GI Flashcards
1
Q
Symptoms of GI disease?
A
Dyspepsia and indigestion
Discomfort of upper abdomen
Dysphagia
Vomiting
Abdo pain
Flatulence
Diarrhoea and constipation
Steaorrhoea
2
Q
Types of endoscopies?
A
Osophagogatrodudenography (OGD)
Sigmoidography
Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic ultrasound
Endoanal + Endorectal ultrasound
Balloon enteroscopy
Capsule Endoscopy
3
Q
How can X rays be used for GI conditions?
A
Oesophageal perforations
Dilated loops of bowel
Calcification of the pancreas
4
Q
Imaging that can be used to confirm malignancy?
A
CT or PET
5
Q
What are contrast studies used for in GI disease?
A
using ingestible barium
Strictures and motility problems
6
Q
Infective causes of mouth ulcers?
A
Coxsackie A
Herpes zoster or simplex virus type 1
7
Q
Non-infective association of mouth ulcers?
A
Anaemia
IBD
Behcet’s (blood vessel inflammation)
Smoking or alcohol
Squamous cell carcinoma
8
Q
What can cause oral white patches on the tongue?
A
Long term use of broad spec antibiotics
Inhaled steroids
DM or immunosuppressants
Smoking and alcohol
Lichen planus
9
Q
Glossitis?
A
Red, smooth and sore tongue -
Decreased B12, Riboflavin, Folate or iron
10
Q
Black and hairy tongue?
A
The proliferation of chemogenic microorganisms - build up of dead cells on the papillae of the tongue
11
Q
Geographic tongue?
A
Harmless
Irregular red and white patches on the tongue
12
Q
Gum bleeding?
A
Gingivitis - inflammatory condition of the gums caused by plaques
13
Q
Vincent’s infection?
A
Acute ulcerative gingivitis which causes crater-like ulcers and spread laterally
14
Q
Salivary gland disorders?
A
Xerostomia - dry mouth (sjorgrens syndrome, anxiety, tricyclics, dehydration)
Infection
Calculus forming on ducts of glands
Tumour of the parotid
15
Q
Symptoms of oesophageal disorders?
A
Dysphagia
Odynophagia
Regurgitation
Heartburn
16
Q
Short history of progressive dysphagia?
A
Due to mechanical stricture as the patient cant handle solids followed by liquids
17
Q
Slow onset dysphagia for both solids and liquids?
A
Achalasia - motility disorder
18
Q
Pathophysiology of GORD?
A
Reflux of gastric acid, bile, pepsin and duodenal content back into the oesophagus overcoming normal defences such as the LOS
(people with GORD are more predisposed to the LOS relaxing)
19
Q
Risk factors of GORD?
A
Increased abdominal pressure (pregnancy)
Delayed gastric emptying
Decreased LOS pressure
Post-prandial
Nocturnal
20
Q
Clinical features of GORD?
A
Heartburn
Sometimes regurgitation then cough or nocturnal asthma due to aspiration of gastric contents in the lungs
21
Q
Investigations done to confirm GORD?
A
>55 + alarm symptoms - OGD - suspected malignancy as it can show inflammation
24 Hour intraluminal pH monitoring - use to confirm GORD before surgery if the patient no respond to PPI
22
Q
Management of GORD?
A
Mild - lifestyle factors + antacids
Alginate containing antacids
Dopamine antagonist prokinetic agents
H2 receptor antagonist
PPI
Surgery - mechanical fundoplication
Linx reflux management system
23
Q
MOA alginate containing antacids?
A
Forms a protective foam over gastric contents stopping them escaping the stomach
Mg containing - diarrhoea
Aluminium containing - constipation
24
Q
MOA dopamine antagonist prokinetic agent?
A
Increase rate of peristalsis and gastric emptying
metoclopramide
25
H2 receptor antagonists?
(-tinide)
Decrease gastric acid
26
PPI?
Inhibits the H+/K+ ATP-ase and decreases acid secretion
Long term use associated with osteoporosis and C.diff
27
Mechanical fundoplication?
Wrapping the fundus of the stomach around the lower part of the oesophagus
28
Linx reflux management system?
Uses row of magnets to increase LOS closure pressure
29
Complications of GORD?
Peptic stricture
Barrets oesophagus - squamous epithelium to columnar epithelium so can be more like the stomach - increase risk of oesophageal cancer
30
NERD?
