Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > GI - Upper GI Bleed, Small Bowel Obstruction, Large Bowel Obstruction, Pseudo-obstruction, Diverticular Disease and Diverticulitis, Gastritis > Flashcards

GI - Upper GI Bleed, Small Bowel Obstruction, Large Bowel Obstruction, Pseudo-obstruction, Diverticular Disease and Diverticulitis, Gastritis Flashcards

1
Q

Upper GI bleed - where is the bleed from?

A

Oesophagus

Stomach

Duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Upper GI bleed - what defines an upper GI bleed from a lower GI bleed?

A

Defined as an UGIB if bleeding is from a source proximal to the LIGAMENT of TREITZ

Ligament of Treitz is a suspensory ligament of the duodenum, and marks the boundary between the upper and lower GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Upper GI bleed - what are some causes?

A
  1. Oesophageal varices
  2. Mallory-Weiss tear - tear of oesophageal mucous membrane
  3. Ulcers or stomach or duodenum
  4. Cancers of stomach or duodenum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Upper GI bleed - what is the common presentation?

A
  1. Haematemesis - ‘COFFEE GROUND’ vomit, caused by digested blood
  2. Melaena - tar like, black, greasy, digested blood
  3. Haemodynamic instability due to blood loss so:
    hypotensive
    tachycardic
    other shock signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Upper GI bleed - what is the scoring system used on initial presentation, and what is taken into account?

A

Glasgow-Blatchford Score

Establishes risk of having upper GI bleed

Score>0 high risk of UGIB

Features taken into account:
Decreased Hb
INCREASED UREA
BP
HR
Melaena
Syncope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Upper GI bleed - why does urea increase?

A

Blood in GI tract broken down by acid and digestive enzymes, and one of the breakdown products is urea, which is then absorbed in the intestines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Upper GI bleed - what is the rockall scoring?

A

Comprised of both a pre and post endoscopy score - added together for overall value

Pre-endoscopy score:
Age 0-2
Shock 0-2
Co-morbidity 0-3

Comprised of two sections:

Post endoscopy score:
Section1,
Diagnosis 0-2
Bleeding 0-2

Section 2,
A - Age
B - BP
C - Comorbidity
D - Diagnosis
E - Endoscopic Findings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Upper GI bleed - what is the main diagnostic and therapeutic investigation?

A

Upper GI endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Upper GI bleed - what are the other bedside, bloods, and imaging you can do?

A

Bedside:
Obs
ECG
Monitor urine output

Bloods:
FBC
U&E
LFTs
VBG/ABG
Group and save with cross match

Imaging:
Chest X-ray - look for oesophageal perforation, aspiration, free air under diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Upper GI bleed - what do ‘group and save’ and ‘crossmatch’ mean?

A

Group and save - lab checks patient blood group, keeps sample in case need to match blood to it

Crossmatch - lab finds blood, tests it is compatible, kept in fridge to be used if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Upper GI bleed - what is the management?

A

ABATED

A - ABCDE resuscitation

B - Bloods (FBC for Hb, U&E for urea)

A - Access, cannulas

T - Transfuse

E - Endoscopy

D - Drugs (stop anticoagulants and NSAIDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Small Bowel Obstruction - what is it?

A

The passage of food, fluids and gas through small intestines becomes blocked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Small Bowel Obstruction - what are the causes?

A

Adhesions - following surgery (most common cause)

Hernias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Small Bowel Obstruction -what are the clinical features?

A

Diffuse, central abdo pain, can be colicky

N+V - typically bilious vomiting

Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Small Bowel Obstruction - what are the findings on examination?

A

‘Tinkling’ bowel sounds

Abdo distension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Small Bowel Obstruction - what are the investigations to do?

A

Abdo XRAY - generally 1st line

CT - definitive investigation, more sensitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Small Bowel Obstruction - what do you see on abdo XRAY?

A

Distended small bowel loops with fluid levels

Dilated if small bowel > 3cm in diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Small Bowel Obstruction - what is the management?

A

Initially:

  • NBM
  • IV fluids
  • NG tube with free drainage

Some patients settle with conservative management, but otherwise will require surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Large Bowel Obstruction - what is it?

A

The passage of food, fluids and gas, through large intestines become blocked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Large Bowel Obstruction - what are the causes?

A

Tumour - colon carcinoma

Volvulus

Diverticular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Large Bowel Obstruction - what are the clinical features?

A

Abdo pain, colicky

Absence of flatus or stools

N+V

22
Q

Large Bowel Obstruction - what are the investigations?

A

Abdo XRAY - usually 1st line

CT - high sensitivity and specificity

23
Q

Large Bowel Obstruction - what do you see on an abdo XRAY, and what are the diagnostic diameter parameters?

A
  1. Dilatation:
    - Caecum 10-12cm
    - Ascending colon 8cm
    - Recto-sigmoid 6.5cm

Diameters greater than these is diagnostic for obstruction

  1. Presence of free intra-peritoneal gas indicates colonic perforation
24
Q

Large Bowel Obstruction - what is the initial management and perforation management?

