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Gen Med and Surg - C.U > Gastroenterology / General surgery > Flashcards

Gastroenterology / General surgery Flashcards

1
Q

Definition of colic

A

Pain in a hollow organ, contraction causes the pain to come in waves

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2
Q

Presentation of acute abdomen

A 
Acute tenderness over the abdomen 
Guarding 
Rigidity of the abdomen 
ABSENCE OF BOWEL SOUNDS 
Septic - sweating, pale, weak pulse, shallow breath
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3
Q

Associated symptoms in an abdo pain hx

A 
Vomiting 
Haematemasis 
Eating / drinking 
Swallowing 
Stools - loose / blood 
Urine - frequency, urgency, blood 
Vaginal discharge 
Menstruation 
FEVER 
Weight loss 
Night sweats
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4
Q

Abdo pain investigations

1) Bloods
2) Bedside
3) Imaging

A

FBC, U&E, LFT, glucose, CRP, amylase

Urine dip - glucose, infection, pregnancy

CXR - perforation
USS abdo
CT

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5
Q

5 Fs of abdo distension

A

Fluid, foetus, flatus, fat and faeces

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6
Q

To complete an abdominal examination

A 
Hernial orifices 
External genitalia 
PR 
Urine dip 
Stool sample if feel appropriate
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7
Q

Where is McBurneys point

A

2/3 of the way between umbilicus and AIDS

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8
Q

Rovsings sign

A

Press on RIF and pain in the LIF

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9
Q

What needs to be ruled out in females with suspected appendicitis ?

A

Ectopic preg

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10
Q

Bed side tests in appendicitis

A

Urine dip
BM
Preg test
BP

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11
Q

Blood tests in suspected appendicitis

A

FBC
U&Es
CRP

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12
Q

Imagining in suspected appendicitis?

A

USS

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13
Q

AB used in appendicitis

A

Metronidazole and cefuroxime

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14
Q

What should be considered with any change in bowel habit?

A

malignancy

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15
Q

GI causes of diarrhoea

A 
Infection 
Malignancy 
IBD
IBS 
Malabsorption
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16
Q

Systemic causes of diarrhoea

A

Endocrine
Anxiety
Bacterial overgrowth

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17
Q

Drugs causing diarrhoea

A

Laxatives
AB
SSRIs
Metformin

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18
Q

Infections leading to blood in stool (4)

A

E.coli
Shigella
Salmonella
Campylobacter

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19
Q

Social hx in diarrhoea hx

A

Travel hx

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20
Q

Bed side test with diarrhoea

A

PR (overflow due to constipation)
Urine dip and culture
Stool sample - viral / bacterial / occult blood

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21
Q

Blood tests in diarrhoea

A 
FBC
UandEs 
LFTs 
CRP 
TFTs
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22
Q

Non bedside tests in diarrhoea

A

GI endoscopy

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23
Q

Imaging in diarrhoea

A

Abdo x-ray

Abdo US

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24
Q

Treatment of diarrhoea

A

Treat the cause
Rehydrate
Slow bowel movements (?) - opioids / stop medication

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25
Q

GI causes of N and V

A

Infection - pancreatitis, pyelonephritis, gastroenteritis, cholecystitis
Obstruction
Inflammatiom

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26
Q

Metabolic causes of N and V

A 
Diabetic ketoacidosis 
Raised calcium 
Low sodium 
Addisions 
Pregnancy
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27
Q

Neurological causes of N and V

A

Head trauma
Tumour
Motion sickness
Menieres

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28
Q

Cardiac cause of N and V

A

Heart attack

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29
Q

Drugs commonly causing N and V

A

Opioid
AB
Chemo
Alcohol

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30
Q

NICE guideline for referral for suspected bowel cancer

A

They are aged 40 and over with unexplained weight loss and abdominal pain or

They are aged 50 and over with unexplained rectal bleeding or

They are aged 60 and over with:
Iron-deficiency anaemia or
Changes in their bowel habit
Tests show occult blood in their faeces (new NICE recommendation for 2015).

