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Module 303 - Medicine > GI > Flashcards

GI Flashcards

1
Q

Causes of abdominal pain (7)

A
  • Peptic ulcer disease
  • GORD
  • Pancreatitis
  • Biliary pain
  • Bowel obstruction
  • GI malignancy
  • IBS
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2
Q

What are the two main causes of peptic ulcer disease?

A

Helicobacter pylori and NSAIDs

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3
Q

How can you diagnose a H.pylori cause of peptic ulcer disease?

A
  • CLO test (uses a gastric biopsy taken during gastroscopy)

- H.pylori faecal antigen

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4
Q

Treatment for H.pylori peptic ulcer disease

A

PPI and 2 Abx (7 day treatment)

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5
Q

Complications of peptic ulcers

A

Bleeding and perforation

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6
Q

GORD risk factors

A

Elevated BMI
Pregnancy
Alcohol
Dietary

Anything that relaxes the lower oesophageal sphincter

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7
Q

What is Barrett’s oesophagus?

A

metaplasia where normal squamous epithelium is replaced by columnar epithelium – a premalignant condition

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8
Q

How is Barrett’s diagnosed?

A

o Acetic acid (pushed through endoscope – highlights abnormal mucosa or evidence of dysplasia) – allows for targeted biopsies

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9
Q

When should patients with Barrett’s undergo regular surveillance?

A

Surveillance if males, long segment Barrett’s, ulcer present

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10
Q

What is the treatment of Barrett’s oesophagus?

A

Long term PPI

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11
Q

Management of GORD

A

Medical management in most cases - PPI (+lifestyle changes)

More severe cases - can have surgical management (Laparoscopic Nissen’s fundoplication)

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12
Q

Causes of pancreatitis

A

Alcohol, gallstones, drugs

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13
Q

Management of pancreatitis

A

fluids, analgesia, antibiotics if indicated, early feeding

o Antibiotics not routinely used, only in some scenarios

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14
Q

Complications of pancreatitis

A 
o	Sepsis/shock
o	ARDS
o	Pancreatic abscess
o	Pancreatic pseudocyst
o	Pancreatic ascites – rupture of the pancreatic duct and leakage of amylase-rich fluid into peritoneal cavity – treatment with stent insertion across pancreatic duct
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15
Q

Causes of diarrhoea

A
  • Irritable bowel syndrome
  • Infective
  • Inflammatory bowel disease
  • Malabsorption (coeliac, pancreatic)
  • Drugs
  • Factitious (self-induced e.g. by taking laxatives
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16
Q

Causes of bloody diarrhoea

A
  • Ulcerative colitis
  • Colonic Crohn’s disease
  • Infective
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17
Q

How to tell the difference between IBD and infective cause of bloody diarrhoea.

A

o Infective diarrhoea tends to be a shorter Hx with worse pain than in IBD

Should send stool cultures to rule out infection

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18
Q

What is the effect of smoking on UC and Crohn’s respectively?

A

UC = protective

Crohn’s = aggravates

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19
Q

Typical endoscopic findings in IBD

A

UC - superficial, continuous lesions

Crohn’s - transmural, skip lesions, cobblestoning

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20
Q

Infective diarrhoea classical features

A
  • Short history
  • Abdominal pain usually a feature and can be bloody or non-bloody
  • Campylobacter jejuni - a common cause of travelers’ diarrhoea
  • Clostridium difficile (pseudomembranous colitis) – seen in hospitalised sick patients, antibiotic use a risk factor. Usually non bloody
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21
Q

Management of UC/Crohn’s

A

• Oral and local steroids and 5ASA preparations

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22
Q

Management of severe acute colitis

A

o IV steroids (methyl prednisolone hydrocortisone), DVT prophylaxis
o Nutritional support
o If no response (Trulove’s criteria) in 3-4 days surgical opinion, second line treatment (biologics like infliximab and adalimumab)

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23
Q

Long term management of IBD

A 
o	5ASA (benefit more in UC) + azathioprine
o	Can adjust azathioprine dose by measuring metabolites in blood (6TGN and 6-MMPN levels)
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24
Q

Side effects of azathioprine

A

bone marrow suppression, pancreatitis and hepatotoxicity and malignancy especially skin

25
Q

How can the risk of bone marrow toxicity be predicted if taking Azathioprine?

