GI Flashcards

Question

IBS definition

Answer 1

A group of abdominal symptoms for which no organic cause can be found.

Answer 2

<40 F>m Western world Symptoms exacerbated by stress, food, gastroenteritis, menstruation

Answer 3

Psychological - stress, depression, anxiety, trauma GI infection - gastroenteritis Sexual, physical, verbal abuse Eating disorders

Answer 4

Female Stress Gastroenterisis Sever and long diarrhoea Hypochondrial anxiety

Answer 5

Dysfunction of the brain gut axis resulting in disorder of intestinal motility and enhanced visceral sensitivity. Recurrent abdominal pain with NO inflammation There are 3 different types…. IBS - c - constipation IBS - D - diarrhoea IBS - M - constipation and diarrhoea

Answer 6

Mucus in stools Change in stool frequency Change in stool consistency Incomplete emptying Urgency Worsening symptoms after food Abdominal pain and bloating Alternating bowel habits Constipation Diarrhoea

Answer 7

There is nothing physical found, so diagnosis is made by ruling out other differentials: * Faecal calprotectin- raised in IBD * Colonoscopy - rule out IBD and colorectal cancer * FBC - anaemia * ESR and CRP for inflammation * Coeliac serology

Answer 8

Coeliac diseases Lactose intolerance IBD Colorectal cancer

Answer 9

* Lifestyle modification- fluids, avoid caffeine alcohol and fizzy drinks, have fibre for wind and bloating * Pain/bloating - Buscopan (muscle relaxer) * Constipation - laxative such as senna * Diarrhoea - anti motility -loperamide If none of the above work - try amitriptyline

Answer 10

* A state of heightened immunological responsiveness to ingested gluten in genetically susceptible individuals Ingestion of gluten stimulates the immune system to attack the small intestine

Answer 11

* 40-60 age * 1/100 Europeans * Associated with other autoimmune conditions - diabetes 1, graves Presentation at any age - but normally after infancy

Answer 12

Gluten found in wheat, barley and rye BROWN - barley, rye, oats, wheat NEVER!!!

Answer 13

Other autoimmune diseases IgA deficiency Age of introduction into the diet Rotavirus infection in infancy increases the risk

Answer 14

* A- gliadin is the toxic part of gluten that is resistant to proteases in the small intestine * Gliadin binds to IgA in the mucosal body * The complex I then moved to the lamina propria via HLA DQ2 DQ8 * It is then taken up by macrophages and expressed on MHCII * T helper cells release cytokines and c cells It causes villous atrophy, crypt hyperplasia, reduced surface area for nutrient absorption, b12, folate and iron deficiencies which causes anaemia

Answer 15

Classic: * Diarrhoea * Statorrhea * Abdo pain * Abdo distention * Weight loss * Faliure to thrive * Nutritional deficency Non classic: * Dermatitis herpiformis - red raised patches with blisters caused by IgA antibodeies * IBS symptoms * Iron deficency aneamia * Osteoporesis * Chroic fatigue * Ataxia * Peripheral neuropathy * Hypospleenism * Amenorema Infertility

Answer 16

* Serology - anti tissue transglutaminase (tTG) - anti-endomysial antibody (EMA) (IgA)- anti-gliadin IgG/IgA * Endoscopies and duodenal biopsies - villous atrophy, crypt hyperplasia, intraepithelial lymphocytes * Scalloping of mucosa, duodenal bulb * FBC - low B12, low ferratin, low Hb Autoimmune condition screening T1DM, Thyroiditis

Answer 17

* BROWN - barley, rye, oats, wheat NEVER!!! * Dietitian review to correct deficiencies * DEXA scan for the osteoporotic risk Treat anaemia

Answer 18

* T cell lymphoma * Osteoporosis * Anaemia * Infertility * Hypospleenism (reduced ability to fight infection) Vitamin deficient

Answer 19

Inflammation of the stomach lining associated with mucosal injury

Answer 20

Gastritis is an inflammation of the stomach lining, while ulcers are open sores in the lining of the stomach – and sometimes in the duodenum (the first part of the small intestine). While they are separate issues, the causes and symptoms of gastritis and ulcers are similar.

