Gastroenterology / GI surgery Flashcards
Px of ulcerative colitis
chronic inflammation of the large bowel
abdominal discomfort,
bloody diarrhoea, tenesmus
what is seen on imaging and stool in UC
loss of haustral markings = lead pipe
continuous inflammation
raised fecal calprotectin
Mx of acute UC
- IV hydrocortisone
- ciclosporin/inflixamab
- surgery
Mx of mild/moderate UC
- mesalazine
- prednisolone
what is seen on Ix in Crohns
high fecal calprotectin
skip lesions, cobblestone appearance
non-casaeated granulomas
IBS Px
abdominal pain, discomfort. worse after eating, relieved by defecation.
what infection causes pseudomembranous colitis?
what is seen on imaging
Mx
C diff infection!!!
Raised yellow plaques
ABs: vancomycin
Ix in celiac disease
Anti TTG IgA antibodies
B12, folate deficiencies, IDA
Zollinger Ellison Syndrome pathophis + assoc.
gastrinoma (neuroendocrine tumour in the duodenum)
results in hypersecretion of gastrin + gastric acid; and peptic ulcer disease
not relieved by PPI
associated with MEN1
gold standard diagnosis for ZES
secretin stimulation test
wilsons disease pathophys, symptoms, Ix
copper deposition in tissues
jaundice, akinesia, tremor
low ceruloplasmin and low serum copper
Hereditary Haemochromatosis
pathophys, symptoms, Ix
iron deposition in tissues
bronzed skin, joint pain, liver cirrhosis
high serum ferritin+transferrin
Haemochromatosis Mx
lifestyle changes (avoid iron supplements, vitamin C)
phlebotomy in later stages
Charcots triad
ascending cholangitis/Biliary obstruction:
1. RUQ pain
2. jaundice
3. fever
ascending cholangitis
px, ix, mx
infection of the biliary tree
Px: charcots triad
Ix: MRCP
Mx: antibiotics,drainage, ERCP to remove blockage, treat systemic illness
difference between primary biliary cholangitis and primary sclerosing cholangitis
PBC = more women, PSC = more men
PSC associated with IBD e.g. UC
PBS = chronic inflammation of the biliary tree
PSC = chronic fibrosis and scarring of the biliary tree
anti mitochondrial antibodies are raised in:
Primary biliary cholangitis
painless rectal bleeding
haemorrhoids
murphys sign positive
on inspiration the inflamed gallbladder moves up and can be palpated, causing pain
Acute cholecystitis
RUQ pain, radiates to the shoulder
Fever, raised CRP, WBC
Px of acute cholecystitis
Mx of acute cholecystitis
cholecystectomy
what do you see on US in acute cholecystitis
thickened gallbladder wall
Gallbladder distension
Causes and Px and Ix of acute pancreatitis
alcohol, gallstones
RUQ pain, relieved when sitting forwards, worse after a meal
High lipase & amylase, hypocalcemia
Mx of pancreatitis
fluid resus (crystalloid)
analgesia
irregular border of enlarged, tender liver
deranged LFTs
weight loss
hepatocellular carcinoma
Rovsing’s sign positive
appendicitis
pain on the right side when the left iliac fossa is palpated
rigid abdomen, rebound tenderness
peritonitis, infection due to perforation
Appendicitis pain
peri-umbilical pain spreading to the right iliac fossa
Trousseu’s syndrome
migratory thrombophlebitis
repeated venous thromboembolism in the peripheries
associated with pancreatic/gastric cancers etc
common cause of sigmoid volvulus
chronic constipation in older patient.
