GI Flashcards
Intestinal Angina due to Abdominal Artery Occlusion
Sublingual GTN
Abdominal Artery Occlusion
PCI
Thrombolysis
Chronic Abdominal Artery Occlusion
Bypass Angioplasty (Stent/No stent) Preventative measures (Antiplatelets)
Coeliac disease
(T cell mediated auto-immune disorder
Gluten is viewed as an antigen by the body and exposure to it causes inflammatory response)
Life-long gluten-free diet
Ulcerative Colitis
Continuous inflammation is confined to the rectum and colon due to an environmental trigger
PICAM Steroids (Prednisolone) Anti-TNF Therapy (Infliximab) Surgery (Colectomy) Immunosuppressants (Azathioprine) 5- ASA (Mesalazine)
Crohn’s Disease
Chronic inflammation of the GI tract that can affect anywhere from mouth to anus
PISAM Steroids (Prednisolone) Anti-TNF Therapy (Infliximab) Surgery Antibiotics Immunosuppression (Methotrexate)
Small Bowel Obstruction (non-strangulation)
- IV Fluids
- Nasogastric Suction
- Laparotomy
- Surgery if doesn’t resolve
Acute Mesenteric Ischaemia
This is when the blood supply to the bowel becomes impaired leading to ischaemia and gangrene
Heparin
Resuscitate with fluid antibiotics:
- (Metronidazole + Gentamycin)
GORD (Gastro-Oesophageal Reflux Disease)
Stomach acidic spill into the oesophagus from the stomach, causing a reddened, inflamed, ulcerated oesophagus
GORD
Antacids (Gaviscon)
PPIS (Omeprazole)
H2 Antagonist (Ranitidine)
Dont do stupid things like get fat/alcohol/smoke Lifestyle change (Lose weight, stop smoking, avoid alcohol)
Barret’s Oesophagus
(Prolonged exposure to gastric acid causes metaplasia from squamous stratified epithelium of the oesophagus to columnar epithelium)
Cannot be treated
Treat same as GORD with GORD
Gaviscon
Omeprazole
Ranitidine
Dont get fat/ do alcohol/ smoke
Oesophageal Cancer
Squamous Cell Carcinoma & Adenocarcinoma
Surgery (Low Grade Tumours only)
Palliative:
- Stenting to allow swallowing
- Intubation to allow adequate nutrition
Mallory-Weiss Tear
(A tear occurs in the oesophageal-gastric junction following prolonged retching and vomiting, usually after a “mad-wan-oot” or drinking bleach/ infection)
Resolves on its own
If appropriate tell patient to lay off the “akkahol”
Oesophageal Varices
This is an affect of severe liver disease causing high blood pressure in the veins which may break
Prophylaxis:
- Propanolol
- Treat underlying liver disease (TIPS)
- Sclerotherapy + Band Ligation
For uncontrolled bleeding:
- Baloon tamponade with Sengstaken Blakemore Tube (Minnesota Tube)
- Fresh Frosen Plasma + Vitamin K
- Terlipressin
Antibiotic (Co-trimoxazole)
Peptic Ulcers
Gastric/ Duodenal Ulcers, arising from H.pylori infection and NSAIDS
H. pylori eradiaction: OAC / MOC if penicillin allerigic
Clarithromycin, Omeprazole, Amoxicillin / Metronidazole
Antacids (Gaviscon)
H2 Antagonist: Ranitidine
Reduce stomach acid to promote self-healing
Achalasia
(This is a motility disorder of the Oesophagus. The oesophageal sphincter doesn’t open properly and there is failure of peristalsis)
Blow-up Heller’s Cunt Now
- Balloon
- Heller’s Cardiomyopathy
Relax LES:
- CCB (Nifedipine)
- Nitrate (Isosorbide dinitrate)
Pharyngeal Pouch
This is a pouch caused by unco-ordinated swallowing movements
Surgery
NOT ENDOSCOPY
Gastric Cancer
An adenocarcinoma in the mucous secreting cells of the gastric pits
Chemotherapy Radiotherapy Surgery: - Resection of the stomach - Total Gastrectomy for proximal lesions - Partial Gastrectomy of distal lesions
11% have 5 year survival = RIP
Appendicitis
Obstruction of the appendiceal lumen
Appendectomy (open or laparoscopically)
Colorectal Cancer
Surgery
Radiotherapy
Chemotherapy
Diverticulitis
Acute inflammation of one or more diverticulum-an outpouching of the mucosa of the large intestine
