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Gastroenterology > General GI > Flashcards

General GI Flashcards

1
Q

What are some causes of abdominal distention?

A 
ascites 
bowel obstruction 
peritonitis 
enlarged intra-abdominal organs 
obesity 
pregnancy 
volvulus
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2
Q

What are some causes of ascites?

A

liver failure
nephrotic syndrome
malignancy

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3
Q

What are some differentials of abdominal pain?

A 
peptic ulcer disease 
biliary tract disease 
pancreatic disease 
endometriosis
AAA
ectopic pregnancy 
renal colic 
acute pyelonephritis 
diverticular disease
appendiciti 
IBS 
mesenteric ischaemia 
intussuseption 
dysmenorrhoea
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4
Q

What are some causes of change in bowel habit?

A 
carcinoma of large bowel
diverticular disease 
IBD 
toddler's diarrhoea 
IBS
Diet 
infectious causes 
malabsorption/pancreatic
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5
Q

What are some causes of diarrhoea?

A 
infective 
IBD
motility disorder 
GI malignancy 
malahsorption 
blind loop syndrome 
cholera
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6
Q

What are some causes of haematemesis?

A 
peptic ulcer disease 
oesophageal-gastric varices
Mallory-Weiss tear 
gastritis (NSAIDs)
malignancy 
bleeding disorders
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7
Q

What are some causes of vomting, nausea or anorexia?

A 
local cause (e.g. malignancy, gastritis, food poisoning)
systemic (pregnancy, infectious)
drug side effects 
CNS disroder (raised ICP, migraine)
non-organic (anorexia, bulimia)
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8
Q

What are some causes of abdominal mass?

A 
heptamegaly, splenomegaly, enlarged kidneys
bowel mass
enlarged bladder 
AA
uterine or ovarian masss
abdominal wall hernia 
lymph nodes 
infective cause
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9
Q

What are some causes of anorectal pain?

A 
fissure-in-ano
thrombosed haemorrhoids
carcinoma 
fistuale 
pilonidal sinus/abscess
perianal abscess
rectal prolapse 
trauma
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10
Q

What are some causes of constipation?

A 
constitutional, dietary
carcinoma of large bowel
laxative abuse 
drug related e.g. opiates 
Hirschprung
hypothyroid 
hyperparathyroidism
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11
Q

What are some causes of dysphagia?

A

oesophageal cancer

gastro-oesophageal reflux disease

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12
Q

What are some causes of rectal bleeding?

A 
haemorrhoids 
fissure-in-ano
cancer 
IBD
angiodysplasia 
ischaemia colitis 
melaena
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13
Q

What should be included in a history for dysphagia?

A 
duration 
solids or liquids or both 
pain 
weight loss 
PMH 
meds 
cigarettes or alcohol 
cough, nasal regurg
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14
Q

How would you treat dysphagia?

A

underlying cause

nutritional support if needed

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15
Q

What are some causes of GI bleed?

A 
oesophagitis 
peptic ulcer 
varices 
erosive duodenitis or gastritis 
mallory weiss tear
malignancy 
vascular malformation
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16
Q

What are some causes of diarrhoea?

A 
surgical - ischaemic, diverticulitis 
medical - drugs, IBD
travel 
gastroenteritis 
osmotic - lactose/fructose intolerance 
secretory - ion absorption 
malabsorption - pancreatic insufficiency, Crohn's, coeliac
abnormal motility - post vagotomy, IBS, carcinoid
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17
Q

What is achalasia?

A

lower oesophageal sphincter fails to open during swallowing

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18
Q

What would you see on barium swallow for achalasia?

A

‘birds beak’ appearance

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19
Q

What are some occult symptoms and test results of GI bleed?

A

fainting
nausea
high urea (not matched with creatinine)
low Hb

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20
Q

What test is mandatory for gastric ulcers?

A

Repeat gastroscopy 6-8 weeks later

- benign ulcers can be early malignant ones

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21
Q

What are the 4 classical symptoms of bowel obstruction?

A 
vomiting 
abdo distention 
constipation 
abdo pain (colic)
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22
Q

What happens in refeeding syndrome?

A

fluid-balance abnormalities
abnormal glucose metabolism
low phosphate, potassium, magnesium and thiamine

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23
Q

What would cause the different colour of ascitic tap?

A

straw = cirrhosis, malignancy, TB
chylous (milky) = cirrhosis, obstruction of lymphatic duct
haemorrhagic = abdominal trauma, malignancy,ectopic pregnancy

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24
Q

Waht are the 5 main types of malabsorption?

A 
Defective intraluminal digestion (e.g. bacterial overgrowth)
Insufficienct absorptive area (e.g. Crohn's)
Lack of digestive enzymes (e.g. lactose intolerance) 
Defective transpot (e.g. primary bile acid malabsorption)
Lymphatic obstruction
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25
Q

What are the 2 types of oesophageal cancer?

A 
oesophageal adenocarcinoma (normal - metaplastic glandular - dysplastic - neoplastic) 
squamous oesophageal cancer
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26
Q

What is diverticular disease?

A

pockets developing in the lining of the intestine which can become inflamed (diverticulitis)

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27
Q

How would you diagnose diverticular disease?

A

bariumenema, colonoscopy

28
Q

How would you treat diverticular disease?

A

diet advice
antibiotics
IV fluids
bowel rest

29
Q

What are some symptoms of oesophageal cancer?

A

dysphagia, vomiting, anaemia, weight loss, reflux, indigestion

30
Q

How would you diagnose an oesophageal cancer?

