Gastrointestinal Flashcards
Left hypochondriac pain
PU
Pancreatitis
Gastric or DUODENAL Ulcer
Epigastric pain
PHUGE
Pancreatitis HEART BURN Gastric Ulcer GALL STONES EPIGASTRIC HERNIA
Right hypochondriac pain
PUBG
Pancreatitis
Gastric Ulcer
Biliary Colic
GALLSTONES
Left lumbar
CUKID
Constipation UTI Kidney stones IBD Diverticular disease
Umbilical
PIG EAR
Pancreatitis
IBD
Gastric Ulcer
EARLY STAGES of APPENDICITIS
AORTIC ANEURYSM
Ruptured AORTIC ANEURYSM
Right lumbar
CUK
Constipation
UTI
Kidney stones
Left Iliac
OI DIE
Ovarian torsion
IBD
Diverticular Disease
Inguinal/ Femoral Hernia
Ectopic Pregnancy
Hypogastric
A IUD
APPENDICITIS
IBD
UTI
Diverticular Disease
Right Iliac
AEIO
Appendicitis
Ectopic pregnancy
Inguinal/ femoral hernia
Ovarian torsion
Causes of UPPER GI bleeding
GP MOM
Gastritis
Peptic ulcer
Mallory Weiss Tear
Oesophageal VARICES
Malignancy
Causes of LOWER GI bleeding
I IUD CHAMP
INFECTIOUS DIARRHOEA
IBD
Ulcerative Colitis
Diverticulitis
Crohn's HAEMMORRHOIDS ANGIODYSPLASIA (breakdown of blood vessels in GI tract (red spots in GI tract)) Malignancy POLYPS
Causes of GASTRITIS
BAN US
Burns: CURLING’s ULCER
Alcohol
NSAIDs
Uraemia
Stress
Two types of CHRONIC GASTRITIS
Type A-
- Autoimmune to PARIETAL CELLS
- Presents with PERNICIOUS ANAEMIA
- FUNDUS or BODY of stomach
Type B-
- Most COMMON
- Associated with H. PYLORI
Investigations for H. Pylori
CUBES
Carbon isotope- urea breath test Urinalysis Bloods- ANAEMIA and H. PULORI Endoscopy with biopsy of stomach lining Stool sample for H. Pylori
Treatment for H. Pylori
TRIPLE THERAPY
PPI and CLARITHROMYCIN (and either AMOXICILLIN or METRONIDAZOLE)
Treatment for Gastritis
Mild- Antacids or H2 antagonists
Moderate/ Sever- PPI
Complications of Gastritis (4 things)
MAPS
Mucosa-associated lymphoid tissue lymphoma
Anaemia (from bleeding ulcers)
Peptic ulcers
Stricture formation
Signs and Symptoms of IBS
Recurrent abdominal pain which improves with defaecation
Change in bowel habit
Treatment of IBS
ANTIMUSCARINICs
Laxatives
Stool Softeners
Appendicitis investigations
FBC, U and E, CRP
Pregnancy test to rule out ECTOPIC PREGNANCY
Complication of Appendicitis
Peritonitis
Where is Ulcerative Colitis seen in the GI tract?
Colon- rarely terminal ileum
Always starts at rectum- never spreads beyond ileocaecal valve
5 P’s of Ulcerative Colitis
Pyrexia Pseudopolyps Lead pipe radiological appearance Poo (bloody diarrhoea) Proctitis (lining of inner rectum is inflamed)- URGENCY and TENESMUS
Investigations of Ulcerative Colitis
ALBUMIN (low albumin)
ESR and CRP
Colonoscopy with biopsy
Radiology- small bowel follow through/ Abdominal X ray for toxic megacolon
AXR
- No faecal shadowing
- Mucosal thickening/ islands
- Colonic dilatation
Treatment of Ulcerative Colitis
Mild (<4 motions a day)-
- 5 ASA (mesalazine)
- +topical steroid foam (hydrocortisone)/ prednisolone
Moderate (4-6 motions a day)-
- Prednisolone
- Then 5-ASA
Severe (>6 motions a day)
- EXCLUDE INFECTIONS
- IV hydration/ electrolyte replacement
- IV hydrocortisone/ methylprednisolone
- If CRP/ motions are still high- CICLOSPORIN/ INFLIXIMAB
What part of the GI tract does Crohn’s affect?
