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
