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Phase 2a > GI conditions > Flashcards

GI conditions Flashcards

1
Q

name 2 types of inflammatory bowel disease

A

crohn’s
ulcerative colitis

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2
Q

what part of the GI tract is affected in crohn’s

A

the entire GI tract- esp terminal ileum

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3
Q

describe the pathology of Crohn’s disease

A

NOD-2 mutations + environment bacteria=dysfunc. + unregulated immune mediated response
- causes tissue damage

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4
Q

what time of inflammation occurs in crohn’s

A

transmural (all 4 layers)

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5
Q

name 3 risk factors for crohn’s

A

ashkenazi jew
family history
smoking (doubles risk)

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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

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7
Q

what can malabsorption in crohn’s cause

A

b-12 deficit- causing gallstones + kidney stones + watery diarrhoea

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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

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9
Q

what antibody test can be done for crohn’s

A

pANCA test - negative

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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

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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’

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12
Q

what would you use to treat flares for crohn’s

A

oral corticosteroids eg prednisolone

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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

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14
Q

what drugs would you use to maintain remission in crohns

A

immunosuppressant
-azathioprine
-mercaptopurine

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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

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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

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17
Q

what are some risk factors for ulcerative colitis

A

jewish
family history
NSAIDs
chronic stress + depression

(smoking= protective factor)

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18
Q

what part of the GI tract does ulcerative colitis occur in

A

colon only
starts @ rectum, sigmoid, proxy colon

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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

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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

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21
Q

what would a pANCA test be for ulcerative colitis

A

positive pANCA test

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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

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23
Q

what is the gold standard test for ulcerative colitis and what would it show

A

colonoscopy with biopsy= cont. rectal + colon inflammation

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24
Q

what would US/CT/MRI show for ulcerative colitis

A

(barium enema)- lead pipe sign

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25
Q

how would you treat flares for ulcerative colitis

A

prednisolone + sulfasalazine

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26
Q

how would you treat severe ulcerative colitis

A
  1. IV hydrocortisone
  2. IV ciclosporin
  3. TNF a inhibitor- infliximab
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27
Q

what drugs would you use to maintain remission for ulcerative colitis

A

aminoacylate, azathioprine, mercaptopurine

if no response- surgery = total/partial colectomy= curative

comp= toxic megacolon

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28
Q

describe IBS

A

IBS= chronic bowel disorder characterised by recurrent bouts of abdominal pain + abnormal bowel motility

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29
Q

name 5 causes of IBS

A

psychological- stress + anxiety
eating disorders
poor diet
drugs
GI infections

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30
Q

what are the 3 kinds of IBS

A

IBS C= mostly constipation
IBS D= mostly diarrhoea
IBS M= mixture of c & d

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31
Q

name 3 symptoms of IBS

A

abdo pain- relieved by shitting
-worse after eating
altered stool form
altered stool frequency

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32
Q

what does an IBS diagnosis require

A

abdo pain + 2 of: pain relieved by shitting, altered stool form, altered stool frequency

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33
Q

how can IBS be diagnosed using a diagnosis of exclusion

A

FBC= norm , therefore no infection
neg faecal calprotectin, therefore not IBD
neg coeliac serology
-exclude cancer

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34
Q

conservative treatment for IBS

A

patient education:
diet mods
low FODMAP diet
increase fibre + fluids
small + reg meals

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35
Q

moderate treatment for IBS

A

IBS-C= laxatives eg Senna
IBS-D= antimotility drugs eg loperamide

more pain/bloating= antispasmodics- buscopan, mebeverine

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36
Q

treatment for severe IBS

A

tricyclic antidepressants- amitriptyline
-consider CBT

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37
Q

describe GORD

A

gastro-oesophageal reflux disease

=gastric reflux due to decreased pressure across lower oesophageal sphincter= inflammation of oseophagus

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38
Q

list 5 causes of GORD

A

hiatal hernia
smoking/alcohol
increased intra abdo. pressure eg preggo, obesity
scleroderma (LOS = scarred)

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39
Q

presentation of GORD

A

HEART BURN- retrosternal chest pain
acid regurgitation- WORSE LYING DOWN
chronic cough + nocturnal asthma
dysphagia
dyspepsia
decreased Hb, increased platelets

