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Phase 2a Yellow Conditions > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What are oesophageal varices?

A
  • dilated veins at sites of portosystemic anastomosis
  • left gastric and inferior oesophageal veins
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2
Q

Causes of oesophageal varices

A

pre-hepatic

  • portal vein thrombosis
  • portal vein obstruction

hepatic

  • cirrhosis
  • schistosomiasis

post hepatic

  • Budd Chiari
  • RHS HF
  • constructive pericarditis
  • compression
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3
Q

Presentation of oesophageal varices

A
  • haematemesis and/or melena
  • epigastric discomfort
  • sudden collapse → haemodynamic instability
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4
Q

Investigations for oesophageal varices

A
  1. urgent endoscopy
  2. FBC, U&E, clotting (INR) LFTs
  3. chest xray/ascitic tap
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5
Q

Management of oesophageal varices

A
  • ABCDE
  • Rockall score

bleeding varices

  • terlipressin
  • prophylactic Abs → ciprofloaxcin
  • balloon tamponade
  • endoscopic banding
  • TIPS

bleeding prevention

  • beta blocker
  • endoscopic banding
  • cirrhosis = screening endoscopy
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6
Q

What is a Rockall score?

A

prediction of rebleeding and mortality

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7
Q

What is a Mallory Weiss tear?

A

haematemesis from tear in oesophageal mucosa

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8
Q

Risk factors for Mallory Weiss tear

A
  • alcoholism
  • hyperemesis gravidarum
  • gastroenteritis
  • bulimia
  • chronic cough
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9
Q

Presentation of Mallory Weiss tear

A
  • haematemesis
  • melena
  • symptoms of hypovolaemic shock
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10
Q

Investigations for Mallory Weiss tear

A
  • Rockall score
  • FBC, U&E, coagulation studies
  • ECG, cardiac enzymes
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11
Q

Management of Mallory Weiss tear

A

most resolve spontaneously

  • ABCDE
  • terlipressin and urgent endoscopy
  • Rockall score
  • inpatient observation
  • banding/clipping
  • adrenaline
  • thermocoagulation
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12
Q

What is Boerhaave syndrome?

A
  • oesophageal rupture

Mackler triad

  • vomiting
  • chest pain
  • subcutaneous emphysema
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13
Q

What are the two types of oesophageal cancer?

A

adenocarcinoma

  • more common in developed world
  • lower 1/3 → near GO junction

squamous

  • more common in developing world
  • upper 2/3
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14
Q

Risk factors of adenocarcinoma

A
  • GORD
  • Barrett’s oesophagus
  • smoking
  • achalasia
  • obesity
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15
Q

Risk factors for squamous oesophageal cancer

A
  • smoking
  • alcohol
  • achalasia
  • obesity
  • low fruit/veg/fibre/vitA,C
  • hot drinks
  • Plummer-Vinson syndrome
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16
Q

Symptoms of oesophageal cancer

A
  • vomiting
  • progressive dysphagia
  • anorexia and weight loss
  • odynophagia
  • hoarseness
  • malaena
  • cough
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17
Q

Typical presentation of oesophageal cancer

A

ALARMS

  • anaemia
  • loss of weight
  • anorexia
  • recent onset progressive symptoms
  • malaena/haematemesis
  • swallowing difficulties eg dysphagia
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18
Q

Investigations for oesophageal cancer

A
  1. upper GI endoscopy and biopsy
    - CT scan/endoscopic US → staging
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19
Q

Management of oesophageal cancer

A
  • operable disease → surgical resection, adjuvant chemo
  • palliation
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20
Q

What are the two types of gastric cancer?

A
  1. intestinal/differentiated → more common
  2. diffuse/undifferentiated
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21
Q

Risk factors of intestinal gastric cancer

A
  • male
  • h.pylori
  • chronic gastritis
  • atrophic gastritis
  • older age
22
Q

Features of intestinal gastric cancer

A
  • histology → glandular
  • appearance →large, irregular
  • locations → antrum, lesser curvature
23
Q

Risk factors of diffuse gastric cancer

A
  • blood type A
  • genetic
  • younger age
24
Q

Features of diffuse gastric cancer

A

histology

  • poorly differentiated
  • signet ring cells

appearance

  • gastric linitis → submucosa invasion
  • no movement on barium swallow = progressed

location = anywhere esp cardia

25
Q

Red flags for upper GI cancer

A

upper abdominal mass consistent with stomach cancer and:
- dysphagia of any age
- age 55+ and weight loss with:
upper abdominal pain or
reflux or
dyspepsia

2 week wait for endoscopy

26
Q

What symptoms qualify for non-urgent endoscopy?

