GI Flashcards
Dysphagia:
Achalasia- Features?
Hx?
Achalasia ↑LOS tone, ↓LOS relaxation, ↓Peristalsis • History o Younger (25-40) o Non-smoker + non-drinker o Solid+liquid dysphagia @ SAME TIME progressively gets worse
Achalasia: Ix, Mx?
• Investigations
o Initial Tests:
Barium swallow
• Tapering of oesophagus/rats tail/birds beak
o Best Test: Manometry
High LOS pressure which fails to relax on swallowing
• Treatment
o First: Heller Myotomy (removal of LOS) + PPI (after) as ↑↑GORD
90% cure rate
Oesophageal Tumours
• Types?
• Types:
o Adenocarcinoma
Cause: GORD
o SCC
Cause: Smoking, alcohol
Dysphagia: Oesophageal Tumours: Features? Ix & Mx?
• Features:
o Dysphagia (solid liquid)
o Weight loss (significant)
• Ix:
o First: Barium swallow
o Best: Endoscopy + Biopsy
o Confirmed cancer: CT CAP
• Rx: Stenting, Radio, Chemo, Surgery
Dysphagia: Diffuse Oesophageal Spasm + Nutcracker Oesophagus: Features, Ix & Mx?
• Features
o History of INTERMITTENT chest PAIN associated with swallowing (sometimes)
• Investigations
o Initial test: Barium swallow Corkscrew oesophagus
o Best test: Manometry
DOS <180mmHg
Nutcracker >180mmHg
• Treatment
o CCB
Dysphagia: Pharyngeal Pouch/Zenker’s diverticulum: Features, Ix & Mx?
• Features o Old male (>70; 5:1 M:F) o Bad breath/halitosis o Regurgitation of undigested food o Neck bulge + gurgling on swallowing
• Investigations
o Best test: Barium swallow
o DO NOT DO ENDOSCOPY
o DO NOT INSERT NASOGASTRIC TUBE
• Treatment
o Diverticulectomy
GORD: Modifiable risk factors & Symptoms?
• Modifiable Risk: Smoking, Alcohol, Caffeine, Spicy food
• Symptoms o Upward flow of acid symptoms Waterbrash reaction Pain radiating to sternum/neck, worse on lying down, better on sitting up Metallic taste in mouth Sore throat + odynophagia o Downward flow of acid symptoms (into trachea region) Hoarse voice Chronic dry cough
GORD: Ix, Mx?
• Ix:
o No investigations – treat empirically
• Rx:
o First: Medical
First: Full dose PPI x1month + LIFESTYLE
If recurs: Lowest effective dose PPI long-term + LIFESTYLE
Still refractory: Increase dose PPI
Full dose PPI fails: Add H2RA (e.g. ranitidine)
o Refractory to MedRx: Surgery
Nissen fundoplication
Peptic Ulcer Disease (PUD – Gastric Ulcer + Duodenal Ulcer): Causes, Symptoms, Dx & Mx?
• Causes
o Helicobacter Pylori
o NSAIDs
• Symptoms
o Epigastric pain + tenderness (on palpation)
o Melena/haematemesis
• Diagnosis
o Best: Endoscopy Look for ulcers, and treat (adrenaline, cautery, clip)
• Treatment
o H pylori absent, NSAID-induced: Lifestyle mod + NSAID removal + PPI
o H pylori present, healing:
First line: Triple therapy (double-dose PPI BD + Clarithromycin + Metro/Amox)
Coeliac disease: Pathophysiology & symptoms?
• Pathophysiology Repeated gluten intake = villous atrophy = malabsorption
• Symptoms o Abdominal pain/cramping o Steatorrhoea o Floating stools o Weight loss 2nd to diarrhoea o Fat soluble vitamin deficiency Vit A, Vit D Hypocalcaemia, Vit E, Vit K Bleeding o Reaction to wheat products
Coeliac Disease: Ix & Mx?
• Investigations
o Antibodies
First:
• Anti-TTG
NB: Abs become NEGATIVE after weeks/months of gluten-free diet
Before testing, ask patient to introduce gluten for 6wk prior to testing
• Best: SB biopsy (Duodenal – D2)
o Findings
Subtotal villous atrophy
Crypt hyperplasia
o MUST be done to exclude lymphoma
• Treatment:
o Conservative: MDT, education, dietician input, gluten free diet
Acute Pancreatitis
• Cause?
GET SMASHED:
Acute pancreatitis: Signs & symptoms?
• Signs and Symptoms
o Sudden onset epigastric pain radiating to back
o N+V (heavy vomiting) – 90%
Acute Pancreatitis: Ix?
• Investigations:
o Blood
Amylase
Lipase
o USS
Acute Pancreatitis: Mx?
• Treatment:
o First:
Heavy IV fluid
Pain relief
o If identified CBD stone:
ERCP
Admit to ITU/HDU if ≥3 of PANCREAS (Glasgow Prognostic Score) PaO₂ <8kPa Age >55 Neutrophils (WBC >15) Calcium <2 Renal (Urea >16) Enzymes (LDH>600, AST>200) Albumin <32 Sugar >10
IBD: Types, epidemiology?
• Types
o Crohn’s disease
o Ulcerative colitis
• Epidemiology
o CD
15-25 y/o
Affects entire bowel (mouth to anus)
o UC
15-30 + 60-80
Affects colon only
IBD: Symptoms?
