Gastrointestinal Flashcards

1
Q

What is achalasia and how does it present?

A
  • Loss of myenteric plexus ganglion causing functional distal obstruction of the oesophagus
  • Dysphagia, weight loss, chest pain, regurgitation and chest infection
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2
Q

How is achalasia treated?

A
  • Nitrates
  • CCBs
  • Botulism
  • Balloon dilatation
  • Myotomy
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3
Q

How does GORD present?

A
  • Heartburn
  • Cough
  • Water brash
  • Sleep disturbance
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4
Q

Name the two types of hiatus hernia

A
  • Sliding

- Para-oesophageal

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5
Q

Name some of the complications of GORD

A
  • Ulceration
  • Stricture
  • Barrett’s oesophagus
  • Carcinoma
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6
Q

How is Barrett’s oesophagus treated?

A
  • Endoscopic mucosal resection
  • Radio-frequency ablation
  • Oesophagectomy
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7
Q

How is GORD managed?

A
  • Lifestyle measures
  • Gaviscon
  • Ranitidine
  • PPIs
  • Fundoplication
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8
Q

How does oesophageal cancer present?

A
  • Progressive dysphagia
  • Weight loss
  • Odynophagia
  • Chest pain
  • Cough
  • Pneumonia
  • Vocal cord paralysis
  • Haematemesis
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9
Q

Name the alarm symptoms that require urgent endoscopy

A
  • Anaemia
  • Loss of weight
  • Anorexia
  • Recent onset
  • Masses and malaenia/haematemesis
  • Swallowing difficulties
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10
Q

How does irritable bowel syndrome present?

A
  • Abdo pain
  • Altered bowel habit
  • Abdominal bloating
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11
Q

How can irritable bowel be treated?

A
  • Education and reassurance
  • Dietetic review
  • Fodmap diet
  • Antispasmodics
  • Probiotics
  • Laxatives
  • Anti-motility agents
  • Psychological interventions
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12
Q

Name the three subtypes of gastritis

A
  • Autoimmune
  • Bacterial
  • Chemical
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13
Q

How can gastritis be managed?

A
  • Antacids
  • H2 blockers
  • PPIs
  • Treat H pylori
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14
Q

How does ulcerative colitis present?

A
  • Bloody diarrhoea
  • Abdominal pain
  • Weight loss
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15
Q

Name the features of a severe ulcerative colitis

A
  • Stools >6 per day
  • Fever
  • Tachycardia
  • Raised CRP
  • Anaemia
  • Albumin <30
  • Leucocytosis and thrombocytosis
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16
Q

How does Crohn’s disease present?

A
  • Diarrhoea
  • Abdo pain
  • Weight loss
  • Malaise, lethargy, anorexia, N&V and fever
  • Malabsorption
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17
Q

How can IBD be managed as an outpatient?

A
  • 5ASA
  • Steroids
  • Immunosuppression: azathioprine, methotrexate and infliximab
  • Elemental feeding
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18
Q

How can IBD be managed in hospital?

A
  • Steroids
  • Anticoagulation
  • Surgery
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19
Q

How are H pylori infections treated?

A
  • Clarithromycin
  • Amoxicillin
  • PPI
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20
Q

How do gastric cancers present?

A
  • Dyspepsia
  • Early satiety
  • Nausea and vomiting
  • Weight loss
  • GI bleeding
  • Iron deficiency anaemia
  • Gastric outlet obstruction
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21
Q

How can spontaneous bacterial peritonitis be managed?

A
  • IV antibiotics
  • Ascitic fluid drainage
  • IV albumin infusion
22
Q

How can intra-abdominal sepsis be managed?

A
  • Amoxicillin
  • Gentamicin
  • Metronidazole
23
Q

Describe the features of Primary Biliary Cholangitis

A
  • Females
  • Anti-mitochondrial auto-antibodies
  • Raised ALP
24
Q

Describe the features of Primary Sclerosing Cholangitis

A
  • Associated with IBD
  • Progresses to cirrhosis
  • Increased risk of cholangiocarcinoma
25
How can biliary sepsis be managed?
- Amoxicillin - Metronidazole - Gentamicin
26
Describe the components of Charcot's triad (ascending cholangitis)
- Jaundice - Fevers - RUQ pain
27
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
28
How does acute mesenteric ischaemia present?
- Colicky pain - Peritonism - Causes (e.g. AF)
29
How should acute mesenteric ischaemia be investigated?
- CT angiography - FBC (raised WCC) - Abdo X-ray - ECG or ECHO
30
How should acute mesenteric ischaemia be managed?
- IV fluids and oxygen - NG tube - IV antibiotics - IV heparin - Laparotomy
31
How does chronic mesenteric ischaemia present?
- Colicky pain - Weight loss - Postprandial pain - Fear of eating - Nausea/vomiting - Bowel irregularity
32
How can chronic mesenteric ischaemia be managed?
- Smoking cessation - Antiplatelet therapy - Open or endovascular revascularisation - TPN
33
How does ischaemic colitis present?
- Acute abdomen - LIF pain - Nausea and vomiting - PR bleeding - Peritonitis - Metabolic acidosis
34
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)
35
How does peritonitis present?
- Abdominal pain - Fever - Tachycardia - Guarding and rebound tenderness - Absent bowel sounds - Hypotension
36
How can peritonitis be managed?
- Antibiotics | - Surgery
37
How does acute pancreatitis present?
- Severe upper abdominal pain - Vomiting - Tachycardia - Jaundice - Hypoxaemia - Serum amylase 3x normal
38
How can acute pancreatitis be managed?
- Fluid resuscitation - Nutritional support - Analgesia - Supportive measures
39
Name the risk factors for adenocarcinoma of the oesophagus
- Tobacco - Barrett's oesophagus - Obesity
40
Name the risk factors for squamous cell carcinoma of the oesophagus
- Tobacco | - Achalasia
41
Name the causes of chronic pancreatitis
- Alcohol - Cystic fibrosis - Congenital anatomical abnormalities - Hypercalcaemia
42
How does chronic pancreatitis present?
- Abdo pain - Weight loss - Steatorrhoea - Diabetes - Jaundice, portal hypertension
43
How can chronic pancreatitis be managed?
- Avoid alcohol - Pancreatic enzyme supplements - Opiates - Coeliac plexus blok - Treatment of pancreatic duct stones and strictures
44
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
45
How can pancreatic cancer be managed?
- Whipple's procedure | - Palliative: stent or surgery
46
How can haemorrhoids be managed?
- Laxatives - Lifestyle avdice - Ligation - Diathermy - Haemorrhoidectomy
47
How can anal fissures be managed?
- Topical nitric oxide - GTN paste - Internal lateral sphincterotomy
48
How can a perianal abscess be managed?
Incision and drainage
49
How does diverticulitis present?
- LIF pain - Changes in bowel habits - Localised tenderness and a palpable mass - Fever and tachycardia
50
How can diverticular disease be managed?
- High fibre diet - Adequate fluid intake - Bulk forming laxatives - Anti-spasmodic
51
How can diverticulitis be managed?
- Oral antibiotics if systemically unwell (IV if complicated) - Paracetamol - Clear fluids - Surgery if complications
52
How can post-operative infections be managed?
- Co-trimoxazole and metronidazole | - Debridement