Non-endoscopic reflux disease - people who don't respond to PPI
31
Achalasia?
Aperistalisis and impaired relaxation of the LOS - \>50% of patient found to have an elevated LOS
32
33
Clinical features of achalasia?
Long history of dysphagia for solids and liquids
Difficulty swallowing, discomfort and regurgitation
34
Investigations done to confirm Achalasia?
CXR - dilated oesophagus
Barium swallow - birds beak and lack of peristalsis and dilation
CT + oesophagoscopy - exclude carcinoma
**Manometry** - shows aperistalsis and contracted LOS
35
Management of Achalaisa?
Nitrates or nifedipine
Endoscopic balloon dilatation
Surgical division of LOS
36
A complication of Achalasia?
A marginal risk of squamous carcinoma
37
What is systemic sclerosis?
Smooth muscle of oesophagus replaced by fibrous tissue which further decreases the LOS pressure (+ hypomotility) so increased reflux of gastric acid into the oesophagus
38
Diffuse oesophageal spasms?
simultaneous contractions in distal oesophagus
39
Nutcracker oesophagus?
High amplitude peristaltic waves
40
Hypersensitive LOS?
Increased contractive pressure of LOS
Dysphagia and chest pain
41
Difference between sliding and para-oesophageal hernia?
Sliding - GO junction slides through the O hiatus alongside the oesophagus and lies above the diaphragms
Para-oesophageal - fundus rolls up the hiatus alongside the oesophagus but the GO junction remains below the diaphragms
42
Benign oesophageal strictures?
Secondary to GORD
Ingestion of corrosives
After radiotherapy
Endoscopic treatment of varices
43
Iatrogenic perforation?
**After endoscopic dilatation** of O strictures or achalasia
Treat with an expanding covered oesophageal stent to seal the hole
44
Traumatic or spontaneous oesophageal rupture?
Occur after blunt chest trauma or forceful vomiting (Boerhaave)
Pain, fever, hypotension and crepitation (surgical emphysema)
45
Which part of the oesophagus is most likely for an adenocarcinoma to develop?
Lower 1/3 and cardia
46
Which part of the oesophagus would a squamous cell carcinoma most likely develop?
Middle and upper 1/3
47
Clinical features of oesophageal cancer?
Dysphagia
Weight loss
Chest pain from bolus food impaction
48
Investigations to diagnose oesophageal cancers?
OGD + tumour biopsy
Barium swallow - rule out motility disorders
CT - look for distant metastasis
**EUS** - depth of wall invasion and local lymph node involvement (stage)
49
Management of oesophageal cancer?
Surgical resection
Induce tumour necrosis (endoscopic metal stent across tumour, laser or alcohol injections)
Radio or chemotherapy
50
The role of stomach acid?
To kill food bourne infections
reservoir for food
secretion of intrinsic factor
Emulsification
51
Pathophysiology of H.pylori?
Urease producing G-ve bacteria that is found in the antrum of the body of the stomach. It lowers the pH of the stomach
52
Conditions associated with H.pylori?
Chronic gastritis, Peptic ulcers, Gastric cancer or gastric B cell lymphoma
53
Non-invasive diagnostic techniques for H.pylori?
Serology (serum antibodies)
Urea breath test
Stool sample (antigens)
54
Management of H.pylori?
Triple PPI therapy
Omeprazole, metronidazole and clarithromycin
or
Omeprazole, amoxicillin and clarithromycin
55
What is a peptic ulcer?
Ulcer/ sores that develop in the stomach wall due to a weakness in the mucosal layer of the stomach lining
DU\>GU
56
Causes of peptic ulcers?
H.Pylori
NSAIDS
Aspirin
(decrease prostaglandins by inhibiting cylco-oxygenase 1 decreasing the protection of the upper GI tract)
57
Clinical features of peptic ulcers?
Burning epigastric pain
Nausea, heartburn or flatulence
DU pain - when hungry or at night
Rare - painless haemorrhaging
58
PU: When would you use a non-invasive test for PU?
\<55 + ulcer type symptoms
59
Other investigations to confirm peptic ulcer?
Routine endoscopy followed by biopsy
Barium meal - if there is suspected outflow obstruction
60
Management of peptic ulcer?
