GI Misc Flashcards
H. pylori treatment abx in peptic ulcers?
- Omeprazole
- Metronidazole
- Clarithromycin
How do to investigate H. Pylori in ulcers?
Stool antigen test, C13 urea test and endoscopy
Name PPi. what does it do
lansoprazone. long term reduction in HCl acid release
Name a H2 blocker. what do they do
rantidine. suppress gastric acid release
what obstructions can lead to appendicitis?
food matter, adhesions, lymphoid hyperplasia which cause mucosal secretions and cause intra-luminal pressure to rise
Appendicitis presentation?
- Abdo pain central -> RIF
- Vomiting
- Diarrhoea
- Loss of appetite
- Pt prefers to have legs bent, not lying straight - guarding
Peritonitis -causes?
perfortation of GI tract. eg. dialysis, post op, spontaneous bacterial, bile leak, pregnancy blood rupture
Peritonisis - symptoms
tenderness, pain, nausea, chills, rigor, vomit, fever, shoulder pain, silent abdomen
Why do an xray for peritonitis /
ERECT X-RAY. look for air under the diaphram. also location of infection using USS.
What is diverticular disease? Who is it n=most ocmmon it?
Diverticula and complications (eg. diverticulitits - inflammation). most common in older population and low fibre diets
What abx do you give for management of Diverticular disease?
ciprofloxacin & metronidazole
Acute diverculitis?
sudden attack of swlling in diverticula. left ileac fossa region pain, fever, tachycardia
Symptoms of diverticular disease?
Asymptomatic in 95% of cases! Symptoms
that do occur relate to luminal narrowing; pain, constipation,
bleeding or diverticulitis. Severe cases; left iliac fossa pain,
fever, nausea.
What causes diverticular disease?
Unknown. ?Related to a low fibre diet -> Increased
intracolonic pressure -> herniation at sites of weakness? most common in older people
difference between direct and indirect inguinal hernia?
Direct - medial to IEA in Heissenback triangle. only passes through superficial inguinal ring
indirect - most common. lateral to IEA. passes through deep and superficial inguinal rings.
How do you treat crohn’s?
stop smoking,
Mild attacks: Prednisolone
Severe: IV hydrocortisone
5-ASA analogues (mesalazine) -> reduces relapses
Corticosteroids -> induce remission/treat relapses
Surgery
is crohn’s improved by smoking?
no. UC is decreased by smoking. Crohn’s is increased.
What does GALS stand for in crohns?
Only GALS can be CROHNS
Granulomas
All Layers and Levels
Skip Lesions
Why do an x-ray in IBS?
to exclude toxic dilation of colon and to see the progression of either UC or crhons
What are the HCV antivirals?
Velpatasvir/sofosbuvir
What are the symptoms of encephalopathy? (brain damage)
confusion, drowsiness, disorientated
Treatment for paracetamol overdose?
N-Acetyl-Cysteine
What is the flapping tremour?
asterixis
Symptoms of fulminant liver failure?
Encephalopathy – confusion, drowsiness, disorientated
Asterixis
Jaundice
Can have presentation of sepsis
Treatment for encephalopathy?
lactulose
what are the chronic liver conditions?
Infectious (Hep B, Hep C)
Autoimmune (AIH, PSC)
Metabolic (iron – haemochromatosis, copper –
Wilson’s, alpha-1-antitrypsin)
Alcoholic liver disease
Non Alcoholic Fatty Liver Disease (NAFLD)
Name a NOAC?
apixibam
Symptoms of overanti-coagulating
burising, bleeding, melena, epistaxis, haematemesis, haemoptysis,
HCC - liver cancer? summar?
risks - hep B, hep C, cirrhosis,
Presentation - right hypochondric pain, anorexia, fatigue, jaundice, weight loss, ascite
Dx - contrast CT showing mass, liver biopsy,
mets - liver, bone, lungs
Acute pancreatitis summary?
causes, presentaton, signs, bloods, urinalysis, scoring system/
treatment?
complication
I GET SMASHED - causes
Presentation - anorexia, epigastric pain radiates to back and relieved by sitting forward, jaundice, guarding and rigidity,nausea,
signs - cullens sign and grey turner’s
bloods - increased amylase, lipase and CRP
urinalysis - increased amylase
USS - gall stones,
contrast CT
Glasgow scoring system, APACHE II
TX- NSAIDs, metronidazole, fluids, O2, ABX, analgesia
complications - DM
Haemochromatosis summary?
autosomal recessive condition. HFE mutation on chromosome 6 causes a mutation on the transferrin receptor leading to increased absorption and deposits.
SX - bronze diabetes, hepatomegaly, tiredness, cardiac failure, cirrhosis, cardiomyopathy
signs - increased iron and ferritin
TX - venesection and desferrioxamine
Wilson’s disease summary?
Children - cirrhosis
adults - tremour/dysphagia, kayser-fleischer rings in eyes.
Cause - autosomal recesive condition on chomosom 13 causing impaired excretion of copper in bile. copper in liver and CNS
IX - serum caeruloplasmin, biopsy for cirrhosis ans hep
MRI - cerebella/basal ganglia degeneration
Tx - Penicillamine to excrete copper, Reduce copper intake
Alpha-1-anti-trypsin deficiency? summary
autosomal recessivelcondition on chromosome 14. accumulation of alpha-1-antitrypsin in
hepatocytes and lack of it in serum causing lack of protease inhibition in alveoli causing damage to alveoli and subsequent emphysema.
Tx - manage COPD ad cirrhosis and liver transplant
children - cirrhosis
adults - SOD, dysponoea
Low serum alpha-1-anti-trypsin.
Biliary colic?
gallstone impacted in the gallbladder neck and temporarily dislodged into the gallbladder
Acute cholecystitis?
Gallstone stuck in gallbladder neck and causes inflammation due to obstruction in drainage.
SX -seveere RUQ pai, vomitting, nausea, fever, NO JAUNDICE