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40
Q

what are the red flag symptoms for GORD

A

dysphagia
low Hb
increased platelet count
weight loss

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41
Q

what would you give to someone with GORD with no red flag symptoms

A

PPI eg pantoprazole

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42
Q

investigations for GORD patients with red flag symptoms

A

endoscopy- oesophagitis/ barrett’s oesophagus (metaplasia of stratified squamous epithelium to simple columnar epithelium)

oesophageal manometry- measure LOS pressure + monitor gastric acid pH

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43
Q

conservative treatment for GORD

A

lifestyle mods- no smoking/alcohol
no obesity
smaller meals + eat 3+ hrs b4 bed

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44
Q

medical treatment for GORD

A

PPI eg omeprazole, lansoprazole

H2 receptor antagonist (anti histamine that reduces stomach acid eg rantidine)

gaviscon for symptom relief

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45
Q

last resort treatment for GORD

A

surgical tightening of LOS- wrap fundus of stomach around LOS to narrow it

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46
Q

what type of hypersensitivity is coeliac disease

A

type 4 hypersensitivity reaction 2 gluten

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47
Q

what are 4 risk factors for coeliac disease

A

HLA-DQ2/DQ8 gene mutation
autoimmune conditions
IgA deficiency
family history

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48
Q

describe the pathology of coeliac disease

A

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

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49
Q

presentation of coeliac disease

A

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

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50
Q

what is the 1st thing you would do to diagnose coeliac disease

A

coeliac serology (screening)- for increased anti- tTG antibodies
then test for increased EMA
increased total IgA- may give false neg in IgA def patients

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51
Q

gold standard test for coeliac disease

A

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

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52
Q

what is a Mallory Weiss tear

A

tear of oesophageal mucosal membrane due to sudden increased intra-abdo pressure

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53
Q

name 5 things that can cause a mallory-weiss tear

A

forceful vomiting
chronic coughing
weight lifting
retching
hiatal hernia

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54
Q

presentation of a mallory- Weiss tear

A

haematemesis after retching history
melaena (black, tarry poo)
hypovolemic shock
dysphagia
NO history of liver disease or portal hypertension

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55
Q

what are 2 things that can be used to diagnose a mallory- Weiss tear

A

endoscopy- 2 confirm tear
ROCKALL score- for severity of upper GI bleeds

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56
Q

how should you manage a mallory-weiss tear

A

most resolve spontaneously

can give antiemetic, PPI

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57
Q

name 2 kinds of Peptic ulcers

A

gastric
duodenal

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58
Q

where are gastric ulcers most commonly located

A

lesser curvature of stomach

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59
Q

where are duodenal ulcers commonly located

A

mostly @ D1/D2, 1st portion of duodenum

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60
Q

what are 3 causes of peptic ulcers

A

H.pylori
NSAIDs
Zollinger Ellison syndrome

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61
Q

presentation of a gastric ulcer

A

epigastric pain- WORSE WHEN EATING, better btwn eats + w, antiacids

weight loss

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62
Q

presentation of a duodenal ulcer

A

epigastric pain- WORSE BETWEEN MEALS, better with food

weight gain

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63
Q

what tests would you do for a patient with a peptide ulcer and no red flag symptoms

A

non-invasive tests
- c-urea breath test
-stool antigen test

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64
Q

what would you do for a patient with a peptic ulcer and red flag symptoms

A

urgent endoscopy + biopsy
- will see Brunner’s gland hypertrophy = more mucus production

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65
Q

management of peptic ulcers

A

stop NSAIDs
if H. Pylori positive- triple therapy= CAP (clarythromycin + amoxicillin + PPI eg lanzoprazole)

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66
Q

what is gastritis

A

inflammation of the stomach mucosal lining

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67
Q

name 6 causes of gastritis

A

autoimmune (related 2 pernicious anaemia)
H.pylori
NSAIDs
mucosal ischaemia
alcohol
stress

