GI Flashcards
Acute Cholangitis presentations
CHARCOT’s triad:
Biliary pain (RUQ)
Fever
Jaundice
Pale stool, pruritus
Gold standard investigation for Acute Cholangitis
ERCP - endoscopic retrograde cholangiopancreatography + biopsy
Gold standard investigation for Primary Biliary Cholangitis
PBC-antibodies + elevated alkaline phosphatase.
Common Ab = AMAs (anti-mitochondrial)
Management of Primary Biliary Cholangitis
ursodeoxycholic acid
(bile acid analogue) + prednisolone
Management of Acute Cholecystitis
Early Laparoscopic Cholecystectomy (w/in 1 week)
Management of Acute Cholangitis
Abx + ERCRP drainage + decompression
Presentation of Acute Cholecystitis
Inflamed gallbladder, biliary pain >8hr. Murphy’s sign.
RUQ/epigastric pain (radiating to right shoulder tip if the diaphragm is irritated)
Fever, N/V
Tender RUQ
Murphy’s sign positive
Presentation of Choledocholithiasis
Colicky RUQ pain
Worse after eating
No fever
Murphy’s sign negative
Chronic cholecystitis presentations
Flatulent dyspepsia Minimal abd pain Nausea Bloating Sometimes colicky pain
Worse after fatty meal
An X-ray demonstrating pneumobilia + dilated small bowel indicates…
Gallstone ileus
Complication: small bowel obstruction
Pt presents with dull, aching LUQ pain. They have a low-grade fever, feel nauseous and are vomiting. They’ve noticed abnormal bowel movements.
Likely cause?
Treatment?
Diverticulitis
- E coli
- B fragilis
Uncomplicated: Co-amoxiclav, ciprofloxacin + metronidazole
Complicated: piperacillin-tazobactam
Pt presents with faecal-like vomiting, constipation and abdominal pain + distension. They have a PHx of Crohn’s.
Likely cause? Management?
Small Bowel Obstruction
Nasogastric decompression
IV Fluid
Laparotomy
Pt presents with rapid abdominal distention, and intermittent pain.
They have been unable to pass wind OR faeces.
Likely cause? Treatment
Large bowel obstruction
Nasogastric Compression
IV Fluid
Laparotomy
IV Neostigmine if CT finds pseudo-obstruction
Squamous Cell Carcinomas occur where in the oesophagus? What are the RFs for SSCs?
Upper 2/3
Alcohol, smoking
Adenocarcinomas occur where in the oesophagus? What are the RFs for Adenocarcinomas?
Lower 1/3
Barret’s/ GORD, gland.
= most common!
Pt presents with lymphadenopathy and abdominal pain. They are being treated for Pernicious anaemia.
Likely cause? Other RFs?
Adenocarcinoma (epithelial) of the stomach.
RF: H pylori, N-nitroso, Pernicious anaemia
Who should undergo a prophylactic proctocolectomy?
Someone with an APC mutation - Familial Adenomatous Polyposis
Huge risk of developing colon cancer
What percentage of colorectal cancers occur in the colon vs rectum?
Colon - 71%
Rectum - 29%
What would a biopsy show in a pt with Barrett’s oesophagous?
Lower 1/3 stratified squamous > stratified columnar.
Oesophagoscopy - salmon mucosa
Pt presents with upper web, post-cricoid dysphagia and is found to have iron-deficiency anaemia.
What is the diagnosis?
Plummer-vinson Syndrome (Squamous Cell Carcinoma)
GORD Management
PPI - Omeprazole
+/- Adjunct Famotidine (H2A)
Pt presents with upper abdominal pain which is worse when hungry, and eased with eating. They’re also bloated and nauseous/ vomiting
They are taking aspirin, steroids, are on SSRIs and are Blood-type O.
Likely diagnosis?
DUODENAL Ulcer
Pt presents with upper abdominal pain which is worse when hungry, and eased with eating. They’re also bloated and nauseous/ vomiting.
They were recently diagnosed with H pylori, and live a stressful lifestyle.
Likely diagnosis?
GASTRIC Ulcer
*Other RF include anything that delays gastric emptying + NSAIDs
Management of Peptic Ulcer Disease
ie duodenal/ gastric ulcers
4-8 wk PPI - Omeprazole
If H Pylori:
PPI + 2 ABx
- Amoxicillin + Clarithromycin 1wk
If penicillin allergy: Metronidazole + Clarithromycin
Ulcerative colitis endoscopy shows
Crypt abscesses
Crohn’s endoscopy shows
NON-caseating TRANSMURAL inflammation in SKIP lesions
Broad linear, transverse, longitudinal ulcerations + inflamed mucosa
Coeliac disease endoscopy shows
Villous atrophy
Crypt hyperplasia
Lymphocytic infiltration
Extra intestinal symptoms of ulcerative colitis
Arthritis
Conjunctivitis
Clubbing
Pyoderma Gangrenosum
Pt presents with severe abdominal pain. The pain is episodic and exacerbated by eating. You suspect an ulcer.
Investigations?
1L
- 13c Urea Breath Test (H pylori?)
- Stool Antigen test
GOLD: Upper GI endoscopy
GORD Mx
1L: PPI - Lansoprazole
2L: H2 receptor blocker - Ranitidine
65-M presents with intermittent rectal bleesing. He has experienced diarrhoea + feeling of incomplete bowel emptying for 8 months. He has lost 8kg recently.
Likely diagnosis? Investigations?
Colorectal cancer
- tenesmus
- rectal bleeding
- wt loss
GOLD: Colonoscopy
Severe UC criteria
Truelove and Witt’s:
- > 6 stools in 1 day
- 1 day of:
- HR>90
- Temp >37.5
- Hb<10.5
- ESR >30mmol/L
Admit to hospital!
Smoking in Crohn’s and UC
Crohn’s: Smoking = RF
UC: Smoking = protective
Lynch syndrome is a RF for which cancer?
Genetic predisposition to non-polyposis colorectal cancer
P tis recovering from resection of the ileo-cecal bowel.
Supplement?
B12
- absorbed in terminal ileum
- no ileo-cecal section = no IF-B12 absorption
Histological change in Barrett’s
How many progress to cancer? What kind of cancer?
Metaplasia
Stratified squamous > SIMPLE columnar epithelium
(stomach lining moves UP into oesophagus)
10% > adenocarcinoma
Causes of gastritis
1) H PYLORI - urea breath test
- HSV
- Cytomegalovirus
- Duodenogastroreflux
- Crohn’s
Describe C diff in Microbiology terms
What increases the risk of getting C diff?
GRAM POSITIVE BACILLIS
ANAEROBIC
Hospitalisation + tx with Cephalosporins (Ceftriaxone - meningitis, pneumoniae)
