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finals - gi > Intestinal > Flashcards

Intestinal Flashcards

1
Q

what 3 things can define constipation

A

<3 times a week // difficulty passing // incomplete emptying

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2
Q

what are common complications of constipation (3)

A

overflow diarrhoea // AUR // haemorrhoids

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3
Q

what defines diarrhoea

A

> 3 loose stools in a day

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4
Q

what is acute vs chronic diarrhoea

A

acute <14 // chronic > 14 days

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5
Q

what are common causes of acute diarrhoea (4)

A

infection // diverticulitis // abx // overflow constipation

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6
Q

what can cause chronic diarrhoea (5)

A

IBS // UC // chrohns // colorectal cancer // coeliac

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7
Q

what symptoms must be present for IBS and how long (3)

A

6 months: abdo pain +/- bloating +/- change in bowels

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8
Q

what red flags need to be ruled out in IBS

A

rectal bleeding // weight loss // FH ovarian cancer // 60+

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9
Q

what invx should be done in IBS

A

FBC // CRP // coeliac TTG antibodes

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10
Q

1st line mx IBS (3)

A

pain = antispaspodic eg hyoscine (buscopan) // consitpation = laxitive // diarrhoea = loperamide

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11
Q

what laxative should be avoided in IBS

A

lactulose

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12
Q

what laxitve can be given in special cases of IBS

A

linaclotide

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13
Q

2nd line mx IBS

A

TCAs low dose eg amitrip 5-10mg

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14
Q

when is CBT offered in IBS

A

after 12 months

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15
Q

what is diverticular disease

A

herniation of colonic mucosa through muscilar wall

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16
Q

where does diverticular disease usually occur in colon + what area is usually spared

A

between teania coli // rectum spared

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17
Q

difference between diverticular disease and diverticulosis

A

diverticulosis is no symptoms

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18
Q

symptoms diverticular disease (3)

A

change bowel habits // PR bleed // abdo pain

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19
Q

complications diverticular disease (6)

A

diverticulitis // bleed // fistula // perforation // peritonitis // abscess

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20
Q

invx diverticular diseae

A

CT 1st –> colonscopy // barium enema

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21
Q

how is severity determined in diverticular disease (4)

A

Hinchey: paracolonic abscess –> pelvic –> purulent peritnotis –> faecal peritonitis

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22
Q

what are risk factors for diverticuloss

A

age and low fibre diet, obese

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23
Q

what is diverticulitis

A

infected diverticulas

24
Q

symptoms of diverticulitis

A

LLQ pain // N+V // consipation or diarrhoea // urinary symptoms // PR bleed // signs of infection

25
Q

what is a serious complication of diverticulitis (5)

A

abcess // peritonitis // obstruction // perforation // colovesical or colovaginal fistula

26
Q

what X rays should be done in diverticulitis and what do they show

A

erect CXR - pneumoperitoneum // AXR - dilation

27
Q

what invx should be avoided in diverticulitis

A

colonscopy –> perforation

28
Q

how is mild –> severe diverticulitis managed

A

oral abx – > IV ceftriaxone + IV metro

29
Q

how is severe diverticulitis with faecal peritonitis managed

A

resection + stoma // less severe = washout

30
Q

what are the 3 main ischaemias to the lower GI tract

A

acute mesenteric // chronic mesenteric // ischaemic colitis

31
Q

risk factors for bowel schaemia (5)

A

age // A fib // thromboemboli eg endocarditis, cancer // CVS eg smoking, HPT, DM // cocaine

32
Q

symptoms bowel ischaemia

A

abdo pain (sevre and sudden) // PR bleed // diarhhoea // fever // raised WCC and lactate

33
Q

invx bowel ischaemia

A

CT

34
Q

what causes mesenteric ischamia

A

embolus usually AF

35
Q

artery block in acute mesenteric ischaemia

A

mesenteric artery

36
Q

mx acute mesenteric ischaemia

A

urgent surgery

37
Q

what is ischaemic colitis

A

acute and transient block in blood flow –> inflam, ulcer, haemorrhage

38
Q

where does ischamic colitis usually occur + initial invx

A

splenic flexure // AXR shows thumbprinting

39
Q

what are the 2 most common causes of SBO

A

adehsions then hernias

40
Q

most common causes large BO

A

tumour // volvulus // diverticular

41
Q

key features SBO (5)

A

abdo pain // bilious vomiting // constipation // distension // tinkling bowel sounds

42
Q

1st line invx for small and large BO

A

AXR

43
Q

diagnostic invx small and large BO

A

CT

44
Q

mx for small and large BO (4)

A

NBM + IV fluid + NG tube // maybe surgery

45
Q

when would bowel obstruction commonly require surgery

A

perforation

46
Q

what is the most common type f volvulus

A

sigmoid (80%)

47
Q

what associations are there with sigmoid volvulus (5)

A

older // chronic constipation // Chagas disease // neruological conditions // psychiatric eg schizo

48
Q

what associations are there with caecal volvulus (3)

A

all ages // adhesions // pregnancy

49
Q

how is voluvulus diagnosed

A

AXR: sigmoid = LBO + coffeebean // caecal = SBO

50
Q

mx sigmoid volvulus

A

rigid sigmoidoscopy + rectal tube

51
Q

mx caecal

A

right hemicolectomy

52
Q

what is maximum normal diameter for small bowel when obstruction suspected

A

35mm

53
Q

what is maximum normal diameter for large bowel when obstruction suspected

A

55mm

54
Q

what type of tumour characterises Zollinger Ellison syndrome

A

gastrin secreting from dudodenum or pancreas

55
Q

what gene is Zollinger Ellison syndrome assoc with

A

MEN1

56
Q

symtoms zollinger ellison (3)

A

multiple gastroduodenal ulcers // diarrhoea // malabsorption

finals - gi (18 decks)

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