GI Flashcards
what part of GI tract does UC affect
from ileoceacal valve - rectum (terminal ileum)
affects it continuously
limited to submucosa
what part of GI tract does crohn’s affect
mouth to anus
skip lesions
full thickness of mucosa
investigations in IBD
bloods: FBC (anaemia), LFT’s (primary sclerosing cholangitis), ESR and CRP, U&E’s
stool: high calprotectin, rule out infection
colonoscopy and biopsy for crohn’s - skip lesions, rose thorn ulcers, cobblestoning, goblet cells, granulomas
flexi sig for UC- crypt abscesses, goblet cell depletion, inflammation
dilated loops of bowel on imaging
what are the extra-gastrointestinal manifestations of crohn’s
episcleritis, erythema nodosum, clubbing, arthritis, pyoderma gangrenosum, anaemia
what are the GI complications of crohn’s
adhesions, fistulae, strictures, obstruction, aphthous oral ulcers
what are the extra-gastrointestinal manifestations of UC
PSC, uveitis, episcleritis, clubbing, arthritis, colorectal cancer, osteoporosis, pyoderma gangrenosum, erythema nodosum
what are the red flags in dyspepsia
ALARMS iron deficient anaemia weight loss anorexia recent/progressive onset Melena/hematemesis swallowing difficulty
list some differential diagnosis of haematemesis
peptic ulcer, mallory-weiss, oesophageal varices, oesophageal rupture, oesophagitis, gastritis, malignancy, nose bleed, drugs
how can you assess risk of upper GI bleeding and how to assess if need medical intervention
rockall risk score
glasgow-blatchford
if patient is shocked/massive GI hemorrhage what actions should you take
secure airway and NBM
IV access- 2 large cannula
bloods - coagulation, G&S, crossmatch 4-6 units
monitor UO
activate major haemorrhage protocol
transfuse O -ve, clotting factor and platelets
if patient is hemodynamically stable and has GI bleed what actions do you take
rockall and glasgow-blatchford score fluids and blood resus FFP and vitamin K platelets if <50 endoscopy ASAP if big or within 24h
management of variceal bleed
correct coagulopathy and fluid and blood resus
terlipressin and Abx
endoscopic variceal band ligation
investigation of dyspepsia in an person under 60 with no ALARMS symptoms
urea breath test/ stool antigen test for H. Pylori
triple therapy: clarithromycin, PPI, amoxicillin
if -ve for H. Pylori 4-8 weeks PPI
who needs endoscopy in dyspepsia?
> 60
or <60 with ALARMS
describe pain pattern in duodenal and gastric ulcers
gastric- worse after eating
duodenal - worse when hungry
2nd line treatment of ulcers/dyspepsia
h2 antagonist - ranitidine
what is barrett’s oesophagus and what does it predispose to
metaplasia of squamous to columnar epithelia due to acid
dysplasia to adenocarcinoma
diagnostic criteria for IBS
> 1 day abdo pain in last 3 months
- related to defecation
- change in frequency
- change in form of stool
most common cause of SBO + other causes
adhesions, hernias, tumours, strictures, foreign body
intussusception, pyloric stenosis and atresia in children
most common cause of LBO
tumours, strictures, adhesions (diverticulosis), fecal impaction, volvulus
what can cause ileus
surgery, endocrine - diabetes, hypokalaemia, infarct, inflammation, drugs - opiods, anticholinergic)
investigations in bowel obstruction
AXR (erect, supine and CXR)
- SBO: dilated loops of bowel and air fluid level proximal to obstruction, no gas in colon
- LBO: air fluid level in colon and dilated bowel proximal to obstruction
CT abdo
bloods: metabolites, lactate, FBC, blood gas
which antibodies are found in PBC
IgM, anti mitochondrial, anti smooth muscle
who gets PBC and assoc conditions
middle aged women
sjogren’s, RA, systemic sclerosis, thyroid disease
how does PBC present
middle aged women
lethargy and itch (also hyperpigmentation, jaundice, clubbing, RUQ pain)
management of PBC
ursodeoxycholic acid
prednisolone
what is PSC (where does it affect). antibody?
inflammation and fibrosis of intra and extra hepatic bile ducts. P ANCA +ve
associations of PSC
UC, crohns, HIV
investigations and management in PSC
LFTs ANCA USS MRCP ERCP stent
causes of acute pancreatits
gallstones, trauma, alcohol, drugs, ERCP, infection, CF, autoimmune - sjrogrens
presentation of pancreatitis
pain radiating to back, worse lying down better when forward
shock
cullen’s sign - periumbilical ecchymoses
grey-turners sign - flank ecchymosis
investigations in pancreatitis
amylase lipase - more specific haematocrit and FBC LFTs CT/ MRI/ USS
how to assess serverity of pancreatitis
modified glasgow score/ APACHE
complications of pancreatitis
abcess, haemorhage, necrosis, oedema, diabetes
what is rovsings sign
press LIF in appendicitis and pain is felt in RIF
presentation of ascending cholangitis
charcots triad: RUQ pain, rigors, jaundice (+hypotension and confusion = reynolds pentad)
what causes prehepatic jaundice
associated symptoms
haemolysis - GPD6, thallassaemia, malaria, SCD, SLE
dark stool, normal urine
increased conjugated bilirubin and urobilinogen
what causes intrahepatic jaundice
associated symptoms
liver damage, hepatitis, cirrhosis
pale stool, dark urine
raised conjugated and unconjugated bilirubin
what causes post hepatic jaundice
associated symptoms
cholestasis
pale stools , dark urine
raised conjugated bilirubin and low urobillinogen
where does the copper get depositied in wilsons disease
liver, brain, eyes - keiser-fleisher rings, kidneys (renal tubular acidosis, haemolysis
investigations in wilsons disease and treatment
low serum copper and caeroloplasmin
increased urinary copper
penicillamine
presentation of haemachromotosis
fatigue, erectile dysfunction, bonze skin, DM, cardiomyopathy, arthritis
investigations and management of haemachromotosis
gene analysis, high transferrin and ferritin
venessection
?iron chelation
name 4 types of laxatives and specific examples of each
bulk forming - ispaghula husk
stimulant - sodium picosulfate, senna
fecal softeners - docusate, glycerol suppository
osmotic - lactulose, movicol
name 2 syndromes associated with colorectal Ca
hereditary non polyposis (aged 40 with 3 +ve family members over 2 generations - amsterdamn criteria)
Familial adenomatous polyposis
staging of bowel cancer
Dukes
investigations in NAFLD
ALT>AST
hypoechogenicity on USS
ELF blood tests
NAFLD fibrosis score
what does coffee bean sign indicate on AXR
sigmoid volvulus
what does fetus sign indicate in AXR
ceacal volvulus
how can you differentiate between LB and SB on AXR
small bowel - can see folds all the way across, more central
large bowel - folds dont go all the way across, more peripheral
What imaging do you do for ?perforation and what do you see?
erect CXR - gas under the diaphragm
what view are most chest x rays done in?
PA
what is thumbprinting indicative off on AXR?
inflammation - IBD
