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Year 3 Drugs + Core Conditions > GI > Flashcards

GI Flashcards

1
Q

Extra-oesophageal manifestations of GORD

A

nocturnal asthma, chronic cough, laryngitis, sinusitis

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2
Q

common triggers of GORD

A

smoking
alcohol, coffee, fatty food
big meals - raised IAP

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3
Q

presentation of GORD

A 
heartburn - burning retrosternal pain
Belching, nausea, vomiting
related to meal time
regurgitation of food into mouth
acid brash, excess saliva
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4
Q

What are the ALARMS symptoms that warrant urgent endoscopy in PUD

A 
Anaemia
Losing weight
Anorexia
Recent onset of symptoms
Melena/Haematemesis
Swallowing difficulty
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5
Q

Investigating and managing GORD?

A

endoscopy if serious, or in over 55s not responding to treatment after 4 weeks + red flags
PPIs, H2 blockers, antacids, lifestyle changes

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6
Q

Causes of peptic ulcer disease? (PUD)

A

H. pylori infection (80%)

NSAID use

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7
Q

Presentation of PUD

A

epigastric, burning pain
associated with meals
haematemesis
melena

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8
Q

How is H. pylori diagnosed?

A

Urea breath test

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9
Q

Which is more common, upper or lower GI bleed?

A

Upper

4x more common

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10
Q

Causes and RF for GI bleed

A

oesophageal varices - alcohol abuse

previous GI problems, NSAIDs

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11
Q

How to manage a GI bleed

A

IV PPI started to reduce chance of re-bleeding
Offer Terlipressin to suspected variceal bleed - dilates splenic artery
not all treatment surgical - resolve acid

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12
Q

What is Mallory-Weiss syndrome?

A

haematemesis from a tear in the mucosa of the oesophagus, brought on by prolonged vomiting

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13
Q

Typical causes of a lower GI bleed?

A

Big bleeds - diverticular disease, ischaemic colitis

Small bleeds - haemorrhoids or anal fissures

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14
Q

Which part of the bowel is affected by UC?

A

Rectum (50%)
Left side of colon (30%)
Whole colon (20%)
it is continuous

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15
Q

Cobblestone appearance, granulomas, fistulae and deep ulcers/fissures more characteristic of which IBD?

A

Crohn’s disease

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16
Q

Typical characteristics of UC?

A

inflammatory polyps
reddened mucosa
superficial inflammation
crypt abscesses

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17
Q

differential diagnoses for IBD

A

infective colitis
IBS
coeliac disease
diverticulitis

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18
Q

Main diagnostic tool for IBD

A

Colonoscopy

mostly exclusion of other potential causes - stool microscopy

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19
Q

Treatment plan for CD

A

Glucocorticoids - prednisolone
Infliximab - anti-TNF-alpha monoclonal antibody
DMARDS - azathioprine
Surgery - 80% pts will require

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20
Q

Treatment plan for UC

A

Aminosalicylates - Mesalazine

surgery - can be curative, eliminates cancer risk

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21
Q

Complications of IBD

A

strictures, fistulae, perforation, colorectal cancer

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22
Q

what is tenesmus?

A

the sensation of needing to pass stool, despite an empty colon

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23
Q

what type of organism is C. diff

A

gram positive bacillus

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24
Q

Management of infective gastroenteritis

A

Oral rehydration solutions
Antibiotics if necessary - systemically unwell
antiemetics/ anti-diarrhoeals if necessary

