GI Flashcards
What are the 3 main characteristics of IBS
Constipation or diarrhoea
Abdominal pain
Cause unknown
What is the most common functional gastrointestinal disorder in the UK, what is its prevalence, and who is most commonly affected?
IBS
Prevalence is 10-20%
Females 2x > Males
Although the cause of IBS is unknown, what disorders is it strongly associated with?
Depression and Hypochondrial anxiety
Give 5 risk factors for IBS
- Female
- Psychological-Depression, anxiety, psychological stress and trauma
- GI infections, pelvic surgery and Abx Rx
- Eating disorder
- Short carbohydrate chain
What are the main symptoms of IBS?
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
Give 3 Ix used to exclude other Dx when investigating IBS
1) CA 125 for ovarian cancer
2) Faecal Calprotectin (raised in intestinal inflammation)
3) Coeliac screen-IgA Tissue transglutaminase (tTG)
What is the main focus of Tx for IBS
Treatment of symptoms:
- Diarrhoea: Loperamide
- Constipation: Laxatives and high fibre diet
- Antidepressants
- Smooth muscle relaxants: Dicyclomide or Hyoscyamide
Give 5 differentials for IBS
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
Who is affected most by GORD?
Males 3x > Females
Define GORD
1) Abnormal reflux of gastric contents
2) Causing mucosal damage, and symptoms
3) At least 2 heartburn episodes per week
Give 6 lifestyle risk factors for GORD
Obesity & big meals-> Increased pressure
Coffee & Alcohol
Smoking and fatty foods->Faulty sphincter
Give 5 medical risk factors for GORD
Hiatus hernia
Gastric acid hypersecretion
Pyloric stenosis (projectile vomit)
Faulty lower oesophageal sphincter
Hypotension
Pregnancy
Drugs-TCA’s, anticholinergics, Nitrates, Alendronate
What are the 5 red flags in GORD
1) Weight loss
2) Dysphagia
3) Heamatemesis
4) Odinophagia-severe pain when swallowing
5) No Sx relief to Tx
What are the characteristics of heartburn in GORD
Retrosternal
Aggravated by bending/stooping/lying down
–>worse at night
What are the main Sx of GORD
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)
What are usually the findings on examination of GORD?
Normal
May have asthma
When do you Ix in GORD and what are the Ix’s?
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
What is the lifestyle Mx advice for GORD?
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)
What are the pharmacological Tx’s for GORD?
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
What is the name of the surgery indicated in GORD and what are it’s indication
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
What is achalasia
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
Give 4 complications of GORD
1) Peptic stricture
2) Barretts oesophagus
3) Oesophageal carcinoma
4) Oesaophageal ulcers
Give some differentials for GORS
Heart pain
Oesophagitis-caused by corrosive drugs like NSAIDs
Duodenal or Gastric ulcers or non-ulcer dyspepsia
Infection (CMV, Herpes, candida)
What are the risk factors/causes of Acute Pancreatitis
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)
