GI brief Flashcards
Describe the first step in the management of a patient with hematemesis.
Establish an IV line and administer normal saline.
If pt needs blood: hametestmessis
packed RBCs.
What is the investigation of choice for hematemesis?
Upper GI endoscopy.
What is the diagnosis for an infant with persistent non-bilious vomiting starting at 2-6 weeks, marked dehydration, and weight loss?
Congenital hypertrophic pyloric stenosis (CHPS).
Inv of choice of CHPS:
US.
What is the treatment of CHPS?
First correct dehydration and electrolyte imbalance, then consider surgery.
- Vomiting at 2-6 Ws+ marked dehydration, bad general condition:
CHPS.
- Vomiting at 2-6 Ws+ NO dehydration, good general condition:
GERD.
Describe the presentation of a patient with acquired pyloric stenosis.
Long-standing history of peptic ulcer disease, recurrent vomiting occurring 1 hour after a meal, and a succussion splash on physical exam.
What is the first most common cause of peptic ulcer disease (PUD)?
H. pylori infection.
What is the second most common cause of PUD?
Smoking (other causes include stress, alcohol, NSAIDs).
Inv of choice of PUD:
upper GI endoscopy (biopsy only from gastric cancer).
What is the regimen for eradicating H. pylori?
Amoxicillin, clarithromycin, proton pump inhibitor (PPI).
Why is metronidazole removed from the regimen for H. pylori eradication?
Due to bacterial resistance.
What is the follow-up test after treatment for H. pylori infection?
Urea breath test.
What is the best advice for a patient with PUD?
Stop smoking.
TTT of Pt with PUD develops hematemesis:
1st step: IV line& normal saline. If need blood: packed RBCs.
Then: endoscopy& injection of adrenaline or heat probe if visible bleeding.
Describe the first step in the treatment of a patient with PUD who develops hematemesis.
Establish an IV line, administer normal saline, and consider packed red blood cells if needed. Then proceed to endoscopy and consider injection of adrenaline or heat probe if visible bleeding.
Pt with PUD develops severe abdominal pain referred to back:
perforation.
What is the first step investigation in suspected perforation in a patient with PUD?
Perform an erect x-ray to check for air under the diaphragm.
TTT of perforation:
resuscitation 1st & then surgery.
What are the symptoms of early dumping syndrome?
Nausea, abdominal pain, fullness, diarrhea, and flushing within 1 hour after a meal. mainly due to hypovelemia
What are the symptoms of late dumping syndrome?
Symptoms occurring 1-3 hours after eating, mainly due to hypoglycemia.
What is the treatment for dumping syndrome?
Diet modification, including light frequent meals with decreased carbohydrate content.
Describe the treatment of choice for morbid obesity with a BMI over 35.
Surgery, specifically gastric band ligation.
What is the diagnosis when a patient with a history of gastric band ligation presents with severe vomiting?
Band slip.
What is the preferred investigation for band slip after gastric band ligation?
Barium meal.
How is band slip typically treated?
Surgery.
Define the prophylaxis for bleeding of esophageal varices.
Beta-blockers (BBs).
What is the treatment for ruptured esophageal varices, similar to upper GI bleeding, along with Fresh Frozen Plasma (FFP)?
Same as upper GI bleeding + FFP.
Describe the likely condition when an exam shows peri-anal swelling in a patient with bleeding per rectum and the bleeding is painless.
Piles.
What is the probable diagnosis when an exam reveals peri-anal swelling in a patient with painful bleeding per rectum?
Peri-anal hematoma.
Old pt with bleeding per rectum DT piles:
colonoscopy is a MUST.
How should recurrent pilo-nidal sinus be managed effectively?
Radical excision.
Define the most common cause of peri-anal fistula.
Anal abscess.
What is the most common cause of recurrent peri-anal fistula?
Crohn’s disease.
MCC of multiple anal fissures:
chrone’s disease.
Describe the most important examination for a patient with an anal fissure.
Just inspection (No digital rectal examination).
What is the primary treatment for an anal fissure?
Local glyceryl trinitrate cream.
How should an anal fissure in Crohn’s disease be managed?
Infliximab.
What is the most likely cause when a mother reports finding blood in her infant’s diaper?
Anal fissure.
Describe the most common causes of bleeding per rectum overall.
Piles and fissure.
What is the most common cause of bleeding per rectum in infants?
Anal fissure.
MCC in adult: bleeding per rectum
upper GIT bleeding (peptic ulcer).
Another MCC in adult:bleeding
MCC in adult: diverticulosis (cancer must be excluded).
BPR in pt with AF:
ischemic colitis.
1st episode of BPR in old pt: investigation.
colonoscopy is a MUST
How should bleeding per rectum be managed initially?