Answer 21

* H Pylori * Immune gastritis - antibodies to parietal cells and iF * Viruses, CMV and HSV * Chrons diseassse * Incrased acid * Alcohol * Mucosal ishchemia * NSAIDs

Answer 22

* H Pylori - lives in the gastric mucosa and secretes urease which splits urea in the stomach into CO2 and ammonia, this then reacts tithe the H+ to mke ammonium which is damaging to the epithelium * This causes gastrin release, histamine release, increased parietal cell mass and decreases somatostatin released form d cells which all leads to increased acid secretion * Autoimmune gastritis - fundus and body of stomach- loss of parietal cells and intrinsic factor deficiency causing pernicious anaemia NSAIDS - inhibit COX1

Answer 23

* Anorexia * Abdominal bloating * Haematemesis * Epigastric pain * Nausea * Vomiting * Indigestion

Answer 24

* Peptic ulcer * GORD * Gastric lymphoma Gastic carcinoma

Answer 25

CAP - clarithromycin, amoxicillin, PPI (omeprazole) Prevention - give PPIs along side chnic NSAID use to prevent ulcers ad gastritis

Answer 26

Gastro-oesophogeal reflux disease Obestity Hiatus hernia Lower oesophoguel sphincter hyotension Overeating

Answer 27

Obestiy Male Regnany Hiatus hernia Smoking

Answer 28

There is an increases in lower oesophageal sphincter relaxation which leads to reflux of gastric acid and pepsin back into the oesophagus, this causes pain

Answer 29

Chest pain aggravated by stooping Nocturnal asthma due to aspiration of gastric contents Heart burn Painful swallowing - odynophagia Hoarse throat Regurgitation Acidic taste in mouth

Answer 30

* Diagnosed in clinical findings Oesophago-gastro- duodenoscopy - may show oesophogitus and hiatus hernia

Answer 31

* Weight loss, stop smoking small regular meals * Antacids - gaviscon * Proton pump inhibitors - lansoprazole, omeprazole * H2 receptors antagonists - cimetedine Surgery

Answer 32

Barrets oesophogus - epitelium of the oesophogus undergoes metaplasia and changes from squampus into columnar epithelium with goblet cells, tjs causes an increasde rosk fof oesophogeal cancer, its premalognant for adenocarcinoma of the oesohphogus Peptic stricture - inflamation of the oesophogus resulting from gastric exposr

Answer 33

A break in the epithelium cells which penetrate down into the muscularis mucosa of the stomach/duodenum

Answer 34

* More common in eldery * Developing cuntries due to H Pylori * Duodenal ulcers are the most common, they are relived by eating, they are 2-3x more common than gastric * Gastric ulcers are worstened by eating and are assocoaited with asptin and other NSAIDS Risk factors for gastric cancer due to chronic inflammation - gastric carcinoma and lymphoma

Answer 35

* H pylori lives in the gastric mucas and creass urease which splits the urea in the stomach into CO2 and amonia * This causes amonnia and H to react to make amonium * Amonium is damading to the mucsa which leads to ulscer forrmation * It also cuases more gastirn, more histamin and more parietal cell mass which all leads to more acid to secretion * NSAIDs - inhibit COX1 one which is needed or prostoglandin synthesis. Prostoglandins are what causes mucus secretion * Ischemia -stomach cells don’t have surficant blood which means that they die off and gastric acid attacks the cells * Increased acid - overwhels the mucosal defence Bile reflux - regurgitated bile strips away the mucas

Answer 36

* Ulcers lead to gastritis Mucin is protective and produced by the gastric cells

Answer 37

* Gastric ulcer pain often occurs when hungry or eating or at night * Duodenal pain occurs several hours after meals, causes weight gain and is relieved by eating * Anorexia * Burning epigastric pain * Vomiting * Bloating * Dyspepsia * Flatulence * Haematemesis

Answer 38

* Reduce smoking, reduce stress, less alcohol * Stop NSAIDs * Antibiotics for H Pylori (clarithromycin, amoxicillin) * H2 antagonists (cimetidine) * Surgery for complications

Answer 39

There are some red flags for cancer - unexplained weight loss Anaemia GI bleeding Dysphagia Upper abdominal mass Persistent vomiting Duodenal ulcers caan eerode into arterys and causes massive hemmorage and shock It can cause perforation, obstruction, peritonitus is stomach acid enters the peritoneum Acute pancreatitis is ulcer reaches the pancreas

Answer 40

Linear muclosal tear occurring in the oesophagitis junction produced by a sudden increase in intraabdominal pressure More common in men 20-50 Alcoholism Forceful vomiting Eating disorder Male

Answer 41

* Vomiting, coughing, increases intraabdminal oressure awhihc forced the stomach contents inot the oesophgus, dilating ti and causing a tear

Answer 42

Vomiting, abdominal pain Haematemesis Retching Melena Dizziness Postural hypotension

Answer 43

Gastroenteritis Cancer Peptic ulcer Oesophageal varices - there are ruptured veins in the oesophogus caused by portal hypertension!