A

Initial steps:

  • NBM
  • IV fluids
  • NG tube with free drainage
  • if cause does not require surgery, trial conservative Rx for 72 hours, if no resolution, further management required

If perforation suspected:
Emergency surgery
IV antibiotics

25
Q

SBO and LBO - which occurs first in which obstruction:
Vomiting?
Constipation

A

Vomiting - occurs earlier in small bowel obstruction

Constipation - occurs earlier in large bowel obstruction

26
Q

Pseudo-obstruction - what is it?

A

Condition where intestinal dilatation and symptoms resemble an obstruction, but on examination there is no obstruction

27
Q

Pseudo-obstruction - what is the pathophysiology behind it?

A

Mechanism unknown, but thought to be due to an interruption of the autonomic nerve supply to the colon, resulting in absence of smooth muscle action in bowel wall

28
Q

Pseudo-obstruction - what are some causes?

A

Electrolyte imbalance - hypercalcaemia

Meds - opioids, CCBs, anti-depressants

Recent surgery

Neurological disease - Hirschsprung’s disease, Parkinson’s, MS

29
Q

Pseudo-obstruction - what are the clinical features?

A

Most patient’s present with the clinical features of SBO and LBO:

Abdo pain
Abdo distension
Constipation
N+V - later feature

30
Q

Pseudo-obstruction - what are the investigations?

A

Bloods:
U&Es - check for electrolyte disturbances

Abdo XRAY

Abdo CT with contrast

31
Q

Pseudo-obstruction - what is the management?

A
  • NBM
  • IV fluids
  • NG tube inserted to aid decompression
  • If not resolved in 24-48h, then endoscopic decompression

Surgery

32
Q

Diverticular Disease - what is a diverticulum?

A

Outpouching of gut wall

33
Q

Diverticular Disease - where is the usual site of diverticula?

A

Usual site is between the taenia coli, where vessels pierce the muscle to supply the mucosa

34
Q

Diverticular Disease - what is diverticulosis?

A

Diverticulosis is just the presence of diverticula

35
Q

Diverticular Disease - when would you use ‘Diverticular Disease’, instead of diverticulosis?

A

Diverticular disease is reserved for when patients with diverticula become symptomatic

36
Q

Diverticular Disease - what is Diverticulitis?

A

Is when one or a few of the diverticula become infected and inflamed

37
Q

Diverticular Disease - what part of the large intestine are diverticula most common?

A

Sigmoid colon

38
Q

Diverticular Disease - what are symptoms for diverticular disease?

A

Abdo pain

Altered bowel habit

Bleeding

39
Q

Diverticular Disease - how is it diagnosed?

A

Commonly diagnosed as an incidental finding

Barium enema

40
Q

Diverticular Disease - what is the main cause?

A

Low-fibre western diet, which leads to high intraluminal pressure that forces mucosa to herniate through muscle layers of the gut

41
Q

Diverticular Disease - what is the treatment?

A

Increase dietary fibre intake

Antispasmodics - Mebeverine

42
Q

Diverticulitis - what are the risk factors?

A

Age

Lack of dietary fibre

Obesity

Smoking

NSAID use

43
Q

Diverticulitis - what are the symptoms?

A

Acute diverticulitis typically presents:

  • LIF severe pain
  • N+V
  • change in bowel habit, constipation (50%), diarrhoea (25%)
  • Urinary frequency, urgency, dysuria, due to irritation of the bladder by the inflamed bowel
44
Q

Diverticulitis - what are the signs?

A

Tender LIF

Pyrexia

Tachycardia

45
Q

Diverticulitis - what investigations can you do?

A

FBC - raised WCC
CRP - raised

Chest XRAY - may show pneumoperitoneum in cases of perforation
Abdo XRAY
CT

46
Q

Diverticulitis - what is the management?

A

Mild cases:

  • Oral antibiotics
  • Liquid diet
  • Analgesia

If symptoms don’t settle within 72 hours, admit for IV antibiotics

47
Q

Diverticulitis - what are the complications?

A

Perforation and development of abscess

Perforation and development of faecal peritonitis

Development of fistula

48
Q

Gastritis - what is it?

A

It is inflammation of the gastric mucosa (lining of the stomach)

49
Q

Gastritis - what are the causes?

A

MOST COMMON - H. Pylori

NSAIDs

Alcohol

Autoimmune gastritis

50
Q

Gastritis - what are the symptoms?

A

Most people with gastritis are asymptomatic

If symptoms are present:

  • Indigestion
  • Epigastric pain
  • N+V
  • Bloating
  • LoA
51
Q

Gastritis - what are the investigations?

A

Usually incidental finding at endoscopy (where a biopsy is taken)

Breath test for H.Pylori

Barium swallow

52
Q

Gastritis - what is the management?

A

Lifestyle:

  • Smaller meals
  • Avoid irritant foods
  • Avoid alcohol
  • Smoking cessation

Meds:

  1. Antacids
  2. H2 blocker, Ranitidine
  3. PPI
  4. Bismuth subcitrate - use it in combintion with antibiotics + PPI for H. Pylori infections

GI (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions