GI Conditions and Treatments Flashcards
What is diffuse oesophageal spasm?
Hypermotility disorder
Cause is unknown
Severe chest pain with dysphagia
What is the treatment for diffuse oesophageal spasm?
Smooth muscle relaxants - nitrates and Ca channel antagonists
What is achalasia?
Hypomotility disorder - functional loss of myenteric plexus
Progressive dysphagia , weight loss, regurgitation and can get chest infections
What is the treatment for achalasia?
Nitrates and CCB
Botulinum toxin and pneumonic balloon dilation
Surgery - myotomy
What is gastro-oesophageal disease (GORD)?
Acid and bile exposure to lower oesophagus - causes inflammation
Heartburn, cough and water brash
What is the treatment for GORD?
Lifestyle management and Gaviscon, H2RA - ranitidine, and PPI- omeprazole
Anti-reflux surgery
What is Barret’s oesophagus?
Intestinal metaplasia related to prolonged acid exposure in distal oesophagus
Squamous cell to columnar epithelium - GORD symptoms
What is the treatment for Barret’s oesophagus?
Endoscopic mucosal resection EMR
Radio-frequency ablation
Esophagectomy rarely
Describe oesophageal cancer
Commonly adenocarcinoma in distal 1/3rd
Progressive dysphagia, anorexia, and weight loss.
What is the treatment for oesophageal cancer?
Oesophagectomy
Adjuvant or neoadjuvant chemo
Combined chemo and RT
Symptom palliation
What is Eosinophilic oesophagitis?
Chronic immune/ allergen mediated condition
Pathological eosinophilic infiltrate
Oesophageal dysfunction symptoms - mucosal stripping
What is the treatment of eosinophilic oesophagitis?
Topical/ oral steroids
Dietary elimination
Endoscopic dilatation
What is dyspepsia?
Group of symptoms which describe bad digestion - last 4 weeks
Abdominal discomfort, N/V, heartburn, bloating…
What is the treatment for dyspepsia?
Stop smoking or alcohol use
Gaviscon, anti-acid medication - PPI, and ranitidine
Explain H.pylori
Colonises in gastric mucosa and resides in mucosa layer
Outcomes are gastritis, gastric/ duodenal ulcer, intestinal metaplasia and cancer
What is the treatment for H.pylori?
Triple therapy for 7 days - amoxicillin, clarithromycin and PPI.
What are the tests for H.pylori?
IgG serology
13c/14c urea breath test
ELISA - stool antigen test
CLO test - urease on biopsy
What is a peptic ulcer?
Imbalance of acid secretion and mucosal barrier - stomach, oesophagus, and duodenum.
Epigastric pain, night/ hunger pain, nausea, and tenderness.
How is a peptic ulcer treated?
Eradication therapy if H. pylori
PPI or H2RA - ranitidine
Stop NSAIDs and treat complications
What is gastric outlet obstruction?
Obstruction at level of pylorus of stomach
Dehydration and loss of H and Cl in vomit - metabolic alkalosis
Vomiting as lack bile
What is the treatment for gastric outlet obstruction?
Endoscopic balloon dilatation and surgery
Describe gastric cancer
Second commonest malignancy
Adenocarcinoma
Dyspepsia, nauseam vomiting, weight loss, and upper GI bleed
What is the treatment/ management for gastric cancer?
Surgery - subtotal or total gastrectomy, and Roux en Y reconstruction
Open or laparoscopic
Surgery and chemo
Describe chronic liver disease
Liver disease lasting more than 6 months - not able to perform metabolic functions
Can be compensated or uncompensated
Liver biopsy for diagnosis
What is the treatment for chronic liver disease?
Possible liver transplant
Treat symptoms - ascites, hepatorenal syndrome, variceal bleeding, and hepatic encephalopathy.
What is primary biliary cholangitis?
Organ specific autoimmune disease - mainly females
Granulomatous inflammation - can progress to cirrhosis
Jaundice and pruritis
What is the treatment for PBC?
UDCA treatment of choice - ursodiol which breaks down gallstones
What is primary sclerosing cholangitis?
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
What is the treatment for PSC?
Liver transplant and biliary stents if one major stricture
What is jaundice?
Yellowing of sclera, skin and other tissues as excess circulating bilirubin - when over 34umol/L
Can be pre-hepatic, hepatic, or post-hepatic
What is the treatment for jaundice?
Therapeutic ERCP - stent, remove stones, or remove tumour.
Sphincterotomy - stone retrieval
Explain viral hepatitis
A,B,C,D and E
A and E are acute
B, C and D are chronic
Diagnosed on antibody testing
What is non-alcoholic fatty liver disease (NAFLD)?
Steatosis and steatohepatitis leading to fibrosis and cirrhosis.
Liver biopsy gold standard
DM, obesity, hypertension
What is the treatment for non-alcoholic fatty liver disease?
Diet on weight reduction, exercise, insulin sensitizers, glucagon like peptide 1 analogues, obeticholic acid, and Vit E
What is ascites?
Accumulation of fluid in the abdomen
Can get spider naevi, palmar erythema and foetor hepaticus
Protein and albumin conc. and SAAG over 11
What is the treatment for ascites?