Answer 44

Most bleeds are minor and heal within 24 hours Might need surgery to repair a tear ADH analouge - Vasporessin - Constircts the blood vessles and so reduced the bleeding Adrenaline- It is enjected using an endoscope to helop close the blood vessles around the tear

Answer 45

The oesophagus doesn’t contract or open properly so you can't swallow. * The nerves stop working properly * Autoimmune condition * Viral infection

Answer 46

Having certain genes. Having a problem with your immune system that causes it to attack nerve cells in your oesophagus. Having herpes simplex virus or other viral infections. Having Chagas disease. This is an infection caused by a parasite.

Answer 47

* Dysphagia * Bring back up undigested food * Heartburn * Chest infections * Weight loss * Chest pain Choking and coughing fits

Answer 48

Manometry – a small plastic tube is passed through your mouth or nose into your oesophagus to measure the muscle pressure along it at different points. Barium swallow – you drink a white liquid containing the chemical barium and X-rays are taken. The barium shows up clearly on X-ray so the doctor can see how long it takes to move into your stomach. Endoscopy – a thin, flexible instrument called an endoscope is passed down your throat to allow the doctor to look directly at the lining of your oesophagus, the ring of muscle and your stomach.

Answer 49

* Nitrase and nifedipine - relax the muscels in the oesophogus and make swallowing easier * Ballon dialation- endoscope is put in and a baloon is inflated to stretch open the muscles, but this caus canses oesophogeusl ruptre which requires emergancy surgery * Botow injection - cuases it to relax Surgery - laproscopic surgeyr to cut the ring of muscles, this is called hellers myotomy

Answer 50

Elderly Underlying atherosclerosis and vessels occlusion

Answer 51

* Atherosclerosis * Thrombosis * Emboli * Decreased co and arrhythmia Vasculitis

Answer 52

* Contraceptive pill * Vasculitis Thrombophilia

Answer 53

Occlusion of a branch - often superior mesenteric artery or inferior mesenteric artery Results in a watershed area of the colon - normally the splenic flexure

Answer 54

* LLQ pain Bloody diarrhoea

Answer 55

* CT/MRI * Stool analysis * Ultrasou and abdominal CT Colonoscopy and biopsy - gold standard

Answer 56

* Symptomatic manegement * Fluid replacement * Antibiotics - reduce infectio risk due to translocation of bacteria across dying gut wall Surgery - for gangrene, perforation, stricture

Answer 57

>50 Usually involved the small bowel

Answer 58

* Superior mesenteric artery thrombosis * Superior mesenteric artery embolism * Mesenteric vein thrombosis * Volvulus - loop of intestine twists round itself and causes bowel obstruction Non occlusive diseases - severe hypotension, vasospasm

Answer 59

Triad of: * Acite severe abdominal pain * No abdominal sign Rapid hypovolemia resulting in shock - pale skin, rapid weak pulse, reduced urine output, confusion

Answer 60

Laparotomy - diagnostic test Bloods - metabolic acidosis and high lactate

Answer 61

* Surgery to remove dead bowel * Fluid resuscitation * Antibiotics - IV gentamycin and vancomycin IV heparin to clot the blood

Answer 62

Inflammation of the apendix, it should be consdered for all right sided pain. The appendix is located ag mcburnys point which is 2/3 of yeh way along from the umbilicus to the ASIS

Answer 63

* Most common surgical emergency * More common in males 10-20 years

Answer 64

* Feacolth - stones made of feaces * Filaral worms * Undigested seeds * Lymphoid hyperplasia - obstruction of tube, they can grow durng viral infection Bacteria - campylobacter jejuni, salmonella, yersinia, bacillus cerueus

Answer 65

* The lumen of the appendix becomes obstructed, as the intestnal lumen is always producing fluid and mucus, it leads to a build uo and this causes incrased pressure ot build up * This pressure presses on afferent visceral nerves nearby causing pain * Bacteria become trapped and multiply leading to invasion of gut organisms into the mucal wall * This leads to oedema, ischaemia, perforation and inflammation

Answer 66

* Tender mass in RIR * Guarding * Rebound tenderness Pyrexia

Answer 67

* Acute pain in umbilicus and Right illiac region * N&V Fever

Answer 68

* CT abdomen * Bloods - FBC shows raised WBC count, elevated CRP and ESR * Ultrasound - women and children especially * Pregnancy test Urinalysis

Answer 69

* Acute terminal ileitis due to crones * Ectopic pregnancy * UTI * Diverticulitis * Perforated ulcer * Food poisoning

Answer 70

* Laproscpoic appendectomy Drainage of apensdix abcess

Answer 71

f the apendix ruptures, infected feacal matter will enter the peritoneum resulting in life threataning peritonitus and rebound tenederness Apendix abcess - can be on the appendix or subphrenic - under the diaphragm, this is a collection of pus.

