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Gastrointestinal Conditions Flashcards

1
Q

Who is typically affected by acute pancreatitis?

A

ELDERLY
MIDDLE AGED
MALE

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2
Q

What are the most common causes of acute pancreatitis

A

GALLSTONES

ALCOHOL

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3
Q

Main risk factors to worry about in acute pancreatitis

A

TRAUMA- (endoscopic procedures, surgery, blunt abdo trauma)
INFECTION- (mumps, cosackie B4, m.pneumonia)
IATROGENIC- (thiazide diuretics, azathioprine, tetracyclines, oestrogens, valproic acid)
AUTOIMMUNE- (systemic lupus erythematous, Sjorgen’s syndrome)

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4
Q

What is the key symptom for acute pancreatitis?

A

EPIGASTRIC PAIN WITH SUDDEN ONSET which becomes continuous. It RADIATES TO THE BACK.
WORSENS WITH MOVEMENT
ALLEVIATED BY FOETAL POSITION

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5
Q

Clinical Signs for acute pancreatitis

A

Jaundice
Ecchymosis
Abdo tenderness and distension
Tachycardia/Hypotension

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6
Q

Main Differentials for acute pancreatitis

A 
Perforated peptic ulcer
Bowel obstruction
Ischaemic Bowel
Ruptured AAA
Biliary colic, acute cholecystitis, cholangitis, viral hepatitis
Gastroenteritis
Diabetic Ketoacidosis
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7
Q

Investigations for suspected acute pancreatitis

A

BLOOD- serum amylase, FBC, glucose, CRP

IMAGING- abdo X-ray, CT scan, USS, laparoscopy

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8
Q

Treatments for acute pancreatitis

A 
PAIN RELIEF- benzodiazepine, buprenorphine, pethidine (NOT MORPHINE)
REMOVE GALLSTONES
LIFESTYLE MANAGEMENT- alcohol management
ANTIBIOTICS- tazocin
SURGICAL- cholecystectomy
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9
Q

What are the complications if acute pancreatitis goes untreated

A

Pancreatic necrosis, infected necrosis, acute fluid collections, pancreatic abscess, acute pseudo-cyst, pancreatic ascites, acute cholecystitis
SYSTEMIC- pulmonary oedema, pleural effusions, ARDS, hypovolaemia, shock, hypocalcaemia, hypomagnesaemia, hyperglycaemia.

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10
Q

Who is typically affected by chronic pancreatitis?

A

MIDDLE AGED MEN

45-54 YEARS

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11
Q

What is the most common cause?

A

ALCOHOL (in 70-80%)

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12
Q

Key risk factors associated with chronic pancreatitis

A

LIFESTYLE- SMOKING as it inhibits exocrine pancreatic secretion
GALLSTONES/PANCREATIC DUCT STRICTURES, IBD, PRIMARY BILIARY CIRRHOSIS
IATROGENIC- (thiazide diuretics, azathioproine, tetracyclines, oestrogens, valproic acid)
AUTOIMMUNE: Sjorgen’s

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13
Q

What are some of the key symptoms for chronic pancreatitis?

A

severe DULL, EPIGASTRIC PAIN that can radiate to the BACK and can LOCALIZE to the UPPER QUADRANTS
Relieved by SITTING UPRIGHT, LEANING FORWARD
Precipitated by EATING

STEATORRHOEA
WEIGHT LOSS

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14
Q

Clinical signs for chronic pancreatitis

A 
Epigastric tenderness
Jaundice
Chronic liver disease
Raised pituitary hormone
Positive secretin stimulation test
Calcification on CT
Speckled calcification on abdominal x-ray
Raised blood glucose
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15
Q

What are some differentials for chronic pancreatitis

A 
Acute pancreatitis
Peptic ulcer disease and IBS
AAA
MI
Biliary colic and acute choleycystitis
Gastroparesis
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16
Q

What investigations should be done in suspected chronic pancreatitis?

A

BLOODS- serum amylase, FBC, U+Es, glucose, CRP, LFTs

IMAGING- abdo x-ray, CT scan, USS, laparoscopy

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17
Q

What is the treatment for chronic pancreatitis?

A

Pain relief- paracetamol and NSAIDs
Creon- to reduce pain and replace pancreatic enzymes for malabsorption
SURGERY- pancreatic resection

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18
Q

What are the main causes of an acute GI bleed?

A 
Peptic Ulcer
Gastritis
Varices
Oesophagitis
Mallory-Weiss Tear
Erosive Duodenitis
Haemorrhoids
Anal Fissure
Colon Polyps
Colorectal Cancer
Ulcerative Colitis
Crohn's Disease
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19
Q

What are some of the risk factors that lead to an acute GI bleed?

