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Phase 3a - GP > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Sx of constipation

A
  1. Less than 3 stools a week
  2. Hard stools that are difficult to pass
  3. Rabbit dropping stools
  4. Straining and painful passages of stools
  5. Abdominal pain
  6. Holding an abnormal posture, referred to as retentive posturing
  7. Rectal bleeding associated with hard stools
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2
Q

Causes of constipation

A
  1. MC - idiopathic
  2. Diet - low fibre, low water, dairy products
  3. Medications - opioids, antidepressants, iron supplements
  4. Obstruction - small/large bowel
  5. Haemorrhoids
  6. Anal fissures
  7. Psychosocial - i.e. Parkinson’s
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3
Q

Tx of constipation

A

Correct any reversible contributing factors, recommend a high fibre diet and good hydration

Start laxatives

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4
Q

What are haemorrhoids?

A

Enlarged anal vascular cushions.

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5
Q

What are anal cushions?

A

Specialised submucosal tissue that contain connections between the arteries and veins - very vascular.

They help to control anal continence, along with the internal and external sphincters.

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6
Q

RF for haemorrhoids

A

pregnancy, obesity, increased age and increased intra-abdominal pressure (e.g., weightlifting or chronic coughing).

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7
Q

Describe classification of haemorrhoids

A

1st degree: no prolapse
2nd degree: prolapse when straining and return on relaxing
3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back
4th degree: prolapsed permanently

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8
Q

Sx of haemorrhoids

A
  1. Constipation and straining.
  2. Painless, bright red bleeding, typically on the toilet tissue or seen after opening the bowels - NO BLOOD mixed with stool
  3. Sore / itchy anus
  4. Feeling a lump around or inside the anus
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9
Q

Ddx of rectal bleeding

A

Anal fissures
Diverticulosis
IBD
Colorectal cancer

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10
Q

Tx of haemorrhoids

A

Topical tx - i.e. anusol
Prevention + tx of constipation

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11
Q

What is an anal fissure?

A

Small tear in the anal mucosa caused defaecation or tight anal sphincter

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12
Q

Sx of anal fissure

A
  1. Rectal bleeding - bright red
  2. Perianal pain - feels like razor blade coming out
  3. Pruritis
  4. They DONT have faecal incontinence
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13
Q

Tx of anal fissure

A

Dietary changes - inc fibre
Laxatives - SOFTEN stools!!
Topical steroids

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14
Q

Difference between haemorrhoids and anal fissures

A

Haemorrhoid = painless
Anal fissure = painful

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15
Q

Define the following:
1. Diverticulum
2. Diverticulosis
3. Diverticular disease
4. Diverticulitis

A
  1. a pouch or pocket in the bowel wall, usually ranging in size from 0.5 – 1cm.
  2. presence of diverticulum, without inflammation or infection.
  3. when patients experience symptoms.
  4. inflammation and infection of diverticula.
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16
Q

RF for diverticular disease

A

Low fibre diet
Ageing
Smoking
Obesity
NSAIDs

17
Q

Sx of:
1. Diverticular disease
2. Diverticulitis

A
  1. Triad:
    LLQ pain - typically occurs in sigmoid colon
    Constipation
    Fresh rectal bleeding
  2. LLQ pain
    Rectal bleeding
    Fever
    N&V
    Diarrhoea
18
Q

Ix for diverticular disease

A

Colonoscopy
Abdo CT w/contrast

19
Q

Tx for:
1. Diverticular disease
2. Diverticulitis

A
  1. Inc fibre in diet
    Bulk-forming laxatives (AVOID stimulant laxatives)
    Surgery
  2. Oral co-amoxiclav
    Paracetamol
    Liquid food (avoid solid food)
20
Q

What is Murphy’s sign and how is it elicited?

A

If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.

Murphy’s sign is elicited in patients by asking them to take in and hold a deep breath while palpating the right subcostal area

21
Q

What is Cullen’s sign?

A

Superficial oedema with bruising around the peri-umbilical region (below belly button)

22
Q

What is Grey Turner’s sign?

A

Bruising of the flanks

23
Q

RF of IBS

A

Anxiety
Depression
Stress
Sleep disturbance
Illness
Medications
Certain foods
Caffeine
Alcohol

24
Q

Ddx for IBS (3)

A

Bowel cancer
Inflammatory bowel disease
Coeliac disease
Ovarian cancer
Pancreatic cancer

25
Q

Sx of IBS

A

Abdominal pain
Diarrhoea
Constipation
Fluctuating bowel habit
Bloating
Worse after eating
Improved by opening bowels
Passing mucus

26
Q

Ix for IBS

A

Faecal calprotectin - detects inflammation in intestines

Tests to rule out Ddx:
FBC - anaemia
Inflammatory markers - CRP, ESR
Coeliac serology - anti-TTG antibodies
CA125 - ovarian cancer

27
Q

Tx of IBS

A

Lifestyle:
fluids, regular small meals, adjust fibre, limit caffeine, alcohol and fatty foods

Meds (Tx Sx)
Loperamide - diarrhoea
Bulk-forming laxatives - constipation
Amitriptyline - severe IBS

28
Q

What is the epithelial lining of:
Oesophagus
Stomach

A

Oesophagus: squamous epithelial lining - more sensitive to the effects of stomach acid.

Stomach: columnar epithelial lining - more protected against stomach acid.

29
Q

Describe GORD

A

Acid from stomach flows through the lower oesophageal sphincter and into the oesophagus, where it irritates the lining.

30
Q

RF for GORD (5)

A

Greasy and spicy foods
Coffee and tea
Alcohol
NSAIDs
Stress
Smoking
Obesity
Hiatus hernia

31
Q

Sx of GORD + red flag Sx

A

Heartburn (dyspepsia) + acid regurgitation - worse after meal or when lying down
Epigastric pain
Bloating
Nocturnal cough

Red flag sx (can indicate cancer):
*** Dysphagia - difficulty swallowing
Haematemesis
N+V
Wgt loss
Upper abdo mass

32
Q

Ix for GORD

A

GS: oesophago-gastro-duodenoscopy (OGD)

33
Q

Tx for GORD

A

Lifestyle: diet change, NSAIDs, elevate head at night, no late night meals

Antacids: e.g. Gaviscon, Pepto-Bismol
PPI: e.g. lansoprazole or omeprazole
H2 receptor antagonists: e.g. famotidine

Surgery: laparoscopic fundoplication - (tightening fundus of stomach to narrow lower oesophageal sphincter)

34
Q

What are the two main complications for GORD and briefly describe each?

A
  1. Oesophageal stricture: abnormal tightening or narrowing of oesophagus
  2. Barret’s oesophagus - metaplasia of lower oesophageal epithelium from squamous to columnar epithelium caused by chronic acid reflux. It’s a pre-malignant condition - for oesophageal adenocarcinoma.
35
Q

What is hiatus hernia?

A

Herniation of the stomach up through the diaphragm. When the opening of the diaphragm is wider, the stomach can enter through the diaphragm, and the contents of the stomach can reflux into the oesophagus.

36
Q

What are the different types of hiatus hernia?

A

Type 1: Sliding - stomach slides up through the diaphragm

Type 2: Rolling - separate portion of the stomach (i.e., the fundus), folds around and enters through the diaphragm opening

Type 3: Combination of sliding and rolling

Type 4: Large opening with additional abdominal organs entering the thorax

37
Q

Ix for hiatus hernia

A

Chest x-ray
CT scan
Endoscopy
Barium swallow

Phase 3a - GP (15 decks)

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