GI conditions Flashcards
1
Q
name 2 types of inflammatory bowel disease
A
crohn’s
ulcerative colitis
2
Q
what part of the GI tract is affected in crohn’s
A
the entire GI tract- esp terminal ileum
3
Q
describe the pathology of Crohn’s disease
A
NOD-2 mutations + environment bacteria=dysfunc. + unregulated immune mediated response
- causes tissue damage
4
Q
what time of inflammation occurs in crohn’s
A
transmural (all 4 layers)
5
Q
name 3 risk factors for crohn’s
A
ashkenazi jew
family history
smoking (doubles risk)
6
Q
presentation of crohn’s
A
pain in RLQ
malabsorption
skip lesions= give cobblestone appearance
bloody diarrhoea
granulomas
xtras=
oral ulcers
anorexia
perianal lesions
bowel obstruction
fatigue
fistulas
7
Q
what can malabsorption in crohn’s cause
A
b-12 deficit- causing gallstones + kidney stones + watery diarrhoea
8
Q
NESTS mnemonic for crohn’s
A
N- no mucus in stools
E- entire GI tract
S- skip lesions
T- transmural inflammation/ terminal ileum
S- smoking = rf
9
Q
what antibody test can be done for crohn’s
A
pANCA test - negative
10
Q
what would you find in a FBC and faecal calportectin test for crohn’s
A
FBC= increased- WWC, ESR, CRP, platelets- anaemia
increased faecal calprotectin
- both indicate inflammation
11
Q
what is the gold standard test for crohns and what would be seen
A
colonoscopy + biopsy:
-granulomatous transmural inflammation
-skip lesions giving cobblestone appearance
- strictures “string sign’
12
Q
what would you use to treat flares for crohn’s
A
oral corticosteroids eg prednisolone
13
Q
what would you use to treat severe crohn’s
A
Iv hyrdocortisone
- if steroids don’t work, add TNF inhibitor- infliximab
OR
immunosuppressants eg azathioprine, methotrexate
14
Q
what drugs would you use to maintain remission in crohns
A
immunosuppressant
-azathioprine
-mercaptopurine
15
Q
what would you do if crohns patient isn’t responding to treatment
A
surgery= not curative
temporary resection eg temporary ileostomy - allows affected areas to rest
16
Q
what gene are both crohns and ulcerative colitis associated with and what does it do
A
HLAB27
- causes T cells to destroy cells lining colon- leaving behind eroded areas called ulcers
17
Q
what are some risk factors for ulcerative colitis
A
jewish
family history
NSAIDs
chronic stress + depression
(smoking= protective factor)
18
Q
what part of the GI tract does ulcerative colitis occur in
A
colon only
starts @ rectum, sigmoid, proxy colon
19
Q
presentation of ulcerative colitis
A
inflammation = confined to mucosa
pain in LLQ
tenesmus
cont. + circumferential inflammation
blood + mucus in stools
tender + distended abdo
xtras=
arthritis
ulcers
oral ulcers
clubbing
anorexia
urgency
20
Q
mnemonic for ulcerative colitis
A
CLOSE UP
C- cont. inflammation
L- limited 2 colon + rectum
O- only superficial mucosa affected
S- smoking = protective
E- excrete blood + mucus
U- use amino salicylates
P- primary sclerosis cholangitis
21
Q
what would a pANCA test be for ulcerative colitis
A
positive pANCA test
22
Q
what would a FBC and faecal calprotecin test show for ulcerative colitis
A
FBC= increased WCC, ESR, CRP , platelets- anaemia
faecal calprotectin= increased
could also do LFT
23
Q
what is the gold standard test for ulcerative colitis and what would it show
A
colonoscopy with biopsy= cont. rectal + colon inflammation
24
Q
what would US/CT/MRI show for ulcerative colitis
A
(barium enema)- lead pipe sign
25
how would you treat flares for ulcerative colitis
prednisolone + sulfasalazine
26
how would you treat severe ulcerative colitis
1. IV hydrocortisone
2. IV ciclosporin
3. TNF a inhibitor- infliximab
27
what drugs would you use to maintain remission for ulcerative colitis
aminoacylate, azathioprine, mercaptopurine
if no response- surgery = total/partial colectomy= curative
comp= toxic megacolon
28
describe IBS
IBS= chronic bowel disorder characterised by recurrent bouts of abdominal pain + abnormal bowel motility
29
name 5 causes of IBS
psychological- stress + anxiety
eating disorders
poor diet
drugs
GI infections
30
what are the 3 kinds of IBS
IBS C= mostly constipation