Answer 72

When diverticula causes symptoms such as intermittent lower abdominal pain without inflammation and infection

Answer 73

* Increaseing age, between 50-70 Mainly in the sigmoid colon

Answer 74

Risk Factors * Increasing age * Low dietary fibre * Obesity * Sedentary lifestyle * Smoking * NSAIDs

Answer 75

Diverticula form in the sigmoid maily because it has a small diameter which mean that there is more pressure.

Answer 76

* Pain relived by defecation on the left lower side * Flatulence * Erratic bowel habits Constipation and diarrhoea

Answer 77

* FBC - anaemia, leucocytosis and neutrophilia Colonoscopy

Answer 78

* High fibre diet Paracetamol

Answer 79

When the diverticula become inflames and infected, causing sever lower abdominal pain, fever, general malaise and occasionally rectal bleeding

Answer 80

Inflamtion that occurs when feacal matter or feacaliths become lodged in the diverticula or when there is erosion of the diverticula wall due to higher luminal pressure

Answer 81

* Fever * Left lower quadrant tenderness and guarding * Rigidity, guarding and tendernes suggests perforation * Fresh blood and pelvic tenderness on rectal exam * Tachycardia and hypotension if there is septicaemia * Pain in left lower quadrant, but right colon in Asian people as well! * N&V * Rectal bleeding Palpable abdominal mass

Answer 82

* U&E - if significantly dehydrated or septic * CRP and ESR - elevated * Venous blood gas - raised lactate in significant PR bleed Colonoscopy

Answer 83

Oral co-amoxiclav (at least 5 days) Analgesia (avoiding NSAIDs and opiates, if possible) Only taking clear liquids (avoiding solid food) until symptoms improve (usually 2-3 days) Follow-up within 2 days to review symptoms If severe pain and in hospital: Nil by mouth or clear fluids only IV antibiotics IV fluids Analgesia Urgent investigations (e.g., CT scan) Urgent surgery may be required for complications

Answer 84

Perforation Peritonitis Peridiverticular abscess Large haemorrhage requiring blood transfusions Fistula (e.g., between the colon and the bladder or vagina) Ileus / obstruction

Answer 85

* Adhesions due to a previous surgery * Hernia * Malignancies * Gallstone illuis Volvulus

Answer 86

* There is obstruction, this causes bowel distention above the block and increased secretion of fluid into the distended bowel This causes vessels to be compressed leading to ischaemia, necrosis, and perforation

Answer 87

* Obstipation - constipation wth no wind * Incrases bowl sounds * Typanic percussion * Tenderness - suggests strangulation * Less distention compared o LBO Vomiting - if green it's probably an obstruction as that’s the bile Colic pain - comes in waves Localised pain - more likely to be pericarditis as the bowel is dying Vomiting following pian Nausea Anorexia

Answer 88

CT scan! - not Xray FBC

Answer 89

* Analgesia for pain * Asses fluid balance, urinary catheter, nasogastric tube * Resuscitate - IV fluids * Alleviate nausea - antiemetics * Nutrition - if more than 5 days without intake, they may need parenteral feed into the vein. Surgery for decompression

Answer 90

* Colorectal malignancy Volvulus

Answer 91

Abdo distention Palpable mass Constipatio Fullness/bloating * Acute onset - on average 5 days, the stmpis persnet lateras the large bowl can stretch so much * Voting faeces * Constant abdominal pain

Answer 92

* Obstruction causes dilation * Increased colonic pressure and decreased mesenteric blood flow Mucosal ulceration, necrosis and perforation

Answer 93

CT scan * DRE - empty rectum, hard stool, blood * FBC - low Hb is a sign of chronic occult blood Occult blood - blood not visible to the naked eye

Answer 94

* Aggressive fluid resuscitation * Bolwel decompression * Anaglesia and anti emetic * Abtibiotics * Surgery * NG tube for feeding * Colostomy potentially Laproscpic exploration

Answer 95

Clinical picture mimicking colonic obstruction but no mechanical causes - also called oglivie syndrome

Answer 96

* Postpartum - the organs are shifting back * Postoperative - the organs are moving back * Intraabdominal trauma * Intra-abdominal sepsis * Pelvic spinal and femoral fractures * Cardiorespiratory and neurological disorders * Antidepresants * Opoids

