GI symptoms Flashcards
Causes of bloody diarrhoea
Vacular - ischaemic colitis
Infective
Inflammatory - UC, Crohn’s
Neoplastic - CRC, polyps
Infective causes of bloody diarrhoea
Campylobacter
Shigella, salmonella
Pseudomembranous colitis
E.coli, amoeba
Rx diarrhoea
Treat cause, oral/IV rehydration, codeine/loperamide
Complications of psuedomembranous colitis
Paralytic ileus
Toxic dilatation
Multi-organ failure
Drug causes of pseudomembranous colitis
Clindamycin
Cephalosporins
Ciprofloxacin
Co-amox
Severe psuedomembrane colitis has at least 1 of
WCC > 15
CR >50% above baseline
Temp >38.5
Clinical/radiological evidence of severe colitis
Rx psuedomembranous colitis
Stop causative abx
1. Metronidazole 400mg TDS PE
2. Vancomycine 125mg QDS PO
Severe - vanc 1st increase to 250mg
Rx constipation
Drink more, increase fibre
Bulking - bran/cellulose/ispaghula husk
Osmotic - lactulose, MgSO4
Stimulant - Senna, docusate sodium
Rome criteria IBS
Abdo discomfort/pain >1week + 2 of: -relieved by defecation -change in stool frequency/form \+2 of: -urgency -incomplete evacuation -abdo bloating -mucous PR -worsening symptoms after food
Rx IBS
Exclusion diets
Bulking agents for constipation and diarrhoea
Antispasmodics, amitriptyline, CBT
Mx new onset dyspepsia (conservative steps)
OGD if >55 or ALARMS features
Conservative for 4 weeks:
-Stop drugs (NSAIDS, CCBs, steroids, bisphophonates)
-Lose weight, stop smoking+alcohol
-Antacids (magnesium trisilicate, gaviscon)
Test for H.pylori (1st line) and subsequent management
Breath/serology/stool antigen
Breath test first line, serology remains +ve after eradication
+ve: eradication therapy, consider OGD if no improvement
-ve: PPI trial for 4weeks, OGD if not improvement
H pylori eradication therapy
PAC500 - PPI, amox 1g, clari 500mg BD
PMC250 - PPI, metron 400mg BD, clari 250mg
Location of ulcer more in duodenum or GU
Duodenum
Affect result of 13c breath test
- Within 4 weeks of antibacterial treatment
- Within 2 weeks of PPI
What is Zollinger Ellison syndrome and its location?
Ix and Rx
Gastrinoma (gastrin secreting adenoma)
Found in pancreas
Increased fasting gastrin levels
High dose PPI
Location of gastric ulcers
Lesser curvature
Elsewhere often malignant
Peptic ulcer Rx (not H. pylori)
Full dose acid suppression for 1-2 months, low dose acid suppression
Extra oesophageal GORD symptoms
Nocturnal asthma
Chronic cough
Laryngitis, sinusitis
Rx GORD
Conservative - as for dyspepsia
Medical - PPI na d H2RA
Surgical - Nissen fundoplication
Indications for surgery in GORD
All 3 of;
- severe symptoms
- refractory to medical therapy
- confirmed reflux
Causes of dysphagia
Inflammatory
-tonsilitis, oesophagitis, ulcer
Mechanical block
-Luminal: FB, benign stricture (Plumer Vinson web)
-Mural: malignant stricture, pharyngeal pouch
-Extra mural: lung ca, hernia, goitre
Motility disorder
-Local: achalasia, oesophageal spasm, nutcracker oesophagus, bulbar palsy
-Systemic: systemic sclerosis, MG
Ix dysphagia
bloods, CXR, OGD
Barium swallow, oesophageal manometry
Cause of achalasia and Ix findinds
Degeneration of myenteric plexus
Ix:
-Ba swallow - dilated tapering oesophagus, bird’s beak
-CXR - widened mediastinum
-Manometry - failure to relax + reduced peristalsis
Complication and Rx achalasia
Complication - Oesophageal SCC
Med - CCBs, nitrates
Intervention - endoscopic balloon dilation, botulinum toxin
Surg - Heller’s cardiomyotomy
Ix and Rx pharngeal pouch/Zenker’s diverticulum
barium swallow
excision, endoscopic stapling
Ix on diffuse oesophageal spasm and symptoms
Barium swallow shows corkscrew oesophagus
Intermittent chest pain
Rectal bleeding differential
DRIPING A Diverticulae Rectal - Haemorrhoids Infection Polyps Inflammation - UC, Crohns Neoplasm Gastric/upper bowel bleeding Angio - ischaemic colitis, HHT
Cause of upper GI bleed
PUD, erosion, oesophagitis
Varices
Mallory weiss tear
Ca stomach/oesophagus
Scores used in upper GI bleed
Rockall score - prediction of rebleeding and mortality
Glasgow Blatchford score (GBS) - chance of needing medical attention
Criteria of GBS
HUB (Hb, urea, BP) + other parameters (pulse>100, melena, syncope, hepatic disease, cardiac failure)
Rockall scoring features
ASC-ED: Age, shock, co-morbidities, endoscopic signs of bleeding, diagnosis
8 risk of death
Pre-endoscopy - ASC, if over 3 indication for surgery
Post-endoscopy - ASC ED, if over 6 indication for surgery
Causes of portal HTN
Pre-hepatic: portal vein thrombosis
Hepatic: cirrhosis (80% in UK), schisto (commonest worldwide), sarcoidosis
Post hepatic - Budd-chiari, constrictive pericarditis
Bleed prevention in oesophageal varices
Primary - B blocker, endoscopic banding
Secondary - B blocker, banding, TIPSS (transjugular intrahepatic porto-systemic shunt)
Acute management of upper GI bleed - variceal
ABCDE - transfuse, correct clotting
Offer endoscopy with 24h of admission to all upper GI bleeds
Variceal bleed
1. terlipressin IV + prophylactic abx
2. banding/sclerotherapy
3. Sengstaken-Blakemore tube (balloon tamponade)
Acute management of upper GI bleed - non-variceal
Adrenaline, thermal/laser coagulation, fibrin glue, endoclips
Post endoscopy for upper GI bleed Mx
Omeprazole, NMB 24h, H pylori test