IBS D= mostly diarrhoea
IBS M= mixture of c & d
31
name 3 symptoms of IBS
abdo pain- relieved by shitting
-worse after eating
altered stool form
altered stool frequency
32
what does an IBS diagnosis require
abdo pain + 2 of: pain relieved by shitting, altered stool form, altered stool frequency
33
how can IBS be diagnosed using a diagnosis of exclusion
FBC= norm , therefore no infection
neg faecal calprotectin, therefore not IBD
neg coeliac serology
-exclude cancer
34
conservative treatment for IBS
patient education:
diet mods
low FODMAP diet
increase fibre + fluids
small + reg meals
35
moderate treatment for IBS
IBS-C= laxatives eg Senna
IBS-D= antimotility drugs eg loperamide
more pain/bloating= antispasmodics- buscopan, mebeverine
36
treatment for severe IBS
tricyclic antidepressants- amitriptyline
-consider CBT
37
describe GORD
gastro-oesophageal reflux disease
=gastric reflux due to decreased pressure across lower oesophageal sphincter= inflammation of oseophagus
38
list 5 causes of GORD
hiatal hernia
smoking/alcohol
increased intra abdo. pressure eg preggo, obesity
scleroderma (LOS = scarred)
39
presentation of GORD
HEART BURN- retrosternal chest pain
acid regurgitation- WORSE LYING DOWN
chronic cough + nocturnal asthma
dysphagia
dyspepsia
decreased Hb, increased platelets
40
what are the red flag symptoms for GORD
dysphagia
low Hb
increased platelet count
weight loss
41
what would you give to someone with GORD with no red flag symptoms
PPI eg pantoprazole
42
investigations for GORD patients with red flag symptoms
endoscopy- oesophagitis/ barrett's oesophagus (metaplasia of stratified squamous epithelium to simple columnar epithelium)
oesophageal manometry- measure LOS pressure + monitor gastric acid pH
43
conservative treatment for GORD
lifestyle mods- no smoking/alcohol
no obesity
smaller meals + eat 3+ hrs b4 bed
44
medical treatment for GORD
PPI eg omeprazole, lansoprazole
H2 receptor antagonist (anti histamine that reduces stomach acid eg rantidine)
gaviscon for symptom relief
45
last resort treatment for GORD
surgical tightening of LOS- wrap fundus of stomach around LOS to narrow it
46
what type of hypersensitivity is coeliac disease
type 4 hypersensitivity reaction 2 gluten
47
what are 4 risk factors for coeliac disease
HLA-DQ2/DQ8 gene mutation
autoimmune conditions
IgA deficiency
family history
48
describe the pathology of coeliac disease
gluten breaks down into gliadin
gliadin triggers immune system 2 produce IgA autoantibodies: anti- tTG & anti-EMA
antibodies target epithelial cells of small bowel causing:
-villous atrophy
-crypt hyperplasia
-intraepithelial lymphocytes
49
presentation of coeliac disease
villious atrophy= malabsorption of Fe, B12, folate= ANAEMIA
steatorrhea- increased fat excretion in stools
diarrhoea
DERMITIS HERPETIFORMIS- red rash on elbows + knees + buttocks
weight loss
osteopenia - decreased calcium absorption
angular stomitis
50
what is the 1st thing you would do to diagnose coeliac disease
coeliac serology (screening)- for increased anti- tTG antibodies
then test for increased EMA
increased total IgA- may give false neg in IgA def patients
51
gold standard test for coeliac disease
duodenal biopsy- looking for
-villious atrophy
-crypt hyperplasia
-intraepithelial lymphocytes
other tests= FBC- decreased Hb, Fe,B12, folate
DEXA bone scan
genetic testing for HLADQ2/8
52
what is a Mallory Weiss tear
tear of oesophageal mucosal membrane due to sudden increased intra-abdo pressure
53
name 5 things that can cause a mallory-weiss tear
forceful vomiting
chronic coughing
weight lifting
retching
hiatal hernia
54
presentation of a mallory- Weiss tear
haematemesis after retching history
melaena (black, tarry poo)
hypovolemic shock
dysphagia
NO history of liver disease or portal hypertension
55
what are 2 things that can be used to diagnose a mallory- Weiss tear
endoscopy- 2 confirm tear
ROCKALL score- for severity of upper GI bleeds
56
how should you manage a mallory-weiss tear
most resolve spontaneously
can give antiemetic, PPI
57
name 2 kinds of Peptic ulcers
gastric
duodenal
58
