Other Flashcards
What things increase risk of stomach disease?
body fatness
alcohol salt in foods
What things increase risk of liver disease?
aflatoxins
alcohol
body fatness
What things increase risk of colon and rectum disease?
processed meat
alcohol body fatness
adult height
red meat
What are the five principles of behaviour change counselling?
Ask Assess Advise Agree Assist
What can endoscopy be used to diagnose?
- Oesophagitis
- Gastritis
- Ulceration
- Coeliac
- Crohn’s
- Ulcerative colitis
- Tumours
- Sclerosing cholangitis
- Vascular abnormalities (varices or angiodysplasia)
What are the main endoscopic procedures?
- Oesophagogastroduodenoscopy (OGD)
- Sigmoidoscopy
- Colonoscopy
- Wireless capsule endoscopy
- Endoscopic retrograde cholangiopancreatography
- Endoscopic ultrasonography
What else can endoscopy be used for?
- take biopsies
- treat down the microscope with stents
- arterial bleeding can be treated with injections, heater probe or clips to ligate
What are the complications of stents?
- Foreign body sensation
- Reflux
- Fever
- Septicaemia
- Fistula formation
- Bleeding
- Perforation
- Pain
- Migration
- Tumour in/overgrowth
What are the complications of endoscopy?
- respiratory arrest
- cardiac arrest
- aspiration
- bleeding
- perforation
- injection
What do you examine for in traveller’s disease?
- fever
- rash
- hepatosplenomegaly
- lymphadenopathy
- insect bites
- wounds
What are some of the causes of fever in travellers?
- respiratory infections
- traveller’s diarrhoea
- malaria
What is acute traveller’s diarrhoea seen as?
- 3 loos stools in 24hrs
- sometimes associated with fever
What causes traveller’s diarrhoea?
a different type of E.coli from out normal type
What are the best investigations for traveller’s diarrhoea?
stool culture and stool wet prep
What is the treatment for traveller’s diarrhoea?
supportive
fluoroquinolone in extreme cases
What is enteric fever caused by?
- salmonella typhi or paratyphi
- Indian travel
- faecal-oral route due to contaminated food
What is the treatment for enteric fever?
IV Ceftriaxone
What the types of traveller’s jaundice?
pre-hepatic
hepatic
post-hepatic
What are the common types of protozoan infections?
- Amoebiasis: poor sanitation
- Giardiasis: malabsorption and watery, malodorous diarrhoea, looks like smiley men
- Amoebic liver abscess
What are helminthic infections?
- Helminth infections are parasites
- increase in eosinophil count
- worms
What are examples of helminthic infections?
- flukes/trematodes
- cestodes/tapeworms
- trypanosoma cruzi
What is globus?
feeling of having a lump in the throat
What is globus caused by?
foreign body reflux inflammation of the pharynx pharyngeal pouch cancers hay fever neurological conditions
What is the management off globus?
reassurance
treatment of reflux
smoking cessation
treat stress
What is function dysphagia?
sensation of solid food sticking in the oesophagus so unable to swallow
What is the management of functional dysphagia?
reassurance
adjusting diet
adjust way of eating
What can psychosis be caused by?
- schizophrenia
- mood disorder
- drugs
- organic causes such as dementia, delirium or brain tumours
What is IBS caused by?
- change in the motility of the gut
- sensory dysfunction
- change in gut reactivity characterised by abdominal discomfort, bloating or pain
What is the management of IBS (psychiatry)?
(linked to abuse in childhood)
- diet changes
- exercise
- reduce stress
- medication eg antispasmodic, laxative, anti motility medicines or low-dose anti-depressants
What is MUS?
medically unexplained conditions that can only really be treated with validation and reassurance
What is anorexia nerves and what does it include?
- include body image distortion
- fear of fatness
- self-induced weight loss
What does anorexia result in?
endocrine abnormality:
- decreased Na, K etc
- arrhythmia
- bone health deterioration
- lack of periods (amenorrhoea)
What is bulimia nervosa characterised by?
- failing of dieting so binging then purging
- depletion of electrolytes
- common history of anorexia
What are the clinical signs of bulimia?
- decay of back of teeth
- ulcer
- scars on back of throat
- russell’s signs on the hands (knuckles)
What is the treatment for bulimia?
- therapeutic alliance
- weight gain
- psychological interventions
- drugs eg antidepressants or antipsychotics
What are the main causes of upper GI bleeds?
1- duodenal ulcers
2- gastric erosions
3- gastric ulcers
4- varices
What is the main acute treatment for an upper GI bleed?
ABC
oxygen
IV access with two grey venflons
What is the severity of an upper GI bleed assessed on?
systolic BP (less than 100) pulse (greater than 100) Hb (less than 100) age comorbidities postural BP drop
What are the main objectives of endoscopy?
- identify cause
- therapeutic manouvres
- assess risk of rebleeding
What are the main upper GI bleed scoring systems?
Rockall Risk Scoring System
Blatchford score
What is the treatment of a bleeding peptic ulcer?
