gastroenterology Flashcards
What is the function of the GI tract?
Turn food into energy
Waste removal
Intake of water- hydration
What are key GI symptoms?
Vomiting
Weight loss
Jaundice
Malaena
Haematemesis
Abdominal pain
Diarrhoea
How do you take a history for dysphagia?
Duration
Solids/liquids
Pain
Weight loss
Previous med history
Meds
Cigarettes/alcohol
Could be oropharyngeal, oesophageal or gastric
What are oropharyngeal causes of dysphagia?
Salivary gland- Sjögren’s syndrome
Tongue- amyloidosis, hypothyroidism, MND
Upper oesophageal- cerebrovascular disease, MMD, Parkinson’s
What are oesophageal causes of dysphagia?
Benign mucosal disease- benign peptic structure, web (Plummer Vinson syndrome), Candida oesophagitis
Malignant mucosal disease- carcinoma
Motility disorders- spasm, achalasia, pouch
What is a pharyngeal pouch?
Defect between constrictor and transverse cricopharyneus muscle
Mostly asymptomatic
Diagnose- Barium swallow
What is achalasia?
Bird beak sign
Tapering of distal oesophagus
What are gastric causes of dysphagia?
Carcinoma
Outlet obstruction- peptic ulceration
How do we manage dysphagia?
Tx underlying cause
Nutritionally deplete- supplementation- oral, NG, PEG
What is GORD?
Gastro-oesophageal reflux disease
Excessive relaxation of lower oesophageal sphincter and raised intra-abdominal pressure
Heartburn, epigastric pain, acid reflux, waterbrash, N&V, tooth decay, asthma
How do we manage acid reflux?
Proton pump inhibitor (omeprazole, lansoprazole)
H2 receptor antagonists- tx symptoms
Lifestyle advice (weight loss, smoking cessation, reduce alcohol)
Surgery- fundoplication
What is a hiatus hernia?
Pressure gradient lost between abdominal and thoracic cavities
Can develop reflux symptoms
2 types- sliding hiatal hernia, paraoesophageal hernia
What is oesophageal manometery?
Use w 24 hr pH monitoring
Diagnoses refractory reflux disease
Used in motility disorders
Measure pressure profiles
Catheter and recording device
If falls below 4- reflux event
When might upper ab pain signify peptic ulceration?
Epigastric pain- can radiate to back
Gastric ulcer- worsened by food, weight loss, more like haematemesis
Duodenal ulcer- improved by eating, more likely vomiting
Complications- bleeding, perforation
Due to H. pylori, NSAIDs
How are peptic ulcers managed?
Treat the cause
Endoscopic tx
Surgery
When might upper ab pain signify gastric carcinoma?
Epigastric pain, weight loss, vomiting
Anyone over 40 w new onset symptoms
Can be asymptomatic
Gastroscopy + biopsy
Staging- CT/ultrasound
Tx= gastrectomy
What are other causes of upper abdominal pain?
Non-ulcer dyspepsia- and nausea and bloating
Pancreatic carcinoma- and unremitting pain, weight loss and jaundice (usually palliative approach)
Pancreatitis- severe pain and vomiting (blood test and ultrasound/CT), long term opiate tx (middle age men, alcohol)
What are causes of lower acute ab pain?
Consider location (RU, RL, LU, LL)
Inflammation (diffuse then localised), perforation (abrupt), obstruction
How is acute ab pain managed?
Surgical referral
Usually kept NBM (nil by mouth)
IV antibiotics
Imaging USS/CT
What is lower chronic ab pain?
Over 6 weeks
Organic/inorganic
Consider location and features
Management- difficult, analgesics, surgery
What are the causes of vomiting?
Systemic illness (infection)
Drugs/alcohol
Centrally mediated
Psychiatric disorders
Oesophageal/gastric/small bowel disease
Colonic disease- obstruction (tumours/volvulus)
How do we manage vomiting?
Identify underlying cause and treat
Antiemetics (cyclizine, metoclopramide)
PPI
CBT (therapy)
What is acute diarrhoea?
3 or more loose/liquid stools a day
Change from normal bowel habit
Infection (bacterial/viral gastroenteritis)- Campylobacter, Salmonella, Shigella, E. coli
Drugs- antibiotics/alcohol/PPI
Food allergy/intolerance
What is chronic diarrhoea?
Diarrhoea more than 6 weeks
Small bowel disease (eg. Coeliac, crohns)
Pancreatic disease (eg. Carcinoma, cystic fibrosis)
Colonic disease (eg. ulcerative colitis, crohns, carcinoma)
What is coeliac disease?
1:100
Mainly GI symptoms but other presentations
Diagnose- serology tests, gastroscopy
Dermatitis Herpetiformis (10%)- blisters (back, buttocks, elbows, knees)
How can you differentiate the cause of diarrhoea?
Small bowel/pancreatic-
Pale, floating
Throughout day
Pain variable timing
Pain not relieved by defaecation
Colonic-
Blood and mucus
Morning
Pain related to defaecation
What is the management of IBS?
Aminosalicylates
Steroids
Immunomodulatory therapy (eg. Methotrexate)
TNF therapy (eg. Infliximab)
What are associated diseases of IBS?
Skin- erythema nodosum, pyoderma gangrenosum
Mouth- ulcers
Joints- ankylosing spondylitis
Eyes- episcleritis, uveitis
Vascular- thromboses
Liver- corrhosis, CAH, primary sclerosing cholangitis
What are symptoms of colorectal cancer?
Asymptomatic (bowel cancer screening- FIT)
Rectal bleeding
Altered bowel habit
Lethargy/weight loss
How is colorectal cancer managed?
Investigations- colonscopy, Barium enema, CT
Tx= evaluate extent, limited to colon- surgical resection, advanced- chemo/radiotherapy
What are post hepatic causes of jaundice?
OBSTRUCTION OF BILE DUCTS/TRACTS, FAILURE TO INITIATE BILE FLOW (HEPATOCYTES)
Gall stones- biliary colic, fever, fluctuating jaundice
Eg. Choledocholithiasis
Malignancy- constant pain radiating to back, weight loss
Eg. Pancreatic carcinoma, cholangiocarcinoma
Benign biliary stricture- fever, pain
Eg. Post op, sclerosing cholangitis
What are hepatic causes of jaundice?
INABILITY OF LIVER TO CONVERT BILIRUBIN INTO BILE
Infection- malaise, anorexia, pale stools, dark urine, RUQ discomfort
Eg. Hep A, B, C, EBV
Alcoholic hepatitis- similar symptoms to infection
Drugs
Eg. Augmentin, flucloxacillin
Decompensated chronic liver disease- ascites, varices, hepatic encephalopathy
Eg. Alcohol cirrhosis, Wilson’s disease, haemochromatosis
What are prehepatic causes of jaundice?
HAEMOLYSIS- ISOLATED RAISED BILIRUBIN LEVEL
Haemolytic anaemia- anaemia, gall stones, splenomegaly, leg ulcers
Eg. Sickle cell disease, hereditary spherocytosis
Signs of chronic liver disease?
Digital clubbing
Palmar erythema
Spider naevi
Distended abdomen- ascites
Complications- variceal bleeding