where are gastric ulcers most commonly located
lesser curvature of stomach
59
where are duodenal ulcers commonly located
mostly @ D1/D2, 1st portion of duodenum
60
what are 3 causes of peptic ulcers
H.pylori
NSAIDs
Zollinger Ellison syndrome
61
presentation of a gastric ulcer
epigastric pain- WORSE WHEN EATING, better btwn eats + w, antiacids
weight loss
62
presentation of a duodenal ulcer
epigastric pain- WORSE BETWEEN MEALS, better with food
weight gain
63
what tests would you do for a patient with a peptide ulcer and no red flag symptoms
non-invasive tests
- c-urea breath test
-stool antigen test
64
what would you do for a patient with a peptic ulcer and red flag symptoms
urgent endoscopy + biopsy
- will see Brunner's gland hypertrophy = more mucus production
65
management of peptic ulcers
stop NSAIDs
if H. Pylori positive- triple therapy= CAP (clarythromycin + amoxicillin + PPI eg lanzoprazole)
66
what is gastritis
inflammation of the stomach mucosal lining
67
name 6 causes of gastritis
autoimmune (related 2 pernicious anaemia)
H.pylori
NSAIDs
mucosal ischaemia
alcohol
stress
68
list 5 presentations of gastritis
epigastric pain with diarrhoea
n + v
indigestion
anorexia
69
what would you use to test for gastritis if H. pylori is suspected
urea breath test
stool antigen test
70
gold standard investigation for gastritis + other investigations
endoscopy + biopsy- looking for gastric mucosal inflammation + atrophy
other= FBC- decreased Hb, B12 + parietal cell/intrinsic factor antibodies
71
management of gastritis
1st treat underlying cause (stop NSAIDS/alcohol)
h.pylori irradiation = triple therapy - CAP
if penicillin allergy (amoxicillin) swap for metronidazole
autoimmune= IM B12
72
causes/rfs for appendicitis
10-20 y/o
faecolith (hard/solidified shit)
lymphoid hyperplasia
intestinal worms
73
presentation of appendicitis (3 types of signs)
pain @ McBurney's point + rebound tenderness and abdo guarding
rosving's sign= palpation of LIF causes pain in RIF
Psok's sign= RIF on R hip extension
obturator sign= RIF pain on R hip flexion + internal rotation
fever, n + v,, anorexia
74
investigations for appendicitis
CT of abdo + pelvis
(preggo test to rule out ectopic pregnancy)
FBC= increased ESR, WCC, CRP
75
management of appendicitis
antibiotics then laparoscopic appendectomy
76
describe diverticular disease
outpouching of the colon wall- most frequently in the sigmoid colon, symptomatic
77
3 kinds of things in diverticular disease
diverticulosis- asymtpo outpouch
diverticulum= out pouch at perforating artery sites
diverticulitis- inflammation of diverticulum
78
pathology of diverticular disease
increased pressures in colon- causes outpouching (diverticula)
-most common @ sigmoid colon
if faecal matter + bacteria get into diverticula = inflammation + rupture of blood vessels = diverticulitis
79
name 4 risk factors for diverticular disease
connective tissue disorders (Ehler's dalos, Marfan's)
ageing
increased colon pressure
COPD + chronic cough
80
presentation of diverticular disease
triad=
LLQ
constipation
fresh rectal bleeding
others=
palpable LIF mass
bloating + flatulance
n + v
81
what would you expect to find in an abdo exam for someone with diverticular disease
tenderness + guarding= irritated peritoneum
distended abdo + gas
bowel sounds diminished
82
gold standard investigation for diverticular disease
abdo/pelvis CT w. contrast
83
management of diverticulosis, diverticular disease and diverticulitis
diverticulosis= watch + wait, lifestyle mods
diverticular disease= bulk-forming laxatives, high fibre diet + fluids, surgery if needed
diverticulitis= antibiotics (co-amoxiclav= amoxicillin/clavulanate) + paracetamol
analgesia
IV fluid + liquid food
84
pathology of a bowel obstruction
distention above blockage + build up of fluids- increased pressure pushes on bv in bowel wall
-bv become compressed + cannot supply blood= ischaemia + necrosis + perforation
85
causes of small bowel obstructions
mc. type
adhesions (after surgery) (mc)
crohn's
strangulating hernias
malignancy
86
causes of large bowel obstructions
25-40% of all cases
-malignancy (mc.)
