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FCM Matrix > GI > Flashcards

GI Flashcards

1
Q

What is Oesophagitis?

A

inflammation of the inner lining of oesophagus

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2
Q

What is the most common cause of Oesophagitis?

A

GORD

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3
Q

What are the symptoms of Oesophagitis?

A
  • Heartburn
  • N + V
  • Dysphagia
  • Painful swallowing (w/o red flags)
  • symptoms resolve spontaneously
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4
Q

How to investigate Oesophagitis?

A

OGD - investigate severity

Barium swallow - r/o malignancy

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5
Q

What medication can cause Oesophagitis?

A

Bisphosphonates

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6
Q

Management of Oesophagitis

A

Medical:

  1. PPI (omeprazole) - 4 weeks
    - -> if due to GORD
  2. H2 recepto anatogonist
    (ranitidine)
    - -> 2nd line
  3. Antacids - neutralise stomach acid

Conservative:

  • weight loss
  • allergen avoidance
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7
Q

What is Mallory Weiss Tear?

A
  • Tear along the right border or near the gastro-oesophageal junction
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8
Q

What commonly causes Mallory Weiss Tear?

A
  • Forceful bout of retching , vomitting, coughing,straining or even hicupping
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9
Q

What are the symptoms of Mallory Weiss Tear?

A
  • Haematemesis
  • Dizziness
  • abdo pain
  • dysphagia
  • Melaena (RARE)

(no systemic symptoms)

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10
Q

How to investigate Mallory Weiss Tear?

A
  • OGD: visualise tear
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11
Q

Management of Mallory Weiss Tear

A

General:

  1. Ensure patient is stable : A-E approach
  2. fluids + blood transfusion : if a lot of blood is lost
  3. Observe BP + pulse

Medical:

  1. Pantoprazole: suppress acid to help heal the tear
  2. Endoscopy:
    - haemoclipping
    - band ligation
    - (anti-emetic pre-endoscopy e.g promethazine)

Surgery:
1. Laparoscopic surgery

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12
Q

What are the most common types of Oesophageal Cancer?

Identify their location.

A
  1. Squamous Cell Cancer
    - Upper 2/3 of oesophagus
  2. Adenocarcinoma
    - Lower 1/3 near gastro-oesophageal junction
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13
Q

What are some of the risk factors for adenocarcinoma (Oesophageal Cancer)?

A
  • GORD
  • Barrett’s oesophagus
  • Obesity
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14
Q

If alcohol caused Oesophageal Cancer, what would the blood findings be?

A
  • Increased GGT

- Macrocytosis

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15
Q

What are the symptoms of Oesophageal Cancer?

A
  • Dysphagia
  • anorexia + weight loss
  • Vomiting

Other:

  • Pain on swallowing
  • Hoarseness
  • acid reflux
  • Melaena
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16
Q

What investigation is use for diagnosis of Oesophageal Cancer?

A

Upper GI endoscopy with biopsy

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17
Q

How is Oesophageal Cancer staged?

A
  1. CT scan : if metastatic

2. Endoscopic USS: no metastases, local staging

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18
Q

Management of Oesophageal Cancer

A

Operable disease: surgical resection

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19
Q

When does a patient warrant an urgent endoscopy (2WW) for Oesophageal Cancer?

A
  1. Dysphagia

2. 55 year + upper abdo pain, reflux, dyspepsia

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20
Q

What is Oesophageal Stricture?

A

Narrowing of the food pipe

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21
Q

What causes Oesophageal Stricture?

A
  • Scarring from acid reflux in persisitent GORD/

- carcinoma of oesophagus

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22
Q

Whata are the symptoms of Oesophageal Stricture?

A
  • Dysphagia
  • Heartburn
  • Weight loss
  • Chest pain
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23
Q

What signs can present with malignant Oesophageal Stricture?

A
  • Lympadenopathy
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24
Q

What investigations can be carried out for Oesophageal Stricture?

A
  • CXR
  • Endoscopy
  • Barium swallow
  • CT or endoscopic USS
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25
Q

Management Oesophageal Stricture

A

Benign stricture = oesophageal dilation at endoscopy

Malignant stricture = oesophagectomy

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26
Q

What is Oesophageal Varices?

A
  • Dilated collateral blood vessels that develop as a complication of portal hypertension
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27
Q

What causes Oesophageal Varices?