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31
Q

Presentation of bowel cancer in RHS

A 
Diarrhoea 
Weight loss 
Anaemia 
RIF mass 
Abdo pain

OFTEN LATE PRESENTING

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32
Q

Presentation of bowel cancer in LHS

A

Constipation
Bleeding
Mucus
Tenesmus

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33
Q

Signs on exam of bowel cancer

A 
Abdominal mass 
Enlarged liver (mets) 
Rectal mass 
Signs of iron deficiency anaemia
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34
Q

Blood tests in suspected bowel cancer

A

FBC - look for iron deficiency anaemia
LFT
UandE
CEA - monitor progress

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35
Q

Investigation options in suspected bowel cancer

A

Colonoscopy
Barium swallow
Imagining - MR / endorectal US

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36
Q

Caecum and right colon affected - surgery ->

A

Right hemicolectomy

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37
Q

Transverse segment affected - surgery ->

A

Extended Right hemicolectomy

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38
Q

Descending colon affected - surgery ->

A

Left hemicolectomy

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39
Q

Sigmoid colon affected surgery ->

A

sigmoid colectomy

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40
Q

Rectum affected surgery ->

A

Anterior resection

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41
Q

Low rectum affected surgery ->

A

abdo-perineal resection with PERMANENT COLOSTOMY

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42
Q

When should radiotherapy be done in bowel cancer?

A

preoperatively

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43
Q

Screening for bowel cancer in the UK

A

Flex sigmoidoscopy - age 55+

FOB 70 -74 (male and female)

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44
Q

90% of oesophageal malignancies are?

A

squamous cell carcinoma

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45
Q

which type of cancer is associated with barretts oesophagus?

A

adenocarcinoma

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46
Q

Risk factors for oesophageal cancer

A 
Smoking 
Alcohol 
Barrets 
Diet 
Coeliac disease
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47
Q

Which virus is squamous cell carcinomas associated with?

A

HPV

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48
Q

Symptoms of oesophageal cancer

A 
Fatigue 
Increasing dysphagia 
Odynophagia 
Hoarseness 
Vomiting 
Haematemisis 
Cough
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49
Q

Signs of oesophageal cancer

A 
Weight loss 
Anaemia 
Lymphadenopathy 
Hepatomegaly 
Ascites
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50
Q

Where does oesophageal cancer often metastasise to?

A

Liver

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51
Q

Tests in oesophageal cancer

A

Blood - FBC, LFTs
Upper GI endoscopy
Barium swallow
Further imaging for staging

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52
Q

Treatment of oesophageal cancer if no mets / not v advanced

A

oesophageal resection

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53
Q

Treatment of oesophageal cancer if mets / advanced

A

palliative

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54
Q

Most gastric carcinomas are?

A

adenocarcinomas

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55
Q

Risk factors for gastric cancer

A 
h.pylori
smoking 
poor diet 
blood group A 
chronic gastritis
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56
Q

Symptoms of gastric cancer

A 
B symptoms  
vomiting 
abdo pain 
dyspepsia 
dysphagia (oesophageal obstruction)
may be an upper GI bleed
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57
Q

Signs of gastric cancer

A

Palpable epigastric mass

Virchows node - CHECK LYMPH NODES

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58
Q

Blood tests in gastric cacner

A

FBC

LFTs - mets

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59
Q

Gold standard investigations for gastric cancer

A

Upper GI endoscopy

Barium swallow

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60
Q

Management in localised gastric cancer

A

Resection / gastrectomy

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61
Q

Management in metastatic gastric cancer

A

Palliative

Stents if obstructions etc

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62
Q

Risk factors for pancreatic cancer

A

Smoking
Diabetes
Pancreatitis

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63
Q

Usual type of cancer in the pancreas?

