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Year 3 - Core Conditions > GI > Flashcards

GI Flashcards

1
Q

What is gastro-oesophageal reflux disease (GORD)?

A

condition which develops when reflux of stomach contents causes symptoms/complications

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2
Q

What is the cause of GORD?

A

dysfunction of the lower oesophageal sphincter

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3
Q

What are some risk factors for GORD?

A

raised intra-abdominal pressure (hiatus hernia, obesity, pregnancy)
too much acid (gastric acid hypersecretion, delayed gastric emptying, overeatting)
smoking

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4
Q

What are the symptoms of GORD?

A

heartburn - restrosternal pain, worse on lying down and eating
belching, acid brash, water brash odynophagia, nocturnal asthma, chronic cough, larygnitis

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5
Q

What are some possible complications of GORD?

A

Barretts oesophagus, oesophageal adenocarcinoma, ulcers, oesophagitis,

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6
Q

What investigations would you do if you suspected GORD?

A 
barium swallow, manometry
upper GI endoscopy if:
->55yrs
-symptoms >4wks
-persistent after treatment
-associated weight loss
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7
Q

How would you treat GORD?

A

lifestyle - weight loss, raise head in bed, small meals, avoid food triggers (hot, spicy, fatty, acidic etc)
drugs - antacids, alginates, PPI (for oesophagitis)
surgery - where symptoms severe even with medication

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8
Q

What is the most common cause of peptic ulcers?

A

H pylori (90% of duodenal and 80% of gastric)

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9
Q

What are some risk factors for peptic ulcers?

A

NSAIDs, delayed gastric emptying, gastric acid hypersecretion, smoking

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10
Q

What are the symptoms of peptic ulcers?

A 
epigastric pain (worse before meals)
can be asymptomatic
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11
Q

What are the signs of peptic ulcers?

A

often nothing on examination but may be epigastric tenderness

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12
Q

What investigations would you do if you suspected a peptic ulcer?

A

upper GI endoscopy (stop PPI 2 weeks before)

H pylori testing

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13
Q

What treatment would you give for peptic ulcers?

A

lifestyle - avoid foods which irritate it, smoking cessation
H pylori eradication - omeprazole + clarythromycin + amoxicillin (/metronidazole in pen allergy)
drugs - PPI (or H2 agonist)

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14
Q

What are the possible complications of a peptic ulcer?

A

bleeding, perforation, malignancy

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15
Q

Are upper of lower GI bleeds more common?

A

upper

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16
Q

What are some possible causes of GI bleeds?

A

peptic ulcer, Mallary Weiss tears, oesophageal varices, NSAIDs/aspirin/anticoagulants, malignancy

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17
Q

What are symptoms of an acute GI bleed?

A

haematemesis, melaena, weight loss

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18
Q

What are signs of an acute GI bleed?

A

peripherally shut down (cool, clammy, slow cap refil), poor urine output, tachycardia, (postural) hypotension, haematchezia (on PR), pallor/signs of anaemia

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19
Q

What investigations would you do if you suspected an acute GI bleed?

A

urgent endoscopy
bloods - FBC (anaemia), U&E (increased urea), LFTs, clotting, cross match (for transfusion)
CXR, ECG, ABG

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20
Q

What would management be for an acute GI bleed?

A

EMERGENCY - RRAPID (oxygen, fluids, transfusion)

-FFP if >4 units transfused (transfuse to maintain HB>10), nil by mouth 24 hrs

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21
Q

What is Crohn’s disease?

A

transmural granulomatous inflammation of the GI tract with skip lesions

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22
Q

When does Crohn’s disease typically present?

A

teends/twenties

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23
Q

What is the cause of Crohn’s disease?

A

genetics (mutation of NOD2/CARD15)

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24
Q

What are some risk factors for Crohn’s disease?

A

smoking, stress, infection, NSAIDS exacerbate

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25
Q

What are symptoms of Crohn’s disease?

A

diarrhoea, abdominal pain, weight loss, fever, malaise, anorexia

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26
Q

What are signs of Crohn’s disease?

A

clubbing, aphthous ulceration, right iliac fossa mass, erythema nodosum, iritis, malnutrition, cholangiocarcinoma

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27
Q

What are some differentials for Crohn’s disease?

A

ulcerative colitis, ischaemic colitis, IBS

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28
Q

What investigations would you do if you suspected Crohn’s disease?

