GI Flashcards
What are the red flag symptoms in GI conditions?
Haematemesis Melaena Weight loss Worsening dysphagia Change in bowel habit
What are the ALARM Symptoms in dyspepsia?
A = anaemia L = loss of weight A = anorexia R = recent onset of progressive symptoms M = melaena S = swallowing difficulty
What are the categories for classing BMIs?
<18.5 = underweight 18.5-24.9 = ideal weight 25-29.9 = overweight 30-34.9 = obese 35-39.9 = severely obese >40 = morbidly obese
What is the cut off BMI for day-case general surgery?
> 32
What BMI is an indication for bariatric surgery?
> 40
Common causes of upper GI bleeding
Peptic ulcer perforation/erosion Gastritis Mallory-Weiss tear Varices Oesophagitis Cancer of the stomach or oesophagus
What is the Rockall Score?
Prediction of occurrence of re-bleeding and mortality in someone who has presented with upper GI bleeding
What are the factors used in the Rockall Score?
Pre-endoscopy - Age - Shock indicators - pulse, BP - Co-morbidities Post-endoscopy - Diagnosis - Any evidence of bleeding
How is the Rockall score calculated?
Score of 0-3 for each category Increasing overall score means there is likely to be an increase mortality 3 = 5% 4-6 = 5-10% 7+ = 10-35%
How would you manage someone with an acute GI bleed?
ABCDE assessment Bloods - FBC, U+Es, LFTs, clotting, x-match 6 units, ABG, glucose Give blood if shocked Take a history Correct any Urgent endoscopy Post-endoscopy - omeprazole IV, continued PO
What bloods would you do in an emergency presentation of acute liver failure?
FBC U+Es Ca2+, Mg2+, PO4 Clotting screen - PT/APTT LFTs Amylase Glucose Paracetamol levels Viral serology
What is irritable bowel syndrome?
A group of abdominal symptoms in which no organic cause can be found.
- Disorders of intestinal motility
- Enhanced visceral perception
How do you diagnose IBS?
Pain/discomfort is relieved by defecation
OR Altered stool form
OR Bowel frequency
With 2+
- urgency
- abdominal bloating
- incomplete evacuation
- mucous PR
- worsening of symptoms after food
What are some other characteristics which can be noticed in IBS?
Chronic - least longer than 6 weeks Made worse by stress/menstruation Nausea Bladder symptoms Back ache
How is IBS investigated?
Have to rule out all other organic causes
- FBC, ESR/CRP, LFT, coeliac serology, faecal calprotectin
Refer if:
>60, blood, weight loss
Have a low threshold if Hx of ovarian or bowel Ca
Upper GI Endoscopy
Duodenal biopsy (coeliac)
How is IBS treated?
Education about illness Exclude foods that exacerbate symptoms Increase fibre intake in constipation Antispasmodic e.g. Mebeverine 135mg/8hr (OTC) Antacids if reflux symptoms Psychological therapy
Describe UC
Relapsing and remitting chronic inflammatory disorder for the colonic mucosa.
Affects the rectum then extends proximally, in continuity. Will not pass the ileocaecal junction.
What are the features of an acute attack of ulcerative colitis?
S - decreased serum albumin H - high fever I - iron deficiency anaemia T - tachycardia E - ESR R - Red - blood in diarrhoea
What are the histological features of UC?
Haemmorhagic colonic mucosa
May have widespread pseudopolyps
Only extends to the submucosa
Crypt abscesses due to neutrophil infiltration
What are the symptoms of UC?
Gradual onset of diarrhoea
Bowel frequency is related to the severity of the disease
Crampy, abdominal discomfort
Often get systemic symptoms
- fever, malaise, anorexia, decreased weight
Urgency and tenesmus in rectal disease
Give some extra-intestinal signs of UC
Arthritis Clubbing Apthous oral ulcers Erythema nodosum Pyoderma gangrenosum Sacroilitis Nutritional deficits
What investigations would you do if you suspected UC?
Bloods
- FBC, U+Es, ESR/CRP, LFTs, blood cultures, faecal calprotectin
AXR and erect CXR
Sigmoidoscopy/colonoscopy
Give some complications of UC
Perforation Bleeding Toxic megacolon Venous thrombosis Colorectal cancer
Inducing remission of mild to moderate UC
1st line = 5-ASAs 2nd line = prednisolone - Suppositories for proctitis - Enemas or foams for proximal disease Azathioprine/metcaptopurine Infliximab in steroid dependent patients