Answer 97

* Abdominal pain and disternion - rapid onset

Answer 98

x ray for gas CT scan

Answer 99

* Withdraw causative agents - drugs stop * Correcnt U&E * IV neosigmine - a choliesterase inhibitor to encourage motility Endoscopic colonic decompression

Answer 100

* Diarrhoea - abnormal passage of loose or liquid stools more than 3 times daily Acute - less than 2 weeks

Answer 101

* Viral -rotavirus, noravirus * Bacterial - campylobacter, shigella, salmonella, c.perfingens, s.aures, b.cereus, e.coli, c.difficil, parasites - giadia * The most common cause in children is rotavirs, the most common in adults is noravirus and campylobacter * Antibiotics can give rise to C.diff diarrhoea bcuases it kills all the other bacteria in the gut so it overgrows and causes an infection of its own! The main antibiotic that causes this are the 4 Cs - clindamycin, ciprofloxican (the group of quinolones genrally), co-amoxicolav (penicillins group genrally) cephalosporins. * Intraluminla infections (caused by cannulas) and systemic infections Non infective causes - cancer, chemicals - poisens, sweetners, drug side effects, IBS, endocrine, radiation.

Answer 102

Immuno suppressed - especially for CMV, HSV, mycobacteria. recent travel

Answer 103

HISTORY IS KEY: * Onset and duration - acute more likely to be virla or bacterial, chronic more likely to be parasites and non-infections * Family history * Characteristic of stools - floating means high fat content, blood or mucus - inflammatory, invasive infection, cancer, if it is watery it means a small bowl infection * Food and drink - meat & BBQs campylobacter * Travel * Immunocompromised? Diabetes, chemo, steroids, HIV (crypto and CMV) * Fresh water swimming - cryptosporidina, giardia * Medications - C. diff caused by antibiotics or side effects of medications * Neuro signs - clostridium botulinum, C.jejuni (they both causes descending weakness paralysis)

Answer 104

Stool tests - faecal calprotectin, faecal occult blood, microscopy, toxin detection, stool culture FBC, inflammatory markers, blood cultures

Answer 105

2nd leading causes of child dath after pneumonia

Answer 106

* Enterotoxigenic e.coli (30-70%) * Campylobacter (5-20%) * Shigella (5-20%) * Non-typhoidal Salmonella (5%) * V.parahaemolyticus (shellfish) * Viral (10-20%) Cholera: * Vibrio cholerae * Contaminated food/water * Cholera toxin * Profuse watery “rice water” diarrhoea 🡪 up to 20L a day * Vomiting * Rapid dehydration * Doxycycline and fluids Parasites: * -Protozoal (5-10% more chronic) * Cyrpto * Giardia * Entamoeba * -Worms * Schistosomiasis * Strongyloides Many are asymptomatic but can become a problem if the normal gut flora is alterd normally due to broad spectrum antobiotics.

Answer 107

* Recurrent diarrhoea * V&N * Fever * Fatigue * Muscle pain Steatorrhea

Answer 108

Diarrhoea and 3 of the following: * Abdo pain * Cramps * Nausea * Vomiting * Dysentry * Blood - e.coli and shigella Stool sample If chronic - sigmoidoscopy and bloo test

Answer 109

Appendicitis IBD UTI Coeliac disease Volvulus

Answer 110

* Rehydration * Antibiotics - metronidazole or vancomycin * Barrier nursing - in a side room, gloves and apron * Fluid and electrolytes * Antiemetics * Antimotility agents - ONLY IF NOT INFLAMATORY DIARRHOEA * C.difficil - vancomycin * E.Coli - fluroquinolones such as ascprofloxican or andlevofloxican * Shigella - azithromycin and ciprofloxacin * Salmonella -fluoroquinolones, such as ciprofloxacin, and azithromycin Campylobacter jejuni - Macrolides (e.g., azithromycin, erythromycin) are generally the treatment of choice in both children and adults, owing to increasing resistance to fluoroquinolones (e.g., ciprofloxacin)

Answer 111

Red flags: * Dehydration * Electrolyte imbalance * Renal failure * Immunocompromised * Severe abdominal pain Cancer risk factors: * Over 50 * Chronic diarrhoea * Weight loss Blood in stool

Answer 112

Forgn travel PPI or H2 antagonist us Crowded area

Answer 113

* 'Clo test' (rapid urease test) during biopsy to check for H.pylori presence * Pylori urea breath test - breath into a bag to measure CO2, you take a urea tablet, then breathe into a bag again, if Pylori are present it causes and increase in CO2 as they have the urease enzyme. Pylori stool antigen test - looks for Pylori associated proteins in the faeces

