Gastroenterology Flashcards
Definition of GORD
A motility disorder of the oesophagus caused by reflux of gastric contents into the oesophagus and characterised primarily by heartburn
Prevalence of GORD
approx 30%
Medications that reduce lower oesophageal sphincter pressure (increase reflux)
Calcium channel blockers Alpha-adrenergic antagonists Nitrates Anticholinergics Sedatives Prostaglandins
Extra-oesophageal syndromes associated with GORD
Chronic cough
Laryngitis
Asthma
Dental erosions
Management of GORD
Avoid drugs/food that reduce LES pressure Avoid acidic foods Adopt behaviours to minimise reflux: - weight reduction, elevation of head of bed, avoid lying directly after eating, smaller more frequent meals, avoid alcohol and cigarettes Antacids (for mild symptoms Proton pump inhibitors Histamine2 receptor antagonists Nissen fundoplication if refractory
Examples of PPIs
Esomeprazole (Nexium)
Omeprazole
Rabeprazole (Pariet)
Examples of histamine2 receptor antagonists for GORD
Ranitidine
Nizatidine
Antacids examples
Mylanta (aluminium hydroxide + magnesium hydroxide)
Calcium carbonate
Which is the most common inflammatory bowel disease
Ulcerative colitis (80-150/100,000) CD prevalence 25-100/100,000
macroscopic pathological findings of Crohn’s disease
Skip lesions
Thickened, narrow bowel
Cobblestone appearance
Macroscopic pathological findings of ulcerative colitis
Contiguous involvement Reddened Inflamed Friable (bleeds easily) Extensive ulceration and polyps in severe disease
Colonic cancer risk in IBD
Increased in Crohn’s affecting colon, no difference in UC
Clinical presentation of Crohn’s disease
Diarrhoea (80%) usually bloody, mucus Crampy abdominal pain Weight loss Constitutional symptoms (malaise, lethargy, anorexia, nausea and vomiting, low-grade fever) Aphthous ulcers, perianal disease
Emergency presentation of acute abdomen mimicking appendicitis (RIF pain)
Clinical presentation of ulcerative colitis
Diarrhoea: severe attacks of more than 6 stools per day - bloody, mucus, night time diarrhoea
Lower abdominal discomfort
Constitutional symptoms (malaise, lethargy, anorexia, weight loss)
Proctitis (urgency, tenesmus, sensation of incomplete evacuation)
Management of Crohn’s disease
Induce remission: oral or IV glucocorticoids, enteral nutrition, anti-TNF antibodies (e.g. infliximab)
Maintain remission: AZA, MTX, anti-TNF antibodies
Symptom relief: supplement deficiencies (Fe, B12), loperamide for diarrhoea
Surgery in Crohn’s disease
Options:
- stricturoplasty
- Bowel resection and anastomosis
- ileostomy
Indications:
- failure of medical treatment
- complications
- FTT
- perianal sepsis
Management of UC
Oral or rectal 5-aminosalicylic acid treatments
Oral prednisolone if poor response
Surgical resection of affected bowel may be curative
Causes of constipation
DOPED
Drugs (opioids, anticholinergics, neurally active drugs, iron supplements)
Obstruction (small or large bowel)
Pain (e.g. anal fissures)
Endocrine (DM, hypothyroid, hyperCa, hypoK)
Depression
Red flags of constipation
Age over 50 Acute or recent onset Weight loss Abdominal pain or cramping Rectal bleeding or melaena Nausea or vomiting Rectal pain Fever Change in stool calibre Iron deficiency anaemia
Clinical features of diverticulitis
Acute LLQ pain Fever, chills Leukocytosis Nausea and vomiting Bleeding
Primary prevention of diverticulosis
High-fibre diet to avoid constipation
Sufficient fluid intake
Adequate physical activity
Management of diverticulitis
Increase dietary fibre intake and regular exercise
Nil by mouth + IV fluids in severe disease
Broad spectrum antibiotics (e.g. ciprofloxacin or bactrim)
Surgical: resection and reanastomosis or ileostomy
Indications for surgery:
- repeated episodes of diverticulitis (2 or more)
- failure of conservative management
- abscess or fistula formation
- obstruction
- peritonitis
- immunocompromised patients, first episode less than 40
- unable to exclude carcinoma
Significant family history of bowel cancer
Immediate relative developed before 55y
More than one relative on the same side of the family
Potential presentations of colon cancer
Rectal bleeding Bowel or abdo symptoms - change in bowel habit - bloating - weight loss - malaise - mucus in stool Iron deficiency anaemia
