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Gastroenterology > GI Conditions pt 4 > Flashcards

GI Conditions pt 4 Flashcards

1
Q

Signs of tumour in head of pancreas

A

Painless obstructive jaundice

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2
Q

Signs of tumour in body and tail of pancreas

What do they cause?

A

Epigastric pain which radiates to back and relieved by sitting forward
Causes: anorexia, wt loss, diabetes, acute pancreatitis

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3
Q

Signs of Pancreatic tumour

A 
Jaundice + palpable gall bladder
Epigastric mass
Hepatomegaly
Splenomegaly
Lymphadenopathy
Ascites
Rare: inc Ca, marantic endocarditis, portal HT, nephrosis, thrombophlebitis migrans
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4
Q

Specific Tests for pancreatic tumour

A

Blood: Ca19-9
Imaging: US/CT – also to guide biopsy + stage; EUS (endoscopic sonography – most accurate); ERCP (localises site of obstruction)

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5
Q

Treatment for pancreatic tumours

A

p/w mets
surgery: pancreatoduodenectomy (whipple’s), Laparoscopic excision, post-op chemotherapy, palliation of jaundice (by stenting), pain relief

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6
Q

Signs and symptoms of Carcinoid tumour

A 
Bronchoconstriction
Paroxysmal flushing, esp in upper body
Diarrhoea
CCF
CNS effects
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7
Q

Specific tests for carcinoid syndrome

A 
24h urine 5-hydroxyindoleacetic acid increase
CXR + chest/pelvis MRI/CT
Plasma chromogranin A
Indium octreotide scintigraphy
Positron emission tomography (PET)
Echo + BNP
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8
Q

Treatment of Carcinoid syndrome

A

Octreotide (+/- Interferon-alpha+ : blocks release of tumour mediators
Loperamide for diarrhoea

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9
Q

What is a carcinoid crisis

A 
Tumour outgrown its blood supply and mediators flood out
Life threatening
-	Vasodilatation
-	Hypotension
-	Tachycardia
-	Bronchoconstriction
-	hyperGly
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10
Q

Symptoms of Gastrointestinal malabsorption

A

Diarrhoea - Steatorrhoea
Wt loss
Lethargy
Bloating

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11
Q

Signs of gastrointestinal malabsorption

A 
Anaemia (low Fe, B12, folate)
Bleeding disorder (low vit K)
Oedema (low protein)
Metabolic bone disease (low vit D)
Neurological ft
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12
Q

Specific tests for GI malabsorption

A

FBC, ↓Ca, ↓Fe, ↓ B12 + folate
↑ INR, lipid profile, coeliac tests
Stool: sudan stain for fat globules, stool microscopy, alpha-1-AT
Ba followthrough: exclude diverticula, crohn’s radiation enteritis
Breath hydrogen analysis: bacterial overgrowth
Endscopy + small bowel biopsy, ERCP

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13
Q

Causes of GI malabsorption

A

Coelia disease, chr pancreatitis, Crohns

Rare: pancreatic insufficiency, bacterial overgrowth, infection, intestinal hurry

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14
Q

Presentation of coeliac disease

A 
Stinking stools/steatorrhoea
Diarrhoea
Abdominal pain
Bloating
N+V
Aphthous ulcers
Angular stomatitis
Wt loss
Fatigue
Weakness
Osteomalacia
Failure to thrive
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15
Q

Specific tests for coeliac

A

Alpha-gliadin
Transglutaminase and anti-endomysial IgA antibody
Duodenal biopsy done at endoscopy
↓ B12 ↓Hb ↑RCDW, ↓ferritin

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16
Q

Treatment for coeliac

A

Lifelong gluten-free diet

Ok: rice, maize, soya, potatoes, oats, sugar

17
Q

Complications for coeliac

A 
Anaemia
Secondary lactose intolerance
GI T-cell lymphoma
↑ risk of malignancy
Osteoporosis
18
Q

Symptoms of chronic pancreatitis

A

Epigastric pain boring through back
Relieved by sitting forward or hot water
Bloating, steatorrhoea, wt loss, brittle diabetes

19
Q

Causes of chr pancreatitis

A 
Alcohol
Cystic fibrosis
Haemochromatosis
Pancreatic duct obstruction
↑PTH
Congenital
20
Q

Tests specific to chronic pancreatitis

A

US – CT
MRCP ERCP
AXR

21
Q

Treatment for chr pancreatitis

A 
Analgesia
Lipase
Insulin
Diet: no alcohol, low fat diet
Surgery: nacrotic abuse, unremitting pain, wt loss
22
Q

Complications for Chr pancreatitis

A 
Pseudocyst, diabetes
Biliary obstruction
Local arterial aneurysm
Splenic vein thrombosis
Gastric varices
Pancreatic ca
23
Q

Signs of alcohol withdrawal

A

↑pulse
Low BP
Tremor, confusion, fits, hallucinations (delirium tremens)

24
Q

Contraindications for alcohol:

A

Driving, hepatitis, cirrhosis
Peptic ulcer
Carcinoid
Pregnancy

25
Q

Management for alcohol withdrawal

A 
Chlordiazepoxide for 3d
Diazepam
Vitamins
Prevention
Group therapy + self-help
Relapse: Acamprosate (to help intense anxiety, insomnia, craving), Disulfiram (treat chr alcohol dependence)

Gastroenterology (6 decks)

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