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Other Flashcards

1
Q

What things increase risk of stomach disease?

A

body fatness

alcohol salt in foods

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2
Q

What things increase risk of liver disease?

A

aflatoxins
alcohol
body fatness

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3
Q

What things increase risk of colon and rectum disease?

A

processed meat
alcohol body fatness
adult height
red meat

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4
Q

What are the five principles of behaviour change counselling?

A 
Ask
Assess
Advise
Agree
Assist
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5
Q

What can endoscopy be used to diagnose?

A
  • Oesophagitis
  • Gastritis
  • Ulceration
  • Coeliac
  • Crohn’s
  • Ulcerative colitis
  • Tumours
  • Sclerosing cholangitis
  • Vascular abnormalities (varices or angiodysplasia)
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6
Q

What are the main endoscopic procedures?

A
  • Oesophagogastroduodenoscopy (OGD)
  • Sigmoidoscopy
  • Colonoscopy
  • Wireless capsule endoscopy
  • Endoscopic retrograde cholangiopancreatography
  • Endoscopic ultrasonography
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7
Q

What else can endoscopy be used for?

A
  • take biopsies
  • treat down the microscope with stents
  • arterial bleeding can be treated with injections, heater probe or clips to ligate
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8
Q

What are the complications of stents?

A
  • Foreign body sensation
  • Reflux
  • Fever
  • Septicaemia
  • Fistula formation
  • Bleeding
  • Perforation
  • Pain
  • Migration
  • Tumour in/overgrowth
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9
Q

What are the complications of endoscopy?

A
  • respiratory arrest
  • cardiac arrest
  • aspiration
  • bleeding
  • perforation
  • injection
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10
Q

What do you examine for in traveller’s disease?

A
  • fever
  • rash
  • hepatosplenomegaly
  • lymphadenopathy
  • insect bites
  • wounds
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11
Q

What are some of the causes of fever in travellers?

A
  • respiratory infections
  • traveller’s diarrhoea
  • malaria
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12
Q

What is acute traveller’s diarrhoea seen as?

A
  • 3 loos stools in 24hrs

- sometimes associated with fever

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13
Q

What causes traveller’s diarrhoea?

A

a different type of E.coli from out normal type

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14
Q

What are the best investigations for traveller’s diarrhoea?

A

stool culture and stool wet prep

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15
Q

What is the treatment for traveller’s diarrhoea?

A

supportive

fluoroquinolone in extreme cases

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16
Q

What is enteric fever caused by?

A
  • salmonella typhi or paratyphi
  • Indian travel
  • faecal-oral route due to contaminated food
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17
Q

What is the treatment for enteric fever?

A

IV Ceftriaxone

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18
Q

What the types of traveller’s jaundice?

A

pre-hepatic
hepatic
post-hepatic

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19
Q

What are the common types of protozoan infections?

A
  • Amoebiasis: poor sanitation
  • Giardiasis: malabsorption and watery, malodorous diarrhoea, looks like smiley men
  • Amoebic liver abscess
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20
Q

What are helminthic infections?

A
  • Helminth infections are parasites
  • increase in eosinophil count
  • worms
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21
Q

What are examples of helminthic infections?

A
  • flukes/trematodes
  • cestodes/tapeworms
  • trypanosoma cruzi
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22
Q

What is globus?

A

feeling of having a lump in the throat

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23
Q

What is globus caused by?

A 
foreign body
reflux
inflammation of the pharynx
pharyngeal pouch
cancers
hay fever
neurological conditions
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24
Q

What is the management off globus?

A

reassurance
treatment of reflux
smoking cessation
treat stress

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25
Q

What is function dysphagia?

A

sensation of solid food sticking in the oesophagus so unable to swallow

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26
Q

What is the management of functional dysphagia?

A

reassurance
adjusting diet
adjust way of eating

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27
Q

What can psychosis be caused by?

