GI Flashcards by Seth Allen

Intestinal Angina due to Abdominal Artery Occlusion

Sublingual GTN

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Abdominal Artery Occlusion

PCI

Thrombolysis

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Chronic Abdominal Artery Occlusion

Bypass
Angioplasty (Stent/No stent)
Preventative measures (Antiplatelets)

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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

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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)

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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)

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Small Bowel Obstruction (non-strangulation)

IV Fluids
Nasogastric Suction
Laparotomy
Surgery if doesn’t resolve

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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)

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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)

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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

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Oesophageal Cancer

Squamous Cell Carcinoma & Adenocarcinoma

Surgery (Low Grade Tumours only)

Palliative:

Stenting to allow swallowing
Intubation to allow adequate nutrition

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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”

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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)

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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

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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)

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Pharyngeal Pouch

This is a pouch caused by unco-ordinated swallowing movements

Surgery

NOT ENDOSCOPY

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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

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Appendicitis

Obstruction of the appendiceal lumen

Appendectomy (open or laparoscopically)

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Colorectal Cancer

Surgery
Radiotherapy
Chemotherapy

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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

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Haemorrhoids

The swelling and inflammation of the veins of the rectum and anus

Sclerotherapy
Band Ligation
Haemorrhoidectomy

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Asymptomatic Anal Prolapse

Advice to stop straining

Take stool softeners

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Symptomatic Complete Anal Prolapse

This is when the entire muscle wall of the rectum protrudes through the opening of the anus

Surgery:

Delome’s Procedure
Rectopexy

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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)

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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

Treat underlying cause

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