GI Flashcards
What kind of inflammation is seen in Chron’s?
Transmural inflammation.
Skip lesions (areas of normal mucosa between affected zones). “Cobblestone” appearance.
Crypt branching
What kind of inflammation is seen in UC?
Lamina propria only inflammation.
Crypt distortion.
No areas of normal mucosa between affected zones
What are the signs/ symptoms of Chron’s?
Umbilical/ RIF pain. Diarrhoea. WEIGHT LOSS. ANAEMIA (malabsorption) ABDO MASS (RIF) ERYTHEMA NODOSUM EPISCLERITIS
how do you diagnose chron’s?
colonoscopy + biopsy
how do you treat Chron’s?
Prednisolone to induce remission.
2nd) Azathioprine 3rd) Methotrexate to maintain remission (1st - stop smoking)
What are the symptoms of UC?
Lower left quadrant pain (chrons is right)
Diarrhoea (blood more common than chrons). Blood PR
TENESMUS
UVEITIS
How do you diagnose UC?
colonoscopy + biopsy
How do you treat UC?
MESALAZINE plus/minus prednisolone
What are some differences between Chrons and UC?
Chrons: Transmural inflammation (compared to lamina propria only). Wight loss and anaemia possible (malabsorption in chrons but not UC). Erythema nodosum. Abdo mass. mouth ulcers
UC: risk of colorectal cancer higher than chrons.
tenesmus
uveitis (compared to episclirits)
blood PR and in diarrhoea
linked to Primary sclerosing cholangitis
What are three common causes of upper GI bleeding?
gastric/ duodenal ulcer
mallory-weiss tear
oesophageal varices (suspect in alcoholics)
over 55 years or ALARMS (dyspepsia or dysphagia) investigation?
upper GI endosocopy
under 55 years, dyspepsia or dysphagia investigation?
C/ urea breath test
How do you treat H. Pylori infection?
full dose PPI
amoxacillin
clarithromycin
(tripple eradication)
What investigations would you do for achalasia?
Barium swallow (bird beak appearance) CXR
What are the symptoms and treatment of achalasia?
haeliotosis (bad breath)
Oesophageal balloon dilation or Hellers myotomy
What are the investigations, treatment and signs of GORD?
Upper GI endoscopy
PPI and antacids
wheeze lying flat, more common in obese
What is the most common GI disease associated with H. Pylori?
duodenal ulcers.
What are the differences between duodenal and gastric ulcers?
duodenal: pain before meals or at night. releived by milk.
gastric: pain associated with meals. relieved by antacids. Weight loss more common
If patient has duodenal/gastric ulcer but negative for H. Pylori, what is the treatment?
PPI (eg. lansoprazole)
Define IBS?
abdo pain for over 3 days per month for over 3 months with 2 or more of: pain relieved on defication, change in stool frequency, change in stool appearance
What is the treatment of IBS?
Low fibre diet and regular meal times.
What is cholangitis?
inflammation of bile duct. Ascending cholangitis due to infection. PSC is autoimmune.
what are the symptoms of ascending cholangitis?
classic triad of: juandice, fever, abdo pain (continuos Epi/RUQ pain)
What is the investigation and treatment of ascending cholangitis?
ERCP Biliary drainage (endoscopically) and IV antibiotics for fever
Describe the pain in biliary colic.
Begins in the Epigastrium. Radiates to RUQ/back. Colicky. Related to large/fatty meals
What is the investigation of choice in biliary colic?
Ultrasound (US for all gallstone related diseases [cholecystitis])
How do you treat biliary colic?
Cholecystectomy (surgical removal of the gall bladder)
What is acute cholecystitis?
obstruction of cystic duct or neck of gallbladder (most often due to gallstones)
What investigations can be done for cholecystitis?
Ultrasound.
Murphys sign postive
WCC
Describe the pain in acute cholecystitis.
(similar to biliary colic but more severe and continuos)
Epigastric/ RUQ pain (may radiate to shoulder/back)
What is primary biliary cirrhosis?
