Gastroenterology & GI Surgery Flashcards
Autosomal dominant
- Familial adenomatous polyposis
- Peutz Jeghers syndrome
Autosomal recessive
Gilbert’s syndrome
Liver damage enzymes
- ALT
- ALP
- AST
Liver function enzymes
- Bilirubin
- Albumin
Category 1 Colorectal cancer risk
Low risk
1 1st degree relative > 60 years at dx
Category 1 Colorectal cancer screening
- iFOBT every 2 years after 45 years to 74
- low-dose (100 mg) aspirin daily should be considered from age 45 to 70
Category 2 Colorectal cancer risk
Moderate risk
One 1st degree relative < 60 years at dx
OR
One 1st degree relative + > 1 2nd degree diagnosed at any range
OR
Two 1st degree relatives diagnosed at any age
Category 2 Colorectal cancer screening
- Colonoscopy every 5 years starting at 10 years younger than the earliest age of diagnosis in 1st degree relative
OR age 50, whichever is earlier, to age 74.
- CT colonography if clinically indicated
- Low dose aspirin (100mg)
- Update history
Category 3 Colorectal cancer risk
High risk
Two 1st degree relatives + One 2nd degree relative diagnosed < 50
OR
Two 1st degree relatives + > Two 2nd degree relative diagnosed at ANY age
OR
> Three 1st degree relatives diagnosed at ANY age
Category 3 Colorectal cancer screening
- Colonoscopy every 5 years starting at 10 years younger than the earliest age of diagnosis of colorectal cancer in a first-degree relative
OR
age 40, whichever is earlier, to age 74. - CT colonography if clinically indicated
- Low dose aspirin (100mg)
- Update history
migratory superficial thrombophlebitis + deep vein
thrombosis
Trousseau’s syndrome
hix of gastric bypass + discomfort, including nausea, vomiting, cramps, and diarrhea
Dumping syndrome
Dumping syndrome management
- Diet modification (high fibre + protein)
- -Hydrogen breath test positive
- Barium fluoroscopy
- radionuclide scintigraphy
reoperation if diet fails
Trousseau’s syndrome associated tumours
1-Pancreas 24%
2-Lung 20%
3-Prostate 13%
4-Stomach12%
5-Acute leukaemia 9%
6-Colon 5%
Small bowel obstruction investigation
initial: Abdominal X-ray
Best: CT abdomen/gastograffin meal (dx & tx)
Elective non-cardiac surgery following PCI
Defer surgery for 6 weeks - 3 months
Elective surgery with history of drug eluding stents
Defer for 12 months
emergency surgery with history of rug eluding stents
Withhold clopidogrel for 5-7 days
- continue aspirin
most common cause of large bowel obstruction
Colon cancer
upper GIT endoscopy 🚩’s
▪ anaemia (new onset)
▪ dysphagia (difficulty swallowing)
▪ odynophagia (painful swallowing)
▪ haematemesis or melaena
▪ unexplained weight loss >10%
▪ vomiting older age >50 yrs
▪ chronic NSAID use
▪ severe frequent symptoms including hiccoughs, hoarseness
▪ family history of upper GIT or colorectal cancer
▪ short history of symptoms
▪ neurological symptoms and signs
Oropharyngeal dysphagia causes
Neuro-muscular disease:
* Stroke
* Parkinson’s disease
* Brain stem tumour
* Degenerative conditions: ALS
MS
* Myasthenia gravis
* Peripheral neuropathy
Obstructive lesion:
* Tumour
* Inflammatory masses: abscess
* Pharyngeal pouch (Zenkers)
* Anterior mediastinal mass
Oesophageal dysphagia causes
Neuro-muscular disease:
* Achalasia
* Scleroderma
* GORD
Obstructive lesion:
* Tumour
* Strictures:
Peptic (reflux oesophagitis)
Radiation
Chemical (caustic Ingestion)
Medication
* Oesophageal webs (Plummer
Vinson)
* Foreign Bodies
Extrinsic Structural Lesions:
* Vascular compression (enlarged or Left Atrium)
* Mediastinal masses:
lymphadenopathy or retrosternal
thyroid.
