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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
What is the treatment for chronic liver disease?
Possible liver transplant Treat symptoms - ascites, hepatorenal syndrome, variceal bleeding, and hepatic encephalopathy.
26
What is primary biliary cholangitis?
Organ specific autoimmune disease - mainly females Granulomatous inflammation - can progress to cirrhosis Jaundice and pruritis
27
What is the treatment for PBC?
UDCA treatment of choice - ursodiol which breaks down gallstones
28
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
29
What is the treatment for PSC?
Liver transplant and biliary stents if one major stricture
30
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
31
What is the treatment for jaundice?
Therapeutic ERCP - stent, remove stones, or remove tumour. Sphincterotomy - stone retrieval
32
Explain viral hepatitis
A,B,C,D and E A and E are acute B, C and D are chronic Diagnosed on antibody testing
33
What is non-alcoholic fatty liver disease (NAFLD)?
Steatosis and steatohepatitis leading to fibrosis and cirrhosis. Liver biopsy gold standard DM, obesity, hypertension
34
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
35
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
36
What is the treatment for ascites?
Diuretics, large volume paracentesis, TIPS, aquaretic and liver transplant
37
What is hepatorenal sydrome?
Excess nitric oxide in splenic vasculature which decrease effective blood volume - renal vasoconstriction- sodium retention
38
What is the treatment for hepatorenal syndrome?
Volume expansion with albumin, vasopressors - terlipressin, TIPS and liver transplant
39
What are varices?
Enlarged veins and are medical emergencies Usually oesophagus but can also be caput medusae, rectal and gastric
40
What is the treatment for varices?
Blood transfusion may be needed and emergency endoscopy Endoscopic band ligation, terlipressin, TIPS, and Sengstaken Blakemore tube
41
What is hepatic encephalopathy?
Confusion due to liver disease Can have flap - asterixis and foetor hepaticus
42
What is the treatment for hepatic encephalopathy?
Treat underlying cause Laxatives - phosphate enemas and lactulose Neomycin, rifaximin and broad spectrum antibiotic
43
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
44
What is the treatment/ management for hepatocellular carcinoma?
Hepatic resection, liver transplant, chemo, TKI and hormonal therapy Chemo - TACE Ablation
45
Describe cholangiocarcinoma
Rare and increases with age. CA19-9 tumour marker Cancer of bile duct Obstructive jaundice, itching, and non specific symptoms
46
What is the treatment/ management for cholangiocarcinoma?
Surgery only curative option Palliative - surgical bypass, stenting, RT and chemo
47
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
48
What is the treatment/ management for head of pancreas cancer?
Surgery - Kausch Whipple or PPPD Palliative - ERCP can stent and remove obstruction
49
What is acute pancreatitis?
Inflammation of pancreas - abdominal pain which can radiate to back, vomiting and systemically unwell Glucose serum amylase increased
50
What is the treatment for acute pancreatitis?
ERCP or cholecystectomy - gallstones IV fluids and analgesia Antibiotics if sepsis or abscess
51
What is chronic pancreatitis?
Irreversible changes so chronic pain or impairment of endocrine and exocrine function Steatorrhea and diabetes as reduced insulin
52
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
53
Describe Chron's disease
Inflammatory bowel disease Location is from mouth to anus - patchy/ skip lesions Granulomas an transmural Faecal calprotectin and colonoscopy
54
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
55
Describe Ulcerative Colitis
IBD - starts in rectum then moves proximally. Only in colon Goblet cells decreased and crypt abscesses Truelove and Witt's criteria
56
What is the treatment for Ulcerative Colitis?
Inducing remission - 5ASA aminosalicylate Add topical/ oral corticosteroid Maintenance - topical/ oral 5ASA Surgery is needed
57
Describe Irritable bowel syndrome - IBS
Effects large intestine Abdominal pain, altered bowel habits, and bloating. Altered motility, hypersensitivity, and links to anxiety/ depression
58
What is the treatment for IBS?
Dietetic review - FODMAP Antispasmodics, linaclotide, anti-depressants, and laxatives or antimotility drugs
59
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
60
What is the treatment/ management for colorectal cancer?
Endoscopic or local resection Laparotomy or laparoscopic Stoma formation Chemo, RT and palliative care
61
What is acute appendicitis?
Inflammation of appendicitis Abdominal pain - starts central then moves to right iliac fossa Tenderness at McBurney's point
62
What is the treatment for haemorrhoids?
Treat underlying cause - constipation Rubber band ligation HALO and haemorrhoidectomy
63
What is the treatment for an anal fissure?
Treat underlying cause - constipation GTN/diltiazem and lignocaine Botox or sphincterotomy
64
What is biliary colic?
Temporary duct obstruction Colicky RUQ pain radiating to shoulder and worse when eaten Obstructive jaundice but bloods normal
65
What is acute cholecytitis?
Long term cystic duct obstruction causing inflammation of gallbladder - Murphy's sign Raised WCC and CRP
66
What is the treatment for acute cholecystitis?
IV fluids, analgesia, IV abx and urgent elective cholecystectomy
67
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

The Alimentary Canal (33 decks)

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