A

Ductal adenocarcinoma

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64
Q

Symptoms of pancreatic cancer

A

Usually painless

Abdo mass

Weight loss

May be non specific back pain

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65
Q

Signs of pancreatic cancer

A

painless progressive jaundice

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66
Q

Bloods in pancreatic cancer

A

FBC

LFTs

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67
Q

Investigations in pancreatic cancer

A

USS
CT
ERCP

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68
Q

Management options in pancreatic cancer

A

Surgical - whipples

Palliative - stenting and pain relief

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69
Q

Oesophageal cancer referal pathway

URGENT DIRECT ACCESS (2ww)

NON URGENT DIRECR ACCESS

A

UPPER GI ENDOSCOPY

1) Dysphagia or 55+ and weight loss + one of upper abdo pain, reflux or dyspepsia
2) Haematemesis

55+ other upper GI symptoms

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70
Q

Causes of constipation - medical

A 
Diverticulitis 
IBD
IBS 
Coeliac 
Immobility 
Dehydration 
Raised calcium / phosphate 
Parkinsons disease 
Pregnancy 
HypoT
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71
Q

Surgical causes of constipation

A

Appendicitis
Malignancy
Ischaemic bowel
obstruction

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72
Q

Drugs causing constipation

A

Anti cholinergics
Opiates
Iron
Calcium channel blockers

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73
Q

Important questions with constipation

A

Normal bowel habit - how many stools per day (? <3 per week) and for how long
Over flow diarrohea
Maelena
Pain

Diet

New medications

Red flags - fever/ weight loss / nightsweats

FOREIGN TRAVEL

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74
Q

Examination in constipation

A

Abdo and PR

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75
Q

Blood tests in constipation

A

FBC - haematinics
U&Es
TFTs
LFTs

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76
Q

Imaging in constipation

A

US
Abdo X-ray
CT - extreme

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77
Q

Conservative management in constipation

A

Exercise and fibre

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78
Q

Types of laxatives - BOSS

A

Bulking - e.g. methylcellulose
Osmotic - Lactulose
Softer - Docusate
Stimulants - Senna

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79
Q

Causes of acute pancreatitis

G
E
T

S
M
A
S
H
E
D
A

Gall stones
Ethanol
Trauma

Steroids 
MUMPS 
Autoimmune 
Scorpion venum 
Hyperlilipidaemia / hypercalacaemia / hyperparathyroidism 
ERCP
Drugs
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80
Q

Define acute pancreatitis

A

acute inflammation of the pancreas by autodigestion

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81
Q

Grey turners sign =

A

haemorrage in the flanks

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82
Q

Cullens sign =

A

bruising at the umbilicus

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83
Q

Presentation of acute pancreatitis

A

abdo pain radiating to the back - relieved by sitting forward
NandV

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84
Q

Criteria for clinical outcome for pancreatitis

A

Glasgow score

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85
Q

Blood tests to do in acute pancreatitis

A 
FBC - increased WBC 
UandE
LFTs 
Glucose - increased 
Albumin - reduced 
Calcium - reduced 
Urea - raised 
CRP - increased 
Amylase - raised 
Serum lipase - raised
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86
Q

Increased ALT in acute pancreatitis suggests?

A

gall stone aetiology

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87
Q

Imaging in acute pancreatitis

A

CXR - check for perforation

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88
Q

Glasgow score to send to intensive care?

A

> 3

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89
Q

Supportive care in acute pancreatitis

A 
O2 
Fluids 
Analgesics 
Anti emetics 
Insulin 
Antibiotics 5-7 days 
PPI
Regular monitoring
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90
Q

Causes of chronic pancreatitis

A 
Alcohol 
Hypercalacaemia 
Hyperparathyrodism 
Hyperlipidaemia 
Biliary disease 
Cystic fibrosis
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91
Q

Clinical feature of chronic pancreatitis

A 
Jaundice 
Abdo pain - radiates to the back, improves on sitting forward  
Bloating 
Steatorhhoea 
Weight loss
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92
Q

Imaging in chronic pancreatitis

A

CXR
CT
USS

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93
Q

Dyspepsia =

A

indigestion

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94
Q

Local causes of dyspepsia

A 
GORD
H.pylori
Gastritis 
Ulcer - gastric / duodenal 
Hiatus hernia
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95
Q