A
  • Anything condition that causes portal hypertension
  • Can be split into 3 categories:
  1. Pre-hepatic:
    - Portal vein thrombosis
    - Portal vein obstruction
  2. Intra-hepatic:
    - Cirrhosis
    - Acute hepatitis
    - Idiopathic portal hypertension
  3. Post- hepatic:
    - compression (tumour)
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28
Q

What are the symptoms of Oesophageal Varices?

A
  • Haematemesis
  • Melaena
  • Abdo pain
  • Dyshpagia /pain on swallowing
  • Ascites
  • Jaundice
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29
Q

What are signs of Oesophageal Varices?

A
  • Spider naevi
  • Caput medusa
  • signs of chronic liver disease
  • Hypotension
  • Pallor
  • Tachycardia
  • Reduced GCS
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30
Q

How to investigate Oesophageal Varices?

A
  • Diagnostic: endoscopy

- Bloods: Hb (low), platelets (low)

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31
Q

Management of acute variceal haemorrhage

A
  1. ABC - pt should be resuscitate prior to endoscopy
  2. Correct clotting: FFP, vit K
  3. Vasoactive agent: terlipressin
  4. Prophylactic IV Abx : quinolones (ciprofloaxacin)
  5. Endoscopy : band ligation
    - both terlipressin + prophylactic abx
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32
Q

What is the prophylaxis management of varices?

A
  1. Propanolol : reduce rebleed
  2. Endoscopic variceal band ligation (every 2 week interval) : until all varcies eradiacted
  3. PPI
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33
Q

What is Achalasia?

A
  • Failure of oesophageal peristalsis and of relaxation of the LOS
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34
Q

What are the symptoms of Achalasia?

A
  • Dysphagia (BOTH liquid + solid)
  • gradual weight loss
  • heart burn
  • regurgitation of food
  • -> may lead to cough, aspiration pneumonia
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35
Q

What is the diagnostic investigation for Achalasia?

A

Oesophageal manometry

- assess motor function

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36
Q

What are other investigation carried out for Achalasia?

A
  1. Barium swallow :
    - ‘bird’s beak’ appearance
  2. CXR:
    - wide mediastinum
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37
Q

What is the 1st line management of Achalasia?

A

pneumatic dilatation

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38
Q

What is GORD?

A

Reflux of gastric contents back into the oesophagus

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39
Q

What are the symptoms of GORD?

A
  • Heartburn worse after meal or supine
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40
Q

What is the investigations for GORD?

A
  • Hx is enough for diagnosis
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41
Q

Management of GORD

A

Medical:

  • PPI (1 month)
  • Anatacids
  • H2 receptor anatogonist (famotidine)

Conservative:

  • weight loss
  • smoking cessation
  • small regular meal
  • avoid meals before sleep
  • avoid: fizzy drinks etc

Surgery:
- long-term +failed medical management: fundoplication

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42
Q

What is gastritis?

A

histological presence of gastric mucosal inflammation

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43
Q

Most common cause of gastritis

A

Helicobacter pylori

Other:
- NSAIDs

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44
Q

What are the symptoms of gastritis?

A
  • epigastric pain
  • N + V
  • Dyspepsia
  • Fever
  • loss of appetite
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45
Q

Signs of gastritis

A
  • Epigastric tenderness
  • glossitis
  • halitosis
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46
Q

Investigations for gastritis

A

H.Pylori:

  • Urea breath test
  • faecal antigen histology
  • rapid urease test
  • Gastric muscosal histology
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47
Q

What is the management for gastritis?

A 
H.Pylori eradication:
7-day course:
1. PPI - omeprazole
2. Abx - clarithomycin
3. Abx - amoxicillin/ metronidazole
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48
Q

What is peptic ulcer disease?

A

A breach in the epithelium of the gastric or duodenal mucosa that penetrates the muscularis mucosa

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49
Q

What are the main causes of peptic ulcer disease?

A
  1. H.pylori

2. Long-term NSAID use

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50
Q

What are the types of peptic ulcer disease and their symptoms?

A

Gastric ulcer:

  • pain increases while eating
  • weight loss

Duodenal ulcer:

  • pain is eased by eating
  • weight gain

General:

  • epigastric pain
  • nausea
  • chest discomfort
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51
Q

If a patient has acute upper abdo pain, what investigation must be carried out?

A

Erect x-ray

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52
Q

What would you see in an x-ray when some one has perforated ulcer?

A

CXR: free air under diaphragm

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53
Q

What investigation should be carried out for peptic ulcer disease?

A
  • H.pylori test

- Upper endoscopy

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54
Q

Management of uncomplicated peptic ulcer disease?

A
  1. H.pylori positive = eradication therapy
  2. H.pylori negative= PPI until ulcer is healed
    - -> full dose PPI : 4-8 weeks
  3. Repeat endoscopy : confirm healing in all pt with proven gastric ulcer
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55
Q

What are the symptoms of gastric cancer?

A
  • dysphagia
  • pain
  • acid reflux
  • loss of appetite + weight loss
  • anaemia
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56
Q

How to investigate gastric cancer?

A
  • Diagnosis: Endoscopy + biopsy
  • Staging : CT
  • Bloods: anaemia
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57
Q

Management of gastric cancer

A

Surgery:

  • endoscopic mucosal resection
  • partial gastrectomy
  • total gastrectomy

Chemotherapy

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58
Q

What are the red flag signs for stomach cancer?

A
  • Abdo mass
  • rebound tenderness with rigid abdomen
  • absent bowel sounds
  • acute pain + vomiting
  • ecchymosis of flanks + abdo
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59
Q

What is the referral requirement for 2WW stomach cancer?

A
  • upper abdo mass
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60
Q

What is the referral requirement for 2WW UGI endoscopy?

A
  1. dysphagia

2. > 55 + upper abdo pain, reflux, dyspepsia

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61
Q

What is pyloric stenosis?

A
  • Pylorus of the stomach is stenosed

- does not allow the passage of food

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62
Q

What are the symptoms of pyloric stenosis?

A
  • projectile vomiting* - typically 30 mins after feed
  • constipation
  • dehydration
  • palpable mass (upper abdo)
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63
Q

What are the signs of pyloric stenosis?

A
  • poor weight gain

- hypokalaemic alkalosis

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64
Q

What investigation is diagnostic pyloric stenosis?

A

USS

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65
Q

What is the management of pyloric stenosis?

A
  • Ramstedt pyloromyotomy*
  • -> H2-anatognoists or PPI
  • IV resuscitation : fluid and electrolyte replacement
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66
Q

What is Cholelithiasis?

A

A gallstone

- solid deposit that forms within the bladder

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67
Q

What are the risk factors for gallstones?

A

5 F’s

  • Female
  • Fat
  • Fair
  • Fertile
  • Forty
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68
Q

What are the classic symptoms for Cholelithiasis?

A
  1. Colicky RUQ pain - post prandially
    - –> worse after fatty meal
    - N + V
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69
Q

What is the diagnostic work up in suspected Cholelithiasis??

A

USS + LFT

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70
Q

What is the management of asymptomatic gallstones?

A

No treatment required

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71
Q

What is the management of asymptomatic gallstones in CBD?

A

referral for bile duct clearance + laparoscopic cholecystectomy

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72
Q

What is the management of symptomatic gallstones?

A
  • Laparoscopic cholecystectomy *
  • Mild pain : Paracetamol /NSAIDs
  • Sever pain : Diclofenac (IM)
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73
Q

What is acute cholecystitis?

A
  • inflammation of the gallbladder
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74
Q

What are the signs for acute cholecystitis?

A
  1. RUQ pain:
    - radiate to right shoulder
    - sudden onset
  2. Fevers (systemic)
  3. Possible jaundice
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75
Q

What are the signs for acute cholecystitis?

A
  • Murphy’s sign : inspiratory arrest upon palpation of RUQ
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76
Q

What blood test findings may you have with acute cholecystitis?

A
  • LFTs typically normal
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77
Q

What is the first investigation for acute cholecystitis?

A

Abdo USS

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78
Q

What is the management of acute cholecystitis?

A
  • IV Abx

- Early lap chole (witihin 1 week of diagnosis)

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79
Q

What is chronic cholecystitis?

A
  • repeated attacks of biliary colic + permanent damage to the gallbladder
  • gallbladder healing by fibrosis + shrinks in size
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80
Q

What are symptoms of chronic cholecystitis?

A
  • RUQ pain after meals

- fat intolerance

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81
Q

What investigative findings will you have for chronic cholecystitis?

A

AXR : porcelain gallbladder

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82
Q

What is the management of chronic cholecystitis?

A

Cholecystectomy

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83
Q

Which finding on biopsy would be most consistent with a diagnosis of gastric adenocarcinoma?

A

signet ring cells

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84
Q

What are the causes of acute pancreatitis?

A 
* GET SMASHED *
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypercholesterolaemia
ERCP
Drugs
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85
Q

What are the symptoms of acute pancreatitis?

A
  • Severe epigastric pain (radiate to back)
  • vomiting
  • low-grade fever
  • sudden onset + short duration
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86
Q

What are the signs of acute pancreatitis?

A
  • Epigastric tenderness
  • low-grade fever
  • Peri-umbilical discoloration (cullen’s sign)
  • Flank discolouration (grey-turner’s sign)
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87
Q

How can you make diagnosis of acute pancreatitis be made without imaging?

A

If characteristic pain + amylase /lipase > 3 time upper limit of normal

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88
Q

What imaging is used in acute pancreatitis?

A

USS

Other : contrast - CT

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89
Q

What scoring systems may be used to identify severe pancreatitis?

A
  • Ranson score
  • Glasgow score
  • APACHE II
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90
Q

What is the management of acute pancreatitis?

A
  1. Fluid resuscitation : crystalloid
  2. Analgesia
  3. DO NOT offer prophylactic abx
  4. NBM

Surgery:

  • Cholecystectomy : if due to gallstone
  • Early ERCP : if obstructed biliary system
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91
Q

What are the symptoms of chronic pancreatitis?

A
  • pain : following meal

- steatorrhea

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92
Q

What are the investigations for chronic pancreatitis?

A
  • Abdominal x-ray: pancreatic calcification

- CT : more sensitive to calcification

93
Q

Management of chronic pancreatitis

A
  • pancreatic enzyme supplements

- analgesia

94
Q

What is the most common type of pancreatic tumour?

A

Adenocarcinoma

95
Q

What is the classic symptom of pancreatic cancer?

A
  • Painless Jaundice *
96
Q

What are the other symptoms of Pancreatic Cancer?

A
  • Pale stools
  • Dark urine
  • Pruritus

Non-specific:

  • anorexia
  • weight loss
  • epigastric pain
97
Q

What is the diagnostic investigation for Pancreatic Cancer?

A

High-resolution CT scan

  • definitve diagnosis require biopsy
  • ‘double duct’ sign

Other:
USS

98
Q

What is the management of Pancreatic Cancer?

A
  • Whipple resection
  • Adjuvant chemotherapy
  • ERCP with stenting (palliation)
99
Q

What is hepatitis?

A

Virus that infects the liver causing inflammation

USE NOTES (DEARSIM)

100
Q

When does heptatitis become chronic?

A

If virus persists past 6 months

101
Q

What are the symptoms of hepatitis?

A
  • Fever
  • RUQ pain
  • Jaundice
  • Dark urine
102
Q

What are the signs of hepatitis?

A
  • Rise in ALT + AST

- Hepatomegaly

103
Q

What are the different components of hepatitis serology?

A
  1. HBsAg = surface antigen
    - acute disease
  2. Anti-HBs = implies immunity
  3. Anti-HBc = previous or current infection
  4. IgM anti-HBc = during acute or recent hep B infection
104
Q

1st line management of hepatitis?

A
  • Pegylated interferon-alpha

Other antiviral = tenofovir

105
Q

What is liver cirrhosis?

A

Scarring of the liver caused by long-term liver damage

106
Q

What are the common causes of Liver Cirrhosis?

A
  • Alcohol
  • Non-alcoholic fatty liver disease (NAFLD)
  • Viral Hepatitis
107
Q

What are symptoms of Liver Cirrhosis?

A

Severe:

  • jaundice
  • abnormal bruising
  • peripheral oedema
  • ascites

High-Risk group:

  • fatigue
  • anorexia
  • nausea
  • weight loss
  • muscle wasting
  • abdo pain
108
Q

What investigations are carried out for Liver Cirrhosis?

A
  • Transient Elastography
  • Traditionally : Liver biopsy
  • NAFLD : use enhanced liver fibrosis score to screen for further testing
109
Q

What further investigations can be carried out for Liver Cirrhosis?

A
  • Upper endoscopy : check for varices

- Liver USS: hepatocellular cancer

110
Q

What is the management of Liver Cirrhosis?

A
  • Hepatology specialist
111
Q

What are the most common Liver Tumours?

A
  • Cholangiocarcinoma

- Hepatocellular carcinoma

112
Q

What are the symptoms of Liver Tumours?

A
  • Weight loss
  • Jaundice
  • Altered mental status
  • itching
  • pale stools + dark urine
  • easy bruising
  • Distended abdomen
113
Q

What investigations are used for diagnosis of Hepatocellular Carcinoma?

A
  • CT/MRI (usually both)

* Avoid biopsy - seeds tumours cells*

114
Q

What is the treatment for Liver Tumours?

A
  • Surgical resection

- Liver transplantation

115
Q

What is the prognosis of Liver Tumours?

A

Poor

116
Q

What investigations are used for diagnosis of Cholangiocarcinoma?

A
  • LFT : obstructive picture
  • CA 19-9, CEA + CA 123 elevated
  • CT/MRI + MRCP
117
Q

What score is used after endoscopy to asses rebleed and mortality ?

A

Rockall

118
Q

What are the different types of hernia?

A
  • Hiatus
  • Icisional
  • Inguinal
  • Umbilical
  • Ventral
119
Q

What are the symptoms of hiatus hernia?

A
  • Heartburn
  • GORD
  • Difficulty swallowing
120
Q

What investigations can be carried out for hiatus hernia?

A
  • Endoscopy

- Barium studies

121
Q

What is the management of hiatus hernia?

A
  • Asymptomatic : no treatment
  • Symptomatic : PPI
  • Severe GORD : Laparoscopic fundoplication
122
Q

What is the management of incisional hernia?

A
  • Surgical repair

- Open mesh repair

123
Q

What are the 2 types of inguinal hernia?

A
  1. Indirect = hernia through the inguinal canal

2. Direct hernia = through the posterior wall of the inguinal canal

124
Q

What are the symptoms of inguinal hernia?

A
  • groin lump
  • -> disappear when lying down
  • -> cough impulse
  • discomfort + ache
  • -> worse with activity
125
Q

What is the management of inguinal hernia?

A
  • Mesh repair

- weight loss

126
Q

What is the management of umbilical hernia?

A
  • Typically resolves by 3 y/o
127
Q

What is peritonitis?

A
  • infection of ascitic fluid
128
Q

What can cause peritonitis?

A
  • perforated ulcer
  • cirrhosis
  • PID
129
Q

What are the symptoms of peritonitis?

A
  • Ascites
  • Abdo pain
  • Fever
  • N + V
  • Diarrhoea
130
Q

What is the diagnostic test for peritonitis?

A

Paracentesis:

–> Ascitic Fluid : neutrophil count > 250 cells/mm3

131
Q

What is the management of peritonitis?

A
  • IV Cefotaxime

Discharge:
- Abx prophylaxis: ciprofloxacin

132
Q

What is the management of GI ulcer perforation?

A
  • surgical intervention
133
Q

What are the clinical features of acute upper GI bleed?

A
  • Haematemesis
  • Melena
  • Abdo pain
  • Raised Urea
134
Q

What scores are used in the management of upper GI bleed?

A
  1. Glasgow- blatchford: 1st assessment
    - outpatient or inpatient
  2. Rockall
    - used after endoscopy
    - rebleed + mortality risk
135
Q

What is the treatment algorithm for upper GI bleed?

A
  1. Resuscitation
    - ABC
    - Platelet transfusion: active bleed + platelet count < 50
    - FFP
    - Prothrombin complex concetrate : pt on warfarin + active bleed
  2. Endoscopy
    - immediately after resuscitation
    - within 24 hours
    - do not prescribe PPI before endoscopy
  3. Further bleed
    - Repeat endoscopy
    - Interventional radiology + surgery
  4. Long-term
    - Give PPI
136
Q

What is intra-abdominal abscess?

A
  • a collection of pus or infected fluid that is surrounded by inflamed tissue inside the belly
137
Q

What are the symptoms of intra-abdominal abscess?

A
  • Fever
  • Change in bowel habits
  • N + V
138
Q

What investigations are carried out for intra-abdominal abscess?

A
  • Abdo CT

- WBC count

139
Q

What is the first line management for intra-abdominal abscess?

A
  • CT or USS guided percutaneous drainage
140
Q

What is constipation and faecal loading?

A

Constipation = infrequent stools, straining

Faecal Loading = retention of faeces to the extent that spontaenoes evacuation is unlikely

141
Q

What symptoms indicate constipation?

A
  1. Bowel movement < 3 times/week
  2. Excessive straining
  3. Lowe abdo pain, distension, bloating
142
Q

What are some non-specific symptoms associated with constipation in elderly?

A
  1. Confusion or delirium, functional decline
  2. Nausea or loss of appetite
  3. overflow diarrhoea
  4. urinary retention
143
Q

When do you suspect faecal loading?

A
  • hard, lumpy stools : large + infrequent
  • Manual method of extraction
  • overflow faecal incontinence or loose stool
144
Q

What examination do you carry out in constipation?

A

PR exam

145
Q

What is the management of constipation?

A
  • Stop any causative drugs, dietary advice

Acute:
1st line: Bulk-forming laxative e.g., ispaghula
2nd line: osmotic laxative e.g., macrogol
3rd line: stimulant laxative

Opioid-induced constipation – X bulk-forming laxative, offer an osmotic laxative

146
Q

What AXR finding would you have in constipation?

A

Sitzmarks

147
Q

What symptoms are required for a diagnosis of IBS?

A
  1. Abdo pain +/-
  2. Bloating +/-
  3. Change in bowel habit
148
Q

What are other symptoms associated with IBS?

A

Positive diagnosis of IBS if:
abdo pain is relieved by defaction

or

altered bowel frequency stool form

+

2 of:

  1. altered stool passage : straining, urgency, incomplete evacuation
  2. abdo bloating, distension, tension or hardness
  3. symptoms worse by eating
  4. passage of mucus
149
Q

What investigations should be carried in primary care for IBS?

A

FBC
ESR/CRP
Coeliac disease screen

150
Q

What is the pharmacological treatment for IBS?

A

First line:

  • pain: antispasmodic agent
  • constipation: laxatives (avoid lactulose)
  • diarrhoea : loperamide

2nd line:
- low-dose tricyclic antidepressants (amitriptyline)

151
Q

What are the non-pharmacological treatments for IBS?

A
  1. Psychological interventions = after 12 months of pharmacological options
  2. complementary or alternative medicine
152
Q

What dietary advice would give for IBS?

A
  1. regular meals
  2. avoid missing meals or leaving long gaps between eating
  3. drink at least 8 cups of fluid per day
  4. reduce intake of alcohol and fizzy drinks
  5. limiting intake of high-fibre food
  6. limit fresh fruit to 3 portions per day
  7. for diarrhoea, avoid sorbitol
153
Q

What is the definition of diarrhoea?

A

Passage of 3 or more loose stools per day

154
Q

What are the different classifications of diarrhoea?

A
  • Acute diarrhoea < 14 days
  • Persistent diarrhoea > 14 days
  • Chronic diarrhoea > 4 weeks
155
Q

What are the different causes of diarrhoea?

A

Bacterial:

  • salmonella
  • campylobacter jejuni
  • shigella
  • E.coli

Drugs:

  • laxatives
  • allopurinol
  • ARB
  • Abx
  • Chemo
  • NSAID
  • PPI
  • SSRI
156
Q

What investigation is carried for infectious diarrhoea?

A
  • Stool sample
157
Q

When should a pt be admitted with diarrhoea?

A
  • Vomiting + unable to retain oral fluids

- sever dehydration or shock

158
Q

When should a pt be referred for diarrhoea?

A

> 40 y/o + :

  • Weight loss
  • Abdo pain

> 50 y/o + rectal bleeding

> 60 y/o iron deficiency anaemia

159
Q

What medication can be used for diarhoea?

A
  • Loperamide
160
Q

What medications can affect can affect urea breath test?

A
  • Abx : within 4 weeks of test

- PPI : within 2 weeks of test

161
Q

When do you offer prophylactic abx in peritonitis?

What abx?

A
  • Cirrhosis + ascites
  • -> until ascites has resolved

Oral ciprofloxacin

162
Q

Which type of H.Pylori test is used to check eradication?

A

Urea breath test

163
Q

What is the strongest risk factor for Barrett’s Oesophagus?

A

GORD

164
Q

What is diverticular disease?

A

Diverticula causes symptoms (intermittent lower abdo pain) without inflammation or infection

165
Q

What are the symptoms of diverticulitis?

A
  • left iliac fossa pain + tenderness
  • bloating
  • anorexia
  • diarhoea or constipation

Infection:

  • pyrexia
  • raised WBC + CRP
166
Q

What is the management of diverticulosis?

A

Increase dietary fibre intake to minimise symptoms

167
Q

What investigations can be carried out for diverticulitis?

A
  1. FBC : raised WCC
  2. Raised CRP
  3. CT: suspected abscess
  4. Colonoscopy : initially avoided due to risk of perforation
168
Q

Management of diverticulitis?

A
  1. Mild : oral abx
  2. Severe: Hospital
    - NBM
    - IV fluids
    - IV Abx (cephalosporin + Metronidazole)
  3. Managing in primary care:
    - co-amoxiclav 5-day course
    - review in 48 hours
  4. Surgery:
    - Resection
    - drainage of abscess
169
Q

Which side of the lung is aspiration pneumonia more common in?

A

Right lower lobe

170
Q

What are the symptoms of appendicitis?

A
  • Periumbilical pain which worsens and migrates to RIF
    (24-48 hours)
  • Pain worse by movement
  • Low-grade fever
  • Nausea
  • Constipation
171
Q

What are the examination findings for appendicitis?

A
  • Tenderness in the RIL
  • -> maximal tenderness over ‘McBurney’s point’
  • Rosving’s sign
  • Psoas sign
172
Q

How is appendicitis diagnosed?

A

Raised inflammatory markers + history + examination findings is enough to justify

173
Q

What is the management of appendicitis?

A
  • Appendicectomy

- Prophylactic IV abx

174
Q

What is intussusception?

A
  • Invagination of one portion of bowel into the lumen of adjacent bowel.
175
Q

What is the most common site for intussusception?

A
  • ileo-caecal region
176
Q

What are the symptoms of intussusception?

A
  • Paroxysmal abdominal colic pain
  • vomiting
    • red-currant jelly* (late sign)
  • sausage-shaped mass in RUQ
177
Q

What is the investigation of choice for intussusception?

A

USS

- target-like mass

178
Q

What is the management of intussusception?

A

1st line: Reduction by air insufflation (via radiology)

  • Laparotomy if above fails or signs of peritonitis
179
Q

What is ischaemic bowel disease?

A
  • Interruption/loss of blood supply to the bowel
180
Q

What are the symptoms of ischaemic bowel disease?

A
  • Sudden onset abdo pain
  • -> reaches peak very quickly
  • Melaena
  • Diarrhoea
  • fever
181
Q

What is the diagnostic investigation for ischaemic bowel disease?

A
  • CT angio
182
Q

What blood findings may you see for ischaemic bowel disease?

A
  • Elevated WCC

- Lactic acidosis

183
Q

What is the management for ischaemic bowel disease?

A

Surgery:

  • laparotomy
  • endovascular therapy +/- open embolectomy
  • Resuscitation + supportive measure (oxygen, fluids, inotropes)
  • Abx: ceftriaxone + Metronidazole
184
Q

What is bowel obstruction?

A
  • Passage of food, fluids and gas becomes blocked
185
Q

What are the symptoms of bowel obstruction?

A
  • Abdominal pain (diffuse + central)
  • N + V (bilious vomiting)
  • Constipation (lack of flatulence)
  • Abdo distension
186
Q

What examination findings may you see with bowel obstruction?

A
  • tinkling bowel sounds
187
Q

What is the 1st line investigation for bowel obstruction?

A

Abdo X-Ray

- dilated bowel > 3 cm

188
Q

What is the definitive investigation for bowel obstruction?

A

CT

189
Q

What is the management of bowel obstruction?

A

Initial steps:

  • NBM
  • IV fluid
  • NG tube with free drainage

Conservative management for upto 72 hours if cause does not require surgery
- surgery

IV Abx if:

  • perforation
  • surgery
190
Q

What is toxic megacolon?

A
  • Acute form of colonic distension
191
Q

What are the features of toxic megacolon?

A
  • Segmental
  • non-obstructive dilation of the colon > 6 cm diameter
  • system toxicity
192
Q

What are the symptoms of toxic megacolon?

A
  • Abdo pain (diffuse, relieved by bowel movement)

- dairrhoea > 1 week

193
Q

What investigation if carried out for toxic megacolon?

A

Abdo x-ray : dilated bowel

194
Q

What is the management of toxic megacolon?

A
  1. Treat underlying cause
  2. supportive care in ICU
    - -> NBM
    - -> NG tube
  3. Surgery
    - if less invasive treatment don’t work within 2/3 days
195
Q

What is Inflammatory Bowel Disease?

A

2 types:

  • Crohn’s
  • Ulcerative Colitis
196
Q

What is Corhn’s?

A

Chronic inflammatory disease

- Mouth –> anus

197
Q

What is Ulcerative Colitis?

A

Relapsing, remitting autoimmune condition

  • Rectum + sigmoid colon (proctitis)
  • Not beyond ileocaecal valver
198
Q

What are the symptoms of Crohn’s?

A
  1. Diarrhoea
  2. Weight
  3. Abdo pain (RLQ)
  4. Mouth ulcers
199
Q

What are the symptoms of Ulcerative Colitis?

A
  1. Bloody diarrhoea (mucus)
  2. Abdo pain (LLQ)
  3. fatigue
  4. Fever
200
Q

What are the signs of IBD (both)?

A
  1. Erythema nodosum

2. Uveitis

201
Q

What investigation can distinguish between IBD + IBS?

A

Faecal calprotectin

elevated in IBD

202
Q

What are the histological differences in IBD?

A

Crohn’s

  1. inflammation in all layers
  2. increased goblet cells
  3. granulomas

UC:

  1. no inflammation beyond submucosa
  2. decreased goblet cells
  3. no granulomas
203
Q

What investigation is carried out for IBD?

A

Colonoscopy:
Crohn’s :
1. ‘Cobble-stone appearance (skip lesions)

UC:

  1. biopsy needed for diagnosis
  2. appearance of polyps (pseudopolyps)

Abdo X-Ray:
UC : lead Pipe radiological appearance

204
Q

What is the management of Crohn’s ?

A

Conservation:
- smoking cessation

Medical:

  • Corticosteroids (prednisolone)
  • azathioprine
  • methotrexate
  • infliximab

Surgery:
- removes strictured or obstructed region of bowel

205
Q

What is the management of Ulcerative Colitis?

A

Conservative:
- Smoking is protective but not advised

Medical:
- Corticosteroids (prednisolone)
- azathioprine
- 5-aminosalicylic acid (5-ASA) analogues 
(sulfasalazine, mesalazine)
-  6-mercaptopurine

Surgery:
- Colectomy

206
Q

Symptoms of haemarrhoids

A
  • painless rectal bleeding
  • feeling like you still need to open bowel after going
  • lumps around the anus
207
Q

What are the 2 types of haemorrhoids?

A

Internal - originate above the dentate line , do not generally cause pain

External- originate below the dentate line, may be painful as prone to thrombosis

208
Q

Grading of haemorrhoids

A

1: do not prolapse out of the anal canal
2: prolapse on defecation but reduce spontaneously
3: can be manually reduced
4: cannot be reduced

209
Q

How are haemorrhoids managed?

A
  • Increased dietary fibre and fluid intake to soften stools
  • topical local anaesthetics and steroids
  • rubber band ligation if outpatient treatment recommended
  • Haemorhoidectomy for large haemorrhoids if outpatient treatment does not work
210
Q

What is an anal fissure?

A

a tear or ulcer in the lining of the anal canal which causes pain on defecation

211
Q

How can anal fissures be classified?

A

Acute - <6 weeks
Chronic - >6 weeks
Primary - no underlying cause
Secondary - underlying cause (e.g constipation, STI, IBD, colorectal cancel)

212
Q

Clinical features of anal fissure

A

anal pain on defecation (with or without bleeding) and anal spasm

213
Q

When would you refer in case of anal fissure?

A

if a serious underlying cause is suspected (rectal cancer or IBD)

214
Q

Management of anal fissure

A
  • high fibre and increased fluid intake
  • analgesia or topical anaesthetics
  • 6-8 week course rectal GTN if symptoms persist for >1week
  • manage underlying cause
215
Q

When should adults with anal fissure be reviewed?

A

primary anal fissure - reviewed at 6-8 weeks or sooner if necessary

216
Q

How should patients with unhealed anal fissures after lifestyle interventions be managed?

A

referred to general/colorectal surgeon

217
Q

What is an Anorectal abscess

A

a collection of pus under the skin in the area of the anus and rectum due to infection of glands

218
Q

Sx of Anorectal abscess

A

painful, hardened tissue in the perianal area
discharge of pus from the rectum
fever
constipation or pain with bowel movements

219
Q

Caustive bacteria of Anorectal abscess

A

E.coli, staph aureus

220
Q

Ix for Anorectal abscess and anal fistula

A

DRE

221
Q

Tx of Anorectal abscess

A

surgical drainage and analgesia

222
Q

What is an Anal fistula

A

a small tunnel that connects an infected gland inside the anus to an opening on the skin around the anus

223
Q

What causes an Anal fistula

A

Usually due to previous ano-rectal abscess

224
Q

Management of anal fistual

A

Fistulotomy

225
Q

What is pilonidal disease?

A

sinuses and cysts form near the upper part of the natal cleft of the buttocks

226
Q

Epidemiology of pilonidal disease

A

common in men around 20yo

227
Q

Clinical features of Pilonidal disease

A

recurrent episodes of natal cleft pain with discharge

228
Q

Management of pilonidal disease

A

asymptomatic - conservative and local hygiene
symptomatic
- acute: incision and drainage
- chronic : excision of pits and obliteration of underlying cavity

FCM Matrix (17 decks)

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