Any part of the GI tract but often targets TERMINAL ILEUM
Signs and Symptoms of CROHN’s (10 things)
Weight loss Abdominal pain with mass Diarrhoea FEVER Skin lesions Cobblestone mucosa FISTULA FORMATION FISSURE FORMATION Clubbing LINEAR ULCERATION
Investigations of Crohn’s
ALBUMIN (low albumin)
ESR and CRP
Colonoscopy with biopsy
Radiology- small bowel follow through/ Abdominal X ray for toxic megacolon
AXR
- No faecal shadowing
- Mucosal thickening/ islands
- Colonic dilatation
Treatment of CROHN’s
Mild-moderate-
- Prednisolone
- Then MAINTENANCE THERAPY
Severe-
- IV hydration/ electrolyte replacement
- IV steroids (hydrocortisone)
- If Hb<80, consider BLOOD TRANSFUSION
- Switch to prednisolone if improving
Complications of Crohn’s (5 things)
Stricture and Fistula formation Obstruction Pyoderma gangrenosum ANAEMIA Osteoporosis (from steroid use)
Complications of Ulcerative Colitis (4 things)
Primary sclerosing cholangitis
Osteoporosis
Increasing incidence of colon cancer
Toxic megacolon
4 side effects of 5-ASAs
Hepatitis
Pancreatitis
Haemolysis rash
Paradoxical worsening of Colitis
50% of CROHN’s patients can get this condition
PERIANAL DISEASE-
- MRI to check for this
- Oral antibiotics- INFLIXIMAB
- Immunosuppressants
- Local surgery
CROHN’s MAINTENANCE THERAPY
4 things
AZATHIOPRINE-
- If steroids are contraindicated (DIABETES, OSTEOPOROSIS, TB, CHICKENPOX, HYPERTENSION)
- If not, use other immunomodulators (METHOTREXATE/ 6-MERCAPTOPURINE)- which are contraindicated in females of reproducing age
BIOLOGICS-
- Anti TNF-alpha- contraindicated in SEPSIS, TB, high LFTs, MALIGNANCY
NUTRITION-
- ENTERAL (polymeric) diet is preferred
- Elemental- amino acids can give remission
- Low residue- helps in those with active disease or strictures
SURGERY if-
- Drug failure
- FISTULA
- PERFORATION
- GI OBSTRUCTION from STRICTURE
- ABSCESS
Cause of COELIAC DISEASE
Autoantibodies to GLIADIN
Issue with GLUTEN
Which part of the GI tract does COELIAC DISEASE affect?
Proximal part of small intestine
Signs of COELIAC DISEASE
Low B12, Low FERRITIN, Low Hb
Steatorrhoea
Weight loss
Signs and Symptoms of Gastrooesophageal reflex disorder
LAND WH
Laryngitis
Acidic taste in mouth
Nocturnal asthma/ chronic cough
Dysphagia (swallowing difficulties)
Water brash (excessive salivation) Heart burn- worse AFTER LYING DOWN/ STOOPING/ HEAVY MEALS
Causes of GORD
Oesophagitis
Genetic inheritance of angle of LOWER OESOPHAGEAL SPHINCTER
Rolling hiatus hernia
Sliding hiatus hernia
Risk factors for GORD
SPEEDO
Smoking Pregnancy Excessive alcohol Excessive coffee Drugs (CCB, Antimuscarinics, Tricyclic antidepressants) Obesity
Investigations for GORD
If <55yo-
- Proceed to treatment unless:
1) Unintentional weight loss
2) DYSPHAGIA
3) Haematemesis
4) Melaena
5) ANOREXIA - Then do ENDOSCOPY if they have these symptoms
If >55yo-
- Endoscopy and biopsy
Treatment for GORD
Weight loss
Raising of head of bed at night
1) ANTACIDS (like Al2O3)
2) PPI (like OMEPRAZOLE)
3) H2 antagonists (RANITIDINE)
SURGERY- Nissen’s Fundoplication
Barret’s Oesophagus (complication of GORD). Investigation/ Treatment/ Complication
- Metaplasia of normal SQUAMOUS epithelium of lower oesophagus into COLUMNAR epithelium
- Investigate with endoscopy
- Treat with radiofrequency ablation or mucosal resection
- Complication- ADENOCARCINOMA of oesophagus
