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FCM > GI > Flashcards

GI Flashcards

1
Q

painless rectal bleeding
blood on stools - not mixed
anal itching/irritation
external small vascular lumps 2, 7, 11 o clock

A

haemorrhoids

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2
Q

haemorrhoids management

A

soften stools - dietary or laxatives
topical anaesthetic/steroids
rubber band ligation or sclerotherapy

very large haemorrhoids = surgery

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3
Q

painful bright rectal bleeding
sharp pain on passing stool
constipated

A

anal fissure

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4
Q

management of anal fissure

A 
acute = soften stool with laxative and prescribe topical analgesics 
chronic = topical GTN - consider surgery or botulinum toxin
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5
Q

pain around anus, worse on sitting
pus-like discharge from the anus
hardened tissue around anus
sometimes systemic features

A

anorectal abscess

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6
Q

management of anorectal abscess

A

surgical incision and drainage

sometimes given Abx

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7
Q

skin irritation around the anus
contant throbbing pain - worse when sitting, moving, coughing or passing stool
smelly discharge near anus
rectal bleeding

hx of rectal abscess

A

rectal fistula

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8
Q

anal fistula tx

A

surgical - fistulotomy

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9
Q

painful, tender lump which may be fluctuant and have purulent discharge. There may be accompanying cellulitis
usually at the tailbone/coccyx /natal cleft

usually male between 16-40yrs

A

pilonodal disease

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10
Q

management of pilonodal disease

A

Incision and drainage
paracetamol for pain/fever
advise long term hygiene and hair removal techniques

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11
Q

often asymptomatic
rectal bleeding, diarrhoea, abdo pain and mucous discharge
dental problems

A

polyps

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12
Q

management of polyps

A

surgical - proctocolectomy with ileostomy or total colectomy with ileorectal anastomosis

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13
Q 
persistent blood in stool 
persistent change in bowel habit 
persistent lower abdo pain , bloating or discomfort 
weight loss
loss of appetite
A

colon cancer

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14
Q

management of colon cancer

A

surgery = cancerous section removed
chemo/radiotherapy
targeted therapies

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15
Q

colon/bowel cancer screening?

A

FIT & FOB when aged 60-74 = every 2 yrs home kit

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16
Q 
commonly young pt 10-20yrs 
periumbilical pain/epigastric which radiated to RIF 
pain worse on coughing 
mild pyrexia 
anorexia 
nausea 
\+ve rovsing and psoas signs
A

acute appendicitis

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17
Q

management of acute appendicitis

A

laparoscopic appendectomy

prophylactic Abx and fluids

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18
Q 
usually in infants 6-18months 
paroxysmal abdo pain (RUQ)
vomiting 
red-currant jelly stool 
sausage shaped mass in RUQ
A

intussusception

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19
Q

investigations for intussusception

A

US = target like mass

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20
Q

Management for intussusception

A

reduction by air inflation and surgery

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21
Q

LIF abdo pain
fever, malaise
occasional rectal bleeding

A

Diverticulitis

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22
Q

management for diverticulitis

A

oral Abx, liquid diet and analgesia = mild cases

symptoms unsettled after 72hrs = admit to hospital and iV abx

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23
Q

what investigation done for diverticulitis

A

erect CXR = pneumoperitoneum (presence of air/gas in peritoneal cavity

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24
Q

abdominal pain
bloating
change in bowel habut
usually for 6 months

symptoms worsened by eating
passage of mucus
usually younger pts ~20-30ys

A

IBS

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25
Q

IBS management

A

first line - antispasmodics for pain, laxative if constiapted and loperamide if diarrhoea

second-line = low dose tricyclic eg: amitriptyline

can suggest
psychological interventions= CBT

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26
Q

management of faecal impaction in children

A

pulyethylene glycol 3350 + electrolytes / Movicol Paediatric Plain

add stimulant laxative

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27
Q 
sudden onset of diarrhoea 3 or more times 
- sometimes with blood or mucus
faecal urgency 
abdo pain/cramps 
sudden N&V
bloating flatulence, weight loss
A

gastroenteritis

infectious diarrhoea

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28
Q

what Ix should be done in gastroenteritis

A

urea breath test for H.pylori

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29
Q

management of gastroenteritis

A

If H.pylori negative = PPI
hydrate
loperamide may help
avoid transmission

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30
Q

abdominal pain - often of sudden onset, severe and out-of-keeping with physical exam findings - sometimes post-prandial
rectal bleeding
diarrhoea
fever
bloods typically show an elevated white blood cell count associated with a lactic acidosis

