Gastrointestinal Flashcards
Achalasia
Imaging
- Upper GI Endoscopy
- Barium Swallow (beak sign)
- Oesophageal Manometry (incomplete relax of LOS + aperistalsis oesoph)
Anal Fissure
Clinical Diagnosis
Anorectal Abscess
Bedside - Clinical Diagnosis - Swab and Culture Bloods - FBC (WCC raised) - Electrolytes in ?Sepsis
Appendicitis
Bloods - FBC - CRP (raised) - G+S (surgery) Imaging (d>6mm) - Abdominal USS - Contrast Abdo CT
Crohn’s Disease
Bloods
- FBC (anaemia, WCC, thrombocytosis)
- Iron Study (anaemia)
- Serum B12 (malabsorption)
- Serum Folate (malabsorption)
- CMP (hypoalbumin, hypocholesterol, Hypocalcaemia)
- CRP (raised)
- ESR (raised)
Imaging
- Plain AXR (bowel dilation, calcification, sacroiliitis, intra abdo abscess)
- CR/MRI (skip lesions, bowel wall thick, inflam, abscess, fistulae)
Special
- Stool Sample (absence of infection)
- Yersinia Enterocolitica Serology (negative)
GORD
PPI Trial 8/52 with symptom improvement
?OGD - oesophagitis, Barrett’s
Haemorrhoids
Bedside
- Anoscopic Examination (visual haemorrhoids)
Bloods
- FBC (prolonged bleeding)
Imaging
- Colonoscopy/ Flexi Sigmoidoscopy (exclusion)
Special
- Stool for occult haem if no haemorrhoidal tissue seen (positive)
Hiatus Hernia
Imaging
- CXR (intrathoracic retrocardiac gastric bubble or air fluid level)
- Upper GI series (barium meal) intrathoracic stomach
Inguinal Hernia
Mainly Clinical Diagnosis
Image if uncertain
- USS of Groin
- CT Scan in obese
- Herniography (contrast into sac)
- MRI groin (abnormal widening of inguinal canal)
Malignant Oesophageal Sphincter
Bloods
- Metabolic Panel (dysphagia --> Hypovolaemia)
1. Hypokalaemia
2. Elevated Creatinine
3. Elevated urea/nitrogen
Imaging
- OGD with biopsyColorectal Cancer
Bloods
- FBC (anaemia)
- LFT (baseline check for chemo)
- U+E (normal)
Imaging
- Colonoscopy + Biopsy (ulcerating exophytic mucosal lesion narrow bowel lumen)
- CT Colonography (ulcerating exophytic lesion narrowing bowel lumen
- Barium Enema (mass lesion in colon and/or ‘apple core’ lesion)
- CT chest, abdomen and pelvis (colonic wall thickening, enlarged lymph nodes, liver mets, lung secondaries)
Ruptured Viscus (Perforated Bowel)
Bedside
- Clinical Examination
- Pregnancy Test (ectopic)
- Urinalysis (infection, stones)
Bloods
- FBC (WCC)
- Electrolytes (obstruction = hypochloraemia, hypokalaemia)
- Urea (raised in AAA or Dissection impairing renal arteries)
- Glucose (elevated in pancreatitis if islets affected)
Imaging
- Plain AXR
- Erect CXR (Pneumoperitoneum)
- USS (GB, pelvis, AAA)
- OGD
Special
- Laparoscopy
Ascending Cholangitis
Bloods
- FBC (WCC, Platelets raised)
- Blood Culture
- Urea (raised in severe)
- Creatinine (raised in severe)
- ABG (metabolic acidosis with raised lactate)
- LFT (bilirubin, ALT, AST, ALP raised)
- CRP (raised)
- Potassium (low)
- Magnesium (high)
- Coagulation (increase PT))
Imaging
- Abdo USS (if RUQ) - dilated CBD, CBD stones
- ERCP - observe CBD stones or obstruction
Acute Pancreatitis
Bedside
- Pulse Oximetry
Bloods
- Lipase and Amylase (>3x upper limit +acute pain)
- FBC (WCC, haematocrit)
- CRP (>200 necrotic)
- Urea/creatinine (dehydration)
- LFT (ALT >3x upper limit = gallstone cause)
- Calcium (hyper is a cause)
- ABG (hypoxaemia, and acid-base disturb)
Imaging
- AUSS (GS, inflammation, calcification, fluid)
- CXR (pleural effusion, basal atelectasis, elevated hemidiaphragm)
Alcoholic Liver Disease
Bloods
- AST/ALT ratio >2
- ALP
- Bilirubin
- Albumin
- Gamma-GT
- FBC (Hb, WCC, platelet)
- Electrolytes (hypo)
- U+E (elevated urea + normal creatinine = GI bleed)
- PT, INR
Imaging
- Hepatic USS (megaly, fatty, cirrhosis, mass, ascites)
Special
- Hepatitis Serology
Cholecystitis
Bloods
- FBC (WCC)
- CRP
- Bilirubin
- ALP (raised)
- ALT/AST (normal unless liver involve)
- Lipase/Amylase (exclude panc if <3 x upper)
- Blood Culture
Imaging
- Abdo USS
- Pericholecystic Fluid
- Distended GB
- Thickened GB Wall >3mm
- Gallstones
- CT/MRI Abdo
- Irreg thick GB wall
- Poor contrast enhanced GB wall
- Increased fatty tissue around GB
- Gas in GB lumen or wall
- Peri GB abscess
Constipation
Bedside
- Anocutaneous Relfex (ext sphinct tone)
- DRE
Bloods
- FBC (anaemia iron)
- TFT (TSH increased in 1. hypothyroid)
- Electrolytes (Hypokalaemia)
- Calcium (Hypercalcaemia >2.75)
- Magnesium (Hypomagnesemia)
- Glucose (elevated DM)
Imaging
- AXR (impaction, rectal mass)
- Barium Enema (impaction, rectal mass)
Ascites
Bedside
- Shifting Dullness
- Fluid Thrill
- Fluid Wave
Bloods
- FBC (thrombocytopenia in portal HTN)
- Metabolic Panel
- Albumin
- Prothrombin time
- Bilirubin
- Hep ABC
Imaging
- Abdo USS (fluid + portal and hepatic vein thrombosis or stenosis)
- CT (malignancy + spleen diameter >12cm or recanalisation of umbilical veins = portal HTN)
Special
- Paracentesis + testing for WCC, culture, serum to ascitic fluid albumin gradient.
- Liver biopsy to rule out or distinguish cause of cirrhosis
Biliary Colic
Bedside
- No Fever or Jaundice
Bloods (Exclusion)
- FBC (normal)
- LFT (normal)
- Amylase/Lipase (normal)
Imaging
- USS RUQ detects Gallstones
- ERCP only if suggestion of bile duct stone