A
  • schizophrenia
  • mood disorder
  • drugs
  • organic causes such as dementia, delirium or brain tumours
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28
Q

What is IBS caused by?

A
  • change in the motility of the gut
  • sensory dysfunction
  • change in gut reactivity characterised by abdominal discomfort, bloating or pain
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29
Q

What is the management of IBS (psychiatry)?

A

(linked to abuse in childhood)

  • diet changes
  • exercise
  • reduce stress
  • medication eg antispasmodic, laxative, anti motility medicines or low-dose anti-depressants
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30
Q

What is MUS?

A

medically unexplained conditions that can only really be treated with validation and reassurance

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31
Q

What is anorexia nerves and what does it include?

A
  • include body image distortion
  • fear of fatness
  • self-induced weight loss
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32
Q

What does anorexia result in?

A

endocrine abnormality:

  • decreased Na, K etc
  • arrhythmia
  • bone health deterioration
  • lack of periods (amenorrhoea)
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33
Q

What is bulimia nervosa characterised by?

A
  • failing of dieting so binging then purging
  • depletion of electrolytes
  • common history of anorexia
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34
Q

What are the clinical signs of bulimia?

A
  • decay of back of teeth
  • ulcer
  • scars on back of throat
  • russell’s signs on the hands (knuckles)
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35
Q

What is the treatment for bulimia?

A
  • therapeutic alliance
  • weight gain
  • psychological interventions
  • drugs eg antidepressants or antipsychotics
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36
Q

What are the main causes of upper GI bleeds?

A

1- duodenal ulcers
2- gastric erosions
3- gastric ulcers
4- varices

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37
Q

What is the main acute treatment for an upper GI bleed?

A

ABC
oxygen
IV access with two grey venflons

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38
Q

What is the severity of an upper GI bleed assessed on?

A 
systolic BP (less than 100)
pulse (greater than 100)
Hb (less than 100)
age
comorbidities
postural BP drop
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39
Q

What are the main objectives of endoscopy?

A
  • identify cause
  • therapeutic manouvres
  • assess risk of rebleeding
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40
Q

What are the main upper GI bleed scoring systems?

A

Rockall Risk Scoring System

Blatchford score

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41
Q

What is the treatment of a bleeding peptic ulcer?

A
  • endoscopic
  • acid suppression (IV omeprazole)
  • surgery
    (H. pylori eradication is secondary treatment)
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42
Q

What is the endoscopic treatment fo a bleeding peptic ulcer?

A
  • injection
  • heater probe coagulation
  • combination moo therapies
  • clips
  • hemospray (forms mechanical barrier over the bleeding site)
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43
Q

When do you suspect variceal bleeding?

A
  • known history of cirrhosis
  • alcohol excess
  • viral hepatitis infection
  • autoimmune disease
  • abdominal surgery
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44
Q

What are the signs of liver disease and therefore the possibility of varices?

A
  • spider naevi
  • ascites
  • jaundice
  • encephalopathy
  • leukonychia
  • palmar erythema
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45
Q

What are the aims of management for variceal bleeding?

A
  • resuscitate
  • achieve haemostasis
  • stop bleeding complications
  • stop liver functioning worsening
  • stop re-bleeding
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46
Q

How is haemostasis in variceal bleeding achieved?

A
  • Terlipressin (prodrug which is splanchnic vasoconstrictor)
  • ligation or banding
  • sclerotherapy
  • balloon
  • TIPS (wire into portal lens and insert balloon and stent)
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47
Q

How do STIs spread to the GI tract?

A 
direct inoculations
trauma
sexual/genital secretions
ingestion
fomites (inanimate object)
IV drug use with sex
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48
Q

What are the risk factors for rectal STIs?

A 
under 25
changing sexual partners
no condoms
MSM
STI past history
large urban area
social deprivation
black
49
Q

What can STIs present as in the GI tract?

A

perianal problems
proctocolitis
hepato-biliary problems

50
Q

What are the features of rectal gonorrhoea?