causes bowel to weight down and twist -> volvulus
sign of sigmoid volvulus
coffee bean sign on xray
signs of peritonitis
rebound tenderness
percussion tenderness
positive urea breath test indicates:
H pylori
ulcer. better after eating, worse when hungry
duodenal ulcer
which hernia is more common in older people and trauma
direct
which hernia is more likely to be strangulated
indirect
Mx of suspected bowel obstruction
insert NG tube
CT abdomen & erect chest x ray
barium enema
surgical exploration
imaging used for penumoperitoneum
use erect chest x ray
severe retching and vomiting, now presenting with chest pain and haemodynamic instability
boerhaave syndrome
definitive treatment of primary sclerosis cholangitis
liver transplant
anal fistula presentation
an abnormal tract that connects the anal canal to the perianal skin
peri-anal discharge, itchiness, pain, swelling
Peutz-jeghers syndrome
autosomal dominant
colonic polyps + mucocutaneous hyper pigmented macules
what drug is used to maintain IBD remission
azathioprine
Mx of relatively stable patient with suspected bowel obstruction
Ng tube, abdominal CT
what antibody is raised in PBC and PSC
PBC: anti mitochondrial
PSC: anti smooth muscle and pANCA
what antibody is raised in celiac disease
anti-endomysial
cause of secondary achalasia
Chagas disease
infection causing destruction of myenteric plexus
two types of oesophageal cancer, which is more common
squamous cell
adenocarcinoma
adenocarcinoma is more common
achalasia
failure of lower oesophageal sprinter to relax
where in the oesophagus are the two types of cancer found?
SCC: upper 2/3
adenocarcinoma: lower 1/3
cause of stress ulcers
ischemia, sepsis, shockl
cause of curlings ulcers
severe burns, trauma
cause of cushings ulcers
intracranial injury
where in the stomach are h pylori ulcers most commonly found
antrum
FAP
familial adenomatous polyposis
development of hundreds of polyps in the colon
100% risk of colorectal cancer if untreated
Require panprotolectomy
Garnder syndrome
FAP + bone cancer
Turcot syndrome
FAP + CNS cancer
Lynch syndrome
Hereditary Non Polyposis Colorectal Cancer
indications for liver transplant in primary sclerosing cholangitis
recurrent bacterial cholangitis
intractable pruritus
what is plummer vinson syndrome and what does it increase the risk of
iron deficiency anaemia
oesophageal web
dysphagia
increased risk of pharynx or oesophageal carcinoma
budd chiari syndrome
hepatic venous outflow obstruction
Mx of budd chiari
mild: anticoagulation, TIPSS
severe: liver transplant
Px of budd chiari
RUQ pain, worsening
young, no history, COCP
gets bad quickly - ascites
where is zollinger ellison syndrome
duodenum
Mx of haemorrhoids
Injection sclerotherapy
pre existing malaria is caused by
plasmodium vivax
where is b12 absorbed from
terminal ileum
where is thiamine absorbed from
proximal small intestine (jejunum)
differences between crohns and UC: inflammation
crohns: transmural
UC: mucosal
crypt abscesses are present in
UC
rose thorn ulcers are present in
crohns
causes of direct inguinal hernia
weakness in abdominal muscle, acquired
causes of indirect inguinal hernia
congenital
contents of the inguinal canal in men
spermatic cord
ilioinguinal nerve
contents of inguinal canal in females
round ligament of the uterus
genital branch of the genitofemoral nerve
ilioinguinal nerve
grey turner sign
retroperitoneal haemorrhage
flank ecchymosis
cullen sign
peri-umbilical ecchymosis
ectopic pregnancy/acute pancreatitis
localised peritonitis can be caused by…
inflammation of an abdominal organ
global peritonitis can be caused by…
result of a viscus perforation
gold standard diagnosis for achalasia
oesophageal manometry
bacterial overgrowth syndrome
pathophis and Px
overgrowth of colonic bacteria
- steatorrhoea (bacteria break down conjugated bile salts, fat can’t be absorbed)
- microcytic anaemia (bacteria use too much b12)
diarrhoea
difficulty swallowing liquids before solids caused by?
neuromuscular issue
e.g. oesophageal dysmotility, achalasia
difficulty swallowing solids before liquids caused by?
