GI FCM Flashcards
How would acute cholecystitis present?
murphy’s sign - pain radiates to back or right shoulder
fever
nausea & vomiting
How would cholelithiasis present?
RUQ pain - severe pain
nausea and vomiting
similar to acute cholecystitis
look out for:
evidence about stones
female obese/overweight in her 40s
How would you investigate cholecystitis?
Bloods - CRP, WCC, Bilirubin, LFTs
Abdominal ultrasound
How would you manage acute cholecystitis?
fasting to help relieve the gallbladder and allow it to heal the gallbladder
pain for analgesia
IV fluids and antibiotics
How would you manage gallstones/cholelithiasis?
diclofenac for severe pain or IM opioid
removal of stones laparoscopic cholecystectomy
What are key things in a Hepatitis presentation
dark urine/pale stools abdo pain loss of appetite jaundice high alcohol consumption patient has had a scan
How is hepatitis investigated?
Bloods - LFTs, FBC, CRP/ESR
abdo US
liver biopsy/serology
How is hep A managed?
No Tx necessary
bedrest, hydration & pain relief
metoclopramide for N&V
itching relieved by using chlorphenamine or corticosteroids
How is Hep B managed?
pain relief & hydration
antiemetics
chlorapenamine/corticosteroids for itching
anti-viral if chronic
vaccinations act as a preventative measure
How is Hep C managed?
antiviral medications to treat both acute and chronic hepatitis C
How is Hep D managed?
a-interferon can be used to treat HepD
prevented through vaccinated against HepB
How is autoimmune hepatitis managed?
corticosteroids like prednisolone/budesonide used to treat autoimmune hepatitis
Azathioprine (Imuran) - suppresses immune system
other immunosuppressive drugs such as mycophenolate, tacrolimus and cyclosporin
How does cirrhosis present?
Jaundice - sclera abnormal bruising peripheral oedema ascites variceal bleeding confusion - hepatic encephalopathy spider navei palmar erythema and muscle wasting
Things to look out for in cirrhosis history?
chronic alcohol abuse
overweight/obese
having viral hepatitis
How is cirrhosis managed?
Tx for alcohol dependency weight loss & BM control antivirals if viral hepatitis present pain relief chloraphenamine/corticosteroids for itch
How does hepatic neoplasms present?
jaundice pale stools ascites unintentional weight loss loss of appetite upper abdo pain nausea & vomiting
How is hepatic neoplasms investigated?
Blood tests - LFTs
Liver biopsy
imaging - US/CT
What does management of hepatic neoplasms involve?
surgery - remove tumour if the liver is still functional and the cancer hasn’t metastasised
- liver transplant if too severe
localised treatments - chemo/radiotherapy, immunotherapy and palliative care
How does acute pancreatitis present?
epigastric abdo pain - worse after eating and radiated to your back - worse when moving and better when in the fetal position
nausea and vomiting
abdominal tenderness - rebound/guarding
Abdominal distension
Cullen’s signs = bluish colour around umbilicus
tachycardia and hypotension - due to shock
How is A.pancreatitis investigated?
blood test - elevation of lipase and amylase
Imaging such as CT and MRI or US
How is A.pancreatitis managed?
Initial Tx
- rescusitation with IV fluids
- supplemental O2
- pain relief
- Abx if infection is suspected
- Early nutritional support - enteral feeding
- endoscopic retrograde cholangiopancreatography or cholecystectomy
What does the presentation of pancreatic neoplasms include?
painless jaundice itchy skin weight loss light stools and dark urine fatigue and weight loss
How are pancreatic neoplasms investigated?
Ultrasound imaging
tissue biopsy
blood tests - amylase and lipase levels and CA19-9
How are pancreatic neoplasms managed?
surgery to remove the tumour
chemo/radiotherapy (prior/adjunct and post surgery)
How does a hiatus hernia present?
chest/epigastric pain - worse when lying down or leaning forward difficulty swallowing belching vomiting SOB
How is hiatus hernia investigated?
X-ray of upper GI tract - barium enema
Upper GI endoscopy
oesophageal manometry
How is hiatus hernia managed?
omeprazole, H2-receptor blockers and PPIs
laparoscopic surgery may be required
lifestyle changes
what is Gastritis presentation like?
burning sensation/pain
nausea and vomiting
belching/indigestion
weight loss/loss of appetite
Investigations of gastritis?
H.pylori testing
stool tests
endoscopy
blood test - FBC (check for anaemia)
How is gastritis managed?
lifestyle changes - avoid alcohol, salt, caffeine and change eating habits and smoking cessation
medications
- omeprazole
- stop NSAIDs
what is most characteristic of peptic ulcer disease?
dypepsia symptoms - bloating/belching/nausea&vomiting
melena stools
What is the management of peptic ulcer disease?
Omeprazole
If H.pylori present - give eradication therapy
cytoprotective agents - misoprostol and sucralfate
Gastric neoplasms presentation
haematemesis nausea and vomiting fevers and weight loss unexplained weight loss dyspepsia jaundice in some cases
How are gastric neoplasms investigated?
Upper GI endoscopy
biopsy of stomach
CT/X-rays (masses and any metastasis)
bloods
