GI Conditions pt 3 Flashcards
Symptoms of Liver tumours
Fever Malaise Anorexia Wt loss RUQ pain
Signs for Liver tumours
Hepatomegaly
Signs of chronic liver disease
Evidence of decompensation: jaundice, ascites
Specific tests for liver tumours
FBC, clotting, LFT, hepatitis serology
Alpha-fetoprotein
Imaging: US/CT + guide biopsy, MRI (benign vs malignant), ERCP + biopsy if cholangioca, liver biopsy
Signs and symptoms of hepatocellular ca
Haemobilia
Fatigue Low appetite RUQ pain Wt loss Jaundice Ascites
Causes of hepatocellular ca
HBV, HCV
Fungi - Aflatoxin
Fluke - Clonorchis sinensis
AIH
Cirrhosis
NAFLD
Anabolic steroids
Treatment of hepatocellular ca
What would u recommend to pts with hepatocellular ca
Liver transplant
HBV vaccination
Don’t reuse needles
Screen blood
6mo screen: AFP, US
Causes for cholangiocarcinoma
HBV, HCV, DM, Caroli's disease Flukes Biliary-enteric drainage surgery PSC Biliary cysts
Signs and symp of Cholangiocarcinoma
Fever, abdo pain, malaise
Inc bilirubin
Inc Alkaline phosphatase
Management of Cholangioca
Surgery: hepatectomy, extrahepatic bile duct excision
Stenting
Liver transplant
What causes UC
Unknown
Symptoms of UC
Episodic or chronic diarrhoea +/- blood + mucus
Crampy abdominal discomfort
Bowel frequency
Urgency/tenesmus = rectal UC
Systemic: fever, malaise, anorexia, wt loss
Signs of UC
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
Specific tests for UC
LFT, blood culture
Stool MC+S
AXR: mucosal thickening/islands, colonic dilatation
Erect CXR: id perforation
Ba enema: never during severe attacks
Colonoscopy
Complications of UC
Perforation + bleeding
Toxic dilatation
Venous thrombosis
Treatment for Mild UC
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
Treatment for Moderate UC
4-6 motions/day
Prednisolone + 5-ASA + twice-daily steroid enemas
Treatment for Severe UC
> 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
When would surgery be needed for UC
Indications - Perforamtion - Massive haemorrhage - Toxic dilatation - Failed medical therapy Proctocolectomy + terminal ileostomy: at any stage Colectomy with ileo-anal pouch later
What is associated with crohn’s disease
Smoking
NSAIDs
Unknown
What are the symptoms of Crohns
Diarrhoea/urgency
Abdo pain
Wt loss / failure to thrive
Fever, malaise, anorexia
Signs of Crohn’s
Clubbing
Aphthous ulcerations
Abdominal tenderness/mass
Perianal abscess/fistulae/skin tags
Anal stricture
Skin, joint, eye problems
Complications for Crohn’s
Small bowel obstruction Toxic dilatation Abscess formation Fistulae Perforation Rectal haemorrhage Colon ca Fatty liver PSC Cholagioca Renal stones, osteomalacia, malnutrition Amyloidosis
Specific tests for Crohn’s
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
Management for Crohn’s
- Mild
- Severe
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
Kinds of surgery in Crohns
Defunction rest distal disease with temporary ileostomy
Resect the worst areas but see short bowel syndrome
When to diagnose IBS through symptoms
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
Signs of IBS
Abdominal tenderness
Insufflation of air during sigmoidoscopy
Specific tests to exclude IBS
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
Treatment for IBS
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
Risk factors for Pancreatic ca
Smoking Alcohol Carcinogens DM Chronic pancreatitis Waist circumference increase High fat + red/processed meat diet
