GI Conditions pt 3

Question 1

Symptoms of Liver tumours

Answer 1

Fever
Malaise
Anorexia
Wt loss
RUQ pain

Question 2

Signs for Liver tumours

Answer 2

Hepatomegaly
Signs of chronic liver disease
Evidence of decompensation: jaundice, ascites

Question 3

Specific tests for liver tumours

Answer 3

FBC, clotting, LFT, hepatitis serology
Alpha-fetoprotein
Imaging: US/CT + guide biopsy, MRI (benign vs malignant), ERCP + biopsy if cholangioca, liver biopsy

Question 4

Signs and symptoms of hepatocellular ca

Answer 4

Haemobilia

Fatigue
Low appetite
RUQ pain
Wt loss
Jaundice
Ascites

Question 5

Causes of hepatocellular ca

Answer 5

HBV, HCV
Fungi - Aflatoxin
Fluke - Clonorchis sinensis

AIH
Cirrhosis
NAFLD

Anabolic steroids

Question 6

Treatment of hepatocellular ca

What would u recommend to pts with hepatocellular ca

Answer 6

Liver transplant

HBV vaccination
Don’t reuse needles
Screen blood
6mo screen: AFP, US

Question 7

Causes for cholangiocarcinoma

Answer 7

HBV, HCV, DM, Caroli's disease
Flukes
Biliary-enteric drainage surgery
PSC
Biliary cysts

Question 8

Signs and symp of Cholangiocarcinoma

Answer 8

Fever, abdo pain, malaise
Inc bilirubin
Inc Alkaline phosphatase

Question 9

Management of Cholangioca

Answer 9

Surgery: hepatectomy, extrahepatic bile duct excision
Stenting
Liver transplant

Question 10

What causes UC

Answer 10

Unknown

Question 11

Symptoms of UC

Answer 11

Episodic or chronic diarrhoea +/- blood + mucus
Crampy abdominal discomfort
Bowel frequency
Urgency/tenesmus = rectal UC
Systemic: fever, malaise, anorexia, wt loss

Question 12

Signs of UC

Answer 12

If acute: fever, tachy, tender, distended abdo
Extraintestinal signs
-	Clubbing
-	aphthous oral ulcers
-	erythema nodosum
-	pyoderma gangrenosum
-	conjunctivitis
-	episcleritis
-	iritis
-	large joint arthritis
-	sacroiliitis
-	ankylosing spondylitis
-	fatty liver
-	PSC
-	Cholangioca
-	Nutritional deficits
-	Amyloidosis

Question 13

Specific tests for UC

Answer 13

LFT, blood culture

Stool MC+S

AXR: mucosal thickening/islands, colonic dilatation
Erect CXR: id perforation
Ba enema: never during severe attacks
Colonoscopy

Question 14

Complications of UC

Answer 14

Perforation + bleeding
Toxic dilatation
Venous thrombosis

Question 15

Treatment for Mild UC

Answer 15

5-ASA: sulfasalazine or mesalazine 1x1d
Steroids to help remission induction: prednisolone+/- twice-daily steroid foams PR
Maintain remission w/ sulfasalazine/mesalazine or olsalazine for 1yr

Question 16

Treatment for Moderate UC

Answer 16

4-6 motions/day

Prednisolone + 5-ASA + twice-daily steroid enemas

Question 17

Treatment for Severe UC

Answer 17

> 6motions/day
Hydrocortisone
Rectal steroids
Monitor T, pulse, BP, record stool frequency and character
Twice-daily exam
Daily FBC, ESR, CRP, U+E, AXR
?Parenteral nutrition
If still continues = Rescue therapy: ciclosporin or infliximab
Immunomodulation by azathioprine or methotrexate if no remission

Question 18

When would surgery be needed for UC

Answer 18

Indications
-	Perforamtion
-	Massive haemorrhage
-	Toxic dilatation
-	Failed medical therapy
Proctocolectomy + terminal ileostomy: at any stage
Colectomy with ileo-anal pouch later

Question 19

What is associated with crohn’s disease

Answer 19

Smoking
NSAIDs
Unknown

Question 20

What are the symptoms of Crohns

Answer 20

Diarrhoea/urgency
Abdo pain
Wt loss / failure to thrive
Fever, malaise, anorexia

Question 21

Signs of Crohn’s

Answer 21

Clubbing
Aphthous ulcerations
Abdominal tenderness/mass

Perianal abscess/fistulae/skin tags
Anal stricture

Skin, joint, eye problems

Question 22

Complications for Crohn’s

Answer 22

Small bowel obstruction
Toxic dilatation
Abscess formation
Fistulae
Perforation
Rectal haemorrhage
Colon ca
Fatty liver
PSC
Cholagioca
Renal stones, osteomalacia, malnutrition
Amyloidosis

Question 23

Specific tests for Crohn’s

Answer 23

INR, Ferritin, TIBC, B12 folate
Stool: MC+S, CDT
Colonoscopy + rectal biopsy
Small bowel enema
Capsule endoscopy
Barium enema: cobblestoning
Colonoscopy preferred to barium enema
MRI

Question 24

Management for Crohn’s

• Mild
• Severe

Answer 24

Optimise nutrition: TPN, elemental diet, low residue diet
Assess Temp(high), pulse (high), ESR (high), WCC(high), CRP(high), low albumin
- Prednisolone
- Admit iV steroids, nil by mouth, IVI dextrose-saline, hydrocortisone, metronidazole
Consider abdominal sepsis complicating Crohn’s – seek surgical advice

Question 25

Kinds of surgery in Crohns

Answer 25

Defunction rest distal disease with temporary ileostomy

Resect the worst areas but see short bowel syndrome

Question 26

When to diagnose IBS through symptoms

Answer 26

Abdo pain is relieved by defecation or ass/w altered stool form or bowel frequency
>2 of the following
- urgency
- incomplete evacuation
- abdominal bloating/distension
- mucous PR
Worsening of symptoms after food
Other: nausea, bladder symptoms, backache

Question 27

Signs of IBS

Answer 27

Abdominal tenderness

Insufflation of air during sigmoidoscopy

Question 28

Specific tests to exclude IBS

Answer 28

FBC, CRP, ESR, LFT, coeliac serology
Colonoscopy
FH of ovarian/bowel ca-125
If diarrhoea: LFT, stool culture, B12/folate;
Anti-endomysial antibodies, TSH< barium follow-through +/- rectal biopsy
Further investigations
- Upper GI endoscopy if dyspepsia + reflux
- Small bowel radiology for crohns
- Duodenal biopsy for coela if anti-endomysial antibodies +ve
- Giardia tests
- ERCP or MRCP if active pancreatitis
Possible referrals: surgeon, dietician, psycho- or hypno therapist, gynae, derma, pain clinic – MDT with therapeutic alliance

Question 29

Treatment for IBS

Answer 29

Diet: fibre, lactose, fructose, wheat, starch, caffeine, orbital, alcohol, fizzy drinks = all can worsen symptoms
Constipation: bisacodyl + sodium picosulfate
Diarrhoea: bulking agent +/- loperamide
Colic/bloating: mebeverine, simeticon to improve spasm
Psych symp/visceral hypersensitivity: Cognitive behaviour therapy, tricyclics and amitriptyline

Question 30

Risk factors for Pancreatic ca

Answer 30

Smoking
Alcohol
Carcinogens
DM
Chronic pancreatitis
Waist circumference increase
High fat + red/processed meat diet