-sigmoid volvulus (gives coffee bean appearance on x-ray)
-inturssuception (bowel folds in on itself)
87
presentation of small bowel obstructions
1ST VOMITING THEN CONSTIPATION
tinkling bowel sounds
colicky abdo pain + distension
88
presentation of large bowel obstructions
1ST CONSTIPATION THEN VOMITING
severe abdo distension + pain
hyperactive, then norm then ABSENT BOWEL SOUNDS
89
initial investigations for bowel obstructions
1st=
abdo exam = dull sounds before obstruction
abdo x-ray
-dilated large bowel >6cm
-dilated caecum >9cm
-dilated bowel loops + **transluminal fluid- gas shadows** (fluid + air accumulates in bowel)
**sigmoid volvulus (LB- coffee bean sign)
***
digital rectal exam= empty rectum, hard compacted stools, maybe blood
90
gold standard investigation for bowel obstructions
CT abdo + pelvis w. contrast
91
management of bowel obstructions
'drip + suck '- insert iV cannula - fluid
resuscitation
nil by mouth
NG tube 2 decompress stomach
catheter- monitor urine output
analgesia + antiemetics
antibiotics
last resort = surgery (laparotomy)
92
define diarrhoea and the number of days that determine each type (3 types)
diarrhoea= 3+ watery stools daily
acute= <14 days
subacute= 14-28 days
chronic= >28 days
93
list 4 non-infective causes of diarrhoea
IBD (crohn's, UC)
hyperparathyroidism
coeliac
inflammation or malignancy
94
name 2 viruses that cause diarrhoea and who do they affect
rotavirus- <3 y/o
norovirus- adult
95
list types of bacteria causing diarrhoea
clostridium difficile infection (antibiotics)
campylobacter jejuni + salmonella (undercooked chicken)
shigella (food)
E. coli + cholera (travellers diarrhoea)
96
list 3 type of parasites that cause diarrhoea
worms
giardiasis
amoeba
97
which infection do antibiotics increase the risk of (List some the antibiotics that cause this)
clostridium difficile infection
caused by=
co-amoxiclav
clindamycin
ciprofloxacin
cephalosporins
clarithromycin
98
what would bloody diarrhoea indicate
bacterial infection
99
what would watery diarrhoea indicate
viral or parasitic infection
100
what symptoms occur along with diarrhoea in a viral infection
fever
fatigue
headache
musc pain
101
traveller's diarrhoea symptoms
fever
n + v
tenesmus
bloody stools
-always ask if travelled abroad
102
what kind of diarrhoea occurs in cholera
rice water diarrhoea
103
what disease can campylobacter cause
Guillain barre
104
which 2 general investigations would you use for diarrhoea
stool sample- microscopy + blood culture + toxin detection
FBC= increased ESR + CRP
105
what investigations would you do for campylobacter jejuni
CCDA or PCR
106
what investigation would you use for shigella and salmonella and what would they show
XLD-
salmonella= pink w. black centre
shigella= pink
107
management of diarrhoea
treat underlying cause- viral = normally self limiting
fluid rehydration + electrolyte replacement
bacterial diarrhoea= metronidazole
meds 4 symptoms=
antiemetics- metoclopramide
antidiarrhoeals- loperamide
broad spectrum antibiotics- ciprofloxacin, ceftriaxone
108
name 2 types of oesophageal cancer
adenocarcinoma
squamous cell carcinoma
109
which part of the oesophagus do adenocarcinomas effect
lower 1/3 of oesophagus
