Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FINALS > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is gastro-oesophageal reflux disease?

A

Symptoms or complications resulting from reflux of gastric contents into the oesophagus or beyond

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why might GORD symptoms be worse at night?

A

Because of vagal stimulation causing upper oesophageal relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What condition can predispose to GORD?

A

Hiatus hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What cancer can GORD predisposed to and why is this?

A

Oesophageal cancer either Adenocarcinoma or squamous cell

because the gastric contents of the damages the mucosal epithelial cells and causes oesophagitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are risk factors of GORD?

A

Family history of heartburn
obesity
increased age
hiatus hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of GORD?

name the red flag symptoms of GORD?

A 
Heartburn
tightness in chest
regurgitation
asthma -like symptoms with cough
burping

dysphasia
bloating
early satiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the initial investigation of GORD?

A

A PPI trial of eight weeks and then check for improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Following a PPI trial there is no improvement in the patient’s GORD symptoms, what is the next line investigation?

when else would you want to order this investigation for GORD?

A

OGD endoscopy

if there are any red flag symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What sign may you see on endoscopy that is a precursor to oesophageal cancer?

A

Barrett’s oesophagus showing cellular metaplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the management plan with GORD?

A

Continue PPI (up to x2 doses a day)or have surgery if that is possible

if there is a nocturnal component ranitidine H2 agonist can be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is oesophageal cancer?

A

Mucosal lesions originating in the epithelial cells lining the oesophagus either adenocarcinoma or squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What other two main causes of oesophageal cancer?

A

Gastro-oesophageal reflux disease and Barrett’s oesophagus

high BMI with an unclear mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risk factors associated with oesophageal cancer?

A 
GORD
High BMI
male
Tobacco use
excess alcohol use
family history
diet low in fibre
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the main presentation of oesophageal cancer?

A

Dysphasia it is usually a late presentation with two thirds of the oesophagus occluded

painful swallow and weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What investigation is required to diagnose oesophageal cancer?

what other investigations useful?

A

OGD with biopsy

and metabolic profile since cancers are usually advanced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What other cancers can cause dysphasia?

A

Mediastinal cancers :
lung
lymphatic inc. non-Hodgkin’s lymphoma
thymoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is oesophageal achalasia?

A

A disorder of unknown aetiology characterised by aspirations and insufficient lower oesophageal sphincter relaxation due to loss of neurons in the oesophageal myenteric plexus - aucherbach plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the presentation of oesophageal achalasia?

A

Aspirations when eating
dysphasia
changing posture when swallowing to help
retro sternal pain and pressure with regurgitation
a gradual weight loss - rapid weight loss indicates malignancy and is a red flag

heartburn is not usually present!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What investigations would you use for oesophageal achalasia?

A

Upper GI endoscopy + barium swallow

oesophageal manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What would you see on an upper GI endoscopy for oesophageal achalasia?

A

Retained saliva with frothy appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What would barium swallow show for oesophageal achalasia?

A

Delayed swallow with a tapered dilated appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the management of oesophageal achalasia?

A

Surgical or pharmacological with Botox and possibly gastrostomy

pharmacological therapy = isorbatide denigrate or CCB (nifiedepine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is systemic scleroderma?

A

Systemic scleroderma is a multisystem autoimmune disease characterised by functional and structural abnormalities of small blood vessels fibrosis of the skin and internal organs as well as the production of autoantibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the pathophysiology of systemic scleroderma?

A

Has a strong genetic component and immunological components (ANA positive in 90%)

immune system activation leading to endothelial cell activation and damage of the endothelium

fibroblasts because increased collagen deposition

activated T cells promote disease by making for pro fibrotic cytokines and down regulating the inhibitory cytokines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the presentation of systemic scleroderma in the hands and feet?

A

Hand and feet swelling
skin thickening
functional loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the presentation of systemic scleroderma in the GI tract?

A

Heartburn
reflux
bloating
faecal incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the presentation of systemic scleroderma in the respiratory system?

A

dysnopea

dry crackles at bases of lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the presentation of systemic scleroderma in the vascular system?

A

Raynaud’s disease

pits and ulcers at the tips of fingers from ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What investigations are required in oesophageal scleroderma?

A

Serum antibodies:
ANA - most common 90%
anti-SCL
anti- rna polymerase

U+E (renal involvement)
urine microscopy (to check the renal crisis,  proteinuria)

ESR and CRP are usually normal

pulmonary function tests (interstitial lung disease)
chest x-ray (interstitial lung disease)

ECG (arrhythmias which show cardiac involvement)
echocardiogram (yearly test for pulmonary hypertension)

barium swallow ( decreased peristalsis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the management of oesophageal scleroderma?

A

Manage any heartburn symptoms with PPI

increased motility using erythromycin or domperidone (pro kinetics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a common complication of oesophageal scleroderma?

what is the treatment?

A

Bacterial overgrowth is causing diarrhoea and weight loss

treat with cephalexin and metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is classed as a peptic ulcer

A

A breakdown in the mucosal lining of the stomach and duodenum reaching the submucosa

an ulcer is classed at 5 mm anything smaller or more shallow is considered an erosion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the protective factors of the stomach for peptic ulcer disease?

A

Prostaglandins
mucus
HCO3
mucosal blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the damaging factors of stomach for peptic ulcer disease?

A

Gastric acid
Patsy
H. pylori
NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the symptoms of peptic ulcer disease?

A

Upper epigastric pain exacerbated by eating (gastric) or 2 to 3 hours after eating (duodenal)

then maybe posterior radiation of pain indicating penetration to the pancreas

epigastric tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what would be your first line investigations for peptic ulcer disease?

A

Urea breath test or stool antigen test for H pylori

but in those >55y you may consider going straight to endoscopy

FBC - check for blood loss (microcytic anaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is the management of an active bleeding peptic ulcer?

A

Stop any NSAIDs

endoscopy to stop the bleeding plus PPIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the management of pt with peptic ulcer which has no bleeding but is positive for H. pylori?

A

Triple therapy of omeprazole clarithromycin and metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what would you do if the H pylori Cannot be eradicated?

A

Long-term acid suppression with PPI and H2 antagonists if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How to manage patient which has a peptic ulcer with no bleeding and negative H. pylori?

A

Treat the underlying cause and give PPIs treatment usually lasts 4 to 8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is the management of peptic ulcer if it isInduced by NSAIDs?

A

Misoprostol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What all gastro-oesophageal varicies?

A

Related collateral blood vessels that develop as a consequence of portal hypertension usually due to cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the pathophysiology behind gastro-oesophageal varices?

A

Increased hepatic vein pressure occurs as liver function deteriorates (usually due to alcohol or hepatitis B) causing the dilation of blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what conditions can indicate a presence of gastro-oesophageal varices?

A

Alcoholic hepatitis
hepatitis B or C
cirrhosis
hepatic encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the symptoms of gastro-oesophageal varices?

A 
Symptoms of cirrhosis:
ascites
jaundice
spider angiomas and caput medusa
haemoptysis or haematochezia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What investigations would you do to diagnose varices?

A

And OGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What investigations should you run on someone who has gastro-oesophageal varices?

A

full blood count (check for bleeding and thrombocytopenia indicate portal hypertension and splenomegaly)
coagulation profile (assesses function of liver but also risk a bleed)
hepatic venous pressure gradient (assesses portal hypertension)
blood type and crossmatch (in case of life-threatening bleed)

you should also attempt to find the cause of the cirrhosis of this has not been established:
serum LFTs ( AST ALT Alk Phos Billi all ++)
hepatitis B antigen – HBsAg
Hepatitis C Ig - HCV IgG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How would you treat an acute haemorrhage caused by rupture of gastro-oesophageal varices?

A

Supportive therapy ABCDE
and vasoactive drugs (vasopressin or another pressin)
endoscopic therapy

consider using BBlocker propranolol as adjunct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What procedure should be performed in anyone who has an acute haemorrhage caused by gastro-oesophageal varices and is high risk of getting it again?

A

Trans-jugular intrahepatic Porto systemic shunt aka tips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How would you treat large varices which are not bleeding?

A

Binding and ligation with a non-selective beta-blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

how would you treat small varices which are not bleeding?

A

Beta-blocker and endoscopic surveillance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How would you treat someone who has portal hypertension but has not yet developed varicies?