A
  • caused by neisseria gonorrhoea

- presents with abdominal pain, diarrhoea, rectal bleeding, anal discharge and tenesmus

51
Q

How is rectal gonorrhoea spread?

A

anal sex
fomite
transmucosal spread

52
Q

What is seen on proctoscopy with gonorrhoea and what are the complications?

A

inflamed mucosa and purulent exudate

abscesses
HIV susceptibility

53
Q

What is rectal chlamydia caused by?

A

chlamydia trachomatis

NB: less severe than gonorrhoea

54
Q

What is the presentation os chlamydia?

A

asymptomatic or with anal discomfort and discharge

55
Q

What is the presentation of lymphogranuloma venereum?

A
  • ulcer to
  • inguinal syndrome and anorectal syndrome to
  • strictures, fistulae and genital elephantiasis
56
Q

What should happen after a diagnosis of LGV?

A
  • test for all other STIs esp HIV
57
Q

What are the main STIs causing proctocolitis?

A

gonorrhoea
chlamydia
lymphogranuloma venereum

58
Q

What are the main STIs causing anorectal ulcers and skin lesions?

A

LGV
syphilis
herpes simplex virus
HPV

59
Q

What is the presentation of syphilis?

A
  • present in any way
  • primary is one painless ulcer at site of infection
  • secondary can go to any system
60
Q

What are the possible GI manifestations of syphilis?

A

ulcers
hepatits
proctoscopy-colitis
condylomata lata

61
Q

What are the features of herpes simplex in GI?

A
  • always type 2 in anal herpes
  • can extend to rectum
  • symptoms are pain, ulcers, painful defecation, bleeding and mucus
62
Q

What are the features of GI related HPV?

A
  • transmitted ano-genitally and oro-genitally

- causes anal warts that can extend to rectum

63
Q

What does HIV do in the GI tract?

A
  • depletion of intestinal GALT regardless of the site of infection
  • leading to gut vulnerability to bacteria
64
Q

What happens in a bowel obstruction?

A
  • any part of GI tract
  • dilation of the bowel before
  • peristalsis is disrupted
65
Q

How does a bowel obstruction present in the upper small bowel?

A
  • acute
  • hours onset
  • large volumes vomited
66
Q

What is the presentation of a bowel obstruction in the lower small bowel or large bowel?

A
  • colicky abdominal pain

- distention with vomiting

67
Q

What are the main symptoms of bowel obstruction?

A
  • vomiting: proximal=early presentation, vomit even if starved
  • pain: colicky and due to distension
  • constipation: bowel stopped moving
  • distension
68
Q

What are the different types of vomit in bowel obstruction and what do they mean?

A
  • semi-digested food = gastric outlet obstruction
  • bile-stained fluid = upper small bowel obstruction
  • thick brown badly-smelling fluid = distal obstruction
69
Q

When does an obstruction in the large bowel present?

A
  • later due to large capacity of the colon

- ileo-caecal valve can be either competent or not, if it is not then the small bowel will distend

70
Q

What happens in an incomplete bowel obstruction?

A
  • less well defined
  • erratic bowel habits
  • intermittent vomiting
  • chronic leads to gradual hypertrophy proximal to obstruction
  • colicky pain gets worse ad hypertrophy occurs
71
Q

What is seen on examination of a bowel obstruction?

A
  • dehydration
  • abdominal distension
  • visible peristalsis
  • lack of abdominal tenderness
  • occasional palpable mass
  • percussion shows resonance due to gas
  • examine groins for hernia
72
Q

What do bowel sounds sound like in bowel obstruction?

A
  • high-pitched and tinkling
  • absent
  • echoing
  • ‘water against a boat’
73
Q

What are the investigations for bowel obstruction?

A
  • supine abdo XR, bowel before will be filled with gas and after will be collapsed
  • CT is used to find transition point of distention and collapse
74
Q

What is the management of a bowel obstruction?