A

ischaemic bowel disease

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31
Q

Ix for ischaemic bowel disease

A

CT (wall thickening)

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32
Q

management of bowel ischaemia

A

intial resuscitation, iV fluids and oxygen
IV broad-spec Abx
surgery - urgent laparotomy

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33
Q 
central diffuse abdo pain 
nausea and vomiting (bilious)
constipation 
distended abdo 
'tinkling bowel sounds'

recent surgery may predispose to adhesions

A

bowel obstruction

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34
Q

investigation for bowel obstruction

A

abdo X-ray = distended bowel loops

CT gives definitive diagnosis

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35
Q

management of bowel obstruction

A

nil by mouth, IV fluids, NG tube

some may require surgery

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36
Q

pain, distention of the abdomen, fever, rapid heart rate, and dehydration, altered mental status

A

toxic megacolon

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37
Q

management of toxic megacolon

A

IV fluids and Abx

colectomy

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38
Q 
diarrhoea 
prominent weight loss 
ulcers, perianal disease 
skip lesions 
lesions from mouth to anus 
cobblestone appearance 
associated with gallstones 
granulomas  and increase goblet cells 
all layers of submucosa inflamed
A

Crohn’s disease

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39
Q 
bloody diarrhoea 
LLQ pain 
tenesmus 
continuous disease does not surpass the ileorectal valve 
crypt abscesses 
widespread ulceration and pseudopolyps 
lower goblet cells and granuloma
A

Ulcerative colitis

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40
Q

drainpipe colon, loss of haustrations

A

ulcerative colitis

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41
Q

management of ulcerative colitis

A

mild cases = topical rectal aminosalicylate (-salazines)

severe = hospital admission - IV steroid /cyclosporin
surgery if no improvement in 72hrs

maintaining = oral azathioprine/mercaptopurine

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42
Q

management of crohn’s

A

first line = glucocorticoids or budesonide
second line = aminosalicylates

can add oral azathioprine/mercaptopurine

eventual surgery

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43
Q 
acidic taste in mouth 
persistent cough (at night)
retrosternal pain 
sore throat 
dyspepsia 
halitosis
A

oesophagitis

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44
Q

investigations of oesophagitis

A

endoscopy and pH testing

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45
Q

management of oesophagitis

A

antacids PPI 12 months or H2Rs

keyhole surgery = tighten lower oesophageal sphincter

46
Q 
haematemesis 
melaena 
abdo pain 
dysphagia/odynophagia 
encephalopathy 
pallor, hypTN, signs of sepsis
A

oesophageal varices

47
Q

management of oesophageal varices

A

vasoactive drugs - adrenaline
endoscopic band ligation
prophylactic antibiotics

48
Q 
progressive dysphagia 
heartburn 
food impaction 
chest pain 
weight loss 
persistent cough
A

oesophageal stricture

49
Q

oesophageal stricture Ix

A

endoscopy, barium swallow, FBC and iron studies

50
Q

management of oesophageal stricture

A

oesophageal dilation with endoscopy

and long term PPI use

51
Q

Usually history of antecedent vomiting.
This is then followed by the vomiting of a small amount of blood.
little systemic disturbance or prior symptoms.

repeated vomiting after binge drinking, severe morning sickness and bulimia

A

mallory weiss tears

52
Q

mallory weiss tear Ix

A

upper endoscopy

53
Q

management of mallory weiss tears

A

initial resuscitation and correct fluid loss

54
Q

change from squamous epithelium to columnar epithelium
usually asymptomatic
some GORD symptoms

