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Gastroenterology > GI Symptoms > Flashcards

GI Symptoms Flashcards

1
Q

Aim of BMI

A

18.5-25

Control quantity more important than quality

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2
Q

Advice given on diet

A 
Base meals on starch 
Eat enough fruit and vegetables
DO NOT Eat foods high in fat, salt or sugar
Eat some meat, fish, eggs and beans
Eat some milk and dairy products
Moderate alcohol use: <14U/wk
Supplements for folic acid at least 12w, Vit D
Increase portions of Oily fish
Decrease refined sugar
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3
Q

When should you avoid a diet?

A 
<5yo
Need for low residue or specific diet
Wt loss is expected
Dyslipidaemia, DM, obesity, constipation
Liver failure, chr pancreatitis, renal failure
Inc BP
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4
Q

Name 9 conditions you will find the in mouth

A 
Leucoplakia
Aphthous ulcers
Candidiasis
Gingivitis
Microstomia
Oral pigmentation
Teeth
Tongue: glossitis, macroglossia, tongue ca
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5
Q

What is Leucoplakia

A

White patch on the tongue

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6
Q

What is an Aphthous ulcer

A

Shallow, painful ulcers on the tongue

Caused by: Crohn’s coeliac trauma, lichen, infections

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7
Q

What is cheilitis

A

Angular stomatitis: fissuring of the mouth’s corners due to denture, candidiasis or Fe/Vit B12 deficiency

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8
Q

What are the tests for Dysphagia?

A 
FBC: anaemia
U+E: dehydration
CXR: mediastinal fluid
Upper GI endoscopy +/-1 biopsy
Video fluoroscopy
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9
Q

What are the specific conditions that contribute to dysphagia?

A 
Oesophagitis
Diffuse oesophageal spasm
Achalance
Benign oesophageal stricture
Oesophageal ca
CNS causes
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10
Q

Specific tests for Nausea and Vomiting

A

Ca, glucose, amylase
ABG: exclude hypochloraemia
Plain AXR: to exclude bowel obstruction
Upper GI endoscopy: if persistent vomiting

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11
Q

What does it mean if N+V

a) At morning
b) 1h post food
c) Preceded by loud gurgling
d) Vomiting that relieves pain

A

a) Pregnancy or ICP
b) Gastric stasis/gastroparesis
c) GI obstruction
d) Peptic ulcer

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12
Q

What are the symptoms of dyspepsia

A 
Epigastric pain related to hunger
\+/- bloating
Fullness after meals
Heartburn
ALARM symptoms
A – anaemia
L – Loss of weight
A – Anorexia
R – Recent onset / progressive symptoms
M – melaena / Haematemesis
S – swallowing difficulty
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13
Q

Rx for dyspepsia

A

Lifestyle: remove stress
H. pylori eradication: triple therapy x4w
Drugs to reduce acid: PPIs, H2 blockers
Drug-induced ulcers: stop the drugs

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14
Q

Name 3 types of diarrhoea

A

Steatorrhoea: fatty, increased gas, offensive smell, floating, hard-to-flush stools (giardiasis, coeliac)
Watery: osmotic (laxative induced), secretory or functional (IBS)
Inflammatory discharge: blood and pus (Crohn’s, UC, bacteria, parasites)

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15
Q

What are the risk factors for acute diarrhoea

A 
<2w = suspect gastroenteritis
HIV
Achlorhydria
Acid suppressants
Travel
Diet change
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16
Q

What are the risk factors for chronic diarrhoea

A

Diarrhoea alternates with constipation = IBS

Wt loss / nocturnal / anaemia = UC / Crohn’s

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17
Q

What causes bloody diarrhoea

A 
Campylobacter
Shigella / Salmonella
E.coli
UC/Crohn’s 
Colorectal ca
Polyps
18
Q

What causes Mucus

A

IBS
Colorectal ca
Polyps

19
Q

What causes frank pus

A

IBD, diverticulitis, firstula / abscess

20
Q

What causes explosive diarrhoea

A

Infectious: cholera / giardia / yersinia / rotavirus

21
Q

What are the signs and symptoms in diarrhoea

A

Dehydration (dry mucous membranes, dec skin turgor)
Increased CRT = shock
Fever / wt loss / clubbing / anaemia / oral ulcers / rashes or abdo mass/scars
Goitre / hyperthyroid signs

22
Q

What are the criteria for constipation?

A

Rome criteria – >2 symp during bowel movements (BM)

  • Straining for >25% of BMs
  • Lumpy or hard stools in >25% of BMs
  • Sensation of incomplete evacuations for >25% BMs
  • Sensation of anorectal obstruction or blockage for >25% of BMs
  • Manual manoeuvres to facility at least 25% of BMs
  • Fewer than 3BMs for week
23
Q

What questions do you ask the pt who is constipated?

A 
Frequency, nature, consistency of stools
Blood / mucus?
Diarrhoea alternating with constipation
Pain
Diet
Drugs
24
Q

What are the tests for constipation?

