1. Clinical diagnosis based upon history 2. 24hr oesophageal pH monitoring 3. Endoscopy if dysphagia or >55 and red flag (e.g. weight loss, coughing blood)

GI Flashcards by Grace Smith

Causes of GORD

Increased intragastric pressure - coughing, large meals, delay in gastric emptying

Decreased oesophageal sphincter tone - alcohol TCAs, peptic strictures

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GORD

Recurrent reflux of the gastric acid into the oesophagus due to a malfunctioning oesophageal sphincter

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Symptoms of GORD

Oesophageal - heartburn, odynophagia, acid brash

Extra-oesophageal - nocturnal asthma, chronic cough, sinusitis

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Ix for GORD

Clinical diagnosis based upon history
24hr oesophageal pH monitoring
Endoscopy if dysphagia or >55 and red flag (e.g. weight loss, coughing blood)

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Mx of GORD

Lifestyle - avoid alcohol, spicy food, eat small regular meals
Pharmacological - PPIs, antacids, H2 receptor agonists
Surgical - Nissen’s fundoplication

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Nissen’s fundoplication

Surgical procedure whereby the fundus of the stomach is wrapped around the oesophageal sphincter to increase the sphincter pressure

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What is Barrett’s oesophagus?

Recurrent acid reflux leads to change in the oesophageal epithelium from stratified squamous –> simple columnar (like stomach lining), initially alleviates the symptoms of reflux, but greatly increases the risk of oesophageal adenocarcinoma (30-125x)

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What is IBS?

Denotes a mixed group of abdominal symptoms for which no organic cause can be found, symptoms a result of the abnormal functioning of what seems an otherwise normal functioning bowel

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Epidemiology of IBS

females, young adult onset

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Triggers of IBS?

Stress, depression, anxiety, eating disorders, GI infection

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Clinical presentation of IBS?

Abdominal pain/discomfort, bloating, constipation/diarrhoea, change in bowel habit, worse after meals, improved after opening bowels

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NICE guidelines for diagnosing IBS?

Abdominal pain: with improvement after opening bowels or associated change in bowel habit + 2 of the following
Bloating, mucus in stools, worse after eating

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Test to differentiate between IBD and IBS?

Faecal calprotectin

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Mx of IBS

Lifestyle - reduce caffeine, alcohol, small regular meals
Bloating - anti-spasmodics (buscopan)
Constipation - laxatives
Diarrhoea - anti-motility agents (loperamide)

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Causes of appendicitis? (which is most common)

Faecolith (small bits of poo - most common)
Lymphoid hyperplasia
Filarial worms

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Pathophysiology of appendicitis?

Obstruction of lumen, invasion of gut bacteria, increased mucus and bacteria increases pressure –> ischaemia –> necrosis –> potential rupture

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Presentation of appendicitis?

Onset of central abdominal pain –> localised to R iliac fossa
Fever
Rebound tenderness
Abdominal guarding

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Ix of appendicitis?

GOLD STANDARD - CT
US
Bloods - raised ESR/CRP and WCC
Pregnancy test and urine dipstick

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Mx for appendicitis

appendectomy and pre-op ABx

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What are diverticula?

Outpouching of the gut wall (false - mucosa only), usually occur at sites of weakness - i.e. where the arteries perforate

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Diverticulosis

Presence of diverticula WITHOUT inflammation

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Most common location for diverticula to form (Western world)?

Sigmoid colon

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Presentation of diverticular disease

95% asymptomatic, intermittent L iliac fossa pain

Presentation of acute diverticulitis

Severe pain in the L iliac fossa, fever, constipation

Ix of diverticulitis?

Barium enema, blood tests (raised neutrophils, ESR/CRP), colonoscopy

Mx of diverticulitis?

Abx, surgical resection, maintain high fibre diet and fluid intake if uncomplicated

What are oesophageal varices?

Abnormal enlarged veins in the oesophagus, occur in patients with chronic liver disease

Causes of oesophageal varices - prehepatic

portal vein thrombosis, portal vein obstruction

Causes of oesophageal varices - intrahepatic

Cirrhosis, acute hepatitis, idiopathic portal HTN

Causes of oesophageal varices - posthepatic

Tumour compression

Presentation of oesophageal varices

Haematemesis, melaena (dark sticky faeces containing partially digested blood), abdominal pain, features of underlying liver disease

Ix for oesophageal varcies?

Urgent endoscopy, FBC, LFT, chest X-ray

Mx of oesophageal varices?

vasoactive drugs, Abx prophylaxis, endoscopic band ligation

Why are diverticula prone to formation in the sigmoid colon?

Smallest luminal diameter, greatest pressure

What is a Mallory-Weiss tear?

Tear in the oesophageal mucosa

Causes/RF for a Mallory-Weiss tear?

Violent coughing/vomiting, bulimia, alcoholism, gastroenteritis

Presentation of Mallory-weiss tear?

Haematemesis, melaena, signs of hypovolaemic shock (cyanosis, tachycardia, rapid breathing)

Ix for mallory-weiss tear?

Endoscopy and use findings to calculate Rockall score

What is the rockall score?

Used to calculate mortality risk due to upper GI bleed (ABCDE approach)

Mx for mallory weiss tear?

1. Vasoactive peptides - Terlipressin | 2. Urgent endoscopy

Two types of ischaemic bowel disease and where do they occur?

Mesenteric ischaemia (acute and chronic) almost always affect the small bowel, ischaemic colitis affects the large bowel

Causes of acute mesenteric ischaemia (AMI)?

Superior mesenteric artery thrombosis/embolism (from AF)

Presentation of AMI?

1. Acute, severe abdo pain 2. No abdo signs on examination 3. Signs of hypovolaemic shock

Causes of ischaemic colitis

Thrombosis/emboli, low CO/arrhythmias, surgery, vasculitis, COCP

Presentation of ischaemic colitis

Sudden onset LIF pain, blood in stools, signs of hypovolaemic shock

Ix for AMI?

Abdominal XR - excl bowel obstruction, CT/MRI angiography to examine arteries, blood tests

Mx of AMI?

Fluid resuscitation, ABx, IV heparin to reduce clotting

Ix for ischaemic colitis

Urgent CT scan - excl. perforation | Colonoscopy + biopsy (gold standard)

Mx for ischaemic colitis

Fluid replacement | ABx

What is a pilonidal sinus/abscess?

Small hole or tunnel in the skin that fills with fluid or pus --> cyst or abscess Occurs in the cleft at the top of the buttocks Contains hair, dirt, and debris Cause pain and can become infected

Tx for pilonidal abscess?

ABx and abscess drainage of pus

Perianal haemorrhoids (piles)

Swelling of BVs found around the rectum causing itching/irritation, swelling, bleeding Tx - lifestyle changes

Perianal fistula

Abnormal connection between the anal canal and perianal skin related to abscess formation. Leads to skin irritation, throbbing pain, smelly discharge from anus, blood/pus in poo. Treat surgically

Perianal fissure

Tear in the lining of the rectum, causing pain and bleeding during bowel movements, caused by constipation, IBD, really hard big poo. Treat with painkilling ointment, laxatives to ease poo and surgery in severe cases

Perianal abscess

Superficial infection that appears as a tender red lump under the skin near the anus, occurs when bacteria gets trapped in glands. Treat with Abx and surgical drainage