A

barrett’s oesophagus

55
Q

management of barrett’s oesophagus

A

endoscopic surveillance
and high dose PPI

resection - resection/ablation

56
Q

dysphagia of BOTH liquids and solids
typically variation in severity of symptoms
heartburn
regurgitation of food
may lead to cough, aspiration pneumonia etc
malignant change in small number of patients

A

achalasia/oesophageal dysmotility

57
Q

investigations of achalasia/oesophageal dysmotility

A

oesophageal manometry
barium swallow = ‘birds beak appearance’
chest-X-ray = wide mediastinum

58
Q

management of achalasia/oesophageal dysmotility

A

pneumatic (balloon) dilation first-line

surgical intervention with a heller cardiomyotomy

intra-sphincteric injection of botulinum toxin

59
Q

retrosternal burning pain
dyspepsia
halitosis
acid brash

A

GORD

60
Q

GORD Ix

A

24hr pH oesophageal monitoring

upper GI endoscopy

61
Q

management of GORD

A

high dose PPI for 1 month

if no response = try H2RA or prokinetic

62
Q

epigastric pain
nausea
dypepsia

hx of NSAID/aspirin use

A

peptic ulcer disease

if pain worse whilst hungry = duodenal

if pain worse after eating something = gastric

63
Q

ulcer relieved by eating

A

duodenal

64
Q

ulcer worsened by eating

A

gastric ulcer

65
Q

Ix for peptic ulcer disease

A

urea breath test for H.Pylori

66
Q

management of peptic ulcer disease

A

H.pylori positive = eradication therapy

H.pylori negative = PPI till ulcer heals

67
Q

dyspepsia
nausea and vomiting
anorexia and weight loss
dysphagia

usually more common in males and ~ 70s-80s

A

gastric cancer

68
Q

diagnosis of gastric cancer

A

endoscopy with biopsy

staging = CT/endoscopic US

69
Q

Management of gastric cancer

A

5-10cm proximal to the OG junction = sub-total gastrectomy

<5cm = total gastrectomy

carcinoma of the cardia= oesophagogastrectomy

70
Q

‘projectile’ vomiting, typically 30 minutes after a feed
constipation and dehydration may also be present
a palpable mass may be present in the upper abdomen
hypochloraemic
hypokalaemic
alkalosis

A

pyloric stenosis

71
Q

diagnosis of pyloric stenosis

A

ultrasound

72
Q

management of pyloric stenosis

A

Ramstedt pyloromyotomy

73
Q

symptoms of peptic ulcer disease
generalised epigastric pain
syncope

A

peptic ulcer perforation

74
Q

haematemesis
melena
hypotension
tachycardia

A

peptic ulcer haemorrhage

75
Q

peptic ulcer haemorrhage management

A

Calculate risk using Glasgow-Blatchford Score

if suspected variceal bleeding = terlipressin & prophylactic Abx
- will also have band ligation

upper GI endoscopy within 24hrs
- clipping with/out adrenaline

calculate ROCKALL score

76
Q 
hepatosplenomegaly - painful/tender 
fatigue 
jaundice 
loss of appetite 
nausea

GGT raised
AST:ALT >2 (>3 even stronger indication)

A

alcoholic liver disease

77
Q

management of alcoholic liver disease

A

prednisolone (glucocorticoids) - acute episodes

pentoxifylline (sometimes used)

78
Q 
splenomegaly 
ascites 
hepatic encephalopathy/confusion 
lower conjugated bilirubin
lowered production of coag factors and albumin 
jaundice 
pruritus 
bruising
A

cirrhosis

79
Q

Ix for cirrhosis

A

Transient Elastography/fibroscan used most to assess the extent of fibrosis in the liver

LFTs may be derranged = low albumin, prolonged PT

Screening Ix

  • endoscopy - variceal
  • afp - every 6/12 to assess risk of hepatocellular cancer
80
Q

management of cirrhosis

A

irreversible = prevent underlying cause
stop alcohol consumption
treat any infections