IV line and normal saline; administer packed RBCs if needed.
What is the next step if upper GI endoscopy and colonoscopy fail to reveal the site of bleeding?
Capsule endoscopy.
Define the most common hernia to complicate.
femoral
What is a significant sign indicating a complication of a hernia?
No impulse on cough.
Describe the diagnosis when a patient with a hernia develops vomiting, absolute constipation, and abdominal distension.
Intestinal obstruction.
What is the initial step in suspected intestinal obstruction?
Abdominal x-ray followed by surgery
What condition is likely when abdominal swelling is observed below the scar of a previous surgery?
Incisional hernia.
MC PF of incisional:
hematoma.
Examination of incisional hernia:
ask pt to stand and cough.
Describe the management of an infant with an irreducible inguinal hernia.
Surgery as soon as possible.
- If obstruction or strangulation:
immediate surgery.
What is the ‘rule of 6-2’ in the treatment of reducible inguinal hernias in infants?
Birth to 6 weeks: surgery in 2 days. 6 weeks to 6 months: in 2 weeks. More than 6 months: in 2 months.
Umbilical hernia in pediatric:
observe if< 4 ys & surgery if > 4 ys.
How is a patient with divarication of recti diagnosed?
Rising up without support.
What is the recommended treatment for divarication of recti?
Physiotherapy.
What is the most important step in the treatment of a child who ingests a corrosive substance?
Endoscopy within 24 hours.
Long term TTT of corrosive injury:
dilators.
Describe the first-line investigation for achalasia.
Barium study.
What is the preferred investigation for achalasia?
Manometry.
How is achalasia typically treated?
Surgery with ‘Heller myotomy’.
What is the treatment of choice for achalasia in elderly patients who are not fit for surgery?
Dilators.
What is the diagnosis for a young female experiencing attacks of dysphagia and chest pain?
Diffuse esophageal spasm.
What is the characteristic appearance of esophageal spasm on a barium study?
Corkscrew appearance.
What is the treatment for esophageal spasm?
Nitroglycerine, Calcium Channel Blockers.
Describe the diagnosis for a patient with dysphagia, heartburn, and food impaction, with a history of atopic or autoimmune diseases.
Eosinophilic esophagitis.
What is the preferred investigation for eosinophilic esophagitis?
Upper GI endoscopy.
What is the first-line medical treatment for eosinophilic esophagitis?
Diet modification. PPI is the first-line medical treatment.
What is the diagnosis for a patient presenting with heartburn, regurgitation, and retrosternal discomfort?
GERD (Gastroesophageal Reflux Disease).
Describe the best investigation for GERD.
24-hour pH monitoring.
What is the mainstay treatment for GERD?
Conservative
Proton pump inhibitors are the drugs of first choice, given initially once in the morning at standard dose (omeprazole 20 mg, pantoprazole 40 mg, lansoprazole 30 mg, rabepra- zole 20 mg).
https://www.racgp.org.au › …PDF
Gastro-oesophageal reflux disease - RACGP
What is the first-line medical treatment for GERD?
PPI (Proton Pump Inhibitors).
What is the investigation of choice for severe cases of GERD?
Upper GI endoscopy.
Describe the diagnosis for a patient with intermittent dysphagia, postprandial pain, and palpitations.
Hiatal Hernia (para-esophageal hernia).
What is the preferred investigation for hiatal hernia?
Barium study.
What is the treatment of choice for hiatal hernia?
Surgery.
What is the diagnosis for a patient with prolonged GERD who develops dysphagia and experiences relief of heartburn?
Esophageal stricture.
Describe the investigation of choice for esophageal stricture.
Upper GI endoscopy.
What condition is a patient with long-standing GERD at risk of developing?
Barrett’s esophagus (precancerous; risk adenocarcinoma of the esophagus)
What is the investigation of choice for adenocarcinoma of the esophagus?
Endoscopy
If metaplasia is detected, what is the recommended procedure?
Biopsy
What is the suggested action if low-grade dysplasia is found during endoscopy for esophageal adenocarcinoma?
Repeat the endoscopy every 6 months
6 months
If LGD persists, consider referral for endoscopic therapy; otherwise, repeat endoscopy every 6 months until clear of dysplasia
What is the recommended treatment for high-grade dysplasia in esophageal adenocarcinoma?
Ablation or surgery
What is the best treatment for esophageal adenocarcinoma?
PPI (Proton Pump Inhibitors) - very important
Describe the typical patient presentation for esophageal cancer.
Old male smoker, alcoholic with recent dysphagia, weight loss
What is the most common type of esophageal cancer?
Squamous cell carcinoma (SCC)
What is the most important risk factor for adenocarcinoma of the esophagus?