Diuretics, large volume paracentesis, TIPS, aquaretic and liver transplant
What is hepatorenal sydrome?
Excess nitric oxide in splenic vasculature which decrease effective blood volume - renal vasoconstriction- sodium retention
What is the treatment for hepatorenal syndrome?
Volume expansion with albumin, vasopressors - terlipressin, TIPS and liver transplant
What are varices?
Enlarged veins and are medical emergencies
Usually oesophagus but can also be caput medusae, rectal and gastric
What is the treatment for varices?
Blood transfusion may be needed and emergency endoscopy
Endoscopic band ligation, terlipressin, TIPS, and Sengstaken Blakemore tube
What is hepatic encephalopathy?
Confusion due to liver disease
Can have flap - asterixis and foetor hepaticus
What is the treatment for hepatic encephalopathy?
Treat underlying cause
Laxatives - phosphate enemas and lactulose
Neomycin, rifaximin and broad spectrum antibiotic
Explain hepatocellular carcinoma
Commonest liver cancer
In background of cirrhosis and associated with hep B and C
Weight loss, abdominal mass, bleeding, and tumour marker AFP
What is the treatment/ management for hepatocellular carcinoma?
Hepatic resection, liver transplant, chemo, TKI and hormonal therapy
Chemo - TACE
Ablation
Describe cholangiocarcinoma
Rare and increases with age. CA19-9 tumour marker
Cancer of bile duct
Obstructive jaundice, itching, and non specific symptoms
What is the treatment/ management for cholangiocarcinoma?
Surgery only curative option
Palliative - surgical bypass, stenting, RT and chemo
Describe cancer of head of pancreas
On ERCP there is double duct appearance - dilatation and obstruction
Obstructive jaundice but presents late
Tumour marker - CA19-9
What is the treatment/ management for head of pancreas cancer?
Surgery - Kausch Whipple or PPPD
Palliative - ERCP can stent and remove obstruction
What is acute pancreatitis?
Inflammation of pancreas - abdominal pain which can radiate to back, vomiting and systemically unwell
Glucose serum amylase increased
What is the treatment for acute pancreatitis?
ERCP or cholecystectomy - gallstones
IV fluids and analgesia
Antibiotics if sepsis or abscess
What is chronic pancreatitis?
Irreversible changes so chronic pain or impairment of endocrine and exocrine function
Steatorrhea and diabetes as reduced insulin
What is the management/ treatment for chronic pancreatitis?
Stop alcohol and smoking
Resection -PPPD, Whipple’s, Frey’s procedure, and central pancreatectomy
Creon, analgesia and ERCP - stenting
Describe Chron’s disease
Inflammatory bowel disease
Location is from mouth to anus - patchy/ skip lesions
Granulomas an transmural
Faecal calprotectin and colonoscopy
What is the treatment for Chron’s disease?
Inducing remission - prednisolone, methylprednisolone, or IV hydrocortisone
Maintenance - Azathioprine or methotrexate
Severe - infliximab and adalimumab
Surgery is not curative
Describe Ulcerative Colitis
IBD - starts in rectum then moves proximally. Only in colon
Goblet cells decreased and crypt abscesses
Truelove and Witt’s criteria
What is the treatment for Ulcerative Colitis?
Inducing remission - 5ASA aminosalicylate
Add topical/ oral corticosteroid
Maintenance - topical/ oral 5ASA
Surgery is needed
Describe Irritable bowel syndrome - IBS
Effects large intestine
Abdominal pain, altered bowel habits, and bloating.
Altered motility, hypersensitivity, and links to anxiety/ depression
What is the treatment for IBS?
Dietetic review - FODMAP
Antispasmodics, linaclotide, anti-depressants, and laxatives or antimotility drugs
Describe colorectal cancer
Mainly adenocarcinoma.
Inheritable - FAP, HNPCC and CRC
Rectal bleeding, mass, obstruction and weight loss.
Colonoscopy + biopsy - Duke’s staging
FIT testing - screenign
What is the treatment/ management for colorectal cancer?
Endoscopic or local resection
Laparotomy or laparoscopic
Stoma formation
Chemo, RT and palliative care
What is acute appendicitis?
Inflammation of appendicitis
Abdominal pain - starts central then moves to right iliac fossa
Tenderness at McBurney’s point
What is the treatment for haemorrhoids?
Treat underlying cause - constipation
Rubber band ligation
HALO and haemorrhoidectomy
What is the treatment for an anal fissure?
Treat underlying cause - constipation
GTN/diltiazem and lignocaine
Botox or sphincterotomy
What is biliary colic?
Temporary duct obstruction
Colicky RUQ pain radiating to shoulder and worse when eaten
Obstructive jaundice but bloods normal
What is acute cholecytitis?
Long term cystic duct obstruction causing inflammation of gallbladder - Murphy’s sign
Raised WCC and CRP
What is the treatment for acute cholecystitis?
IV fluids, analgesia, IV abx and urgent elective cholecystectomy
What is ascending cholangitis?
Long term common bile duct obstruction causing duct infection
Charcot’s triad - fever, jaundice and RUQ
LFTs show obstruction
IV abx and emergency ERCP
