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The Alimentary Canal > GI Conditions and Treatments > Flashcards

GI Conditions and Treatments Flashcards

1
Q

What is diffuse oesophageal spasm?

A

Hypermotility disorder
Cause is unknown
Severe chest pain with dysphagia

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2
Q

What is the treatment for diffuse oesophageal spasm?

A

Smooth muscle relaxants - nitrates and Ca channel antagonists

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3
Q

What is achalasia?

A

Hypomotility disorder - functional loss of myenteric plexus
Progressive dysphagia , weight loss, regurgitation and can get chest infections

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4
Q

What is the treatment for achalasia?

A

Nitrates and CCB
Botulinum toxin and pneumonic balloon dilation
Surgery - myotomy

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5
Q

What is gastro-oesophageal disease (GORD)?

A

Acid and bile exposure to lower oesophagus - causes inflammation
Heartburn, cough and water brash

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6
Q

What is the treatment for GORD?

A

Lifestyle management and Gaviscon, H2RA - ranitidine, and PPI- omeprazole
Anti-reflux surgery

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7
Q

What is Barret’s oesophagus?

A

Intestinal metaplasia related to prolonged acid exposure in distal oesophagus
Squamous cell to columnar epithelium - GORD symptoms

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8
Q

What is the treatment for Barret’s oesophagus?

A

Endoscopic mucosal resection EMR
Radio-frequency ablation
Esophagectomy rarely

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9
Q

Describe oesophageal cancer

A

Commonly adenocarcinoma in distal 1/3rd
Progressive dysphagia, anorexia, and weight loss.

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10
Q

What is the treatment for oesophageal cancer?

A

Oesophagectomy
Adjuvant or neoadjuvant chemo
Combined chemo and RT
Symptom palliation

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11
Q

What is Eosinophilic oesophagitis?

A

Chronic immune/ allergen mediated condition
Pathological eosinophilic infiltrate
Oesophageal dysfunction symptoms - mucosal stripping

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12
Q

What is the treatment of eosinophilic oesophagitis?

A

Topical/ oral steroids
Dietary elimination
Endoscopic dilatation

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13
Q

What is dyspepsia?

A

Group of symptoms which describe bad digestion - last 4 weeks
Abdominal discomfort, N/V, heartburn, bloating…

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14
Q

What is the treatment for dyspepsia?

A

Stop smoking or alcohol use
Gaviscon, anti-acid medication - PPI, and ranitidine

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15
Q

Explain H.pylori

A

Colonises in gastric mucosa and resides in mucosa layer
Outcomes are gastritis, gastric/ duodenal ulcer, intestinal metaplasia and cancer

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16
Q

What is the treatment for H.pylori?

A

Triple therapy for 7 days - amoxicillin, clarithromycin and PPI.

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17
Q

What are the tests for H.pylori?

A

IgG serology
13c/14c urea breath test
ELISA - stool antigen test
CLO test - urease on biopsy

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18
Q

What is a peptic ulcer?

A

Imbalance of acid secretion and mucosal barrier - stomach, oesophagus, and duodenum.
Epigastric pain, night/ hunger pain, nausea, and tenderness.

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19
Q

How is a peptic ulcer treated?

A

Eradication therapy if H. pylori
PPI or H2RA - ranitidine
Stop NSAIDs and treat complications

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20
Q

What is gastric outlet obstruction?

A

Obstruction at level of pylorus of stomach
Dehydration and loss of H and Cl in vomit - metabolic alkalosis
Vomiting as lack bile

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21
Q

What is the treatment for gastric outlet obstruction?

A

Endoscopic balloon dilatation and surgery

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22
Q

Describe gastric cancer

A

Second commonest malignancy
Adenocarcinoma
Dyspepsia, nauseam vomiting, weight loss, and upper GI bleed

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23
Q

What is the treatment/ management for gastric cancer?

