Gastrointestinal Flashcards
Classic presentation of gallstones?
Right upper quadrant
Radiates to shoulder tip
Classic presentation of appendicitis?
Central to start
Moving to right iliac fossa
Classic presentation of pancreatitis?
Central
Radiating through to back
Classic presentation of renal colic?
Sudden onset flank pain
Radiates to lateral abdomen or groin
What is biliary colic?
A dull pain in the middle to upper right area of the abdomen. It occurs when a gallstone blocks the bile duct.
This is the most common symptom of gallstones.
What is renal colic?
A type of pain you get when urinary stones block part of your urinary tract.
Where are gallstones formed?
Digestive tract
When do gallstones cause pain?
When they cause a blockage in the gallbladder or the bile ducts.
Where does pain from gallstones hurt?
Gallstones cause pain in the mid-upper abdomen that may radiate to the back or under the right shoulder.
Other symptoms of gallstones?
Nausea, vomiting, sweating, fever
Who’s at risk from gallstones?
Gallstones are most common in middle-age adults. Increased risk for women, adults over 40 and people who are overweight, have lost a lot of weight in a short period of time or take cholesterol-lowering drugs.
Foods that contribute to gallstones?
A diet high in fat or cholesterol
Treatment for chronic gallstones?
Gallbladder removal (can be done laparoscopically)
What are gallstones made of?
Gallstones are small stones, usually made of cholesterol, that form in the gallbladder.
Where do kidney stones develop?
Urinary tract
When do kidney stones cause pain?
They move through the urinary tract (into the ureter) and block the flow of urine
Where do kidney stones cause pain?
Kidney stones cause sharp pain in the lower back or side of the body that may radiate to the lower abdomen and groin
Other symptoms of kidney stones?
Blood in the urine, painful urination, inability to urinate or frequent urination. Often accompanied by nausea, vomiting, fever or sweating
Who’s at risk from kidney stones?
Kidney stones are most common in middle-age adults. Increased risk for people who have a family history of kidney stones, very low urine output or other health condition that affect the levels of certain substances in the urine
Foods that contribute to kidney stones?
A diet high in sodium, oxalates or animal protein. Insufficient intake of fluids or calcium
Treatment for kidney stones?
Smaller stones (<10mm) may pass on their own, or with the help of medications that can relax the ureter. A number of minimally invasive surgical options are also available
Are kidney stones recurrent?
Yes, many people have recurrent kidney stones. The risk of forming more stones is actually higher than the first-time risk for the general population.
What are kidney stones made of?
Calcium stones, the most common type of stone (usually in the form of calcium oxalate or calcium phosphate)
Struvite stones, usually caused by an infection, like a urine infection
Uric acid stones, usually caused by a large amount of acid in your urine
What are the 2 main types of dysphagia?
Mouth or throat
Oesophagus
What categories of causes of dysphagia?
- Obstruction
- Neurological
- Congenital and developmental conditions
- Muscular conditions
- Age
- COPD
What symptoms are consistent with an obstructive cause of dysphagia?
Dysphagia to solids and odynophagia (pain on swallowing)
What is an example of an obstructive cause of dysphagia?
Cancer; mouth, throat, oesophageal
What symptoms are consistent with a neurological cause of dysphagia?
Dysphagia to liquids or coughing after swallowing liquids
What is ‘melaena’?
Production of dark sticky faeces containing partly digested blood, as a result of internal bleeding or the swallowing of blood
Its black and tarry as has gone through the GI tract so blood has been altered by enzymes
Is melaena present if someone is having a high volume GI bleed from upper GI tract e.g. stomach or oesophagus?
Normally present as haematemesis (vomiting of blood) instead
A degree of melaena may also be present
Where may fresh blood from the anus be coming from?
More likely to be coming from colon
Bowel cancer? Diverticulum disease?
Causes of an upper GI bleed?
- Peptic ulcer
- Gastritis
- Varices
What are varices?
Oesophageal varices are enlarged veins in the esophagus. They’re often due to obstructed blood flow through the portal vein, which carries blood from the intestine, pancreas and spleen to the liver
What is a Mallory Weiss tear?
A tear of the tissue of your lower oesophagus. It is most often caused by violent coughing or vomiting.
What is a Mallory Weiss tear usually preceded by?
A vomiting episode and produces fresh blood in the vomit
Why can liver cirrhosis lead to GI bleed?
People who have cirrhosis may develop varices in the oesophagus. As the blood pressure in the portal vein system continues to increase, the walls of these expanded veins become thinner, causing the veins to rupture and bleed. This is called variceal bleeding.
What is Murphy’s sign?
A manoeuvre during a physical examination as part of the abdominal examination. It is useful for differentiating pain in the right upper quadrant.
What bacteria is a major risk factor for PUD?
Helicobacter Pylori in the stomach
Treated with triple antibiotic therapy
What are the side effects of steroids?
Short term:
- Mood change
- Depression
- Anxiety
Long term:
- Osteoporosis
- Adrenal suppression
What can a rapid withdrawal from steroids lead to?
Addisonian crisis
What is Addisonian crisis?
With adrenal insufficiency, the inability to increase cortisol production with stress can lead to an addisonian crisis.
An addisonian crisis is a life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium.
What does fresh blood on toilet paper alone tend to indicate?
Can be a sign of anal cancer but is more commonly due to haemorrhoids or an anal fissure
What do dark blood clots tend to indicate?
Dark blood clots can indicate bleeding from higher up in the large bowel
What is melaena?
Black tarry stool
What causes a melaena?
Caused by bleeding in the upper GI tract and then blood being altered by the digestive juices as it passes through the GI tract.
Common characteristics of diverticulitis?
Diverticulitis usually is episodic and acute onset and often has associated features of abdominal pain or generalised infective symptoms such as fever or chills.
What is the major symptom of inflammatory bowel disease?
Uncontrollable diarrhoea and abdominal pain. Associated. bloating or relationship to eating.
NOT presence of bleeding
When is a CT colon used over colonoscopy?
A CT colon is often used as a first line investigation in frail older people with iron deficiency anaemia or PR bleeding because a colonoscopy is invasive and carries a higher risk of perforation in frail older people.
When is a plain abdominal x-ray helpful?
Plain abdominal xray is helpful in establishing if there is any dilatation of the bowel. This is an essential part of investigation in causes of diarrhoea where toxic mega colon can occur such as in inflammatory bowel disease and clostridium difficile infection.
When is ultrasound helpful?
To look at the solid organs such as the liver for the presence for example of metastases but not the bowel
What are the NICE guidelines for referring adults for colorectal cancer?
- They are aged 40 and over with unexplained weight loss and abdominal pain
- They are aged 50 and over with unexplained rectal bleeding
- They are aged 60 and over with: iron deficiency anaemia or changes in their bowel habit, or tests show occult blood in their faces
- Adults with rectal or abdominal mass
- Those aged under 50 with rectal bleeding and the following unexplained symptoms:
- Abdominal pain, change in bowel habit, weight loss
- Iron-deficiency anaemia
