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Gastro > GI 2 > Flashcards

GI 2 Flashcards

1
Q

What are some mechanisms of intestinal obstruction?

A

Mechanical

True (intraluminal/extraluminal)

Functional - paralytic ileus

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2
Q

What can cause intestinal obstruction?

A

Tumour - carcinoma, lymphoma

Diaphragm disease

meconeum ileus

gallstone ileus

crohn’s

diverticulitis

hirschprung’s

adhesions (most common)

volvulus

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3
Q

How does small intestinal obstruction present?

A

pain - colicky then diffuse, pain higher than in large bowel obstruction

profuse vomiting that follows pain

less distension than LBO

nausea

tenderness = strangulation

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4
Q

How would you investigate a SBO?

A

Abdo X-ray - partial SBO = gas throughout the abdomen and into the rectum

complete SBO = no distal gas, staggered air-fluid levels

FBC

Urea

Electrolyte panel

Abdo CT

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5
Q

How would you a treat a SBO?

A

Emergency laparotomy plus fluid resus

Preoperative antibiotic prophylaxis - ampicilin + gentamicin

morphine

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6
Q

How would a large bowel obstruction present?

A

on av. 5 days of symptoms - present slower and later than in SBO

abdo pain that is more constant than in SBO

bowel sounds normal then quiet

palpable mass

late vomiting

constipation

fullness/bloating/nausea

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7
Q

How would you investigate a LBO?

A

FBC

serum electrolytes

renal function

serum amylase/lipase

erect chest x-ray

plain abdo x -ray- gaseous distension of large bowel, kidney shape seen in volvulus

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8
Q

How would you manage a LBO?

A

emergency surgery

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9
Q

What causes LBO?

A

colorectal malignancy

volvulus

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10
Q

What is a pseudo-obstruction?

A

clinical picture mimicking obstruction but with no mechanical cause

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11
Q

What are some causes of pseudo-obstruction?

A

intra-abdominal trauma

pelvic, spinal and femoral fractures

postoperative states

intra-abdominal sepsis

pneumonia

drugs (opiates, antidepressants)

metabolic disorders (electrolyte disturbances, malnutrition)

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12
Q

What are the 3 main types of bowel ischaemia?

A

acute mesenteric ischaemia

chronic mesenteric ischaemia (intestinal angina)

ischaemic colitis (chronic colonic ischaemia)

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13
Q

Where is blood supply to colon come from?

What are watershed areas which are most susceptible to ischaemia?

A

inferior and superior mesenteric arteries

splenic flexure and caecum

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14
Q

What is acute mesenteric ischaemia? What are the causes?

A

bowel ischaemia affecting the small bowel

caused by superior mesenteric thrombosis

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15
Q

How does acute mesenteric ischaemia present?

A

Acute severe abdominal pain - constant, central or around right iliac fossa

No abdo signs

Rapid hypovolaemia - shock

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16
Q

How would you investigate ischaemic bowel disease?

A

CT - first line

sigmoidoscopy or colonoscopy

FBC

Chemistry panel - acidosis, uraemia, elevated creatinine

Coag panel - underlying prothrombotic disorder

ABG/lactate level

ECG - arrthmias or acute infarct that may be cause

Erect CXR - free air if perforation present

Abdo x-rays

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17
Q

How would you manage iscahemic bowel disease when there is no sign of infarction, perforation or peritonitis?

A

Supportive - NG tube, NBM, O2

Empiric Abx - ceftriaxone and metronidazole

SMA Embolus - open embolectomy or arterial bypass +/- bowel resection

Papaverine - antispasmodic

Chronic mesenteric ischaemia - medical optimisation + surgival systemic mesenteric bypass

Non-acute colonic ischaemia - segmental colectomy

Non-acute colonic ischaemia - segmental colectomy

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18
Q

What are the causes/RFs of Ischaemic Colitis?

A

Low flow in the inferior mesenteric artery territory

thrombosis
emboli
decreased cardiac output
drugs - oestrogen, antihypertensives, vasopressin

surgery

vasculitis - SLE, sickle cell

Coag disorders

COCP

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19
Q

How would ischaemic colitis present?

A

sudden onset lower left side abso pain

bright red blood without diarrhoea

signs of shock

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20
Q

What are some causes of haemorrhoids?

A

constipation

diarrhoea

congestion - pelvic tumour, pregnancy, portal hypertension

anal intercourse

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21
Q

When do haemorrhoids become painful?

A

Only painful if they are below the dentate line - protrude and are gripped by the anal sphincter

22
Q

How would you classify internal haemorrhoids?

A

1st - remain in rectum

2nd - prolapse through the anus on defection but then reduce

3rd - prolapse but can be reduced manually

4th - remain persistently prolapsed

23
Q

How would haemorrhoids present?

A

bright red rectal bleeding - on tissue or drips onto toilet

mucus discharge

pruritus ani

severe anaemia

change in bowel habit

24
Q

How would you investigate haemorrhoids?

A

anoscopic examination

colonoscopy - exclude serious pathology such as IBD

FBC

25
Q

How would you manage haemorrhoids?

A

25-30g of fibre

bowel habit advice

rectal hydrocortisone

rubber band ligation or sclerotherapy

surgical haemorroidectomy

26
Q

What are some causes of anal fistula formation?

A

perianal sepsis

abscesses

crohns

TB

diverticular disease

rectal carcinoma

27
Q

How would an anal fistula present?

A

pain
discharge
pruritus ani
systemic abscess

28
Q

How would you treat an anal fistula?

A

fistulotomy and excision

drain abscess with abx if infected

29
Q

What is a fissure-in-ano?

A

painful tear distal to dentate line

90% posterior
10% anterior most likely following childbirth

30
Q

What are some causes of fissure-in-ano?

A

hard faeces

childbirth

syphilis

herpes

trauma

crohns

anal cancer

31
Q

How would you treat fissure-in-ano?

A

diet - fibre and fluids

lidocaine ointment + GTN ointment or topical diltiazem

botox

32
Q

What are the 3 types of IBS?

A

IBS-C - constipation

IBS-D - diarrhoea

IBS-M - constip and diarrhoea

33
Q

What are some intestinal presentations of IBS?

A

ABC + 2 more

Abdo pain/discomfort
Bloating
Change in bowel habit

2 more of =

urgency
incomplete evacuation
abdo bloating/distension
muscous in stool

worsening symptoms after food

34
Q

What are some extra-intestinal presentations of IBS?

A

urinary frequency, urgency, nocturia

bac pain

joint hypermobility

fatigue

nausea

35
Q

What are some red flag symptoms to be aware when investigating IBS?

A

unexplained weight loss

PR bleed/blood in stool

FHx of bowel or ovarian cancer

change in bowel habit >50

rectal/abdo mass

raised inflamm markers

anaemia

36
Q

What is the ROME IV criteria for IBS?

A

Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria:

i) Related to defecation
ii) Associated with a change in frequency of stool
iii) Associated with a change in form (appearance) of stool.

37
Q

How would you investigate IBS?

A

diagnosis of exclusion

FBC - investigate anaemia

Stool study - rule out infection

Anti-endomysial & tTG - rule out coeliac

abdo x-ray - obstruction

colonoscopy - IBD

38
Q

How would you manage IBS?

A

Constip

i) laxative (lactulose)
ii) antispasmodics (dicycloverine, peppermint oil)
iii) SSRI (citalopram)

Diarrhoea
I) loperamide
ii) dicycloverine
iii) TCA - amitriptyline

39
Q

What are some differentiating factors between IBS and IBD?

A

IBD more systemic :

Fever
Extra-intestinal symptoms
Melena
Weight loss
Mouth ulcers
40
Q

What is diverticulosis, diverticular disease and diverticulitis?

A

Diverticulosis = presence of diverticula

Diverticular disease = diverticula are symptomatic

Diverticulitis = inflammation of a diverticulum

41
Q

What are some causes of diverticulitis?

A

low fibre diet

Obesity

Smoking

NSAIDs

Over 50

42
Q

How would diverticulitis present?

A

Asymp in 95%

Intermittent left iliac fossa pain

Erratic bowel habit

Constipation

*similar to appendicitis but left sided

febrile
tachycardia

tendernessand guarding on left side

43
Q

What are some complications of diverticular disease?

A

perforation

fistula formation

  • into bladder = dysuria
  • into vagina = discharge

intestinal obstruction

bleeding

mucosal inflammation

44
Q

How would you investigate diverticular disease?

A

FBC - polymorphonuclear leucocytosis

CT colonography

Abdo x-ray

45
Q

How would you treat diverticular disease?

A

Dietary - fibre
Amoxicillin
Paracetmol/Tramadol/Morphine
Low residue diet - refined bread, white rice, vegetable without pulp

endoscopic embolization

surgery

46
Q

What is Meckel’s diverticulum?

A

most common congenital abnormality of GI tract

diverticulum projects from the wall of the ILEUM

can secrete HCL = peptic ulcers

47
Q

Where is the appendix located?

A

McBurney’s point = 2/3rds of the way from the umbilicus to the ASIS

48
Q

What are the causes of appendicitis?

A

faecolith
lymphoid hyperplasia
filarial worms

49
Q

How does acute appendicitis present?

A

pain umbilical region that migrates to the right iliac fossa (McBurney’s)

anorexia

nausea and vomiting

constipation

fever

50
Q

How would you investigate acute appendicitis?

A

FBC - mild leucocytosis

abdo and pelvic CT scan

pregnancy test - rule out ectopic

51
Q

How would you treat acute appendicitis?

A

appendectomy

IV abx - cefoxitin

Gastro (4 decks)

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