Gastrointestinal Flashcards
What is ischaemic bowel disease?
- Ischaemia/infarction in the GI tract due to reduced blood flow.
What are the two most common causes of mesenteric ischaemia?
- Embolism (over 50%)
- Hypotension.
Which artery is most commonly occluded in mesenteric ischaemia?
- Superior mesenteric artery.
What are the 3 main types of ischaemic bowel disease?
- Acute mesenteric ischaemia.
- Chronic mesenteric ischaemia.
- Colonic ischaemia.
How do both acute and chronic mesenteric ischaemia present?
Abdominal pain out of proportion to the clinical findings.
- Acute will be rapid onset, whereas chronic will be insidious.
What is the presentation of colonic ischaemia?
- Bloody, loose stools (due to mucosal damage).
- Usually left sided abdominal pain/tenderness.
How are colonic ischaemia and mesenteric ischaemia differentiated?
- Bloody stools indicative of colonic ischaemia rather than mesenteric.
What is the first line investigation for suspected bowel ischaemia?
- CT scan.
What is the treatment for ischaemic bowel disease?
- Fluids + oxygen.
- Consider antibiotics (if there is perforation of the mucosal wall, gut flora can spread and cause infection).
- Surgical intervention (bowel reconstruction/segment resection).
What are the investigations used for perianal disorders?
- DRE + physical exam.
What are the four main types of perianal disorder? Brief description of each.
- Haemorrhoids. Enlarged/swollen hemorrhoidal cushions so they protrude outside the anal canal.
- Perianal abscess. Infection of the soft tissues around the anus.
- Perianal fistula. Tunnel between the anus and the perianal skin.
- Anal fissure. Split perianal skin.
What is the clinical presentation of haemorrhoids?
- PAINLESS rectal bleeding.
- Pain on shitting.
What are the two types of haemorrhoids?
- Internal or external.
- Differentiated by position in relation to the dentate line.
What is the treatment for haemorrhoids?
- Increased dietary fibre.
What is the presentation of perianal abscess?
- Perianal pain.
- Fever common (infective element).
What disease is commonly associated with perianal abscess/anal fistula?
- Crohn’s disease.
How is perianal abscess treated?
- Abscess drainage.
- NOT ANTIBIOTICS.
What is usually the proceeding condition for an anal fistula?
- Perianal abscess.
- When drained, may leave an anal fistula in its place.
Clinical presentation of anal fistula?
Blood and pain on shitting.
How is an anal fistula treated?
Surgery. Normally a fistulostomy.
What is the clinical presentation of an anal fissure?
- Pain on shitting (like glass)
- Burning pain 1-2 hours after.
- Small amount of bright-red blood on surface of stool
How is anal fissure treated?
GTN (topical) until fissure resolves.
What is pilonodial disease?
- Hair follicles become inserted into the skin at the crease of the buttocks, creating a sinus/cyst.
Who is most likely to be affected by pilonodial disease?
- Men aged 18-40.
What is the treatment for pilonodial disease?
If asymptomatic:
Keep area clean and hair free (shave/laser hair removal).
If symptomatic:
Consider surgical sinus excision.
What is gastritis?
- Stomach lesions that involve gastric mucosal inflammation.
What is gastropathy?
- Stomach lesions that with little to no evidence of mucosal inflammation.
What are the most common causes of gastritis?
- H. Pylori infection.
- Alcohol use.
- NSAID use.
- Autoimmune gastritis (but this is rarer).
What us the pathophysiology of autoimmune gastritis?
- Anti-parietal cell antibodies (ACAs) and anti-intrinsic factor (IFAs) are produced, which stimulate inflammation and necrosis of the parietal cells.
What are the diagnostic factors for gastritis?
- Presence of risk factors.
- Dyspepsia (indigestion).
- Epigastric discomfort.
BE AWARE OF RED FLAG SYMPTOMS.
What are the risk factors for gastritis?
- H. Pylori infection.
- NSAID use.
- Alcohol abuse.
What investigations are used if H.Pylori gastritis is suspected?
1st line - Urea breath test or Faecal antigen testing.
GOLD STANDARD - Endoscopy + mucosal biopsy.
What is the investigation used for NSAID/alcohol-induced gastritis?
- None needed.
- Stop NSAID or alcohol, and see if symptoms improve.
What investigations are used for autoimmune gastritis?
- IFAb (Intrinsic factor antibody) testing. Will be +ve in autoimmune gastritis.
- Serum B12 (reduced in B12 deficiency, a common complication of gastritis).
What is the treatment for H.Pylori gastritis?
- Triple therapy (Omeprazole + amoxicillin + clarithromycin) for 14 days.
What is the treatment for NSAID/Alcohol gastritis?
- If possible, stop NSAIDS/alcohol use.
What is the treatment for autoimmune gastritis?
- GIve B12 supplementation IM/IV.
What is the common complication of gastritis? Which forms of gastritis cause it?
- Peptic ulceration.
- Caused by H. pylori and NSAID forms of gastritis.
What is diverticular disease?
- Refers to the presence of diverticula.
- These are small herniated portions of bowel that span through the mucosa, submucosa and muscle in the bowel wall.
What is diverticulitis?
- Inflammation of the diverticula, usually due to infection.