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ihd > gastroenterology > Flashcards

gastroenterology Flashcards

1
Q

What is the function of the GI tract?

A

Turn food into energy
Waste removal
Intake of water- hydration

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2
Q

What are key GI symptoms?

A

Vomiting
Weight loss
Jaundice
Malaena
Haematemesis
Abdominal pain
Diarrhoea

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3
Q

How do you take a history for dysphagia?

A

Duration
Solids/liquids
Pain
Weight loss
Previous med history
Meds
Cigarettes/alcohol

Could be oropharyngeal, oesophageal or gastric

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4
Q

What are oropharyngeal causes of dysphagia?

A

Salivary gland- Sjögren’s syndrome

Tongue- amyloidosis, hypothyroidism, MND

Upper oesophageal- cerebrovascular disease, MMD, Parkinson’s

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5
Q

What are oesophageal causes of dysphagia?

A

Benign mucosal disease- benign peptic structure, web (Plummer Vinson syndrome), Candida oesophagitis

Malignant mucosal disease- carcinoma

Motility disorders- spasm, achalasia, pouch

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6
Q

What is a pharyngeal pouch?

A

Defect between constrictor and transverse cricopharyneus muscle

Mostly asymptomatic
Diagnose- Barium swallow

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7
Q

What is achalasia?

A

Bird beak sign
Tapering of distal oesophagus

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8
Q

What are gastric causes of dysphagia?

A

Carcinoma

Outlet obstruction- peptic ulceration

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9
Q

How do we manage dysphagia?

A

Tx underlying cause

Nutritionally deplete- supplementation- oral, NG, PEG

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10
Q

What is GORD?

A

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

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11
Q

How do we manage acid reflux?

A

Proton pump inhibitor (omeprazole, lansoprazole)

H2 receptor antagonists- tx symptoms

Lifestyle advice (weight loss, smoking cessation, reduce alcohol)

Surgery- fundoplication

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12
Q

What is a hiatus hernia?

A

Pressure gradient lost between abdominal and thoracic cavities

Can develop reflux symptoms

2 types- sliding hiatal hernia, paraoesophageal hernia

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13
Q

What is oesophageal manometery?

A

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

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14
Q

When might upper ab pain signify peptic ulceration?

A

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

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15
Q

How are peptic ulcers managed?

A

Treat the cause
Endoscopic tx
Surgery

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16
Q

When might upper ab pain signify gastric carcinoma?

A

Epigastric pain, weight loss, vomiting
Anyone over 40 w new onset symptoms
Can be asymptomatic
Gastroscopy + biopsy
Staging- CT/ultrasound
Tx= gastrectomy

17
Q

What are other causes of upper abdominal pain?

A

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)

18
Q

What are causes of lower acute ab pain?

A

Consider location (RU, RL, LU, LL)

Inflammation (diffuse then localised), perforation (abrupt), obstruction

19
Q

How is acute ab pain managed?

A

Surgical referral
Usually kept NBM (nil by mouth)
IV antibiotics
Imaging USS/CT

20
Q

What is lower chronic ab pain?

A

Over 6 weeks
Organic/inorganic
Consider location and features
Management- difficult, analgesics, surgery

21
Q

What are the causes of vomiting?

A

Systemic illness (infection)
Drugs/alcohol
Centrally mediated
Psychiatric disorders
Oesophageal/gastric/small bowel disease
Colonic disease- obstruction (tumours/volvulus)

22
Q

How do we manage vomiting?

A

Identify underlying cause and treat
Antiemetics (cyclizine, metoclopramide)
PPI
CBT (therapy)

23
Q

What is acute diarrhoea?

A

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

24
Q

What is chronic diarrhoea?

A

Diarrhoea more than 6 weeks

Small bowel disease (eg. Coeliac, crohns)
Pancreatic disease (eg. Carcinoma, cystic fibrosis)
Colonic disease (eg. ulcerative colitis, crohns, carcinoma)

25
Q

What is coeliac disease?

A

1:100
Mainly GI symptoms but other presentations
Diagnose- serology tests, gastroscopy
Dermatitis Herpetiformis (10%)- blisters (back, buttocks, elbows, knees)

26
Q

How can you differentiate the cause of diarrhoea?

A

Small bowel/pancreatic-
Pale, floating
Throughout day
Pain variable timing
Pain not relieved by defaecation

Colonic-
Blood and mucus
Morning
Pain related to defaecation

27
Q

What is the management of IBS?

A

Aminosalicylates
Steroids
Immunomodulatory therapy (eg. Methotrexate)
TNF therapy (eg. Infliximab)

28
Q

What are associated diseases of IBS?

A

Skin- erythema nodosum, pyoderma gangrenosum

Mouth- ulcers

Joints- ankylosing spondylitis

Eyes- episcleritis, uveitis

Vascular- thromboses

Liver- corrhosis, CAH, primary sclerosing cholangitis

29
Q

What are symptoms of colorectal cancer?

A

Asymptomatic (bowel cancer screening- FIT)
Rectal bleeding
Altered bowel habit
Lethargy/weight loss

30
Q

How is colorectal cancer managed?

A

Investigations- colonscopy, Barium enema, CT

Tx= evaluate extent, limited to colon- surgical resection, advanced- chemo/radiotherapy

31
Q

What are post hepatic causes of jaundice?

A

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

32
Q

What are hepatic causes of jaundice?

A

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

33
Q

What are prehepatic causes of jaundice?

A

HAEMOLYSIS- ISOLATED RAISED BILIRUBIN LEVEL

Haemolytic anaemia- anaemia, gall stones, splenomegaly, leg ulcers
Eg. Sickle cell disease, hereditary spherocytosis

34
Q

Signs of chronic liver disease?

A

Digital clubbing
Palmar erythema
Spider naevi
Distended abdomen- ascites

Complications- variceal bleeding

ihd (19 decks)

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