Rugby GI Powerpoint Flashcards
How does oral thrush present?
White plaques on the oral mucosa that can be wiped off to leave red, painless base
How is oral thrush treated?
Anti-fungals (miconazole)
What is the main type of malignant tumour in the mouth?
Squamous cell carcinoma
How do salivary gland stones present and what is the first line investigation?
Colicky post-prandial pain and swelling
Refer for ultrasound
What is achalasia?
Poor relaxation of the low oesophageal sphincter - causes birds beak appearance on barium swallow
How is achalasia treated?
Myotomy (Hellers cardiomyotomy)
How is Baretts oesophagus managed?
PPIs
Lifestyle advice
What is the first line investigation of dysphagia?
OGD +/- biopsy
How is oesophageal cancer treated?
Surgery
What causes oesophageal varices and how are they treated?
Portal hypertension
Band ligation + TIPS
What is TIPS?
Addition of an artificial vein that bypasses the liver (if cirrhosed)
How does hiatus hernia present?
Reflux
How is dyspepsia managed?
Lifestyle advice,
Antacids,
PPIs
What are the most common causes of dyspepsia?
GORD,
Peptic ulcer
How do peptic ulcers present?
Bleeding,
Postprandial epigastric pain (if duodenum is relieved by food, if gastric worsened by food),
Nausea,
Bloating
What test is done to check for H pylori?
Carbon 13 urea test
How are peptic ulcers treated?
Lifestyle advice,
H pylori eradication therapy,
PPIs
What causes lymphomas in the stomach and how are they treated?
H pylori
PPI + antibiotics to eradicate H pylori
What pathological process occurs in coeliac disease?
Abnormal response to wheat leads to atrophy of small intestinal villi
How is coeliac screened for and diagnosed?
Screening: TTG
Diagnosis: duodenal biopsy
What type of disease increases risk of small bowel ischaemia?
Cardiac diseases (AF, AAA, previous MI - increase risk of emboli)
How does mesenteric ischaemia present?
Pain out of context to clinical findings + acidosis
How is mesenteric ischaemia treated?
Warfarin/heparin
Surgery if gangrenous/necrotic
Why is the blood supply to the large bowel more effective than the small bowel if there is a blockage?
Due to the marginal artery (of Dummond)
What causes chronic mesenteric ischaemia and what are the symptoms? (what is the treatment)
Caused by atheroma of the vessels supplying the large bowel
Symptoms: weight loss, fear of eating, postprandial pain
(treatment = surgery - usually bypass)
What causes ischaemic colitis?
Compromise of the blood supply to the colon (affects middle and left colic arteries)
What occurs in a hernia?
A section of bowel protruding through a weakness in the body wall
What is the risk associated with an irreducible hernia?
Strangulation
What is the sign of complete small bowel obstruction?
Absolute constipation - no faeces or flatus can pass through
How is small bowel obstruction diagnosed and treated?
Diagnosis: dilated SI on AXR
Treatment: ‘drip and suck’ + bowel rest
What is peritonitis and how does it present?
Inflammation of the peritoneum
Presentation: pain, fever, tachycardia
What is ileus?
Non-mechanical intestinal obstruction (can be paralytic (inactivity of the bowel) often post-op|)
What test is used to screen for colorectal cancer and what is used to diagnose it?
Screening: FOB test
Diagnosis: colonoscopy +/- biopsy
What is the difference between diverticulosis, diverticulitis and diverticular disease?
Diverticulosis: asymptomatic diverticula
Diverticular disease: symptomatic diverticula
Diverticulitis: inflammation of diverticula
How does diverticulitis present?
Abdominal pain (especially in LIF) - exacerbated by eating and relieved by defecation
Fever,
Constipation,
Bloating,
What is a volvulus and what are its symptoms?
A twisting of the bowel (usually the sigmoid)
Presents with gross abdominal distention, sudden onset colicky pain and absolute constipation
How is a volvulus diagnosed?
AXR (coffe bean sign)
What is proctitis?
Inflammation of the lining of the rectum (causes renal pain)
What are haemorrhoids?
NOT distended veins - are swollen mucosal tissue in the vascular canal
What is the grading for haemorrhoids?
Grade I: do not prolapse
Grade II: prolapse upon straining, spontaneously reduce
Grade III: prolapse upon straining, can be manually reduced
Grade IV: permanently prolapsed (cannot be reduced)
How are haemorrhoids treated?
If asymptomatic - nothing
If symptomatic; analgesia, banding, haemorrhoidectomy
Which LFTs indicate that the liver is not functioning correctly?
Bilirubin, prothrombin and albumin (takes up to 20 days to be affected)
Which LFTs indicate liver damage and which indicate bile duct damage?
Liver damage: ALT, AST
Bile duct: ALP GGT
How does viral hepatitis present?
Nausea and vomiting (N&V),
Itch,
Pain (RUQ),
Diarrhoea
Which forms of viral hepatitis can become chronic?
B and C
What pathological process occurs in auto-immune hepatitis and how does it present?
Chronic hepatocellular inflammation leading to cirrhosis
Presents with fatigue, upper abdominal discomfort, diarrhoea, anorexia
How is autoimmune hepatitis tested for and treated?
Test = AMA (anti smooth muscle antibodies) Treatment = prednisolone/azathioprine (immunosuppression)
How does fatty liver disease present and how is it treated?
Fatigue, RUQ pain, hepatomegaly, malaise
Treatment: lifestyle changes (weight loss, good diet, abstinence)
What is fatty liver disease associated with?
Obesity and alcohol
What are the consequences of cirrhosis?
Portal hypertension; oesophageal varices, haemorrhoids, caped medusa, ascites, jaundice
How is portal hypertension treated?
Nitrates + B-blockers
What increases risk of hepatocellular carcinoma and how is it treated?
Previous liver injury (cirrhosis, chronic liver disease)
Treatment: surgical resection, radiotherapy, liver transplant
How does primary biliary cirrhosis present and what is the treatment?
Fatigue, RUQ pain, cirrhosis
Treatment: urseodeoxycholic acid
What is primary sclerosis cholangitis and who is it most common in?
Fibrosis of the bile ducts
More common in males (association with UC)
How is primary sclerosis cholangitis diagnosed and treated?
Diagnosis: LFTs, MRCP, ERCP (+ biopsy)
Treatment: symptom relief (antihistamines, urseodeoxycholic acid), liver transplant
What is cholangiocarcinoma and what increases risk of developing it?
Carcinoma in the biliary tree
Risk increased with primary sclerosis cholangitis and hepC
How is cholangiocarcinoma treated?
Surgery or stents
How do gall stones (cholethiasis) typically present and what is their cause and treatment?
Usually asymptomatic, so no treatment
Made from cholesterol or bilirubin
What is biliary colic and how does it present?
When a gallstone travels out of the gallbladder and gets stuck in the biliary tree
Presents with sudden onset RUQ/epigastric pain (can radiate to the back), N&V
How is biliary colic investigated and treated?
Investigation: CXR, LFTs, abdo ultrasound
Treatment: ERCP
What causes cholecystitis and how does it present?
Inflammation of the gall bladder after a stone has got stuck in the cystic duct
Presentation: continuous Run/epigastric pain, mass, vomiting, fever
How is cholecystitis investigated and treated?
Investigation: FBC, LFTs, abdominal ultrasound
Treatment: Cholecystectomy
How does acute pancreatitis present?
Sudden onset epigastric pain which radiates through to the back, vomiting, nausea, fever
How is pancreatitis investigated and treated?
Investigation: serum amylase (3x normal limit)
Treatment: Analgesics, fluid, nil by mouth (if infected = antibiotics)
How does chronic pancreatitis present?
Severe abdominal pain, loss of exocrine and endocrine functions, decreased appetite, nausea and vomiting
How is chronic pancreatitis treated?
Creon to replace loss of digestive enzymes, diabetes treatment
Which type of pancreatic tumour is more common?
Exocrine
How is pancreatic cancer treated?
Usually palliative as presents late, surgery if young and fit enough
Where can gastrinoma affect?
Pancreas or duodenum - severe peptic ulceration
What are the causes of acute and chronic pancreatitis?
Acute: GET SMASHED G- gall stones E- ethanol T- trauma S- steroids M- mumps A- autoimmune S- scorpion H- hyperlipidaemia/thermia E- ERCP D- drugs
Chronic:
Alcohol, gallstones, idiopathic
