Gastrointestinal Flashcards
50yo male presents with burning, intermittent retrosternal pain that is partially relieved by antacids
Reflux oesophagitis
20yo male presents with difficulty swallowing food. It is worse when he eats certain foods and is not relieved by antacids. He has a history of asthma and eczema
Eosinophilic oesophagitis
45yo obese male presents with burning retrosternal pain after meals. It is worse when lying down or leaning forward
GORD
66yo patient presents with dysphagia to solids and liquids. This is aided by postural change. Associated history of mild, ongoing weight loss and regurgitation
Achalasia
60yo male with long-standing GORD and progressive dysphagia. Most likely pathology seen on endoscopy?
Barrett’s oesophagus
75yo male with heavy smoking and alcohol histories presents with progressive dysphagia and weight loss
Oesophageal cancer (SCC)
75yo obese male with long-standing GORD presents with progressive dysphagia and weight loss
Oesophageal cancer (adenocarcinoma)
55yo woman with chronic hepatitis C infection presents with haematemesis and melaena. She later becomes hypotensive and tachycardic
Oesophageal varices
60yo patient with burning epigastric pain, relieved by antacids. She has a history of arthritis for which she takes an NSAID daily
PUD
60yo patient with history of burning epigastric pain presents with acute onset sharp epigastric pain, that is worse on movement and is associated with melaena and haematemesis
Ruptured peptic ulcer
55yo male presents with persistent, vague epigastric pain for many months. Associated with this is nausea and weight loss. He has a history of H. pylori infection
Stomach cancer (adenocarcinoma shown)
22yo woman travelling in Thailand presents with 4 hours of vomiting and diarrhoea, associated with crampy abdominal pain
Infectious enterocolitis
65yo patient who has been in hospital and on broad spectrum antibiotics complains of new onset diarrhoea, abdominal pain and fever
Pseudomembranous colitis
33yo patient presents with diarrhoea associated with crampy abdominal pain localised to the RLQ. Associated with this is a fever and mild arthralgia
Crohn’s disease
45yo male presents with two months of faecal frequency with loose stools, urgency and tenesmus. Associated with this is abdominal pain prior to defaecating and rectal bleeding
Ulcerative colitis
22yo patient presents with a chronic history of diarrhoea, bloating, flatulence and abdominal cramps. The patient is HLA DQ2 positive
Coeliac disease
80yo male with CVD risk factors presents with sudden onset periumbilical pain and tenderness. This pain appears out of proportion to the perceived pain
Ischaemic bowel disease
Other causes: arterial compromise (embolus, thrombus, vasculitis, external compression), venous thrombosis, shock or hypotension
55yo patient presents with LLQ pain and fever. They describe a past history of bloating and constipation (with occasional intermittent diarrhoea)
Diverticulitis
A patient presents with crampy abdominal pain associated with bilious vomiting, abdominal distension and constipation. They have had previous abdominal surgery
SBO
Causes: adhesions from previous surgery, inguinal hernia with incarceration, Crohn’s disease, malignancy, appendicitis
A patient with known CRC presents with progressive distension associated with obstipation and faeculent vomitus
LBO
Causes: CRC, colonic volvulus, benign stricture
65yo male presents with a 6 month history of rectal bleeding and change in bowel habit. Associated with this he has a many month history of unintentional weight loss and fatigue
CRC
A 30yo female presents with a 3 month history of “erratic” bowel habits and bloating. This is made worse by stress and eating certain foods
IBS
A 55yo known IVDU presents with fatigue and increasing confusion. On examination, he is jaundiced, and spider naevi and ascites are noted
Chronic liver disease/cirrhosis Causes: viral hepatitis, alcoholic hepatitis, autoimmune hepatitis, inherited liver disease
A 45yo patient with CVD risk factors presents with deranged LFTs
Fatty liver disease
