Gastroenterology Flashcards
Causes of bowel obstruction
V.A.N.I.S.H.I.N.G. P.O.O.
Volvulus Adhesions Neoplasia Inflammation (Crohns, ischaemia, diverticulitis) Strangulation Hernia Intussusception (meckels diverticulum, polyp) Neonatal (imperforate anus) Gallstone ileus
Pseudo-Obstruction (reflex atony)
Causes diarrhoea
SOILINGS
Secretory
Osmotic
Inflammation
Laxative and other drugs
Irritable bowel syndrome
Neuropathy
Gastrectomy and other surgery (short bowel, fistulae)
Structural (rectal adenoma, neoplasia, diverticula disease)
Special (alcohol, overflow, dietary indiscretion)
Causes constipation
OPEN IT WIDE
Obstruction
Pain
Endocrine/electrolytes
Neurological
Inflammation or ischaemia
Toxins
Wall disease
Irritable bowel syndrome
Diet or dehydration
Elderly, pregnancy
Types of laxative
BOSSES
Bulking eg bran, ispaghula Osmotic eg lactulose, MgSO4 Stimulant eg senna, bisacodyl Softeners eg liquid paraffin Enemas eg PO4, Na citrate Suppositories eg glycerol
Causes of nausea and vomiting
GIN & TONICS
Gastrointestinal
Infection
Neoplasia
Toxins Obstetric Ophthalmic Neurology Infarction Calcium high/ endocrine elevation Systemic
Sore throat - causes
INTERNALS
Infection
Neoplasia
Toxins (smoking, alcohol, drugs - lamotrigine; carbimazole and propylthiiuracil due to neutropenia)
Exogenous
Reflux
Nutritional (B12, folate, iron deficiency)
Autoimmune (sjogrens)
Long styloid process (chronic sore throats in children)
Sinusitis (chronic post nasal drip)
Haematemesis - Causes
VINTAGE
Varices Inflammation Neoplasia Trauma Angiodysplasia and vascular Generalised bleeding disorder Epistaxis Exogenous eg factitious
Rectal bleeding - causes
DRIPPING TAPS
Diverticulae Rectal (piles, ulcer) Infection Polyps - benign Polyps - neoplastic Inflammation Neoplasia Gastric upper bowel bleeding Trauma Arterial Systemic
Causes of splenomegaly
BIG SPAN
Blood disorders (CML, CLL, haemolytic anaemia) Infection (hepatitis, CMV, HIV, endocarditis) Granulomatous (sarcoidosis, PBC)
Storage disease eg Gauchers
Portal hypertension
Autoimmune (RA, SLE, Graves)
Neoplasia
Causes of gastric neoplasia
JAPANS SHAME
Japanese A blood group A Pernicious... Anaemia Nitrates Smoked, salted, pickled food
Surgery –> bile reflux
Helicobacter pylori
Adenomatous polyp
MEnetries disease: glandular hyperplasia
Abdo complications of UC
A.B.C.
Acute colitis
Bleeding - massive
Carcinoma
Abdo complications of Crohns
F.O.A.M
Fistula
Obstruction
Abscess
Malabsorption
Treatment IBD
S.N.A.C.K.S
Supportive - anti-diarrhoeal and anti mortality
Nutrition
Aminosalicylates - mesalazine, sulphasalazine
Corticosteroids/ other immunosuppressants
Kill bacteria - antibiotics
Surgery
Coeliac disease - PC
Anti - G.L.I.A.D.I.N.S.
Gastrointestinal and malabsorption Lymphoma and carcinoma Immune abnormalities (DM, infertility, IBD) Anaemia Dermatological IgA mesangial nephropathy Neurological eg peripheral neuropathy, cerebral calcification Systemic
Causes ascites
PAT PINTS
(transudate)
Portal hypertension
Albumin low
Thyroxin low
(exudate) Pancreatitis Infection Neoplasia Thrombosis, hepatic vein - Budd Chiari Severe pain - ectopic pregnancy, aortic aneurysm
Primary Biliary Cirrhosis - PC
P.B.C.
Pruritis: excoriations, pale stool, dark urine
Pigmentation: Melanesia of face
Bones: osteomalacia, osteoporosis
Big organs: hepatosplenomegaly, lymphadenopathy
Cirrhosis: clubbing, varices, ascites
Cholesterol increased, xanthomata
Chronic autoimmune hepatitis - PC
C.A.H.
Early - Constitutional Cushingoid: striae, hirsute, acne Amenorrhoea Arthralgia Hepatitis (recurrent jaundice) Hepatosplenomegaly
Complications-
Cirrhosis
Autoimmune
Haematological
Haemochromatosis - PC
Iron M.E.A.L.S
Myocardial: arrhythmias, heart block, dilated and restrictive cardiomyopathy
Endocrine: pancreas- diabetes; pituitary - amenorrhoea; parathyroid - hypocalcaemia, hypothyroidism
Arthritis
Liver: chronic hepatitis, cirrhosis, hepatocellular carcinoma
Skin: slatey grey
Systemic: fatigue &a scurvy
OGD if?
>55 years persistent symptoms ALARMS Anaemia Loss of weight Anorexia Recent onset progressive symptoms Melaena Swallowing difficulty
Risk factors pancreatic carcinoma
SINED
Smoking Inflammation: chronic pancreatitis Nutrition: high fat diet EtOH DM
Causes chronic pancreatitis
AGITS
Alcohol (70%) Genetic Immunes Triglycerides high Structural eg tumour, pancreas divisum
Carcinoid syndrome presentation
FIVE HT
Flushing Intestinal: diarrhoea Valve fibrosis wheeze: bronchoconstriction Hepatic involvement: bypassed 1st pass metabolism Tryptophan deficiency: pellagra
Portal hypertension - PC
SAVE
Splenomegaly
Ascites
Varices
Encephalopathy
Precipitants to encephalopathy
HEPATICS
Haemorrhage e.g. varices Electrolytes (low K, low Na) Poisons: diuretics, sedatives Alcohol Tumour: HCC Infection: SBP, pneumonia, UTI Constipation (commonest cause) Sugar (glucose) low e.g. low calorie diet
Clinical features of Wilson’s disease
CLANKAH
Cornea - Kayser-Fleischer rings
Liver disease: acute hepatitis in children, fulmninant necrosis –> cirrhosis
Arthritis: Chondrocalcinosis, osteoporosis
Neurology: Parkinsonism, depression, ataxia
Kidney: Fanconi’s syndrome
Abortions
Haemolytic anaemia: coombs negative
Presentation of PBC
PPBBCCS
Pruritus and fatigue
Pigmentation of face
Bones - osteoporosis, osteomalacia (dec.vit D)
Big organs - hepatosplenomegaly
Cirrhosis and coagulopathy (dec. vit K)
Cholesterol high: xanthelasma, xanthomata
Steatorrhoea
