GI Symptoms Flashcards
Aim of BMI
18.5-25
Control quantity more important than quality
Advice given on diet
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
When should you avoid a diet?
<5yo Need for low residue or specific diet Wt loss is expected Dyslipidaemia, DM, obesity, constipation Liver failure, chr pancreatitis, renal failure Inc BP
Name 9 conditions you will find the in mouth
Leucoplakia Aphthous ulcers Candidiasis Gingivitis Microstomia Oral pigmentation Teeth Tongue: glossitis, macroglossia, tongue ca
What is Leucoplakia
White patch on the tongue
What is an Aphthous ulcer
Shallow, painful ulcers on the tongue
Caused by: Crohn’s coeliac trauma, lichen, infections
What is cheilitis
Angular stomatitis: fissuring of the mouth’s corners due to denture, candidiasis or Fe/Vit B12 deficiency
What are the tests for Dysphagia?
FBC: anaemia U+E: dehydration CXR: mediastinal fluid Upper GI endoscopy +/-1 biopsy Video fluoroscopy
What are the specific conditions that contribute to dysphagia?
Oesophagitis Diffuse oesophageal spasm Achalance Benign oesophageal stricture Oesophageal ca CNS causes
Specific tests for Nausea and Vomiting
Ca, glucose, amylase
ABG: exclude hypochloraemia
Plain AXR: to exclude bowel obstruction
Upper GI endoscopy: if persistent vomiting
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) Pregnancy or ICP
b) Gastric stasis/gastroparesis
c) GI obstruction
d) Peptic ulcer
What are the symptoms of dyspepsia
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
Rx for dyspepsia
Lifestyle: remove stress
H. pylori eradication: triple therapy x4w
Drugs to reduce acid: PPIs, H2 blockers
Drug-induced ulcers: stop the drugs
Name 3 types of diarrhoea
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)
What are the risk factors for acute diarrhoea
<2w = suspect gastroenteritis HIV Achlorhydria Acid suppressants Travel Diet change
What are the risk factors for chronic diarrhoea
Diarrhoea alternates with constipation = IBS
Wt loss / nocturnal / anaemia = UC / Crohn’s
What causes bloody diarrhoea
Campylobacter Shigella / Salmonella E.coli UC/Crohn’s Colorectal ca Polyps
What causes Mucus
IBS
Colorectal ca
Polyps
What causes frank pus
IBD, diverticulitis, firstula / abscess
What causes explosive diarrhoea
Infectious: cholera / giardia / yersinia / rotavirus
What are the signs and symptoms in diarrhoea
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
What are the criteria for constipation?
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
What questions do you ask the pt who is constipated?
Frequency, nature, consistency of stools Blood / mucus? Diarrhoea alternating with constipation Pain Diet Drugs
What are the tests for constipation?
Blood: FBC, ESR, U+E, Ca2), TFT
Sigmoidoscopy
Ba enema / colonoscopy
What is the Rx of constipation
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
Name the types of Jaundice
Pre-hepatic Hepatocellular Cholestatic/obstructive Conjugated Unconjugated
What are the specific tests of Jaundice
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
Name common causes of Upper GI bleeding
Peptic ulcers Mallory-Weiss tear Oesophageal varices Gastritis/gastric erosions Drugs: NSAIDs, aspirin, steroids, thrombolytics, anticoagulants Oesophagitis Duodenitis Malignancy
Rare causes of Upper GI bleeding
Bleeding disoders Portal HT gastropathy Aorto-enteric fistula Angiodysplasia Haemobilia Meckel’s diverticulum Peutz-Jeghers syndrome Osler-Weber-Rendu syndrome
What are the criteria for GI bleeds?
Age Shock: systolic BP + pulse rate Comorbidity Post endoscopy diagnosis Signs of recent haemorrhage
How do u manage GI bleeds?
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
What is cirrhosis?
Irreversible liver dmg, where hepatic architecture is lost with bridging fibrosis and nodular regeneration
What are the signs of cirrhosis – chronic liver disease?
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
Complications of Hepatic failure
Coagulopathy, encephalopathy + confusion/coma Hypoalbuminuria: oedema, leukonychia Sepsis: pneumonia, septicaemia Spontaneous bacterial peritonitis hypoGly
Complications for portal HT
Splenomegaly
Portosystemic shunt incl oesophageal varices
Caput medusae
What are the specific tests for Cirrhosis
- What inc in these tests?
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
General management for cirrhosis
Good nutrition Alcohol absintence Avoid NSAIDs, sedatives, opiates Colestyramine Consider US +/- alpha-fetoprotein every 3-6mo
Specific management for cirrhosis
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
Causes of cirrhosis
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
What is the grading system of Cirrhosis?
To evaluate the risk of variceal bleeding
Child-Pugh grading
What is the link of cirrhosis to deteriorating renal function
Decrease hepatic clearence of immune complexes lead to trapping in kidney
Thus IgA nephropathy +/- hepatic glomerulosclerosis
