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GRACE Phase 2a Medicine > GI > Flashcards

GI Flashcards

1
Q

Causes of GORD

A

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

Decreased oesophageal sphincter tone - alcohol TCAs, peptic strictures

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2
Q

GORD

A

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

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3
Q

Symptoms of GORD

A

Oesophageal - heartburn, odynophagia, acid brash

Extra-oesophageal - nocturnal asthma, chronic cough, sinusitis

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4
Q

Ix for GORD

A
  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)
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5
Q

Mx of GORD

A

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

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6
Q

Nissen’s fundoplication

A

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

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7
Q

What is Barrett’s oesophagus?

A

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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8
Q

What is IBS?

A

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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9
Q

Epidemiology of IBS

A

females, young adult onset

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10
Q

Triggers of IBS?

A

Stress, depression, anxiety, eating disorders, GI infection

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11
Q

Clinical presentation of IBS?

A

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

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12
Q

NICE guidelines for diagnosing IBS?

A

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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13
Q

Test to differentiate between IBD and IBS?

A

Faecal calprotectin

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14
Q

Mx of IBS

A

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

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15
Q

Causes of appendicitis? (which is most common)

A
  1. Faecolith (small bits of poo - most common)
  2. Lymphoid hyperplasia
  3. Filarial worms
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16
Q

Pathophysiology of appendicitis?

A

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

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17
Q

Presentation of appendicitis?

A

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

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18
Q

Ix of appendicitis?

A

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

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19
Q

Mx for appendicitis

A

appendectomy and pre-op ABx

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20
Q

What are diverticula?

A

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

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21
Q

Diverticulosis

A

Presence of diverticula WITHOUT inflammation

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22
Q

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

A

Sigmoid colon

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23
Q

Presentation of diverticular disease

A

95% asymptomatic, intermittent L iliac fossa pain

24
Q

Presentation of acute diverticulitis

A

Severe pain in the L iliac fossa, fever, constipation

25
Q

Ix of diverticulitis?

A

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

26
Q

Mx of diverticulitis?

A

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

27
Q

What are oesophageal varices?

A

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

28
Q

Causes of oesophageal varices - prehepatic

A

portal vein thrombosis, portal vein obstruction

29
Q

Causes of oesophageal varices - intrahepatic

A

Cirrhosis, acute hepatitis, idiopathic portal HTN

30
Q

Causes of oesophageal varices - posthepatic

A

Tumour compression

31
Q

Presentation of oesophageal varices

A

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

32
Q

Ix for oesophageal varcies?

A

Urgent endoscopy, FBC, LFT, chest X-ray

33
Q

Mx of oesophageal varices?

A

vasoactive drugs, Abx prophylaxis, endoscopic band ligation

34
Q

Why are diverticula prone to formation in the sigmoid colon?

A

Smallest luminal diameter, greatest pressure

35
Q

What is a Mallory-Weiss tear?

A

Tear in the oesophageal mucosa

36
Q

Causes/RF for a Mallory-Weiss tear?

A

Violent coughing/vomiting, bulimia, alcoholism, gastroenteritis

37
Q

Presentation of Mallory-weiss tear?

A

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

38
Q

Ix for mallory-weiss tear?

A

Endoscopy and use findings to calculate Rockall score

39
Q

What is the rockall score?

A

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

40
Q

Mx for mallory weiss tear?

A
  1. Vasoactive peptides - Terlipressin

2. Urgent endoscopy

41
Q

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

A

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

42
Q

Causes of acute mesenteric ischaemia (AMI)?

A

Superior mesenteric artery thrombosis/embolism (from AF)

43
Q

Presentation of AMI?

A
  1. Acute, severe abdo pain
  2. No abdo signs on examination
  3. Signs of hypovolaemic shock
44
Q

Causes of ischaemic colitis

A

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

45
Q

Presentation of ischaemic colitis

A

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

46
Q

Ix for AMI?

A

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

47
Q

Mx of AMI?

A

Fluid resuscitation, ABx, IV heparin to reduce clotting

48
Q

Ix for ischaemic colitis

A

Urgent CT scan - excl. perforation

Colonoscopy + biopsy (gold standard)

49
Q

Mx for ischaemic colitis

A

Fluid replacement

ABx

50
Q

What is a pilonidal sinus/abscess?

A

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

51
Q

Tx for pilonidal abscess?

A

ABx and abscess drainage of pus

52
Q

Perianal haemorrhoids (piles)

A

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

53
Q

Perianal fistula

A

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

54
Q

Perianal fissure

A

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

55
Q

Perianal abscess

A

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

GRACE Phase 2a Medicine (20 decks)

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