H.pylori +ve - triple therapy
H.Pylori -ve - PPI and stop causative medication
PPI prophylaxis
61
Complications of peptic ulcers?
Perforation
Gastric outlet obstruction (projectile vomit - mostly cancer)
Haemorrhage
(IV FLUIDS AND ANTIBIOTICS TO BE GIVEN)
62
Causes of gastritis?
H.pylori
Autoimmune (pernicious anaemia)
Virus
Duodenogastric reflux
63
Difference between acute and chronic gastritis?
Acute - neutrophil infiltration
Chronic - lymphocytes, macrophages, plasma cells and mononuclear cells
64
What kind of cancers are usually gastric cancers?
adenocarcinomas of the antrum
65
Clinical features of gastric cancer?
Nausea, anorexia and weight lost
Peptic ulcer pain
if near pylorus: Dysphagia + vomiting
Palpable epigastric mass
66
Investigations of gastric cancer?
Gastroscopy + biopsy - identify
CT, EUS and laproscopy - stage
67
Signs of acute upper GI bleed?
Haematemesis - cough up blood
Melaena - dark tarry poop
if in shock and lots or rectal blood - badddddd
68
Most common cause of upper GI bleed?
PU
Made worse by anticoagulants
(other varices, NSAIDs, alcohol, mallory-weis (tears of the mucosal membrane of the OE junction))
69
Scoring system used to identify those at risk of recurrent or life-threatening upper GI haemorrhage or those low risk enough to be discharged?
Rockall Score - age, shock?, endoscopic stigmata and diagnosis
70
What can cause a massive lower GI bleed?
Diverticular disease or ischaemic colitis
71
72
What can cause a minor lower GI bleed?
Haemorrhoids
Anal fissure
73
What is a proctoscopy used for?
Anarectal disease
74
What do chronic GI bleed present with?
Iron deficiency anaemia
75
Causes of chronic GI bleeding?
Angiodysplasia (abnormal or enlarged blood vessels of the GI)
Cancer
Colitis
Polyps
Diverticular disease
76
Investigations to confirm chronic GI bleeding?
OGD + endoscopy
Distal duodenal biopsy
Angiography
77
Management of chronic GI bleed?
Treat the cause of bleeding
oral iron given to treat anaemia
78
what are some presenting symptoms of small bowel disease?
Steatorrhoea
Diarrhoea
Abdo pain and discomfort
Anorexia
Malabsorption - deficiencies
79
common investigations used to identify small bowel disease?
coeliac serology
small barium follow
MRI
Endoscopy
80
Coeliac?
Villous atrophy and crypt hyperplasia due to inflammatory cause by gluten and gluten-sensitive T cells
81
What component of gluten causes coeliac and dermatitis hepatiformis?
Gliadin
82
Pathophysiology of coeliac?
In the jejunum
Gliadin is resistant to the proteases in the small intestine
The DQ code of inflammatory T cells recognise gluten and cause an inappropriate inflammatory response
Gliadin passes through the damaged epithelium and is deaminated by tissue transglutaminase - increases immunogenicity
83
Which HLA are associated with coeliac?
HLA DQ 2.5
HLA DQ 8
HLA DQ 2.2
84
Clinical features of coeliac?
Abdo pain
Malaise
Tiredness
Deficiency
associated with other autoimmune conditions
85
Investigations done to confirm coeliac?
IgA tissue transglutaminase
IgA endomysial antibodies
Distal duodenal biopsy (histological features)
Blood count (deficiency and anaemia)
Bone densitometry
Small bowel radiology
86
Management of coeliac?
Gluten free diet + correct vitamin deficiencies
Pneumococcal vaccination
87
Complications of coeliac?
**Dermatitis hepatiformis** - skin manifestation of coeliac that itches and you get fluid-filled blisters (IgA at dermoepidermal junction)
**Whipple's disease** - rare bacterial infection that affects joins and digestive system
**Intestinal resection** - malabsorption and short bowel syndrome
**Bacterial overgrowth** - stasis in upper small bowel normally sterile causes bacteria to grow and they can deconjugate bile salts and use up B12
**Tropical sprue** - abnormal flattening of the villi and inflammation fo the lining of the small intestine
88
How can intestinal resection caused by coeliac lead to oxalate stones?
Malabsorption of B12 and bile sals causes diarrhoea's so you lose water and electrolytes and you get increased oxalate - renal oxalate stones
89
How to identify if a patient has bacterial overgrowth as a complication of coeliac?