A 
bloods - raised Hb, ESR, CRP & WCC ; decreased albumin
stool sample (exclude infective cause)
sigmoidoscopy/colonoscopy/capsule endoscopy
MRI (assess pelvic disease and fistula)
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29
Q

What is the treatment for a mild attack* of Crohn’s disease?

* (symptomatic but systemically well)

A

prednisolone until parameters return to normal

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30
Q

What is the treatment for a severe attack* of Crohn’s disease?

A

hospital admission
IV hydrocortisone, metronidazole
nil by mouth, IV fluids, monitor obs and bowel movements

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31
Q

When may surgery be necessary in Crohn’s disease and what would it be?

A

if not responsive to treatment or there is bowel obstruction

ileostomy

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32
Q

What is ulcerative colitis?

A

relapsing and remitting condition of inflammation of the conolic mucosa
-hyperaemic and haemorrhagic colonic mucosa

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33
Q

What is the rate of Crohn’s and UC in the UK?

A

Crohn’s - 145/100,000

UC - 400/100,000

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34
Q

How does smoking effect UC?

A

Protective against symptoms

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35
Q

What is the main risk factor for an exacerbation of UC?

A

stress

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36
Q

What are the symptoms of UC?

A

gradual onset diarrhoea (+/- blood/mucous), cramping abdo pain, more frequent bowel motions, systemic symptoms during acute attacks (fever/malaise/anorexia), urgency/tenesmus in rectal disease

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37
Q

What are the signs of UC?

A

may be none
in acute and severe cases: fever, tachycardia, tender distended abdo
extraintestinal: clubbing, aphthous ulcers, erythema nodosum, conjunctivitis, malnourishment

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38
Q

How would you investigate if you suspected UC?

A

bloods - FBC, ESR, CRP, U&Es, LFTs, blood cultures
stool MC&S
AXR (no faecal shadows), CXR (perforation)
sigmoidoscopy (inflamed mucosa)
rectal biopsy - goblet cell depletion

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39
Q

What are the possible complications of UC?

A

perforation, haemorrhage, toxic dilation of the colon

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40
Q

What is the aim of treatment in UC?

A

induce remission

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41
Q

How do you treat mild* UC?

*(<4 motions per day)

A

prednisoloone and mesalazine

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42
Q

How do you treat moderate* UC?

*(4-6 motions per day)

A

larger doses of prednisolone and mesalazine and twice daily steroid enemas

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43
Q

How do you treat severe* UC?

*(>6 motions per day and systemically unwell)

A

hospital admission
nil by mouth, IV hydration
IV hydrocortisone, rectal steroids
monitor obs and bowel motions

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44
Q

When is surgery indicated for UC and what would be done?

A

if perforation/haemorrhage/toxic megacolon

remove effected portion of bowel

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45
Q

What is IBS?

A

mixed abdominal symptoms with no organic cause

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46
Q

What percentage of the population are affected by IBS?

A

10-20%

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47
Q

What is the cause of IBS?

A

unknown - related to disorders of intestinal motility/enhanced visceral perception

48
Q

What are the diagnostic criteria for IBS?

A

6 month history of abdo pain (relived by defacating)/bloating/change in bowel habit
+2 of: altered stool passage, abdo distension, symptoms worse on eating, mucous rectally

49
Q

What are some possible differentials of IBS?

A

coeliac, GORD, Crohn’s , giardia

50
Q

What investigations would you perform if you suspected IBS?

A

sigmoidoscopy (insufflation of air)
PR (look for bleeding)
blood test for coeliac

51
Q

What is the treatment for IBS?

A

increase fibre intake, mebeverine (antispasmodic), anatcids, try an exclusion diet (for food intolerances)

52
Q

What are common viral causes of gastroenteritis? (3)

A

norovirus, rotavirus, adenovirus

53
Q

What are common bacterial causes of gastroenteritis? (4)

A

E coli, salmonella spp., campylobacter spp., shigella

54
Q

Which bacteria cause gastroenteritis though their toxins?

A

staph aureus, bacillus cereus, clostridium perfinges

55
Q

What are some common parasitic causes of gastroenteritis? (2)

A

giardia lambia, cryptosporidium

56
Q

What are the main symptoms of gastroenteritis?

A

diarrhoea (if bloody-

bacterial) and vomiting

57
Q

What are the signs of gastroenteritis?