A

Endoscopic surveillance and vasoactive drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

how would you treat someone Who has cirrhosis but has not yet developed varices or portal hypertension?

A

Endoscopic surveillance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is a Mallory Weiss tear?

A

A tear or laceration in the oesophagus caused by a sudden increase in the pressure gradient

it is usually spontaneous and self-limiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the most common location for a Mallory Weiss tear?

A

Near the gastro-oesophageal junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the risk factors for Mallory Weiss tear?

A 
Conditions predisposing to vomiting
retching
straining including from coughing
chronic cough
hiatal hernia
endoscopy
alcohol with excessive vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what investigations are required in a Mallory Weiss tear?

A

Full blood counts
OGD

if severe crossmatch and save
plus…

urea and creatinine – monitoring severity please
a T assessing for liver disease
PT/INR consider anticoagulation
chest x-ray normal in an uncomplicated Mallory Weiss tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How would you manage a Mallory Weiss tear?

A

ABCDE management
when giving fluids make sure bilateral IV
if severe intubate and give phytomenadione IV aka Vit K

endoscopic clip placement +/- adrenaline - always before 24h even if not severe

plus…
pantoprazole and promethazine (antiemetic)and erythromycin (contracts stomach) pre surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is gastritis?

A

The histological presence of gastric mucosal inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is gastropathy?

A

Lesions characterised by minimal or no inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the causes of gastritis?

A

H. pylori (causes acute or chronic non-erosive gastritis)
erosive (NSAIDs or alcohol induced)
stress induced (in the critically ill on mechanical ventilation> 48 hours or coagulopathy)
autoimmune
phlegomonus (S. aureus, strep, e coli)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are symptoms of gastritis?

A

Dyspepsia
epigastric discomfort
nausea and vomiting
loss of appetite

lack of red flags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the management of gastritis caused by H. pylori?

A

Triple therapy of lansoprazole clarithromycin and metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the management of gastritis caused by erosive causes?

A

Discontinue exposure use PPI or H2 antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What could you give to someone who is at risk of gastritis?

A

Ranitidine

misoprostol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What type of cancer is stomach cancer?

A

adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are some risk factors for developing stomach cancer?

A 
NHS anaemia
H. pylori
50 to 70 years
family history
smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are symptoms of stomach cancer?

A 
Epigastric pain – an early symptom
lymphadenopathy – see virchows node
nausea
dysphagia
lower GI bleeding and Melina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What investigations are necessary for stomach cancer?

A

Endoscopy and biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is the management of stomach cancer?

A

Pre-and post op chemotherapy or radiotherapy
surgery
consider immunotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is viral gastroenteritis?

A

Acute inflammation of the lining of the stomach and intestines caused by an enteropathic virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What viruses cause gastroenteritis?

A

norovirus
rotavirus
cytomegalovirus – significant in immunocompromised groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What risk factors are associated with viral gastroenteritis?

A

Exposure to contaminants or close contact with someone infected
living in close quarters such as care homes
Poor hygiene
extremities age – causes more severe dehydration
comorbidities
immunocompromised groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

when would you need to investigate viral gastroenteritis?

A

If there is severe volume depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What investigations would you perform for viral gastroenteritis?

A

Full blood count - is the white cell count elevated indicating a bacterial or parasitic infection are the signs of anaemia indicating a chronic cause such as IBD

U+E- check renal function

consider a stool sample for culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

When would you perform a stool culture for patients with viral gastroenteritis?

A 
Blood or pus installs
high fever
diarrhoea lasting two weeks
history of foreign travel
persistent antibiotic use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is management of viral gastroenteritis?

A

Dehydration is mild-to-moderate: oral rehydration salts severe: IV fluids
antiemetics may be used but antidiarrhoeal should not routinely be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is IBS?

A

A chronic condition characterised by abdominal pain and bowel dysfunction without the presence of structural abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are risk factors for developing IBS?

A

Female
previous enteric infection
history of physical or sexual abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What symptoms does IBS carry?

A 
Cramping abdominal pain
pain in lower/middle abdomen
mild/severe pain
altered bowel habit
relief of symptoms on defecation
abdominal bloating/distension
mucus-y stool
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

How would you diagnose IBS?

A

IBS would be a diagnosis of exclusion, a history of typical symptoms is suggestive of IBS

differentiate from coeliac and IBD
stool cultures will be negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What tests differentiate IBS from coeliac disease?

A

Anti-endomyseal +ve in coeliac

Anti- tTG antibodies +ve in coeliac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what tests would differentiate from IBD?

A

Faecal calprotectin

flexible sigmoidoscopy or colonoscopies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

How do you treat IBS?

A

Management must be symptomatic

if constipated - lactulose
if diarrhoea – loperamide (antidiarrhoeal)
pain or bloating – dicycloverine (antispasmodic)

CBT or hypnotherapy is also useful
high-fibre diets and eliminating triggers
SSRIS such as citalopram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is Crohn’s disease?

A

and inflammatory bowel disease causing transmural inflammation of the GI tract which can involve any or all of the GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What histopathological findings would you find for crohns disease?

A

Transmural inflammation
skip lesions
can be anywhere in the GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

where Is most common for Crohn’s disease to occur?

A

Terminal ileum and peri-anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is the presentation of Crohn’s disease?

A 
Abdominal pain
prolonged diarrhoea
perianal lesions
fatigue
weight loss
abdominal tenderness

can have some mucous blood and purse install but this is not a typical presentation
fever from inflammation or as a complication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are perianal lesions?

A

Skin tags

fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What are the more common complications of Crohn’s disease?

A

Obstruction – from fibrosis

perforations and fistula – due to sinus tracts caused by inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What investigation is diagnostic for Crohn’s disease?

A

Flexible sigmoidoscopy (colonoscopies) with biopsy and histological examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

A patient presents with symptoms of IBD disease what are the first line investigations you would do as a GP?

A

FBC – may find anaemia and increased white cell count

iron studies, B12, folate

comprehensive metabolic panel albumin, calcium, magnesium, phosphate all reduced

CRP, ESR

Faecal calprotectin - raised, marker of bowel inflammation

you may want to do a stool test

you may consider imaging from:
x-ray (obstruction)
CT or MRI (lesions, bowel thickening, accesses/fistulae)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

How would you manage crohns ?

A

Budesonide (steroid) or 5 ASA therapy

Azothioprine + CS

methotrexate and folic acid

biologics and CS reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is ulcerative colitis?

A

an inflammatory bowel disorder characterised by its involvement of the rectum and extending approximately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What are the risk factors forInflammatory bowel disease?

A

Ages 15 – 40 or 60 – 80
family history
white ancestry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What are the symptoms of ulcerative colitis?

A

Most common symptom is rectal bleeding and blood in stool

diarrhoea abdominal pain malnutrition and weight loss are more common in Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What vitamin deficiencies occur in ulcerative colitis?

A

Vitamins ACD he

beta-carotene, magnesium, zinc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What would imaging show for Crohn’s disease?

A

x-ray (obstruction)

CT or MRI (lesions, bowel thickening, accesses/fistulae)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What would imaging show for ulcerative colitis?

A

dilatoed loops with air or fluid,

free air suggests a perforation dilation of loops over 6 cm suggests toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What are the histopathological findings of ulcerative colitis?

A 
Only rectal involvement with continuous and uniform diffuse erythema
biopsy shows :
mucosal involvement 
mucosal depletion 
absence of granulomata 
anal sparing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is the management for ulcerative colitis?

A

mesalazine (mainstay for remission)

hydrocortisone or pred +/- tacrolimus

IV hydrocortisone (in acute flare)

In recurrent disease:
Thiopurines (azothioprine)
Biologics/TNF a inhibitor (infliximab)

colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is fulminant ulcerative colitis?

A

Sudden and extensive inflammation which can be life-threatening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What are symptoms of fulminant ulcerative colitis?

A

6+ bloody stools daily

evidence of toxicity:

  • fever
  • tachycardia
  • anemia
  • ++ESR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

what is the management of fulminant ulcerative colitis?

A

Investigate with ultrasound and emergency colonoscopies

IV corticosteroids and IV fluids
a stable enough start infliximab and cyclosporin if not rush for a colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is toxic megacolon?