A

by TPMT enzyme levels

26
Q

Treatment of IBD that still creates symptoms despite Azathioprine

A

consider biologics: Infliximab, vedolizumab, tofacitinib

27
Q

Coeliac disease

A
  • Positive antiendomysial and tissue transglutamase antibody
  • D2 biopsy shows villous atrophy
  • Gluten free diet corrects malabsorption, improves symptoms and reduces risk of malignancy (EATL)
28
Q

Causes of malabsorption

A

Coeliac disease
Small bowel Crohn’s disease
Chronic pancreatitis

29
Q

Causes of dysphasia and associated features

A 
•	Oesophageal cancer:
o	Weight loss, progressive symptoms
•	Benign stricture 
o	History of GORD
•	Motility disorder
o	Painful dysphasia
•	Achalasia cardia
o	Young
•	Stroke
o	Neurological signs and symptoms, coughing/choking on swallowing
30
Q

Causes of upper GI bleed

A

Peptic ulcer disease
Varices
Upper GI malignancy
AV malformations

31
Q

Causes of lower GI bleed

A

Haemorrhoids/anal fissure
Colonic cancer
Diverticular disease
Angiodysplasia

32
Q

GI bleed management (non-variceal)

A
  • Stabilize haemodynamically
  • Transfuse based on clinical need and not level of haemoglobin (keep Hb between 7-9 grams)
  • Gastroscopy once resuscitated
  • IV PPI if stigmata of recent bleed on gastroscopy and endoscopic treatment performed
  • If there is evidence of peptic ulcer consider H pylori eradication
33
Q

GI bleed management (variceal)

A
  • Correct coagulopathy (thromboelastrography)
  • Avoid fluid overload as raises portal pressure
  • IV Terlipressin
  • IV antibiotics
  • Endoscopic banding
34
Q

What procedure can be done for more severe variceal bleeding?

A

Balloon tamponade +/- TIPSS procedure

35
Q

Causes of microcytic anaemia

A

Iron deficiency

Thalassemia

36
Q

Causes of macrocytic anaemia

A 
Acute blood loss
B12/folate deficiency
Hypothyroidism
Bone marrow infiltration 
Alcohol
37
Q

Risk factors associated with oesophageal cancer

A

Achalasia, Barrett’s, alcohol, obesity

38
Q

Risk factors associated with stomach cancer

A

Nitrates/nitrites, ethnicity, pernicious anaemia, prior surgery

39
Q

Risk factors associated with pancreatic cancer

A

DM, chronic pancreatitis, mucinous cystadenomas, obesity

40
Q

Risk factors associated with colon cancer

A

COLONIC POLYPS

Long standing IBD, FAP, HNPCC, Alcohol, obesity

41
Q

Common symptoms of oesophageal cancer

A

Weight loss

Dysphasia

42
Q

Common symptoms of stomach cancer

A

Anaemia, weight loss, vomiting

43
Q

Common symptom of pancreatic cancer

A

Jaundice

44
Q

Common symptoms of Colon cancer

A

Weight loss, anaemia, rectal bleeding, changes in bowel habit

45
Q

Which LFTs are raised significantly in a hepatic picture?

A

AST and ALT

46
Q

Which LFTs are raised significantly in a cholestatic picture?

A

Bilirubin, ALP

47
Q

When ALT is more than 10x its normal value and ALP is less than 3x normal. What is the potential cause?

A

Hepatocellular injury

48
Q

When ALT is less than 10x its normal value and ALP is more than 3x normal. What is the potential cause?

A

Cholestasis

49
Q

If ALT>AST - what is the likely picture

A

Chronic liver disease

50
Q

If ALT is

A

Cirrhosis or acute alcoholic hepatitis

51
Q

If ALP is very high, what test should this be considered alongside?

A

GGT

52
Q

If ALP and GGT are both high - possible causes

A
  • Biliary epithelial damage
  • Bile flow obstruction
  • Alcohol and drugs
53
Q

If ALP is high, but GGT is normal - possible causes

A

Non-hepatobiliary pathology or pathologies that increase bone breakdown (e.g. malignancies)

54
Q

What can cause raised bilirubin?

A

Liver damage

Severe RBC damage (e.g. haemolysis)

55
Q

Colour of urine if unconjugated bilirubin is high

A

Normal

56
Q

Colour of urine if conjugated bilirubin is high

A

Dark

57
Q

Cancer of head of the pancreas can

A

obstruct the bile duct and cause obstructive jaundice

58
Q

Causes of painful jaundice

A

Cancer of the head of the pancreas

Cholangio carcinoma

Module 303 - Medicine (5 decks)

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