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GI Upset Flashcards

1
Q

Common complication of viral gastroenteritis

A

Lactose intolerance

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2
Q

How does coeliac disease present in a blood test

A

Mild anaemia
Calcium, phosphate and vit D deficiency
Rise in ALP

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3
Q

How does Crohn’s disease present on a blood test

A

Anaemia
Vit D, calcium and phosphate deficiency
Increased CRP

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4
Q

How to differentiate between gastric ulcers and duodenal ulcers

A

Gastric ulcers cause pain when eating or shortly after
Duodenal ulcers pain comes on an hour or 2 after eating

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5
Q

What is the main cause of painless massive GI bleeding requiring transfusion in children between 1 and 2

A

Meckel’s diverticulum

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6
Q

What % of weight loss is diagnostic of malnutrition

A

Unintentional weight loss greater than 10% within the last 3-6 months

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7
Q

Define acute diarrhoea

A

3 or more episodes of loose stool per day lasting <14 days

Most common cause is infective (gastroenteritis)

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8
Q

Features of gastroenteritis

A

Diarrhoea
+/- abdo pain
Nausea
Vomitting

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9
Q

Features of diverticulitis

A

Diarrhoea
Left lower quadrant pain
Fever

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10
Q

Features of constipation causing overflow

A

Alternating diarrhoea and constipation

Can lead to faecal incontinence in the elderly

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11
Q

Infective agents causing diarrhoea

A

Norovirus / rotavirus

E. coli, salmonella, shigella, campylobacter

Giardia lamblia, entamoeba histolytica

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12
Q

CF of infective diarrhoea

A

Acute onset diarrhoea
+/- vomitting
Fever
Abdo pain
Blood in stools suggesting colitis

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13
Q

OE for infective diarrhoea

A

Soft and mildly tender abdomen

Examine hydration status

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14
Q

Investigations for suspected infective diarrhoea

A

Stool samples for MCS and virology should be sent if:
- systemically unwell / immunocompromised
- blood / mucus in stool
- public health indications eg food poisoning or outbreaks
- recent foreign travel
- recent abx use or hospitalisation

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15
Q

Management for infective diarrhoea

A
  • importance of oral hydration
  • advise on hygiene to prevent transmission
  • imaging
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16
Q

Define chronic diarrhoea

A

Diarrhoeal symptoms lasting longer than 4 weels

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17
Q

Differential diagnoses for chronic diarrhoea

A
  • IBD
  • IBS
  • malabsorption
  • coeliac disease
  • thyrotoxicosis
  • colorectal malignancy
  • post cholecystectomy diarrhoea
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18
Q

Epidemiology of Crohn’s disease

A

50/100,000
M=F
Risks: poor diet, FH, smoking, altered immune states

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19
Q

Pathology of Crohn’s disease

A

Inflammation can affect any part of the GI tract (mouth to anus)

Skip lesions

Rose thorn ulcers

Cobblestone appearance on CT

Inflammation extends through all layers of bowel

Fistulae and stenosis are common

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20
Q

CF of crohn’s

A

Abdo pain
Diarrhoea: steatorrhea in ileal disease, blood in colonic
Mouth ulcers
Anal: fissures, fistulas, haemorrhoids, skin tags, abscesses

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21
Q

Epidemiology of UC

A

100-200/100,000
Peak at 15-30 and also around 60
Smoking is protective
F>M

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22
Q

Pathology of UC

A

Inflammation starts in rectum extends proximally along colon

Inflammation only affects mucosa which is excessively ulcerated

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23
Q

CF of UC

A

Crampy lower abdo discomfort
Gradual onset diarrhoea (bloody)
Urgency and tenesmus if disease confined to rectum