Answer 114

* It is triple therapy * PPI for acid suppression (lansoprazole or omeprazole * Plus two of metronidazole, clarithromycin, amoxicillin, tetracycline, bismuth. If no penicillin allergy do amoxicillin plus another one. Quinolines - ciprofloxacin, furazolidone, rifabutin are used when the other have failed as a last ditch attempt

Answer 115

1% of all malignancies Adenocarcinoma most common

Answer 116

* Family history * Coeliac disease Chronns diseases

Answer 117

* Abdominal pain * Diarrhoea * Weight loss * Anorexia * Anaemia Palpable mass

Answer 118

Ultrasound Endoscopic biopsy CT/MRI

Answer 119

Surgical resection Radiotherapy

Answer 120

* More common in men * 60-80 age group Adenocarcinoma is the most common in the UK

Answer 121

lder age Smoking Achlasia smoking For adenocarcinoma; * Barrettes oesophagus * Obesity * Male * Coeliac disease For SSC: * Alcohol * Caustic strictures * Hot beverages Palmoplantar keratoderma - thick patches of skin on hands and skin

Answer 122

quamous cell carcinoma (cancer of the flat lining cells): * Arises from squamous epithelium, most commonly in the upper 2/3ds * When the epithelium is repeatedly exposed to toxins such as alcohol, soke, hot fluids it gets damaged do the cells divide to make more * With each division there is more risk of mutation Adenocarcinoma (cancer of glandular tissue): * Arises from the columnar glandular epithelium, this is in the lower third of the oesophagus and develops as a consequence of GORD, the acid leads to barrettes oesophagus (squamous to columnar) Over time these cells turn into metaplastic and result in a tumour

Answer 123

* Lymphadenopathy * Vocal cord paralysis * Meleana * Progressive dysphagia * Regurgitation * Pyrosis * Pain in chest and back * Odynophagia (painful swallowing) * Hoarse voice * Vomiting Weight loss

Answer 124

* Upper GU endoscopy and biopsy * Barium swallow for staging * CT of chest abdomen and pelvic to look for metastatic disease * PET scan to look for metastasis Staging laparoscopy

Answer 125

Benign oesophageal tumours - they are smooth muscle tumours that arise from the wall and are very low growing, treated by endoscopic removal and surgery.

Answer 126

* Surgical resection - is the patients fir, age, co morbidities, severity of cancer, is it respectable? * Chemo and radiotherapy Palliative care

Answer 127

Males Eastern Europe and Asia more

Answer 128

Smoking H pylori

Answer 129

Adenocarcinoma, lymphoma, carcinoid tumour (slow growing neuroendocrine tumours of the bowel), leiomyosarcoma (cancer of smooth muscle)

Answer 130

* Epigastric pain * N&V * Anorexia * Weight loss * Dysphagia * Anaemia Liver metastasis - jaundice

Answer 131

* Gastroscopy with biopsy * Endoscopic ultrasound * CT/MRI PET scan

Answer 132

hang in there !

Answer 133

* Surgcial removal * Radiation therapy * Chemoterapy * Immunotherapy * HER-2 targert theraypy (herceptin) - if people test poeiitve for the gene the it can be used as a treatment Palliative care

Answer 134

* Colorectal cancer is the fourth most common UK cancer behind breast prostate and lung * Males Western countries

Answer 135

Sporadic mutation * FAP - familial adenomatous polyposis, where you have thousands and thousands of polyps which can turn malignant. It is autosomal dominant. * Lynch syndreome (hereditary non-polyposis colorectal cancer (HNPCC)) - genetic predisposition to developing different cancers, especiallt colerectal, utrine, gastric, overian, pancreatic, prostrae, kidney, bile duct and brain. * Male * Smoking * Pbeses * Precoessed/red meats * Polyps Older age

Answer 136

* There are some cancers sure to inherited genetic mutations such as APC which shoud causes apoptoasis of damaged cells, but is mutated so doesn’t which causes the formation of polyps

Answer 137

The cancer is in the inner lining of the bowel. Or it is slightly growing into the muscle layer. Diagram showing Dukes' A bowel cancer Dukes' B The cancer has grown through the muscle layer of the bowel. Diagram showing Dukes' B bowel cancer Dukes' C The cancer has spread to at least 1 lymph node close to the bowel. Diagram showing Dukes' C bowel cancer Dukes' D The cancer has spread to another part of the body, such as the liver, lungs or bones. In the number staging system, this is the same as stage 4. It is also called advanced bowel cancer.