Barrett’s esophagus
Alcoholic vomit up blood after violent retchingor vomiting…
Dx: Mallory weiss $.
What is the definitive diagnostic procedure for conditions like Mallory-Weiss tears?
Endoscopy
What is the main treatment approach for Mallory-Weiss tears?
Conservative management; if bleeding persists: cauterization or epinephrine injection
Describe the presentation of Boerhaave syndrome.
Alcoholic with severe chest pain, pleural effusion after violent retching or vomiting hypotension
What is the main treatment for Boerhaave syndrome?
Emergent surgery
At what age should screening for familial adenomatous polyposis (FAP) start with colonoscopy?
12 years old
What is the fate of individuals with FAP?
100% develop cancer
What is the main treatment approach for FAP once polyps start to appear?
Surgery
What syndrome is characterized by FAP, epidermoid cysts, desmoid tumors, and osteomas?
Gardner’s syndrome
What syndrome involves hamartomatous polyps of the colon, lip pigmentation?
Peutz-Jeghers syndrome
What is the most common premalignant colonic adenoma?
Villous adenoma
Which type of colonic adenoma is most likely to cause electrolyte disturbances?
Villous adenoma
Which type of colonic polyp has the least malignant potential?
Tubular adenoma
What are the most common symptoms of cancer in the cecum?
Anemia, pallor, and fatigue
What are the most common symptoms of cancer in the rectum?
Bleeding per rectum
What are the most common symptoms of cancer in the left colon?
Altered bowel habits
What is the preferred investigation for colon cancer?
Colonoscopy
What should be considered in an old male with iron deficiency anemia?
Colon cancer until proven otherwise
In an older male with iron deficiency anemia, several key considerations should be taken into account to identify the underlying cause:
-
Gastrointestinal Bleeding:
- Colorectal Cancer: This is a significant concern and should be ruled out through appropriate screening, including colonoscopy.
- Gastric Ulcers: Upper GI endoscopy can help detect peptic ulcers or other sources of upper GI bleeding.
- Diverticulosis: Common in older adults and can lead to chronic blood loss.
-
Dietary Insufficiency:
- Assess dietary intake to ensure that there is sufficient iron intake. This is less common but should still be considered.
-
Malabsorption Syndromes:
- Celiac Disease: Can lead to poor absorption of iron from the diet.
- Atrophic Gastritis: Common in the elderly and can affect iron absorption.
-
Chronic Diseases:
- Chronic kidney disease, heart failure, or chronic inflammatory diseases can contribute to anemia of chronic disease, which may coexist with iron deficiency.
-
Medications:
- Non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulants can cause GI bleeding.
-
History and Physical Examination:
- Detailed history of GI symptoms, medication use, and dietary habits.
- Physical examination focusing on signs of chronic disease or GI pathology.
-
Laboratory Tests:
- Complete blood count (CBC) with iron studies (serum iron, ferritin, total iron-binding capacity).
- Stool occult blood test to check for hidden GI bleeding.
-
Endoscopic Procedures:
- Colonoscopy: To rule out colorectal cancer and other sources of lower GI bleeding.
- Upper GI Endoscopy: To detect upper GI sources of bleeding.
-
Other Imaging:
- If endoscopy is inconclusive, consider imaging studies like CT enterography to evaluate the small intestine.
For more detailed information, refer to the RACGP guidelines and other authoritative sources such as:
- RACGP Clinical Guidelines: Iron Deficiency Anaemia
- UpToDate: Evaluation of Iron Deficiency in Adults
What is the first step in the evaluation of a patient with suspected colon cancer?
FOBT (Fecal Occult Blood Test); if positive finding: colonoscopy
-
Initial Assessment:
- History: Detailed medical and family history.
- Physical Examination: Includes a digital rectal exam.
-
Screening Tests:
- Fecal Occult Blood Test (FOBT).
- Fecal Immunochemical Test (FIT).
-
Diagnostic Procedures:
- Colonoscopy: Gold standard for diagnosis.
- Flexible Sigmoidoscopy: If colonoscopy is not available.
- CT Colonography: Alternative if colonoscopy is not possible.
-
Imaging Studies:
- CT Scan: Abdomen and pelvis.
- MRI: For local spread, especially in rectal cancer.
-
Laboratory Tests:
- Complete Blood Count (CBC).
- Liver Function Tests.
- Carcinoembryonic Antigen (CEA).
-
Multidisciplinary Team Review:
- Refer for further management and treatment planning.
For more details, refer to the RACGP guidelines.
What is the initial step for high-risk patients in colon cancer screening?
Colonoscopy from the beginning
What is the recommended treatment sequence for colon cancer patients?
Chemotherapy and radiotherapy pre-operatively, followed by chemotherapy post-operatively
What is the follow-up protocol after surgery for colon cancer?
Colonoscopy every year and CEA (Carcinoembryonic Antigen)
Old age with prolonged constipation develops painless bleeding per rectum
Diverticulosis.
What is the most common site for diverticulosis?
Sigmoid colon
What is the main treatment approach for diverticulosis?
Increase fiber diet
Describe the presentation of a patient who develops fever and left lower quadrant pain. What is the likely diagnosis in this case?
Patient with diverticulosis presenting with fever and LLQ pain is likely diagnosed with acute diverticulitis.
What is the imaging modality of choice for investigating acute diverticulitis?
CT scan is the imaging modality of choice for acute diverticulitis.
What is the initial treatment approach for acute diverticulitis, focusing on intravenous fluids and antibiotics? What is the next step if perforation occurs?
Initial treatment for acute diverticulitis involves conservative management with IV fluids and antibiotics. Surgery is indicated in case of perforation.
Define the most common cause of painless rectal bleeding in the elderly population.
Diverticulosis is the most common cause of painless rectal bleeding in the elderly.
Describe the typical symptoms seen in a patient with chronic abdominal pain, distension, and alternating diarrhea and constipation.
Symptoms of IBS include chronic abdominal pain, distension, and alternating diarrhea and constipation.
What is the recommended drug for treating IBS?
The drug of choice for treating IBS is an SSRI.
What is the most common cause of bloody diarrhea?
Campylobacter is the most common cause of bloody diarrhea.
What is the second most common cause of bloody diarrhea?
Shigella is the second most common cause of bloody diarrhea.
How would you manage traveler’s diarrhea caused by E. coli?
Traveler’s diarrhea caused by E. coli is managed mainly with fluid replacement.
Describe the most common cause of diarrhea in pediatric patients.
The most common cause of diarrhea in pediatrics is viral infections.
What is the most common virus causing diarrhea in children?
Rotavirus is the most common virus causing diarrhea in kids.
What neurological condition can present with diarrhea followed by weakness and areflexia?
Guillain-Barré Syndrome (GBS) can present with diarrhea followed by weakness and areflexia.
What condition is characterized by diarrhea followed by renal impairment?
Hemolytic Uremic Syndrome (HUS) is characterized by diarrhea followed by renal impairment.
Describe the presentation of a patient with bloody diarrhea followed by right upper quadrant pain. What is the likely causative agent?
Bloody diarrhea followed by RUQ pain is suggestive of amebic infection.
What parasite is commonly associated with diarrhea after camping activities?
Giardia is commonly associated with diarrhea after camping.
Describe the typical presentation of chronic bloody diarrhea in a young male. What condition is often implicated in this scenario?
Chronic bloody diarrhea in a young male is often associated with Irritable Bowel Syndrome (IBS).
What is a common cause of diarrhea following prolonged antibiotic use?
Clostridium difficile infection is a common cause of diarrhea following prolonged antibiotic use.
How would you treat Clostridium difficile infection?
Clostridium difficile infection is treated with metronidazole or vancomycin.
What antibiotic is commonly associated with causing Clostridium difficile infection?
Clindamycin is commonly associated with causing Clostridium difficile infection.
Diarrhea after eggs or chicken
salmonella
Diarrhea just hours after meal…..
staph toxin
Diarrhea in bed ridden with constipation…
fecal impaction
Main ttt of diarrhea…..
fluid
Describe the treatment approach for Staphylococcal toxin-induced diarrhea.
Staphylococcal toxin-induced diarrhea is primarily managed with fluid replacement.
TTT of traveler diarrhea…..
fluid only
What is the treatment of choice for Shigella or Campylobacter infections?
Antibiotics are the treatment of choice for Shigella or Campylobacter infections. Ciproflaxin
How would you manage diarrhea caused by Entamoeba histolytica or Giardia lamblia?
Diarrhea caused by Entamoeba histolytica or Giardia lamblia is managed with metronidazole.
Describe the diagnosis of pseudomembranous colitis in a patient with severe watery diarrhea after prolonged antibiotic use. What is the causative organism?
Pseudomembranous colitis is diagnosed in a patient with severe watery diarrhea after prolonged antibiotic use, commonly caused by Clostridium difficile.
MC antibiotic causing pseudomembranous colitis :
clindamycin.
If mild diarrhea………..
Clostridium defficle
just fluid
What is the first-line medical treatment for pseudomembranous colitis?
Metronidazole is the first-line medical treatment for pseudomembranous colitis.
What is the next step if diarrhea persists after treatment with metronidazole for pseudomembranous colitis?
Oral vancomycin is the next step if diarrhea persists after treatment with metronidazole for pseudomembranous colitis.