Reasons for Prehepatic Jaundice (6 things)
Drugs (Rifampicin) MALARIA Haemolysis (THALASSAEMIA/ SICKLE CELL ANAEMIA) Haemolytic uraemic syndrome CRIGLER-NAJJAR SYNDROME GILBERT's SYNDROME
Reasons for Intra-hepatic Jaundice (6 things)
Viral/ drug induced hepatitis ALCOHOLIC liver disease Primary biliary CIRRHOSIS Hepatic CIRRHOSIS LEPTOSPIROSIS Physiological neonatal jaundice
Reasons for Posthepatic Jaundice (6 things)
Pancreatic cancer Cholangiocarcinoma GALLSTONES in COMMON BILE DUCT BILIARY ATRESIA SCHISTOSOMIASIS Mirizzi's syndrome
Investigations in Prehepatic Jaundice-
URINE- STOOL- Conjugated bilirubin- Unconjugated bilirubin- Total bilirubin- Alkaline phosphatase-
URINE- NORMAL STOOL- NORMAL Conjugated bilirubin- NORMAL Unconjugated bilirubin- NORMAL or HIGH Total bilirubin- NORMAL or HIGH Alkaline phosphatase- NORMAL
Investigations in Intrahepatic Jaundice-
URINE- STOOL- Conjugated bilirubin- Unconjugated bilirubin- Total bilirubin- Alkaline phosphatase-
URINE- DARK STOOL- PALE Conjugated bilirubin- HIGH Unconjugated bilirubin- HIGH Total bilirubin- HIGH Alkaline phosphatase- HIGH
Investigations in Post-hepatic Jaundice-
URINE- STOOL- Conjugated bilirubin- Unconjugated bilirubin- Total bilirubin- Alkaline phosphatase-
URINE- DARK STOOL- PALE Conjugated bilirubin- HIGH Unconjugated bilirubin- NORMAL Total bilirubin- HIGH Alkaline phosphatase- HIGH
Treatment of Jaundice
Treat UNDERLYING CAUSE
Adequate hydration
Broad spectrum ANTIBIOTICS if OBSTRUCTION
Complications of Jaundice (6 things)
- Liver/ Renal failure
- Pancreatitis
- Biliary CIRRHOSIS
- SEPSIS
- CHOLANGITIS
- KERNICTERUS (serious complication in NEONATES)
Hepatitis A
DNA/RNA- Transmission- Incubation period- Investigations- Treatment- Complication-
DNA/RNA- RNA picornvirus
Transmission- Faecal-oral transmission, associated with contaminated shellfish- passes into bile after replication within liver cells. Leads to necrosis in ZONE 3 of hepatic lobule
Incubation period- 2-3 weeks
Investigations- Anti-HAV IgM in serum
Treatment- Supportive since often self-resolving
Complications- Rarely-acute liver disease
Hepatitis B
DNA/RNA- Transmission- Incubation period- Investigations- Treatment- (6 things) Complications- (3 things)
DNA/RNA- DNA
Transmission- Contaminated needles, Infected blood products, sexual intercourse, VERTICAL TRANSMISSION
Incubation period- 1-5 months
Investigations- HBV DNA in serum, and antigens etc. present in histology with GROUND GLASS appearance
Treatment- Antiviral medications-
- Pegylated alpha 2a interferon
- Telbivudine
- Lamivudine
- Adefovir
- Tenofovir
- Entecavir
Complications-
- Hepatic cirrhosis
- Hepatocellular carcinoma
- Fulminant hepatitis B
Hepatitis C
DNA/RNA- Transmission- Incubation period- Investigations- Treatment- (4 things) Complications- (3 things)
DNA/RNA- RNA
Transmission- Contaminated needles, Infected blood products, VERTICAL TRANSMISSION
Incubation period- 6-9 weeks
Investigations- Antibody to HCV in serum
Treatment- Antiviral medications-
- Pegylated alpha 2a interferon
- Ribavirin
- Taribavirin
- Telaprevir
Complications-
- Hepatic cirrhosis
- Hepatocellular carcinoma
- Liver Failure
Hepatitis D
DNA/RNA- Transmission- Incubation period- Investigations- Treatment- (1 thing) Complications- (2 things)
DNA/RNA- Defective RNA (COINFECTS with HBV)