Measure hydrogen after oral lactulose which is produced by colonic bacteria
90
Conditions that can cause protein loss enteropathy?
Coeliac
Crohns
Thicken and enlargement of gastric folds (menetrier disease)
INCREASED PROTEIN LOSS DUE TO ABNORMAL MUCOSA
91
Meckel's diverticulum?
True diverticula of the small intestines that can contain gastric mucosa - secrete acid = ulcer
## Footnote
**RULE OF 2 - 2 years old, 2ft from ileocecal valve and 2% of the population**
**LOWER GI BLEEDING, PERFORATION, INFLAMMATION, OBSTRUCTION**
92
where do carcinoid tumours of the small intestine originate form?
Enterochromaffin cells that produce serotonin
93
Carcinoid syndrome?
Where they have liver metastasis and drain into the hepatic vein and therefore systemic circulation
symptoms: **flushing, wheezing, diarrhoea**, abdo pain, heart failure
94
Investigations used to confirm carcinoid tumours?
liver ultrasound
Increased 5 - hydroxy-in-dole-actic acid
95
Management of carcinoid tumours of the small intestine?
Serotonin antagonist
Somatostatin analogue (octreotide)
Surgical resection
96
Host immune response in IBD?
Effector T cell \> Regulatory T cell
Pro-inflammatory cytokines - IL12, INF-GAMMA, IL5, IL17
causes:
release of mast cells, neutrophils, eosinophils
Macrophages - TNF alpha, IL1 AND IL6
97
Macroscopic differences between UC and CD?
**_UC_:** Rectus and sigmoid colon - left-sided and transverse
rectum and extends proximally
continuous colonic involvement
Red mucosa that bleeds easily
Ulcers and pseudopolyps
**_CD:_** any part of the GI tract
ileocaecal and perianal - can affect small bowel
skip lesions
Deep ulcers and fissures - cobblestone appearance
98
Microscopic differences between UC and CD?
**_UC:_** mucosal inflammation
no granulomata
goblet cell depleation
crypt abscess
**_CD:_** transmural inflammation
Granulomatous formation
99
Differences in clinical features between UC and CD?
**_UC:_** Diarrhoea with blood and mucus
**_CD:_** SB - Abdo pain
TI - mimics appendicitis
COLON - diarrhoea, bleeding and pain at poo
PERIANAL - anal tags, fissure, fistulae or abscess formation
100
Extragastrointestinal manifestations of IBD?
Eyes - conjunctivitis
Joins - Ankylosing spondylitis, small joint arthritis, inflammatory back pain
Skin - Erytherma nodosum, pyoderma gangrenosum (necrotising ulceration of ksin of lower leg)
Hepatobiliary - gall stones, PSC, Hepatitis
Renal - oxalate stones
Venous thrombosis
101
Investigations done to confirm IBD?
**Aim is to identify IBD - Severity and if it is UC or CD**
**BLOODS** -Anaemia due to malabsorption (CD - platelet, ESR, C reactive protein and decreased albumin)
**RADIOLOGY AND IMAGING** -
Rigid or flexible sigmoidoscopy
Colonoscopy
Small bowel imaging
Plain Abdo X ray - toxic megacolon and loss of colon folds or gas
**STOOL** - faecal calprotein - migration of neurophils in mucosa
102
Management of IBD?
**Oral 5 ASA** - aminosalicylic acid (mild) - interfere with arachidonic acid meaning enzymes needed to produce leukotrienes and prostaglandins don't work - decrease leukocytes and production of cytokines
**STEROIDS** - prednisolone, hydrocortisone of budesonide
**LIQUID ENTERAL NUTRITION**
**AZATHIOPRINE** -bone marrow suppression
**METRONIDAZOLE** - antibiotic
**METHOTREXATE** - immunosuppressant
**ANTI-TNF ANTIBODIES** - for patients resistant to everything
103
What needs to be measured when prescribing azathioprine?
**Thioprine methyltransferase** because this is needed to metabolise and active azathioprine so if there is no activity from the enzyme - greater risk of pancytopenia
104
Surgical management of IBD?
**Colectomy with ileoanal anastomosis** - terminal ileum is used to form a reservoir so the patient can be continent a few times a day however this can become inflamed
**Panprotocolectomy with ileostomy -** whole colon and rectum removed and ileum attached to abdo wall as a stoma
105
Complications of IBD?
