GI Flashcards
How would SB obstruction look on an Xray?
Centrally located multiple dilated loops of gas filled bowel
Valvula conniventes (plicae circulares) are visible confirming that it is small bowel
No gas seen in the large bowel
Multiple dilated bowel loops
What are the causes of SMO in adults?
Adhesions secondary to intra-abdominal surgery
Hernias
Malignancy
Crohn’s disease
How do you treat UC to try and induce remission?
1) High dose PO mesalazine
2) + PO prednisolone
3) + PO tacrolimus
How do you maintain remission in UC?
1) PO mesalazine
2) Azathioprine if needed
What drug class is mesalazine in?
Aminosalicylate
What are the two most likely causes of cholestatic jaundice?
Gallstones
Head of pancreas cancer
What are the auto abs in systemic sclerosis?
Anti-centomere
Anti-SCL 70 (anti-topoisomerase)
ANA
Give some drugs that can cause dyspepsia
Nitrates
Bisphosphonates
Corticosteroids
NSAIDs
What are the ALARMS symptoms?
Anaemia Loss of weight Anorexia Recent onset Melena/haemetemesis Swallowing difficulty
What investigations can you do with dysphagia?
CXR
Barium swallow
Manometry
OGD
What is Barretts oesophagus?
When a proportion of normal distal squamous epithelium is replaced by metastatic columnar epithelium
Give some neurological causes of dysphagia
CVA
Achalasia
MS
MND
Define achalasia
Oesophageal peristalsis and failure of LOS relaxation due to reduction in ganglionic cells and degeneration of myenteric plexus
–> Impaired oesophageal emptying
What is the gold standard test for achalasia?
Manometry
What medical management can be used for achalasia?
CCB - nifedipine for SM relaxation
What score can you use in upper GI bleed to assess mortality?
Rockall score
What is a volvulus?
Volvulus is the rotation of the gut around its mesenteric axis
What skin pathology do you see in coeliacs?
Dermatitis herpetiformis
= Itchy, stinging red papules + blisters
Dx with IgA presence on skin biopsy
What are the complications of coeliacs?
Osteoporosis
Cancer
Infertility
Depression
A patient compains of diarrhoea 5 times a day with small amounts of blood and mucus.
A barium enema shows loss of haustrations and a narrow, short colon that looks like a ‘lead pipe’
What could the dx be?
UC
What are the criteria for dx IBS?
Pain relieved by deflation // altered bowel habit + 2:
- Mucus
- Worse when eating
- Bloating
- Strainging/urgency
What treatments would you use for the following symptoms of IBS?
- Pain
- C
- D
- Pain = anti-spasmodics meberverine
- C = laxatives/linaclotide
- D = loperamide
How do you treat a volvulus?
Sigmoidoscopy + flatus tube
You have a 78 yr old male with known CVD and AF. He comes presenting with acute abdo pain, he’s had diarrhoea with blood PR and a fever.
What could be the cause?
Ischaemic of the lower GI tract
- Acute mesenteric ischaemia
- Chronic mesenteric ischaemia
- Ischaemic colitis
You have a 78 yr old male with known CVD and AF. He comes presenting with acute abdo pain, he’s had diarrhoea with blood PR and a fever.
How would you investigate this?
CT
= investigation of echoic in ischaemic disease of the lower GI tract
Acute mesenteric ischaemia is usually of which artery?
And which risk factor?
Commonly a mesenteric artery emboli or mesenteric venous obstruction
RF: AF
What is ischaemic colitis
Ischaemic colitis describes an acute but transient compromise in the blood flow to the large bowel. This may lead to inflammation, ulceration and haemorrhage. It is more likely to occur in ‘watershed’ areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries
What would you see on an AXR of ischaemic colitis
‘thumbprinting’ may be seen on abdominal x-ray due to mucosal oedema/haemorrhage
Give an example of a palliative surgical adjunct for colon cancer
Stents, surgical bypass and diversion stomas
What are the 3 types of colon cancer?
genetics
- Sporadic (95%)
- Hereditary non-polyposis colorectal carcinoma (AD)
- Familial adenomatous polyposis (activation of K-ras oncogene and inhibition of p53 + DCC)
What are the tumour markers associated with colon cancer?
CEA = carcinoembryonic antigen
Faecal occult blood in stool
How can you estimate the 5 year survival in a person with colon cancer?
By using Duke’s criteria
How would you treat constipation?
C + M
C = increase activity, fluids and fibre M: 1) Bulk-forming laxatives = isphaghula 2) Osmotic laxatives = macrogol, lactulose 3) Stimulant laxatives = senna 4) Enema = phosphate enema
BOSE
Cause of D due to hx:
1) Small children
2) Travelers
3) Salad
4) Poultry/shellfish
5) with HUS/ITP
1) Small children = Rotavirus
2) Travelers = Enterotoxic E.Coli
3) Salad = shigella
4) Poultry/shellfish = salmonella
5) with HUS/ITP = E.coli 0157
