GIT Flashcards
What causes anal fissures? What is the non-pharm management?
Usually constipation/diarrhoea. Posterior midline 90%. If lateral may be Crohn’s, cancer, infection. Mx: high fibre diet, sitz baths TDS after bowel motions to relax sphincter and improve blood flow, stool softeners.
What topical agents are used to manage anal fissures?
Rectinol (zinc + anaesthetic), soovit (anaesthetic + steroid). To reduce sphincter spasm + improve blood flow: topical GTN rectogesic (use lying down), diltiazem or nifedipine.
How are haemorrhoids managed?
Fibre/fluid, avoid straining. Surgery if not responding or older. Thrombosed - can excise if < 72hr, otherwise cool compress, donut pillow, sitz baths.
What is a pilonidal sinus/cyst vs a perianal abscess? Management.
Pilonidal - in midline, sinus if no collection/infection. Treatment is eradication of tract and heal from bottom up, need packing if open. Abscess not in midline, surgery to treat abx as adjunct.
How do you manage pruritis ani?
Consider dermatoses. Soap substitute, greasy emollient barrier, psyllium if stool loose, loose cotton underwear. Can use advantan and diprosone if required.
What are the risk factors/indicators for hepatitis C?
Deranged LFTs/jaundice, MSM, IVDU, prison, transfusion before 1990, needlestick injury, unsterile tattoo/piercing, active HIV or Hep B, birth in parts of Asia/Africa.
What tests are indicated before treating hepatitis C?
RNA for active Hep C, FBE, UEC, LFT, INR, HIV, Hep A ,Hep B. Cirrhosis: APRI score < 1 unlikely, can U/S but fibroscan better.
How is Hep C treated? What are the contraindications and followup?
8-12weeks of maviret or epclusa, test of cure 3mo later. C/I: ESKD, liver Ca, HIV, decompensated cirrhosis. Pregnancy unclear. Avoid PPI, statins, antieplipetics. Specialist if cirrhosis, GFR < 50 coinfection or complex drug use.
When are scopes indicated in GORD? How is GORD treated pharmacologically?
Diagnosis unclear, anaemia or dysphagia, severe or changing symptoms. Initial PPI 4-8 weeks then aim to reduce gradually (1/2 dose or alt daily, then PRN).
What are the non-pharm aspects of GORD management?
Identify triggers and avoid (fat, alcohol, coffee, chocolate, citrus, spice), eat small meals, eat slowly, avoid before bed 2-3hr, avoid lying down post meals, use wedge pillow, reduce smoking, weight loss.
How is GORD managed in pregnancy?
Antacids first line. Ranitidine safe. PPIs are B3, trial PRN only if required - omeprazole has most experience.
How do you reduce colorectal cancer risk?
Avoid smoking, limit alcohol < 2 std, high fibre diet 90g wholegrains, moderate red meat 3 portions per week and avoid charred/processed, exercise, BMI < 25. Low dose aspirin for 2.5 years.
What are the differentials for dyspepsia (epigastric burning after eating)?
GORD, PUD, biliary colic, gastritis (H. pylori, NSAID, alcohol), pancreatitis, crohn’s, coeliac, oesophagitis; gastric/oesophageal/pancreatic cancer; cardiac ischaemia.
How do you manage peptic ulcers? What if pt is on aspirin?
Test for h.pylori. Usually 4-8 weeks PPI. If no cause, may need lifelong PPI. If develop whilst on aspirin or long term NSAID, continue PPI.
What is the workup for deranged LFTs with hepatocellular pattern?
If mild, check again 6mo. Initial: screen alcohol, drugs (panadol), Hep B, Hep C, ferritin, U/S for NASH. 2nd line: autoimmune (SPEP, ANA), thyroid, coeliac. 3rd: wilsons, alpha 1, muscle disorders.
What are the causes of a raised ALP?
Diabetes, pregnancy 3rd trimester, drugs (erythromycin, fluclox, oestrogen), cancer (liver, GB, pancreas), biliary colic, PSC, PBC.
What can cause c.diff? How is it treated?
Abx even after months. PPIs also implicated. Treat if symptomatic: metonidazole 10d or vanc.
How is uncomplicated diverticulitis managed?3 indications for abx and which abx?
Clear liquid diet 2-3d, low fibre diet until pain improves, panadol and antispasmodics. Abx if R sided, immunocompromised or not improving in 3 days: AugBD 5 days or bactrim + metro 5 days
What is complicated diverticulitis? Management and followup
Bacteraemia, sepsis, abscess >5cm, perforation, peritonitis. IV abx/fluid + gut rest. Need scope 6-8 weeks and aim for soft stools.
Scopes also if atypical symptoms or imaging. No evidence for seeds/fibre.
Pancreatitis - common causes, investigations, management.
Triglycerides, calcium, alcohol, gallstone, ERCP. FBE, UEC, LFT, BSL, CXR, Lipase, ECG. Analgesia, antiemetic, fluid.
