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JMS Investigation and Management > Gastrointestinal Ix and Mx > Flashcards

Gastrointestinal Ix and Mx Flashcards

1
Q

Iron deficiency anaemia Investigations

A 
• FBC + ferritin 
• U&Es
• CRP
Investigate for blood loss:
• Do they have menorrhagia 
• Otherwise investigate for GI blood loss → gastroscopy, sigmoidoscopy, barium enema or colonoscopy.
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2
Q

Iron deficiency anaemia Management

A
  • Treat the cause
  • Oral iron e.g. ferrous sulphate
  • Blood transfusion
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3
Q

Colorectal cancer Investigations

A
  • FBC + faecal occult blood + Ca2+
  • U&Es
  • CRP
  • LFT
  • Sigmoidoscopy
  • Barium enema or Colonoscopy
  • CT/MRI to help stage the cancer
  • Liver USS
  • Carcinoembryonic antigen
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4
Q

Colorectal cancer Management

A

Surgery: aims to cure and may increase survival time by >50%
• Right hemi-colectomy → caecal cancer, ascending or proximal transverse colon tumours.
• Left- hemicolectomy → For tumours in the distal transvers or descending colon.
• Sigmoid colectomy → for sigmoid tumours
• Anerior resection → for low sigmoid or high rectal tumours
• Abdomino-perineal resection → for tumours low in the rectum: permenant colostomy and removal of rectum and anus.
• Hartmanns procedure → if emergency bowel obstruction or bowel perforation.
Radiotherapy → mostly used in pallitive care for colorectal cancer
Chemotherapy → reduces dukes C mortality by 25%. In dukes B there is an absolute survival benefit by about 3-5%.

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5
Q

Gasteroenteritis Investigations

A
  • FBC
  • U&Es
  • CRP
  • Stool MC&S
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6
Q

Gasteroenteritis Management

A
  • IV fluids

* Anti-emetics

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7
Q

Intestinal obstruction Investigations

A
  • FBC + amylase + lipase + Ca2+ + glucose
  • U&Es
  • CRP
  • Liver enzymes → AST, ALT (raised in liver pathology) ALP, GGT (raised in biliary tree pathology)
  • Albumin → good prognostic factor if patient has pancreatitis
  • ABG
  • ECG
  • AXR
  • Erect CXR
  • CT if clinical and radiographic findings are i nconclusive
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8
Q

Intestinal obstruction Management

A
  • ABCD approach
  • Analgesia + anti-emetics
  • Drip and suck – NGT
  • IV fluids
  • Catheterize
  • Strangulation and closed loop obstruction needs immediate surgery
  • Hartmanns procedure → if perforation or in emergency bowel obstruction
  • Stents may be used for obstructing large bowel malignancies
  • Small bowel obstructions secondary to adhesions should rarely lead to surgery.
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9
Q

Epigastric pain, jaundiced and sitting forward - Investigations

A
  • FBC + glucose + troponin + amylase + lipase
  • U&Es
  • CRP
  • Liver enzymes → AST, ALT (raised in liver pathology) ALP, GGT (raised in biliary tree pathology)
  • Albumin → good prognostic factor if patient has pancreatitis
  • Calcium levels → good prognostic factor if patient has pancreatitis
  • ABG
  • ECG
  • AXR
  • Erect CXR
  • Abdominal ultrasound → exclude gallstones and AAA
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10
Q

Epigastric pain, jaundiced and sitting forward - Management

A
  • ABCD approach
  • IV fluids
  • Oxygen
  • Nill by mouth
  • Analgesia + anti-emetics
  • Catheter
  • DVT prophylaxis
  • Hourly pulse, BP and urine output
  • Daily FBC + amylase + lipase + Ca2+ + glucose and ABG
  • ERCP and gallstone removal if LFTs worsen and there is progressive jaundice
  • Repeat imaging in order to monitor progress
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11
Q

RUQ Investigations

A
  • FBC + amylase + lipase + Ca2+ + Albumin
  • Blood cultures if suspect ascending cholangitis
  • Liver enzymes → AST, ALT (raised in liver pathology) ALP, GGT (raised in biliary tree pathology)
  • Bilirubin
  • Erect CXR
  • AXR
  • Ultrasound
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12
Q

RUQ (If cholecystitis) Management

A
  • Nil by mouth
  • IV fluids
  • Analgesia and anti-emetics
  • IV Antibiotics (cefuroxime)
  • Laparascopic cholecystectomy if operative
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13
Q

RIF pain Investigations

A
  • Bloods + glucose + amylase + lipase
  • CRP
  • U&Es
  • Liver enzymes → AST, ALT (raised in liver pathology) ALP, GGT (raised in biliary tree pathology)
  • Urinalysis
  • AXR
  • Abdominal ultrasound
  • Erect CXR
  • Abdominal CT → good for preoperative incision planning aiding discussion of stomas
  • ECG → atypical presentation of MI in elderly patients
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14
Q

RIF pain (if appendicitis) Management

A
  • ABCD approach
  • IV fluids
  • Analgesia and anti-emetics
  • Nil by mouth prior to surgery
  • Peri-operative broad spectrum antibiotics
  • Appendectomy
  • DVT prophylaxis
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15
Q

LIF Investigations

A 
• Bloods 
• U&Es
If diverticulitis:
• Abdominal CT with contrast 
• Erect CXR
• AXR
If premenopausal:
• Transabdominal +- transvaginal ultrasound
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16
Q

LIF (Diverticulitis and perforation) Management

A 
Diverticulitis:
• Analgesia and anti-emetics 
• Bowel rest by clear fluids
• Antibiotics 
• Monitor → if symptoms haven’t improved within 48-72 hours further investigation is required to rule out an abscess or if initial diagnosis was wrong 
If perforated diverticulitis:
• Fluid restriction 
• Bloods + clotting and cross match 
• Analgesia 
• Antibiotics 
• CT
• Emergency laparotomy
17
Q

Flank pain (Ureteric colic) Investigations

A
  • FBC + Ca2+ + phosphate + urate
  • U&Es
  • Urinalysis
  • Urine microscopy, culture and sensitivity (MC&S)
  • CRP
  • CT-Kidney, ureters and bladder
18
Q

Flank pain (Ureteric colic) Management

A
  • ABCD approach
  • 0.5stone diameter → Lithotripsy, Ureterorenoscopic removal, stenting, antibiotic cover if an invasive procedure is employed.

JMS Investigation and Management (4 decks)

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