A
  • no food
  • IV cannula
  • bloods
  • fluids and electrolytes
  • NG tube to decompress stomach
75
Q

What are the mechanical causes of a bowel obstruction?

A
  • adhesions or bands: congenital or from surgery
  • incarcerated abdominal wall hernia: inguinal or femoral
  • volvulus: mobile loop of bowel, sigmoid or caecum
  • tumour
  • inflammatory strictures: Chron’s or diverticular disease, incomplete
  • bolus obstruction: food, faeces, gallstone ileus, trichobezoar
  • intussusception: telescoping caused by a mass
  • bowel strangulation: infarction and perforation
76
Q

What are the causes of dynamic paralytic bowel obstruction?

A
  • paralytic ileus: peristalsis stops, small intestine, no pain but bowel obstruction symptoms, treat with drip and suck (NG suction and IV fluids)
  • pseudo-obstruction: large intestine, acute dilation fo colon and rectum, can need decompression
77
Q

What is paralytic ileus associated with?

A
  • recent GI surgery
  • inflammation with peritonitis
  • diabetic ketoacidosis
78
Q

What are the risk factors for pseudo-obstruction?

A
  • hip replacement
  • CABG
  • spinal fracture
  • pneumonia
  • frail and elderly
  • in hospital
79
Q

What is the mechanism of how alcohol affects the body?

A

causes inflammation in hepatocytes leading to fibrosis and scarring

80
Q

What are the characteristic features of alcoholic hepatitis?

A

hepatomegaly
fever
leukocytosis
hepatic bruit

81
Q

What are the 6Fs of abdominal mass?

A 
fat
faeces
flatus
foetus
fluid 
fatal growth
82
Q

What are the associated symptoms to abdominal masses?

A
  • Blood loss
  • Jaundice
  • Gynae problems
  • Operations
  • Vomiting
  • Urinary problems
  • Change in bowel habit
  • Weight loss
  • Anorexia
83
Q

What are the main abdominal masses?

A
  • AAA
  • Hepatic mass
  • Splenic mass
  • Renal mass
  • Pancreatic mass
  • Colorectal cancer
  • Gynaecological mass
  • Incisional and midline hernia
  • Inguinal hernia
84
Q

What are haemorrhoids?

A

enlarged vascular cushions in the lower rectum and anal canal
(anal cushions are at 3,7 and 11 o’clock in the lithotomy position)

85
Q

What are the symptoms of haemorrhoids?

A

painless bleeding with bright red blood on paper

perianal itching

86
Q

What are the investigations for haemorrhoids?

A

PR normal
rigid sig
proctoscopy
flexi sig if over 50

87
Q

What is the treatment for haemorrhoids?

A

symptomatic
rubber band ligation
HALO/THD

88
Q

What are the features of a rectal prolapse?

A
  • partial or complete
  • poor anal tone
  • protruding mass esp in defecation
  • bleeding and mucus per rectum
89
Q

What is the treatment for a complete rectal prolapse?

A
  • manual reduction
  • laxatives
  • abdo rectopexy
  • Delorme’s procedure
90
Q

What is the treatment for an incomplete rectal prolapse?

A
  • dietary advice and constipation treatment in children

- similar treatment to haemorrhoids in adults

91
Q

What is an anal fissure?

A

tear in the anal margin due to constipation

usually in the midline posteriorly

92
Q

What are the symptoms of an anal fissure?

A
  • multiple is usually due to Crohn’s
  • pain after defecation like glass
  • bright rectal bleeding
93
Q

What is the treatment for anal fissures?

A
  • dietary advice
  • stool softeners
  • meds to relax muscles (ointments)
  • lateral sphincterotomy
  • botox injection
94
Q

What is a fistula-in-ano?

A

an abnormal communication between two epithelial surfaces- internal opening in anal canal and one/more external opening on peri-anal skin

95
Q

What are fistula-in-ano caused by?

A

from delay or inadequate treatment of anorectal abscess

96
Q

What are the investigations for a fistula-in-ano?