A 
Alcohol abuse
Chronic Renal Failure
NSAID use
High age
Low socio-economic class
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20
Q

The main symptoms of acute GI bleeds:

A

PAIN- especially in conjunction with gallstones and alcohol abuse.
BLEEDING- bright red/black (coffee-ground) vomit, melaena (black tarry stools).
SYNCOPE/SHOCK- due to loss of blood

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21
Q

Clinical signs of an acute GI bleed?

A

Shock
Anaemia
Dehydration
Liver Pathology signs- spider naevi, gynaecomastia, flap
Dyspepsia
Weight loss (which could signify malignancy)
Jaundice (Seen in portal hypertensive gastropathy and varices)

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22
Q

What are some of the differentials for acute GI bleeds?

A

AAA
OESOPHAGEAL- Barrett’s, cancer, varices, -itis.
GASRTIC- outlet obstruction, cancer, -itis, PUD
Merkel’s
Small Bowel Ulceration

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23
Q

What are key investigations in suspected acute GI bleed?

A

BLOODS- FBC, U+E, glucose, CRP

IMAGING- Endoscopy, USS, laparoscopy, CT scan, CXY, erect and supine AXR

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24
Q

What is the best treatment for acute GI bleeds?

A

Fluid resuscitation- correct all of the fluid that has been lost
stop NSAIDs if necessary
Potential treatment for H.Pylori- Lansoprazole, Amoxicillin, Clarithromycin

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25
Q

Who is most affected by acute hepatitis?

A

Children and young adults

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26
Q

What are the main causes of acute hepatitis?

A

VIRAL- Hep A-E and cytomaegalovirus
NON-VIRAL INFECTION- toxoplasma gondii, Coxiella burnetti (Q-fever)
ALCOHOL
DRUG- paracetamol OD, halogenated anaesthetics, Anti TB
PREGNANCY
POISION
WILSONS DISEASE

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27
Q

What are the main risk factors associated with acute hepatitis

A

Alcohol abuse

Ingesting contaminated food/drink

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28
Q

What are some symptoms associated with acute hepatitis

A

PAIN AND PRESSURE IN THE RIGHT HYPOCHONDRIUM
tiredness, malaise, light fever
poor appetite, change in taste
skin rash

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29
Q

Clinical signs associated with acute hepatitis?

A

Tender enlargement of the liver
Splenomegaly
Lymphadenopathy
Liver failure

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30
Q

What are the main differentials for acute hepatitis?

A

HEPATIC- Liver abscess, autoimmune hepatitis, hepatocellular cancer
PANCREATIC- cancer, -itis
GALLBLADDER- cholecystitis, cholelithiasis
GASTRIC- PUD
Small bowel obstruction
AAA

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31
Q

What investigations should be used for suspected acute hepatitis?

A

BLOODS- FBC, ESR, CRP, LFTs, serum AST, ALT, bilirubin, serum antibodies

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32
Q

What treatment is used for acute hepatitis?

A

Mostly symptom management (fluids, antiemetics, rest)

Hep C - Interferon alfa

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33
Q

What complications can arise from untreated acute hepatitis?

A

Chronic hepatitis

Liver failure

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34
Q

Who is most affected by appendicitis?

A

Early teens
Those in their late 40s
Males

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35
Q

What are the main causes of appendicitis?

A

INFECTION- parasites, infection secondary to obstruction of appendix lumen, bacterial overgrowth
STRUCTURE- tumour, faecolith, fragments of indigestible food, raised intraluminal pressure
Mucus
Ischaemia
Necrosis of the appendix

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36
Q

What are the main risk factors associated with appendicitis?

A

AGE
GENDER (male)
FREQUENT ANTIBIOTIC USE
SMOKING

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37
Q

What are the common symptoms of appendicitis?

A

PAIN- PERIUMBILICAL/EPIGASTRIC pain that is constant and sharp that radiates to the RIGHT ILIAC FOSSA
worsened by movement and driving over speed bumps
ANOREXIA, NAUSEA, VOMITING, CONSTIPATION

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38
Q

Clinical signs of appendicitis include:

A

ABDO TENDERNESS- on percussion, maximum at McBurney’s point
facial flushing, halitosis
ROSVING’S SIGN- (palpation of the left lower quadrant increases pain on right lower quad)
PSOAS SIGN- (extension of right thigh elicits pain in right lower quad)
OBTURATOR SIGN- (internal rotation of flexed right thigh elicits pain in right lower quad)

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39
Q

Differential Diagnoses for appendicitis include:

A

GI- gastroenteritis, perforated peptic ulcer, acue cholecystitis, diverticulitis, pancreatitis
URO- right ureteric colic, right pyelonephritis, UTI, renal caliculi
GYNAE- ectopic pregnancy, ruptured ovarian follicle, torted ovarian cyst, salpingitis
OTHER- pneumonia, mesenteric adenitis, rectus sheath haematoma, diabetic ketoacidosis, shingles, porphyria.

