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Year 5 Notes > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Dyspepsia (new):

Management

A 
>55 OR
Anaemia
Loss of weight
Anorexia
Recent onset
Melaena/haematemesis
Swallowing problems
--> refer for upper GI endoscopy
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2
Q

H pylori regimes

A

PPI + 2 abx

PAC500
PMC250
Bd for 7 days

Review after 4w

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3
Q

Melaena:

Causes

A 
Peptic ulcers
Mallory-Weiss 
Varices
Drugs (NSAIDs)
Dudodenitis
Malignancy
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4
Q

Appendicitis:

Presentation

A 
Periumbilical pain moves to RIF (guarding, rebound) 
anorexia
Vomiting
Constipation
Fever
Tachycardia
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5
Q

Leukoplakia

A

Oral musical white patch
Does NOT rub off

Refer - premalignant

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6
Q

Oral hairy leukoplakia

A

Shaggy patch on sides of the tongue
In HIV
caused by EBV

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7
Q

Sliding hiatus hernia

A

GOJ slides up into chest
Reflux as LES becomes less competent
Diagnose - barium swallow
Tx - lose weight, treat reflux, surgery last line

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8
Q

Rolling hiatus hernia

A

GEJ remains in abdo, but stomach herniated into stomach alongside esophageal
Less common to have bad GORD
Diagnose - barium swallow
Tx - lose weight, GORD Tx, surgery last line

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9
Q

Pancreatitis:

Symptoms and signs

A 
Gradual or sudden severe central abdominal pain
Radiates to back
Alleviated sitting forward
Vomiting 
Tachycardia
Fever 
Jaundice
Rigid tender abdo
Cullen's sign
Grey Turners sign
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10
Q

Cullen’s sign

A

Peri umbilical bruising - sign of pancreatitis

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11
Q

Grey turners sign

A

Flank bruising - in pancreatitis

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12
Q

Pancreatitis:

Ix

A 
Serum amylase >1000 (but can be normal)
Serum lipase raised
ABG - monitor O2 and acidosis
AXR - no psoas shadow
CXR - can exclude other causes eg perforation 
CT/MRI to assess severity
ERCP is deteriorating LFTS
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13
Q

Pancreatitis:

Management

A 
Fluids
Analgesia 
Monitor closely
ERCP + gallstone removal if progressive jaundice
Retreat imaging to monitor progress
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14
Q

Pancreatitis:

Complications

A 
Pancreatic necrosis +pseudocyst
Access
Bleeding/thrombosis 
Bowel fistulae
Recurrent pancreatitis
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15
Q

Glasgow Criteria for pancreatitis

A

To assess severity PANCREAS

PaO2 55
Neutrophilia
Calcium 
Renal function
Enzymes 
Age
Sugar
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16
Q

Ulcer pain relieved by eating

A

Duodenal

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17
Q

Skip lesions

A

Crohn’s disease

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18
Q

Painless jaundice+steatorrhea

A

Pancreatic cancer

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19
Q

Post-splenectomy vaccines

A 
Hib 
Pneumococcal
Meningococcal
Pen V (2 years to life)
Medicard
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20
Q

Peritonitis signs

A 
T tenderness and tachycardia
R reflex and rigidity
A absent bowel sounds
P pyrexia
P percussion pain
E extremely unwell
R rovsing sign
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21
Q

Gout:

Acute management

A

NSAIDS (colchicine if ulcer etc)
Intraarticular steroid injection
Oral steroids if above CI
If already taking allopurinol then continue

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22
Q

Gout:

Allopurinol prophylaxis

A

Not until 2w after attack has settled

Initially 100mg then titration, aim for Uric acid

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23
Q

Gout:

Allopurinol indications

A 
Recurrent attacks
Tophi 
Renal disease
Uric acid stones
Prophylaxis if on gout causing meds
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24
Q

Ginigivitis:

Causes

A

Pregnancy
AML
Vit C deficiency
Phenytoin, cicoosporin, nifedipine

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25
Q

Gastric ulcer

A

Worse when eating, relieved by antacids
Weight loss
Need to biopsy if worried gastric ca