Toxic megacolon + perforation
Stricture formation
Abscess formation
fistulae and fissures
colon cancer
106
Microscopic colitis?
Colonic mucosa looks normal on colonscopy but histological examination shows:
lamina propia inflammation
Increased intraepithelial lymphocytes
Subepithelial collagen layer
107
Symptoms and management of microscopic colitis?
Symptoms - watery diarrhoea induced by coeliac or NSAIDS
Loperamide - not to be given to people with bloody diarrhoea's
Budesonide
108
IBS?
Irritable bowel syndrome is a mixture of abdominal symptoms with no known organic or identifiable cause
problems with intestinal motility, enhanced visceral perception or microbial dysbiosis
109
Epidemiology of IBS?
10 - 20% \<40 years old
2:1 F:M
110
Diagnostic criteria for IBS?
Abdo pain + 2 or more of the following:
Pain relief at defecation
Pain associated with change in stool consistency
Pain associated with change in frequency of defecation (Constipation or diarrhoea)
111
Other symptoms of IBS?
Urgency
Incompetnant
Bloating
Mucous PR
112
What can exacerbate IBS?
Stress
Menstruation
Gastritis
113
Management of IBS?
Lifestyle and diet change
Constipation - Laxatives (lactulose - bloating), PRUCALOPRIDE, LUBIPROSTONE, LINACLOTIDE
Diarrhoea - Loperamide after loose stool
Bloating - mebeverine or hyoscine butyl bromide + low FODMAP- antispasmodics
Psychological - CBT or SSRI
114
Appendicitis?
Inflammation of the appendix due to gut bacteria and leukocytes invading the wall of the appendix following obstruction
(most common surgical emergency of the abdomen)
115
What 3 things can cause an obstruction of the appendix?
**Faecolith**
**Pinworm infections**
**Lymphoid hyperplasia** - increase in size during adolescence and increase more during viral infections and they can get so big the occlude the appendix
116
Pathophysiology of appendicitis?
Lumen of the appendix is always filled with mucous and fluid to keep pathogens entering blood and to keep it moist but even when obstruction enters it continues to secrete + bacteria multiply
Increase pressure on the appendix wall puts pressure on the nerves which lead to RLQ pain
Puss formation and increased WCC
Increased pressure ow pressing on blood vessels and ischaemia occurs - cells die - bacteria are now able to invade the wall
Wall becomes weaker and thinner and then ruptures - bacteria now escape into peritoneum = peritonitis
Pus and fluid now surround the appendix and abscess form (periappendeal or subphrenic)
117
Investigations done to confirm appendicitis?
CT
Increased CRP
Increased WCC
118
Signs and symptoms of appendicitis?
Tachycardia
Fever
Pain during PR
Constipation
RLQ pain
Rebound sign - PRIF\> PLIF when pressing on LIF
Psoas sign - Pain on extension of thigh
Cope's sign - Pain on flexion and rotation of thigh
119
Management of appendicitis?
Appendectomy
Drain the fluid around the appendix
Antibiotics - Tazobactam or piperacillin
120
Complication of appendicitis?
Perforation
Appendix abscess
Appendix mass - inflamed appendix becomes covered with omentum
121
Signs and symptoms of bowel obstruction?
Nausea
Vomiting
Cramping
Obstipation
Distended abdo
Fever
Tachycardia
Tinkling or absent abdo sounds
122
5 causes of mechanical obstruction?
**Adhesion -** 2 parts connected by a fibrous band (most common)
**Tumour** - colorectal cancer
**Intussusception** - Bowel invaginates on itself
**Herniation** - protrusion of a part of bowel through the wall that is meant to contain it - can become ischaemic
**Volvulus** - twisting of intestines around its self at a single point
123
3 causes of pseudo-obstruction?
**Myopathy** - no peristaltic contractions of the GI
**Neuropathy** - No innervation of smooth muscle so no peristaltic movements
**Hirschprung disease** - nerves missing at the distal end of the colon resulting in no/ abnormal peristalsis
124
Investigations of bowel obstructions?
AXR
CT
125
Complications of bowel obstruction?
**Bowel ischaemia** - due to venous compression - ischaemia and necrosis
**Perforation**
**Sepsis** - due to perforation as bowel cells die and rupture occurs - release of gut bacteria into circulation
**Hypovolaemiac shock** - venous compression means more fluid in the abdomen meaning loss of electrolytes and water or fluid loss through wanting to vomit
126
Management of bowel obstruction?
NGT and IV fluids to rehydrate and correct electrolyte balance
Analgesia
CT
Surgery
**Neostigmine** - promotes colonic motility by increasing acetylcholine as it is a reversible acetylcholinesterase inhibitor
127
# Define:
Diverticulum
Diverticula
Divertculosis
Diverticular disease
Diverticulitis
OUTPOUCHING OF COLONIC MUCOSA AND UNDERLYING CONNECTIVE TISSUE THROUGH THE COLON WALL AT WEAK POINT OF THE WALL WHERE BLOOD VESSELS PENETRATE ALL THE LAYERS
**Diverticulum** - 1 outpouching
**Diverticula** - multiple outpouchings
**Diverticulosis** - multiple outpouching but no symptoms
**Diverticular** **disease** - multiple outpouching and symptoms
**Diverticulitis** - inflammation of the diverticula
128
What is the difference in diverticula distribution between western patients and Asian patients?
Western - Sigmoid colon
Asian - Ascending, H. flexure and part of transverse
129
Pathophysiology of diverticulitis?
IMA branches penetrate all the layers of the GI wall causing them to be weaker
insufficient dietary fibre increases intracolonic pressure and the mucosa forms an outpouching at these weak points in the wall
Diverticulitis - microflora or faeces get lodged in the neck of the diverticulum - ischaemia - necrosis and inflammation
130
Risk factors for diverticulitis?
Age
M \> F
Low fibre diet
NSAIDS
Corticosteroids
Exercise
131
Signs and symptoms of diverticulitis/ diverticular disease?
1. 95% asymptomatic + pain in LIF
2. Constipation along with IBD
3. Bleeding diverticulum - large volume of blood at defecation due to rupture of the blood vessels
4. Diverticulitis - nausea, fever, tachycardia - acute LIF pain and loose stool
132
Investigations use to confirm diverticular disease?
Colonoscopy
Barium enema
FBC, CRP, ESR
CT - identify complications
133
Management of diverticular disease?
Increase fibre and water
**_ACUTE:_**
IV antibiotics - cephalosporin or metronidazole
Analgesia
fluid
Resection - **SEGMENTAL COLECTOMY**
134
When is it recommended to do segmental colectomy on a patient who has diverticular disease?
Perforate
Undrainable abscess
Inflammation not responding to medical treatment
Fistulae formation
135
Complications of diverticular disease?
Abscess
Diverticulitis
Perforation - peritonitis
Fistulae formation between colon and bladder or colon and vagina
Intestinal obstruction
136
3 types of bowel ischaemia?
Acute mesenteric ischaemia
Chronic mesenteric ischaemia
Chronic colonic ischaemia
137
Acute mesenteric ischaemia?
SMA + small bowel
Thrombosis, embolism or mesenteric vein thrombosis
Trauma, vasculitis, radiotherapy, strangulation
**SEVERE ABDO PAIN OUT OF PROPORTION TO PHYSICAL EXAM FINDINGS**
_SYMPTOMS TRIAD:_
Acute abdo pain, Rapid hypovolaemia, Minimal abdo signs on exam
138
Investigations done to confirm acute mesenteric ischaemia?
**AXR** - gasless abdomen
**ANGIOGRAPH**
**BLOODS** - Increase Hb due to loss of plasma, WCC, amylase and metabolic acidosis (lactate)
**LAPAROTOMY** - nasty necrotic bowel
139
Management of bowel ischaemia?
Fluid and antibiotics (tazobactam)
LMWH (long term anticoagulation)
Thrombolysis
Removal of dead bowel
Revasularisaition followed by 2nd laparotomy
140
Complications of acute mesenteric ischaemia?
septic peritonitis and systemic inflammation
141
Chronic mesenteric ischaemia?
Intestinal angina
SYMPTOM TRIAD: Decreased weight, upper abdo bruit, severe postprandial abdo pain
INVESTIGATIONS - CT/ MR angiography
MANAGEMENT - Revascularisation - Percutaneous transmural angiography or stent
142
Chronic colonic ischaemia (ischaemic colitis)?