- endoscopic
- acid suppression (IV omeprazole)
- surgery
(H. pylori eradication is secondary treatment)
What is the endoscopic treatment fo a bleeding peptic ulcer?
- injection
- heater probe coagulation
- combination moo therapies
- clips
- hemospray (forms mechanical barrier over the bleeding site)
When do you suspect variceal bleeding?
- known history of cirrhosis
- alcohol excess
- viral hepatitis infection
- autoimmune disease
- abdominal surgery
What are the signs of liver disease and therefore the possibility of varices?
- spider naevi
- ascites
- jaundice
- encephalopathy
- leukonychia
- palmar erythema
What are the aims of management for variceal bleeding?
- resuscitate
- achieve haemostasis
- stop bleeding complications
- stop liver functioning worsening
- stop re-bleeding
How is haemostasis in variceal bleeding achieved?
- Terlipressin (prodrug which is splanchnic vasoconstrictor)
- ligation or banding
- sclerotherapy
- balloon
- TIPS (wire into portal lens and insert balloon and stent)
How do STIs spread to the GI tract?
direct inoculations trauma sexual/genital secretions ingestion fomites (inanimate object) IV drug use with sex
What are the risk factors for rectal STIs?
under 25 changing sexual partners no condoms MSM STI past history large urban area social deprivation black
What can STIs present as in the GI tract?
perianal problems
proctocolitis
hepato-biliary problems
What are the features of rectal gonorrhoea?
- caused by neisseria gonorrhoea
- presents with abdominal pain, diarrhoea, rectal bleeding, anal discharge and tenesmus
How is rectal gonorrhoea spread?
anal sex
fomite
transmucosal spread
What is seen on proctoscopy with gonorrhoea and what are the complications?
inflamed mucosa and purulent exudate
abscesses
HIV susceptibility
What is rectal chlamydia caused by?
chlamydia trachomatis
NB: less severe than gonorrhoea
What is the presentation os chlamydia?
asymptomatic or with anal discomfort and discharge
What is the presentation of lymphogranuloma venereum?
- ulcer to
- inguinal syndrome and anorectal syndrome to
- strictures, fistulae and genital elephantiasis
What should happen after a diagnosis of LGV?
- test for all other STIs esp HIV
What are the main STIs causing proctocolitis?
gonorrhoea
chlamydia
lymphogranuloma venereum
What are the main STIs causing anorectal ulcers and skin lesions?
LGV
syphilis
herpes simplex virus
HPV
What is the presentation of syphilis?
- present in any way
- primary is one painless ulcer at site of infection
- secondary can go to any system
What are the possible GI manifestations of syphilis?
ulcers
hepatits
proctoscopy-colitis
condylomata lata
What are the features of herpes simplex in GI?
- always type 2 in anal herpes
- can extend to rectum
- symptoms are pain, ulcers, painful defecation, bleeding and mucus
What are the features of GI related HPV?
- transmitted ano-genitally and oro-genitally
- causes anal warts that can extend to rectum
What does HIV do in the GI tract?
- depletion of intestinal GALT regardless of the site of infection
- leading to gut vulnerability to bacteria
What happens in a bowel obstruction?
- any part of GI tract
- dilation of the bowel before
- peristalsis is disrupted
How does a bowel obstruction present in the upper small bowel?
- acute
- hours onset
- large volumes vomited
What is the presentation of a bowel obstruction in the lower small bowel or large bowel?
- colicky abdominal pain
- distention with vomiting
What are the main symptoms of bowel obstruction?
- vomiting: proximal=early presentation, vomit even if starved
- pain: colicky and due to distension
- constipation: bowel stopped moving
- distension
What are the different types of vomit in bowel obstruction and what do they mean?
- semi-digested food = gastric outlet obstruction
- bile-stained fluid = upper small bowel obstruction
- thick brown badly-smelling fluid = distal obstruction
When does an obstruction in the large bowel present?
- 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
What happens in an incomplete bowel obstruction?
- less well defined
- erratic bowel habits
- intermittent vomiting
- chronic leads to gradual hypertrophy proximal to obstruction
- colicky pain gets worse ad hypertrophy occurs
What is seen on examination of a bowel obstruction?
- dehydration
- abdominal distension
- visible peristalsis
- lack of abdominal tenderness
- occasional palpable mass
- percussion shows resonance due to gas
- examine groins for hernia
What do bowel sounds sound like in bowel obstruction?
- high-pitched and tinkling
- absent
- echoing
- ‘water against a boat’
What are the investigations for bowel obstruction?
- 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
What is the management of a bowel obstruction?
- no food
- IV cannula
- bloods
- fluids and electrolytes
- NG tube to decompress stomach
What are the mechanical causes of a bowel obstruction?
- 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
What are the causes of dynamic paralytic bowel obstruction?
- 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
What is paralytic ileus associated with?
- recent GI surgery
- inflammation with peritonitis
- diabetic ketoacidosis
What are the risk factors for pseudo-obstruction?
