Lower GI Flashcards
acute cholecystitis
- what is it
- S&S
- risk factor
- complications
- investigations
- treatment
- inflammation of gallbladder
- RUQ pain/epigastric pain, pyrexia, tachycardia, tenderness guarding, murphy’s sign, N&V
- Hx of gallstones, BM, infection (epstein-Barr virus)
- necrosis, perforation, jaundice
- urine dip, FBC, U+E, CRP, LFTs (raise ALP->ductal occlusion), Amylase*, USS
- IV, antibiotics, analgesia, cholecystectomy
Acute cholangitis
- what is it
- triad presentation
- cause from?
- investigation
- treatment?
- infection of the biliary tree
- RUQ pain, jaundice, fever
- biliary obstruction (choledocholithiasis) / biliary strictures (narrowing)
- USS, CT abdomen/pelvis, *MRCP (pancreatic system MRI)
- IV antibiotics, biliary drainage by ERCP
Acute pancreatitis
- definition
- cause
- risk factors
- S&S
- investigation
- management
- inflammation of the pancreas
- gallstones / alcohol misuse
- infection (mumps), medications (ACEi, statins, oestrogens), chronic pancreatitis/adenocarcinoma
- N&V, epigastric pain, diarrhoea, pyrexia, tachycardia, tender, distention, grey turners, cullen’s
- BT: amylase, LFTs, U+E, CRP/ ESR, USS (if gallstones)
- analgesia, antibiotics (if fever), drainage / Pancreatectomy, fluid resus
Chronic pancreatitis
- cause
- symptoms
- investigation
- alcohol misuses
- Epigastric pain, nausea and vomiting, loss of appetite
- CT or MRI with MRCP
Irritable bowel syndrome (IBS)
- symptoms and requirement for IBS?
- non-pharmalogical treatment
- abdo discomfort > 6months +
altered bowel frequency/stool form, altered stool passage, abdo bloating, distension, tension/ hardness, worse by eating passage of mucus
Extra-> lethargy, nausea, back pain, headache gynaecological bladder symptoms - reduce intake of insoluble fibre, reduce exacerbate food,
FODMAP/dietician
pharma logical treatment for IBS:
> constipation
> diarrhoea
> abdo pain / spasm
constipation
- bulk-forming laxative (ispaghula husk)
Diarrhoea
- Antimotility drug (loperamide)
abdo pain / spasm
- Antispasmodic drug
mebeverine hydrochloride
alverine citrate
peppermint oil
(TCA second line)
possible cause of constipation & diarrhoea
constipation
- medication
- hypothyroidism
diarrhoea
- IBD
- coeliac
- gastroenteritis
- C.diff
screening tool for colorectal cancer
- Symptoms for colorectal cancer
- management after that?
- Faecal immunochemical test (FIT)
- Rectal bleeding
Change in bowel habit
Abdominal/ rectal mass
Weight loss
Anaemia - Two-week wait referral
Coeliac disease
- triggers factor
- investigation
- management
- dietary gluten
- IgA tissue transglutaminase antibody (tTGA)
biopsy - gluten free diet
Acute gastroenteritis
- causes
- treatment
- management
- Rotaviruses, caliciviruses, astroviruses, coronaviruses, noroviruses, and enteric adenoviruses
- oral rehydration salt
- gradually usual diet, small light , non-fatty, non-spicy meals
don’t attend work
Inflammatory bowel disease (IBD)
- types
- symptoms
- investigations
- Crohn’s disease & Ulcerative Colitis (UC)
- Diarrhoea for 4-6 weeks – blood more common in UC.
Nocturnal defecation
LIF pain
Faecal urgency
Mucus in the stool
Fever, fatigue, weight loss - BT (FBC, CRP, U+Es, LFTs, TFTs, Ferritin/ B12, coeliac screen, Faecal calprotectin, FIT test)
Refer to gastro - colonoscopy with biopsy
Ulcerative colitis (UC)
- main risk factor
- complications
- Treatment
- Smoking
– psychosocial impact, toxic megacolon (dilation of the colon), bowel obstruction, bowel perforation, intestinal strictures, fistulas, anaemia, malnutrition.
- Aminosalicylate (anti-inflammatory)
Corticosteroids ( e.g. Prednisolone)
Immunosuppressors (e.g.Tacrolimus)
severe cases - surgery
Crohn’s disease
- Risk factors
- appearance
- S&S
- complications
- treatment
- abnormal immunological response, genetic and environmental
- fibrosis with luminal narrowing and intestinal obstruction. fissures fistulas
- Periods of flare up
Abdominal Pain
Diarrhoea
Fever
Weight loss
Anal Pain - obstruction, fistula formation -> UTI/faecal vaginal discharge, carcinoma, arthritis/uveitis
- Aminosalicylate
Prednisolone
Tacrolimus
surgery (proctocolectomy/colectomy with ileorectal anastomosis
Diverticulosis
- definition
- risk factor
- complications
- treatment
- presentation
- investigation
- diverticula are present without symptoms
- Older age (50-60 years old)
low-fibre diet,
smoking,
obesity,
NSAIDs and opioids,
immunosuppression. - Bleeding, Abscess formation, perforation and peritonitis, stricture and fistula formation, intestinal obstruction.
- balance diet w whole grains, fruit and vegetables
- painless rectal bleeding, LIF – triggered by eating and relieved by passing stool or flatus, bloating, fever, dysuria.
- endoscopy and possibly CT.
diverticulitis
- definition
- presentation
- investigation
- treatment
- diverticula that are inflamed or infected
- constant LIF pain associated with fever, sudden change in bowel, rectal bleeding, tenderness on palpation with previous history of diverticulosis.
- endoscopy and possibly CT.
- co-amoxiclav 500/125mg TDS for 5 days, simple analgesia
