GI: Presentations Flashcards

1
Q

What is the differential diagnosis for acute epigastric pain?

A
  • acute pancreatitis
  • gastritis/duodenitis
  • peptic ulcer disease
  • perforated peptic ulcer
  • oesophagitis (GORD)
  • ruptured AAA
  • MI
  • mesenteric ischaemia
  • biliary disease
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2
Q

In a Pt with acute epigastric pain, which drugs should you particularly ask about?

A

Drugs that can induce peptic ulcer disease:

  • NSAIDs
  • steroids
  • bisphosphonates
  • salicylates

Drugs that can induce acute pancreatitis:

  • sodium valproate
  • steroids
  • thiazides
  • azathioprine
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3
Q

A Pt presents with haematemesis. What are the 4 most common causes? Suggest some rarer causes.

A

Most common:

  1. Oesophagitis/gastritis/duodenitis
  2. Bleeding peptic ulcer
  3. Oesophageal varices
  4. Mallory-Weiss tear

Rarer causes:

  1. Oesophageal cancer
  2. Gastric cancer
  3. Boerhaave’s syndrome
  4. Bleeding diathesis
  5. Trauma to oesophagus/stomach
  6. Vascular angiodysplasia in oesophagus/stomach
  7. Arterio-venous malformation
  8. Aorto-enteric fistula
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4
Q

What scoring system is used to determine severity of haematemesis?

A

ROCKALL SCORE: used to predict risk of rebleeding and mortality in Pts with upper GI haemorrhage, and as an indicator of severity to guide urgency of endoscopy.

Initial score (pre-endoscopy):

  • age: 60-79yrs (1 point); >80 yrs (2 points)
  • shock: HR >100bpm (1 point); systolic BP <100mmHg (2 points)
  • comorbidities: heart failure, ischaemic disease, any major comorbidities (2 points); renal or liver failure, disseminated malignancy (3 points)

Final score (post-endoscopy):

  • stigmata of recent haemorrhage: blood in upper GI tract, adherent clot, visible or spurting BV (2 points)
  • diagnosis: mallory-weiss tear or no lesions identified (0 points); all other diagnoses (1 point); malignancy of upper GI tract (2 points)
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5
Q

In which 4 cases should a Pt presenting with haematemesis have an emergency OGD?

A
  1. suspicion of continuing upper GI bleeding
  2. suspicion of oesophageal varices as cause of bleeding
  3. initial Rockall score 3+
  4. Pt has aortic graft - suspect aorto-enteric fistula until proven otherwise
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6
Q

What investigation should be performed in a Pt presenting with haematemesis if OGD has failed to reveal source of bleeding?

A

angiography

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7
Q

How would you manage a Pt presenting ith ongoing haematemesis?

A

A-E assessment

  1. place 2 wide-bore cannulae and send bloods at same time
  2. fluid resuscitation, up to 2L normal saline
  3. activate major haemorrhage protocol:
    - give O- RBCs and FFP in at least 2:1 ratio (via blood warmer)
    - tranexamic acid (e.g. 1g bolus in non-traumatic bleeding)
    - platelet concentrates to maintain levels >100 x 10^9
    - repeat coagulation screens after every 4 units to determine need for other blood products, e.g. cryoprecipitate
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8
Q

A Pt presents with acute RUQ pain. What is the diffferential diagnosis?

A

Hepatobiliary system:

  1. BILIARY COLIC
  2. CHOLECYSTITIS
  3. ASCENDING CHOLANGITIS
  4. hepatitis
  5. cholangiocarcinoma

Other GI conditions:

  1. DUODENAL ULCER
  2. PANCREATITIS
  3. Small bowel obstruction

Non-GI conditions:

  1. Basal pneumonia
  2. pyelonephritis
  3. aortic dissection
  4. ruptured AAA
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