A

Blood: FBC, ESR, U+E, Ca2), TFT
Sigmoidoscopy
Ba enema / colonoscopy

25
Q

What is the Rx of constipation

A

Drink + diet/exercise
Senna +/- bulking agent lactulose, Ispaghula husk, methylcellulose, sterculia
Stimulant laxative: increase intestinal motility, senna, bisacodyl, glycerol
Stool softeners: arachis oil, liquid paraffin
Osmotic laxatives: lactulose, Mg or Na salts, Phosphate enemas
Mdt

26
Q

Name the types of Jaundice

A 
Pre-hepatic
Hepatocellular
Cholestatic/obstructive
Conjugated
Unconjugated
27
Q

What are the specific tests of Jaundice

A

Urine: bilirubin
Bloods: FBC, clotting, film, reticulocyte count, Coomb’s test, haptoglobins, malaria parasites, Paul Bunnel (EBV)
Chem: U+E, LFT, ALT, AST, alk phos, ggt, total protein, albumin, paracetamol level
Microbiology: leptospira, hep a, b, c
Radio: US, ERCP, MRCP, Liver biopsy, CT/MRI

28
Q

Name common causes of Upper GI bleeding

A 
Peptic ulcers
Mallory-Weiss tear
Oesophageal varices
Gastritis/gastric erosions
Drugs: NSAIDs, aspirin, steroids, thrombolytics, anticoagulants
Oesophagitis
Duodenitis
Malignancy
29
Q

Rare causes of Upper GI bleeding

A 
Bleeding disoders
Portal HT gastropathy
Aorto-enteric fistula
Angiodysplasia
Haemobilia
Meckel’s diverticulum
Peutz-Jeghers syndrome
Osler-Weber-Rendu syndrome
30
Q

What are the criteria for GI bleeds?

A 
Age
Shock: systolic BP + pulse rate
Comorbidity
Post endoscopy diagnosis
Signs of recent haemorrhage
31
Q

How do u manage GI bleeds?

A

2 large bore IV cannulae: FBC, U+E, LFT, clotting, give blood crossmatched/fluids
Urine catheter, monitor ourly urine output
CXR, ECG, ABG
?CVP line to monitor and guide fluid replacement
Ransfuse until haemodynamically stable
Correct clotting abnormalities
Monitor pulse, bp, cvp
Omeprazole
Urgent endoscopy
4h later: re-examine + ?FFP + ?Hb >100gL
Nil by mouth

32
Q

What is cirrhosis?

A

Irreversible liver dmg, where hepatic architecture is lost with bridging fibrosis and nodular regeneration

33
Q

What are the signs of cirrhosis – chronic liver disease?

A 
Leuconychia (from hypoalbuminaemia)
Terry’s nails
Clubbing
Palmar erythema
Hyperdynamic circulation
Dupuytren’s contracture
Spider naevi
Xanthelasma
Gynaecomastia
Atrophic testes
Loss of body hair
Parotid enlargement
Hepatomegaly
34
Q

Complications of Hepatic failure

A 
Coagulopathy, encephalopathy + confusion/coma
Hypoalbuminuria: oedema, leukonychia
Sepsis: pneumonia, septicaemia
Spontaneous bacterial peritonitis
hypoGly
35
Q

Complications for portal HT

A

Splenomegaly
Portosystemic shunt incl oesophageal varices
Caput medusae

36
Q

What are the specific tests for Cirrhosis

- What inc in these tests?

A 
LFT: bilirubin, AST, ALT, Alk phos, gammaGT
-	All increase
Hypersplenism seen: dec WCC + dec platelets + dec albumin =/- inc INR
Ferritin, Iron/total Fe-binding capacity
Hepatitis serology
Immunoglobulins
Autoantibodies (ANA, AMA, SMA)
Alpha-feto protein
Caeruloplasmin
Alpha-antitrypsin
Liver US + duplex: small liver or hepatomegaly, splenomegaly, focal liver lesions, hepatic vein thrombus, asicits
MRI: caudate lobe size inc
Ascitic tap for MC+S, neutrophils
Liver biopsy
37
Q

General management for cirrhosis

A 
Good nutrition
Alcohol absintence
Avoid NSAIDs, sedatives, opiates
Colestyramine
Consider US +/- alpha-fetoprotein every 3-6mo
38
Q

Specific management for cirrhosis

A 
High dose ursodeoxycholic acid in PBC
Penicillamine in Wilson’s
If ascites:
-	Bed rest
-	Fluid restriction
-	Low-salt diet
-	Spironolactone 100mg/24h
-	Chart daily wt + wt loss
-	Add furosemide <120mg/24h
-	U+E
If spontaneous bacterial peritonitis
-	Cefotaxime or tazocin
-	Metronidazole until sensitivities known
39
Q

Causes of cirrhosis

A

Chronic alcohol abuse
Chronic HBV or HCV infection
Genetic: Wilson’s, alpha1 antitrypsin deficiency, haemochromatosis
Hepatic vein events (Budd-Chiari)
Non-alcoholic steatohepatitis (NASH)
Autoimmunity: PBC, Primary sclerosing cholangitis, autoimmune hep
Drugs: amiodarone, methyldopa, methotrexate

40
Q

What is the grading system of Cirrhosis?

A

To evaluate the risk of variceal bleeding

Child-Pugh grading

41
Q

What is the link of cirrhosis to deteriorating renal function

A

Decrease hepatic clearence of immune complexes lead to trapping in kidney
Thus IgA nephropathy +/- hepatic glomerulosclerosis

Gastroenterology (6 decks)

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