A

A potentially lethal complication of acute colitis with total or segmental non-obstructive chronic distension associated with systemic toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What are the risk factors for toxic megacolon?

A 
Inflammatory bowel disease
infected colitis
immunosuppression
discontinuation of IBD medication
anti-motility agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

How does toxic megacolon present?

A

Fever tachycardia hypotension
abdominal pain tenderness and dissension
diarrhoea
mental status changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What investigations should you perform?

A

Abdominal x-ray – die rotation of over 6 cm

stool studies

full blood count (+white cell count - haemacrit)
serum electrolytes (- magnesium and potassium due to volume loss)
serum albumin (- due to volume last)
serum lactic acid if ischaemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is the initial management of toxic megacolon?

A

ABCDE

Nil by mouth IV fluid recess
broad-spectrum antibiotics
NG decompression

rancour myosin – if presumed CDF
IV hydrocortisone – history of inflammatory colitis

surgery if no improvement after 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is mesenteric ischaemia?

A

An umbrella term for disorders which cause a decrease in blood flow to the GI tract

it can be acute or chronic, occlusive or non-occlusive, transient or fulminant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What are the risk factors for mesenteric ischaemia?

A 
Old-age
smoking history
however quite liberal state
atrial fibrillation
myocardial infarction
structural heart disease
history of vasculitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What is a presentation of mesenteric ischaemia?

A 
Abdominal pain
Melena – due to mucosal sloughing
 diarrhoea
abdominal tenderness
weight loss

abdominal bruit may be heard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is a first-line diagnostic test for mesenteric ischaemia?

A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What would a CT show for mesenteric ischaemia?

A

Thickening
dilatation
pneumatosis intestinalis
thumbprint sign – showing mucosal oedema or haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

which artery does mesenteric ischaemia usually affect?

A

Superior mesenteric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What is diverticular disease?

A

A herniation of the mucosa and submucosa through the muscular layer
it is any clinical state caused by symptoms relating to colonic diverticula
symptoms ranging from asymptomatic to severe uncomplicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What is the most common complication of diverticular disease?

A

Diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What is diverticulitis?

A

Inflammation of a diverticulum which may be caused by infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What are complications of diverticular disease?

A

(Diverticulitis)

segmental colitis
lower GI bleed
abscess
perforation and peritonitis
fistula
obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What are risk factors of diverticular disease?

A

Low dietary fibre

anyone over the age of 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What is the presentation of diverticular disease?

A

It is usually asymptomatic until there’s diverticulitis

but may have some IBS type symptoms of bloating and constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What are the symptoms of diverticulitis?

A

Lower quadrant abdominal pain
fever
guarding
leucocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What are the diagnostic tests for diverticular disease?

A

Contrast anime shows diverticulitis abscesses

if unclear go to sigmoidoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

how would you Diagnose acute diverticulitis?

A

CT with contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

How would you treat diverticular disease?

A

If asymptomatic no treatment

if symptomatic:
high fibre diet and supplements
any symptoms of bacterial infection require broad-spectrum antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

How would you manage symptomatic diverticulitis?

A 
Analgesia
oral antibiotics (moved to IV if not getting better)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What is appendicitis?

A

An acute inflammation of the veniform form appendix most likely caused by obstruction of the lumen of the appendix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

what causes the obstruction in appendicitis?

A

faecolith
stool
infection
lymph drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What are the risk factors for acute appendicitis?

A

There are no real risk factors however:

child/teen
low dietary fibre
smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What is the presentation of appendicitis?

A 
Constant made abdominal pain that moves to the right quadrant
pain worse on coughing and movement
tenderness at McBurney's point
rebound tenderness may be present
anorexia

nausea fever decreased bowel sounds on the right side

be aware of tachycardia as it’s a sign of perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

What does tachycardia in a patient with suspected appendicitis indicate?

A

Perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What is the diagnostic test of appendicitis?

A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What is the management of an uncomplicated appendicitis?

A

Appendectomy (adjunct IV antibiotics)

antibiotic only therapy for patients who wish not to have surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

what is the management of Appendicitis complicated by perforation or abscess?

A

IV antibiotics appendectomy and supportive care

drainage may be necessary if there is an abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What are the three main types of hernia?

A

Umbilical
inguinal
hiatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

what is an umbilical hernia?

A

A defect of the interior wall fascia occurring when the umbilical ring fails to close and the peritoneal sack protrudes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What are the risk factors for an umbilical hernia?

A

Low birthweight

African or African-American ethnicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What is the presentation of an umbilical hernia?

A

Presents at birth with a bolt at the umbilicus
becoming larger or tense during movement or crying
stretched skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What features would you find on examination for an umbilical hernia?

A

easily reducible

on examination the ring of the fascia can be felt around the defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

If an umbilical hernia presents as a tender abdominal mass what does this mean?

A

It’s incarcerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What is the management of an umbilical hernia?

A

First attempt reduction
asymptomatic and small:

observe and offer elective outpatient surgical repair otherwise move to ASAP surgical repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

What is an inguinal hernia?

A

The most common type of hernia
it is a protrusion of abdominal or pelvic contents through her dilated internal inguinal ring to the external inguinal ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

What is the presentation of an inguinal hernia?

A

Easily visible and palpable bulge
groin discomfort or pain if the hernia is bulging
groin mass

may be confused with pathologies of the testicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

If a patient presents the tender distended abdomen with absent bowel sounds who has had a past history of groin pain what could this be?

A

Strangulated hernia causing an acute abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

What investigations are necessary for an inguinal hernia?

A

Usually the diagnosis is clinical if you are uncertain and ultrasound scan of the groin or CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What is the management of a strangulated inguinal hernia?

A

Surgery with IV/IM cephalexin prophylaxis if open repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What is the management of a large or symptomatic hernia

A

Surgery unless a patient is nonsurgical then a truss can be worn (device that compresses over inguinal canal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

What is the management of a small asymptomatic inguinal hernia?

A

Observation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

What is a hiatus hernia?

A

Protrusion of intra abdominal contents through an enlarged oesophageal hiatus of the diaphragm most commonly containing a portion of stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What are the risk factors for a hiatus hernia?

A

Anyone over the age of 50
obesity
previous GI procedure
intra-abdominal pressure increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

What is the presentation of a hiatus hernia?

A

Heartburn
regurgitation
GORD like

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

How do you diagnose a hiatus hernia?

A

A barium swallow

endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

How do you treat a hiatus hernia?

A

PPI and lifestyle changes
surgical repair

if there’s obstruction resus and urgent surgical repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

What is large bowel obstruction?

A

Mechanical interaction occurring to the flow of the intentional contents it is a surgical emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What can cause large bowel obstruction?

A

Colorectal cancer
colonic Volvos
benign structure such as diverticular disease
foreign body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What are risk factors for large bowel obstruction?

A 
older age
female
institutionalisation
mental illness
Megacolon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

What is the presentation of large bowel obstruction?

A

Colicky abdominal pain
abdominal distension
tympanic handling
change in bowel habits no or very little faeces or flatus
rectal bleeding - indicates malignancy
abnormal bowel sounds can be increased frequency or absent in advanced disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

what does hard faeces on DRE in the context of large bowel obstruction mean?

A

Faecal impaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

What does an empty rectum mean in the context of a DRE in large bowel obstruction?

A

Proximal obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Why should you perform a faecal occult blood in the context of large bowel obstruction?

A

To exclude barrel malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

what are symptoms of a Large bowel perforation?

A

Constant pain which is worsening
worse on movement or coughing or deep breathing
fever
abdominal rigidity – peritonitis secondary to perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What is a diagnostic test for a large bowl obstruction?

A

Plain abdominal x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

What is the first test you should do if you suspect perforation in large bowel obstruction

A

Erect chest x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Apart from imaging what other tests are useful in large bowel obstruction?

A

Full blood count – WCC for infection anaemia in malignancy
serum electrolytes and renal function – check renal function
serum amylase – raised in intra abdominal events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

you suspect abdominal perforation what investigations are indicated?

A

Chest X ray (USS abdominal if in unstable situation)

Septic screen

FBC, LFT and U+E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What is the management of large bowel obstruction?

