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GI Flashcards

1
Q

What are the risk factors for hiatus hernias

A
  • Increased intraabdominal pressure due to ascites/multuparity
  • Obesity
  • Increasing age
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2
Q

What is the pathophysiology of hiatus hernias

A

sliding or rolling
sliding - gastro-oesophageal junction above diaphragm
rolling - GO junction below diaphragm, but separate part of stomach above diaphragm

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3
Q

What are the symptoms of hiatus hernia

A 
heartburn
dysphagia
chest pain
acid reflux
food reflux
burping
bloating
halitosis
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4
Q

what investigation for hiatus hernia

A

barium swallow
ct
endoscopy
cxr

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5
Q

how is hiatus hernia treated

A

medical - control GORD with PPI/famotidine

surgical - fundoplication

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6
Q

define anal fissure, and where do they occur

A

tear in squamous lining of distal anal canal. most commonly in posterior midline

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7
Q

what are the RFs for anal fissures

A
  • constipation
  • IBD
  • STDs - HIV, syphilis
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8
Q

What are the signs/symptoms of anal fissures

A

painful bright red PR bleeding

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9
Q

what is management of acute anal fissures (<1 week)

A 
soften stool - fluid intake increase, and high fibre diet. 
1. bulk forming laxatives
2. lactulose
lubricants before defecation
topical anaesthesia
analgesia
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10
Q

what is mgmt of chronic anal fissure (>6 weeks)

A

topical GTN

referral for sphincterotomy/botox

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11
Q

explain the pathophys of appendicitis

A
  1. lymphoid hyperplasia or faecolith cause obstruction of appendiceal lumen
  2. gut micro-organisms invade the appendiceal wall
  3. Oedema, ischaemia, perforation
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12
Q

what are the symptoms of appendicitis

A
  • peri-umbilical pain migrates to RIF (mcburney’s pt)
  • some vomiting
  • mild pyrexia
  • anorexia
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13
Q

what signs would you find on examination of appendicitis

A
  • localised peritonitis (generalised if ruptured)
    - rebound and percussion tenderness
  • right-sided tenderness on PR exam
  • Rovsing’s sign (LIF palpation -> RIF pain)
  • Psoas sign - extension of hip causes pain
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14
Q

how would appendicitis be investigated

A

FBC - neutrophilia
Urine dip - mild leukocytosis with no nitrites
USS - free fluid in abdomen - pathological in males

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15
Q

what is treatment of appendicitis

A

laparoscopic appendicectomy

IV Abx

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16
Q

define diverticulosis

A

outpouching in bowel wall (commonly sigmoid)

17
Q

what are RFs for diverticulosis

A

low fibre diet
increasing age
chronic constipation

18
Q

what are symptoms of diverticular disease

A
  • altered bowel habit

- colicky left sided abdo pain

19
Q

how can diverticular disease be treated

A

high-fibre diet

20
Q

what are symptoms of diverticulitis

A
  • LIF pain and tenderness
  • anorexia
  • N+V
  • diarrhoea
  • pyrexia
21
Q

what would you see on blood tests of diverticulitis

A

raised WBC, CRP

22
Q

how is diverticulitis managed

A

mild - oral Abx

severe - admit, NBM, IV Abx and fluids

23
Q

what are the complications of diverticulitis?

A

abscess formation
peritonitis
intestinal obstruction
perforation

24
Q

Explain the pathophysiology of coeliac disease

A

autoimmune condition caused by sensitivity to the protein gluten.
exposure leads to villous atrophy which leads to malabsorption

25
Q

which HLA are coeliac associated with

A

HLA DQ2

HLA DQ8

26
Q

what symptoms of coeliac

A
  • diarrhoea (steatorrhea, greasy, offensive)
  • weight loss/failure to thrive in children
  • fatigue
  • recurrent abdo pain, distention, cramping
  • unexplained anaemia, especially iron deficiency
27
Q

what blood tests for coeliac disease

A
  1. Anti-Tissue transglutaminase (TTG) antibodies
  2. Anti-Endomysial (EMA) antibodies

These are both IgA so need to test for total IgA levels.
If total IgA levels are low, and antiTTG/EMA levels are also low, this is a false negative.
Do blood test for IgG version of antiTTG/antiEMA

28
Q

what is the gold standard for diagnosing coeliac

A

endoscopy with biopsy - duodenum mostly, but sometimes jejunum

29
Q

what would biopsy of coeliac disease show?

A

villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

30
Q

which group of patients is offered coeliac screening

A

newly diagnosed type 1 diabetes

31
Q

where does dermatitis herpetiformis typically affect

32
Q

what neuro symptoms might coeliac present with

A
  • epilepsy
  • cerebellar ataxia
  • peripheral neuropathy
33
Q

what complications of coeliac disease

A
  • anaemia
  • osteoporosis
  • vitamin deficiency
  • ulcerative jujunitis
  • enteropathy-associated T-Cell lymphoma
  • non-hodgkin lymphoma
  • lactose intolerance
  • small bowel adenocarcinoma
34
Q

how can compliance with gf diet be tested?

A

anti TTG antibodies

35
Q

why PCV vaccine for coeliac every 5 years?

A

functional hyposplenism

FINALS REVISION (17 decks)

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