- hip replacement
- CABG
- spinal fracture
- pneumonia
- frail and elderly
- in hospital
What is the mechanism of how alcohol affects the body?
causes inflammation in hepatocytes leading to fibrosis and scarring
What are the characteristic features of alcoholic hepatitis?
hepatomegaly
fever
leukocytosis
hepatic bruit
What are the 6Fs of abdominal mass?
fat faeces flatus foetus fluid fatal growth
What are the associated symptoms to abdominal masses?
- Blood loss
- Jaundice
- Gynae problems
- Operations
- Vomiting
- Urinary problems
- Change in bowel habit
- Weight loss
- Anorexia
What are the main abdominal masses?
- AAA
- Hepatic mass
- Splenic mass
- Renal mass
- Pancreatic mass
- Colorectal cancer
- Gynaecological mass
- Incisional and midline hernia
- Inguinal hernia
What are haemorrhoids?
enlarged vascular cushions in the lower rectum and anal canal
(anal cushions are at 3,7 and 11 o’clock in the lithotomy position)
What are the symptoms of haemorrhoids?
painless bleeding with bright red blood on paper
perianal itching
What are the investigations for haemorrhoids?
PR normal
rigid sig
proctoscopy
flexi sig if over 50
What is the treatment for haemorrhoids?
symptomatic
rubber band ligation
HALO/THD
What are the features of a rectal prolapse?
- partial or complete
- poor anal tone
- protruding mass esp in defecation
- bleeding and mucus per rectum
What is the treatment for a complete rectal prolapse?
- manual reduction
- laxatives
- abdo rectopexy
- Delorme’s procedure
What is the treatment for an incomplete rectal prolapse?
- dietary advice and constipation treatment in children
- similar treatment to haemorrhoids in adults
What is an anal fissure?
tear in the anal margin due to constipation
usually in the midline posteriorly
What are the symptoms of an anal fissure?
- multiple is usually due to Crohn’s
- pain after defecation like glass
- bright rectal bleeding
What is the treatment for anal fissures?
- dietary advice
- stool softeners
- meds to relax muscles (ointments)
- lateral sphincterotomy
- botox injection
What is a fistula-in-ano?
an abnormal communication between two epithelial surfaces- internal opening in anal canal and one/more external opening on peri-anal skin
What are fistula-in-ano caused by?
from delay or inadequate treatment of anorectal abscess
What are the investigations for a fistula-in-ano?
EUA, rigid sig, proctoscopy, flex sig or MRI
What is fistula-in-ano managed with?
- laying open
- insertion of seton then LIFT procedure
( - complications are pain, bleeding, incontinence or more surgery)
What is a hernia?
an abnormal protrusion of a cavity’s contents through a weakness of the cavity’s wall
What are the causes of a hernia?
anatomical, inherited collagen disorders and site where surgical cuts are made
What are the main types of hernia?
epigastric paraumbilical inguinal femoral spigelian lumbar incisional parastomal port-site
What are the features of an epigastric hernia?
- fascial defect in the linea alba between xiphoid and umbilicus
- asymptomatic midline lump
What are the causes of a paraumbilical hernia?
stretching of the abdominal wall so obesity, pregnancy and ascites
How do paraumbilical hernias present?
-pain
-resolve spontaneously
-commonly become incarcerated and strangulated
(management is surgical)
What is an inguinal hernia (direct and indirect)?
- 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
What is the presentation of an inguinal hernia?
- 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
What are the features of a femoral hernia?
- bowel enters femoral canal
- women
- very common to present as strangulation
- surgical
What are the features of spigelian hernia?
- uncommon
- in six pack but not middle line, in the side line
- level with or below the umbilicus
What are the features of a lumbar hernia?
through inferior or superior lumbar triangles in the posterior abdominal wall
What are the features of an incisional hernia?
- iatrogenic
- causes are wounds, collagen abnormalities, old age, smoking, obesity, malignancy and surgical technique
What are the three classifications of hernias?
- 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
What are the most important nutritional factors to monitor in IBD?
CRP U&Es Mg Ph LFTs with serum albumin level FBC ferritin and transferrin saturations folate level vit B12
What are the most common nutrient deficiencies in IBD?
UC= anaemia and iron deficiency Crohn's= anaemia, weight loss and malnutrition
What is EN used for in IBD?
to induce remission in children and sometimes adults (over steroids)
When is TPN indicated in IBD?
- in active disease of the small bowel
- previous multiple surgeries
- short gut syndrome
What is IBS classified as?
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
What is the first-line dietary change for IBS?
- regular meals, small and not late at night
- limit alcohol, caffeine and fizzy drinks
- lots of fluid
- less fatty foods
- limit fresh fruit
What is the second-line dietary change for IBS?
- Fermentable
- Oligo-saccharides
- Disaccharides
- Monosaccharides
- Polyols
What is the treatment for Coeliac disease?
a gluten-free diet
What are the complications of GI surgery?
- wound infection
- anastomotic leak
- paralytic ileus
- bleeding or haematoma
- formation
- short gut syndrome
- adhesions
- scars
