Gastrointestinal Flashcards
What is achalasia and how does it present?
- Loss of myenteric plexus ganglion causing functional distal obstruction of the oesophagus
- Dysphagia, weight loss, chest pain, regurgitation and chest infection
How is achalasia treated?
- Nitrates
- CCBs
- Botulism
- Balloon dilatation
- Myotomy
How does GORD present?
- Heartburn
- Cough
- Water brash
- Sleep disturbance
Name the two types of hiatus hernia
- Sliding
- Para-oesophageal
Name some of the complications of GORD
- Ulceration
- Stricture
- Barrett’s oesophagus
- Carcinoma
How is Barrett’s oesophagus treated?
- Endoscopic mucosal resection
- Radio-frequency ablation
- Oesophagectomy
How is GORD managed?
- Lifestyle measures
- Gaviscon
- Ranitidine
- PPIs
- Fundoplication
How does oesophageal cancer present?
- Progressive dysphagia
- Weight loss
- Odynophagia
- Chest pain
- Cough
- Pneumonia
- Vocal cord paralysis
- Haematemesis
Name the alarm symptoms that require urgent endoscopy
- Anaemia
- Loss of weight
- Anorexia
- Recent onset
- Masses and malaenia/haematemesis
- Swallowing difficulties
How does irritable bowel syndrome present?
- Abdo pain
- Altered bowel habit
- Abdominal bloating
How can irritable bowel be treated?
- Education and reassurance
- Dietetic review
- Fodmap diet
- Antispasmodics
- Probiotics
- Laxatives
- Anti-motility agents
- Psychological interventions
Name the three subtypes of gastritis
- Autoimmune
- Bacterial
- Chemical
How can gastritis be managed?
- Antacids
- H2 blockers
- PPIs
- Treat H pylori
How does ulcerative colitis present?
- Bloody diarrhoea
- Abdominal pain
- Weight loss
Name the features of a severe ulcerative colitis
- Stools >6 per day
- Fever
- Tachycardia
- Raised CRP
- Anaemia
- Albumin <30
- Leucocytosis and thrombocytosis
How does Crohn’s disease present?
- Diarrhoea
- Abdo pain
- Weight loss
- Malaise, lethargy, anorexia, N&V and fever
- Malabsorption
How can IBD be managed as an outpatient?
- 5ASA
- Steroids
- Immunosuppression: azathioprine, methotrexate and infliximab
- Elemental feeding
How can IBD be managed in hospital?
- Steroids
- Anticoagulation
- Surgery
How are H pylori infections treated?
- Clarithromycin
- Amoxicillin
- PPI
How do gastric cancers present?
- Dyspepsia
- Early satiety
- Nausea and vomiting
- Weight loss
- GI bleeding
- Iron deficiency anaemia
- Gastric outlet obstruction
How can spontaneous bacterial peritonitis be managed?
- IV antibiotics
- Ascitic fluid drainage
- IV albumin infusion
How can intra-abdominal sepsis be managed?
- Amoxicillin
- Gentamicin
- Metronidazole
Describe the features of Primary Biliary Cholangitis
- Females
- Anti-mitochondrial auto-antibodies
- Raised ALP
Describe the features of Primary Sclerosing Cholangitis
- Associated with IBD
- Progresses to cirrhosis
- Increased risk of cholangiocarcinoma
How can biliary sepsis be managed?
- Amoxicillin
- Metronidazole
- Gentamicin
Describe the components of Charcot’s triad (ascending cholangitis)
- Jaundice
- Fevers
- RUQ pain
How can refeeding syndrome be managed?
- 10kcal/kg/day nutrition
- Close monitoring of fluid balance
- Thiamine and other vitamin supplements
- Potassium, phosphate and magnesium replacement
How does acute mesenteric ischaemia present?
- Colicky pain
- Peritonism
- Causes (e.g. AF)
How should acute mesenteric ischaemia be investigated?
- CT angiography
- FBC (raised WCC)
- Abdo X-ray
- ECG or ECHO
How should acute mesenteric ischaemia be managed?
- IV fluids and oxygen
- NG tube
- IV antibiotics
- IV heparin
- Laparotomy
How does chronic mesenteric ischaemia present?
- Colicky pain
- Weight loss
- Postprandial pain
- Fear of eating
- Nausea/vomiting
- Bowel irregularity
How can chronic mesenteric ischaemia be managed?
- Smoking cessation
- Antiplatelet therapy
- Open or endovascular revascularisation
- TPN
How does ischaemic colitis present?
- Acute abdomen
- LIF pain
- Nausea and vomiting
- PR bleeding
- Peritonitis
- Metabolic acidosis
How can ischaemic colitis be managed?
- Bowel rest
- Stop any causes
- Antibiotics
- Repeat colonoscopy if symptomatic after 24-48 hours
- Laparotomy (guarding, rebound tenderness, fever, paralytic ileus)
How does peritonitis present?
- Abdominal pain
- Fever
- Tachycardia
- Guarding and rebound tenderness
- Absent bowel sounds
- Hypotension
How can peritonitis be managed?
- Antibiotics
- Surgery
How does acute pancreatitis present?
- Severe upper abdominal pain
- Vomiting
- Tachycardia
- Jaundice
- Hypoxaemia
- Serum amylase 3x normal
How can acute pancreatitis be managed?
- Fluid resuscitation
- Nutritional support
- Analgesia
- Supportive measures
Name the risk factors for adenocarcinoma of the oesophagus
- Tobacco
- Barrett’s oesophagus
- Obesity
Name the risk factors for squamous cell carcinoma of the oesophagus
- Tobacco
- Achalasia
Name the causes of chronic pancreatitis
- Alcohol
- Cystic fibrosis
- Congenital anatomical abnormalities
- Hypercalcaemia
How does chronic pancreatitis present?
- Abdo pain
- Weight loss
- Steatorrhoea
- Diabetes
- Jaundice, portal hypertension
How can chronic pancreatitis be managed?
- Avoid alcohol
- Pancreatic enzyme supplements
- Opiates
- Coeliac plexus blok
- Treatment of pancreatic duct stones and strictures
How does pancreatic cancer present?
- Upper abdominal pain (body and tail)
- Painless obstructive jaundice (head)
- Weight loss
- Diarrhoea/steatorrhoea
- Nausea and vomiting
- Hepatomegaly and splenomegaly
- Abdominal mass
How can pancreatic cancer be managed?
- Whipple’s procedure
- Palliative: stent or surgery
How can haemorrhoids be managed?
- Laxatives
- Lifestyle avdice
- Ligation
- Diathermy
- Haemorrhoidectomy
How can anal fissures be managed?
- Topical nitric oxide
- GTN paste
- Internal lateral sphincterotomy
How can a perianal abscess be managed?
Incision and drainage
How does diverticulitis present?
- LIF pain
- Changes in bowel habits
- Localised tenderness and a palpable mass
- Fever and tachycardia
How can diverticular disease be managed?
- High fibre diet
- Adequate fluid intake
- Bulk forming laxatives
- Anti-spasmodic
How can diverticulitis be managed?
- Oral antibiotics if systemically unwell (IV if complicated)
- Paracetamol
- Clear fluids
- Surgery if complications
How can post-operative infections be managed?
- Co-trimoxazole and metronidazole
- Debridement