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40
Q

What investigations are appropriate for suspected appendicitis?

A

BLOODS- FBC, LFTs, CRP

OTHER- pregnancy test, urine dipstick

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41
Q

Treatment for appendicitis?

A

SURGICAL- appendectomy

ANTIBIOTICS

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42
Q

What are the main complications of untreated appendicitis?

A

PERFORATION AND RUPTURE

septicaemia, ileus

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43
Q

Who is typically most affected by femoral hernias?

A

WOMEN

middle age and elderly

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44
Q

Who is typically affected by inguinal hernias?

A

MEN

middle age and elderly

45
Q

What is the cause of hernia development?

A

Weakening of the abdominal wall, allowing fatty tissue or bowel to protrude through the inguinal or femoral canal.

46
Q

What are the risk factors associated with hernias?

A

Obesity, constipation, chronic cough, heavy lifting, past ABDO surgery.

47
Q

What symptoms are present in hernias?

A 
Reducible lump
Pain in the scrotum
Sudden and intensifying pain in the inguinal region
Visible hernia bulge
Palpable impulse
48
Q

How can you differentiate between indirect and direct hernias

A

Palpate the lump during coughing. Reduce the lump, then occlude the deep inguinal ring. Ask the patient to cough/stand. If the hernia remains restrained, it is direct.

49
Q

Differentials for hernias?

A 
These include:
UNDESCENDED TESTES
VARICOCELE
HYDROCELE
BLEEDING
ABSCESS
50
Q

What investigations are best for suspected hernia?

A

IMAGING: USS, CT, MRI

51
Q

Treatment for hernias?

A

SURGERY- reinforcement of the abdominal wall. Usually using mesh and done laparoscopically.

52
Q

Who is typically affected by gallstones?

A

WOMEN

and those of INCREASING AGE

53
Q

What are the main causes of gallstones?

A

IMBALANCE of the chemical composition of BILE which leads to precipitation.
CHOLESTEROL
PIGMENTED
MIXED

54
Q

What key risk factors are associated with gallstones?

A

LIFESTYLE- obesity, smoking, weight cycling
PMH: Diabetes, Crohn’s, high serum triglycerides and low HDLs
IATROGENIC- oral contraceptives, HRT
NON-MODIFYABLES: Ethnicity, gender (female), genetic factors, increasing age.

55
Q

What symptoms are typically seen in gallstones?

A

PAIN- Biliary colic, pain in the upper abdo/ right upper quadrants. The pain is more than 30mins and less than 8 hours. Worse on inspiration.
JAUNDICE
PYREXIA, TACHYCARDIA
LOSS OF APPETITE

56
Q

Clinical signs of gallstones?

A

Murphy’s sign
Cholangitis
Acute cholecystitis

57
Q

What are the differential diagnoses for gallstones?

A

PUD, gastritis, IBS, gastro-oesophageal reflux, empyema, pancreatitis, tumour of the gallbladder. liver, stomach or gut.
acute hepatitis, IBD, bile duct stricture

58
Q

What investigations are appropriate in suspected gallstones?

A

BLOODS: LFTs, AlkPh
IMAGING: USS

59
Q

What is the best form of management for gallstones?

A

SURGICAL- cholecystectomy, cholecystotomy

60
Q

Who is more affected by gastro-oesophageal reflux?

A

MEN and OBESE

61
Q

What is the cause of gastro-oesophageal reflux?

A

Weakening of the LOWER OESOPHAGEAL sphincter which allows stomach acid to pass back up into the oesophagus

62
Q

What are the main risk factors associated with reflux?

A

LIFESTYLE- Obesity, fatty foods, excessive alcohol consumption, coffee, chocolate, smoking, stress, tight clothing.
PMH: Hiatus hernia, pregnancy
IATROGENIC- calcium blockers, NSAIDs, nitrates

63
Q

What are the symptoms of gastro-oesophageal reflux?

A

Heartburn
Oesophagitis
Bloating, nausea
Tooth disease/decay and sore throat

64
Q

Differential diagnoses for gastro-oesophageal reflux are:

A 
Peptic ulcer disease
Oesophagitis
GI cancer
Non-ulcer dyspepsia
Oesophageal spasm
Infection- CMV, herpes, candida
65
Q

What investigations are most appropriate for suspected gastro-oesophageal reflux?

A

BLOODS
IMAGING- Endoscopy, barium swallow, barium meal test, manometry
pH monitoring

66
Q

What is the best treatment for gastro-oesophageal reflux?

A 
Antacids, alignates
low dose PPIs, (-azoles)
H2 receptor antagonists
LNF- Laparoscopic nissen fundoplication
Gastroplasty
67
Q

Who is most likely to be affected by infective gastroenteritis?

A

CHILDREN

HOSPITAL WARDS

68
Q

What is the most common cause?

A

INFECTION of various types

VIRAL- rotavirus, norovirus, adenovirus (R.N.A)
BACTERIAL- campylobacter, e.coli, salmonella, shigella, yersinia enterocolitica (CESSY)
PARASITES- cryptosporidium, entamoeba histolytica, giardia. (CEG)
TOXINS- staph. aureus, bacillus cereus, c. perfringens

69
Q

What are the common symptoms associated with infective gastroenteritis?

A 
DIARRHOEA
NAUSEA, SUDDEN VOMITING, LOSS OF APPETITE
BLOOD/MUCUS IN STOOL
fever/malaise
headaches
muscle pain
dehydration
70
Q

What are the main clinical signs of infective gastroenteritis?

A

Parasites/ova found in stool
Signs and dehydration
Low BP (below 90mmHg)

71
Q

Differential diagnoses for infective gastroenteritis include:

A

Systemic Infections
GI conditions- traveller’s diarrhoea, IBS, UC, Crohn’s, Hirschprung’s, Short bowel syndrome, food-sensitive enteropathy, coeliac disease
Side effects from medication
Endocrinopathy- diabetes, hyperthyroidism, congenital adrenal hyperplasia, addison’s, hypoparathyroidism
Non- enteral infections- HIV/AIDS
Secretory tumours- carcinoid tumours

72
Q

What investigations would be necessary for suspected infective gastroenteritis?

A

BLOODS- FBC, renal function and electrolytes
STOOL SAMPLE
IMAGING

73
Q

What is the management for infective gastroenteritis?

A

Good fluid intake

Antibiotics if the specific microbe has been identified

74
Q

Who is most typically affected by Crohn’s disease?

A

Peaks ages 15-30 and 50-70

75
Q

Who is most typically affected in Ulcerative Colitis

A

Peak incidence 15-25 and 55-65

76
Q

What is the cause for Crohn’s?

A

Environmental factors with immunological factors with strong ties to genetic associations.

77
Q

What is the main cause for Ulcerative Colitis?

A

Environmental factors with immunological factors. It is an autoimmune condition triggered by colonic bacteria causing inflammation (interferon gamma and TNF alpha) in the GI tract.

78
Q

What are the main risk factors for Crohn’s?

A

NON MODIFIABLE- family history
LIFESTYLE- smoking
PMH- appendectomy
IATROGENIC- NSAIDs, oral contraceptives

79
Q

What are the main risk factors for UC?

A

NON MODIFIABLE- family history
LIFESTYLE- not smoking
IATROGENIC- oral contraceptives

80
Q

What are the main signs and symptoms of Inflammatory Bowel Disease (UC + Crohn’s)

A

BLOODY DIARRHOEA
COLICKY ABDO PAIN in the right iliac fossa
PAIN on defecation
WEIGHT LOSS
NIGHT SWEATS
SYSTEMIC ILLNESS- fever, malaise
EXTRA-INTESTINAL MANIFESTATIONS- Pauci-articular arthritis, Erythema Nodosum, Apthous ulcers, Episcleritis, Metabolic bone disease

81
Q

What are the clinical signs for IBD?

A

Tachycardia
Hypotension
Abdo tenderness/ palpable masses
Mouth ulcers (Crohn’s)

82
Q

What are the differential diagnoses for IBD?

A 
Infective colitis
Colorectal cancer
Diverticular disease
Coeliac disease
Anal fissure
Pseudomembranous colitis
Ischaemic colitis
Malignancy
Behcet's
IBS
83
Q

What would be the investigations for IBD?

A

BLOODS- FBC, CRP, ESR, U+E, LFTs
STOOL SAMPLE
TISSUE TRANSGLUTAMINASE

84
Q

What is the best management for Crohn’s disease?

A

Glucocorticosteroid
Infliximab and adalimumab mediate in Crohn’s.
Smoking cessation
Azathioprine

85
Q

What is the best management for Ulcerative Colitis?

A 
Aminosalicylates (Mesalazine, 5-ASA)
Corticosteroids
Thiopurines
Ciclosporin
Infliximab
Stool bulking agents
86
Q

What are some of the complications of IBD?

A

Colorectal cancer

Osteoporosis

87
Q

Who is most commonly affected by IBS?

A

WOMEN

Commonly affects 20-30yrs of age

88
Q

What is the cause of IBS?

A

Some of the suggested underlying processes include: abnormal GI motility, visceral hypersensitivity, abnormal GI immune function, abnormal autonomic activity, abnormal CNS modulation

89
Q

What are the risk factors of IBS?

A

NON-MODIFIABLE- female, age, family history

90
Q

What are the symptoms of IBS

A

A.B.C
Abdo pain/discomfort
Bloating
Change in bowel habit

Altered stool passage/bowel frequency, passage of mucus
Symptoms made worse by eating.

91
Q

What are some of the differential diagnoses for IBS?

A

SYSTEMIC- Unintentional/ unexplained weight loss,
UPPER GI- coeliac disease, GORD, PUD, gallstones, chronic pancreatitis
LOWER GI- rectal bleeding, abdo/rectal mass, functional/drug-induced constipation, IBD, laxative abuse, antibiotic associated diarrhoea (c.diff colitis), diverticular disease.

92
Q

What are the best management options for IBS?

A

LIFESTYLE- Identify a source of stress and advise relaxation, reduced fibre intake, regular meals and eat slowly, physical activity, probiotics.
ANTI-MOTILITY- Loperamide

93
Q

Who is most likely to be affected by peptic ulcers?

A

MEN

Elderly

94
Q

What is the main cause of peptic ulcer disease?

A

H.PYLORI infection

Also NSAIDs

95
Q

What are the main risk factors associated with peptic ulcers?

A

MODIFIABLE- smoking, alcohol, stress, steroids

NON-MODIFIABLE- pepsin, bile acid

96
Q

What are the main symptoms of peptic ulcers?

A

PAIN- epigastric

bloating, heartburn, nausea/vomiting

97
Q

What are the main differential diagnoses for peptic ulcers?

A

AAA, GORD, gastric cancer, CHD, IBD, drug induced dyspepsia, hepatitis, zollinger-ellison syndrome, diverticular disease, chronic pancreatitis, gallstones.

98
Q

What are the best investigations needed for peptic ulcers?

A

BLOODS- FBC
IMAGING- endoscopy in iron deficiency anaemia, chronic blood loss, weight loss, progressive dysphagia, persistent vomiting, an epigastric mass.
TESTING for H.PYLORI

99
Q

What is the main treatment for peptic ulcer disease?

A

STOP NSAIDs if these are causing the PUDs

Administer PPI treatments (LAC)- lansoprazole, amoxicillin, clarithromycin.

100
Q

Who is most affected by small and large bowel obstructions?

A

MEN

101
Q

What is the cause for small bowel obstruction?

A

Mostly due to ADHESIONS, strangulated hernia, malignancy or volvulus

102
Q

What is the cause for large bowel obstruction?

A

Mostly due to colorectal malignancies found in patients over 70.

103
Q

Cause of paralytic ileus?

A

Lack of peristalsis

104
Q

What are the some of the risk factors of small and large bowel obstruction?

A

Alzheimer’s, Parkinson’s, MS, quadriplegia, schizophrenia, gallstone, body packers of drugs, Hirschsprung’s disease

105
Q

What are the symptoms of small and large obstruction?

A

PAIN
LACK OF BOWEL MOVEMENT
DYSPHAGIA
NAUSEA/VOMITING (faecal vomiting usually means lower obstruction)

106
Q

Clinical signs of small and large bowel obstruction include?

A

Distended abdomen
Active and tinkling bowel sounds
Signs of dehydration

107
Q

What are some of the differential diagnoses associated with small and large bowel destruction?

A

Bowel ischaemia, gastroenteritis, pancreatitis, PUD, diverticular disease

108
Q

What investigations are necessary for suspected bowel obstruction?

A

BLOODS- FBC, U+Es, creatinine

IMAGING- CT, X-RAY

109
Q

What is the treatment necessary for bowel obstruction?

A

MEDICAL- Fluid resuscitation, electrolyte replacement, intestinal decompression
SURGERY- Endoscopic self- expanding stents, resections
IMAGING- Sigmoidoscopy

Core Conditions (11 decks)

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