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26
Q

Duodenal ulcer

A

Same risk factors as gastric

Relieved by eating or drinking milk

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27
Q

Portal hypertension:

Causes

A

Prehepatic: thrombosis
Hepatic: cirrhosis, schistosomiasis
Post hepatic: buds chiari, right heart failure

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28
Q

Varicies:

Prophylaxis

A

Primary: propanalol, band ligation
Secondary: TIPS, banding

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29
Q

Varicies:

Acute bleed management

A

Fluid resus
Vit K if abnormal clotting, FFP, platelets
IVI terlipressin
Banding/ balloon compression

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30
Q

Hepatorenal syndrome

A

Cirrhosis+ascites+renal failure

Liver failure causes renal vasoconstriction even though all others are vasodilation

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31
Q

Spontaneous Bacterial Peritonitis

A

Sudden deterioration of patient with ascites
E. coli, klebsiella, strep
Broad spec ABx

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32
Q

Haemochromatosis:

Signs and symptoms

A 
Tiredness
Joint pain
Grey skin 
Signs if liver disease
Diabetes
Hypogonadism
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33
Q

Haemochromatosis:

Blood results

A

Raised LFTS
Raised serum ferritin
High glucose

34
Q

Primary billiary Cirrhosis:

Signs and features

A 
Lethargy
Pruritis
⬆️ alk phos 
AMA +ve
Jaundice
Pigmented skin
Hepatosplenomegaly
Hyperlipidaemia
35
Q

Primary billiary cirrhosis:

Blood results

A 
⬆alk phos
️⬆GGT️
Mildly⬆ AST, ALT
⬇️albumin
 ️⬆Billirubin
 ⬆PT, immunoglobulins, cholesterol
36
Q

Primary billiary cirrhosis:

Management

A

Treat pruritis and diarrhea
Give vitamin DAK
Osteoporosis prophylaxis
Eventually liver transplant

37
Q

PBC vs PSC

A

PSC affects intra and extra hepatic bile ducts
Only PBC has AMA
PSC 90% have IBD
PSC mainly men can also be children, PBC only adults
PSCcan cause various malignancies

38
Q

Primary sclerosing cholangitis:

Features

A 
Pruritis
Fatigue
Often IBD
Liver disease
Male
Ascending cholangitis
39
Q

Primary sclerosing cholangitis:

Blood results

A

⬆️alk phos
⬆️bilirubin
Hypergammaglobuminaemia

40
Q

Primary sclerosing cholangitis:

Management

A

Management pruritis
Liver transplant for end stage
ABX for bacterial cholangitis

41
Q

NAFLD:

Presentation

A 
Middle aged
Obese
Women 
DM, dislipidaemia
Amiodarone, methotrexate, tetracycline 
Raised LFTs with fatty liver on USS
42
Q

Never proximal to ileocaecal valve

A

UC

43
Q

Inflammation of entire colon

A

UC

44
Q

UC:

Presentation

A

Diarrhoea +- blood, mucus
Cramps
Frequency/urgency/tenesmus
Attacks: fever, malaise, anorexia, weight loss
Aphthous ulcers
Conjunctivitis/episcleritis/arthritis/ank spond

45
Q 
Goblet cell depletion
Mucosal ulcers
Crypt abscesses
Inflammatory infiltrate
Mucosal thickening/islands
A

UC

46
Q

AXR findings for UC

A

No face cal shadows
Mucosal thickening/islands
Colonic dilatation

47
Q

Colonoscopy findings for UC

A 
Inflammatory infiltrate
Goblet feel depletion
Glandular distortion
Mucosal ulcers
Crypt abscesses
48
Q

Complications of UC

A

Toxic dilation
Venous thrombosis when inpatient
Malignancy - needs regular colonoscopy

49
Q

UC:

Treatment

A

5ASAs - sufalazine
Steroids - pred (oral/suppositories for mild, enema mod)
IV hydrocortisone for severe (or rectal)
Ciclosporin or infliximab
Immunomodulation last line - azothiaprine, methotrexate

50
Q

GI inflammation anywhere from mouth to anus

A

Crohns

51
Q

Not continuous - areas of unaffected in between bowel inflammation - skip lesions