A

Surgery - subtotal or total gastrectomy, and Roux en Y reconstruction
Open or laparoscopic
Surgery and chemo

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24
Q

Describe chronic liver disease

A

Liver disease lasting more than 6 months - not able to perform metabolic functions
Can be compensated or uncompensated
Liver biopsy for diagnosis

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25
Q

What is the treatment for chronic liver disease?

A

Possible liver transplant
Treat symptoms - ascites, hepatorenal syndrome, variceal bleeding, and hepatic encephalopathy.

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26
Q

What is primary biliary cholangitis?

A

Organ specific autoimmune disease - mainly females
Granulomatous inflammation - can progress to cirrhosis
Jaundice and pruritis

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27
Q

What is the treatment for PBC?

A

UDCA treatment of choice - ursodiol which breaks down gallstones

28
Q

What is primary sclerosing cholangitis?

A

Chronic inflammation and fibrous obliteration of bile ducts
Loss of intrahepatic bile ducts - lead to cirrhosis and cholangiocarcinoma
Recurrent cholangitis and jaundice - is stricturing disease

29
Q

What is the treatment for PSC?

A

Liver transplant and biliary stents if one major stricture

30
Q

What is jaundice?

A

Yellowing of sclera, skin and other tissues as excess circulating bilirubin - when over 34umol/L
Can be pre-hepatic, hepatic, or post-hepatic

31
Q

What is the treatment for jaundice?

A

Therapeutic ERCP - stent, remove stones, or remove tumour.
Sphincterotomy - stone retrieval

32
Q

Explain viral hepatitis

A

A,B,C,D and E
A and E are acute
B, C and D are chronic
Diagnosed on antibody testing

33
Q

What is non-alcoholic fatty liver disease (NAFLD)?

A

Steatosis and steatohepatitis leading to fibrosis and cirrhosis.
Liver biopsy gold standard
DM, obesity, hypertension

34
Q

What is the treatment for non-alcoholic fatty liver disease?

A

Diet on weight reduction, exercise, insulin sensitizers, glucagon like peptide 1 analogues, obeticholic acid, and Vit E

35
Q

What is ascites?

A

Accumulation of fluid in the abdomen
Can get spider naevi, palmar erythema and foetor hepaticus
Protein and albumin conc. and SAAG over 11

36
Q

What is the treatment for ascites?

A

Diuretics, large volume paracentesis, TIPS, aquaretic and liver transplant

37
Q

What is hepatorenal sydrome?

A

Excess nitric oxide in splenic vasculature which decrease effective blood volume - renal vasoconstriction- sodium retention

38
Q

What is the treatment for hepatorenal syndrome?

A

Volume expansion with albumin, vasopressors - terlipressin, TIPS and liver transplant

39
Q

What are varices?

A

Enlarged veins and are medical emergencies
Usually oesophagus but can also be caput medusae, rectal and gastric

40
Q

What is the treatment for varices?

A

Blood transfusion may be needed and emergency endoscopy
Endoscopic band ligation, terlipressin, TIPS, and Sengstaken Blakemore tube

41
Q

What is hepatic encephalopathy?

A

Confusion due to liver disease
Can have flap - asterixis and foetor hepaticus

42
Q

What is the treatment for hepatic encephalopathy?

A

Treat underlying cause
Laxatives - phosphate enemas and lactulose
Neomycin, rifaximin and broad spectrum antibiotic

43
Q

Explain hepatocellular carcinoma

A

Commonest liver cancer
In background of cirrhosis and associated with hep B and C
Weight loss, abdominal mass, bleeding, and tumour marker AFP

44
Q

What is the treatment/ management for hepatocellular carcinoma?

A

Hepatic resection, liver transplant, chemo, TKI and hormonal therapy
Chemo - TACE
Ablation

45
Q

Describe cholangiocarcinoma

A

Rare and increases with age. CA19-9 tumour marker
Cancer of bile duct
Obstructive jaundice, itching, and non specific symptoms

46
Q

What is the treatment/ management for cholangiocarcinoma?

