General GI Flashcards
What are some causes of abdominal distention?
ascites bowel obstruction peritonitis enlarged intra-abdominal organs obesity pregnancy volvulus
What are some causes of ascites?
liver failure
nephrotic syndrome
malignancy
What are some differentials of abdominal pain?
peptic ulcer disease biliary tract disease pancreatic disease endometriosis AAA ectopic pregnancy renal colic acute pyelonephritis diverticular disease appendiciti IBS mesenteric ischaemia intussuseption dysmenorrhoea
What are some causes of change in bowel habit?
carcinoma of large bowel diverticular disease IBD toddler's diarrhoea IBS Diet infectious causes malabsorption/pancreatic
What are some causes of diarrhoea?
infective IBD motility disorder GI malignancy malahsorption blind loop syndrome cholera
What are some causes of haematemesis?
peptic ulcer disease oesophageal-gastric varices Mallory-Weiss tear gastritis (NSAIDs) malignancy bleeding disorders
What are some causes of vomting, nausea or anorexia?
local cause (e.g. malignancy, gastritis, food poisoning) systemic (pregnancy, infectious) drug side effects CNS disroder (raised ICP, migraine) non-organic (anorexia, bulimia)
What are some causes of abdominal mass?
heptamegaly, splenomegaly, enlarged kidneys bowel mass enlarged bladder AA uterine or ovarian masss abdominal wall hernia lymph nodes infective cause
What are some causes of anorectal pain?
fissure-in-ano thrombosed haemorrhoids carcinoma fistuale pilonidal sinus/abscess perianal abscess rectal prolapse trauma
What are some causes of constipation?
constitutional, dietary carcinoma of large bowel laxative abuse drug related e.g. opiates Hirschprung hypothyroid hyperparathyroidism
What are some causes of dysphagia?
oesophageal cancer
gastro-oesophageal reflux disease
What are some causes of rectal bleeding?
haemorrhoids fissure-in-ano cancer IBD angiodysplasia ischaemia colitis melaena
What should be included in a history for dysphagia?
duration solids or liquids or both pain weight loss PMH meds cigarettes or alcohol cough, nasal regurg
How would you treat dysphagia?
underlying cause
nutritional support if needed
What are some causes of GI bleed?
oesophagitis peptic ulcer varices erosive duodenitis or gastritis mallory weiss tear malignancy vascular malformation
What are some causes of diarrhoea?
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
What is achalasia?
lower oesophageal sphincter fails to open during swallowing
What would you see on barium swallow for achalasia?
‘birds beak’ appearance
What are some occult symptoms and test results of GI bleed?
fainting
nausea
high urea (not matched with creatinine)
low Hb
What test is mandatory for gastric ulcers?
Repeat gastroscopy 6-8 weeks later
- benign ulcers can be early malignant ones
What are the 4 classical symptoms of bowel obstruction?
vomiting abdo distention constipation abdo pain (colic)
What happens in refeeding syndrome?
fluid-balance abnormalities
abnormal glucose metabolism
low phosphate, potassium, magnesium and thiamine
What would cause the different colour of ascitic tap?
straw = cirrhosis, malignancy, TB
chylous (milky) = cirrhosis, obstruction of lymphatic duct
haemorrhagic = abdominal trauma, malignancy,ectopic pregnancy
Waht are the 5 main types of malabsorption?
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
What are the 2 types of oesophageal cancer?
oesophageal adenocarcinoma (normal - metaplastic glandular - dysplastic - neoplastic) squamous oesophageal cancer
What is diverticular disease?
pockets developing in the lining of the intestine which can become inflamed (diverticulitis)
How would you diagnose diverticular disease?
bariumenema, colonoscopy
How would you treat diverticular disease?
diet advice
antibiotics
IV fluids
bowel rest
What are some symptoms of oesophageal cancer?
dysphagia, vomiting, anaemia, weight loss, reflux, indigestion
How would you diagnose an oesophageal cancer?
endoscopy, and biopsy
How would you treat an oesophageal cancer?
surgery - resection, stent
palliative
How would you test for coeliac disease?
bloods - EMA/tTG (HLA DQ2/HLA DQ8 antibodies)
gold standard is duodenal biopsy and endoscopy showing villous atrophy and crypt hyperplasia
How would you stage gastric cancer?
early - submucosal (in lymph nodes), 90% 5 year survival
late - invaded the muscle wall, 60% 5 year survival
How would you treat GORD?
lifestyle PPI e.g. lansoprazole antacids H2 receptor blockers e.g. ranitidine Nissen fundoplication (reinforces LOS)
What are some complications of GORD?