Answer 138

* Right sided tumours are often asymptomatic but pressnt with iron deficency aneamia . * Abdominal discomfort * Bowel obstruction symptoms * Constitutional symptoms dysponea and fatigue * Left sided are associated with a change in bowel habits and have high rates of rectal bleeding and large bowel obstruction * Rectal mass * Diarrhoea or constipation * Abdomonal consipation * Colicky pain, vomiting, blood streaked stools Rectal bleeding and tenesmus (the feeling of needing a poo when you don’t actually)

Answer 139

* FBC - microcytic aneamia * U&E - renal function may be alter in advanced pevic disease * Colonoscopy and biopsy - gold standeard investigation may demonstrate an ulcerating lesion * CT colonography - CT bowel preop and contrast to visulise the colon * CT chest abdomen and pelvis (CAP) - if a biopsy is diagnostic of malinancy, this is used for staging MRI - sometimes better for staging rectal cancers

Answer 140

* IBS * Ulcerative colitis * Chrons * Haemorroids * Anal fissure Diverticular disease

Answer 141

There are screening tests to look for straces of blood in the stool - Fealcal occlut blood (FOB) and Faecal immunochemical test (FIT). If these come back positive there is a colonoscopy does to have a further look. * Iron replacement for the aneamia * Chemotherapy * Radiotherapy - for rectal cancer as it is extraperitoneal * Surgical resection

Answer 142

Pseudomembranous colitis (PMC) is a manifestation of severe colonic disease that is usually associated with Clostridium difficile infection, but can be caused by a number of different etiologies. Prior to the use of broad-spectrum antibiotics, PMC was more frequently related with ischemic disease, obstruction, sepsis, uremia, and heavy metal poisoning

Answer 143

Brad spectrum antibiotics - can kill off all bacteria apart form c.dificcil so it takes over and causes an infection.

Answer 144

pathophysiologyThere are yellow fatty lumps growing on top of the mucosa

Answer 145

Stool sample Blood tests Imaging tests Colonoscopy

Answer 146

Antibiotics agsint c.difficile Fecal microbial transplant Repeat antibiotics Surgery - orgen faliue or rupture

Answer 147

Haemarroids are normal spongy vascular structeus that cision the stool as it passes through. In heamarroids disease, they gaet disrupted swollen and inflamed.

Answer 148

* Chronic or reoccuring increase in abdominal pressure such as straing for poos, diahrroea or constipation * congestion fomr tumour, pregnancy, portal hypertension Anal intercourse

Answer 149

Obesity Older age

Answer 150

nternal ones are above the dentate line. Internal ones fall into 4 classifications - **Grade I:** no protrusion outside the anal canal. **Grade II:** protrusion outside the anus during bowel movement, but they retract spontaneously. **Grade III:** prolapsed haemorrhoids that don’t retract spontaneously, but they can be pushed back in manually. **Grade IV:** prolapsed haemorrhoids that cannot be manually pushed back in. * Hemmaroids are vunerable to trauma (hard stools) so will bleed easily on impact * Internal hemmaorids arent painful unless they get caught in the anal sphincter * Exteral haemorrhoids are painful There is a vicious circle; the vascular cushions protrude through a tight anus → become more congested and hypertrophy → protrude again more readily

Answer 151

NTERNAL: Itching * Burning * Bright red blood in stool External: * Painful hemarroids * Thrombosed with purplish hue * Sweling * Mucus discharge Itching

Answer 152

* Abdo investigation * Rectal exam * Protoscopy to look for intenal haemorrhoids Flexible sigmoidoscopy ot colonoscpy to exclude pathology

Answer 153

st * - incrases finre and fluid * Stool softners * Topical analgesia * Topical steriods * Topical analgesia 2nd * Rubber band ligation - **Sclerotherapy:** injection of drugs causes coagulation - **Infrared coagulation** - **Bipolar diathermy and direct current electrotherapy:** local heat causes coagulation Surgical excision

Answer 154

An abnormal connection between the anal canal and skin

Answer 155

Perineal Sepsis Tb Chrons Rectal carinoma

Answer 156

Blockedge of deep intramusclea glan duct thought to predispose to the formation of abcess

Answer 157

Pain Dischareg of blood or mucus Itchy bum Systemic abcess

Answer 158

* Palpation on digital exam * MRI - to exclude sepsis, will show contrast material in fistula * Endoanal ultrasoud