AH Fuck My Colon
Analgesia (Not Morphine) Hartmann's procedure- resection of colon) Fluids Mentronidazole Co-trimaxazole
Haemorrhoids
The swelling and inflammation of the veins of the rectum and anus
Sclerotherapy
Band Ligation
Haemorrhoidectomy
Asymptomatic Anal Prolapse
Advice to stop straining
Take stool softeners
Symptomatic Complete Anal Prolapse
This is when the entire muscle wall of the rectum protrudes through the opening of the anus
DR
Surgery:
- Delome’s Procedure
- Rectopexy
Symptomatic Partial Anal Prolapse
This is when the anterior muscle of the rectum protrudes through the opening of the anus
Kids:
- Dietary Advice
- Treat constipation
Adults:
- Sclerotherapy and Band Ligation
- DDD (Don’t do dildos)
Anal Fissure
This is a tear in the skin that lines the anus below the dentate line
Dietary Advice Antiseptic Cream Stool Softener Botox Injection Internal Sphincterotomy
Anal Fistula
(This is an abnormal communication between two epithelial surfaces - a track between the internal opening and an opening in the perianal skin)
Seton Insertion (to drain pus) Corrective Surgery (Fistulotomy) Seton Suture
Anal Abscess
Collection of pus on the anus that may be tender, swollen and discharging
Surgical Excision
Drainage
Large Bowel Obstruction
(Three types:
- Volvulus (Closed Loop)
- Incompetent Ileo-Caecal Valve
- Incomplete Obstruction)
All:
- Nasal Gastric Tube (to decompress)
- Nil by mouth
- Fluids
- IV Access
Volvulus:
- Surgery Resection
Meckel’s Diverticulum
This is a diverticulum on the distal ileum that is present from birth)
Surgery Resection
Intussusception
Air enema
Cholangitis
Inflammation of the bile duct
IV Cephalosporin
Urgent Biliary Drainage
Acute Cholecystitis
Inflammation of the gall bladder due to blockage of the cystic duct or the neck of gallbladder
Nil by mouth
IV Fluid
Cefuroxime
Cholecystectomy
Chronic Cholecystitis
Cholecystectomy
Pancreatitis
Acute inflammation of the pancreas
Supportive
Peritonitis
Inflammation of the peritoneum, usually a surgical rupture
Mild: Supportive
Severe: AGM
- Antibiotics (Amoxicillin + Metronidazole + Gentamicin)
Gastroenteritis
Nothing unless systematically unwell or post-antibiotic
Severe:
- Antibiotics (specific to bug)
Hypertensive Peristalsis
Excessive amplitude and frequency of peristaltic waves
Pain Relief:
- Isosorbide dinitrate
Relax LES:
- CCB (Nifedipine or Diltiazem)
- Phosphodiesterase inhibitor (Sildenafil)
Gastroparesis
Delayed gastric emptying with no physical obstruction
Gastro-prokinetic agents:
- Domperidone
- Metoclopramide
Lifestyle changes (stop drugs, change diet, eat little and often, low fat, lots of fibre)
Zollinger- Ellison syndrome
Gastrin-secreting tumour, leading to excessive HCL secretion
Surgery (resection of tumour)
Chronic small bowel ischaemia
Chronic atherosclerotic disease of mesenteric vessels
Angioplasty
Chronic colonic ischaemia
Inflammation and injury of the large intestine result from inadequate blood supply
Fluid replacement
Antibiotics
Angioplasty
Small Intestine Cancer
3 types:
- Lymphoma (coeliac disease)
- Carcinoid (common in appendix)
- Carcinoma (Crohn’s + coeliac disease)
Surgery and Chemotherapy
Irritable Bowel Syndrome
Disturbed GI motility, exaggerated gastro-colic reflex
Diet:
- regular meal times
- reduce fibre
- stop drugs
Psychological treatment
Liver Disease
Any damage to a previously healthy liver
For itch:
- sodium bicarbonate bath
- ursodeoxycholic acid
- cholestyramine
Fluids
No Alcohol
Increase Calories, decrease fatty foods
Fulminant Hepatic Failure
(Acute Liver Failure, they gon die, gon die fast)
- leads to hepatic encephalopathy
- and failure of kidneys
Did someone say transplant?
Supportive
Renal replacement
Manage intra-cranial-pressure
Cirrhosis
(Liver cannot function properly due to normal tissue being replaced with scar tissue due to long-term damage
Yep definitely transplant
Palliative- RIP
Non-fatty alcoholic liver disease
Liver disease not caused by alcohol
Weight loss, exercise and hope (we always have hope)
Primary Sclerosing Cholangitis
(A disease of the bile ducts that causes inflammation and obliterative fibrosis of bile ducts inside and/or outside of the liver. Impedes the flow of bile to the intestines and can lead to cirrhosis of the liver)
Transplant? You guessed it
ERCP with balloon/stenting if you’re lucky
Autoimmune hepatitis
(A chronic, autoimmune disease of the liver that occurs when the body’s immune system attacks liver cells causing the liver to be inflamed)
Corticosteroids (Prednisolone)
Immunosuppressant (Methotrexate)
Haemochromatosis
An increased intestinal absorption of iron, leading to iron depositions in organs
Venesection (removal of blood- like donating but this time to save yourself)
Wilson’s Disease
(Autosomal recessive disease leading to toxic accumulation of copper in the liver and the CNS
Chelation drugs (penicillamine)
Alpha 1 anti-trypsin deficiency
Deficiency of A1AT levels in the blood
Supportive for liver disease
Supportive for emphysema in lungs
Budd-Chiari Syndrome
Occlusion of the hepatic veins by thrombosis or tumour, that drain the liver, leads liver damage
Anticoagulants (Heparin or Warfarin)
TIPS
Portal hypertension
TIPS
(transjugular intrahepatic portosystemic stent shunting) -an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein
Acute Viral Hepatitis
Hepatitis:
A- Faecal-oral in shanty town type place (Sam’s gap year)
B- Blood, sex, from mother
C- Sex, from mother (name a more iconic duo, I’ll wait)
D- Presence of B
E- Faecal-oral in tropics
No “akkahol”
Supportive
Monitor condition
Turn to religion as spontaneous cure can occur in Hep B
Chronic Viral Hepatitis
Hepatitis:
A- Faecal-oral in shanty town type place (Sam’s gap year)
B- Blood, sex, from mother
C- Sex, from mother (name a more iconic duo, I’ll wait)
D- Presence of B
E- Faecal-oral in tropics
Anti-virals:
Hep B- IF-alpha (peginterferon), tenofovir, entecavir
Hep C- IF-alpha (peginterferon), ribavirin, sofosbuvir
Screening for hepatocellular carcinoma
Supportive
No alcohol
Hepatic tumours
Most common are secondary metastatic tumours
Surgical Resection
Pancreatic Tumour
Pancreatoduodenectomy (Whipple procedure)
Hernias
(An abnormal protrusion of a viscus outwith
its normal body cavity)
Types:
- Inguinal (protrude through Hesselbach’s triangle)
- Umbilical (near umbilicus- obese/ ascites)
- Incisional (failed muscle closure after surgery)
- Femoral (defect in femoral canal)
- Epigastric (congenital weakness in the linea alba)
- Paediatric inguinal (pre 1yo- Low Birth Weight)
Laparoscopic Surgery
Perianal haematoma
A clotted collection of vessels on the anus border
Syringe the blood out, then cut around
Hydatid Cyst
- From tape worm parasite
Echinococcus granulosus parasite
Albendazole
Surgery
Encephalopathy
Lactulose
slows down bacteria producing ammonia
Inflammatory Bowel Disease
Mesalanine suppository