110
which part of the oesophagus do squamous cell carcinomas effect
upper 2/3 of oesophagus
111
causes of Adenocarcinoma in the oesophagus
BARRETT'S OESOPHAGUS
GORD
obesity
hernias
old age
smoking
male + caucasian
112
causes of squamous cell carcinoma
SMOKING + ALCOHOL
older age
male + BAME
hot food + bevs
Plummer vinson syndrome
113
pathology of adenocarcinoma
GORD= acid- metaplasia from squamous 2 columnar
mutations in neoplastic cells can cause dysplasia in2 malignant tumour
114
pathology of squamous cell carcinoma
epithelial cells damaged from smoke + alcohol- cells divide 2 replace damaged ones-= division increases risk of mutation
115
which red flag symptoms does ALARMS stand for
Anaemia
Loss of weight
Anorexic
Recent + sudden onset of symptoms
Melaena/haematemesis
Swallowing difficulties
116
presentation of oesophageal cancers
Red flag symptoms= ALARMS
hoarse voice (recurrent laryngeal nerve)
odynophagia (painful swallowing)
cough
heart burn
117
what would you do with a patient presenting with red flag symptoms with suspected oesophageal cancer
urgent 2 week endoscopy referral
118
what kind of investigations would you do for oesophageal cancer
oesophagogastroduodenoscopy + biopsy (w. barium swallow)
CT/MRI of chest/abdo for metastases + staging
119
management of oesophageal cancer
surgical resection + radio/chem
palliative care
120
which type of bowel cancer is most common
colorectal (mostly in distal colon)
-small bowel= v. rare
121
which 2 inherited conditions increase the risk of polyps in bowel cancer
polyps + adenomas= precursors for bowel cancer
familial adenomatous polyposis (FAP)
Lynch syndrome/hereditory nonpolyposis colorectal cancer
122
describe FAP (familial adenomatous polyposis)
auto dom mutation in APC tumour suppressor gene= leads to high polyp formation
123
describe Lynch syndrome/ hereditary nonpolyposis rectal cancer
auto dom MSH-1 mutation= DNA mismach repair gene- rapidly increases the progression of adenomas to adenocarcinomas
124
list 5 causes of bowel cancer
family Hx
IBD
obesity
diabetes mellitus
smoking/alcohol
125
list 5 presentations of bowel cancer
LLQ pain
fresh bloody + mucous stool
tenesmus
abdo/rectal mass
change in bowel habit
126
red flag presentations for GI cancer
● Unexplained weight loss
● Anaemia
● Melaena (blood in faeces)
● Nocturnal symptoms - waking up at night with diarrhoea / pain
● Rectal or abdominal mass
● Family history of GI cancer
rectal bleeding
127
age and symptoms for referral for suspected GI cancer
>40 y/o w. abdo pain + unexplained weight loss
>50 y/o w. unexplained rectal bleeding
>60 y/o w. change in bowel habit + Fe deficient anaemia
128
what investigation would you do for someone who is over 60 w. a change in bowel habit and Fe deficient anaemia
FIT test (Fecal immunochemical test)
- done at home, screens 4 micro blood particles in poo
| red flags for bowel cancer
129
gold standard investigations for bowel cancer
| what is the tumour marker for bowel cancer
colonoscopy + biopsy
CEA (carcinoembryonic antigen) tumour marker 4 bowel cancer
FBC- anaemia
CT of chest/abdo/pelvis for 4 tumour staging
130
describe Duke's classification for colorectal cancer staging
Duke's classification:
A- confined 2 submucosa
B- through muscularis
C- regional lymph node involvement
D- distant lymph node involvement
131
describe TNM for bowel cancer staging
T=tumour
T1-confined 2 submucosa
T2-muscularis
T3- serosa
T4a- breach mucosa + spread 2 peritoneum
T4b- breach mucosa + entered nearby organs
N=node
N0= no lymph nodes containing cancer
N1=
a, cancer in 1 node
b, cancer in 2 or 3 nodes
c, cancer in tissue near tumour
N2=
a, cancer in 4-6 nodes
b, cancer in 7+ nodes
M=metastasis
M0= no metastases
M1=
a, spread to 1 distant site
b, spread to 2 distant sites
c, spread to distant sites + peritoneum
132
management of bowel cancer
surgical resection + chemo (fluorouracil)/radio
133
describe T1 gastric carcinomas
intestinal
well differentiated
good prognosis
134
describe T2 gastric carcinomas
diffuse
undifferentiated 'signet ring carcinomas'
worse prognosis
135
list 4 risk factors for gastric carcinomas
H.pylori
smoking
pernicious anaemia (caused by chronic gastritis)
CDH-1 mutation
136
specific risk factors for intestinal carcinomas
H.pylori
male + older age
chronic gastritis (end result of inflammatory process: chronic gastritis>atrophic gastritis>intestinal metaplasia + dysplasia)
137
where do intestinal carcinomas normally occur
lesser curvature of the antrum
138
specific risk factors for diffuse carcinomas
female + younger (under 50)
blood type A
CDH-1 mutation
H.pylori
139
where do diffuse gastric carcinomas usually affect
| what affect do they have on the stomach
anywhere in the stomach
-causes development of linitis plastica (leather bottle stomach- thickening + rigidity of stomach wall)
140
presentation of gastric carcinomas
severe epigastric pain
lymph node spread:
-Virchow's node @ L supraventricular
-Sister Mary Joseph node @ umbilical
metastatic signs:
jaundice- liver mets
Krukenberg tumour- ovaries
Red flag symptoms for GI cancer
141
what is the gold standard investigation for gastric carcinomas
upper gastrointestinal endoscopy- ulcer + mass + mucosal changes
CT/MRI for staging- use TNM (or Siewert's classification)
PET scan 2 identify mets
142
how would intestinal and diffuse gastric carcinomas look histologically
intestinal= well differentiated + glandular
diffuse= poorly differentiated + signet ring cells
143
management of gastric carcinomas
surgical resection> total/sub-total gastrectomy + adjuvant radio/chemo (fluorouracil/cisplatin)
-palliative care
144
how does H.pylori survive in the acidic conditions of the stomach
produces urease- urease hydrolyses urea to ammonia- elevates pH + neutralises gastric acid
H.pylori= gram neg bacteria
145
which 3 conditions can H.pylori cause
gastritis
peptic ulcers
gastric carcinomas
146
which investigations are used for H.pylori
c-urea breath test- swallow urea tablet w. carbon molecules, if any carbon found= urease enzyme present
stool antigen test
147
treatment of H.pylori infections
triple therapy x2 daily for 7 days
CAP= 500g clarithromycin + 1g amoxicillin + PPI
(if penicillin allergy, swap amoxicillin for metronidazole)
148
list the 4 types of antibiotics that can lead to c.difficile infections
Clindamycin.
Cephalosporins.
Penicillins (eg co-amoxiclav).
Fluoroquinolones.