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68
Q

list 5 presentations of gastritis

A

epigastric pain with diarrhoea
n + v
indigestion
anorexia

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69
Q

what would you use to test for gastritis if H. pylori is suspected

A

urea breath test
stool antigen test

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70
Q

gold standard investigation for gastritis + other investigations

A

endoscopy + biopsy- looking for gastric mucosal inflammation + atrophy

other= FBC- decreased Hb, B12 + parietal cell/intrinsic factor antibodies

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71
Q

management of gastritis

A

1st treat underlying cause (stop NSAIDS/alcohol)

h.pylori irradiation = triple therapy - CAP
if penicillin allergy (amoxicillin) swap for metronidazole

autoimmune= IM B12

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72
Q

causes/rfs for appendicitis

A

10-20 y/o
faecolith (hard/solidified shit)
lymphoid hyperplasia
intestinal worms

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73
Q

presentation of appendicitis (3 types of signs)

A

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

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74
Q

investigations for appendicitis

A

CT of abdo + pelvis
(preggo test to rule out ectopic pregnancy)
FBC= increased ESR, WCC, CRP

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75
Q

management of appendicitis

A

antibiotics then laparoscopic appendectomy

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76
Q

describe diverticular disease

A

outpouching of the colon wall- most frequently in the sigmoid colon, symptomatic

77
Q

3 kinds of things in diverticular disease

A

diverticulosis- asymtpo outpouch
diverticulum= out pouch at perforating artery sites
diverticulitis- inflammation of diverticulum

78
Q

pathology of diverticular disease

A

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
Q

name 4 risk factors for diverticular disease

A

connective tissue disorders (Ehler’s dalos, Marfan’s)
ageing
increased colon pressure
COPD + chronic cough

80
Q

presentation of diverticular disease

A

triad=
LLQ
constipation
fresh rectal bleeding

others=
palpable LIF mass
bloating + flatulance
n + v

81
Q

what would you expect to find in an abdo exam for someone with diverticular disease

A

tenderness + guarding= irritated peritoneum
distended abdo + gas
bowel sounds diminished

82
Q

gold standard investigation for diverticular disease

A

abdo/pelvis CT w. contrast

83
Q

management of diverticulosis, diverticular disease and diverticulitis

A

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
Q

pathology of a bowel obstruction

A

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
Q

causes of small bowel obstructions

A

mc. type
adhesions (after surgery) (mc)
crohn’s
strangulating hernias
malignancy

86
Q

causes of large bowel obstructions

A

25-40% of all cases
-malignancy (mc.)
-sigmoid volvulus (gives coffee bean appearance on x-ray)
-inturssuception (bowel folds in on itself)

87
Q

presentation of small bowel obstructions

A

1ST VOMITING THEN CONSTIPATION
tinkling bowel sounds
colicky abdo pain + distension

88
Q

presentation of large bowel obstructions

A

1ST CONSTIPATION THEN VOMITING
severe abdo distension + pain
hyperactive, then norm then ABSENT BOWEL SOUNDS

89
Q

initial investigations for bowel obstructions

A

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
Q

gold standard investigation for bowel obstructions

A

CT abdo + pelvis w. contrast

91
Q

management of bowel obstructions

A

‘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
Q

define diarrhoea and the number of days that determine each type (3 types)

A

diarrhoea= 3+ watery stools daily

acute= <14 days
subacute= 14-28 days
chronic= >28 days

93
Q

list 4 non-infective causes of diarrhoea

A

IBD (crohn’s, UC)
hyperparathyroidism
coeliac
inflammation or malignancy

94
Q

name 2 viruses that cause diarrhoea and who do they affect

A

rotavirus- <3 y/o
norovirus- adult

95
Q

list types of bacteria causing diarrhoea

A

clostridium difficile infection (antibiotics)
campylobacter jejuni + salmonella (undercooked chicken)
shigella (food)
E. coli + cholera (travellers diarrhoea)

96
Q

list 3 type of parasites that cause diarrhoea

A

worms
giardiasis
amoeba

97
Q

which infection do antibiotics increase the risk of (List some the antibiotics that cause this)