Answer 159

Surgery - cutting it open fully to heal better Antibiotics

Answer 160

Tearing of squamous lining of lower anal canal on defecation

Answer 161

* Can be isolated due to hard poos * Enemas * Endoscope * Vaginal delivery * Anal intercours Stis - symphyliss, heres, traums, chrons

Answer 162

Normal tissues is split apart and cuases invaion of nearby pathogen

Answer 163

ainful swelling Tender Dishcarge

Answer 164

* The diagnosis can usually be made by physical examination * MRI Endoanal ultrasound

Answer 165

Surgical excision and drainage - Treatment with antibiotics

Answer 166

A small hole in the skin which haooen in the area where the buttocks divide. It can lead to a pus filled absess

Answer 167

Pain Swelling Leakage if infected

Answer 168

* Watch and wait * Good hygone * Antibiotic * Painkillers to reduce swelling * Surgery tp drain sinus * Surgery to remove sinus - its cut out

Answer 169

Definition Inflammation of the peritoneum - generalised inflammation of the abdominal cavity Peritonism - tensing of the muscles to prevent movement of the peritoneum

Answer 170

Aetiology AEIOUP! * Appendicitis * Ectopic pregnancy * Infection - E cli and klebsiella, staphylococcus aureus * Obstruction - * Ulcer - epigastric pain radiating to shoulder * Peritoneal dialysis Causes of inflammation - * Inflamed organ * Air - ulcers, stabbings * Pus * Feaces * Lumoncal contents (its not feaces untill it reaches the colcin) * Blood - spleen problems Common causes of abdominal pain - gast

Answer 171

Pathophysiology Can result from any inflammation of the peritoneum Perforation of the appendix Spontaneous bacterial peritonitis

Answer 172

Key presentations * Dull pain that become sharp * Systemic cymptoms and genrally unwell * Pain relived by resting hands on abdome * Gaurding and reboud tenderness * Abscenc of bowel souds * Rigid abdome * Pain worse on coughing or moving * Wants to lie still * Sepsis - hypotension, tachycardia, oliguria

Answer 173

1st line test * CT scan * Clinical examination - rigid and guarding, lying still * Abdo Xray - dilated bowel, flat fluid level, gas under diaphragm * Bloods - FBC, U&E, LTF, clotting factors * Ascitic tap - night neutrophil count

Answer 174

Treatment * Bread spectrum antibiotics - metronidazole * Fluid resuscitation - IV and electrolytes * Pain meds * Surgery - treat the cause, patch any holes, remove the organ or causes, wash out the infection

Answer 175

Differential diagnosis * Bowel obstruction

Answer 176

Other notes Common causes of abdominal pain: Gastritis – epigastric pain Cholecystitis – right hypochondrium, mid-clavicular line Pancreatitis – midway between epigastric and umbilicus Appendicitis – right iliac fossa Diverticulitis – left iliac fossa

Answer 177

Definition A common congenital abnormality that is a small out-pouch of the small bowel which can be asymptomatic.

Answer 178

Pathophysiology RULE OF 2: * M-f ratio is 2 * 2% of population * 2 inches in length * 2 age diagnosis

Answer 179

1st line test FBC - anaemia Technitium-99m scan - meckles scan to look for it CT of abdomen and pelvis Ultrasound of the abdomen

Answer 180

Treatment If it is found during surgery it might be excised, if it is causing obstruction it will be excised and any adhesions associated fixed.

Answer 181

Rosvings sign - press on the left illiac fossa and when released there is pain of teh right psoas sign - leg is pulled back and this causes pain obturator sign - hip if flexed and then roated and this cuases pain

Answer 182

women (sespecially preganct) and children - dur to avoiding unecacerry eposure to radiation

Answer 183

IV fluids pain reief - paracetamol, opioids antibiotics - metronidazole and ceftriaxone laprscoic apendectomy

Answer 184

perforation leading to sepsis and peritonistis

Answer 185

rectume becuases there is an extra muscle band so it can withstand more pressure

Answer 186

in the liver

Answer 187

gastic - made worse by eating so weight loss duodenal - relived by eating so weight gain !

Answer 188

There are some red flags for cancer - over 55 and then one of these other symptoms: unexplained weight loss Anaemia GI bleeding Dysphagia Upper abdominal mass Persistent vomiting refer for 2 week endoscopy and biopsy to look for bowel cancer

Answer 189

A screening tool to assess the likelihood a person with an upper GI bleed will need medical intervention such as blood transfusion or endoscopy .

Answer 190

A system for known upper GI bleeds with a completed endoscopy to estimate re-bleeding and mortality rate due to upper gastrointestinal bleeding