81
Q 
A yellow tinge to the skin or eyes (jaundice).
Feeling tired.
Muscle or joint aches and pains.
Tummy (abdominal pain).
A poor appetite.
Feeling sick (nausea).
Darker-coloured urine and pale-coloured stools.
Headache.
A high temperature (fever) in some cases
A

hepatitis

> 6months = chronic heaptitis

82
Q

hepatitis B serology

A

HBsAg = acute hepatitis
IgM = acute
IgG = previous
Anti-HBs implies immunity

core antigen = chronic
surface antigen = acute

83
Q

Hepatitis B management

A

pegylated interferon-a first line

anti-virals = tenofovir, entecavir and telbivudine

prevention with Hep B vaccine = 2, 3 and 4 months of age

84
Q

a transient rise in serum aminotransferases / jaundice
fatigue
arthralgia

hx of IV drug use

A

Hep C hepatitis

85
Q

management of Hep C hepatitis

A

currently a combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir)

+/- ribavirin are used

86
Q

jaundice
raised AFP
B symptoms
ascites, RUQ pain, hepatomegaly, pruritus, splenomegaly

A

hepatic cancer/neoplasm

87
Q

Ix of hepatic neoplasm

A

CT/MRI

serial CT and aFP measurments

88
Q

management of hepatic neoplasm

A

surgical resection
chemo/radiotherapy
tumour ablation

89
Q

common hepatic neoplasms

A

cholangiocarcinoma and hepatocellular carcinoma

90
Q

severe epigastric pain - radiates to back
vomiting common
low grade fever
cullen’s signs (periumbilical discolouration)
grey turner’s sign (flank discolouration)
ileus

hx of gallstones or excessive alcohol consumption

A

acute pancreatitis

91
Q

Ix for acute pancreatitis

A

raised lipase, amylase

US/contrast induced CT

92
Q

management of acute pancreatitis

A

fluid resus - aggressive hydration with crystalloids
IV opioids
enteral nutrition provided

if due to gallstones = cholecystectomy
if biliary obstruction = ERCP
necrosis = debridement and fine needle aspiration

93
Q

epigastric pain worse 15-30 mins after a meal
steatorrhea
diabetes mellitus

A

chronic pancreatitis

94
Q

Ix for chronic pancreatitis

A

pancreatic calcification on abdo X-ray or CT

faecal elastase

95
Q

chronic pancreatitis management

A

pancreatic enzyme supplements
analgesia
antioxidants

96
Q 
painless jaundice 
pale stool, dark urine and pruritis
anorexia 
weight loss 
epigastric and back pain 
steotorrhoea and DM
A

pancreatic cancer

97
Q

Ix for pancreatic cancer

A

CT = double duct sign

can do US

98
Q

management of pancreatic cancer

A

surgery - usually very little suitable for surgery

adjunctive chemotherapy

99
Q

RUQ pain
fever
positive murphy’s sign
mildly deranged LFTs

A

Acute cholecystitis

100
Q

Ix for Acute cholecystitis

A

Ultrasound

101
Q

management for Acute cholecystitis

A

cholecystectomy (ideally within 48hrs)

102
Q

RUQ pain - colicky

following fatty meal

A

Gallstones/cholethiasis

103
Q

Ix for Gallstones/cholethiasis

A

US/MRCP

LFTs

104
Q

management of Gallstones/cholethiasis

A

laparoscopic cholecystectomy

105
Q

very unwell pt
RUQ pain
jaundice

A

cholangitis

106
Q

herniation of part of the stomach above the diaphragm

GORD symptoms

A

hiatus hernia

107
Q

management

A

lifestyle changes
PPI
Surgery

108
Q

groin lump
superior and medial to the pubic tubercle
disappears on pressure or when the patient lies down
discomfort and ache: often worse with activity, severe pain is uncommon

usually in males

A

inguinal hernia

109
Q

management of inguinal hernia

A

mesh repair is associated with the lowest recurrence rate

either open or laproscopic

110
Q

ascites
abdominal pain
fever

usually hx of cirrhotic liver

A

peritonitis

111
Q

diagnosis for peritonitis

A

paracentesis: neutrophil count > 250 cells/ul

112
Q

management for peritonitis

A

IV cefotaxime

FCM (16 decks)

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