G.I.t Flashcards by HUDA AMIR

Barette oesophagus

Squamous cell to columnar cell

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Itching,pruritis,skin excoriation middle age,in 40’s,women,elevated ALP,Sjogren Syndrome,Antimitochondrial antibodies positive( HALLMARK)

Primary biliary cirrhosis

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Elderly
Smoker
Dysphagia difficulty swallowing
Weight loss

Oesophageal carcinoma

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Right hemiparesis
Absent gag reflex
Strike unit
Dysphagia

Dysphagia less than 4 weeks -nasogastric tube.
Dysphagia is more than 4 weeks
-percutaneous endoscopic gastrostomy.

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Large villous adenoma in sigmoid colon
Stools voluminous and foul smelling

Hypokalemia

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Diarrhoea 6 Months/mild diarrhea 6weeks.
Bloating post meals
Flatulence post meals
No weight loss
No abdominal pain or intermittent abdominal pain
Type 1 DM*

Screen coeliac disease
TtG test
Serum Tissue Transglutaminase Antibody IgA
tTg-IgA
Positive then endoscopy and biopsy

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Diarrhoea(6 month)
Bloating post meals
Flatulence post meals
No weight loss
No abdominal pain

Screen coeliac disease
Tissue Transglutaminase Antibody (TTG test)

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Severe Pain abdomen
Blood stool +
Systemic signs inflammation
Fever
weight loss

Inflammatory Bowel Disease
Faecal calprotectin

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Change in bowel habits

Ruling out colorectal cancer
Faecal immunochemical test (FIT)

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Hb
WBC
Crp
Platlet

130-180
4-11
<10
150-400

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Right abdomen tenderness
Late teens,twenties
Active inflammation (plt+,CRP+)
Faecal calprotectin positive

Colonoscopy (direct visualization ileum)
Crohn’s disease

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Epigastric pain few hours
Bouts diarrhoea few hours
Nauseous
No vomiting

Gastroenteritis (norovirus)
Isolate until diarrhea resolves

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Pathology report
Large Iron pigment within hepatocytes
Abnormal liver function test
Triad
Diabetes
Hepatomegaly
Bronze pigmentation

Hemochromatosis
Hereditary hemochromatosis -autosomal recessive genetic disease.
(Increased intestinal absorption iron)

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Iron in kuppfer cells

Hemosiderosis

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Hemochromatosis investigation

Ferritin raised >1000
Transferrin saturation raised> 45%
Genetic testing
Liver biopsy

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Liver firm ,span 10cm
Skin pigmentation
Heart murmur( restrictive cardiomyopathy)

Heamochromatosis
Hepatoma(hepatocellular carcinomas)

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Palpable mass right iliac fossa
Bloody diarrhoea
Weight loss
H/E
Granulomas

Crohn’s disease

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Palpable mass right iliac fossa
Bloody diarrhoea
Weight loss
H/E
Granulomas

Crohn’s disease

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Upper gastrointestinal bleed
Urgent Endoscopy (to find out site bleed)

Melena- black tarry stools.
Anemia .
Haemoglobin ,72(130-18)
Haematocrit 21(40-50)
Hemodynamically unstable .

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Upper gi bleed

Inj adrenaline
Application clips
Cauterisation to stop bleeding

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Intervention for upper gi bleed

1.resuscitation with fluids +/- packed red cells
2. Endoscopy

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Investigation hiatus hernia

Endoscopy
Barium swallow
Oesophageal manometry
Treatment
Proton pump inhibitors
Laparoscopic fundoplication

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Symptoms hiatus hernia

Retrosternal burning sensation lying down or bending
Asymptomatic

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Bloody diarrhoea
Non bloody diarrhoea
Abdominal mass RT iliac fossa
Any part gi tract from anus to rectum
Histology - increased goblet cells,granulomas
Weight loss prominent
Endoscopy -transmural skip lesions
Cobble stone appearance.
Rx- corticosteroids - prednisolone

Crohn’s disease

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Oesophageal cancer co dysphagia palliative care

