Revision GI Flashcards
Diarrhoea presentations
Osmotic (non absorbed from the bowel)-like fats, lactulose
Secretory - from toxins from infection
Inflammatory- IBD
Abnormal motility- hyperthyroid, IBS, etc
IBS
should always do- FBC, CRP, calprot, coeliac
calprot- raised if inflam, not if functional
No red flags- faecal calprot is probs 1st start but
colonoscopy is a good second
very common, in 30/40 y/o
Abdo pain, bloating, Change of freqeuency, relieves on defecating
NO RED FLAGS AT ALL
IBD -chrons/UC
Chrons
Non-caseating granulomas
Fissures/fistula/transmural disease
Erythema nodosum
Smoking worsen
surgery more common-peri-anal and SB-
Pyoderma gangrenosum, arthritis, uveitis
toxic megacolon
UC
erythema
Small bowel cancer more common
only surgery is Colostomy
Crypt absesses
PSC assox
Toxic megacolon
Large dilated colonic loop on xray/ct
large dilation of colon from colitis- inflam or infect (c diff classic), ischemic
Usually abdo distention, abdo pain, fever, pain, shock
CT scan best IX as check for perforation
Coeliac disease
Gold standard- Biopsies of small bowel for adult
Ab- anti-TTG and anti-endomysial
HLADQ2
very common in Europe-hypersensitive to gliadin
causes vilous atrophy, crypt elongation and increased lymphocyte
Any form of BO change- aneamia, diarhhoea, bloating,
in children-failure to thrive
Other causes of vilous atrophy
coeliac-
giardia–ix-stool , whipples-arhtropathy with, tropical sprue-malabsorption disease in tropic- cause unkown (infection?) last a long time, but treatable with tetracyclines. biopsy similar to coeliac
true lactose intolerance
cancer
dyspepsia mx
ANY redflag==OGD (weight loss, swallowing, etc
if no red flags- H.pylori testing/PPI test and then if that doesn’t work do the other one
remember wait 2w before Hpylori testing if PPI using
H,pyolori- either breath, poop, biopsy- assox with ulcer, maltoma, gastric adenocarcenoma
mx with Amox, Clarythro, PPI
Rectal bleeding
bright or old
bright- Heamorhoids, fissure, diverticulitis
Old- ulcer/cancer,
Jaundice causes
Pre-hepatic- Heamolysis, Gilbert, Drugs, malaria
Hepatic- Hepatitis, wilsons, AI (ALT>ALP)
post hepatic- gallstones, tumour, PBC, PSC (uc assox). (ALP>ALT)
USS is Best 1st Ix- dilation of duct (post hepatic) or not (hepatic)-takefurther with MRI/CT
viral hepatitis
A- RNA, foacal oral- acute jaundice with assox constitutional -rarely cause other issues
B-DNA-blood route-incubate 1-5m- acute jaundice and constix and 5% can become chronic carriers (HbS/Hbc/Hbe) (e=replication, c=infection)–most clear acute hep B
assox with Hep D– only works with B
C-RNA-Blood rout- 80% go on to chronic hepatitis-> Cirrhosis-> 30% HCC
serology for ddx- sero 1/3 in UK
Now with direct acting drugs- 8/12w eg- sodospivir, or combinations
RF-shared needles, sexual hx, world travel, immunodeficient
PBS vs PSC
PSC- UC/IBD assox
Strong assox with cancer-cholangiocardinoma
No treatment except with transplant
See Beading in ERCP/MRCP
PBC-F>M- Anti Mito +ve
pruritis and fatigue very common–
assox with cirrhosis and fibrosis, and hyperlipedemia
AI Hepatitis
Anti Smooth muscle AB
manage with pred/Azathioprine
cirrhosis common- think if young female
AScites
Fluid in peritoneum
classified by serum albumin gradient
hgih gradient->1.1-Portal HTN and caises
Lower gradient imply other- infections, nephrotic, cancer, pancreas
mx with salt restrict, diuretics (Furo/Spiro)
Drainage
and portohepatic shunt