Systemic causes of dyspepsia

A

Infection
Alcohol
Smoking

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96
Q

Drugs causing dyspepsia

A

NSAIDS
Steroids
Bisphosphinates

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97
Q

Conservative management for dyspepsia

A

Weight loss
stop smoking
reduce alcohol intake
less hot drinks

98
Q

Intraluminal causes of dysphagia

A

Inflammation - oesophagitits

Malignancy

99
Q

Extraluminal causes of dysphagia

A 
Stricture
Malignancy 
Acalasia 
Goite 
Vascular obstruction
100
Q

Systemic causes of dysphagia

A 
Parkinsons 
Myasthenia Gravis 
Scleroderma 
Bulbar palsy 
MND
101
Q

Important questions in dysphagia

A

Solids / liquids

B symptoms

102
Q

1st line investigation in dysphagia

A

endoscopy

103
Q

Imaging in dysphagia

A

barium swallow

ct

104
Q

gall stones made of?

A

cholestrol, calcium and bile salts

105
Q

choleithiasis is?

A

gallstones in the gallbladder

106
Q

choledocholithiasis is?

A

gallstones passed into the biliary tree

107
Q

cholecystitis is?

A

inflammation of the gallbladder

108
Q

what percentage of gall stones are radio opaque?

A

10% seen on x-ray

109
Q

What increases the incidence of gall stones?

A

Over weight
Pregnancy
Diuretics
?smoking

110
Q

main precipitant for mixed stones?

A

infection

111
Q

Courvoisiers law?

A

Pt presents with painless obstructive jaundice with an enlarged gallbladder NOT gallstones

112
Q

size of gall bladder in

1) gall stone disease?
2) obstruction of biliary tree?

A

smaller

enlarged

113
Q

5 Fs of gall stone disease

A

fat, female, fertile, forty and fair

114
Q

presentation of gall stones most commonly?

A

80% asymptomatic

115
Q

cause of obstructive jaundice due to gall stones?

A

choledocholithiasis

116
Q

Imaging option in gall stones?

A

X-ray
US

MRCP
ERCP

117
Q

Management of asymptomatic stones found incidentally?

A

conservative treatment

118
Q

Medical therapy for gall stones?

A

pain relief
anti emetics
antibiotics if infection

119
Q

Surgical treatment used when in gall stones?

A

symptomatic / complications

120
Q

What is the surgical treatment for gall stones?

A

either laproscopic or open cholecystectomy

121
Q

When inoperable what at the options for symptomatic gall stones?

A

Could have ERCP or lithotripsy (US shock waves)

122
Q

Main cause of cholecystitis?

A

gallstones

123
Q

Presentation of cholecystitis?

A

feverish and unwell
URQ pain
previously told had gallstones

124
Q

Symptoms of cholecystitis

A 
Pain in RUQ which can refer to right shoulder
Fever 
Pt has to take shallow breaths 
Can have N&amp;V 
Indigestion
125
Q

Signs of cholecystitis

A

fever
tachycardia
increased RR

MURPHY’S sign
- pain when two fingers put on RUQ and pt asked to breath in (gallbladder moves up to the costal margin on inspiration)

126
Q

Blood tests in cholecystitis?

A 
FBC
U&amp;E 
LFT
CRP
Amylase 
?blood cultures
127
Q

Medical management of cholecystitis?

A

Nil by mouth
Fluids
Antibiotics - cover gram -ve and +ve
anti emetic and analgesia

128
Q

surgical management of cholecystitis?

A

cholecystectomy - if severe / complications within 72hrs

129
Q

what is cholangitis?

A

inflammation of bile duct

130
Q

Causes of cholangitis

A

Infection
Iatrogenic - past stent
Obstruction

131
Q

Charcots triad (only in 25% of those with cholangitis) but what is it?

A

Jaundice
Fever
RUQ pain

132
Q

Common presentation of cholangitis?

A

SEPSIS

133
Q

Treatment of cholangitis

A

EMERGENCY - ABCDE….

134
Q

Gallbladder cancer usually?

A

adenocarcinoma

135
Q

RF for gallbladder cancer?

A

Chronic gallstones

congenital malformation

136
Q

Presentation of gallbladder cancer

A

late presentation
weight loss
jaundice
RUQ mass

137
Q

Organisms that cause vomiting in gastroenteritis

A

Staph aureus

Bacillus cereus

138
Q

Organisms causing watery diarrhoea gastroenteritis

A

Cholera

E.coli (enterotoxigenic)

139
Q

organisms causing dysentry

A

Shigella
Campylobacter
E.coli (enterohaemorrhagic)
Salmonella

140
Q

those at risk of gastroenteritis?

A

young / old
immunosuppressed
travellers

141
Q

If symptoms of gastroenteritis emerge

within 4 hours - indicates which type of infection?

12-48hrs - indicates which type of infection?

A

food poisoning

toxin producing / cell invaders

142
Q

Treatment of gastroenteritis

A

most resolve on their own
fluids
anti emetics
rehydrate

AB - if systemically unwell / immunocompromised

143
Q

three types of bacteria causing gastroenteritis

A

food poisoning
toxin producing
cell invaders

144
Q

viruses causing gastroenteritis

A

norovirus

rotovirus

145
Q

group most common to contract viral gastroenteritis

A

children

146
Q

Classification of an upper GI bleed

A

mouth to second part of duodenum

147
Q

Classification of a lower GI bleed

A

2nd part of duodenum to rectum

148
Q

Oesophageal causes of bleeding

A

oesophagitis
mallory- weiz tear
malignancy

149
Q

Gastric causes of bleeding

A

gastritis
ulcer
cancer

150
Q

Small and large bowel causes of bleeding

A 
Cancer
Gastritis 
Inflammatory bowel disease 
Diverticulitis 
Ulcer 
Polyps
151
Q

Rectal causes of bleeding

A

Malignancy

152
Q

Anal causes of bleeding

A

Fissure
Haemorrhoid
Fistula

153
Q

Associated symptoms and signs of GI bleeding

A

Weight loss
Vomiting
Signs of chronic liver disease
Signs of anaemia ?

154
Q

PMH q. in GI bleed

A

Binge drinking - MWT

Liver decompensation

155
Q

Medications leading to GI bleeds

A 
Warfarin 
Antiplatlets 
Anticoagulants 
Steroids 
NSAIDs 
Alcohol
156
Q

Bedside tests in GI bleed

A

BP (lying and standing)
PR
Monitor urine output

157
Q

Blood tests in GI bleed

A 
FBC 
Haematimics 
LFTs 
U&amp;Es 
Clotting screen 
Group and save

ABG

158
Q

Imaging in GI bleed

A

CXR ( look for perforation)

could do barium swallow / endoscopy

159
Q

Score used to determine prognosis of acute GI bleeds

A

Rockall

160
Q

Management of an acute GI bleed

A

ABCDE
IV access and transfuse if necessary
Manage clotting problems

Endoscopy when they are stable

Interventional radiology - identify bleeding point and stop

Medical management - AB, PPI and H.pylori eradication

Surgery - if failure to stop bleeding

161
Q

Lifestyle advice post bleeding

A

Avoid NSAIS and reduce alcohol intake

162
Q

Treatment if high risk of re bleeding post GI bleed

A

PPI infusion

163
Q

Risk factors for hernia

A

Obesity
Previous surgery
Coughing
Straining due to chronic constipation

164
Q

Incarcerated hernia =

A

Hernial contents fixed due to adhesions, surgical emergency

165
Q

Strangulated hernia

A

Ischaemia of the bowel contents of the hernia, surgical emergency

166
Q

Surgical treatment of hernias

A

Mesh or suture to secure

167
Q

Where does a femoral hernia sit in relation to pubic tubercle

A

Below and lateral

168
Q

Where does an inguinal hernia sit in relation to the pubic tubercle

A

Above and medial

169
Q

Strangulation more likely in an inguinal or femoral hernia?

Why?

A

femoral because the lacunar ligament is sharp

170
Q

How do femoral hernias present?

A

Tender swelling in upper medical thigh

Often irreducible

171
Q

Treatment of femoral hernias

A

Surgical treatment quickly as likely to strangulate

172
Q

Indirect hernia passes through?

Direct passes though?