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24
Q

Histology of Crohn’s disease

A

Transmural inflammation, lymphoid hyperplasia and granulomas

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25
Histology of UC
Mucosal inflammation, crypt abscesses and goblet cell depletion
26
Investigations for suspected IBD
Bloods: FBC, U&E, CRP / ESR, LFT, serum iron, B12, folate Stool: - stool chart - stool MCS x3 to exclude infective causes - faecal calprotectin Radiology: AXR / CXR Sigmoidoscopy in UC Colonoscopy in crohn’s
27
Management of a mild crohn’s flare up (Symptomatic but systemically well)
- oral prednisolone - tapered steroids - review in clinic
28
Management of a severe crohn’s flare up (Symptoms + systemic upset)
Start IV steroids (hydrocortisone) NBM Thiopurines Infliximab Once improving transfer to oral prednisolone If unable to control - surgery
29
Crohn’s maintenance therapy
Thiopurines eg azathioprine or 6-mercaptopurine Methotrexate Oral metronidazole for anal disease
30
Management of mild / moderate UC flare (less than 6 motions / day - systemically well)
Topical aminosalicylate for procitits Loading dose of oral mesalazine +/- topical mesalazine for extensive disease After 4 weeks add oral prednisolone
31
Management of severe UC flare up
IV corticosteroids DVT prophylaxis Avoid anti motility drugs Assess need for surgery
32
UC maintenance therapy
5-ASA derivatives first line : sulfalazine, mesalazine Oral thiopurines second line
33
IBD complications
Bowel perforation Lower GI haemorrhage Toxic dilatation Colonic carcinoma
34
Features of toxic dilatation (toxic megacolon)
Persistent fever Tachycardia Loose blood stained stool AXR shows dilated colon with mucosal islands
35
Describe surgery for Crohn’s disease
Is never curative Temp ileostomies can be used to rest distal diseased bowel Limited resection of the worst areas can be required
36
What is short bowel syndrome
When <1m small bowel remains after surgery for crohn’s - can lead to malabsorption
37
Describe emergency surgery for UC
Subtotal colectomy and end ileostomy: leaves a rectal stump that can form an anastomosis at a later date Proctocolectomy and end ileostomy: rectal stump also removed: stoma for rest of life
38
Describe elective surgery for UC
Completion proctocolectomy and ileoanal pouch reconstruction: ileo-anal pouch formed, maintaining faecal continence (risk of pouchitis) Colectomy and ileorectal anastomosis: anastomosis formed in single procedure but the rectum remains
39
Outline some extra GI manifestations of IBD
Eyes: conjunctivitis / episcleritis / iritis MSK: arthralgia of large joints Skin: erythema nodosum, pyoderma gangrenosum
40
Symptoms of malabsorption
Chronic diarrhoea / steatorrhoea Bloating Weight loss Lethargy
41
Signs of malabsorption
- anaemia - bleeding disorders (vit K) - oedema (decreased protein) - osteomalacia (vit D) - neuropathy
42
Common causes of malabsorption in UK
Coeliac disease Chronic panc Crohn’s
43
Investigations for suspected malabsorption
- bloods: FBC, iron, B12, folate, Ca, Mg, phosphate, lipid profile, LFT, TFT, inflammatory markers, clotting Stool studies: MCS, faecal elastase (panc), calprotectin Endoscopy Breath hydrogen analysis: bacterial overgrowth
44
Pathology of coeliac disease
Inflammation of the jejunal mucosa in response to gluten Biopsy of duodenal mucosa will show flattened mucosa due to loss of villi
45
Presentation of coeliac disease
1/3 asymptomatic Diarrhoea, abdo pain, bloating, N+V Weight loss, fatigue, ulcers Dermatitis herpetiformis
46
Investigations for suspected coeliac disease
Bloods: endomysial antibodies and TTG antibodies present Duodenal biopsy: gold standard Bone densitometry
47
Management of coeliac disease
Lifelong gluten free diet Endomysial antibody tests to ensure gluten free is working Small increased risk of small bowel lymphoma / adenocarcinoma
48
Pathology of chronic pancreatitis
High alcohol intake leads to inappropriate pancreatic enzyme activity Precipitation of protein - plugs the pancreatic ducts - ductal hypertension Fibrosis of the parenchyma - disturbed exocrine function
49
Presentation of chronic panc
Epigastric pain Radiating to back Relieved by sitting forwards or hot water bottle Weight loss Bloating Steatorrhoea
50
Investigations for chronic panc
Bloods: - serum amylase / lipase rarely elevated - signs of alcohol abuse (macrocytic anaemia, GGT) Stool - faecal elastase elevated - trypsinogen levels >10 Imaging - USS may show pseudocyst - contrast CT / mRCP can confirm diagnosis with calcification
51
Chronic panc management
Analgesia Creon Blood sugar monitoring Treat alcohol abuse Low fat diet Partial pancreatectomy
52
Define IBS
Chronic, functional bowel disorder with a prevalence of up to 10% in the UK population Mixed abdo symptoms with no organic cause
53
Epidemiology of IBS
F:M >2:1, onset generally before age 40 Stressful live events Co-morbid anxiety + depression Preceding GI infection
54
ABC model for considering diagnosis of IBS
Abdominal pain Bloating Change in bowel habit
55
CF of IBS
12 consecutive weeks in 12 months of abdo pain with: - pain relieved with defecation - onset associated with a change in stool freq - onset associated with a change in stool form - bloating - passing mucus - associated gynae, urological or back pain
56
Investigations for IBS
FBC ESR / CRP Coeliac disease screen
57
IBS management
Lifestyle: advise on regular meals, hydration, limit caffeine, low FODMAP diet 1st line: anti spasmodic for pain Constipation: laxatives (avoid lactulose) Diarrhoea: loperamide 2nd line: low dose TCA After 12mo of antidepressants, refer to CBT
58
Define malnutrition
BMI <18.5 Unintentional weight loss greater than 10% within the last 3-6mo BMI <20 and unintentional weight loss >5% within 3-6mo
59
Risk factors for malnutrition
Age Hospitalisation Chronic illness Alcohol abuse Mental health
60
CF of malnutrition
Low BMI Bradycardia, hypotension, hypothermia Poor wound healing / recurrent infections
61
Management of malnutrition
Dietician support Food first approach rather than oral nutritional supplements
62
Describe refeeding syndrome
A period of prolonged starvation leads to depletion of intracellular electrolyte stores - if a patient is then provided with nutrition the metabolic changes can cause intracellular shifts
63
Subdivisions of dyspepsia
Reflux type: heart burn and regurgitation Ulcer type: epigastric pain Dysmotility type: bloating and nausea
64
When do symptoms of GORD occur
When there is prolonged contact of the gastric contents with oesophagus mucosa - inflammation
65
Risk factors for GORD
Hiatus hernia Raised IAP Large meals late at night Smoking Caffeine High fat food
66
CF of GORD
Heartburn / indigestion - worse on bending / lying - relieved on antacids Regurgitation of food: worse when bending / lying Waterbrash - filling of mouth with saliva
67
Red flag symptoms that indicate a need for urgent upper GI endoscopy to rule out malignancy (ALARMS 55)
Anaemia Loss of weight Anorexia Recent onset, progressive symptoms Melaena Swallowing difficulties >55
68
Management of endoscopically proven oesophagitis
Full dose PPI 1-2 mo If response - low dose If no response - double dose PPI
69
Management of endoscopically negative reflux disease
Full dose PPI for 1mo If response offer low dose treatment prn If no response then H2RA or prokinetic 1mo
70
Complications of GORD
Oesophagitis Ulcers Anaemia Benign strictures Barrett’s oesophagus Oesophageal carcinoma
71
What is Barrett’s oesophagus
Normal stratified squamous epithelium of the oesophagus undergoes metaplasia to glandular columnar epithelium in long standing reflux Continued inflammation can then lead to dysplasia and malignant change
72
Where is the oesophageal hiatus
An oval aperture in the right crus of the diaphragm at T10
73
What happens in a hiatus hernia
Part of the stomach passes into the thoracic cavity through the oesophageal hiatus Is usually asymptomatic but can lead to GORD symptoms
74
What are the 2 types of oesophageal hiatus hernia
Sliding hiatus hernia: - Gastro-oesophageal junction slides through the hiatus to lie above the diaphragm Para-oesophageal / rolling hernia - small part of the fundus rolls up through the hernia alongside the oesophagus but the sphincter remains competent below the diaphragm
75
Risk factors for PUD
H. Pylori (95% of duodenal, 75% of gastric) NSAIDs SSRIs Corticosteroids Bisphosphonates Zollinger ellison syndrome
76
Features of PUD
Epigastric pain Nausea Duodenal ulcers - relieved by eating Gastric ulcers - worsened by eating
77
Investigations for peptic ulcer type pain
Start a trial of PPI therapy If symptoms persist test for H pylori with urea breath test or stool antigen test
78
Management of H pylori
PPI until ulcer heals If + for H pylori - eradication therapy
79
Complications of peptic ulcers
Perforation - epigastric pain that then becomes generalised Syncope
80
What is the difference between pancreatic cancer and cholangiocarcinoma
Cholangiocarcinoma: colicky RUQ pain, palpable mass, clay coloured stools, dark urine - due to biliary obstruction Pancreatic Ca: anorexia, painless jaundice
81
What is the difference between primary sclerosing cholangitis and primary biliary cholangitis
PSC is damage of medium to large extrahepatic and intrahepatic bile ducts PBC targets small intrahepatic bile ducts
82
What is the key investigation for suspected perforated ulcer
Erect CXR
83
Why should metoclopramide be avoided in bowel obstruction
It has prokinetic properties which can stimulate peristalsis in the bowel This can exacerbate mechanical bowel obstruction and precipitate perforation
84
Triad of symptoms for mesenteric ischaemia
CVD High lactate Soft but tender abdomen
85
Triad of symptoms for mesenteric ischaemia
CVD High lactate Soft but tender abdomen

Junior Medicine (6 decks)

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