GI Conditions Flashcards
Hepatitis/cirrhosis (Viral,autoimmune, alcoholic, drug induced)
Ix: LFT (albumin reduced and clotting (PT) increased - raised ALP but normal ALT/AST with jaundice suggests obstructive picture, all raised suggests hepatic picture), FBC (increased MCV, raised WCC, CRP/ESR), U+E (Hepatorenalsyndrome), viral serology (hep b +c), autoantibodies/immunoglobulins for AI, ETOH/drug screen
Imaging: Liver USS/CXR/AXR/CT abdo shows hepatomegaly + formation of scar tissue (ELF/fibroscan), endoscopy for varices/portal HTN, ascitic tap if ascites, liver biopsy to confirm diagnoses
Mx: depends on the cause + symptoms: supportive/antivirals for viral infection, high dose steroids for AI, alcohol detox + nutritional support, chlordiazepoxide/lactulose, NAC. Diuretics for ascites, liver transplant if Acute damage due to viral/AI/drug induced cause
PBC/PSC
Ix: LFT (raised ALP), FBC, U+E, autoantibodies (AMA, ANA for PBC, p-ANCA, ANA for PSC), Also consider UC ix for PSC
Imaging for PSC: MRCP (diagnostic)
Mx: ursodeoxycholic acid, colestyramine for PBC/PSC, ERCP (diagnostic/treatment for PSC)
Hepatocellular/cholangio carcinoma/Pancreatic cancer
HCC main RF is cirrhosis, PSC RF for cholangiocarcinoma
Ix: AFP for HCC, Ca19-9 for cholangiocarcinoma (and also pancreatic cancer)
Mx: kinase inhibitors for HCC not chemo/radio, surgery for pancreatic cancer - pancreatectomy, whipple procedure for head of pancreas tumour
Bowel carcinoma -
Ix: FBC, U+E, LFT, Stool culture (FIT), tumour markers (CEA),
Imaging: Abdo USS, colonoscopy + biopsy, CT staging
Mx: surgical resection (see below), chemo/radiotherapy,
IBD
Ix: FBC, U+E, LFT, CRP/ESR, faecal calprotectin
Imaging: OGD + biopsy
Mx:induce remission with steroids (e.g. oral pred, Iv hydrocort), maintain with azathioprine, mercaptopurine, methotrexate, infliximab. For UC: induce remission with aminosalicylate e.g. mesalazine rectal/oral before steroids, also used to maintain remission (+ azathioprine, mercaptopurine) Surgery: in crohn’s resection possible if only distal ileum affected, UC only affects colon and rectum so panproctocolectomy will remove disease with ileostomy/j pouch
Coeliac
Ix: Routine Ix + anti TTG and anti EMA autoantibodies whilst looking at total IgA levels,
Imaging: endoscopy/biopsy shows villous atrophy + crypt hyperplasia
Mx:gluten free/Low fodmap diet
GORD
Ix: FBC, U+E, LFT,
Mx: conservative - reduce coffee, ETOH, smaller meals, avoid eating before bed
medical - OTC antacids, PPIs, surgery - lap fundoplication to narrow LOS
H.pylori/PUD (ABCDE if bleeding)
Ix: stool antigen test, endoscopy (CLO/rapid urease test),
Mx: triple therapy (PPI + 2 Abx - amox, clarithro 7 days), urea breath test (after treatment)
HH/Wilsons
Ix: HH: ferritin, transferrin imaging: liver biopsy with pearls stain, ?CT abdo/Mri, Wilsons: reduced serum ceruloplasmin, 24h copper assay, liver biopsy
Mx: HH: venesection, Wilsons: copper chelation with penicillamine
Acute abdomen: appendicitis, pancreatitis, SBP, acute cholecystitis, ascending cholangitis, AAA, bowel obstruction (adhesions, hernias, tumor, volvulus, diverticular disease)
Ix: FBC (anaemia-bleeding, raised WCC infection/inflammation, CRP/ESR), U+E (renal function), LFT (ALP for cholestatic picture), amylase + calcium (acute pancreatitis), serum hCG/pregnancy test, blood cultures, lactate, G+S (if they need surgical Mx), ABG(metabolic acidosis/alkaloosis - ischaemia, vomiting. diarhhoea), FIT to look for bowel cancer,
Imaging: AXR (distended loops of bowel for obstruction, coffee bean sign -volvulus), CXR (air under diaphragm) , Abdo USS, CT, colonoscopy/sigmoidoscopy/CT staging (bowel cancer), MRCP/ERCP
Mx: acute abdomen - A to E approach + iv fluids, iv Abx, NBM, NG tube, G+S/crossmatch (prepare for surgery) Appendicitis - lap appendicectomy, bowel obstruction - laprotomy: adhesionlysis, tension free repair with mesh for hernias with incarceration/obstruction/strangulation), resection/hemicolectomy for bowel ca, hartmann’s for volvulus), revascularisation for mesenteric ischaemia, cholecystectomy - complicated gallstones/cholecystitis, ERCP (ascending colangitis), may need to replace pancreatic enzymes in pancreatitis