A
  • haematemesis
  • treatment resistant dyspepsia
  • upper abdominal pain
  • anaemia
27
Q

Presentation of gastric cancer

A
  • often late presentation
  • anorexia
  • weight loss
  • anaemia
  • dysphagia
  • N&V
  • epigastric pain → better with antacids
  • paraneoplastic syndromes
  • metaplastic signs
28
Q

Investigations for gastric cancer

A
  • gastroscopy → 8-10 biopsies
  • endoscopic US → depth of invasion
  • CT/MRI/PET
29
Q

Management of gastric cancer

A
  • nutritional support → fruit/veg/folate/fibre
  • surgical resection
  • chemo
30
Q

Risk factors for colon cancer

A
  • family history
  • hereditary conditions → FAP
  • IBD
  • diet → high fat/red meat, low fibre/folate/Ca2+
  • DM
  • lifestyle
  • history of bowel/endometrial/breast/ovarian cancer
  • later first pregnancy/early menopause
31
Q

Symptoms of colon cancer

A

depends on location

  • pain
  • palpable mass
  • bleeding
  • change in bowel habit
  • weight loss
  • vomiting
  • obstruction
32
Q

Diagnosis of colon cancer

A

faecal occult blood test

  • >50 and bowel habit change/iron deficient anaemia
  • >60 and anaemia

colonoscopy and biopsy

flexible sigmoidoscopy/barium enema/CT colonoscopy

33
Q

Management of colon cancer

A
  • surgical resection
  • depends on site of cancer
  • normally anastomosis required
34
Q

What are the key hereditary causes of colon cancer?

A
  • familial adenomatous polyposis
  • hereditary nonpolyposis colorectal cancer
  • Lynch syndrome
35
Q

What are bowel obstructions?

A

an arrest on the onward propulsion of intestinal contents

36
Q

What are the types of bowel obstructions?

A
  • small bowel → most common
  • large bowel
  • psudeo
37
Q

Causes of SBO

A
  • adhesions → previous abdominal/pelvic surgery or previous abdominal infections
  • hernias
  • malignancy
  • Crohn’s
38
Q

Clinical presentation of SBO

A
  • pain → initially colicky then diffuse, high in abdomen
  • profuse vomiting following pain (earlier than LBO)
  • less abdominal distention than LBO
  • tenderness = strangulation/risk of perforation
  • constipation = late in SBO
  • increased bowel sounds → tinkling
39
Q

Diagnosis of SBO

A
  1. abdominal xray → central gas shadows, distended loops, fluid levels
  • examination of hernia orifices and rectum
  • FBC

GOLD STANDARD = non-contrast CT → locates obstruction

40
Q

Management of SBO

A
  • aggressive fluid resuscitation
  • decompression of bowel
  • analgesia and anti-emetics
  • Abs
  • surgery to remove obstruction → laparotomy
41
Q

What is involved in decompression of the bowel?

A
  • IV fluids with nasogastric tube
  • always try before surgery
42
Q

Causes of LBO

A
  • malignancy
  • volvulus
  • diverticulitis
  • Crohn’s
  • intussusception
43
Q

What is volvulus?

A
  • rotation/twisting of bowel on mesenteric axis
  • commonly in sigmoid colon
44
Q

What is intussusception

A
  • bowel roles inside of itself
  • almost only in neonates/infants → softer bowels
45
Q

Clinical presentation of LBO

A
  • abdominal pain → more constant and diffuse than SBO, lower abdomen
  • more abdominal distention than SBO
  • palpable mass eg hernia
  • vomiting → later than SBO
  • constipation → earlier than SBO
  • normal bowel sounds then louder then silent
46
Q

Diagnosis of LBO

A
  1. abdominal xray
  • FBC
  • digital rectal exam → empty rectum, hard/compacted stools, blood

GOLD STANDARD = CT

47
Q

What can be seen on an abdominal xray in LBO?

A
  • peripheral gas shadows proximal to blockage
  • caecum and ascending colon distended
48
Q

Management of LBO

A

same as SBO

49
Q

What are the two types of diarrhoea?

A
  • acute → <2 weeks
  • chronic → >2 weeks
50
Q

Causes of diarrhoea

A

viral → majority

  • children = rotavirus
  • adults = norovirus

bacterial

  • campylobacter jejuni
  • bloody diarrhoea
    • e.coli
    • salmonella
    • shigella

parasitic
- giardia lamblia

51
Q

Management of diarrhoea

A
  • treat underlying cause → bacterial = metronidazole
  • oral rehydration therapy
  • anti-emetics agents eg metoclopramide
  • anti-motility agents eg loperamide

self-limiting

Phase 2a Yellow Conditions (12 decks)

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