PT 1 - GI Flashcards
Q. What red flags for upper GI cancer require 2 week wait for endoscopy?
A. Dysphagia or age >55 with weight loss and all of: upper abdo pain, reflux, dyspepsia (post prandial fullness, early satiation, epigastric pain/burning)
B. Non urgent: haematemesis, >55 + treatment-resistant dyspepsia, upper abdo pain + anaemia, raised platelets and sx of GI Ca, N/V + sx of GI CA
Q. What is a Mallory-Weiss tear? Name 4 RFs
A. Haematemesis from a tear near the gastroesophageal junction brought on by prolonged vomiting or retching
B. RF: alcohol excess, hyperemesis gravidarum, chronic cough, bulimia, gastroenteritis
Q. What clinical features are seen with a Mallory-Weiss tear?
A. Haematemesis after vomiting, melaena, sx of hypovolaemia/shock
B. Mx: ACBDE, endoscopy, Rockall score + I/P obs
Q. What Ix for coeliac’s disease?
A. Tissue transglutaminases, endomysial antibodies, endoscopy (of small intestine) and biopsy is definitive
Q. What Ix for UC? Tx?
A. Faecal calprotectin, sigmoidoscopy + biopsy, Abdo XR
Tx: Mesalazine + Pred to induce remission, then Maintenance with Mesalazine
Q. What Ix for crohn’s? Tx?
A. Ix: faecal calprotectin, colonoscopy + biopsy, CT abdo
B. Mx: stop smoking, steroids to induce remission, azathioprine to maintain, surgery
Q. Where is appendicitis pain felt?
A. Generalised then localises to Mcburney’s point in left iliac fossa
Q. What occurs in hiatus hernia? Which two mechanisms can occur?
A. Sliding: fundus of stomach slides up through existing hiatus and lies above the diaphragm
B. Rolling: uncommon, fundus protrudes out of hernia and lower oesophageal sphincter remanding below. Risk of gastric volvulus (rotation and strangulation of the stomach), bleeding and resp complications. Treat surgically.
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Q. What occurs in achalasia of the oesophagus? Ix?
A. Degeneration of ganglion cells within the sphincter and body of oesophagus, degeneration of the vagus nerve
B. Sx: long history of dysphagia for both liquids and solids – may be associated with regurgitation, retrosternal pain possible
C. Ix: barium swallow (beak deformity), absence of peristalsis, some asynchronous, purposeless contractions of the oesophagus, oesophageal manometry (confims diagnosis – aperistalsis and failure of LOS relaxation on swallowing)
D. Mx: endoscopic balloon dilation, medication relaxation (oral nitrates, endoscopic injection, botox in elderly), GORD is complication of all txs
Q. How can HPV be investigated?
- Q. How can HPV be investigated?
A. C-urea breath test, stool antigen test, serology, invasive (endoscopic gastric mucosa), rapid urease test (CLO), histology