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25
antibiotic of choice to treat infection with Shigella / Campylobacter / salmonella
Ciprofloxacin PO
26
Common viral causes of gastroenteritis
Rotavirus - children | Norovirus - adults
27
How does gastroenteritis cause its symptoms?
inflammation of the lining of the stomach and small intestine affects absorption of salts and water in the intestine - D+V
28
What relieves pancreatic pain?
sitting forward
29
what is the effect of inflammation of the pancreas
release of exocrine enzymes, causing autodigestion of the organ, and maybe local tissues
30
Main causes of pancreatitis
alcohol - chronic | gallstones - acute
31
what signs can be expected with acute pancreatitis?
systemic infection jaundice - gallstone obstruction Periumbilical bruising - Cullen's sign Flank bruising - Grey Turner's sign
32
what blood findings suggest acute pancreatitis?
serum amylase more than 3x the upper limit within 24hrs of pain onset
33
what can cause raised serum amylase?
``` acute pancreatitis cholecystitis mesenteric infarction GI perforation renal failure ```
34
what investigations would you order if suspected pancreatitis
serum amylase CXR - to exclude perforation abdo USS - gallstones Contrast spiral CT - assess pancreatic necrosis
35
how is acute pancreatitis treated?
gallstones removed if cause | supportive if not - analgesia, H2 antagonist, nasogastric tube, nutrition
36
management for chronic pancreatitis
abstinence from alcohol low fat diet, enzyme supplements, fat-soluble vitamins analgesia surgery if severe
37
How does alcohol cause chronic pancreatitis?
alcohol causes proteins to precipitate in the ducts >> dilatation and fibrosis
38
who is affected by gallstones
``` 5 F's Fat Female Fertile Fair Forty ```
39
what are the types of gallstone?
``` Cholesterol stones (80%) Bile pigment stones ```
40
What are the presentations of gallstones?
Biliary colic Acute cholecystitis Cholangitis
41
Symptoms of biliary colic
Epigastric/RUQ pain, radiating to the back in waves obstructive jaundice
42
presentation of acute cholecystitis
Epigastric/RUQ pain referred to tip of scapula systemically unwell obstructive jaundice
43
what is the difference between cholecystitis and cholangitis
Cholecystitis - inflammation of the gallbladder | Cholangitis - inflammation of the bile duct
44
What is Murphy's sign?
place 2 fingers on RUQ ask pt to breathe in pt cannot due to pain from inflamed GB
45
most sensitive investigation for gallstones?
abdo USS
46
Name of the scoring system to determine if endoscopy necessary in GI bleed
Blatchford score
47
treatment of Hep A, D and E
supportive | avoid alcohol
48
Treatment of Hep B
supportive avoid alcohol avoid sexual intercourse
49
Treatment of Hep C
Weekly peginterferon-alpha SC | daily ribavirin
50
Prognosis of Hep B
Majority will recover completely some go on to develop chronic hepatitis, cirrhosis or HCC complete eradication of Hep B is rare
51
Prognosis of Hep C
90% develop chronic liver disease | 15% develop HCC
52
what is the prognosis of Hep A
usually acute, passes within 3 months
53
typical symptoms of chronic hepatitis
muscle/joint pain, fever, jaundice, abdominal pain, dark urine, grey faeces
54
What is McBurney's sign
Appendicitis | Pain, guarding, rebound tenderness 2/3rd of the way between umbilicus and ASIS
55
In what cases is surgical treatment of appendicitis contra-indicated
If pt has IBD, as it impairs healing | treat with DMARDs instead
56
most common cause of bowel obstruction?
Small bowel - adhesions from previous surgery | Large bowel - colorectal cancer
57
how is obstruction treated
full blockages will require surgery | blockage removal, or colon resected
58
complications of hernias
strangulation, incarceration, irreducible hernia
59
characteristics of oesophageal carcinoma
Squamous cell carcinoma | Barrett's oesophagus leads to adenocarcinoma
60
presentation of oesophageal carcinoma
swallowing problems, persistent heartburn, retrosternal pain, cough/hoarseness + red flags
61
Characteristics of gastric carcinoma
90% are adenocarcinomas | often asymptomatic/ non-specific
62
Signs associated with gastric carcinoma
Acanthosis nigricans in axilla | Dermatitis herpatiformis
63
presentation of pancreatic adenocarcinoma
epigastric/back pain, painless obstructive jaundice, pale stools, dark urine, palpable mass
64
What is Courvoisier's sign?
Painless gall bladder mass | indicates not gallstones - pancreatic cancer
65
characteristics of colorectal cancer
adenocarcinoma 60% are in the rectum common with familial adenomatous polyposis
66
classic red flags for colorectal cancer
persistent bloody stools + change in bowel habit (increased frequency and looseness), worsening obstruction
67
What are the types of liver failure
Toxic - drugs, alcohol, paracetamol Metabolic - NASH, PBC Viral - hepatitis, CMV
68
Presentation of liver failure
clubbing, palmar erythema, spider naevi, testicular atrophy, jaundice, encephalopathy, ascites
69
LFT findings in liver failure
raised bilirubin, ALT and AST
70
causes of ascites
``` excessive alcohol + cirrhosis metastatic cancer portal hypertension right heart failure Nephrotic syndrome ```
71
common causes of a perforated viscus
Perforated peptic ulcer tumour, abdominal trauma ruptured diverticulum
72
presentation of coeliac disease
diarrhoea, abdo pain, bloating, flatulence, indigestion, constipation when eating gluten - leading to villous atrophy and malabsorption
73
What mediates coeliac disease
T cells
74
Malabsorption issues with coeliac disease
Steatorrhoea - fats apthous ulcers iron deficiency anaemia delayed growth and puberty
75
complications of a perforated viscus?
Upper GI - usually sterile but can cause chemical peritonitis Lower GI - normally causes severe sepsis
76
Difference between left and right sided colorectal cancer?
Left - bleeding/mucous PR, obstruction, tenesmus, PR mass | Right - weight loss, anaemia, abdo pain, obstruction less likely

Year 3 Drugs + Core Conditions (23 decks)

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