GI Flashcards
What is the treatment for H.pylori?
triple therapy
PPI + Amox + Cipro/Metronidazole
How is H.pylori diagnosed?
Urea breath test
C13 stool test
How are peptic ulcers managed?
Test for H.pylori
H.pylori positive + NSAID use= PPI for 8 weeks!!! and then triple therapy
H.pylori positive + no NSAID use= triple therapy
H.pylori negative + NSAID use = PPI for 8 weeks
H.pylori negative + no NSAID use = PPI for 4 weeks
Which artery is associated with significant gastrointestinal disease in the context of peptic ulcer disease?
Gastroduodenal artery
How long to stop PPI prior to testing for H.pylori?
2 weeks
What to check prior to starting Azathioprine?
TPMT activity
What vaccine is needed in coeliac disease?
Pneumococcal every 5 years
What electrolytes are seen in refeeding syndrome?
Hypokalaemia
Hypomagnasaemia
Hypophosphataemia
What are risk factors for diverticular disease?
obesity, older age, low fibre diet, NSAID use
What is mesenteric ischaemia and how is it diagnosed? How is it managed?
Ischaemia due to the small bowel due to an embolus - main RF is AF!!!
Presents with acute abdomen
Blood gas = raised lactate
Diagnosis = CT angiogram
Management = immediate laporotomy - HIGH MORTALITY
What is ischaemic colitis and how is it managed?
Ischaemia to the large bowel
Less severe abdominal pain, bloody diarrhoea
thumbprinting on XR
Conservative management
What is toxic megacolon? How is it managed?
Complication of severe UC
Leadpipe bowel , loss of haustrations, dilated loops of bowel
Acute abdomen, severe bloody diarrhoea, fever
Tachycardia, raised WCC
Management =
Resus + Broad spectrum abx
How are internal haemorrhoids graded?
Grade 1 – do not prolapse
Grade 2 – prolapse but reduce spontaneously
Grade 3 – can be manually reduced
Grade 4 – cannot be reduced
What is small bowel bacterial overgrowth syndrome? How is it diagnosed? How is it managed?
Excessive bacteria in the small bowel –> diarrhoea, bloating, flatulence, abdominal pain
Diagnosis = hydrogen breath test
Management = Rifaximin
What is Whipple’s disease?
A rare systemic condition caused by Trophenyma Whipplei
Causes diarrhoea, abdominal pain and joint pain
What is seen on small bowel biopsy in Whipple’s disease?
Acid-Schiff-positive macrophages
How is Whipple’s disease managed?
Co-trimoxazole
What is the most common hereditary condition associated with colorectal cancer? What other cancers are associated with this condition?
HNPCC (Lynch syndrome)
Endometrial cancer and gastric cancer
What is the familial condition with the highest risk of developing colorectal cancer? How is it monitored?
Familial adenomatous polyposis
Annual flexible sigmoidoscopy from 15 years old
What is Kantor’s string sign and what is it seen in?
Seen in Crohn’s
Narrowing of the terminal ileum due to stricturing
What is the Glasgow-Blatchford score?
Used to determine whether patients with an upper GI bleed can be discharged home
How to manage abdominal wound dehiscence?
Cover wound with saline soaked gauze + give IV abx
Return to theatre
What is the main risk factor of aminosalicylates?
Agranulocytosis
What complication of diverticular disease can present with bubbles or faecal matter in the urine?
Colovesical fistula
Which part of the colon is most commonly affected by Ischaemic colitis?
Splenic flexure
How is a colorectal cancer in the caecal, ascending or proximal transverse colon managed? (including the hepatic flexure)
Right hemicolectomy
How is a colorectal cancer in the distal transverse or descending colon managed? (including the splenic flexure)
Left hemicolectomy
How is a colorectal cancer in the sigmoid colon managed?
High anterior resection
How is a colorectal cancer in the rectum managed?
Low anterior resection
How is a colorectal cancer in the anal verge managed?
Abdomino-perineal excision
What is Plummer-Vinson syndrome and how is it managed?
Condition where there is..
1) Dysphagia
2) Glossitis
3) Iron-deficiency anaemia
management: iron supplementation
External vs. internal haemorrhoids?