A

Crohns

52
Q

Crohns:

Symptoms

A 
Diarrhea
Urgency
Weight loss
Fever malaise anorexia 
Aphthous ulcers
Abdo tenderness
Perianal abscess or fistula
53
Q

Crohns:

Complication

A 
Toxic dilatation 
Small bowel obstruction 
Access
Fistulae
Peroration
Rectal haemorrhage
Cancer
54
Q

Barium enema findings for Crohns

A

Cobblestone
Rose thorn ulcers
Colon strictures

55
Q

Crohns:

Treatment

A 
Pred
Or hydrocortisone if severe
Metronidazole 
Infliximab 
Azothiaprine/sufalazine
56
Q

Painless obstructive jaundice

A

Carcinoma of pancrea

57
Q

No inflammation beyond submucosa

A

UC

58
Q

Acute cholecysitis:

Presentation

A 
Continuous epigastric or RUQ pain
Vomiting
Fever
Local peritonitis 
GB mass
59
Q

Acute cholecysitis vs billiary colic

A

AC is inflammatory - so raised WCC, fever, local peritonism

60
Q

Murphys sign

A

Fingers over RUQ ask patient to breathe in, they stop breathing due to pain as inflamed gallbladder hits your fingers
Only positive if same in LUQ doesn’t hurt
+ve shows acute cholecysitis

61
Q

Acute cholecysitis:

Ix

A

Bloods show raised WCC

USS shows thick walled shrunken GB, pericholecystic fluid, stones,

62
Q

Acute cholecysitis:

Treatment

A

NBM
Pain relief
Broad spec eg cefuroxime

63
Q

Chronic cholecysitis:

Presentation

A 
Chronic inflammation
Colic
Flattening dyspepsia 
Abdo distention
Fat intolerance
64
Q

Billiary colic:

Presentation

A

RUQ pain radiating to back +-jaundice

65
Q

Cholangitis:

Presentation

A

RUQ pain, jaundice, rigors

66
Q

Billiary colic vs acute cholecysitis vs cholangitis

A

Billiary colic: RUQ pain
Acute cholecysitis: RUQ pain + fever⬆️WCC
Cholangitis: RUQ pain + fever⬆️WCC + jaundice

67
Q

Boerhaave syndrome

A

HSevere vomiting –> esophageal rupture

68
Q

Plummer-Vinson syndrome

A

Triad of

Dysphasia (from esophageal webs) + glossitis + IDA

69
Q

Mesenteric ischemia:

Presentation

A

Elderly patient
Vascular history/risk factors
Abdo pain, rectal bleeding, diarrhea, fever
Metabolic acidosis

70
Q

Rovsing sign

A

Pressing left lower quadrant causes pain in right lower quadrant
Appendicitis

71
Q

Hirschprungs disease

A

failure of mesenteric plexus to develop
Neonate so fail/delay to pass meconium or older children constipated
More common in males and downs

72
Q

Budd-Chiari syndrome

A

Hepatic vein thrombosis
Usually from haematological or coagulation disorder
E.g polycythaemia, pregnancy, COCP

Sudden severe abdo pain, ascites, tender hepatomegaly

73
Q

Cholangiocarcinoma

A

Persistent biliary colic symptoms
Jaundice, anorexia, weight
Palpable gallbladder (Courvosier)

74
Q

Kantors string sign

A

Crohns

75
Q

Gallstones ileus

A

Small bowel obstruction secondary to impacted gallstone

Abdo pain, distention, vomiting +- hx of gallstones

76
Q

Most common travelers diarrhea
Watery stools
Cramps and nausea

A

E. coli

77
Q

Infective diarrhea, prolonged non bloody

A

Giardia

78
Q

Infective diarrhea

Bloody diarrhea, vomiting and Abdo pain

A

Shigella

79
Q

Infective diarrhoea
Flu symptoms then cramps Abdo pains, fever, diarrhoea
Can cause GBS

A

Campylobacter

80
Q

C diff treatment

A

Metronidazole

81
Q

Barium enema with loss of hays teal markings creating lead pipe colon

A

Ulcerative colitis

Year 5 Notes (19 decks)

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