A

pyrexia, hypotension, sweating, malaise

58
Q

What investigations would you perform if you suspected gastroenteritis?

A

stool MC&S (if been abroad/institution/outbreak)

culture food source

59
Q

How do you manage someone with gastroenteritis?

A

maintain oral fluid intake, consider antiemetics
antibiotics if systemically unwell/immunosuppressed/elderly –> tertacycline for cholera, cirpofloxacin for salmonella/shigella/campylobacter

60
Q

What are the causes of acute pancreatitis?

A 
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion bite
Hypothermia/hypercalcaemia/hyperlipidaemia
ERCP
Drugs
61
Q

What are the symptoms of acute pancreatitis?

A

severe epigastric pain (radiates to back)/central abdo pain, vomiting

62
Q

What are the signs of acute pancreatitis?

A

tachycardia, fever, jaundice, ileus, rigid abdo, Cullen’s and Grey-Turner’s sign (if haemorrhagic)

63
Q

What investigations would you perform if you suspected acute pancreatitis?

A 
raised serum amylase raised serum lipase
AXR (psoas shadow)
erect CXR (exclude perforation)
US/ERCP (gallstones)
64
Q

What is the treatment for acute pancreatitis?

A

nil by mouth, NG tube, IV saline, analgesia, hourly monitoring, gallstone removal

65
Q

What are the causes of chronic pancreatitis?

A

alcohol, CF, haemochromatosis, pancreatic duct obstruction

66
Q

What are the symptoms of chronic pancreatitis?

A

epigastric pain ‘bores’ through to back (relived by sitting forward & hot water bottle)
bloating, steatorrhoea, weight loss

67
Q

What is the treatment for chronic pancreatitis?

A

drugs - analgesia, lipase, fat-soluble vitamins, insulin
diet - no alcohol, low fat
surgery - Whipple’s (ampullary carcinoma)

68
Q

What can gallstones be made from?

A

cholesterol, pigment or mixed

69
Q

Who are the most at risk group for gallstones?

A

‘fat, fair, febrile, female and forty’

70
Q

What are the causes of cholesterol gallstones?

A

sex, age, obesity

71
Q

What are the causes of pigment gallstones?

A

haemolysis

72
Q

What are the risk factors for gallstones?

A

increased age, family history, sudden weight loss, diabetes

73
Q

What are the symptoms of gallstones in the common bile duct?

A

biliary colic - sudden pain in epigastrium/RUQ pain for 15 mins to 24hrs with nausea and vomiting

74
Q

What are the symptoms of gallstones in the neck of the gallbladder?

A

acute cholecystitis - continuous epigastric/RUQ pain, vomiting, fever, local peritonism

75
Q

What symptoms come with chronic cholecystits from gallstones?

A

vague abdo discomfort, distension, nausea, flatulence, fat intolerance, jaundice

76
Q

What are the signs of gallstones?

A

Murphy’s sign - 2 fingers in RUQ and a deep breath with cause mega pain
phlegmon - RUQ mass of inflamed omentum/bowel

77
Q

What investigations would you do if you suspected gallstones?

A

USS - if CBD dilated with stones do ERCP + sphincterotomy

urinalysis, AXR, ECG (exclude other disease)

78
Q

What is the treatment for gallstones?

A

analgesia, nil by mouth, consider laparoscopic cholecystectomy

79
Q

What are the general causes of acute hepatitis?

A

viral, autoimmune, alcohol, drug-induced, ischaemic, vaccination

80
Q

How are hepatitis A, B, C and D spread?

A

A: faecal-oral

B&C: blood spread/sexual intercourse

81
Q

What are the signs and symptoms of hepatitis infections?

A

A: fever, malaise, anorexia, nausea, jaundice
B: same as A with urticaria and arthralgia
C: none in early infection
D: increased risk of acute hepatic failure and cirrhosis

82
Q

What is important about hepatitis D?

A

Can only infect WITH hep B

83
Q

Which hepatitis infections have vaccinations available?

A

A and B

84
Q

What is the treatment and prognosis for hepatitis A?

A

supportive, avoid alcohol

usually self-limiting (NO CHRONIC LIVER DISEASE)

85
Q

What would blood test show in hep A?

A

raised AST and ALT (days 22-40), raised IgM (day 25)

86
Q

What is the treatment for hep B?