A

clostridium difficile infection

caused by=
co-amoxiclav
clindamycin
ciprofloxacin
cephalosporins
clarithromycin

98
Q

what would bloody diarrhoea indicate

A

bacterial infection

99
Q

what would watery diarrhoea indicate

A

viral or parasitic infection

100
Q

what symptoms occur along with diarrhoea in a viral infection

A

fever
fatigue
headache
musc pain

101
Q

traveller’s diarrhoea symptoms

A

fever
n + v
tenesmus
bloody stools

-always ask if travelled abroad

102
Q

what kind of diarrhoea occurs in cholera

A

rice water diarrhoea

103
Q

what disease can campylobacter cause

A

Guillain barre

104
Q

which 2 general investigations would you use for diarrhoea

A

stool sample- microscopy + blood culture + toxin detection
FBC= increased ESR + CRP

105
Q

what investigations would you do for campylobacter jejuni

A

CCDA or PCR

106
Q

what investigation would you use for shigella and salmonella and what would they show

A

XLD-
salmonella= pink w. black centre
shigella= pink

107
Q

management of diarrhoea

A

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
Q

name 2 types of oesophageal cancer

A

adenocarcinoma
squamous cell carcinoma

109
Q

which part of the oesophagus do adenocarcinomas effect

A

lower 1/3 of oesophagus

110
Q

which part of the oesophagus do squamous cell carcinomas effect

A

upper 2/3 of oesophagus

111
Q

causes of Adenocarcinoma in the oesophagus

A

BARRETT’S OESOPHAGUS
GORD
obesity
hernias
old age
smoking
male + caucasian

112
Q

causes of squamous cell carcinoma

A

SMOKING + ALCOHOL
older age
male + BAME
hot food + bevs
Plummer vinson syndrome

113
Q

pathology of adenocarcinoma

A

GORD= acid- metaplasia from squamous 2 columnar
mutations in neoplastic cells can cause dysplasia in2 malignant tumour

114
Q

pathology of squamous cell carcinoma

A

epithelial cells damaged from smoke + alcohol- cells divide 2 replace damaged ones-= division increases risk of mutation

115
Q

which red flag symptoms does ALARMS stand for

A

Anaemia
Loss of weight
Anorexic
Recent + sudden onset of symptoms
Melaena/haematemesis
Swallowing difficulties

116
Q

presentation of oesophageal cancers

A

Red flag symptoms= ALARMS

hoarse voice (recurrent laryngeal nerve)
odynophagia (painful swallowing)
cough
heart burn

117
Q

what would you do with a patient presenting with red flag symptoms with suspected oesophageal cancer

A

urgent 2 week endoscopy referral

118
Q

what kind of investigations would you do for oesophageal cancer

A

oesophagogastroduodenoscopy + biopsy (w. barium swallow)
CT/MRI of chest/abdo for metastases + staging

119
Q

management of oesophageal cancer

A

surgical resection + radio/chem
palliative care

120
Q

which type of bowel cancer is most common

A

colorectal (mostly in distal colon)
-small bowel= v. rare

121
Q

which 2 inherited conditions increase the risk of polyps in bowel cancer

A

polyps + adenomas= precursors for bowel cancer

familial adenomatous polyposis (FAP)

Lynch syndrome/hereditory nonpolyposis colorectal cancer

122
Q

describe FAP (familial adenomatous polyposis)

A

auto dom mutation in APC tumour suppressor gene= leads to high polyp formation

123
Q

describe Lynch syndrome/ hereditary nonpolyposis rectal cancer

A

auto dom MSH-1 mutation= DNA mismach repair gene- rapidly increases the progression of adenomas to adenocarcinomas

124
Q

list 5 causes of bowel cancer

A

family Hx
IBD
obesity
diabetes mellitus
smoking/alcohol

125
Q

list 5 presentations of bowel cancer

A

LLQ pain
fresh bloody + mucous stool
tenesmus
abdo/rectal mass
change in bowel habit

126
Q

red flag presentations for GI cancer

A

● 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
Q

age and symptoms for referral for suspected GI cancer

A

> 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
Q

what investigation would you do for someone who is over 60 w. a change in bowel habit and Fe deficient anaemia

A

FIT test (Fecal immunochemical test)
- done at home, screens 4 micro blood particles in poo

red flags for bowel cancer

129
Q

gold standard investigations for bowel cancer

what is the tumour marker for bowel cancer

A

colonoscopy + biopsy

CEA (carcinoembryonic antigen) tumour marker 4 bowel cancer
FBC- anaemia

CT of chest/abdo/pelvis for 4 tumour staging

130
Q

describe Duke’s classification for colorectal cancer staging

A

Duke’s classification:
A- confined 2 submucosa
B- through muscularis
C- regional lymph node involvement
D- distant lymph node involvement

