GIT Flashcards
Autoimmune chronic active hepatitis
Risk factors: Female; Genetic predisposition, Autoimmune diseases: thyroiditis, type1DM, ulcerative colitis, coeliac disease, RA, Viruses: measles virus, CMV, hepatitis viruses (A,C,D), and EBV; Drugs: minocycline, methyldopa, nitrofurantoin, diclofenac, atorvastatin, interferon, ezetimibe; Herbal agents: blackcohosh Signs & Symptoms: fatigue; malaise ; lethargy; anorexia; nausea; abdominal discomfort mild pruritus, small joint arthralgia; Fever; Encephalopathy; GI bleeding associated with portal hypertension Examination: Hepatomegaly; Jaundice; Splenomegaly; spider angiomata; ascites Investigations: - LFTs: elevated Aminotransferase levels; - Bilirubin and alkaline phosphatase levels- increased; - serum gamma globulins elevated; - Serum albumin levels - reduced. - Coagulation studies: prothrombin time prolonged.
Helicobacter pylori gastritis
- dyspepsia/epigastric discomfort - nausea - vomiting - loss of appetite - no suspicious features of malignancy, ie. GI bleeding, anaemia, early satiety, unexplained weight loss (>10% body weight), progressive dysphagia, odynophagia, or persistent vomiting
Hepatitis A
early: - abrupt-onset fever - abdominal pain - malaise, nausea +/- vomiting - headache +/- diarrhoea - +/- upper abdo discomfort late: - dark urine - pale stools - jaundice - hepatomegaly - splenomegaly - marked elevation of serum transaminases (usually >1000 units/L)
Hepatitis B
- cirrhosis or liver failure - jaundice - polyarthralgia - transient maculopapular or urticarial rash - multiple sexual partners - men who have sex with men (MSM) - injection drug use - Asian, eastern European, or African ancestry
Hepatitis C
- often asymptomatic, detected on screening LFTs - constitutional symptoms (fatigue, myalgia, or arthralgia) - jaundice - ascites - Confusion, altered consciousness, or coma - vasculitis, renal injury
Alcoholic hepatitis
- excess alcohol - bruising, leukonychia, clubbing, palmar erythema, spider naevi - Dupuytren contracture - liver enlargement - pale, fatty motions which are difficult to flush away - leucocytosis - raised transaminase levels with AST higher than ALT in a ratio of 2:1, but with neither above 300 IU/dl - elevated bilirubin - hypoalbuminaemia - prolonged prothrombin levels
Hirschsprung’s disease
- <12mo - vomiting - explosive passage of liquid and foul stools - abdominal distension - delayed passage of meconium - fever - failure to thrive
Hydatid disease (Tapeworm infection)
- living on farm - poor hygiene - eating or handling undercooked meat - eating or handling undercooked fish or crustaceans - ingestion of contaminated water - dog owner - child - anaemia - cough - haemoptysis - allergy manifestations (urticaria or anaphylaxis) - seizures
Intussusception
- age 6 to 12 months - male - abdominal pain - vomiting - lethargy/irritability - blood per rectum/currant jelly stool
Irritable bowel syndrome
- Hx of physical or sexual abuse - age <50 years - female - previous enteric infection - abdominal discomfort - alteration of bowel habits associated with pain - abdominal bloating or distension - normal examination of abdomen - normal investigations
Ascending cholangitis
Risk factors: > 50 years; Hx cholelithiasis; Hx primary or secondary sclerosing cholangitis; stricture of the biliary tree (benign/malignant); injury of bile ducts (e.g. surgery, ERCP, PTC, stent) Signs and Symptoms: RUQ pain and tenderness; Jaundice; Fever (may be absent in over 60 yrs); Nausea and vomiting; Pruritis; Malaise Charcot’s triad (50-75% of cases): fever, RUQ pain and jaundice Reynold’s pentad (~5% of cases): Charcot’s triad plus altered mental state and shock Examination: RUQ tenderness; Jaundice; Fever >38C; Tachycardia; Hypotension; Shock
Coeliac disease
Risk factors: FHx of this condition; IgA deficiency; type 1 DM; autoimmune thyroid disease; Down’s syndrome; Sjogren’s syndrome; inflammatory bowel disease; primary biliary cirrhosis Signs and Symptoms: diarrhoea, weight loss, abdominal pain, bloating; fatigue, skin rash (intensely pruritic papulovesicular), recurrent severe aphthous stomatitis, deficiency states (e.g., iron deficiency) or extra-intestinal manifestations (e.g., fatigue, elevated liver enzymes, or infertility).
