gastroenterology Flashcards
ulcerative colitis on barium enema
colon has irregular mucosa loss of haustral markings continuous - no skip lesions pseudopolyps longstanding disease - drainpipe colon - colon narrow + short
where is inflammation in UC?
starts at rectum (commonest site)
never spreads beyond ileocaecal valve
initial presentation of UC
insidious + intermittent bloody diarrhoea urgency tenesmus LLQ pain extra-intestinal features
peak incidence of UC (age)
15-25
55-65
extra-intestinal features of IBD
arthritis - esp sacroiliitis in UC
episcleritis
osteoporosis
clubbing
what type of oesophageal cancer is associated with GORD + barrett’s?
adenocarcinoma (commonest type of OC)
where in the oesophagus are tumours most likely to lie?
middle 1/3
diagnosis + staging of oesophageal cancer
upper GI endoscopy
staging - CT TAP
if CT doesn’t show mets - endoscopic USS
management of oesophageal cancer
surgical removal + adjuvant chemo
risk of surgery for oesophageal cancer
anastomotic leak - can cause mediastinitis
chrons - where affected + whats it like?
mouth-anus - terminal ileum + colon most affected
skip lesions
what acute complication can occur in UC?
toxic megacolon
what acute complication can occur in chron’s?
caecal volvulus
what are the RFs for caecal volvulus in chron’s?
adhesions secondary to chron’s
previous surgery
how does volvulus present + show on xray?
abdo pain + distension
constipation
N/V
large dilated loop of bowel
what are 3 associations of sigmoid volvulus?
chronic constipation
neuro or psych conditions
old age
2 associations of caecal volvulus
adhesions
pregnancy
(all ages)
how does sigmoid volvulus look on xray?
LBO: large dilated loop of colon
air + fluid levels
coffee bean sign
how does caecal volvulus look on xray?
small bowel obstruction
management of sigmoid volvulus
rigid sigmoidoscopy + rectal tube insertion
management of caecal volvulus
operative - right hemicolectomy often
classic appearance of chron’s on barium enema
kantor’s string sign: long segment of narrowed terminal ileum in string-like configuration - ie a long stricture
proximal bowel dilation
rose thorn ulcers + fistulae
what’s a marker of activity in chron’s?
CRP
how do you diagnose bowel perforation?
erect CXR - pneumoperitoneum - air under the diaphragm
CT now preferred
what do positive anti-endomysial antibodies indicate?
coeliac
how to manage a patient with dysphagia (GP)
urgent referral
age 55+ with weight loss and:
upper abdo pain / reflux / dyspepsia
urgent referral
management of general dyspepsia
trial of full dose PPI for 1mo
diagnosis of h pylori
carbon-13 urea breath test or stool antigen test
h pylori - test of cure
carbon-13 urea breath test
jejunal biopsy shows villous atrophy, raised intra-epithelial lymphocytes + crypt hyperplasia - what is it?
coeliac: repeated gluten exposure → villous atrophy → malabsorption (reverses on gluten elimination)
(cancer would be dysplasia)
c diff - 1st line treatment
oral metronidazole 10-14 days
giardia lamblia - what medication treats?
giardia lamblia
coeliac - diagnosis
immunology (TTG, endomyseal antibody) + jejunal biopsy
reintroduce gluten for at least 6wk prior to testing
diagnosis of coeliac - immunology
TTG (IgA) - 1st choice endomyseal antibody (IgA)
what is achalasia?
lack of relaxation of LOS on swallowing
achalasia - investigations when scope normal
assess oesophageal motility:
fluoroscopic barium swallow
oesophageal manometry - pressures usually high
pH studies
pain on swallowing (odynophagia) + hx heartburn (no weight loss, systemically well)?
oesophagitis
achalasia pattern + symptoms
dysphagia of liquids + solids from the start
heartburn
regurgitation → cough, asp pneumonia
systemic sclerosis - how does it affect GI system?
oesophageal dysmotility
LOS pressure decreased
associated symptoms of IBS
lethargy
nausea
backache
bladder symptoms
IBS symptoms in someone over 60 - significance?
red flag
bowel obstruction + fistulae - what kind of IBD?
chron’s
goblet cells + granulomas - what kind of IBD?
chron’s
abdo mass in RIF - what kind of IBD?
chron’s
chron’s - histology
inflammation in all layers from mucosa to serosa - more prone to strictures, fistulas + adhesions
goblet cells
granulomas
think - chrons everywhere - mouth to anus, down to serosa
UC - histology
no inflammation beyond submucosa inflammatory cell infiltrate in lamina propria crypt abscesses depleted goblet cells + mucin granulomas infrequent
deep ulcers + cobble-stone appearance on scope?
chron’s
widespread ulceration + pseudopolyps om scope?