131
Q

describe TNM for bowel cancer staging

A

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
Q

management of bowel cancer

A

surgical resection + chemo (fluorouracil)/radio

133
Q

describe T1 gastric carcinomas

A

intestinal
well differentiated
good prognosis

134
Q

describe T2 gastric carcinomas

A

diffuse
undifferentiated ‘signet ring carcinomas’
worse prognosis

135
Q

list 4 risk factors for gastric carcinomas

A

H.pylori
smoking
pernicious anaemia (caused by chronic gastritis)
CDH-1 mutation

136
Q

specific risk factors for intestinal carcinomas

A

H.pylori
male + older age
chronic gastritis (end result of inflammatory process: chronic gastritis>atrophic gastritis>intestinal metaplasia + dysplasia)

137
Q

where do intestinal carcinomas normally occur

A

lesser curvature of the antrum

138
Q

specific risk factors for diffuse carcinomas

A

female + younger (under 50)
blood type A
CDH-1 mutation
H.pylori

139
Q

where do diffuse gastric carcinomas usually affect

what affect do they have on the stomach

A

anywhere in the stomach
-causes development of linitis plastica (leather bottle stomach- thickening + rigidity of stomach wall)

140
Q

presentation of gastric carcinomas

A

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
Q

what is the gold standard investigation for gastric carcinomas

A

upper gastrointestinal endoscopy- ulcer + mass + mucosal changes

CT/MRI for staging- use TNM (or Siewert’s classification)

PET scan 2 identify mets

142
Q

how would intestinal and diffuse gastric carcinomas look histologically

A

intestinal= well differentiated + glandular
diffuse= poorly differentiated + signet ring cells

143
Q

management of gastric carcinomas

A

surgical resection> total/sub-total gastrectomy + adjuvant radio/chemo (fluorouracil/cisplatin)
-palliative care

144
Q

how does H.pylori survive in the acidic conditions of the stomach

A

produces urease- urease hydrolyses urea to ammonia- elevates pH + neutralises gastric acid

H.pylori= gram neg bacteria

145
Q

which 3 conditions can H.pylori cause

A

gastritis
peptic ulcers
gastric carcinomas

146
Q

which investigations are used for H.pylori

A

c-urea breath test- swallow urea tablet w. carbon molecules, if any carbon found= urease enzyme present

stool antigen test

147
Q

treatment of H.pylori infections

A

triple therapy x2 daily for 7 days
CAP= 500g clarithromycin + 1g amoxicillin + PPI

(if penicillin allergy, swap amoxicillin for metronidazole)

148
Q

list the 4 types of antibiotics that can lead to c.difficile infections

A

Clindamycin.
Cephalosporins.
Penicillins (eg co-amoxiclav).
Fluoroquinolones.

149
Q

how to antibiotics cause c.difficile

A

normal GI flora is killed by antibiotics- c.diff replaces norm GI flora in gut

150
Q

presentation of c.difficile infections

A

dangerous + severe diarrhoea (v. watery + increased dehydration) + highly infectious

151
Q

management of c.difficile infections

A

stop antibiotics
give vancomycin

152
Q

what drug would you use to treat E.coli infections

A

amoxicillin

153
Q

what is achalasia

A

lower smooth muscles of oesophagus fail to relax causing impaired peristalsis

154
Q

presentation of achalasia

A

struggle 2 swallow anything
chesty + substernal pain
food regurgitation
aspiration pneumonia

155
Q

investigations for achalasia

A

‘bird beak’ appearance on barium swallow
manometry- measure pressure across LOS

156
Q

management of achalasia

A

only surgery= curative- Heller myotomy
non surg= balloon stenting

157
Q

describe ischaemic colitis

A

ischaemia of colonic artery supply- colon becomes inflamed due 2 hypoperfusion

158
Q

name 3 causes of ischaemic colitis affecting the IMA

A

thrombosis
emboli
decreased CO + arrhythmias

159
Q

presentation of ishcaemic colitis

A

LLQ pain + bright red bloody stool
+/- signs of hypovolemic shock

160
Q

investigations for ischaemic colitis

A

colonoscopy + biopsy
-rule out other causes eg stool sample 4 h.pylori)