Typhoid Fever (Salmonella typhi)
Clinical Features: Insidious onset, headache prominent, relative bradycardia, dry cough, fever gradually increase in “stepladder” manner over ~4 days, abdominal pain and (early) constipation, diarrhoea (classic pea soup) and rose spots (late), +/- splenomegaly.
Strongyloides (Human threadworm)
Clinical Features: Recurrent abdominal pain and swelling, diarrhoea, chronic cough, wheezing, pruritus, dermatitis, urticaria, blood eosinophilia. Classic triad: abdominal pain (low grade) + recurrent diarrhoea + blood eosinophilia High risk: migrants and refugees from tropical developing countries, returned soldiers, former prisoners of war from SE Asia and workers or residents in northern aboriginal communities.
Ulcerative Colitis
Clinical Features: Mainly in young adults (15-40yrs), recurrent attacks of loose stools (main system bloody diarrhoea), blood & pus or mucus in stools, High risk factors: Family hx, previous attacks, low fibre diet
Volvulus (Most common are sigmoid)
Clinical Features: Abdominal pain, bilious vomiting, infant age <1year, abdominal distension, dark blood in nappy, weight lost, rebound tenderness & guarding, Dx: Abdominal X-ray classic coffee bean sign
Wilson’s Disease
Clinical features: Kayser-Fleischer rings, jaundice, sloppy or small handwriting, hx of hepatitis, hx of behavioural abnormalities, tremor, incoordination, signs of liver failure.
Pseudomembranous colitis
Risk factors: advanced age, recent hx of antibiotic use, comorbid conditions (immunosuppression, IBD), PPI’s, prolonged hospitalisation, residence in a nursing home Signs and Symptoms: abdominal pain (mild- severe), nausea, mild-severe diarrhoea, fever, nausea & vomiting, and malaise
Cholecystitis
Risk factors: cholelithiasis; pregnancy; COCP; elderly; obesity; certain ethnic groups (Northern European and Hispanic); rapid weight loss; and liver transplant, prolonged fasting; diabetes, HIV; hemolytic diseases Signs and Symptoms: Severe, constant RUQ pain and tenderness, right shoulder/ interscapular pain; nausea & vomiting after eating fatty food. May have fever, Mild jaundice, positive Murphy’s sign, gallbladder palpable as a distinct mass (30-40% of cases)
Carcinoid syndrome
Risk factors: male, multiple endocrine neoplasia type 1 peptic ulcer disease Signs and Symptoms: Diarrhoea; flushing (triggers stress, tyramine-containing foods (chocolate, bananas, walnuts), and alcohol); telangiectasia; peripheral cyanosis; palpitations; wheezing; and abdominal cramps Examination: pink/red discolouration of face & upper trunk; telangiectasia; hypertrophy facial features; wheeze on respiratory exam; tachycardia, raised JVP, pedal oedema, Right-sided cardiac murmurs (tricuspid regurgitation & pulmonary stenosis) on cardiovascular examination; Abdominal examination may reveal a large tender, pulsatile liver and/or fixed masses
Biliary colic
Risk factors: cholelithiasis; pregnancy; COCP; elderly; obesity; certain ethnic groups (Northern European and Hispanic); prolonged fasting; rapid weight loss; and liver transplant, diabetes, HIV; hemolytic diseases Signs and Symptoms: Typical gallbladder 1-5 hours of severe, dull or boring, constant pain, in the epigastrium or RUQ; may radiate to the right scapular region or back. Patients tend to move around to seek relief from the pain. Nausea +/- vomiting, bloating, The onset of pain develops hours after a meal.