A

Deep and superficial ring

Just superficial ring

173
Q

Inidrect or direct hernia has higher chance of strangulation?

A

Indirect

174
Q

How to ascertain if an inguinal hernia is direct or indirect

A

direct reduces on lying down

But also 
- get the patient to lie down 
- put finger over the mid point of inguinal ligament (over deep ring) 
get the patient to stand and cough 
- direct - no restrained (protrudes) 
- indirect - restrained
175
Q

Periumbilical hernia presentation

A

umbilicus is a semicircle

176
Q

Umbilical hernia presentation

A

mass bulges directly from the umbilicus

177
Q

How to distinguish small bowel from large on x-ray

A

Valvulae conniventes - span the whole lumen, found in small bowel

Large bowel have haustra - don’t cross the whole lumen

178
Q

Causes of small bowel obstruction

In the lumen
In the wall
Outside the bowel

A

1) Polyp
Interssuception
Gallstone
Faeces

2) Tumour
Crohns
Infarction
Stricture

3)
Interssusception
Adhesions
Vovulus

179
Q

Typical presentation of small bowel obstruction

A

Crampy / colicky central abdominal pain
Bilious vomiting
Can be some distension
increased bowel sounds - tickling

180
Q

Examinations in bowel obstruction

A

Abdo exam
Hernial orifices
PR exam

181
Q

Blood tests in bowel obstruction

A

FBC
UandEs
ABG
Amylase

182
Q

Imaging small bowel obstruction

A

CXR

Abdo x-ray

183
Q

Main treatment of small bowel obstruction

A

Conservative in adults
Put in a drip to rehydrate
Insert a nasogastric tube to remove bowel contents

184
Q

When is surgery needed to treat small bowel obstruction

A

Ischaemic bowel

Incarcerated hernia

185
Q

Cause of large bowel obstruction

Inside the lumen
In the wall
Outside the bowel

A

1) Polyp
Mass

2) 
Diverticulitis 
Crohns 
Mass
Impacted faeces

3)Outside
Volvulus
Adhesions

186
Q

Small bowel obstruction
Early symptom
Late symptom

Vs
Large bowel obstruction

A

Vomiting
Constipation

Constipation
Vomiting

187
Q

Large bowel obstruction presentation

A

Colicky pain
Distended abdomen (more than in small)
Constipation

188
Q

Imaging in large bowel obstruction

A

CXR
AXR

consider sigmoidoscopy, barium enema and CT

189
Q

Treatment of large bowel obstruction

A

Medical - drip and suck
- water soluble enema

Surgical

  • emergency surgery is ischaemic bowel
  • stenting
  • laparotomy
190
Q

Volvulus =

A

twisting of bowel around its mesenteric attachement

191
Q

Where does volvulus usually occur?

A

Sigmoid

192
Q

Presentation of volvulus

A

Colicky abdo pain
Distension
Constipation

193
Q

Types of lesions in

UC

Crohns

A

Continuous

Skip

194
Q

The extent of inflammation in at a cellular level

UC

Crohns

A

Muscosal inflam

Transmural

195
Q

Which of UC and Crohns commonly has bleeding

A

UC

196
Q

Extraintestinal manifestations in IBD

A 
Eyes - Uveitis 
Joint arthritis 
Erythema nodosum 
Pyoderma gangrenosum 
Clubbing 
Sclerosing cholangitis -> cirrhosis
197
Q

