GI Conditions pt 1 Flashcards
What happens if GORD is prolonged
Oesophagitis, benign oesophageal stricture, barrett’s oesophagus
Symptoms of GORD
Heart burn Belching Acid brash Waterbrash Odynophagia (painful swallowing) Nocturnal asthma, chronic cough, laryngitis, sinusitis
Complication of GORD
Oesophagitis, ulcers, benign stricture, Fe-deficiency
What induces Barrett’s oesophagus?
GORD
Distal oesophageal epithelium undergoes metaplasia from squamous to columnar
Intestinal metaplasia looks velvety
Differentials of GORD?
Oesophagitis from corrosives NSAIDs Herpes Candida Duodenal or gastric ulcers or cancers Cardiac diseases Non-ulcer dyspepsia, sphincter of Oddi malfunction
What are the tests for GORD
Endoscopy: >4w symptoms, GI bleed, persistent vomiting, Fe-deficiency, >55yo; Palpable mass; Dysphagia
Barium swallow: exclude hiatus hernia
24h oesophageal pH monitoring +/- manometry: diagnoses GORD when endo is normal
Rx for GORD
Raise bed head + wt loss
Smoking cessation
Small regular meals
Avoid: hot drinks, alcohol, citrus fruits, tomatoes, spicy food, coffee, tea, chocolate
Drugs: antacids, PPI for oesophagitis
Surgery: laparoscopy: to increase resting lower oesophageal sphincter pressure
Name the classification of GORD with the grades
Los Angeles classification
- > 1 mucosal breaks but <5mm – not extending 2 mucosal fold tops (mft)
- > 5mm mucosal break between 2mft
- Mucosal break continuous between 2mft – has less than 75% of oesophageal circumference
- > 75% of oesophageal circumference
Define Sliding hiatus hernia
Gastro-oesophageal junction slides up into the chest
Acid reflux is at lower oesophageal sphincter
Define Rolling hiatus hernia
Gastro-oeso junction is at abdomen, but bulge of stomach herniates up into the chest
Imaging of hernia
Barium swallow
Upper GI endoscopy
Treatment of hernia
Wt loss
Treat reflux symptoms
Surgery: if reflux does not resolve with medical therapy
Risk factors for Duodenal ulcer
Major: H.pylori, drugs (NSAIDs, steroids, SSRI)
Minor: increase gastric acid secretion, increase gastric emptying, blood group O, smoking
Symptoms for duodenal ulcer
Epigastric pain before meals or at night
Relieved by drinking milk
Signs for duodenal ulcer
Epigastric tenderness
Differentials for duodenal ulcer
Non-ulcer dyspepsia Duodenal crohn’s TB Lymphoma Pancreatic ca
Risk factors Gastric ulcers
H. pylori Smoking NSAIDs Reflux Stress Delayed gastric emptying
Symptoms of Gastric ulcers
Asymp or epigastric pain +/- wt loss
Tests for gastric ulcers
Upper endoscopy to exclude malignancy
Multiple biopsies from ulcer rim and base
Brushings needed
Rpt endoscopy to check healing
What is the work up for diarrhoea
Blood: FBC, ESR / CRP inc, U+E: low K, TSH, coeliac serology
Stool: MC+S, Faecal fat excretion, C-hiolein breath test
Rigid sigmoidoscopy, colonoscopy / barium enema
How do you manage diarrhoea?
Treat causes
Oral rehydration, but if >2w IV fluids
Codeine phosphate or loperamide
Antibiotic-ass diarrhoea = probiotics
What is the cause of Pseudomembranous colitis? Name symptoms
C. difficile High T Colic Mild diarrhoea or bloody diarrhoea Multi-organ failure
Name three predictors of C. diff colitis
Name the triad
Girotra’s triad
- Inc abdo pain/distension + diarrhoea
- Leukocytosis >18,000
- Haemodynamic instability
What is the work up of Pseudomembranous colitis
Tissue culture, ELISA, PCR
What is the treatment of Pseudomembranous colitis?
If symptomatic: metronidazole <400mg / 8hPO for <10d
Probiotics will prevent recurrences
What causes unconjugated hyperbilirubinaemia
Impaired hepatic intake: drugs, RHF
Impaired conjugation: Gilbert’s, Crigler-Najjar
Overproduction haemolysis, ineffective erythropoiesis
Physiological neonatal jaundice
What causes conjugated hyperbilirubinaemia
Hepatocellular dysfunction: viruses incl CMV, EBV; alcohol, liver mets, cirrhosis, haemochromatosis, septicaemia, alpha1 antitripsin deficiency, Wilson’s RHF
Impaired hepatic excretion: primary biliary cirrhosis, primary sclerosing cholangitis, gallstones, pancreatic ca
Causes of portal hypertension
Pre-hepatic: thrombosis
Intra-hepatic: cirrhosis, schistosomiasis, sarcoid, myeloproliferative diseases, congenital hepatic fibrosis
Post-hepatic: RHF, constrictive pericarditis, veno-occlusive disease
Risk factors for variceal bleeds
Inc portal pressure
Variceal size
Endoscopic ft of variceal wall
Child-Pugh score >8
What is primary prophylaxis for variceal bleeding?
- Non-selective B-blockade
2. Repeat endoscopic banding ligation
