G.I.t Flashcards
Barette oesophagus
Squamous cell to columnar cell
Itching,pruritis,skin excoriation middle age,in 40’s,women,elevated ALP,Sjogren Syndrome,Antimitochondrial antibodies positive( HALLMARK)
Primary biliary cirrhosis
Elderly
Smoker
Dysphagia difficulty swallowing
Weight loss
Oesophageal carcinoma
Right hemiparesis
Absent gag reflex
Strike unit
Dysphagia
Dysphagia less than 4 weeks -nasogastric tube.
Dysphagia is more than 4 weeks
-percutaneous endoscopic gastrostomy.
Large villous adenoma in sigmoid colon
Stools voluminous and foul smelling
Hypokalemia
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
Diarrhoea(6 month)
Bloating post meals
Flatulence post meals
No weight loss
No abdominal pain
Screen coeliac disease
Tissue Transglutaminase Antibody (TTG test)
Severe Pain abdomen
Blood stool +
Systemic signs inflammation
Fever
weight loss
Inflammatory Bowel Disease
Faecal calprotectin
Change in bowel habits
Ruling out colorectal cancer
Faecal immunochemical test (FIT)
Hb
WBC
Crp
Platlet
130-180
4-11
<10
150-400
Right abdomen tenderness
Late teens,twenties
Active inflammation (plt+,CRP+)
Faecal calprotectin positive
Colonoscopy (direct visualization ileum)
Crohn’s disease
Epigastric pain few hours
Bouts diarrhoea few hours
Nauseous
No vomiting
Gastroenteritis (norovirus)
Isolate until diarrhea resolves
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)
Iron in kuppfer cells
Hemosiderosis
Hemochromatosis investigation
Ferritin raised >1000
Transferrin saturation raised> 45%
Genetic testing
Liver biopsy
Liver firm ,span 10cm
Skin pigmentation
Heart murmur( restrictive cardiomyopathy)
Heamochromatosis
Hepatoma(hepatocellular carcinomas)
Palpable mass right iliac fossa
Bloody diarrhoea
Weight loss
H/E
Granulomas
Crohn’s disease
Palpable mass right iliac fossa
Bloody diarrhoea
Weight loss
H/E
Granulomas
Crohn’s disease
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 .
Upper gi bleed
Inj adrenaline
Application clips
Cauterisation to stop bleeding
Intervention for upper gi bleed
1.resuscitation with fluids +/- packed red cells
2. Endoscopy
Investigation hiatus hernia
Endoscopy
Barium swallow
Oesophageal manometry
Treatment
Proton pump inhibitors
Laparoscopic fundoplication
Symptoms hiatus hernia
Retrosternal burning sensation lying down or bending
Asymptomatic
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
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