Imaging investigations in IBD

A

Endoscopy
Barium swallow
CT / MR

198
Q

Colonic surveillance in IBD

A

10 years after first diagnosis, repeat depending on risk stratification

199
Q

Prognosis in IBD

A

life long remitting and relapsing

200
Q

“cure” in UC

A

Colectomy

201
Q

What can precipitate UC

A

Infection / stress

202
Q

Gene UC is linked with

A

HLA-B27

203
Q

Type of mediated response in UC

A

T helper - type 2

204
Q

Severe colitis presenation

A

fever
weight loss
haemodynamic compromise

205
Q

Liver condition linked with UC

A

Sclerosing cholangitis

206
Q

Blood tests in IBD

A

FBC
UandE
CRP/ESR
LFTs

207
Q

Bedside tests in IBD

A

Stool sample

Faecal calprotectin

208
Q

Presentation of severe UC in AXR

A

Loss of colonic markings - lead pipe picture

209
Q

How to introduce remission in UC

Mild / mod

Severe

A

Pred, aminosalicylate, steroid enema

IV hydrocortisone with hydration

210
Q

Maintaining remission in UC

A

5-Aminosalicylate
Mesalazine
Immunosuppressants

211
Q

Surgical management of UC

A

20%

Colectomy / ileostomy

212
Q

Indications for surgery in UC

A

Carcinoma
Haemorrhage
Obstruction
Perforation

213
Q

Complications of UC

A

Peroration
Bleeding
Toxic mega colon
Colonic cancer risk

214
Q

Disease associated with Crohns

A

Ank Spond

215
Q

Presenation of Crohns

A

Diarrhoae (non bloody)
Abdo pain - RIF / suprapubic
Weight loss / fever/ malaise
Mouth ulcers

216
Q

Mild to mod crohns intor remission treatment

A

Prednisolone / aminosalicylates

217
Q

Severe crohns intro remission treatment

A

IV hydrocortisone

IV fluids

218
Q

Maintaining remission in crohns

A

Immunosuppresants - azathioprine

Biologics

219
Q

Indications for surgery in Crohns

A

Failure of medical therapy
Intestinal obstruction
Perforation

220
Q

H.pylori eradication treatment

A

Amoxicillin and clarithromycin + PPI (for a month)

221
Q

Important q to ask in H.pylori

A

Had eradication before?

222
Q

Classification of IBS

A

Diarrhoea and Constipation

223
Q

What are bowel changes usually related to in IBS?

A

Stressful events

224
Q

Symptoms of IBS

A 
Bloating 
Pain 
Feeling of not emptying bowel 
Nausea
Anxiety / depression
225
Q

Blood tests to exclude other causes when IBS suspected

A 
FBC
UandE
CRP 
Haematimics 
TFTs
Coeliac serology 
Ca-125
226
Q

Other tests to exclude other causes when IBS suspected

A

Stool culture
Faecal calprotectin
Urinalysis
?US

227
Q

Medical treatment for diarrhoea IBS

A

Imodium

228
Q

Medical treatment for constipation IBS

A

Gentle laxative

Antispasmodics

229
Q

Causes of malabsorption

A 
Failure of digestive enzymes 
Inflammation 
Structural abnormalities - resections . diverticulae 
Pancreas disease 
CF 
Coeliac 
Malignancy
230
Q

Clinical features of malabsorption

A 
Diarrhoea 
Weight loss 
Failure to thrive 
Letheragy 
Flatus 
Ascites and oedema 
Abdo pain
Distension 
May be vitamin deficiences
231
Q

Blood tests in suspected malabsorption

A 
FBC 
Iron studies 
LFTs 
Clotting 
Coeliac serology
232
Q

Other tests in suspected malabsorption

A

faecal calprotectin
Faecal appearance and fat collection over 3 days
Faecal elastase

233
Q

Imaging in malabsorption

A

endoscopy

234
Q

+ 55y/o + dyspepsia should have what?

A

OGD and h.pylori test

235
Q

<55 with dyspepsia and no red flags

A

urea breath test

236
Q

Causes of bleeding from the rectum

A

Vascular - haemorroids
Trauma - anal fissure
Inflammatory - Crohns / UC
Malingancy

237
Q

Inital investigations for patients with rectal bleeding

A

PR

Procto-sigmoidoscopy

238
Q

If patient with rectal bleeding has change in bowel habit / evidence of IBD what investigations should be done?

A

colonoscopy

239
Q

Causes of massive splenomegaly?

A

CML
Malaria
Myelofibrosis

240
Q

Causes of splenomegaly

A 
Sickle-cell thalassaemia 
Rheumatoid arthritis 
Haemolytic anaemia 
CLL 
Infectious mononucleosis

CML
Malaria
Myelofibrosis

Gen Med and Surg - C.U (16 decks)

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