs
Define pyloric stenosis
Hypertrophy and narrowing of the pylorus - preventing food traveling from the stomach to duodenum as normal
Presentation of pyloric stenosis
Failure to thrive
Projectile vomiting
Firm round mass in upper abdomen - large olive
Metabolic alkalosis - hypochloric
Management of pyloric stenosis
Abdominal ultra sound
Laparoscopic pyloromyotomy
Define gastroenteritis
Inflammation of the stomach leading to nausea vomiting and diarrhoea
Causative organism in gastroenteritis
Rotavirus
Norovirus
E. coli - shiga toxin
Campylobacter
Salmonella
Bacillus cereus
Management of gastroenteritis
Barrier nursing
Prevent dehydration
Anti-diarrhoeals - loperamide
Abx
Define coeliac disease
Autoimmune condition where exposure to gluten causes an immune reaction that creates inflammation in the small intestine
Presentation of coeliac disease
Failure to thrive
Diarrhoea
Fatigue
Weight loss
Mouth ulcers
Anaemia - iron, B12 or folate
Dermatitis herpetiformis
Neurological symptoms
Investigations in coeliac disease
Auto antibodies - anti-TTH, anti-EMA
Endoscopy and biopsy - crypt hypertrophy, villous atrophy
What conditions are associated with coeliac disease
Type 1 diabetes
Thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Down’s
Management of coeliac disease
Life-long gluten free diet
Define inflammatory bowel disease
Umbrella term for conditions causing chronic inflammation in the bowel
Features of Crohns
Crows NESTS
No blood or mucus
Entire GI tract
Skip lesions
Terminal ileum
Smoking is a risk factor
Features of ulcerative colitis
UC CLOSEUP
Continuous inflammation
Limited to colon and rectum
Only superficial mucosa
Smoking protective
Excrete blood and mucis
Use aminosalicylates
Primary sclerosing cholangitis
Presentation of IBD
Perfuse diarrhoea
Abdominal pain
Bleeding
Weight loss
Anaemia
Systemically unwell
Fevers
Malaise
Dehydration
Extraintestinal manifestations of IBD
Finger clubbing
Erythema nodosum
Pyoderma gangrenosum
Episcleritis and iritis
Inflammatory arthritis
Primary sclerosing cholangitis
Investigations in IBD
Faecal calprotectin
Endoscopy
Imaging - CT
Management of Crohns
Induce remission - steroids (azathioprine, mercaptopurine, infliximab)
Maintain remission - Azathioprine (methotrexate, infliximab)
Surgery -
Management of ulcerative colitis
Inducing remission - mesalazine (corticosteroids, ciclosporin)
Maintaining remission - mesalazine, azathioprine, mercaptopurine
Surgery - ileostomy
Define biliary atresia
A congenital condition where a section of the bile duct is either narrowed or absent - results in cholestasis and jaundice.
Managment of biliary atresia
Kasai portoenterostomy
Define intestinal obstruction
A physical obstruction preventing the flow of faeces through the bowel.
Causes of intestinal obstrucction
Meconium ileus
Hirschsprung’s disease
Oesophageal atresia
Duodenal atresia
Intussusception
Imperforate anus
Malrotation
Strangulated hernia
Presentation of bowel obstruction
Vomiting - bilious?
Abdo pain
Failure to pass stool or wind
Bowel sounds - absent or tinkling
Define hirschsprungs disese
A congenital condition where the nerve cells of the myenteric plexus are absent in the distal bowel and rectum - Bowel looses its motility and stops passing food along its length
There is an absence of parasympathetic ganglion` cells
Genetic associations with Hirschsprung’s disease
Down’s Neurofibromatosis
Waardenburg syndrome
MEN II
Presentation of Hirschsprungs disease
Acute obstruction at birth or gradual development of symptoms
Delayed meconium passing
Chronic constipation
Abdominal pain
Vomiting
Poor weight gain and failure to thrive
Investigation in Hirschsprung’s disease
Abdo xray
Rectal biopsy
Management of Hirschsprung’s disease
Fluids
Manage obstruction
Surgical removal of affected bowel
Define intussusception
Where a portion of bowel invaginates into itself - telescoping of the bowel.
Associations with intussusception
Concurrent viral illness
Henoch-Schonlein purpuraa
Cystic fibrosis
Intestinal polyps
Meckel diverticulum
Presentation of intussusception
Severe colicky pain
Pale lethargic unwell
Redcurrant jelly stool
Mass on palpation - sausage shapped
Vomiting
Obstruction
Management of intussusception
Ultrasound
Therapeutic enemas - air or water
Surgical reduction
Define appendicitis
Inflammation of the appendix
PResentation of appendicitis
Central abdominal pain
Moves to right iliac fossa
Tenderness in McBurney’s point
Loss of appetitis
Nausea and vomiting
Rovsings signs - pain on palaption of left
Guarding
Rebound tenderness
Percussion tenderness
Management of appendicitis
Appendicetomy
Laparoscopic exploration
