GI symptoms Flashcards by Dele Famokunwa

Causes of bloody diarrhoea

Vacular - ischaemic colitis
Infective
Inflammatory - UC, Crohn’s
Neoplastic - CRC, polyps

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Infective causes of bloody diarrhoea

Campylobacter
Shigella, salmonella
Pseudomembranous colitis
E.coli, amoeba

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Rx diarrhoea

Treat cause, oral/IV rehydration, codeine/loperamide

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Complications of psuedomembranous colitis

Paralytic ileus
Toxic dilatation
Multi-organ failure

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Drug causes of pseudomembranous colitis

Clindamycin
Cephalosporins
Ciprofloxacin
Co-amox

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Severe psuedomembrane colitis has at least 1 of

WCC > 15
CR >50% above baseline
Temp >38.5
Clinical/radiological evidence of severe colitis

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Rx psuedomembranous colitis

Stop causative abx
1. Metronidazole 400mg TDS PE
2. Vancomycine 125mg QDS PO
Severe - vanc 1st increase to 250mg

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Rx constipation

Drink more, increase fibre
Bulking - bran/cellulose/ispaghula husk
Osmotic - lactulose, MgSO4
Stimulant - Senna, docusate sodium

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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

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Rx IBS

Exclusion diets
Bulking agents for constipation and diarrhoea
Antispasmodics, amitriptyline, CBT

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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)

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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

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H pylori eradication therapy

PAC500 - PPI, amox 1g, clari 500mg BD

PMC250 - PPI, metron 400mg BD, clari 250mg

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Location of ulcer more in duodenum or GU

Duodenum

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Affect result of 13c breath test

Within 4 weeks of antibacterial treatment

- Within 2 weeks of PPI

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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