A 
ABCDE - consider blood products if theres coagulopathy
catheter monitoring urinary output
broad-spectrum antibiotics presurgery
NG decompression!
surgery

NO OPIATES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

What is volvulus?

A

A loop of interesting twists around itself and its mesentery

causing a bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Where are volvulus common?

A

In the sigmoid or coecal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

What classic sign is found on CT/x-ray for a volvulus?

A

a coffee or kidney bean shape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

What are risk factors for a volvulus?

A

intestinal malrotation
enlarged colon
hirsprungs
adhesions form prev. surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

What is a small bowl obstruction?

A

Mechanical disruption in the patency of the GI tract resulting in vomiting which may be pillars absolute constipation and abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

What are common causes in adults for small Bowel obstruction?

A 
Previous surgery
inguinal hernia – other hernias
Crohn's disease
intestinal malignancy
appendicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

what are common causes for children for small bowel Obstruction?

A

Appendicitis
inrucusseption
intestinal atresia
volvulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

What is the presentation of small bowel obstruction?

A 
Failure to pass glasses or stool
abdominal pain
vomiting
abdominal tenderness and distension
if there's perforation peritonitis

there may be fever tachycardia and lethargy from inflammation and dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

What is the diagnostic investigation for small bowel obstruction?

A

CT abdominal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

What is the gas distribution you would see on imaging in the bowels in a partial small-bowel obstruction?

A

Gas throughout the abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What is the gas distribution you would see on imaging in the bowels in a complete small-bowel obstruction?

A

No distal gas and staggered air - fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

What is the gas distribution you would see on imaging in the bowels in a complicated small-bowel obstruction?

A

Complicated by a perforation will be free air under the diagram
if complicated by ischaemia there will be thumb printing sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

What is the management of partial small-bowel obstruction?

A 
Fluid recuss
NG decompression 
antiemetic (ondesatron)
antispasmodic (loperamide) if a more severe partial
opiate analgesia

surgery if no change after 48 to 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

What is the management of a complete small-bowel obstruction?

A

NG decompression
morphine analgesia
perioperative antibiotics
Laparotomy

if the candidate is nonsurgical then treat as a partial obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

what is an ileus?

A

The slowing of GI motility accompanied by distension in the absence of mechanical obstruction

182
Q

What causes ileus?

A 
It is something which occurs in response to physiological stress such as:
surgery 
sepsis 
metabolic derangements
GI diseases
183
Q

What risk factors are associated with developing an ileus?

A 
Abdominal surgery
acute or systemic illness:
 sepsis
MI
pneumonia
trauma
metabolic derrangements
184
Q

What is the presentation of an ileus?

A

Similar to that of obstruction but without its clinical features on examination

nausea and vomiting
abdominal distension
constipation
discomforts
abdominal cramping
decreased or hypoactive bowel sounds

BUT.. no features of mechanical obstruction such as peritoneal inflammation, hernias, rebound tenderness

185
Q

What is the diagnosis of an ileus?

what other investigation may you like to perform?

A

It is a diagnosis of exclusion of obstruction

abdominal x-ray is diagnostic (showing no specific gas pattern and diffuse distension)

Full blood count - rule out infection

186
Q

What differences would you see on x-ray for an obstructed bowel versus an ileus?

A

Obstructed bowel will have little to no air distal to the obstruction whereas an ileus will have a diffuse non-specific gas pattern

187
Q

What is the management of an ileus?

A

Nil by mouth and IV fluids

NG decompression if there is significant vomiting or distension

parenteral nutrition if symptoms lasting more than three days

188
Q

What is peritonitis?

A

inflammation of the peritoneum

189
Q

What can cause peritonitis?

A

Perforation of the GI tract - most common
local or systemic infection
leakage of non-infectious bodily fluids- blood gastric juice pancreatic enzymes (pancreatitis)

190
Q

What is spontaneous bacterial peritonitis?

A

Inflammation of the peritoneum caused by leakage of infected ascitic fluid due to end stage cihrossis

191
Q

What are the symptoms of peritonitis?

A 
Abdominal pain
Guarding
rigidity
rebound tenderness
fever
tachycardia
altered mental state
192
Q

What features does spontaneous bacterial peritonitis have that peritonitis does not have?

A

Spontaneous bacterial peritonitis Has all the same symptoms as normal peritonitis but with additional signs of ascites cirrhosis and diarrhoea caused by intestinal hyper mobility

193
Q

What is the management of peritonitis?

A

Broad-spectrum antibiotics e.g. cephalexin or laparotomy

194
Q

What investigations is it important to carry out in spontaneous bacterial peritonitis?

A

Check LFT And PT/INR
Ascitic fluid analysis gram staining culture – diagnostic
blood cultures may also be useful

195
Q

What is the management of spontaneous bacterial peritonitis?

A

Broad-spectrum antibiotics IV

if there is a hypo renal syndrome (renal impairment) – IV albumin

large-volume paracentesis may be given

196
Q

Is antibiotic prophylaxis indicated for people who have had spontaneous bacterial peritonitis?

A

Yes and a beta-blocker may also be added

197
Q

What is the definition of obesity?

A

A chronic adverse condition due to excess body fat mainly determined by BMI
BMI over 30

198
Q

What is classed as underweight (BMI)?

A

<18.5

199
Q

What is classed as normal weight (BMI)?

A

18.5-24.9

200
Q

What is classed as overweight (BMI)?

A

25-29.9

201
Q

What is classed as obese (BMI)?

A

30-39.9

202
Q

What is classed as extremely obese (BMI)?

A

> /= 40

203
Q

How do you calculate BMI?

A

Weight (KG) / [height(m)]^2

204
Q

What are some Hormonal causes of obesity?

A

PCOS
hypothyroidism
hyper- cortical-ism
insulinoma

205
Q

What are some behavioural causes of obesity?

A

Sedimentary
large portions
habits

206
Q

What is the physiology of leptin?

What role does leptin have in satiety?

A

An increase in ad oppose causes leptin to be released
leptin reduces appetite
adipose is used up

207
Q

How is leptin affected in obesity?

A

There is leptin resistance

208
Q

What is the physiology of ghrelin?

What role does ghrelin have in satiety?

A

Secreted by a stomach acting by the vagus nerve

acts centrally on the hypothalamus to increase appetite

209
Q

What role does endocannabinoids have in satiety?

A

Increase appetite by affecting the central nervous system a.k.a. the hypothalamus

210
Q

What role does T3 have in satiety? and how?

A

Increases appetite

hypothyroidism causes excess energy expenditure causing weight loss

211
Q

What role do peptins have in satiety?

A

Decrease appetite and food intake centrally and on GI organs like the pancreas

212
Q

What role does insulin have in satiety?

A

Decreases appetite centrally

213
Q

What role does cholecystokinin have in satiety?

A

Decreases appetite centrally

214
Q

What investigations may want to undertake in an obese individual?

A

SBC
lipid levels
LFT – check liver dysfunction caused by fatty liver
TFTs
ECG – check for heart disease
abdominal ultrasound scan – check for fatty liver disease

215
Q

What pharmacological management can you offer an individual with obesity?

A

Orlistat - inhibits fat absorption

2ry = liraglutide - peptide like agonist

216
Q

what are the criteria to be eligible for bariatric surgery?

A

BMI ≥ 40,

BMI ≥ 35 and at least one or more obesity-related co-morbidities

217
Q

What type of cancer is colorectal cancer?

A

Majority are adenocarcinomas from epithelial cells

218
Q

What is the most common location for large bowel cancer?

A

The:

219
Q

What risk factors are associated with large bowel cancer/colorectal cancer?

A 
Age- very rare under 40
APC gene mutation -a Polly process syndrome
IBD
obesity
low fibre diet
220
Q

What is the presentation of colorectal cancer?

A 
Rectal bleeding
change in bowel habits - increase frequency and loose stools
hard mass on DRE
anaemia
weight loss
221
Q

What is diagnostic for colorectal cancer?

What other tests should be performed?

A

CT colonography or colonoscopies with biopsy
-barium enema can also be used but it is less sensitive

in FBC showing anaemia is a red flag especially in older men or postmenopausal women

222
Q

Describe the screening process for colorectal cancer?

A

Starts at 60 years old until 74
F IT testing done yearly

screening starts at 50 years if there is a positive family history of two first-degree relatives

223
Q

In patients with IBD what is the process for screening for colorectal cancer?

