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Yr3 Core Conditions Leeds > GI > Flashcards

GI Flashcards

1
Q

What are the 3 main characteristics of IBS

A

Constipation or diarrhoea
Abdominal pain
Cause unknown

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2
Q

What is the most common functional gastrointestinal disorder in the UK, what is its prevalence, and who is most commonly affected?

A

IBS

Prevalence is 10-20%

Females 2x > Males

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3
Q

Although the cause of IBS is unknown, what disorders is it strongly associated with?

A

Depression and Hypochondrial anxiety

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4
Q

Give 5 risk factors for IBS

A
  1. Female
  2. Psychological-Depression, anxiety, psychological stress and trauma
  3. GI infections, pelvic surgery and Abx Rx
  4. Eating disorder
  5. Short carbohydrate chain
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5
Q

What are the main symptoms of IBS?

A

1) Abdominal pain or discomfort
2) Altered passage of stools (Diarrhoea/constipation, tenesmus, morning rush, urgency, incomplete evacuation, straining)
3) Early satiety (bloating, nausea, dysphagia)
4) Chronic symptoms
5) Depression or anxiety

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6
Q

Give 3 Ix used to exclude other Dx when investigating IBS

A

1) CA 125 for ovarian cancer
2) Faecal Calprotectin (raised in intestinal inflammation)
3) Coeliac screen-IgA Tissue transglutaminase (tTG)

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7
Q

What is the main focus of Tx for IBS

A

Treatment of symptoms:

  • Diarrhoea: Loperamide
  • Constipation: Laxatives and high fibre diet
  • Antidepressants
  • Smooth muscle relaxants: Dicyclomide or Hyoscyamide
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8
Q

Give 5 differentials for IBS

A

1) Coeliac
2) IBD-no constipation; bleeding; aphthous ulcer
3) Gastroenteritis-no constipation; acute; could be infective trigger for IBS
4) CRC (colorectal carcinoma)
5) Diverticular disease
6) Gynaecological problems eg pelvic inflammatory disease

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9
Q

Who is affected most by GORD?

A

Males 3x > Females

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10
Q

Define GORD

A

1) Abnormal reflux of gastric contents
2) Causing mucosal damage, and symptoms
3) At least 2 heartburn episodes per week

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11
Q

Give 6 lifestyle risk factors for GORD

A

Obesity & big meals-> Increased pressure

Coffee & Alcohol

Smoking and fatty foods->Faulty sphincter

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12
Q

Give 5 medical risk factors for GORD

A

Hiatus hernia

Gastric acid hypersecretion

Pyloric stenosis (projectile vomit)

Faulty lower oesophageal sphincter

Hypotension

Pregnancy

Drugs-TCA’s, anticholinergics, Nitrates, Alendronate

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13
Q

What are the 5 red flags in GORD

A

1) Weight loss
2) Dysphagia
3) Heamatemesis
4) Odinophagia-severe pain when swallowing
5) No Sx relief to Tx

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14
Q

What are the characteristics of heartburn in GORD

A

Retrosternal

Aggravated by bending/stooping/lying down

–>worse at night

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15
Q

What are the main Sx of GORD

A

1) Abdominal pain-Relieved by antacid
2) Related to meals, hot drinks or alcohol
3) Belching, N&V
4) Food regurg, acidbrash (acid or bile regurg), and waterbrash (xs salivation)

5) Extra-oesophageal Sx
- Nocturnal asthma (Asthma and GORD are assoc)
- Chronic cough
- Laryngitis
- Sinusitis (due to aspiration)

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16
Q

What are usually the findings on examination of GORD?

A

Normal

May have asthma

17
Q

When do you Ix in GORD and what are the Ix’s?

A

Only investigate is dysphagia, >55, >4wks, weight loss amd persistant Sx despite Tx

1)GI endoscopy-if oesophagitis or barrets then GORD confirmed

2) 24 hr pH monitoring
- xs reflux=pH<4 for >4% of the time
- SHould be a good correlation between Sx and pH

3) FBC’s-exclude significant anaemia
4) Barium swallow- may show hiatus hernia

18
Q

What is the lifestyle Mx advice for GORD?

A

1) Encourage: weight loss, smoke cessation, raised bed, small regular meals
2) Avoid: Alcohol, hot drinks, coffee, spicy food < 3hrs before bed, drugs that slow motility (TCA’s, nitrates and anticholinergics) or that damage mucosa (NSAIDS, bisphosphonates)

19
Q

What are the pharmacological Tx’s for GORD?

