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Gastroenterology > GI Conditions pt 1 > Flashcards

GI Conditions pt 1 Flashcards

1
Q

What happens if GORD is prolonged

A

Oesophagitis, benign oesophageal stricture, barrett’s oesophagus

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2
Q

Symptoms of GORD

A 
Heart burn
Belching
Acid brash
Waterbrash
Odynophagia (painful swallowing)
Nocturnal asthma, chronic cough, laryngitis, sinusitis
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3
Q

Complication of GORD

A

Oesophagitis, ulcers, benign stricture, Fe-deficiency

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4
Q

What induces Barrett’s oesophagus?

A

GORD
Distal oesophageal epithelium undergoes metaplasia from squamous to columnar
Intestinal metaplasia looks velvety

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5
Q

Differentials of GORD?

A 
Oesophagitis from corrosives
NSAIDs
Herpes
Candida
Duodenal or gastric ulcers or cancers
Cardiac diseases
Non-ulcer dyspepsia, sphincter of Oddi malfunction
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6
Q

What are the tests for GORD

A

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

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7
Q

Rx for GORD

A

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

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8
Q

Name the classification of GORD with the grades

A

Los Angeles classification

  1. > 1 mucosal breaks but <5mm – not extending 2 mucosal fold tops (mft)
  2. > 5mm mucosal break between 2mft
  3. Mucosal break continuous between 2mft – has less than 75% of oesophageal circumference
  4. > 75% of oesophageal circumference
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9
Q

Define Sliding hiatus hernia

A

Gastro-oesophageal junction slides up into the chest

Acid reflux is at lower oesophageal sphincter

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10
Q

Define Rolling hiatus hernia

A

Gastro-oeso junction is at abdomen, but bulge of stomach herniates up into the chest

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11
Q

Imaging of hernia

A

Barium swallow

Upper GI endoscopy

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12
Q

Treatment of hernia

A

Wt loss
Treat reflux symptoms
Surgery: if reflux does not resolve with medical therapy

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13
Q

Risk factors for Duodenal ulcer

A

Major: H.pylori, drugs (NSAIDs, steroids, SSRI)
Minor: increase gastric acid secretion, increase gastric emptying, blood group O, smoking

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14
Q

Symptoms for duodenal ulcer

A

Epigastric pain before meals or at night

Relieved by drinking milk

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15
Q

Signs for duodenal ulcer

A

Epigastric tenderness

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16
Q

Differentials for duodenal ulcer

A 
Non-ulcer dyspepsia
Duodenal crohn’s
TB
Lymphoma
Pancreatic ca
17
Q

Risk factors Gastric ulcers

A 
H. pylori
Smoking
NSAIDs
Reflux
Stress
Delayed gastric emptying
18
Q

Symptoms of Gastric ulcers

A

Asymp or epigastric pain +/- wt loss

19
Q

Tests for gastric ulcers

A

Upper endoscopy to exclude malignancy
Multiple biopsies from ulcer rim and base
Brushings needed
Rpt endoscopy to check healing

20
Q

What is the work up for diarrhoea

A

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

21
Q

How do you manage diarrhoea?

A

Treat causes
Oral rehydration, but if >2w IV fluids
Codeine phosphate or loperamide
Antibiotic-ass diarrhoea = probiotics

22
Q

What is the cause of Pseudomembranous colitis? Name symptoms

A 
C. difficile
High T
Colic
Mild diarrhoea or bloody diarrhoea
Multi-organ failure
23
Q

Name three predictors of C. diff colitis

Name the triad

A

Girotra’s triad

  1. Inc abdo pain/distension + diarrhoea
  2. Leukocytosis >18,000
  3. Haemodynamic instability
24
Q

What is the work up of Pseudomembranous colitis

A

Tissue culture, ELISA, PCR

25
Q

What is the treatment of Pseudomembranous colitis?

A

If symptomatic: metronidazole <400mg / 8hPO for <10d

Probiotics will prevent recurrences

26
Q

What causes unconjugated hyperbilirubinaemia

A

Impaired hepatic intake: drugs, RHF
Impaired conjugation: Gilbert’s, Crigler-Najjar
Overproduction haemolysis, ineffective erythropoiesis
Physiological neonatal jaundice

27
Q

What causes conjugated hyperbilirubinaemia

A

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

28
Q

Causes of portal hypertension

A

Pre-hepatic: thrombosis
Intra-hepatic: cirrhosis, schistosomiasis, sarcoid, myeloproliferative diseases, congenital hepatic fibrosis
Post-hepatic: RHF, constrictive pericarditis, veno-occlusive disease

29
Q

Risk factors for variceal bleeds

A

Inc portal pressure
Variceal size
Endoscopic ft of variceal wall
Child-Pugh score >8

30
Q

What is primary prophylaxis for variceal bleeding?

A
  1. Non-selective B-blockade

2. Repeat endoscopic banding ligation

Gastroenterology (6 decks)

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