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Phase 2 - Gen Med > GI > Flashcards

GI Flashcards

1
Q

What are the red flag symptoms in GI conditions?

A 
Haematemesis 
Melaena
Weight loss
Worsening dysphagia 
Change in bowel habit
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2
Q

What are the ALARM Symptoms in dyspepsia?

A 
A = anaemia
L = loss of weight
A = anorexia
R = recent onset of progressive symptoms
M = melaena
S = swallowing difficulty
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3
Q

What are the categories for classing BMIs?

A 
<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
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4
Q

What is the cut off BMI for day-case general surgery?

A

> 32

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5
Q

What BMI is an indication for bariatric surgery?

A

> 40

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6
Q

Common causes of upper GI bleeding

A 
Peptic ulcer perforation/erosion
Gastritis
Mallory-Weiss tear
Varices
Oesophagitis
Cancer of the stomach or oesophagus
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7
Q

What is the Rockall Score?

A

Prediction of occurrence of re-bleeding and mortality in someone who has presented with upper GI bleeding

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8
Q

What are the factors used in the Rockall Score?

A 
Pre-endoscopy
- Age
- Shock indicators - pulse, BP
- Co-morbidities
Post-endoscopy
- Diagnosis
- Any evidence of bleeding
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9
Q

How is the Rockall score calculated?

A 
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%
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10
Q

How would you manage someone with an acute GI bleed?

A 
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
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11
Q

What bloods would you do in an emergency presentation of acute liver failure?

A 
FBC
U+Es
Ca2+, Mg2+, PO4
Clotting screen - PT/APTT
LFTs
Amylase 
Glucose
Paracetamol levels
Viral serology
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12
Q

What is irritable bowel syndrome?

A

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

  • Disorders of intestinal motility
  • Enhanced visceral perception
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13
Q

How do you diagnose IBS?

A

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
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14
Q

What are some other characteristics which can be noticed in IBS?

A 
Chronic - least longer than 6 weeks
Made worse by stress/menstruation 
Nausea
Bladder symptoms
Back ache
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15
Q

How is IBS investigated?

A

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)

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16
Q

How is IBS treated?

A 
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
17
Q

Describe UC

A

Relapsing and remitting chronic inflammatory disorder for the colonic mucosa.
Affects the rectum then extends proximally, in continuity. Will not pass the ileocaecal junction.

18
Q

What are the features of an acute attack of ulcerative colitis?

A 
S - decreased serum albumin
H - high fever
I - iron deficiency anaemia
T - tachycardia
E - ESR
R - Red - blood in diarrhoea
19
Q

What are the histological features of UC?

A

Haemmorhagic colonic mucosa
May have widespread pseudopolyps
Only extends to the submucosa
Crypt abscesses due to neutrophil infiltration

20
Q

What are the symptoms of UC?

A

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

21
Q

Give some extra-intestinal signs of UC

A 
Arthritis
Clubbing
Apthous oral ulcers
Erythema nodosum
Pyoderma gangrenosum 
Sacroilitis
Nutritional deficits
22
Q

What investigations would you do if you suspected UC?

A

Bloods
- FBC, U+Es, ESR/CRP, LFTs, blood cultures, faecal calprotectin
AXR and erect CXR
Sigmoidoscopy/colonoscopy

23
Q

Give some complications of UC

A 
Perforation
Bleeding
Toxic megacolon
Venous thrombosis
Colorectal cancer
24
Q

Inducing remission of mild to moderate UC

A 
1st line = 5-ASAs
2nd line = prednisolone
- Suppositories for proctitis
- Enemas or foams for proximal disease
Azathioprine/metcaptopurine 
Infliximab in steroid dependent patients
25
Q

Maintaining remission in UC

A

1st = 5-ASAs e.g. sulfasalazine
2nd = Azathioprine (steroid dependent of 5-ASA led to relapse)
3rd line = infliximab

26
Q

When would surgery be an options in UC?

A
  1. Severe acute episode if on day 3, stool frequency >8 or CRP >45
  2. Chronic symptoms in spite of medical therapy
  3. Carcinoma/ high grade dysplasia
27
Q

Differences between UC and Crohn’s

A 
Location of disease
Depth of inflammation
UC = blood/ Crohns = no blood
UC = smoking is protective
Crohn's = smoking makes it worse 
UC = colorectal cancer
Crohn's = not for colorectal Ca
28
Q

What will you see in UC after a barium enema?

A

Loss of haustrations
Superficial ulcerations
Drainpipe colon (arrow and short colon)

29
Q

What are the classic symptoms in carcinoid syndrome?

A

Crampy abdominal pain
Diarrhoea
Flushing

30
Q

What condition has a typical presentation of:

  • dysphagia of both liquids and solids
  • regurgitation of food, which can cause a cough, aspirations pneumonia etc?
A

Achalasia

31
Q

What is the most common cause of travellers diarrhoea?

A

E coli

32
Q

What are the indications for surgery following endoscopic management of acute upper GI bleed?

A 
Re-bleeding
Bleeding despite 6 units being transferred
Uncontrollable bleeding at endoscopy 
Initial Rockall score >3
Final Rockall score >6
33
Q

What should be ensured before H. pylori testing is carried out?

A

Should stop PPI for 2 weeks beforehand to allow for washout of the medication

34
Q

How is H. pylori tested for?

A

Carbon-13 Urea breath test

Stool antigen test

35
Q

What is the first line treatment for H. pylori?

A

PPI
Amoxicillin
Clarithromycin or metronidazole

36
Q

What is a further treatment for someone with GORD who is on long term acid suppression therapy?

A

Laparascopic fundoplication

  • can’t tolerate acid suppression
  • don’t want to continue long term suppression

Phase 2 - Gen Med (8 decks)

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