A

Perform colonoscopy 10 years after diagnosis and then every five, three, one year depending on their level of risk

224
Q

Who should you refer to 2 week wait in regards to colorectal cancer?

A

> 40 with unexplained weight loss or abdominal pain
50 with unexplained rectal bleeding
60 unexplained iron deficiency anaemia or changes in bowel habits

anyone with a positive FIT +/- Sx depending on age
anyone with a rectal or abdominal mass

anyone under the age of 50 with rectal bleeding and one other finding of:
abdominal pain
change in bowel habits
weight loss
iron deficiency anaemia
225
Q

What are the causes of dietary diarrhoea?

A 
Sugars
dairy
FODMAP
gluten
fatty foods
Spicy foods
caffeine
226
Q

How do sugars cause diarrhoea?

A

stimulate water movement into the bowels causing loose stool

227
Q

How does dairy cause diarrhoea?

A

Lactose can cause difficulty on digestions as an intolerance

228
Q

What is the criteria for travellers diarrhoea?

A

Three or more unformed stools in 24 hours

plus one or more of:
- fever nausea vomiting cramps or bloody stools

during a trip abroad

229
Q

What common pathogens cause travellers diarrhoea?

A

E. coli
Shigella
Campylobacter Jejuni
Salmonella

230
Q

What are the differences in presentation between a bacterial and parasitic infection?

A

Parasitic infections cause persistent symptomsOver two weeks

bacterial usually lasts 3 to 5 days

231
Q

What are the risk factors for contracting travellers diarrhoea?

A 
<30y
Prior travellers diarrhoea
chronic disease
immunocompromised
travelling in hot and wet climates and endemic areas
232
Q

What are indications for antibiotics in travellers diarrhoea?

A

Blood and fever

233
Q

When would you do further testing for travellers diarrhoea?

A

If symptoms are severe or if antibiotics haven’t worked

234
Q

What tests could you perform for travellers diarrhoea?

A

stool culture and sensitivity
+stool occult blood
+PCR

stool ova and parasite examination

235
Q

What is the management for travellers diarrhoea?

A

Loperamide is used as long as there is no blood or fever which is an anti-motility drug to help cramping and diarrhoea

rehydration therapy

if symptoms are severe then use azithromycin

236
Q

What commonly gives you travellers diarrhoea in terms of Food & Drink?

A 
Ice and tapwater
salad
previously peeled fruits
raw food
unpackaged sauces and condiments
Street vendors and buffets
237
Q

When would prophylactic antibiotics be given for travellers diarrhoea?

A

For short-term critical trips or critically ill/immunocompromised patients with trips lasting less than three weeks

238
Q

Why would you want to give fluids over 48 hours and replace sodium if hyponatraemic?

A

To avoid cerebrally oedema

239
Q

What is a classic symptom of an E. coli infection?

A

Profuse diarrhoea

240
Q

What symptom would not be present in viral/parasytic induced travellers diarrhoea?

A

Bloody stool

241
Q

What is a classic symptom of a campylobacter infection?

A

Severe abdominal pain

242
Q

What are classic symptoms of a shigella infection?

A

High fever with person blood in stool

243
Q

What pathogen is cholera caused by?

A

vibris cholerae

244
Q

What is the pathophysiology of cholera?

A

cholera endotoxin leads to continued activation of adenylate cyclase in the intestinal epithelial cells
this causes secretion of water and salt into the gut lumen

245
Q

Which demographic does cholera usually affect?

A

children under five living in Endemic countries

246
Q

What is the presentation of cholera?

A

Watery diarrhoea with rice water appearance

Diarrhoea of more than 1 L per hour for a sustained period of time

evidence of severe water depletion:
sunken eyes
dry mucous membrane
irritability
significant postural hypotension
a decrease in skin turgor
Cap Refill of over two seconds
247
Q

what investigations should you perform for cholera if available?

A

rapid dipstick test – diagnostic

FBC- + WCC and haemocrit (+ in vol. depletion)
serum electrolytes- check K+
urea and creatinine
ABG- acidosis if severe
ECG- low K+ causes prolonged PR and flattened T wave. Bradycardia = v bad sin

248
Q

What is the management of cholera?

A

Aurore therapy aggressive rehydration for two – four hours followed by maintenance fluids until diarrhoea is absent
doxycycline
zinc and vitamin A supplementation children

IV rehydration can used in severe cases

249
Q

is there a vaccine for cholera?

A

Yes it is an oral vaccine used in endemic countries

250
Q

What is coeliac disease?

A

As systemic autoimmune diseases triggered by dietary gluten peptides

251
Q

what is the pathophysiology of coeliac’s disease?

A

Immune activation of the small intestine is caused by gluten peptides
this leads to villous atrophy hypertrophy of intestinal crips and increases the number of lymphocytes in the epithelium and lamina propria
this causes malabsorption and systemic effects

252
Q

What’s HLA does coeliac carry?

A

HLA DQ2

HLA DQ8

253
Q

What is the purpose of the HLA proteins?

A

causes the gluten peptides to be presented to T cells in a manner which activates them and being in response

254
Q

What antibodies are present in coeliac disease?

A

anti-gliadin

anti-tTG

255
Q

What is the presentation of coeliac disease?

A

Diarrhoea
bloating
abdominal pain/discomfort
anaemic symptoms and failure to thrive in children

256
Q

what investigation allows for DEFINITIVE DIAGNOSIS of coeliac?

A

Small-bowel histology is diagnostic

and gluten challenge

257
Q

What blood tests would you want to run for coeliac disease?

A

anti TTG
EMA antibody (endomyseal antibody)
FBC + blood smear - microcytic

258
Q

what histological findings would you find in coeliac disease?

A

Intraepithelial lymphocytes villus atrophy and crypt hyperplasia

259
Q

How do you diagnose coeliac disease in children?

A

IgA tTG + EMA + HLA DG2/ HLA DG8

260
Q

What is the management of coeliac disease?

A

Gluten-free diet
calcium and vitamin D supplements (ergocalciferol + calcium carbonate)
Do a bone mineral density scan one year after a gluten-free diet
iron supplements if anaemic

261
Q

What is the management of a coeliac crisis?

A

Rehydration therapy with electrolyte corrections and adjunct corticosteroids if severe enough

262
Q

Where can small bowel cancer occur?

A

Duodenum
jejunum
ileum
+ appendix

263
Q

what is the most common type of small bowel cancer Of the duodenum?

A

adenocarcinoma

264
Q

What is most common type of small bowel cancer of the appendix or ileum?

A

neuroendocrine A.k.a. carcinoid

265
Q

What are risk factors for small bowel cancer?

A 
Increasing age
familial polyposis
 Crohn's
coeliac
diets rich in smoked foods red meats or very high fibre
266
Q

What is the presentation of small bowel cancer?

A 
Abdominal pain
abdominal rash
weight loss
feeling or being sick
Melina
obstruction symptoms
anaemia and associated symptoms
267
Q

What investigations would you perform for small bowel cancer?

A

Endoscopy with histological sample

can consider ultrasound scan or CT

268
Q

What is gastroparesis?

A

Delayed emptying of solids by the stomach in the absence of any mechanical obstruction

269
Q

What risk factors are associated with gastroparesis?

A

Diabetes
previous gastric and pancreatic surgery
achalasia

270
Q

What is the presentation of gastroparesis?

A 
Post-prandial nausea
vomiting
early satiety
epigastric pain
fullness and bloating
weight loss
271
Q

What is important to roll out in gastroparesis?

A

Obstruction with abdominal x-ray

pancreatitis using serum amylase and lipase

272
Q

Why is it important to check white cell count and gastroparesis?

A

White cell count elevation suggests a viral infection which can temporally cause gastroparesis

273
Q

what is the management of gastroparesis?

A

Pro kinetic agent such as Metoclopramide or retro myosin

antiemetic

274
Q

What is eosinophilic oesophagitis?

A

Oesophageal dysfunction caused by an immune/allergic mediated reaction causing eosinophil infiltration

275
Q

What risk factors are associated with eosinophilic oesophagitis?

A

Family history of atopy
atopy
children and young adults

276
Q

What other symptoms of eosinophilic oesophagitis?

