GI Flashcards
What do you get with referring syndrome and what is it caused by
feeding a person following a period of starvation
hypophosphataemia
hypokalaemia
hypomagnesaemia: may predispose to torsades de pointes
abnormal fluid balance
what type of stoma do you do to defunction a bowel e.g while recovering from tumour resection
Loop - usually ileostomy, can be colostomy if distal
End stomas usually when not re-anastamosing to bowel later e.g a permanent stoma
Achalasia signs
Dysphagia, initially intermittent
Involves both solids and liquids
Undigested foods or retained saliva can be regurgitated, esp at night
atypica/cramping retrosternal chest discomfort or fullness
Coughing & recurrent chest infections
Barium swallow - absent peristalsis in oesophagus, tapering into sphincter = bird beak appearance
what is achalasia
Motor disorder of oesophagus - loss of peristalsis
Failure of lower oesophageal sphincter to open
Rx of achalaisia
Medical - nifedipine or verapamil or isorboide mononitrate pre meal
endoscopic - pneumatic balloon dilation of LES, or botulinum toxin injection into LES
Surgery
Signs of oesophageal carcinoma
early - asytompatic or reflex
Later - dysphagia, initially worse for solids, regurg, cough, choking, pain (odynophagia), wt loss, fatigue, voice hoarseness
ix = endoscopy
Rx = surgical resection (e.g Ivor Lewis right thoracotomy) or chemo
what are the causes of oesophageal perforation
boorhave’s syndrome –> barogenic disruption of wall wo/ pre-exisiting patholoogy, usually forceful vomiting, severe valsalva manoeuvre or heavy lifting
Upper GI endoscopy
Trauma - penetrating, foreign bodies
Caustic - acid or alkali lye indigestion
Oesophageal perforation signs
sudden severe chest pain during an episode of raised intra-abdo pressure
Subcutaneous emphysema (mackler’s triad = subcut emphysema, vomiting, chest pain)
Tachycardia & tachypnoea
epigastric tenderness
Rx = NBM, resus, IV PPI, broad spec Abx,
Surgery - 1º repair & reinforcement (e.g w/ flap of pleura or intercostal muscle), or repair over t tube (allows formation of controlled oesophageocutaenous fistula), or resection w/ reconstruction or exclusion and diversion (forming oesophagostomy –> also need jujenostomy for feeding)
Gastric Volvos signs
Acute = severe epigastric or chest pain and non-productive retching, occasionally haematemesis and reds distress Chronic = epigastric pain and fullness after meals
Upper abdo distension and tenderness
Borchardt’s triad is pain, retching and inability to pass NH tube
Rx = resus and trial of nasogastric decompression, then surgical reduction of Volvos
Different types of diverticular disease
Diverticulosis = presence of diverticular (out pouching of colonic mucosa and submucosa through muscular wall of LI –> most common sigmoid, absent from rectum)
Diverticular disease = diverticulosis w/ complications –> haemorrhage, infection, fistulae
Diverticulitis = acute inflammation and infection of diverticular
Signs of diverituclar disease
Often asymptomatic
PR bleeding
Left iliac fossa or lower abdo pain
altered bowel habits and left sided colic relieved by defecation
fever
tender abdomen
can get phelgmon and abscesses
if perforation = signs of local or general peritonitis
Can develop fistula - bladder, SI, vaginal
Rx for diverticular disease
Asymptomatic = high fibre diet
PR bleeding = IV dehydration + blood transfusion if require + angiography and embolisation if severe
Diverticulitis - IV antibiotics and IV fluid rehydration and bowel rest
If abscess develop, drains it
Surgery for recurrent or perforation or peritonitis –> resection and stoma or resection and anastomosis
types of haemorrhoids
1st º - don’t prolapse
2º prolapse with defecation but reduce spontaneously
CAN TREAT THESE WITH INJECTION SCLEROTHERAPY OR BANDING
3º prolapse and require manual reduction
4º prolapse and not reducible
surgery = resection of the haemorrhoid cushion
haemorrhoids seen at 3, 7 and 11 o’clock
What is toxic megacolon and what are the signs
Severe colitis associated w/ segmental or total dilation of inflamed colon
Systemically unwell - pyrexia, tachycardia, hypotension, dehydration
abdo cramps and pain
Urgency & bloody diarrhoea
tender distended abdomen
decreased bowel sounds
AXR/CT shows dilated >6cm colon –> more than 10cm at risk of perforation
Rx = fluid resus, IV abx, steroids, total colectomy w/ ileostomy
UC inducing and maintaining remission
N.b mucosal inflammation only
Inducing remssion - mezalsaine or prednisolone + 5ASA supposteroires
Maintaining remission - oral mezalasine (or sulphasalazine)
, 2nd line = azathioprine or mercaptopurine,
3rd line = infliximab