Transmission- Contaminated needles, Infected blood products, sexual intercourse
Incubation period- 1-5 months
Investigations- Serum IgM anti-D
Treatment-
- Pegylated alpha 2a interferon
Complications-
- Hepatic cirrhosis
- Hepatocellular carcinoma
Hepatitis E
DNA/RNA- Transmission- Incubation period- Investigations- Treatment- Complications-
DNA/RNA- Single stranded RNA
Transmission- Faecal-oral transmission, associated with contaminated WATER
Incubation period- 2-3 weeks
Investigations- IgG and IgM anti-HEV
Treatment-
- Usually self-liniting
Complications-
-High mortality of pregnant women (20%)
Signs and Symptoms of Colorectal Cancer (6 things)
2F 3A U
Fatigue FAECAL OCCULT BLOOD Anaemia Altered bowel habit ABDOMINAL PAIN Unintentional weight loss
Risk factors for Colorectal Cancer (7 things)
Smoking
Increased age
Family history of CRC
INFLAMMATORY BOWEL DISEASE
Strep bovis bacteraemia
CONGENITAL POLYPOSIS SYNDROMES:
- Juvenile polyposis syndrome
- Peutz-Jeghers Syndrome
Genetic predisposition:
- Familial Adenomatous Polyposis (FAP)- all lead to CRC
- Hereditary nonpolyposis CRC
Investigations for COLORECTAL CANCER (4 things)
- Faecal Occult blood test
- Bloods- IRON DEFICIENCY ANAEMIA/ CARCINOEMBRYONIC ANTIGEN
- Endoscopy= colonoscopy/ sigmoidoscopy
- Double contrast BARIUM ENEMA study ‘APPLE CORE’ sign
Two types of staging systems for COLORECTAL CANCER
Duke’s and TMN
Treatment for Colorectal Cancer
Chemotherapy-
- Oxaliplatin
- Folinic Acid
- 5-Fluorouracil
Radiotherapy
Surgical resection
Signs and Symptoms of Acute Pancreatitis
CG PAN
- Cullen’s sign- PERIUMBILICAL BRUISIING
- Grey Turner’s sign- FLANK BRUISING
- Pain in EPIGASTRIC region which radiates to the back
- ANOREXIA
- Nausea/ vomiting
Causes of Acute Pancreatitis
GET SMASHED
Gallstones
Ethanol
Trauma
Scorpion sting Mumps Autoimmune disease STEROIDs HYPERLIPIDAEMIA/ HYPERCALCAEMIA ERCP Drugs (AZATHIOPRINE)
Investigations for Acute Pancreatitis
Bloods- RAISED serum AMYLASE and LIPASE
US to scan for gallstones
CT to rule out complications
Treatment for Acute Pancreatitis
KEEP NIL BY MOUTH
Treatment usually symptomatic relief (ANALGESICS like TRAMADOL)
Treat underlying cause (ERCP for gallstones)
Complications of Acute Pancreatitis
HDAMN
Haemorrhage Disseminated intravascular coagulation Acute respiratory distress syndrome Multi organ failure Necrosis
Signs and Symptoms of Chronic Pancreatitis
A epigastric pain which radiates to the back and is also-
- recurrent
- worse when eating/ drinking heavily
- relieved by sitting forward
Causes of Chronic Pancreatitis
CAMP
Cystic Fibrosis
Alcohol
Malnourishment
Pancreatic duct obstruction
Investigations for Chronic Pancreatitis
Decreased Faecal Elastase
CT SCAN- shows calcification
Perform MRCP
Treatment of Chronic Pancreatitis
Alcohol cessation/ low fat diet
Analgesia (TRAMADOL)
Pancreatic enzyme replacement therapy
Start insulin therapy if diabetes has developed
Complications of Chronic Pancreatitis
PODS
Pseudocysts
Obstruction (pancreatic)
Diabetes Mellitus
Steatorrhoea
5 microbes involved in food poisoning
Vibrio vulnificus Bacillus cereus Staphylococcus aureus Clostrididium botulinium E. coli
5 microbes involved in bloody diarrhoea
Campylobacter jejuni Salmonella E. coli Shigella Yersinia enterocolitica
Intestinal tapeworm microbe
Taenia solium