A

GORD type

can have dysphagia and failure to thrive

277
Q

How would you diagnose eosinophilic oesophagitis?

A

OGD with biopsy showing using Ophelia

OGD will have narrowing with white plaques

278
Q

What is the management of eosinophilic oesophagitis?

A

Corticosteroid such as budesenone

279
Q

What is dyssenergic defication?

A

Dysfunction of the pelvic floor muscles and nerves causing failure of contemporary relaxation for defication

280
Q

What risk factors are associated with dyssenergic defication?

A

Previous pregnancy and childbirth
chronic constipation
previous surgery in pelvic floor

281
Q

What are the symptoms of dyssenergic defication?

A 
Access training
feeling of incomplete evacuation
positive hard stool
lesson three movements per week
the use of digital manoeuvres to pass stool
282
Q

What is important to rule out in dyssenergic defication?

and how would you diagnose dyssenergic defication?

A

obstruction - use X ray

sigmoidoscopy

283
Q

What is the management for dyssenergic defication?

A

Improving toilet habits
increasing fibre intake
laxatives

284
Q

What is hirsprungs disease?

A

Also all complete colonial functional obstruction associated with the absence of ganglion cells
this causes luminal obstruction

285
Q

what part of the GI tract does hirsprungs disease affect?

A

The distal part of the colon

286
Q

What nerve plexus is affected in hirsprungs disease?

A

The mesenteric nerve plexus

287
Q

What conditions is hirsprungs disease heavily associated with?

A

downs syndrome

288
Q

What is the presentation of hirsprungs disease?

A 
Vomiting
abdominal distension
delayed meconium passage
lack of desiccation
explosive passage of liquid and foul stool on DRE
presenting <1y
289
Q

What complications can occur due to hirsprungs disease?

and why?

A

Enterocolitis and sepsis

stasis leads to bacterial overgrowth and secretory diarrhoea

290
Q

How do you diagnose hirsprungs disease?

A

Contrast enema

abdominal x-ray is non-specific in young children

291
Q

What is the management of hirsprungs disease?

A

Bowel irrigation and surgery

292
Q

how do you manage hirsprungs disease complicated by hirsprungs disease?

A

Add antibiotics and IV fluids and decompression via colostomy before surgery

293
Q

what is chronic diarrhoea?

A

The presence of 3+ loose stools in a day for four weeks

294
Q

How do you assess chronic diarrhoea?

A

Determine the duration frequency pattern and severity of symptoms
ask about red flags such as bleeding weight loss anaemia
look for red flags such as masses raised inflammatory markers
check hydration status
look for potential causes in history such as foreign travel laxative use antibiotic use or other drugs

295
Q

What other potential causes of chronic diarrhoea?

A

Ulcerative colitis
Crohn’s colitis
viral bacterial parasitic enteropathy’s
ibs

296
Q

If you suspect malabsorption what tests should you run?

A 
FBC- anaemia
folate and B12 ferratin
serum albumin may be low
serum electrolytes such as magnesium potassium calcium 
zinc
check INR which can be deranged
can also do vitamin screen
297
Q

What is tropical sprue?

A

An infectious malabsorption condition caused by long-term stay in specific endemic areas in the tropics

298
Q

What is the presentation of tropicals sprue?

A

Low-grade fever
abdominal cramping and diarrhoea
hair loss and. oedema - due to low protein/albumin
signs of vitamin B12 and folate deficiency such as parlour angular chelitis

299
Q

What investigations should you perform in tropical sprue?

A

Malabsorption screen

endoscopy with biopsy

300
Q

how do you manage Topical sprue?

A

Folic acid plus antibiotics like tetracycline

and B12 supplements

301
Q

What is Whipple’s disease?

A

Rare infection caused by tropheryma whipplei

302
Q

What is the presentation of Whipple’s disease?

A 
Diarrhoea weight loss
arthralgia
lymphadenopathy and fever
steatorrhea
anaemia
skin darkening
303
Q

How do you diagnose Whipple’s disease?

A

Upper GI endoscopy with biopsy and PCR

304
Q

What is giardiasis?

A

An enteric infection caused by a protozoan Guardia lamblia

305
Q

what risk factors are associated with giardiasis?

A

Contaminated food and water

domestic animals living in the house

306
Q

What is the presentation of giardiasis?

A 
Diarrhoea
frequent belching
abdominal bloating and discomfort
weight loss
nausea and vomiting
307
Q

How do you diagnose giardiasis?

A

Store microscopy

308
Q

how do you treat giardiasis?

A

Anti-protozoan therapy – metronidazole

309
Q

what is the pathophysiology of lactase deficiency?

A

There is reduced lactase in the mucosal brush border
lactase is broken down and passes into the:
the unbroken lactose increases osmolality of the colon
it then gets broken down by bacteria in the colon
causing symptoms of diarrhoea and gas

310
Q

In children what can cause a temporary lactose intolerance?

A

Viral (usually) enteritis/gastroenteritis

311
Q

How do you diagnose lactase deficiency?

A

There should be no signs of malabsorption

the trial of dairy elimination

312
Q

What is the management of lactase deficiency?

A

Dietary modification with calcium and vitamin D supplements

in infants give oral lactase as well as appropriate formula

313
Q

What is a short bowel syndrome?

A

A substantial portion of the small intestine is absent either due to congenital or surgical causes

314
Q

What is the pathophysiology of short bowel syndrome?

A

There is a loss of surface area causing disturbances and fluid nutrients and medication absorption

315
Q

What are problems associated with short bowel syndrome?

A

Inability to maintain a protein energy fluid electrolytes or micronutrients balance when eating a normal diet

316
Q

What is the presentation of short bowel syndrome?

A

Fatigue
fractures
dysuria or renal colic due to the formation of kidney stones (if there is significant fluid loss)
abnormal neurological exam a due to low vitamin a and B12
jaundice or pruritus from liver failure in consequence to long-term intestinal failure

317
Q

What is the management of short bowel syndrome

A

Electrolyte vitamin and micronutrient replacement which may require PN feeding

318
Q

What are the investigations required for short bowel syndrome?

A

malabsorption screen
LFT + INR
U+E
ultrasound scan and CT for kidney stones or gallstones

319
Q

What are haemorrhoids?

A

vascular rich connective tissue cushions /structures located within the anal canal however as they enlarge they can protrude outside the anal canal causing symptoms

320
Q

What are the risk factors associated with haemorrhoids?

A

45 to 65 years old
constipation
pregnancy

321
Q

what is the presentation of haemorrhoids?

A

bright red blood on defecation
perianal pain or discomfort
if the haemorrhoid is thrombosed then pain and discomfort is worse

322
Q

On DRE what would you find for haemorrhoids?

A

Tender palpable lesion

323
Q

What investigations can you perform for haemorrhoids?

A

Anus copy exam
colonoscopies suspecting malignancy
FBC for anaemia

324
Q

What is the management of haemorrhoids?

A

Lifestyle modification and dietary modification
topical corticosteroids
Rubber band ligation

325
Q

What are anal fissures?

A

A split in the skin of the distal anal canal

326
Q

What are the symptoms of anal fissures?

A

Pain on defecation very severe feels like passing shards of glass or tearing sensation
and rectal bleeding

327
Q

How do you diagnose anal fissures?

A

Clinical diagnosis unless it has been caused by a previous treatment (anal manometry) or you suspect an anal sphincter defect then anal USS

328
Q

what is the management ofAn anal fissure?

A

Conservative management with high fibre diets and increasing fluids
a severe surgery may be considered

329
Q

What is pilondial disease?

A

The forceful insertion of hairs into the skin of the natal cleft above the bum
prompts of chronic inflammatory reaction and forms multiple communicated sinuses or an abscess

330
Q

who is affected by pilondial disease?

A

Young men who tend to be more hairy

331
Q

What is the presentation of pilondial disease?

A

Discharge pain and swelling around that area

332
Q

how do you diagnose pilondial disease?

A

On examination you find several connecting sinus tracts and possibly an abscess

333
Q

How do you manage pilondial disease?

A

Hair removal and local hygiene and if infected give ABx

pain relief if there’s an abscess

334
Q

What type of cancer is anal carcinoma?

A

squamous cell

335
Q

what usually causes anal carcinoma?

A

HPV - 16 and -18

336
Q

what are the risk factors for anal carcinoma?