A

supportive

for chronic - lamivudine

87
Q

What would blood tests show in hep C infection?

A

AST:ALT <1:1

88
Q

What is the treatment for hep C?

A

ribavirin and PEGinterferon alpha2a

89
Q

How would you manage autoimmune acute hepatitis?

A

immunosuppression (prednisolone, azothiaprine), liver transplant

90
Q

What causes appendicitis?

A

gut organisms invading appendix wall after lumen obstruction

91
Q

What are the symptoms of appendicitis?

A

periumblical pain that moves to RIF, anorexia, vomiting, constipation

92
Q

What are the signs of appendicitis?

A

tachycardia, pyrexial, lying still, coughing hurts, shallow breathing, guarding and rebound tenderness
Rovsing’s sign - pain in RIF>LIF when LIF pressed
Psoas sign - pain on extending hip
Cope sign - pain on flexion and internal rotation of right hip

93
Q

What investigations would you do if you suspected appendicitis?

A

USS

bloods - raised CRP

94
Q

What are possible complications of appendicitis?

A

perforation, appendix abscess

95
Q

What is the treatment for appendicitis?

A

prompt appendicectomy, antibiotics post op (metronidazole and cefuroxime)

96
Q

What is difference between simple, closed loop and strangulated bowel obstructions?

A

simple - one obstruction point, no vascular compromise
closed loop - two point obstruction forming loop (very distended)
strangulated - compromised blood supply

97
Q

What are some causes of bowel obstruction?

A

constipation, hernias, adhesions, tumours, Crohn’s, diverticular stricture

98
Q

What are the symptoms of bowel obstruction and the differences between small and large?

A

vomiting, colic, constipation, distension
small - vomit earlier, less distension
large - pain more constant

99
Q

What would you hear on auscultation of bowel obstruction?

A

active ‘tinkling’ bowel sounds (absent bowel sounds if ileus)

100
Q

What would you see on abdominal X-ray for bowel obstruction?

A

small - central gas shadows with valvulae conniventes

large - peripheral gas shadows, proximal to blockage with haustrae

101
Q

What is the treatment for bowel obstruction?

A

strangulation - surgery (EMERGENCY!)

ileus/incomplete obstruction - NG tube feeding and IV fluids

102
Q

What is the difference between direct and indirect inguinal hernias?

A

direct - through defect in posterior wall of inguinal canal

indirect - through internal inguinal ring (more common, can strangulate)

103
Q

What are the risk factors for inguinal hernias?

A

weakness of inguinal ring, increased age, chronic cough, constipation, heavy lifting, asictes, urinary obstruction (anything that increases intrabdominal pressure)

104
Q

What are the signs and symptoms of inguinal hernias?

A

symptoms: severe abdo pain, sudden groin pain, nausea, vomiting
signs: visible lump (is it reducible??), ask to cough (cough impulse) –> repeat standing

105
Q

What is the treatment for inguinal hernias?

A

if small - reassurance

surgical emergency if obstructed or incarcarated

106
Q

What are femoral hernias?

A

herniating bowel through femoral canal - frequently irreducible and strangulate

107
Q

What is the treatment for femoral hernias?

A

surgery is recommended (hernitomy and herniorrhaphy)

108
Q

What type of cancers are oesophageal carcinomas?

A

SCC or adenocarciinoma

109
Q

What are the risk factors for oesophageal carcinoma?

A

GORD + Barrett’s oesophagus, alcohol, smoking, obesity, M>F

110
Q

What are the signs & symptoms of oesophageal carcinoma?

A

dysphagia, retrosternal pain, weight loss, hoarse voice

111
Q

What test would you perform if you suspected oesophageal carcinoma?

A

barium swallow, CXR, oesophagoscopy, biopsy, MRI

112
Q

What is the treatment for oesophageal carcinoma?

A

radical curative oesophagectomy, chemo and radio

survival rate poor

113
Q

What classification is used for gastric carcinoma?

A

Borrman’s

114
Q

What are the signs & symptoms of gastric carcinoma?

A

non-specific - dyspepsia, weight loss, dysphagia, anaemia, epigastric mass, hepatomegaly, Virchow’s node, acanthosis nigricans

115
Q

How would you treat gastric carcinoma?

A

partial/total gastrectomy and chemotherapy (5 year survival <10%)

Year 3 - Core Conditions (2 decks)

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