UC
where does diverticulosis most commonly occur?
sigmoid colon
diverticulitis - presentation
LIF pain + tenderness
anorexia, N+V, diarrhoea
features of infection
management of diverticulitis
mild - oral abx
severe - admit, NBM, IV fluids + abx (a cephalosporin + metronidazole)
diverticulitis - complications
abscess
peritonitis
obstruction
perforation
oesophageal cancer - gold standard investigation
endoscopy
toxic megacolon - mgmt
aggressive medical therapy 24-72h
no improvement - colectomy
what is clindamycin associated with (adverse)?
c diff
complication of c diff
toxic megacolon
c diff - diagnosis
c diff toxin on stool test
3 causes of bowel ischaemia
AF
endocarditis
malignancy
cocaine
bowel ischaemia - features
abdo pain rectal bleeding diarrhoea fever high WCC + lactic acidosis
bowel ischaemia - diagnosis
CT
oesophageal variceal haemorrhage - mgmt (after resus)
correct clotting - FFP, vit K terlipressin prophylactic IV abx if liver cirrhosis endoscopic variceal band ligation SB tube → TIPSS if all fail
prophylaxis of variceal haemorrhage
propanolol
endoscopic variceal band ligation + PPI (2-weekly)
coeliac - presentation (kids + adults)
kids - failure to thrive, diarrhoea, abdo distension
adults - lethargy, anaemia, diarrhoea, weight loss, poss other AI conditions
factors used to classify liver cirrhosis (MELD)
bilirubin
creatinine
INR
what does reduced serum caeruloplasmin indicate?
wilson’s
caeruloplasmin carries 95% of plasma copper
wilson’s - initial presentation
age 10-25
kids - liver disease
adults - neuro disease
wilson’s - diagnosis
reduced serum caeruloplasmin
reduced serum copper
increased 24h urinary copper excretion
wilson’s - mgmt
penicillamine (chelates copper)
staging of gastric cancer
endoscopic USS or CT
laparoscopy to identify peritoneal disease
PET CT
gastric cancer - mgmt
partial/gastrectomy
lymphadenectomy
chemo
Duodenal ulcers on histology
Granulation tissue
SBO - investigations + management
AXR + erect CXR
IV fluids
sucking via NG tube
CT + surgery if no improve
SBO - what seen on AXR?
dilated bowel loops
SBO - what seen on erect CXR?
pneumoperitoneum
small bowel on AXR
valvulae extend all way across
large bowel on AXR
haustra extend 1/3 way across
coeliac disease - link to immunisations?
functional hyposplenism - have pneumococcal vaccine
what is the modified hartmann’s procedure?
mainly for carcinoma w acute obstruction
primary resection w delayed anastomosis
excise lesion, create colostomy + cross-staple rectal stump
can have restorative anastomosis at later date
what scar does a hartmann’s leave?
emergency laparotomy scar - midline abdo (confirm this and get name)
what is an abdominoperineal resection? what is the main indication?
rectal carcinoma in the distal 1/3 of the rectum
removal of the anus, rectum, part of sigmoid + regional LNs
incisions made in abdo + perineum
end of remaining sigmoid is brought out permanently as a colostomy
how can you tell if a stoma is the result of an emergency hartmann’s or an AP resection?
need to palpate anus + inspect perineal area
in an APR, pt has imperforate anus - can’t do DRE
indications for an anterior resection vs AP resection
tumours in upper and middle ⅓ of rectum
lower ⅓ rectum
how do fistulae form in chron’s?
chron’s inflammation can go all way through bowel wall, creating fistulae from erosion - entero-enteric fistulae
what does an apple core sign suggest?
infiltrating carcinoma in bowel wall causing stricture
signet ring histology - significance
gastric cancer
gastric cancer - presentation - symptoms + OE
epigastric fullness/pain
anorexia + weight loss
vomiting
anaemia
cachexia
hepatomegaly
virchow’s node
gastric cancer - investigations
endoscopy + biopsy
Ba meal
CT - local spread
gastic cancer - mgmt
partial gastrectomy; or gastroenterostomy
radical gastrectomy if v early polypoid lesion (eg incidental finding)
chemo + radio of little benefit