A

HIV
men who have sex with men
repeated anal trauma
exposure to those with HPV

337
Q

what is the presentation of anal carcinoma?

A

rectal bleeding and pain
mass palpable
lymphadenopathy in more advanced

338
Q

how do you diagnose anal carcinoma?

A

anoscopy and biopsy

but can view initially with USS - anal

339
Q

what is rectal prolapse?

A

When the rectal wall slides out through the anus

340
Q

Why does rectal prolapse occur?

A

Usually when the intra-abdominal pressure increases (coughing or desiccation) and due to the weakening of muscles and ligaments prolapse occurs

341
Q

What are the symptoms of rectal prolapse?

A

mass palpable outside the rectum

342
Q

What does it mean if a rectal prolapse is painful and swollen?

A

That it is strangulated

343
Q

What is the management of rectal prolapse?

A

lifestyle management to decrease training if it is very severe than surgery

344
Q

What medication causes constipation?

A 
Opioids
anticholinergics
antispasmodic
tricyclic antidepressants
calcium channel blockers
levodopa and other Parkinson's drugs
diuretics
iron supplements
calcium supplements
antidiarrhoeal's
NSAIDs
345
Q

What is laxative abuse?

A

The repeated use of laxatives to purge calories or food

346
Q

What does laxative abuse leads to?

A

Dehydration
electrolyte disturbances
mineral deficiencies
constipation- due to XS stimulation causing nerve damage and thus constipation

347
Q

What is angiodysphasia of the colon?

A

A degenerative vascular malformation of the GI tract characterised by fragile leaky blood vessels

348
Q

what is the presentation of angiodysphasia of the colon?

A

Chronic painless low-grade and intermittent bleeding
colour of blood depends on the level of malformation:
fresh red blood – lower GI
Melena – upper GI
anaemia Sx

Rarely present with massive haemorrhage

349
Q

what investigations should you perform for angiodysphasia of the colon?

A

Colonoscopy / endoscopy / both– diagnostic

FBC - assess anaemia

350
Q

How do you treat angiodysphasia of the colon?

A

Interventional endoscopy with the supportive care

351
Q

What is paediatric GORD?

A

Reflux leading to inadequate intake or tolerance to fluids in children>1y

352
Q

Why does paediatric GORD occur?

A

Inappropriate relaxation of the lower oesophageal sphincter due to functional immaturity

353
Q

What are risk factors for developing paediatric GORD?

A

Prematurity
IUGR
under one years old
developmental delay (e.g. cerebral palsy)
short intra-abdominal oesophagus or other anatomical abnormalities of the upper GI tract

354
Q

What is a presentation for paediatric GORD?

A

Stressful mealtimes with the feed time over 30 minutes
regurgitation and vomiting
abdominal pain/colic
irritability or lethargy at meals

355
Q

What’s important to note in the history of a patient with paediatric GORD?

A

Abnormal perinatal events such as prolonged time to pass meconium
abnormal feeding patterns
an increased volume of feed

356
Q

How does the presentation of paediatric GORD differ in very young/premature infants?

A

may present as:
apnoea
desaturation
bradycardia

357
Q

How do you diagnose paediatric GORD?

A 
Mainly through response to treatment however if you are concerned about any DD such as:
 obstruction
aspirations
pyloric stenosis
oesophageal atresia

you will need to do further testing

358
Q

What is the management of paediatric GORD?

A

Education and reassurance – advised to lie prone or laterally while awake

give feed thickening is or anti-regurgitation formula

failure to respond should prompt a trial of cows milk protein free formula

if paediatric GORD is unresponsive to nonpharmacological treatment then give PPI

359
Q

What is pyloric stenosis?

A

The hypertrophy of the pyloric sphincter resulting in a narrowed pyloric canal
the most common cause of gastric outlet obstruction in those 2w-12w

360
Q

What is a presentation of pyloric stenosis?

A

Numberless projectile vomiting occurring soon after feeding
peristaltic waves moving from left to right across the stomach

features of dehydration irritability failure to thrive patient

361
Q

what may you feel on abdominal examination of a patient with pyloric stenosis?

A

An upper abdominal mass/hollow shape

362
Q

How do you diagnose pyloric stenosis?

A

Abdominal ultrasound scan

check U+E

363
Q

what electrolyte abnormalities may be present in pyloric stenosis?

A

hypochloremic acidosis with hypokalaemia

classic vomiting derangement

364
Q

What is the management for pyloric stenosis?

A

IV fluids and resus

surgery

365
Q

What commonly causes viral gastroenteritis in children?

A

Rotavirus

366
Q

What risk factors are associated with viral gastroenteritis in children?

A

Younger than five
daycare attendance
poor personal hygiene
Winter

367
Q

what is an inguinal hernia (paediatric)?

A

A protrusion of abdominal or pelvic contents caused indirectly by patent processus vaginalis

368
Q

What are risk factors associated with paediatric inguinal hernias?

A

Premature

mail

369
Q

How does an inguinal hernia present in paediatrics?

A

Intermittent swelling in groin or scrotum and crying or straining
inguinal swelling
irritable and vomiting

370
Q

Are you able to reduce paediatric inguinal hernias?

A

No unless opioid analgesia is used

a truly irreducible hernia requires surgery ASAP

371
Q

what is the management of an inguinal hernia?

A

Try and reduce the hernia

wait 24-48h to resolve oedema then proceed to surgery

372
Q

What are inguinal hernias associated with?

A

Undescended testes

373
Q

What is marasmus?

A

Severe protein and energy malnutrition

374
Q

What is the weight to height ratio in marasmus?

A

Abnormal

375
Q

What is the presentation of marasmus?

A

low made arm circumference
reduced skinfold thickness
withdrawn and apathetic

376
Q

What is Kwashiorkor?

A

Protein malnutrition

377
Q

What is the weight to height ratio in Kwashiorkor?

A

normal (due to increased fluid)

378
Q

What is the presentation of Kwashiorkor?

A 
Oedema with distended abdomen
severe wasting
desquamation of the skin and hyper keratosis
angular estimate hoses
diarrhoea
hypotension and bradycardia
hypothermia
379
Q

What are causes of paediatric malnutrition?

A 
IBD
coeliac
cholestatic liver disease
short bowel syndrome
exocrine pancreatic dysfunction
380
Q

What is the management of paediatric malnutrition?

A

Glucose and dextrose
fluids
replace electrolytes especially sodium potassium in chlorine
give micronutrients especially vitamins ADEK
small and often feeds

381
Q

What is intusucception?

A

A common cause of intestinal obstruction in young children caused by prolapse of one part of the lumen into the adjoining part

382
Q

Where is the most common location for intussusception?

A

Ileocecal

383
Q

What risk factors are associated with intussusception?

A

Male

aged 6 to 12 months

384
Q

What is the presentation of intussusception?

A

Colicky abdominal pain with flexing of the legs
normal behaviour in between episodes
vomiting
Lethargy and irritability between waves of pain
redcurrant jelly store
fever
pallor

385
Q

What do you need to be careful of in intussusception?

A

It can cause hypovolaemic shock if perforated ischaemic or necrotic

386
Q

On abdominal examination what might you feel in a child with intussusception?

A

RUQ or epigastric mass

387
Q

How do you diagnose intussusception?

A

Contrast enema or ultrasound scan

if you suspect obstruction or perforation then Abdominal X Ray

388
Q

What would a contrast enema show in Intussusception?

A

Meniscus sign- the round apex of the intussusception coiled spring sign- the oedematous mucosal folds

389
Q

What are contraindications to a contrast enema?

A

Shock
suspected perforation
peritonitis
evidence of necrosis

390
Q

What is the acute management of intussusception?

A

ABCD approach
fluid resuscitation and contrast enema reduction
give broad-spectrum antibiotics (clindamycin gentamicin)

if the reduction doesn’t work or the enema is contraindicated then surgical resection is used

391
Q

What is the ongoing management of Intussusception?

A

Only really used if there are three or more occurrences
do a CT
if possible reduce it but otherwise surgical resection is needed

392
Q

what causesIntussusception to occur?

A

Lymph-node thin payers patches often are the first part of an intussusception
a pathological lead to point (first part) can be because by cystic fibrosis and HSP if they cause bowel wall abnormalities

393
Q

What is meckles diverticulum?