Bowel cancer
Signs and Symptoms: frequently non-specific late stage diagnosis - fatigue; blood in stools, palpable rectal mass, persisting change in bowel habit, anaemia, anorexia, weight loss, and abdominal pain/bloating/cramping. Examination: may be normal or signs of anaemia, rectal mass, abdominal mass
Mesenteric Adenitis
Presents in school age children Diffuse abdominal pain history of recent or current URTI Fever Abdo tenderness not localised to RLQ rhinorrhoea pharyngitis associated lymphadenopathy (usually cervical)
Oesophageal Cancer
Key RFs: male, smoker, excessive alcohol intake, GORD and Barrett’s oesophagus, FHx of oesophagus, stomach, oral or pharyngeal Ca, diet low in fruit and veg. Presents with weight loss dysphagia odynophagia hoarseness
Acute pancreatitis
Key RFs: gallstones, alcohol, hypertriglyceridaemia, Medications (thiazides, azathioprine, frusemide) ECRP procedure, HIV/AIDS, SLE, Sjogren’s syndrome. Presents with Nausea & vomiting anorexia abdo pain (epigastric radiating to back) tachycardia fever Cullens sign Grey-Turners sign
Primary Biliary Cirrhosis
RFs: Female, age 45-60, Fam hx of condition or autoimmune disease, hx of hypercholesterolaemia sx: weight loss and other metabolic features of malabsorption itch fatigue dry eyes and dry mouth jaundice ascites splenomegaly skin pigmentation
Peptic Ulcer Disease
Key RFs: Helicobacter pylori infection, NSAID use, smoking, increasing age, Fam hx of condition Presents as: Abdominal pain - chronic or recurrent abdo pain or discomfort centred in upper abdomen abdominal pain (common) Commonly related to eating and is often nocturnal. Pain may be radiate through to back Epigastric tenderness Early satiety Nausea +/- vomiting
Pyloric Stenosis
presents in infants 3-6 weeks, M>F Presents with: Non bilious projectile vomiting (soon after feed) Upper abdo mass palpable - ‘olive’ like may see peristaltic waves may see signs of dehydration or failure to thrive.
Proctalgia fugax
Episodic sudden, severe pain in the anal canal that lasts only seconds or minutes. May awaken patient from sleep. lasts 3-30 min affects adults, M>F No coccygeal tenderness PR negative
Small Bowel Obstruction
Key RFs: Previous abdominal surgery, hernia, Crohn’s disease, foreign body ingestion, appendicitis, intestinal malignancy, intussusception, malrotation, volvulus, intestinal atresia (in neonates) Presents with: Failure to pass flatus or stool Abdominal pain (crampy and intermittent) vomiting Abdominal distension (with tinkling bowel sounds) Abdominal tenderness Peritonitis
Infantile Colic
-Baby between 2 and 16 weeks age -Prolong crying (>3 hours) -Inconsolable -At least 3 times a week -Crying worst at around 10/52 age -Especially during late afternoon and early evening -Very characteristic behaviour with flexing legs and clenching fists -Normal physical examination
Crohn’s disease
• Recurrent diarrhoea in a young person • Blood and mucus in stools • Colicky abdominal pain • Right iliac fossa pain • Constitutional symptoms (e.g. fever, weight loss, malaise) • Might accompany by perianal disorders (e.g. anal fissure, fistula, ischiorectal abscess), and mouth ulcers
Diverticulitis
• Acute or recurrent onset of pain in the left iliac fossa • pain increased with walking and change of position • Irregular bowel habit, usually constipation • Peritoneal sign tenderness, guarding and rebound in LIF • Constitutional signs, ie fever • Maybe LIF mass can be palpated
Eosinophilic oesophagitis
• Associated with allergic disorder hayfever and asthma • Dysphagia • Acute bolus food stuck in throat regularly
Gastric cancer
• Male to female ratio = 3:1 • Usually asymptomatic early • Recent-onset dyspepsia in middle age • Dyspepsia unresponsive to treatment • Vague fullness or epigastric distension • Anorexia, nausea, ± vomiting • Dysphagia—a late sign • Onset of anaemia
Gastroenteritis
1.Self-limiting problem (1-3 days) 2. Abdominal cramps, nausea, vomiting / diarrhoea 3. Usually no acute peritonism 4. Constitutional signs fever, malaise
GORD
RF: -FHx of condition -Older age -Hiatus hernia -Obesity Clinical findings: -Heartburn -Acid regurgitation, especially lying down at night -Water brash -dysphagia (uncommon) -bloating/early satiety (uncommon) -laryngitis (uncommon) -globus (uncommon) -enamel erosion (uncommon) -halitosis
Giardiasis
RF: -Contaminated water/food -Domestic animals living in or around the house Clinical findings: -Watery malodorous diarrhoea, -Abdominal cramps and distention, flatulence, belching -Intermittent nausea, epigastric discomfort, and anorexia -Low-grade malaise -Weight loss (chronic)
Bechet’s syndrome
RF: 20-30yo’s, ethnicity (ME/Asia/mediterr), Family Hx -Oral mucosal ulcers / genital ulcers -erythema nodosum -uveitis -acne arms/legs rare presentation - stroke, pulmonary involvement Ix - +ve pathergy test