Oesophageal stenting

Stroke difficulty swallowing risk aspirations pneumonia Long term feeding

Percutaneous endoscopic gastrostomy (peg)

Chest pain (retrosternal) Interscapular pain Subcutaneous emphysema Retching Vomitting Fever Tachycardia Post gi endoscopy

Oesophageal rupture cause mediastinitis. Macklers triad 1.Chest pain 2.Vomitting 3.Emphysema

Urgent Endoscopy

Dysphagia to rule out oesophageal and stomach cancer 55yrs above- wt loss,upper gi pain,reflux, dyspepsia H/o ibuprofen ,tender abdomen over 55yrs

Routine endoscopy

Refractory dyspepsia (4 weeks ppi) Hbpylori eradication regimen

Sudden onset dysphagia Drooling Regurgitation No signs respiratory distress Vitals stable Next investigation

Oesophagogastroduodenoscopy OGD

Re-testing helicobacter pylori

Carbon -13 urea breath test (ppi are stopped 2 weeks back,28 day break after treatment) not available Stool antigen test

Children Abdominal pain rt iliac fossa Diarrhoea Weight loss

Crohn's disease

Type 2 DM Arthropathy joint ache Increase breast size gynaecomastia Deep tan colour skin Increasingly fatigue

Hemochromatosis

Cirrhotic man Gradually worsening Abdominal swelling Fever ,absent bowel sounds Examination -rebound tenderness, shifting dullness Elevated temp, tachycardia Most appropriate investigation?

(Cirrhosis-Ascites-bacterial peritonitis -) Neutrophil count more than 250 Rx- antibiotics

Bloody diarrhoea more common Abdominal pain left quadrant Histology -decreased goblet cells,granulomas infrequent,primary sclerosing cholangitis more common Barium enema-loss haustrations,drain pipe colon

Ulcerative collitis

Lethargy Dull worsening pain right hypochondrium Histology of liver Biopsy-adenocarcinoma;TTF -Primary pulmonary tumour Most likely route metastases

Hematogenous

Epigastric pain Nausea Vomitting @ 35 weeks gestation ++ Preeclampsia Deranged liver function test ++ Low platelets ++ Low serum glucose ++ Raised serum ammonia++

Acute fatty liver of pregnancy

Difficulty Swallowing solids-dysphagia Loss weight Heart burn Acidic taste Elderly

(GORD - oesophageal cancer) most appropriate investigation Upper GI endoscopy

Severe epigastric pain Radiate to back Relieved sitting forward* Nauseous, vomiting twice Tender epigastric Appropriate investigation One half glasses wine per day

Serum lipase sensitive (3*) Dx-acute pancreatitis

72 yrs old women Tender mass left side abdomen iliac fossa Guarding+

(Diverticulitis) Diverticular abscess

Intermittent dysphagia + 6 months great relief after regurgitation+ Recurrent respiratory tract infection + Night time coughing fits

Achalasia Loss ability to relax (close) lower oesophageal sphincter. 1.endoscopy 2.manometry(gold standard) 3.barium swallow.

Severe diarrhea Opens her bowels (8) Hereditary factor colorectal carcinoma Colicky abdominal pain Ulcerative collitis on sulfalazine Pale Tender abdomen no mass

Severe exacerbation ulcerative collitis Intravenous hydrocortisone.

Difficulty swallowing foods Barium meal - dilatation oesophagus narrowing lower end (birds beak )

Achalasia

Impacted faeces for 1 week

Fast acting laxative Phosphate enema(2-5min)

Stool blood and mucus Abdominal pain 4-5 stools / day Anca positive As a negative

Mesalazine(mild to moderate ulcerative collitis

Long standing heart burn, dysphagia (GORD) HIATUS HERNIA

barrets oesophagus

Long standing heart burn, dysphagia (GORD) HIATUS HERNIA

barrets oesophagus

Stinking stools Frothy stools Stearohea Ferritin low Folate low Weight loss Bloating Intermittent diarrhea (long term)