A

Common congenital malformation of the small bowel

394
Q

what is the pathophysiology of meckles diverticulum?

A

A true diverticulum resulting from failure of embryonic tissue (vitelline duct) to obliterated in the fifth week of gestation

395
Q

How does meckles diverticulum present ?

A

Commonly is asymptomatic, if symptoms present it is usually before two years

acute episodic painless passage of maroon blood
constipation
nausea and vomiting
abdominal cramps

396
Q

How can meckles diverticulum show in adults?

A

Lower abdominal pain caused by diverticulitis

397
Q

What is the diagnostic test for meckles diverticulum?

A

Technetium 99 pertechnetate scan

or CT

398
Q

What complications or differential diagnoses are associated with meckles diverticulum?

and how would you manage these?

A

Intussusception
diverticulitis
bowel obstruction - surgery + abc (cefotaxime and metronidazole )

399
Q

What would a full blood count show in meckles diverticulum?

A

Anaemia

increased white cell count in inflammation

400
Q

What is the management of meckles diverticulum?

A

If asymptomatic:
no treatment is required

if symptomatic:
excision of the diverticulum

401
Q

What is toddlers diarrhoea?

A

A chronic non-specific diarrhoea causing the passage of stools of varying consistency
it is very common

402
Q

What is the pathophysiology behind toddlers diarrhoea?

A

Occurs due to an underlying delay in maturation of the intestine leading to intestinal hurry

403
Q

Is there any malnutrition or failure to thrive associated with toddlers diarrhoea?

A

no

404
Q

How do you manage toddlers diarrhoea

A

Start a high fibre diet

405
Q

are any investigations required in toddlers diarrhoea?

A

Not really
check the toddlers awaits their growth charts and assess any signs of malnutrition
if you have any doubts do a full blood screen

406
Q

What is the definition of recurrent abdominal pain?

A

pain severe enough to disrupt daily activities for >3m

407
Q

how would you diagnose recurrent abdominal pain?

A

it is a diagnosis of exclusion

you want a full examination (including genital and peri anal area - GU causes and IBD signs)

and include some imagine (X Ray/less commonly CT)

also an USS to check for gallstones/obstruction

+urine cultures and dipstick

408
Q

How would you manage recurrent abdominal pain?

A

the same as wit IBS

reassure and educate on diet
small frequent feeds
low fat and high fibre diet

can try probiotics

laxatives (fibrogel)
antispasmodics (cimetropium)

409
Q

What is colic?

A

a symptom complex occurring within the first few months of life

410
Q

What is the presentation of colic?

A

paroxysmal inconsolable crying with drawing of knees
XS flatulance
worse in evenings

411
Q

what are the risks of colic?

A

in itself nothing but…

increases risk of:
postnatal depression
parental stress
increased risk of domestic abuse

412
Q

what is the management of colic?

A

no real remedies

reassurance and lots of support

usually resolves by 4m

413
Q

what could persistent (after 4m) colic indicate?

A

GORD

cows milk protein allergy

414
Q

what is the definition of childhood obesity?

A

BMI>95th centile

415
Q

what BMI is defines ad severely obese in children?

A

BMI>99th centile

416
Q

what BMI is defined as overweight in children?

A

BMI>85th centile

417
Q

What are non-environmental causes of childhood obesity?

A 
hypothyroidism
prader willi
pseudohypoparathyroidism
bushings
injury/abnormality of the hypothalamus and pituitary
418
Q

what are measurements of a Childs weight?

A

mid arm circumference
waist to hip ratio
skinfold thickness

419
Q

what should always be checked in a child with obesity?

A

BP ?hypertension

420
Q

what are risk factors associated with childhood obesity?

A

obese parents
rapid weight gain in infancy and early childhood
poor SE status
sedentary

421
Q

What investigations should you perform in a child with obesity?

A

Fasting blood glucose
serum lipids
LFT (non-alcoholic fatty liver disease)

422
Q

What is the management of childhood obesity?

A

Lifestyle modifications with counselling

the aim of management is not on losing weight but rather not gaining weight and allowing a child to grow into their current weight

if severely obese orlistat can be used and if old enough surgery is very rarely offered

423
Q

What is a diagrammatic hernia?

A

Herniation of the abdominal contents through foreign men in the diaphragm

424
Q

How is a diaphragmatic hernia diagnosed in infants?

A

Usually on antenatal ultrasound

Dan confirmed once born with chest and abdominal x-ray

425
Q

What is the management of a diagrammatic hernia in infants?

A

NG tube + suction to prevent distension

after stabilisation surgical repair

426
Q

What is the most common complication with a diagrammatic hernia in infants?

A

pulmonary hypoplasia due to their compression en utero

427
Q

What is necrotising enterocolitis?

A

A bacterial invasion of ischaemic bowel wall upon bowel death

428
Q

What is the pathophysiology of necrotising enterocolitis?

A

The bowel and immune system are immature allowing for bacterial invasions of the gut
causes inflammation and can lead to perforation
causing further bacterial invasion
eventually leads to necrosis

429
Q

How does necrotising enterocolitis present?

A 
Feeding intolerance
abdominal pain and distension
shiny skin on abdomen
bloody stools
bile stained vomit
shock
430
Q

What word an x-ray show in necrotising enterocolitis?

A

Dilated and distended bowel loops
thickened bowel walls
intramural gas, gas under the diaphragm and in biliary tree

431
Q

Apart from x-ray what other quick test can show necrotising enterocolitis?

A

Abdominal trans-illumination

432
Q

How do you manage necrotising enterocolitis?

A

Nil by mouth start PTN
antibiotics
ventilation and surgery

433
Q

What complications are associated with necrotising enterocolitis later in life?

A

Strictures

malabsorption

434
Q

What is gastroschisis?

A

Congenital defect of the abdominal wall resulting in herniation from the abdominal cavity

435
Q

what is the difference between gastroschisis and omphalocele?

A

an abdominal sac covers the contents of an ompahloele whereas it isn’t present in gastroschisis

436
Q

what are the risk factors for gastroschiasis/ompahlocele?

A

smoking
maternal age 20< (gastroschiaisis)
maternal age >40 (omphalocele)

437
Q

Which congenital abnormalities is ompahlocele associated with?

A

trisomy 13, 18, 21

438
Q

what other condition is usually present if theres gastroschiasis/omphalocele?

and why?

A

intestinal atresia

due to constriction of the mesenteric blood supply causing decreased perfusion

439
Q

how are gastroschiasis/ompahlocele detected?

A

antenatal USS in 2nd trimester

440
Q

what compound is elevated in gastroschiasis/ompahlocele?

A

alpha-feto protein

441
Q

what test should you offer after detecting gastroschiasis/ompahlocele?

A

amniocentesis at 15-20w

CVS at 10-12w

442
Q

what is the management of gastroschiasis/ompahlocele?

A

Emergancy
ABCDE
fluid resus, temperature measurements and support, bowel protection until surgery
after surgery PTN/NG feed

443
Q

what does gastroschiasis/ompahlocele cause that makes it a medical Emergancy?

A

massive fluid and heat loss

444
Q

why is recovery longer in gastroschiasis than ompahlocele?

A

because the lack of sac means that theres development of a thick inflammatory film over the bowels

445
Q

what is intestinal atresia?

A

any congenital malformation resulting in bowel obstruction - either misconnection, narrowing or total block

446
Q

what are the classifications of intestinal atresia?

A 
complete
incomplete
mesenteric gap
blind end complete
apple peel syndrome
multiple blockages
447
Q

where does intestinal usually occur?

A

SI namely the ileum and jejunum because duodenal atresia is its own diagnosis

448
Q

what causes intestinal atresia?

A

a vascular event en utero causing a decrease in perfusion and death of bowel

449
Q

what is the presentation of intestinal atresia?

A

vomiting +/- bile
swollen soft abdomen
no meconium passage

450
Q

how is intestinal atresia diagnosed?

A

fetal USS
+ contrast Xray after birth to confirm

usually not necessary is laparoscopy however can be used if unclear

451
Q

What sign in pregnancy indicated intestinal atresia?

A

polyhydramnious

452
Q

what is the management of intestinal atresia?

A

laparoscopic surgery
+stoma to allow healing

IV fluids and NG feeds

FINALS (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions