GI Flashcards
RF for gastric cancer?
H-pylori atrophic gastritis Diet Smoking male >75
CF of gastric Ca?
- dyspepsia / epigastric pain
- Wt loss
- N + V
- Dysphagia
Ix / Dx of Gastric Ca?
endoscopy with biopsy
- Signet rings
CT for staging
gastric Ca Tx?
- endoscopic mucosal resection
- partial / total gastrectomy
- chemo
Classic CF of gall stone ileus?
Acute, severe abdo pain
Vomiting
Not passed stool or flatus
Previous intermittent colicky RUQ pain
Classic X-ray findings in gallstone ileus?
small bowel obstruction (dilated loops of bowel) and air in biliary tree
plain abdo X-ray shows ‘coffee bean’ sign - likely Dx?
sigmoid volvulus
What CF would you expect to find in a Px with a pharyngeal pouch?
- Dysphagia
- Hx aspiration pneumonia
- halitosis (bad breath)
How would you Dx pharyngeal pouch?
barium swallow combines with dynamic video fluoroscopy
How would you Mx pharyngeal pouch?
Surgery
How would you treat life-threatening C. Diff infection?
oral vancomycin and IV metronidazole
What can cause C. diff infection?
- ABx - clindamycin, cephalosporins
- PPIs
CFs of C. Diff?
- Diarrhoea
- Abdo pain
- Raised WCC (esp. if severe toxic megacolon develops)
Dx of C Diff?
C diff toxin in stool
C. Diff Tx?
- Stop any causative ABx if poss.
- 1st: oral vancomycin 10 days
- 2nd: oral fidaxomicin (and in recurrent)
RF’s for bowel cancer?
- FHx
- Familial adenomatous polyposis (FAP)
- Hereditary nonpolyposis colorectal cancer (HNPCC)
- IBD
- older age
- diet (meat and low fibre\0
- obesity and sedentary lifestyle
- smoking and alcohol
What is a panproctocolectomy?
Prophylactic resection of large bowel in Px with FAP
What Ca does HNPCC increase risk of ?
- colorectal
- endometrial
CF of bowel cancer?
- change in bowel habit - usually looser
- wt loss
- rectal bleeding
- abdo pain
- microcytic anaemia
- abdo/rectal mass
When to 2 week wait suspected bowel Ca?
- > 40 with unexplained abdo pain and unexplained weight loss
- > 50 with unexplained rectal bleeding
- > 60 with change in bowel habit or Fe anaemia
When would you FIT test?
- Px who don’t meet TTW referral but suspected bowel ca
- looks at amount of human haemoglobin in stool
- used as screening in people 60-74 every 2 years
Ix for bowel Ca?
- colonoscopy and biopsy
- CT for staging
- CT colonography if unfit for colonoscopy
- sigmoidoscopy in PX with rectal bleeding only
Summarise the TMN classification for bowel Ca?
T for Tumour:
TX – unable to assess size
T1 – submucosa involvement
T2 – involvement of muscularis propria (muscle layer)
T3 – involvement of the subserosa and serosa (outer layer), but not through the serosa
T4 – spread through the serosa (4a) reaching other tissues or organs (4b)
N for Nodes:
NX – unable to assess nodes
N0 – no nodal spread
N1 – spread to 1-3 nodes
N2 – spread to more than 3 nodes
M for Metastasis:
M0 – no metastasis
M1 – metastasis
Options for bowel ca :
- Surgical resection
Chemotherapy
Radiotherapy
Palliative care
What symptoms may you experience in low anterior resection syndrome ?
- urgency and frequency of bowel movements
- faecal incontinence
- difficulty controlling flatulence
What follow-up is involved in bowel cancer?
- Serum carcinoembryonic antigen (CEA)
- CT TAP
a woman presenting with lethargy, arthralgia, easy bruising and bleeding gums, what is the likely Dx?
Scurvy - vitamin C deficiency
It is associated with severe malnutrition as well as drug and alcohol abuse, and those living in poverty with limited access to fruits and vegetables.
