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Gastrointestinal Flashcards

1
Q

What is the pertinent epi for rotavirus?

A

Children
Childcare workers
F/O route + respiratory

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2
Q

What is the pertinent epi for Norovirus?

A 
Adults
Cruise ships
Winter
Aged care
Shellfish
F/O route only
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3
Q

What is the pertinent epi for Adenovirus?

A

Infant

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4
Q

What is the pertinent epi for ETEC?

A

Bali belly (travellers diarrhoea)

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5
Q

What is the pertinent signs for EHEC?

A

HUS, Purpuric skin rash

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6
Q

What is the pertinent epi for Capylobacter?

A

Milk
Farm
Bird droppings

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7
Q

What is the pertinent epi for salmonella?

A

Chicken / eggs

Developing country

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8
Q

What is the pertinent epi for Shigella?

A

Brothels
MSM
HIV

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9
Q

What is the pertinent epi for Cholera?

A

Shellfish

Contaminated water

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10
Q

What is the pertinent epi for C.Diff?

A

Post Abx

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11
Q

What is the pertinent epi for C. perfringens?

A

Inadequately heated meat

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12
Q

What is the pertinent epi for Yesrsinia?

A

Pork
Milk
Developing country

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13
Q

What is the pertinent epi for B.Cereus?

A

Undercooked / refrigerated rice

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14
Q

What is the pertinent epi for S. Aureus?

A

Old / unrefrigerated food

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15
Q

What is the pertinent epi for Listeria?

A

Pregnant
Cheese
Unpasteurised milk

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16
Q

What is the pertinent epi for Giardia?

A

Contaminated water / lake

Russia?

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17
Q

What is the pertinent epi for Entamoeba?

A

Trophozoites

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18
Q

What is the pertinent epi for crypto-sporidium?

A 
Children
Immunocompromised
Contaminated water
Farm animals
Berries
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19
Q

What bugs cause dysentery?

A 
CHESSY
Campylobacter
Ecoli (EHEC, EIEC)
Histolytica
Shigella
Salmonella
Yersinia
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20
Q

Which bugs cause rapid onset gastro (toxin)?

A

B. Cereus

S Aureus

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21
Q

What are the causes of pancreatitis?

A

I GET SMASHED

Idiopathic

Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune (SLE, Chrons)
Scorpion
Hyperlipidaemia
ERCP
Drugs (NSAID, Erythromycin, sulfasalazine, metronidazole)
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22
Q

What is the typical history findings in acute pancreatitis?

A 
Epigastric pain +++
Radiates to back
Relieved by foetal position
Worse lying down
N+V (retching)
Fevers
Steatorrhea
Weight loss
23
Q

What are possible exam findings in acute pancreatitis?

A

Ecchymoses (Grey-turner- flank, cullen- umbilical, Fox’s- inguinal)
Epigastric tenderness
Haemodynamic instability

24
Q

What are the Atlanta criteria for diagnosis of pancreatitis?

A

2 of Pain, Lipase, or Radiographic features

Serum lipase >3x ULN
US: Gallstones, hyperechoic pancreas, peripancreatic fluid
CT: Enlarged + oedematous, Fat stranding, Splenic vein thrombosis