Barrett’s oesophageus
aneamia
LOS stricture
What are some symptoms of IBS?
abdominal pain, bloating, change in bowel habit
- one day a week for at least 3 months
Why does IBS occur?
nerves from embryonic neural crest form the gut and the brain - link between brain and bowels
How would you treat ulcerative colitis?
aminosalicylates e.g. mesalazine corticosteroids immunosuppressants e.g. azathioprine, cyclosporin infliximab surgery
How would you treat gastric cancer?
surgery (Roux-en-Y)
laproscopic
pre-op chemo
analgesia, physio, fluid balanced, feeding tube
Which genetic factors increase risk of colorectal cancer?
familial adenomatous polyposis
HNPCC
family clustering
What is a pilonidal sinus and its symptoms?
ingrown hair follicle in natal cleft
= foul smelling discharge, acute pain, pus
What are the symptoms of ascites?
distended abdomen, dull percussion, shifting dullness
How would you test for ascites?
history
US of liver
ascitic tap - transudate/exudate
How would you treat oesophageal varices?
prevention - BB, elastic bands
Bleeding - elastic bands decrease blood to portal vein so blood is shunted away from it
Restore blood volume
prevent infection
What is a volvulus?
twisting of sigmoid colon on its mesentry
looks like coffee bean on XR
How would you treat a volvulus?
decompression by sigmoidoscope and insertion of a flatus tube
sigmoid colectomy
What is the difference in treatment for the 2 types of inguinal hernias?
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
What are the common mechanisms for formation of gastric ulcer?
mucosal ischaemia increased acid drugs - e.g. aspirin, NSAIDs bile reflux helicobacter pylori
What is the treatment for a gastric ulcer?
PPI
H2 blockers
How would you diagnose pancreatitis?
serum amylase and lipase
CT, XR, US
How would you treat pancreatitis?
anaglesia, catheterise, drain, antibiotics, surgery, bowel rest
What are some causes of pancreatitis?
GET SMASHED
gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion stings, hyperlipidaemia, ERCP, drugs
What is the treatment for IBS?
education - diet (low FODMAP), triggers, exercise
antispasmodics, laxatives, anti-motility
antidepressants
psychological therapies
What are the 5 main different diagnosis of IBS?
coeliac disease IBD lactose intolerance bile malabsorption colorectal cancer
How would you test for peritonitis?
history bloods XR of chest and abdo B-HCG ECG
How would you treat peritonitis?
ABCDE
treat underlying cause
primary - broad spectrum antibiotics
call surgeon
What is the difference between Crohn’s and ulcerative colitis?
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
How would you treat Crohn’s disease?
lifestyle corticosteroids aminoscalicylates immunosuppressants biological therapies surgery
How would you stage colorectal cancer?
Duke's A - not in wall B - penetrates muscle C - in lymph nodes D - metasteses
What are the classifications of hiatus hernias?
sliding - stomach pulled through diaphragm at site of oesphagus
Rolling - stomach pulled through diaphragm at seperate site to oesophagus
What is peritonitis?
infection of peritoneal cavity
What are some common causes of peritonitis?
surgery spontanous secondary to dialysis ectopic pregnancy abdominal TB
How do oesophgeal varices form?
portal hypertension causes blood to enter back into systemic blood whenever possible causing oesophageus and rectum to be overloaded
How common is GORD and what are some risk factors?
30% of population
RF: hiatus hernia, diet (fat, chocolate), alcohol, obesity, smoking, dysfunctional LOS
What is achlasia?
lower oesphageal sphincter fails to close
= dysphagia, regurgitation, substernal cramps, weight loss