mechanical obstruction
oesophageal stricture
mcburneys point
1/3 of the way from ASIS to umbilicus
what requires a 5 yearly colonoscopy
low risk
1/2 adenomas <10mm
what requires a 3 year colonoscopy
intermediate risk
3/4 <10mm
1/2 >10mm
what requires a 1 yearly colonoscopy
high risk
5/6 <10mm
3/4 >10mm
where does diverticulitis commonly occur
sigmoid and descending colon
left side
what drug is used for secondary prevention of bleeding oesophageal varices
propanolol
Mx of neuroendocrine tumour (gastronome)
octeotride (somatostatin)
Autoimmune hepatitis first line Mx
Azathioprine
Prednisolone
colostomies usually have….faeces
solid
ileostomies usually have …. faeces
liquid
how much alcohol is one unit
10ml of pure alcohol
how many units is 1 pint of 5% beer
3 units
moa of cyclizine
H2 receptor anatagonist
moa of metaclopramide
D2 receptor antagonist
moa of haloperidol
d2 antagonist
moa of hyoscine
MAChr antagonist
moa of odansetron
5-HT3 receptor antagonist
what structures are cut through during a midline incision
Skin, Camper’s fascia, Scarpa’s fascia, linea alba, transversalis fascia, extraperitoneal fat, peritoneum
PSC is associated with what antibody rise
Anti smooth muscle antibody
Abx for sbp
Pip taz
hemochrombtosis Mx
venesection
chelation (desferroxamine)
small bowel bacterial overgrowth syndrome Ix
hydrogen breath test (fasted pt given glucose drink, bacteria in bowel will metabolised this and produce Hydrogen, can be measured during exhalation)
small bowel aspiration and culture
3 risk factors for small bowel overgrowth syndrome
diabetes
scleroderma
neonates with congenital GI abnormlaities
Mx of small bowel overgrowth syndrome
rifampicin
bloody stool and abdominal pain after travelling from abroad
campylobacter jejuni
non bloody diarrhoea and nausea and abdominal pain after travelling
e coli
how to tell the difference between femoral and inguinal hernias
femoral hernia: inferolateral to the pubic tubercle
inguinal hernia: superomedial to the pubic tubercle
Courvoisiers law
in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones . it is probably a malignant obstruction of the bile duct
whipples procedure..what is it, indication, complications
pancreaticoduodenectomy
used to treat pancreatic cancer (resectable head of pancreas tumours)
Complications: dumping syndrome (food moves too fast into stomach: abdominal pain and cramps)
marginal ulcer (ulcer that forms at the site of anastamosis)
how to classify ascites
SAAG (serum ascites albumin gradient) >11 = portal hypertension, so likely to be cirrhosis as the cause
management of inguinal hernia (2)
mesh repair
hernia truss if not fit for surgery
1st and 2nd line for C diff
- oral vancomycin
- oral fidaxomicin
mx of severe c diff with systemic illness
iv metronidazole and iv vancomycin
hypocalcemia despite calcium supplementation. which ion is deficient?
Mg
triple therapy for H pylori
omeprazole + amoxicillin + clarithromycin or metronidazole
what serious complication is assoc with clarithromycin
long QT -> tornadoes des pointes
Indications for oral vanc and iv metro
If they have c diff and systemic illness. Shock, intestinal obstruction, hypotension
prophylaxis after getting SBP
ciprofloxacin
Drug to manage ascites
Spironolactone
omeprazole rules before endoscopy
stop 2 weeks before
young patient with personality changes, tremors and liver disease….
wilson’s disease
older patient with recently diagnosed diabetes, bronzed skin and liver disease
hereditary haemachormatosis
criteria for mild, moderate and severe UC flares
mild = <4
moderate = 4-6
severe = >6
Mx of severe UC flare 3 steps
- IV steorids
- IV ciclosporin
- surgery
Most common site of inflammation for Crohn’s disease
Terminal ileum
Young patient with tremors, personality changes and liver disease
Wilson’s disease
Middle aged person with diabetes, darkened skin and liver problems
Hereditary haemochromatosis
gi bleed, what blood test can be used to differentiate upper vs lower
upper gi bleed has high urea
which nerve controls taste in posterior 1/3rd of tongue
glossopharyngeal