A

EUA, rigid sig, proctoscopy, flex sig or MRI

97
Q

What is fistula-in-ano managed with?

A
  • laying open
  • insertion of seton then LIFT procedure
    ( - complications are pain, bleeding, incontinence or more surgery)
98
Q

What is a hernia?

A

an abnormal protrusion of a cavity’s contents through a weakness of the cavity’s wall

99
Q

What are the causes of a hernia?

A

anatomical, inherited collagen disorders and site where surgical cuts are made

100
Q

What are the main types of hernia?

A 
epigastric
paraumbilical
inguinal
femoral
spigelian
lumbar
incisional
parastomal 
port-site
101
Q

What are the features of an epigastric hernia?

A
  • fascial defect in the linea alba between xiphoid and umbilicus
  • asymptomatic midline lump
102
Q

What are the causes of a paraumbilical hernia?

A

stretching of the abdominal wall so obesity, pregnancy and ascites

103
Q

How do paraumbilical hernias present?

A

-pain
-resolve spontaneously
-commonly become incarcerated and strangulated
(management is surgical)

104
Q

What is an inguinal hernia (direct and indirect)?

A
  • loop of intestine comes through the inguinal canal
  • direct is forward through the posterior wall of the inguinal canal into a defect in the abdominal wall (Hesselbach triangle)
  • indirect is through the internal ring
105
Q

What is the presentation of an inguinal hernia?

A
  • more common in males
  • lump disappears when lying down
  • occlude deep ring and patient coughs if it if restrained then it is indirect if not it is direct
106
Q

What are the features of a femoral hernia?

A
  • bowel enters femoral canal
  • women
  • very common to present as strangulation
  • surgical
107
Q

What are the features of spigelian hernia?

A
  • uncommon
  • in six pack but not middle line, in the side line
  • level with or below the umbilicus
108
Q

What are the features of a lumbar hernia?

A

through inferior or superior lumbar triangles in the posterior abdominal wall

109
Q

What are the features of an incisional hernia?

A
  • iatrogenic

- causes are wounds, collagen abnormalities, old age, smoking, obesity, malignancy and surgical technique

110
Q

What are the three classifications of hernias?

A
  • Reducible- can be pushed back into abdomen
  • Incarcerated or irreducible- cannot be manipulated back into the abdomen
  • Strangulated- vascular supply is compromised so there is ischaemic or gangrenous tissue
111
Q

What are the most important nutritional factors to monitor in IBD?

A 
CRP
U&Es
Mg
Ph
LFTs with serum albumin level
FBC
ferritin and transferrin saturations
folate level
vit B12
112
Q

What are the most common nutrient deficiencies in IBD?

A 
UC= anaemia and iron deficiency 
Crohn's= anaemia, weight loss and malnutrition
113
Q

What is EN used for in IBD?

A

to induce remission in children and sometimes adults (over steroids)

114
Q

When is TPN indicated in IBD?

A
  • in active disease of the small bowel
  • previous multiple surgeries
  • short gut syndrome
115
Q

What is IBS classified as?

A

abdominal pain on average 1 day a week in the last three months

  • related to defecation
  • change in frequency of stool
  • change in consistency of stool
116
Q

What is the first-line dietary change for IBS?

A
  • regular meals, small and not late at night
  • limit alcohol, caffeine and fizzy drinks
  • lots of fluid
  • less fatty foods
  • limit fresh fruit
117
Q

What is the second-line dietary change for IBS?

A
  • Fermentable
  • Oligo-saccharides
  • Disaccharides
  • Monosaccharides
  • Polyols
118
Q

What is the treatment for Coeliac disease?

A

a gluten-free diet

119
Q

What are the complications of GI surgery?

A
  • wound infection
  • anastomotic leak
  • paralytic ileus
  • bleeding or haematoma
  • formation
  • short gut syndrome
  • adhesions
  • scars

My Gastrointestinal (18 decks)

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