A

endoscopy, and biopsy

31
Q

How would you treat an oesophageal cancer?

A

surgery - resection, stent

palliative

32
Q

How would you test for coeliac disease?

A

bloods - EMA/tTG (HLA DQ2/HLA DQ8 antibodies)

gold standard is duodenal biopsy and endoscopy showing villous atrophy and crypt hyperplasia

33
Q

How would you stage gastric cancer?

A

early - submucosal (in lymph nodes), 90% 5 year survival

late - invaded the muscle wall, 60% 5 year survival

34
Q

How would you treat GORD?

A 
lifestyle 
PPI e.g. lansoprazole 
antacids 
H2 receptor blockers e.g. ranitidine 
Nissen fundoplication (reinforces LOS)
35
Q

What are some complications of GORD?

A

Barrett’s oesophageus
aneamia
LOS stricture

36
Q

What are some symptoms of IBS?

A

abdominal pain, bloating, change in bowel habit

- one day a week for at least 3 months

37
Q

Why does IBS occur?

A

nerves from embryonic neural crest form the gut and the brain - link between brain and bowels

38
Q

How would you treat ulcerative colitis?

A 
aminosalicylates e.g. mesalazine 
corticosteroids 
immunosuppressants e.g. azathioprine, cyclosporin
infliximab 
surgery
39
Q

How would you treat gastric cancer?

A

surgery (Roux-en-Y)
laproscopic
pre-op chemo
analgesia, physio, fluid balanced, feeding tube

40
Q

Which genetic factors increase risk of colorectal cancer?

A

familial adenomatous polyposis
HNPCC
family clustering

41
Q

What is a pilonidal sinus and its symptoms?

A

ingrown hair follicle in natal cleft

= foul smelling discharge, acute pain, pus

42
Q

What are the symptoms of ascites?

A

distended abdomen, dull percussion, shifting dullness

43
Q

How would you test for ascites?

A

history
US of liver
ascitic tap - transudate/exudate

44
Q

How would you treat oesophageal varices?

A

prevention - BB, elastic bands
Bleeding - elastic bands decrease blood to portal vein so blood is shunted away from it
Restore blood volume
prevent infection

45
Q

What is a volvulus?

A

twisting of sigmoid colon on its mesentry

looks like coffee bean on XR

46
Q

How would you treat a volvulus?

A

decompression by sigmoidoscope and insertion of a flatus tube
sigmoid colectomy

47
Q

What is the difference in treatment for the 2 types of inguinal hernias?

A

Reduce both
Indirect (from deep to external ring) stays in when cough after reduction
Direct (from posterior canal) is easier to reduce, strangulates less often

48
Q

What are the common mechanisms for formation of gastric ulcer?

A 
mucosal ischaemia
increased acid
drugs - e.g. aspirin, NSAIDs
bile reflux 
helicobacter pylori
49
Q

What is the treatment for a gastric ulcer?

A

PPI

H2 blockers

50
Q

How would you diagnose pancreatitis?

A

serum amylase and lipase

CT, XR, US

51
Q

How would you treat pancreatitis?

A

anaglesia, catheterise, drain, antibiotics, surgery, bowel rest

52
Q

What are some causes of pancreatitis?

A

GET SMASHED

gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion stings, hyperlipidaemia, ERCP, drugs

53
Q

What is the treatment for IBS?

A

education - diet (low FODMAP), triggers, exercise
antispasmodics, laxatives, anti-motility
antidepressants
psychological therapies

54
Q

What are the 5 main different diagnosis of IBS?

A 
coeliac disease 
IBD 
lactose intolerance 
bile malabsorption 
colorectal cancer
55
Q

How would you test for peritonitis?

A 
history 
bloods
XR of chest and abdo 
B-HCG
ECG
56
Q

How would you treat peritonitis?

A

ABCDE
treat underlying cause
primary - broad spectrum antibiotics
call surgeon

57
Q

What is the difference between Crohn’s and ulcerative colitis?

A

UC: colon only, inflammation of mucosa only, continous ulceration
CD: all of GI tract, inflmmation of entire gut wall (mucosa, muscle, adventitia), skip lesions, gramulomatous

58
Q

How would you treat Crohn’s disease?

A 
lifestyle 
corticosteroids 
aminoscalicylates 
immunosuppressants 
biological therapies 
surgery
59
Q

How would you stage colorectal cancer?

A 
Duke's 
A - not in wall 
B - penetrates muscle 
C - in lymph nodes 
D - metasteses
60
Q

What are the classifications of hiatus hernias?

A

sliding - stomach pulled through diaphragm at site of oesphagus
Rolling - stomach pulled through diaphragm at seperate site to oesophagus

61
Q

What is peritonitis?

A

infection of peritoneal cavity

62
Q

What are some common causes of peritonitis?

A 
surgery 
spontanous 
secondary to dialysis 
ectopic pregnancy 
abdominal TB
63
Q

How do oesophgeal varices form?

A

portal hypertension causes blood to enter back into systemic blood whenever possible causing oesophageus and rectum to be overloaded

64
Q

How common is GORD and what are some risk factors?

A

30% of population

RF: hiatus hernia, diet (fat, chocolate), alcohol, obesity, smoking, dysfunctional LOS

65
Q

What is achlasia?

A

lower oesphageal sphincter fails to close

= dysphagia, regurgitation, substernal cramps, weight loss

Gastroenterology (3 decks)

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