Symptoms in IBD
• Common:
o Primary Symptoms: Pain, Diarrhea, Weight loss, Fever
o Extra-Intestinal Manifestations (30% of IBD [NB: %s reflect proportion of IBD who get EIM)
Joint (e.g. enteropathic arthritis) – 25%
Skin
• Erythema nodosum
• Pyoderma gangrenosum
Eye
• Anterior uveitis
• Episcleritis
• Scleritis
Liver (PSC [UC])
• Different
o Crohn’s = Mucous diarrhoea, mouth ulcers, perianal disease (fissures, fistulae)
o UC = Bloody diarrhoea
IBD: Dx?
- Best: Endoscopy + Biopsy
* Normal endoscopy, but Crohn’s suspected: Video Capsule Endoscopy (CD)
IBD: Acute Treatment?
CROHN’S DISEASE:
Steroids
5-ASA/Mesalazine drugs
Infliximab
ULCERATIVE COLITIS:
5-ASA/Mesalazine drugs
ADD steroids
Infliximab
Consider emergency colectomy
IBD: Maintenance Mx?
CROHN’S DISEASE
6Mercaptopurine OR Azathioprine
Oral/rectal 5-ASA
Methotrexate
Infliximab
ULCERATIVE COLITIS
Oral/rectal 5-ASA
6-Mercaptopurine OR Azathioprine
Ciclosporin
Infliximab
Clostridium Difficile Infection AKA Pseudomembranous Colitis:
Definition, Pathology & risk factors?
• Definition: Acute exudative colitis caused predominantly by C difficile
• Pathology:
o Antibiotic use causes selective overgrowth of C difficile in gut
• Risk factors: o Abx in past TWO MONTHS (most occur 4-9d after) Clindamycin RR = 30 Cephalosporins RR = 15 Ciprofloxacin RR = 5
CD infection: Features, Ix & Mx?
• Features:
o Symptoms most often occur 5-10d following antibiotic therapy (but can be last 2 months)
o Fever
o Abdominal pain
o Watery diarrhea ± blood (but often not blood) - +foul smelling, ?green colour
• Ix:
o Stool C Diff toxin (80% sensitive, 95% specific) + MCS (to rule out other causes)
• Rx: Inform HPA
o Metronidazole
o Vancomycin
Colon Cancer: Epidemiology & Risk factors?
• Epidemiology Lifetime risk = 5%
• Risk factors o Diet/lifestyle (low fibre, red meat, obesity, sedentary, smoking, EtOH) Need to ask specifically o IBD o Endocrine – diabetes, acromegaly o FH o Polyposis syndromes FAP (auto dom) HNPCC (auto dom) • Colon (~45 y/o, 80% lifetime risk) • Endometrium (50%), Ovary • Stomach, Small intestine, Hepatobiliary tract, Brain, Skin
Colorectal Ca: Symptoms?
• Symptoms: o *Change in bowel habit* o *Tenesmus* o *Abdominal/rectal mass* o *Rectal bleeding* o *Night symptoms*
o WEIGHT LOSS
Colorectal Ca: Dx & MX?
• Diagnosis
o First: Blood – iron deficiency anaemia
o Best test: Colonoscopy + Biopsy
• Treatment
o Surgery
o Chemo
o Stenting
Appendicitis: Causes & Features?
• Cause: Sudden inflammation of appendix
• Features:
o Vague central colicky pain then constant RIF pain
o Fever
o N+V+D
o RIF tenderness
Tenderness maximal at McBurney’s point (2/3 from umbilicus ASIS)
Rovsing’s sign LIF palpation causes RIF pain
Appendicitis: IX & Mx?
• Ix:
o Bloods
o USS (trans-vaginal if female)
o Diagnostic laparoscopy
• Rx:
o Appendicectomy
Liver Cirrhosis- Features?
Whats the Ix & Mx for all?
Scoring?
Liver Disease + Cirrhosis
• FEATURES
o Portal hypertension
Varices
Splenomegaly
Ascites
o Poor function
Encephalopathy
↓Albumin
↑PT/INR
A nice way of remembering the Child-Pugh score
A - albumin B - bilirubin C - clotting D - distention (ascites) E - encephalopathy
Specific causes of Cirrhosis?
- Alcohol
- NAFLD
- Hepatitis B/C
- PBC
- PSC
- HH
- Wilson’s
- A1AT
- Autoimmune Hep
- Budd-Chiari
- Drug-induced
Investigation for all – USS liver, liver biopsy
Treatment for all – Liver transplant
Acute Viral Hepatic Infection/Acute Viral Hepatitis: Features of ALL?
Acute Viral Hepatic Infection/Acute Viral Hepatitis
Risk factors for Blood-born hepatitis (BCD)?
o Current or previous IVDU or intra-nasal drug use
o MSM
o Blood products
o Tattoo overseas/with unsterile needles
Hepatitis Dx?
• Diagnose:
o Routine bloods ALT
o Hep B Diagnosis: Hep B Serology
ANTIGENS
• Surface
- E
- NO core antigen (it is present, but we cannot measure it)
ANTIBODIES
• Surface
- E
- Core
o Hep C Diagnosis: Hep C RNA
Hepatitis: Mx?
o Hep B: Interferon alfa
o Hep C Treatment: Interferon + ribavirin, Sofosbuvir
Cirrhosis – Primary Biliary Cirrhosis (PBC): Definition, Epidemiology?
Features, Dx & Mx?
• Definition: Destruction of bile ducts
• Epidemiology:
o 90% women
o ~50y/o
• Features
o Middle aged (though often diagnosed even up to 70s)
o Fatigue (65%), pruritus (55%)
o Jaundice
• Diagnosis:
o High ALP
o AMA +
• Treatment:
o Ursodeoxycholic acid (best Rx; improves prognosis by slowing disease progression)