A

Surgery only curative option
Palliative - surgical bypass, stenting, RT and chemo

47
Q

Describe cancer of head of pancreas

A

On ERCP there is double duct appearance - dilatation and obstruction
Obstructive jaundice but presents late
Tumour marker - CA19-9

48
Q

What is the treatment/ management for head of pancreas cancer?

A

Surgery - Kausch Whipple or PPPD
Palliative - ERCP can stent and remove obstruction

49
Q

What is acute pancreatitis?

A

Inflammation of pancreas - abdominal pain which can radiate to back, vomiting and systemically unwell
Glucose serum amylase increased

50
Q

What is the treatment for acute pancreatitis?

A

ERCP or cholecystectomy - gallstones
IV fluids and analgesia
Antibiotics if sepsis or abscess

51
Q

What is chronic pancreatitis?

A

Irreversible changes so chronic pain or impairment of endocrine and exocrine function
Steatorrhea and diabetes as reduced insulin

52
Q

What is the management/ treatment for chronic pancreatitis?

A

Stop alcohol and smoking
Resection -PPPD, Whipple’s, Frey’s procedure, and central pancreatectomy
Creon, analgesia and ERCP - stenting

53
Q

Describe Chron’s disease

A

Inflammatory bowel disease
Location is from mouth to anus - patchy/ skip lesions
Granulomas an transmural
Faecal calprotectin and colonoscopy

54
Q

What is the treatment for Chron’s disease?

A

Inducing remission - prednisolone, methylprednisolone, or IV hydrocortisone
Maintenance - Azathioprine or methotrexate
Severe - infliximab and adalimumab
Surgery is not curative

55
Q

Describe Ulcerative Colitis

A

IBD - starts in rectum then moves proximally. Only in colon
Goblet cells decreased and crypt abscesses
Truelove and Witt’s criteria

56
Q

What is the treatment for Ulcerative Colitis?

A

Inducing remission - 5ASA aminosalicylate
Add topical/ oral corticosteroid
Maintenance - topical/ oral 5ASA
Surgery is needed

57
Q

Describe Irritable bowel syndrome - IBS

A

Effects large intestine
Abdominal pain, altered bowel habits, and bloating.
Altered motility, hypersensitivity, and links to anxiety/ depression

58
Q

What is the treatment for IBS?

A

Dietetic review - FODMAP
Antispasmodics, linaclotide, anti-depressants, and laxatives or antimotility drugs

59
Q

Describe colorectal cancer

A

Mainly adenocarcinoma.
Inheritable - FAP, HNPCC and CRC
Rectal bleeding, mass, obstruction and weight loss.
Colonoscopy + biopsy - Duke’s staging
FIT testing - screenign

60
Q

What is the treatment/ management for colorectal cancer?

A

Endoscopic or local resection
Laparotomy or laparoscopic
Stoma formation
Chemo, RT and palliative care

61
Q

What is acute appendicitis?

A

Inflammation of appendicitis
Abdominal pain - starts central then moves to right iliac fossa
Tenderness at McBurney’s point

62
Q

What is the treatment for haemorrhoids?

A

Treat underlying cause - constipation
Rubber band ligation
HALO and haemorrhoidectomy

63
Q

What is the treatment for an anal fissure?

A

Treat underlying cause - constipation
GTN/diltiazem and lignocaine
Botox or sphincterotomy

64
Q

What is biliary colic?

A

Temporary duct obstruction
Colicky RUQ pain radiating to shoulder and worse when eaten
Obstructive jaundice but bloods normal

65
Q

What is acute cholecytitis?

A

Long term cystic duct obstruction causing inflammation of gallbladder - Murphy’s sign
Raised WCC and CRP

66
Q

What is the treatment for acute cholecystitis?

A

IV fluids, analgesia, IV abx and urgent elective cholecystectomy

67
Q

What is ascending cholangitis?

A

Long term common bile duct obstruction causing duct infection
Charcot’s triad - fever, jaundice and RUQ
LFTs show obstruction
IV abx and emergency ERCP

The Alimentary Canal (33 decks)

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