A

1) Antacid
- Gaviscon & -Mg Trisilicate

2) H2-receptor antagonist
- Ranitidine & -Cimetidine

3) PPI -best Tx for all but mild cases
- Omeprazole & -Lansoprazole

4) Prokinetic agents
- Metocloperamide

20
Q

What is the name of the surgery indicated in GORD and what are it’s indication

A

Nissen Fundoplication

Indications unclear, but usually in severe symptoms, meds intolerance/desire not to take meds, concern of long term S/E

NOTE: Ptns who do not respond to PPI or those with functional bowel disease should NOT have surgery

21
Q

What is achalasia

A

Achalasia is a serious condition that affects your esophagus. The lower esophageal sphincter (LES) is a muscular ring that closes off the esophagus from the stomach. If you have achalasia, your LES fails to open up during swallowing, which it’s supposed to do. This leads to a backup of food within your esophagus. Therefore, LES dysfunction in achalasia may serve as a substantial barrier to the reflux of gastric contents, and GERD may not be expected to appear frequently in patients with achalasia

22
Q

Give 4 complications of GORD

A

1) Peptic stricture
2) Barretts oesophagus
3) Oesophageal carcinoma
4) Oesaophageal ulcers

23
Q

Give some differentials for GORS

A

Heart pain

Oesophagitis-caused by corrosive drugs like NSAIDs

Duodenal or Gastric ulcers or non-ulcer dyspepsia

Infection (CMV, Herpes, candida)

24
Q

What are the risk factors/causes of Acute Pancreatitis

A

I GET SMASHED

  • Idiopathic
  • Gallstones (common; blocks sphincter of Oddi)
  • Ethanol or Alcohol (common; causes leakage on enzymes out of pancreas into duct)
  • Trauma
  • Steriods
  • Mumps (Coxachie B)
  • Autoimmune (+trauma)
  • Scorpion stings
  • Hyperlipidaemia or Hypercalcaemia
  • ERCP
  • Drugs (Azathiopurine, Corticosteriods, Oestrogens, Diuretics, Didonosine)
25
Q

What are the symptoms of acute pancreatitis

A

Epigastric or central abdominal pain

…Radiates to back

Bloating,

Diarrhoea,N&V, fever

Anorexia or weight loss

Steatorrhoea (if malabsorption)

Jaundice (due to bile duct obstruction)

26
Q

What are the signs of acute pancreatitis

A
  • Tachycardia
  • Fever
  • Jaundice
  • Ileus
  • Local generalised tenderness
  • Cullens sign
  • Grey Turners sign
  • Shock
27
Q

What is the most specific marker of acute pancreatitis in bloods?

A

Serum Lipase-more specific and sensitive than serum amylase

CRP also a good marker to measure

Serum Amylas- significant if 3x above upper limit

28
Q

Give 4 radiological Ix’s for acute pancreatitis

A

1) Contrast enhanced spiral CT-essential in all but mild attacks of pancreatitis
2) MRCP–assess degree of damage & identify gallstones
3) CXR-to exclude gastroduodenal perf. which increases serum amylase
4) USS-allows you to identify gallstones

29
Q

What scoring system is used in acuta pancreatitis, what does it indicate, and what are the scoring criteria?

A

Modified glasgow scriteria

Used to assess severity of pancreatitis

PANCREAS

  • paO2 < 8kpa
  • Age > 55
  • Neutrophils (WBC > 15 x10^9/l)
  • Calcium (<2mmol/l)
  • Renal failure (urea >16mmol/l)
  • Enzymes (AST/ALT >200iu/L or LDH > 60iu/L)
  • Albumin < 32g/l
  • Sugar >10mmol/l

> /= 3: Sever acute pancreatitis
<3: mild acute pancreatitis

30
Q

Acute pancreatitis Tx?

A

VACCINES
-Vital signs monitoring: mainly oxygen

-Analgesia (Pethidine or tramadol; avoid Morphine due to oddi contraction)
and
Abx-Cefuroxime

  • Catheter/Calcium gluconate if required
  • Cimetidine (H2r antagonist)
  • IV access and fluids
  • NBM/Nutrition (total parenteral)
  • Empty gastric contents (NG tube)
  • Surgery (if requred)

Also ERCP to remove bile duct stones

31
Q

Give 4 complications of acute pancreatitis.

A

PAIN
-Perpancreatic fluid colection/Pseudocyst (can cause infetion or intraperitoneal bleed -> hypovolaemic shock)

  • Abscess (usually presents several months after and requires surgery)
  • Infection (biggest concern, may develop into sepsis)
  • Necrosis (infection occurs in most cases and requires surgery)
32
Q

Suggest some differentials to acute pancreatitis

A

Ruptured/dissecting AAA

Any acute abdomen

  • Duodenitis
  • Gastritis
  • UC
  • Perforation
  • Kidney problems
33
Q

What is the most common surgical emergency?

A

Acute appendicitis.

Most common cause of acute abdomen .

Incidence/yr = 10%

34
Q

What is the most common cause of acute appendicitis? Give other causes.

A

Faecolith

Other causes:

  • Worms
  • Seeds
  • Lyphoid hyperplasia

Yr3 Core Conditions Leeds (1 decks)

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