A 45yo woman presents with acute onset, constant, severe abdominal pain radiating through to the back and nausea. She has a past history of gallstones
Acute pancreatitis
Causes: IGETSMASHED
A patient with a known alcohol problem presents with a chronic history of intermittent abdominal pain, nausea, steatorrhoea and jaundice
Chronic pancreatitis
A male patient with a chronic history of steatorrhoea, associated with bloating after meals. Associated with this is oedema and bruising
Pancreatic insufficiency
Causes: long-term alcohol abuse, long-standing pancreatic duct obstruction, tropical pancreatitis, hereditary pancreatitis, CFTR gene mutations
A 50yo obese woman presents with sudden onset abdominal pain that is severe, constant and sharp in nature. She feels like that pain radiates around to her back. The pain is worse after fatty meals
Cholelithiasis
A patient presents with acute onset dyspepsia, epigastric discomfort and nausea. On further questioning, they admit to heavy ibuprofen use
Acute gastritis (NSAID-induced)
Other causes: alcohol, shock, physiological stress, H. pylori
A patient presents with chronic dyspepsia, nausea and vomiting. On further investigation, they are shown to have a vitamin B12 deficiency and auto-antibodies to intrinsic factor
Chronic gastritis (autoimmune) Other causes: H. pylori, NSAIDs, bile, radiation, coeliac disease, drugs, food allergies, Crohn’s disease, sarcoidosis, infectious
A patient with known cirrhosis presents with splenomegaly and bleeding from oesophageal varices. Portal pressure is 15mmHg
Portal hypertension
A patient recently returned from SE Asia presents 2 weeks of fever, fatigue and vomiting; they are mildly jaundice. They had no travel vaccinations. Over the next week their symptoms subside and there are no further complications
Hepatitis A virus
An African-born patient presents with signs of CLD. They are unsure of their vaccination status. They admit to having had many sexual contacts in their youth. Serum antibody levels suggest chronic disease
Hepatitis B virus
A 34yo IVDU presents with altered LFTs. Serum antibody levels suggest chronic disease. No vaccination is available for this infection
Hepatitis C virus
A 44yo male presents with RUQ abdominal discomfort and tender hepatomegaly. They admit to having 6-10 standard drinks/day for the last 15 years. LFTs reveal large elevation in GGT
Alcohol liver disease
A 56yo female presents with altered LFTs. Further investigations reveal elevated serum globulin (particularly IgG) and ANA antibodies
Autoimmune hepatitis
A 52yo male presents with fatigue and lethargy. History reveals diabetes mellitus and loss of libido. Investigation reveals elevated serum ferritin. He has a family history of liver and heart disease
Haemochromatosis
A 22yo patient presents with RUQ tenderness. Investigations reveal elevated urine copper
Wilson’s disease
A 33yo male presents with productive cough and SOBOE. On examination, hepatomegaly is noted. Pulmonary function tests reveal reduced FEV1 (obstructive pattern)
Alpha-1 anti-trypsin deficiency
A 66yo male with known alcoholic liver disease presents with unintentional weight loss. He has mild hepatic encephalopathy and is jaundiced. US of the liver is performed and a mass is noted
Hepatocellular carcinoma
A patient known colorectal cancer presents with upper abdominal pain and hepatomegaly. US of the liver reveals target lesions
Liver metastases
A 58yo female presents with fatigue and pruritis. LFTs reveal elevated ALP and GGT. She is AMA positive
Primary biliary cirrhosis
A 44yo male presents with elevated ALP. Further investigations are organised: MRCP reveals a “prune tree” pattern and biopsy reveals onion skin periductular fibrosis
Primary sclerosing cholangitis
A 68yo male presents with jaundice and non-specific abdominal pain. Further investigation reveals an abdominal mass and deranged LFTs.
The patient dies 4 months later
Pancreatitic adenocarcinoma
65yo male with a history of UC presents with painless jaundice, weight loss and nausea. ERCP reveals a mass obstructing a bile duct
Cholangiocarcinoma