Coeliac disease Tissue Transglutaminase antibodies (TTG,IgA)

Head pancreas removed Worsening Abdominal pain Rigid abdomen Pud (peptic ulcer disease) BP -95/55 Pr -125

Erect chest x-ray and abdomen (Perforated peptic ulcer - air under diaphragm)

Head pancreas removed Worsening Abdominal pain Rigid abdomen Pud (peptic ulcer disease) BP -95/55 Pr -125

Erect chest x-ray and abdomen (Perforated peptic ulcer - air under diaphragm)

Long standing gastric reflux Dysphagia - solid then soft food also Chest pain Barium meal- irregular narrowing

Oesophageal carcinoma

Recurrent abdominal pain Periumbilically Associated Nausea,episodic headache Interferes normal activity

Reassure Rx abdominal migraine

Severe upper Abdominal pain Vomitted several times ,5 children Female Forties Fair Fertile Fat

Cholecystitis( gallstones)

Difficulty swallowing blood One episode once every few days Chest pain with dysphagia Regurgitate food Chest infection recurrence No weight loss Investigation?

Endoscopy

Crushing chest discomfort 1 HR On drinking colddrink*

Oesophageal spasm

Lump left supraventricular region Loss appetite Lost 10 kg

Gastric cancer Lump -virchow 's node- trousers sign.

Intermittent episodes sudden chest pain Dysphagia 3 weeks ago Crushing lower substernal

(Dx-Oesophageal spasm) Gold standard - manometry

RT. Upper quadrant pain Jaundice Well nourished man No weight loss Tenderness in RT. upper quadrant Next investigation

Ultrasound

Bloody diarrhoea Bloody diarrhoea Biopsy -colonic mucosa crypt abscesses

Ulcerative collitis

Rash buttock Recurrent chronic diarrhea I'll fitting clothes

Villous atrophy (Rash - dermatitis herpetiformis)

Bloating, abdominal pain worsened post meal,relieved by defecation

Irritable bowel syndrome

Increasingly fatigue Gastrectomy

Hypersegmented neutrophils (Vitamin b 12 deficiency)

Wt loss Colonoscopy fistulas

Crohn's ds

Night rectal shooting pain Pr is normal

Proctalgia fugac

Charcot triad fever Right upper quadrant pain Jaundice Procedure retrograde cholangiopancreatography

Ascending cholangitis

Pain relieves on leaning forward

Acute pancreatitis

Tenesmus Intermittent diarrhea Chronic abdominal pain

Inflammatory bowel disease

Intermittent dysphagia Nocturnal cough weight loss Heart burn lying flat

Endoscopy

Acute severe collitid

Intravenous hydrocortisone

Clindamycin - increases clostridium defficle infections

Oral vancomycin

Right upper quadrant pain On palpation right costal margin at midclavicular line,interruption of breathing (muphys sign)

Acute cholecystitis

Blistering rash elbow- red raised patches ,blisters,severe itching. Biopsy - shortening villi ( villous atrophy) Low haemoglobin Lymphocytosis

Rash - dermatitis herpetiformis Coeliac disease

Investigation coeliac disease Symptoms Intermittent diarrhea Stearohea Stinking stools Bloating Nausea Vomiting Fatigue Weight loss Iron ,bit B 12 Def,folate Def.

Tissue Transglutaminase antibodies TTG

Jejunal / duodenal biopsy in coeliac disease

Villous atrophy Crypt hyperplasia Increase in intraepithelial lymphocytes

Endoscopy Chest pain Shortness breath Cxr-mediastinal widening Epigastric pain radiating to interscapular

Mediastinitis (oesophageal perforation)

Pain,bloating,change in bowel habits Pain relieved defecation,

Tissue Transglutaminase antibody (coeliac ds) Faecal calprotectin (inflammatory bowel ds Fit sample(colon cancer 50yrs above) Ca 125 ovarian cancer (women 50 yrs above)

Low Hb,high MCV Ileal resection

Vitamin b12 def