Autoimmune disease of liver. destruction of the small bile ducts in liver, leading to accumulation of bile in liver. (more common in females)
what are the symptoms/signs of primary biliary cirrhosis?
(often asymptomatic)
itch, jaundice, xanthelasma, hyperpigmentation, hepatomegaly, arthralgia
What antibodies are positive in 1) Primary sclerosing cholangitis?
2) primary biliary cirrhosis?
1) anti-neutrophilic cytoplasmic antibodies (ANCA+)
2) anti-mitochondrial antibodies (AMA+)
What disease causes “onion skinning fibrosis, beading of bile ducts?”
primary sclerosing cholangitis
How is the diagnosis of pre-hepatic jaundice made?
testing for urine-urobilinogen (increase) with no change in urine colour.
What are 2 causes of pre-hepatic jaundice?
sickle cell anaemia.
malaria.
What are the signs of intra-heptic jaundice?
Dark urine.
What is the most significant LFT change in intra-hepatic jaundice?
rise in ALT (ALT + AST represent hepaTocyTe function)
slight rise in biliruben
What are 3 cause of intra-heptic jaundice?
Hepatitis. Cirrhosis. Alcoholic liver disease.
What are the signs of Post-hepatic jaundice?
PALE STOOLS and dark urine
What are 2 causes of Post-hepatic jaundice?
gallstones. carcinoma of head of pancreas.
what 2 LFTs are most raised in Post-hepatic jaundice?
ALP and billiruben.
ALP and GGT = obstruction bile duct
What is coeliac disease?
intolerance to gluten
What investigations are done for coeliacs disease?
IgA anti-tissue transglutaminase test.
Duodenal biopsy to confirm.
What are the signs/symptoms of coeliac disease?
Acute diarrhoea and vomitting.
vesicular rash and weight loss.
(may present as iron defficiency anaemia–> do FBC to check)
What is Budd-Chiari syndrome and what does it cause?
occlusion of the hepatic vein.
causing triad of abdominal pain, ascites and liver enlargement.
(investigation = US)
What are signs/symptoms of compensated liver failure?
spider naevi. palmar erythema. gynocomastia. clubbing. spleenomegaly.
What are signs/symptoms of decompensated liver failure?
Jaundice. Ascites. Encephalopathy.
hepatomegaly.
How do you treat decompensated liver failure?
Calcium and Vit D.
Thaimine (Vit B1) if alcohol induced cirrhosis
reduce salt intake and avoid NSAIDs.
What is ascites and what are the signs/symptoms?
Accumulation of fluid in the peritoneal cavity.
causing abdominal distension, caput medusae, shifting dulness (due to PORTAL HYPERTENSION)
How do you treat ascites?
with spironolactone.
pulmonary oedema = furosemide (loop)
What is encephalopathy and what is it caused by?
neuropsychiatric syndrome secondary to cirrhosis.
due to ammonia tampering with neurotransmitter trafficking. (treat with lactulose)
What are the symptoms of encephalopathy?
flapping tremor. confusion, drowsiness.
What is pancreatitis and what is it caused by?
inflammation of pancreas.
Gall stones. Ethanol. Trauma. Steroids. Mumps. Autoimmune. Scorpion sting. Hyperlipidemia/Hypercalcaemia. ERCP. Drugs (eg. azathioprine)
Describe the pain in acute pancreatitis.
(Severe) upper abdo pain. Usually beginning in Epi, bores through to back.
What are the associated signs/symptoms of acute pancreatitis and what investigations are suitable?
nausea and vomitting.
“Grey turners sign” (lumbar redness) + “Cullens sign” (umbilical redness)
increase in serum AMYLASE (and lipase)
What are 3 causes of malabsorption?
dysfunction of pancreas.
problem in biliary tree
problem in small bowel (lumen and wall)
What investigations and treatment is relevant to anaemia?
do FBC (check if Hb levels below normal)
Serum ferritin levels.
Give iron/ferrous supplements.
(anaemia may cause angular cheilitis)
What is a common cause of iron deficiency anaemia in males over 60? what investigation should be done?
Colorectal cancer. All males over 60 with iron deficiency anaemia should receive colonoscopy