25
What is the management for acute pancreatitis in the GP setting?
Assess hydration state + Hypotension Analgesia + antiemetics Send to hospital for management (Abx, Tazocin IV, or Ceftriaxone
26
What are the complications of acute pancreatitis?
``` Splenic vein thrombosis Renal failure SIRs Pancreatic phlegmon --> pseudocyst --> necrosis --> abscess APO Ileus ```
27
What are the signs of peritonitis?
Rebound tenderness Washboard rigidity Involuntary guarding
28
What is the most common cause of chronic pancreatitis?
Alcohol
29
What vitamins are deficient in chronic pancreatitis?
ADEK
30
What are the complications of chronic pancreatitis?
``` Exocrine insufficiency Diabetes mellitus Pancreatic calcification Duct obstruction Low trauma fractures (low BMD) Pancreatic cancer Pancreatic cysts ```
31
What is the management of chronic pancreatitis?
Pancreatic enzymes +/- pancreatectomy
32
What is the pathogenesis of diverticular disease?
Occur when the vasa recta penetrate the muscularis propria, an anatomical weak spot. Compression at the weak spot causes outpouching and the superficiality of vasa recta causes bleeding Retained faecal matter increases infection risk
33
What is the typical history in diverticulitis?
``` Blood in stool N/V Fever Anorexia LLQ pain (RLQ in asian) Worse with food Bowel changes Urinary frequency + urgency Peritonitis Obstructive symptoms ```
34
What are the complications of Diverticulitis?
``` Fistulae CRC Abscess Peritonism Stricture Obstruction ```
35
What investigation is diagnostic for diverticulitis?
Abdo CT woth PO and IV contrast (looks at obstruction and ischaemia) - sigmoid diverticular with thickened walls - Inflammation in pericolic fat - Abscess, obstruction Colonoscopy at 6W
36
What is the management of uncomplicated Diverticulitis?
Augmentin Lifestyle modifications
37
What is the management for complicated Diverticulitis?
Amoxycillin+Gentamycin+Metronidazole (Gentamycin+clindamycin if allergic) Send to ED for surgical assessment
38
What are the risk factors for PUD?
NSAIDs H.Pyori Bisphosphonates Glucocorticoids Stress Zolinger-ellisons (gastrin secreting tumour)
39
What is the typical history for PUD?
``` Epigastric burning pain Pointing sign Food-provoked (gastric) 2-5h after meal (duodenal) N/V Weight loss ```
40
What are the complications of PUD?
Bleeding Perforation outlet obstruction
41
What is the management of PUD
Send to hospital (ACUTE) Pantaprazole IV Erythromycin IV Endoscopy ``` (CHRONIC) Oral pantaprazole Iron supplementation H.pylori testing Counsel about NSAIDS, Smoking, alcohol Repeat endoscopy in 6W ```
42
What are the risk factors for GORD?
``` Hiatus hernia Scleroderma Obesity Drugs (SM relaxants, anticholinergics, nitrates, CCB, theophyline) Diet Pregnancy Stress ```
43
What is the aetiology of GORD?
``` Hypotension of the LES Hiatus hernia Oesophageal dysmotility Gastric acid hypersecretion Delayed gastric emptying ```
44
What is the typical history for GORD?
``` Heartburn+epigastric pain Worse after food Worse lying down Dry cough Nausea Bloating ```
45
What are the complications of GORD?
Oesophagitis Barrett's Adenocarcinoma
46
What is the management of GORD?
Lifestyle *** Pharm: Antacids, PPI Surgical: Nissen fundoplication
47
What is the main investigation for GORD?
PPI trial | gastroscopy for Barrett's
48
What are the key differences between UC and Chron's on HISTORY?
``` UC= mucous in diarrhoea Chron's= B12 deficiency, mouth ulcers, perianal disease, RLQ pain ```
49
What are the histopathological features of Chron's?
``` Transmural inflammation Skip lesions Whole GI tract Fat wrapping Cobblestone appearance --> linear ulcers Crypt abscesses Fissures Fistulas Strictures ```
50
What are the histopathological features of UC?
``` Mucosal inflammation Continuous with clearly demarcated end Confined to the colon Loss of Haustra Pseudopolyps Crypt abscess ```
51
What are the extra intestinal manifestations of Chron's and UC
BOTH: Anterior uveitis, scleritis Erythema nodosum, pyoderma gangrenosum Chrons Gallstones, kidney stones UC Primary sclerosing cholangitis Ankylosing spondylitis
52
What is the medical management of Chron's
Induction of remission: Steroids Maintenance: MTX, azathioprine
53
What is the medical management of UC?
Acute flares: Steroids Induction of remission: 5-ASA (tacrolimus) Maintenance of remission: 5-ASA (tacrolimus)

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