External = originate below the dentate line, can be painful Internal = originate above the dentate line, not usually painful
What are conservative measures for haemorrhoids?
Increase fluid intake
Increase fibre intake
Analgesia
What are surgical measures for haemorrhoids?
Band ligation
Haemorrhoidectomy
What are long term side effects of Crohn’s disease?
Perianal abscess
SBO
Colonic carcinoma
Malnutrition
What is Zollinger-Ellison syndrome?
How is it diagnosed?
Condition characterised by excessive levels of gastrin
Usually from gastrin secreting tumour
Often part of MEN type I
Features = multiple peptic ulcers, diarrhoea, malabsorption
Diagnosis = fasting gastrin levels
What are ENDOSCOPY findings for Crohn’s?
Skip lesions
Cobblestone appearance
What are ENDOSCOPY findings for UC?
Continuous inflammation
Pseudopolyps
What are HISTOLOGICAL findings for Crohn’s?
Transmural inflammation
Increased goblet cells
Granulomas
What are HISTOLOGICAL findings for UC?
Submucosal inflammation only
Crypt abscesses
Goblet cell depletion
What is seen on small bowel enema in Crohn’s disease?
Strictures - Kantor’s string sign
Rose thorn ulcers
Fistulae
What is seen on barium enema in UC?
Loss of haustrations
Pseudopolyps
Drainpipe colon
What are features of Lower GI bleeding?
Bright red/dark red blood per rectum
Lower GI bleeding rarely presents with melaena - not retained long enough for transformation to occur
What are features of upper GI bleeding?
Haematemesis
Melaena
Raised urea
What score is used to assess management of upper GI bleeding?
Glasgow-Blatchford score
What score is used after endoscopy for upper GI bleeding to provide risk of re-bleeding?
Rockall score
How soon should someone with upper GI bleeding get an endoscopy?
Within 24 hours
How does oesophageal cancer appear on barium swallow?
“apple core” sign –> part of oesophagus = strictured
Lower GI 2WW guidelines
> 40 with unexplained weight loss+abdo pain
50 + unexplained rectal bleeding
60 +iron deficiency anaemia
If 2WW guidelines not met - FIT (faecal occult blood)
How is colorectal cancer staged?
Dukes Staging A - confined to mucosa B - invading bowel wall C - lymph node mets D - distant mets
What are options for short term and long term enteral feeding?
Short term = NG tube, NJ tube
Long term = PEG, PEJ
If stomach not able to function - TPN
What is the management of a sigmoid volvulus?
Rigid sigmoidoscopy with rectal tube insertion
What is the management of a caecal volvulus?
Management is usually operative - right hemicolectomy
How do you induce remission in UC?
- Topical mesalazine
- Oral sulfasalazine
- Oral corticosteroid
If extensive - go straight to topical mesalazine + oral sulfasalazine
If severe (>6 bloody stools, fever, raised WCC) - treated in hospital with IV steroids
How do you maintain remission in UC?
- Topical mesalazine
2. Topical mesalazine AND oral sulfasalazine
How to maintain remission in someone who has had a severe relapse or has had more than 1 exacerbation in the last year?
Go straight to oral azathioprine/mercaptopurine (check TPMT activity first)
How can you diagnose UC?
Colonoscopy + biopsy
If severe colitis —> flexible sigmoidoscopy instead. Colonoscopy can cause perforation.
How do you induce remission in Crohn’s?
Steroids - topical/oral/IV
2nd line = Azathioprine/Mercatopurine
How do you maintain remission in Crohn’s?
1) Azathioprine/Mercaptopurine
2) Methotrexate
How do you monitor Barrett’s oesophagus?
Endoscopy every 3-5 years
If dysplasia is seen - resection/ablation
How is achalasia diagnosed?
Birds beak appearance on barium swallow
Increased lower oesophageal sphincter tone on oesophageal manometry
How does vitamin B3 (niacin) deficiency present?
Also known as Pellagra
Dermatitis
Diarrhoea
Dementia
How does vitamin B6 deficiency present?
Peripheral neuropathy
Sideroblastic anaemia
Can be caused by isoniazid
Which cancer is associated with Achalasia?
Squamous cell carcinoma of the oesophagus
What electrolyte abnormalities can PPIs cause?
Hyponatraemia
Hypomagnasaemia
