GI Flashcards
Wilson’s Ix?
Low caeruloplasmin
Low total serum copper
Increased free copper
Epigastric pain, non-bilious vomiting, inability to pass NG tube?
Gastric volvolus
Link between Crohn’s and Gall Stones?
Crohn’s commonly causes inflammation in terminal ileum, where bile salts are reabsorbed
Less bile salts being reabsorbed causes pigment gall stones
(Crohn’s = Stones; UC = PSC)
Richter hernia?
Hernia where only one side of the bowel wall herniates through - can strangulate without causing obstruction
Budd-Chiari triad?
Risk factors?
Ix?
Triad:
- sudden onset, severe abdo pain
- ascites (high saag - transudate)
- tender hepatomegaly
COCP, polycythaemia, pregnancy, thrombiphilia
USS with doppler
Foul smelling, greasy stools in an alcoholic?
1st line Ix?
Chronic pancreatitis
CT pancreas - look for calcifications
Approach to treating dyspepsia with no red flags and no meds/food?
Full dose PPI for 1 month
If response then low dose treatment PRN
If no recovery - take 2 weeks off then test for H Pylori using urea breath test or stool antigen
If negative then double dose PPI may be trialled for 1 month
Then can try other drugs like Ranitidine (H2 antagonist) or Metoclopramide (pro-kinetic)
No need to test for cure but if done then urea breath test
Dyspepsia:
- what warrants urgent referral?
- non-urgent?
URGENT:
Dysphagia + dyspepsia
Palpable abdo mass
> 55 with weight loss AND dyspepsia, reflux or upper abdomen pain
NON-URGENT:
Haematemesis
Treatment resistant dyspepsia
Upper abdo pain + low Hb
Raised platelet count or nausea and vom with weight loss/reflux/pain
Dysphagia:
- weight loss, vomiting with eating, GORD?
- Heartburn, odynophagia, no systemic?
- HIV or steroid inhalers?
- solids+liquids, heartburn, regurgitate food, aspiration pneumonia?
- older man, midline lump in neck, regurgitates food, aspiration pneumonia, bad breath?
- Raynaud’s, talengiectasia, stiff fingers, difficulty breathing?
- Ptosis, muscle weakness at end of day, difficulty swallowing solids+liquids?
- anxiety, intermittent symptoms, painless?
Cancer
Oesophagitis
Oesophageal candidiasis
Achalasia
Pharyngeal pouch
Systemic sclerosis
Myasthenia gravis
Globus hystericus
Symptoms of carcinoid syndrome? What does the tumour secrete? Ix? Rx? Where are they commonly found?
Flushing
Diarrhoea
Bronchospasm
Hypotension
Can release ACTH - cushingoid symptoms and hypokalaemia
Can release GHRH - acromegaly
Secretes serotonin into bloodstream - can develop pellagra as dietary tryptophan is diverted to make serotonin by tumour (common precursor with Niacin)
Ix: urinary 5-HIAA
Plasma chromogranin A
Management: Octreotide
Cryoheptadine may help diarrhoea
Liver and lung
When fever, constant RUQ pain, raised inflammatory markers, what points towards cholangitis rather than cholecystitis?
Jaundice or raised bili
Absence of Murphy’s sign
Management peptic ulcer?
Drugs that can cause ulcer?
Test for H pylori
If neg, PPI until healed
NSAIDs
SSRIs
Corticosteroids
Bisphosphonates
Why can TPN result in deranged LFT’s?
Cholestasis as nothing passing though bowel - causes slight raise in bili, AST and moderately raised ALP, gGT
What gastroenteritis pathogens have an incubation of:
- 1-6 hrs?
- 12-48 hrs?
- 48-72 hrs?
- > 7 days?
1-6: Staph Aureus, Bacillus Cereus
12-48: Salmonella, E Coli
48-72: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
Shigella pattern and what Gram stain?
Gm -ve bacilli
Occurs in outbreaks, especially in schools and nurseries - abdominal pain, bloody diarrhoea, vomiting
Never invades further than gut wall - pus and blood in stools
Cryptosporidium - what is it, gastroenteritis pattern, test, treatment?
Protozoal infection (commonest protozoal infection in UK)
Cysts are ingested from animal sources or contaminated water or swimming pools (resistant to chlorine)
Diarrhoea - esp severe in HIV
Red spores seen on Ziehl-Neelson stain of stool
Symptomatic
Giardiasis - what is it, gastroenteritis pattern, test, treatment?
Single parasite - protozoa
Often asymptomatic
Abdo pain, flatulence, non-bloody CHRONIC diarrhoea, malabsorption and lactose intolerance can occur. Also resistant to chlorine so can get in pools.
(returned from holiday 3 weeks ago, has been opening bowels 5 times a day, crampy, bloating - stools float and are greasy (fat malabsorption))
- Stool microscopy for trophozoite and cysts usually negative
- duodenal fluid aspirate or ‘string tests’ sometimes needed
Metronidazole
Amoebiasis - what is it, gastroenteritis pattern, liver pattern, tests, treatments?
Protozoal infection - estimated 10% of world chronically infected. Can cause severe dysentry or colonic/liver abscesses
Dysentry:
- profuse, bloody diarrhoea,
- Stool may show trophozoites if examined within 15 mins (hot stool)
- Rx - metronidazole
Liver abscess:
- Single mass in right lobe usually (may be multiple). ‘anchovy sauce’
- Fever, RUQ pain
- Serology +ve 90%
Cystic stage: luminal amoebicide
Invasive stage: metronidazole and tinidazole
4 main causes of liver cirrhosis?
Diagnosis?
Monitoring?
- Alcohol, Hep B, Hep C, NAFLD
- Transient elastography (Fibroscan) 1st line, biopsy if not
Monitoring:
- OGD to check for varices on diagnosis
- Liver USS every 6 months + AFP to check for hepatocellular carcinoma
RF for SIBO?
Features?
Ix?
Rx?
- Neonates with GI problems
- Scleroderma (dysmotility)
- Diabetes (gastroparesis)
Similar to IBS - chronic diarrhoea, flatulence, bloating, abdo pain
H breath test
Rifaximin
Management of thromboses haemorrhoid?
If <72 hrs - refer for excision
If >72 hrs - stool softeners, analgesia, ice packs
Symptoms normally settle in 10 days
Levels of AA branches:
- Coeliac?
- SMA?
- Renal?
- Gonadal?
- IMA?
- Bifurcation?
Coeliac - T12
SMA - L1
Renal - L1/L2 (leave laterally - right renal artery goes behind IVC)
Gonadal - L2 - leave laterally
IMA - L3
Bifurcation to common iliacs - L4
Spectrum of alcoholic liver disease?
- alcoholic fatty liver disease
- alcoholic hepatitis
- cirrhosis
Ix:
- gGT elevated
- AST:ALT ratio >2, if >3 suggestive of alcoholic hepatitis
Rx:
- prednisone in acute alcoholic hepatitis
- pentoxyphylline also used sometimes
MUST score?
Step 1:
- BMI <20 = 0
- 18.5-20 = 1
- <18.5 = 2
Step 2: unplanned weight loss in 3-6 months <5% = 0 5-10% = 1 >10% = 2
Step 3:
if patient is acutely ill and there has been/is likely to be no nutritional intake for >5 days = 2
0 = low risk 1 = med risk - observe 2 = high risk - treat
Management of Barrett’s?
Endoscopic surveillance every 3-5 years with biopsies
High dose PPI (prevents progression but no regression)
If dysplasia of any grade found:
- endoscopic mucosal resection
- radiofrequency ablation
Management of alcoholic ketoacidosis?
IV saline and thiamine
NAFLD spectrum?
What is NASH?
Steatosis - fat in liver
Steatohepatitis - fat with inflammation
Fibrosis and cirrhosis
NASH:
Similar to the changes in alcoholic hepatitis but absence of alcohol abuse
Assoc: obesity, T2DM, hyperlipidaemia, jejunal bypass, sudden weight loss/starvation
Features:
- usually asymptomatic
- hepatomegaly
- ALT>AST
- ALP may be raised as well with increased bile and decreased albumin
- increased echogenicity on USS
Ix NAFLD?
USS - can often be an incidental finding
If changes seen:
Enhanced liver fibrosis blood test
- pro collagen II
- tissue inhibitor metalloproteinase 1
If ELF not available:
- Fibroscan for fibrosis
- FIB4 score
Management:
- Lifestyle change and weight loss
- potentially metformin/TZD
- monitor
Cancers assoc w coeliac, pernicious anaemia and H Pylori?
Coeliac - T cell lymphoma
Pernicious - gastric
H Pylori - MALToma - 80% regress after treatment of H Pylori
Dielofeau lesion?
Upper GI bleed, prominent vessels on lesser curvature
intestinal angina/chronic mesenteric ischaemia?
Classically a triad of:
- colicky post-prandial abdo pain
- weight loss
- abdominal bruit
Most common cause is atherosclerosis of arteries supplying GI tract
Management of abdominal wound dehiscence?
- Cover with sterile saline-soaked gauze
- IV broad-spec abx
- Analgesia
- IV fluids
- Arrange return to theatre
Pt on immunosuppressants gets campylobacter, what is treatment?
Clarithromycin
Also used in severe infection (bloody stool, fever etc)
