GI Flashcards
What is achalasia?
Neurological disorder of  gastrointestinal tract due to failure of lower oesophageal sphincter to relax
Features of sigmoid diverticulitis
- change in bowel habit
- LIF pain
- features infx
- +/- blood mixed into stool
Features of UC
- Bloody diarrhoea
- Eye syx
Norovirus features
- ~48h D+V from one another
- Often when people live/work close proximity
- Not necessary to have shared food
Norovirus Ix
Stool for viral PCR
Features of Crohn’s
- Non caseating granulomata
- Transmural inflammation
- Mouth to anus
- Skip lesions
What vaccination do pts with coeliac need
Pneumococcal (due to hyposplenism)
Causes of SBO
- Adhesions
- Hernias
- Tumours
What is chronic mesenteric ischaemia/angina and how does it present?
Narrowing of superior mesenteric artery - inadequate blood flow to intestines.
- Pain OE, I.e., cramping soon after eating
- Weight loss
- N+V
Oesophageal rupture/ Boerhaave’s syndrome features
- Vomiting and severe chest pain after eating large meal
- Hypotensive
- Tachypnoeic
Duodenal ulcer features
- Epigastric pain, radiating to back
- Better after eating
- Worse at night
- Worse when stressed
Paralytic ileus v bowel obstruction
PI
- temporary paralysis or inhibition of normal contractions that propel food and liquid through GIT (functional, not physical)
- often post surg/caused by meds etc
- No bowel sounds
BO
- hard, physical blockage
- tinkling bowel sounds
Mesenteric adenitis
Inflammation of lymph nodes of the mesentery (tissue that attaches intestines to abdo wall)
Mesenteric adenitis and features
Inflamm of lymph nodes of mesentery often due to viral illness
- Abdo pain (+/- crampy)
- Fever, sore throat
- Swollen lymph nodes
Meckel’s diverticulum
Congenital abnormality where you have a pouch-like structure that protrudes from wall of small intestine
Blood supply to each part of GIT
-Coeliac trunk (or celiac trunk) supplies foregut
mouth to beginning of duodenum <gastroduoedenal>
- Superior mesenteric artery supplies midgut
mid duod to 2/3 transv colon
- Inferior mesenteric artery supplies hindgut
2/3 tansv colon to anus</gastroduoedenal>
Which electrolyte abnormality is associated with paralytic ileus?
hypo K
Haemorrhoids and features
(Piles) are swollen veins in rectum and anus
- Discomfort/pain (can be painless)
- Bleeding
- Internal/external
Anal fissures and features
Small tears in the skin or lining of anus
- Pain
- Bleeding
- Itching
Most common causes LBO
- Colorectal ca
- Diverticular stricture
- Volvulus
What is the most common type of polyp in the colon and anus?
Adenoma
GORD v duodenal ulcer
GORD
- worse on lying down
- burning sensation throat/chest
Duodenal ulcer
- worse in AM
- epigastric tenderness
Barrett’s oesophagus histology
metaplastic columnar epithelium replacing the oesophageal squamous epithelium
Barrett’s oesophagus and mx
Changes due to longstanding reflux disease
- High dose PPIs
- Regular endoscopies
Anal abscess mx
incision and drainage
Mallory weiss v boerhaave
MV: from repeated retching/vomiting; tear to mucous membrane lining of lower oesoph/upper stomach
Boerhaave: Complete tear/rupture oesophagus - needing immediate surgical intervention
What can be seen on biopsy of coeliac?
- villous atrophy
- crypt hyperplasia
Skin manifestation coeliac
dermatitis herpetiformis
(blistering skin condition commonly on extensor surface)
Histology crohn’s v UC
Crohns: granuloma + incr goblet cells
UC: crypt abscess + decr goblet
Endoscopy crohn’s v UC
Crohn’s: cobblestone
UC: Pseudopolyps
Skin manifestations for crohn’s v UC
Crohn’s: pyoderma gangrenosum (painful, big-ass ulcers)
UC: erythema nodosum (bruise vibes)
True Love and Witt’s UC flares
Mild
- <4 BO
Mod
- 4-6 BO
Sev
- >6 BO
- Frank blood
- Syx features
- ESR >= 30
Acute, severe UC flare mx
- Admit + IV hydrocortisone
- after 72h, if improve: cont steroids and then wean off
if no improvem: IC ciclosporin + surg input -> biologics, e.g., infliximab
UC - proctitis/proctosigmoiditis/ LHS colitis mx
- Topical aminosalicyclate (e.g., mesalazine)
- If no improv after 4 weeks, PO aminosali.
UC - pancolitis mx
- Topical + PO aminosalicyclate
- If no improv after 4 weeks, POcorticosteroids
Toxic megacolon mx
IV hydrocortisone, infliximab, or sug (if perf)
Colonic polyps +++ and autosomal dominant APC gene mutation
FAP
Autosomal dom mutation in mismatch repair gene
HNPCC (lynch syndrome)
SB polyps + macules in lips or genitals + AD mutation STK11 gene
peutz-jegher syndrome
Bowel ca screening
aged 60-74 + FIT or FOB test every2 years
T staging for colorectal ca
T1 - no muscular involvement
T2 - involves muscularis propria
T3 - involves serosa/adventitia
T4 - invades local structures
Rectal ca mx according to T score
T1-2: transanal excision
T3-4: neoadjuvant trx + colonic resection
Nodal disease: adjuvant chemo
Colon ca mx according to T score
T1-3: colonic resection
Nodal disease: adjuvant chemo
T4: neoadjuvant mx
Anterior resection v abdominoperineal resection for rectal tumour
Anterior resection
- Rectal tumour >5cm from anal verge
- Rectum, sparing sphincters
Abdominoperineal resection
- Rectual tumour <5cm from anal verge
- Rectum, sphincters, anus
- Stoma needed - colostomy
RIF pain after appendicectomy
Meckel’s diverticulum
BO acutely unstable / bowel ischaemia / closed loop obstruction
emergency laparotomy
AAA screening
Men at 65 will have US
Syx AAA mx
refer to surgeons
AAA asyx mx
3-4.4cm - yearly USS
4.5-5.4cm - 3 monthly USS
>=5.5cm - refer to surgeons
actue, severe abdo pain + AF
Acute mesenteric ischaemia
Early v late stages acute mesenteric ischaemia
Early: Severe abdo pain, lactate v slight raise
Late: Peritonism + high lactate
Most common hernia in F w relatively high incidence of strangulation/obstr?
Femoral
Recurrent episodes acute LBO
Recurrent sigmoid volvulus
V sudden onset abdo pain + CXR showing free gas under hemi-diaphragm
Perforated peptic ulcer
(quick onset pain due to leakage of gastric acid causing immediate chemical peritonitis)