Low flow in IMA territory and this can range from mild ischaemia to gangrenous colitis
**Symptoms** - Lower left-sided abdo pain and bloody diarrhoea
**Investigations -** GI endoscopy + CT
**Management** - Fluid replacements + antibiotics + resuscitation - resection and STOMA :(
143
Complications of chronic colonic ischaemia?
Ischaemic stricture
Gangrenous ischaemic colitis - peritonitis and hypovolaemic shock
144
Mallory Weiss tears?
Most common cause of upper GI bleeding
Tears at the OG junction due to persistent retching, vomiting or coughing resulting in haematemesis
**SYMPTOMS** - Haematemesis, melena, dizziness and abdo pain
**INVESTIGATIONS** - Endoscopy
**MANAGEMENT** - Heal on its own or endoscopic injection therapy :
- Epinephrine injection
- Haemoclipping
Embolization
Cauterization
145
Haemorrhoids pathophysiology?
Anus is surrounded by anal cushions which contribute to the anal closure
Cushions are attached by smooth muscle and elastic tissue which are prone to displacement and they protrude through the tight anus and become congested - hypertrophy and strangulation
146
causes of haemorrhoids?
Constipation with prolonged straining
Congestion - pelvic tumour or pregnancy
147
Signs and symptoms of haemorrhoids?
Bright red blood coating stool, tissue and pan
Mucus discharge and pruritus discharge
Anaemia, weight loss and tenesmus
148
Management of haemorrhoids?
Fluid and fibre
Stool softener
Topical analgesics
Rubber band ligation
Sclerosant injection - vessels dilate and cut off flow which in turn then causes the vessels to shrink
Infrared coagulation
149
Pruritus ani?
Itchy anus - avoid scratching, have good hygiene and avoid food that softens stools
150
Anal fissure?
Painful tear of the squamous lining of the lower anal canal caused by hard faeces or spasms constricting blood flow meaning it takes longer for the fissures to heal
(SYPHILIS, CROHNS, HERPES, TRAUMA OR ANAL CANCER)
MANAGEMENT: Lidocaine, GTN ointment, Topical diltiazem, fibre and fluids or stool softener
151
Anal fistulae?
Abscess forms due to anal crypts being infected - then they rupture and a fistula (track route) between skin and anal canal is formed
(CROHNS AND DIVERTICULAR DISEASE)
152
Pilonidal sinus?
(small hole in the skin)
obstruction of the natal cleft 6cm above the anus - hair follicles become clogged with debris and it excites a foreign body reaction forming an abscess with a foul-smelling discharge
MANAGEMENT - Excision of sinus tract, primary closur, antibiotics or cover with skin flaps
153
Rectal prolapse?
Mucosa (1) or all the layers (2) of the rectum protrudes through the anus due to a lax sphincter (or neurological or prolonged straining)
MANAGEMENT- Rectoplexy - fix the rectum to the sacrum
154
Proctalgia Fugax?
Idiopathic cramping rectal pain often worse at night
MANAGEMENT - reassurance, salbutamol (shortens attacks of pain), topical GTN or Diltiazem
155
What staging system is used to measure the severity of colon cancer?
Duke's stages of colon cancer - How much of the GI wall has been invaded
156
T/F proximal cancer have a worse prognosis?
T
157
T/F majority of cancers are in the distal colon?
T
158
Key features of coeliac?
Atrophic villi and hypertrophic crypts graded using marsh stages
159
Symptoms of C.diff?
Spore forming bacteria
Watery diarrhoea, abdo pain, bloody, Increased WBC and toxic megacolon
160
What things would increase if a patient had PBC compared to PSC?
PBS - Increased ALP and bilirubin
- Fatigue, pruritus, xathelasma, +ve AMA + IgM, intrahepatic duct
PSC - Increased ALT and AST
- Fatigue, pruritus, jaundice, ANCA, intra and extrahepatic
161
How would a patient with a paracetamol overdose present?
Metabolic acidosis, Increased PTT, Increased creatinine, hypoglycaemia, Increase ALT, Coagulopathy and renal failure
\<8 hours - activated charcoal
\>8 hours - acetylcysteine
162
Wernicke's encephalopathy?
Decreased thiamine causes ataxia, nystagmus, Ophalmoplegia (paralysis of muscles surrounding the eye) and confusion
If untreated it develops into korsakoff's which is untreatable
163