149
how to antibiotics cause c.difficile
normal GI flora is killed by antibiotics- c.diff replaces norm GI flora in gut
150
presentation of c.difficile infections
dangerous + severe diarrhoea (v. watery + increased dehydration) + highly infectious
151
management of c.difficile infections
stop antibiotics
give vancomycin
152
what drug would you use to treat E.coli infections
amoxicillin
153
what is achalasia
lower smooth muscles of oesophagus fail to relax causing impaired peristalsis
154
presentation of achalasia
struggle 2 swallow anything
chesty + substernal pain
food regurgitation
aspiration pneumonia
155
investigations for achalasia
'bird beak' appearance on barium swallow
manometry- measure pressure across LOS
156
management of achalasia
only surgery= curative- Heller myotomy
non surg= balloon stenting
157
describe ischaemic colitis
ischaemia of colonic artery supply- colon becomes inflamed due 2 hypoperfusion
158
name 3 causes of ischaemic colitis affecting the IMA
thrombosis
emboli
decreased CO + arrhythmias
159
presentation of ishcaemic colitis
LLQ pain + bright red bloody stool
+/- signs of hypovolemic shock
160
investigations for ischaemic colitis
colonoscopy + biopsy
-rule out other causes eg stool sample 4 h.pylori)
161
management of ischaemic colitis
symptomatic= IV fluid + antibiotics (prophylactics)
gangrenous (infarcted colon)- surgery
162
what is mesenteric ischaemia
ischaemia of the small intestine
163
describe acute vs chronic mesenteric ischaemia
acute= blockage of mesenteric veins + arteries supplying small intestine
chronic= narrowing of GI blood vessels causing ishcaemia to the bowel
164
name 2 causes of mesenteric ischaemia affecting the SMA
thrombosis
emboli (due 2 AF)
165
presentation of mesenteric iscahaemia
triad=
central/RIF acute + severe abdo pain
no abdo signs on exam (tenderness, guarding)
rapid hypovolemic shock
also=
abdo bruit
malaena
n + v
weight loss
166
investigations for mesenteric ischaemia
CT angiogram
FBC + ABG= persistant metabollic acidosis
167
management of mesenteric ischaemia
IV fluids
antibiotics
IV heparin- 2 reduce clotting
infarcted bowel= surgery
168
what is Zenker's diverticulum
out pouching of pharynx causing food 2 become stuck
169
name 4 presentations of Zenker's diverticulum
smelly breath
regurgitation + aspiration of food
pseudo- choking
dysphagia
170
investigations and management of Zenker's diverticulum
oesophogram
barium swallpw
endoscopy
treat= surgery or change of diet
171
describe CMV (cytomegalovirus)
CMV= causes owl eye colitis (on histology) in immunosuppressed patient
-AIDS defining illness
172
describe haemorrhoids
swollen veins around anus disrupt anal cushions - parts of anal cushions prolapse thru. tight anal passage
173
list 4 causes of haemorrhoids
constipation + straining
coughing
heavy lifting
pregnancy
174
what are the 2 types of haemorrhoids and where do they originate
external- originate below denate line (painful 2 sit)
internal- originate above denate line (less painful)
175
grading of internal haemorrhoids 1-4
1. bleeding- no prolapse
2. prolapse when straining- reduces when relaxing
3. prolapse on straining- require manual pushback
4. permanently prolapsed
176
presentation of haemorrhoids
bright red bleeding on wiping- not in stool
pruritus ani- itchy bum
constipation + straining
lumps in + around anus
177
investigations for haemorrhoids
external examination (4 external)
DRE
proctoscopy (2 see internal haemorrhoids)
178
management of haemorrhoids
conservative= topical treatment + stool softener
1st + 2nd grade= rubber band ligation
3rd + 4th grade= haemorrhoidectomy
179
describe a perianal abscess
infection in anorectal tissue
-forms walled off collections of stool/bacteria abscess near anus
180
list 3 causes of a perianal abscess
trauma eg anal sex (mc.)
anal fistula
crohn's
181
presentation of a perianal abscess
puss in stool
constant perianal pain
perianal swelling
182
investigations and management of a perianal abscess
DRE
treat= surgical drainage + removal
183
what is an anal fistula
abnormal open connection between anal canal + skin of buttocks
typically forms from perianal abscesses
184
presentation of an anal fistula
bloody/mucous discharge
throbbing pain- worse when sitting
pruritis ani
185
investigations and management of an anal fistula
DRE
stool softening + increased fibre & fluids + topical creams eg lidocaine ointment
surgical removal + drainage
186
describe a pilonidial sinus
hair follicles get stuck in natal cleft (bumcrack)
forms tracts= sinsuses
get infected= abscesses
affects v hairy people, males, hirstuism
187
presentation of a pilonidial sinus
swollen + pus filled smelly abscess on bum crack
sacrococcygeal discharge
pain + swelling
188
investigations + management of a pilonidial sinus
clinical examination
treat= surgery + hygiene advice + abxs