161
Q

management of ischaemic colitis

A

symptomatic= IV fluid + antibiotics (prophylactics)
gangrenous (infarcted colon)- surgery

162
Q

what is mesenteric ischaemia

A

ischaemia of the small intestine

163
Q

describe acute vs chronic mesenteric ischaemia

A

acute= blockage of mesenteric veins + arteries supplying small intestine
chronic= narrowing of GI blood vessels causing ishcaemia to the bowel

164
Q

name 2 causes of mesenteric ischaemia affecting the SMA

A

thrombosis
emboli (due 2 AF)

165
Q

presentation of mesenteric iscahaemia

A

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
Q

investigations for mesenteric ischaemia

A

CT angiogram
FBC + ABG= persistant metabollic acidosis

167
Q

management of mesenteric ischaemia

A

IV fluids
antibiotics
IV heparin- 2 reduce clotting
infarcted bowel= surgery

168
Q

what is Zenker’s diverticulum

A

out pouching of pharynx causing food 2 become stuck

169
Q

name 4 presentations of Zenker’s diverticulum

A

smelly breath
regurgitation + aspiration of food
pseudo- choking
dysphagia

170
Q

investigations and management of Zenker’s diverticulum

A

oesophogram
barium swallpw
endoscopy

treat= surgery or change of diet

171
Q

describe CMV (cytomegalovirus)

A

CMV= causes owl eye colitis (on histology) in immunosuppressed patient
-AIDS defining illness

172
Q

describe haemorrhoids

A

swollen veins around anus disrupt anal cushions - parts of anal cushions prolapse thru. tight anal passage

173
Q

list 4 causes of haemorrhoids

A

constipation + straining
coughing
heavy lifting
pregnancy

174
Q

what are the 2 types of haemorrhoids and where do they originate

A

external- originate below denate line (painful 2 sit)
internal- originate above denate line (less painful)

175
Q

grading of internal haemorrhoids 1-4

A
  1. bleeding- no prolapse
  2. prolapse when straining- reduces when relaxing
  3. prolapse on straining- require manual pushback
  4. permanently prolapsed
176
Q

presentation of haemorrhoids

A

bright red bleeding on wiping- not in stool
pruritus ani- itchy bum
constipation + straining
lumps in + around anus

177
Q

investigations for haemorrhoids

A

external examination (4 external)
DRE
proctoscopy (2 see internal haemorrhoids)

178
Q

management of haemorrhoids

A

conservative= topical treatment + stool softener

1st + 2nd grade= rubber band ligation
3rd + 4th grade= haemorrhoidectomy

179
Q

describe a perianal abscess

A

infection in anorectal tissue
-forms walled off collections of stool/bacteria abscess near anus

180
Q

list 3 causes of a perianal abscess

A

trauma eg anal sex (mc.)
anal fistula
crohn’s

181
Q

presentation of a perianal abscess

A

puss in stool
constant perianal pain
perianal swelling

182
Q

investigations and management of a perianal abscess

A

DRE

treat= surgical drainage + removal

183
Q

what is an anal fistula

A

abnormal open connection between anal canal + skin of buttocks

typically forms from perianal abscesses

184
Q

presentation of an anal fistula

A

bloody/mucous discharge
throbbing pain- worse when sitting
pruritis ani

185
Q

investigations and management of an anal fistula

A

DRE

stool softening + increased fibre & fluids + topical creams eg lidocaine ointment
surgical removal + drainage

186
Q

describe a pilonidial sinus

A

hair follicles get stuck in natal cleft (bumcrack)
forms tracts= sinsuses
get infected= abscesses

affects v hairy people, males, hirstuism

187
Q

presentation of a pilonidial sinus

A

swollen + pus filled smelly abscess on bum crack
sacrococcygeal discharge
pain + swelling

188
Q

investigations + management of a pilonidial sinus

A

clinical examination

treat= surgery + hygiene advice + abxs

Phase 2a (12 decks)

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