What are 4 risk factors for pancreatic cancer?
2 first degree relatives, BRCA2 gene carrier, chronic pancreatitis, cystic fibrosis.
How is coeliac disease diagnosed?
Anti-tissue transglutaminase and anti deamidated gliadin abs if having gluten for 4-6 weeks; HLA DQ2/DQ8 can exclude if negative. Scope w biopsy for intraepithelial lymphocytosis w blunting of duodenal villi is gold standard.
What are the risks/associations of coeliac disease?
Untreated - lymphoma. Screen for TSH, iron, B12, Vit D, DEXA scan. Dermatitis herpetiformis - itchy symmetrical blistering rash, may start as vesicles. Biopsy to confirm. FDR should be screened.
What are the Rome IV criteria for IBS diagnosis? What are some differentials?
6mo of abdo pain at least 1d/week for 3mo and 2 of: pain w defaecation, pain assoc w change in stool freq or stool form. DDx: coeliac, IBD, food intolerance, giardia, H.pylori, SIBO, gastroparesis, obstruction.
What tests are indicated for IBS? And for food intolerances?
FBE, CRP, coeliac ab, calprotectin. Trial of exclusion diet better as breath tests only look for malabsorption. 125mL low fat milk for lactose challenge.
How is IBS managed?
Food diary to identify triggers, soluble fibre if constipated (psyllium), regular meal times, low FODMAP trial, CBT. PRN loperamide, buscopan, iberogast (bloating). Amitriptyline 2nd line.
What are the different causes of haematemesis?
PUD (gastric, oesophageal, duodenal), severe gastritis/oesophagitis, varisces, mallory-weiss tear, cancer, vascular ectasia or AV malformation.
How does oesophageal spasm present? Management.
Deep constricting retrosternal pain, worse w hot or cold drinks. Exclude cardiac then treat empirically: sip warm water when painful. GTN 400microg spray or 600microg tab PRN. Diltiazem, imdur if severe/recurrent
What are the features of ulcerative colitis and crohn’s disease?
UC: recurrent loose stools w blood/mucus, only affects large bowel, less pain/fever. Ca risk after 7 year. CD: recurrent diarrhoea, blood/mucus, pain, perianal disease, mouth ulcers. 50% ileocolic.
Hep B serology - what results in acute, chronic, resolved and vaccinated Hep B infection?
A: HBsAg +, Anti-HBc +, Anti-HBc IgM +, Anti-HBs -ve. C: HBsAg +, Anti-HBc +, Anti-HBc IgM -ve, Anti-HBs -ve. R: HBsAg -ve, Anti-HBc +, Anti-HBs +. V: HBsAg -ve, Anti-HBc -ve, Anti-HBs +.
What tests are indicated if Hep B infection is diagnosed?
HBV DNA, HBe antigen, FBE, LFT, INR, Hep A, C, D and HIV. Consider APRI or fibroscan. Consider Ca screen (cirrhosis, asian >40, ATSI >50) - alpha fetoprotein + U/S.
How is Hep B managed (5 features)?
Refer for treatment depending on activity. Avoid smoking and alcohol. Vaccinate for Hep A. Contact tracing for 6mo, use condoms. Screen and vaccinate household contacts.
How is acute infectious diarrhoea treated? What are 3 concerning causes?
Redhydration only. If severe, cipro 500BD 3 days. Giardia (foul smelling, greasy chronic) = metro. Amoebiasis - blood + liver abscess. Shigellosis - blood for 1 week.
How are gallbladder polyps managed?
Monitor if < 10mm, no IBD or PSC, age < 60 and not indian. Monitor 6mo to 1 year (< 5mm)
How is functional and opioid induced constipation managed?
F: footstool, fibre, fluid, exercise. Bulk laxative then osmotic movicol/lactulose then stimulant senna. O: avoid lactulose and bulk forming, due to bloat/gas. Can use prucalopride 1-2mg.
When is H.pylori testing indicated? How is it treated?
Dyspepsia, PUD, FDR w gastric ca. Consider if long term PPI use. Tx: esomeprazole 20mg BD, amoxicillin 1g BD, clarithromycin 500mg BD for 7-14 days.
What is the followup for treated H. pylori?
Re-test if complicated PUD, stopping PPI. Breath test 4-6 weeks. Stool test can also check for eradication. Serology not helpful. Don’t treat twice, refer.
What are 4 pathologies caused by gallstones?
Biliary colic - cholelithiasis. Acute GB inflammation - pain + fever, cholecystitis. If shock + confusion + jaundice suggests cholangitis. If lower, can cause pancreatitis.
What are the features of Hep A infection? What are some differentials?
Incubation 2-5 weeks. N/V, headache, epigastric pain, diarrhoea. Later get jaundice and LFT derangement. Resolve in 3-6 weeks. DDx: hepatitis, CMV, EBV, yellow fever, syphilis, autoimmune hepatitis,.