Iron deficiency anaemia in elderly
colon cancer
high INR + low calcium + hypochromic microcytic anaemia
malabsorption syndrome
malabsorption syndrome investigation
Anti-gliadin antibodies
Coeliac disease Symptoms:
Chronic diarrhoea
Steatorrhoea
Weight loss
Anorexia
Abdominal distension
Nutritional deficiency: folate, calcium, zinc or iron (in particular)
Grouped blisters around the knees, elbows and buttocks (dermatitis herpetiformis)
Hair loss
Mouth ulcers
Coeliac vitamin deficiencies
- iron (most common)
- B12
- ADEK
Coeliac disease investigation
Serum transglutaminase antibodies
conditions is associated with an increased risk of coeliac disease
- Type I diabetes mellitus
- Hashimoto’s thyroiditis
- autoimmune diseases
- Down’s syndrome
- Turner’s syndrome
- IgA deficiency
long hx of vomiting after food + reduced appetite
Gastro-oesophageal reflux disease (GORD)
Most common complication of GORD
Oesophagitis
Gastro-oesophageal reflux disease (GORD) investigation
Initial: Intraoesophageally pH probe monitoring
diagnostic: oesophageal endoscopy with multiple biopsies
GORD management
Therapeutic trial of proton pump inhibitor
high age + progressive dysphagia + decreased contractions + increased tertiary wave activity
Presbyoesophagus
- Dysphagia to solids and liquids
- Heartburn unresponsive to a trial of proton pump inhibitor therapy for 4weeks
- Retained food in the oesophagus on upper endoscopy
- Unusually increased resistance to passage of an endoscope through the oesophagogastric junction
achalasia
Most important diagnostic feature of achalasia?
Dysphagia for both solids and liquids
Barrett’s oesophagus monitoring
2-5 years by endoscopy and biopsy depending on segment length
bariatric surgery indications
– BMI above 40 with no co-morbidities
– BMI above 35 with co-morbidities such as hypertension
– BMI above 30 with poorly controlled type 2 diabetes
– BMI above 30 with increased cardiovascular risk due to multiple risk factors such as hypertension, hyperlipidemia, strong family history of cardiovascular disease at a young age
bariatric surgery contraindications
– Irreversible end-organ dysfunction.
– Cirrhosis with portal hypertension.
– Medical problems precluding general anaesthesia.
– Centrally mediated obesity syndromes such as Prader-Willi syndrome or Craniopharyngioma.
PUD risk factors
-Male sex.
-Family history of peptic ulcer disease.
-Smoking.
-Stress.
-NSAIDs.
-H.pylori.
H. Pylori
Gram -ve
- corkscrew-shaped, motile bacillus with three to seven flagella
- rapid urease test
- Eradication with colloidal bismuth (Pepto-Bismol), an antibiotic (amoxicillin or ampicillin), and a nitroimi-dazole such as metronidazole.
Left supraclavicular lymph node cancer
- abdominal or pelvic
Acute pancreatitis investigation
- serum lipase (elevated)
acute pancreatitis surgery indications
- Uncertainty of clinical diagnosis
- Worsening clinical condition despite optimal supportive car2
- Infected pseudocysts
- Gallstone-associated pancreatitis
Pancreatic pseudocyst management
- size > 6cm ERCP
- Present for > 6 weeks
- Wall thickness for > 6 mm
NOTE: if ERCP fails, then move on to laporotomy
Pancreatic cancer risks
-Smoking.
-Long-standing diabetes mellitus.
-Chronic pancreatitis.
-Obesity.
-Inactivity (high cholesterol/obesity?
-Non–O blood group
freckling + gastrointestinal polyposis (polyps in small bowel) + intussusception + pigmented macules (1–5mm) on lips, buccal mucosa and fingers
Peutz Jeghers Syndrome
Peutz Jegers Syndrome complications
high risk of specific cancers:
intestine
colon
pancreas
breasts
cervix
ovaries
testes
Diverticultis highest mortality rate complication
Perforation 20%
- Bleeding especially in elderly
– Intra-abdominal abscess.
– Peritonitis.
– Fistula formation.
– Intestinal obstruction.
Meckel diverticulum investigation
- painless large-volume intestinal hemorrhage
Technetium-99m pertechnetate scintigraphic study
– Severe colicky epigastric and periumbilical pain
– Absolute constipation.
– Nausea and vomiting.
– Abdominal distension
small bowel obstruction
jaundice, dark urine, and pale stool + palpable gall bladder
Periampullary tumor
GI bleed with weight loss and decreased appetite
colon adenocarcinoma
5 F’s of cholecystitis
- Fair
- Fat
- Female
- Fertile
- Forty
infective cholecystitis pathogen
E. Coli
hx of cholecystectomy + abdominal pain + dyspepsia + increased liver enzymes abd cholesterol
post-cholecystectomy syndrome
post-cholecystectomy syndrome investigation
Perform ERCP
gall stone investigation
initial:
diagnostic: US/ERCP