TO DO GI Flashcards
INTESTINAL OBSTRUCTION
What investigations might you do in someone who you suspect to have a small bowel obstruction?
- FBC
- abdominal x-ray - shows central gas shadow that completely cross the lumen, distended loops of bowel proximal to obstruction, fluid levels seen
- CT - gold standard to localise lesion accurately
COLORECTAL TUMOURS
Explain Dukes staging and prognosis
A = limited to muscularis mucosae = 95% 5-year survival B = extension through muscularis mucosae (not lymph) = 75% 5-year survival C = involvement of regional lymph nodes = 35% 5-year survival D = distant metastases = 25% 5-year survival
COLORECTAL TUMOURS
What does the T mean for colorectal cancer staging?
T1 = invades submucosa T2 = Muscularis propria T3 = Bowel wall T4 = Peritoneum
GASTRITIS
Name 5 things that can break down the mucin layer in the stomach and cause gastritis
- Mucosal ischameia
- H. pylori
- Aspirin, NSAIDs - most common
- Increased acid (stress)
- Bile reflux
- Alcohol
PEPTIC ULCER
How does NSAIDs cause ulcer formation?
Reduced prostaglandin synthesis due to salicylic acid release –> cell death –> no mucin production = no mucosal protection –> ulcer formation
PEPTIC ULCER
How does H. pylori cause ulcer formation?
- causes decrease in HCO3- which increases acidity
- H.pylori secretes urease
- splits urea into CO2 and ammonia
- ammonia + H+ forms ammonium which is toxic to gastric mucosa
- Acute inflammatory reaction (neutrophils) with less mucosal defence
PEPTIC ULCER
Give 3 symptoms of peptic ulcers
- recurrent burning epigastric pain
- pain occurs at night (duodenal)
- nausea
- anorexia and weight loss
MALABSORPTION
Give 5 broad causes of malabsorption
- Defective intraluminal digestion
- Insufficient absorptive area
- Lack of digestive enzymes
- Defective epithelial transport
- Lymphatic obstruction
ULCERATIVE COLITIS
give 3 microscopic features that will be seen in ulcerative colitis
- Crypt abscess
- goblet cell depletion
- mucosal inflammation - does not go deeper
ULCERATIVE COLITIS
Give 4 signs and symptoms of Ulcerative colitis
- Episodic/chronic diarrhoea +/- blood/ mucus
- Abdominal pain - left lower quadrant
- Systemic - fever, malaise, anorexia, weight loss
- Clubbing
- Erythema nodosum
- Amyloidosis
CROHNS DISEASE
Give 4 signs and symptoms of Crohn’s disease
- Diarrhoea - urgency
- Abdominal pain
- Systemic - weight loss, fatigue, fever, malaise
- Bowel ulceration
- Anal fistulae/stricture
- Clubbing
- Skin/joint/eye problems
CROHNS DISEASE
What is the treatment for induction of remission for Crohn’s disease?
INDUCTION OF REMISSION
MILD (1st presentation/1 exacerbation in 1yr)
- 1st line = IV/PO steroid
- 2nd line = oral ASA (MESALAZINE)
- distal/ileocaecal disease = budesonide
MODERATE (>2 exacerbations in 1yr)
- 1st line = azathioprine or mercaptopurine
- 2nd line = methotrexate
SEVERE (unresponsive to conventional therapy)
- 1st line = infliximab or adalimumab (anti-TNF)
- 2nd line = other biological agents
REFRACTORY
- surgery
ULCERATIVE COLITIS
What is the treatment for induction of remission for Ulcerative colitis?
INDUCTION OF REMISSION
PROCTITIS
- 1st line = topical ASA (RECTAL MESALAZINE)
- 2nd line = topical ASA + oral ASA (oral MESALAZINE)
- 3rd line = oral ASA + oral corticosteroid
PROCTOSIGMOIDITIS/LEFT-SIDED UC
- 1st line = topical ASA
- 2nd line = topical ASA + high-dose oral ASA / high-dose oral ASA + topical corticosteroid
- 3rd line = oral ASA + oral corticosteroid
EXTENSIVE DISEASE
- 1st line = topical ASA + high-dose oral ASA
- 2nd line = oral ASA + oral corticosteroid
SEVERE DISEASE
- should be treated in hospital
- 1st line = IV steroids (IV ciclosporin if contraindicated)
- 2nd line = IV steroids + IV ciclosporin or consider surgery
ULCERATIVE COLITIS
Give 5 complications of Ulcerative colitis
- Colon –> blood loss, colorectal cancer, toxic dilatation
- Arthritis
- Iritis, episcleritis
- Fatty liver and primary sclerosing cholangitis
- Erythema nodosum
CROHNS DISEASE
Give 5 complications of Crohn’s
PERFORATION AND BLEEDING = MAJOR
- Malabsorption
- Obstruction –> toxic dilatation
- Fistula/abscess formation
- Anal skin tag/fissures/fistula
- Neoplasia
- Amyloidosis
COELIAC DISEASE
Describe the pathophysiology of Coeliac disease
- Gliadin from gluten deaminated by tissue transglutaminase –> increases immunogenicity
- Gliadin recognised by HLA-DQ2 receptor on APC –> inflammatory response
- Plasma cells produce anti-gliadin and tissue transglutaminase –> T cell/cytokine activated
- Villous atrophy and crypt hyperplasia –> malabsorption
COELIAC DISEASE
Give 5 symptoms of Coeliac disease
- Diarrhoea and steatorrhoea (stinking/fatty)
- Weight loss
- Irritable bowel
- Iron deficiency anaemia
- Osteomalacia
- Fatigue
- abdominal pain
- angular stomatitis
- dermatitis herpetiform
COELIAC DISEASE
What investigations might you do in someone who you suspect to have coeliac disease?
- anti-tTg antibody test - must keep gluten diet 6 weeks prior
- Endoscopy - duodenal biopsy post 6 weeks gluten diet (gold standard)
COELIAC DISEASE
What 3 histological features are needed in order to make a diagnosis of coeliac disease?
- Raised intraepithelial lymphocytes
- Crypt hyperplasia
- Villous atrophy
COELIAC DISEASE
What part of the bowel is mostly affected in coeliac disease?
Proximal small bowel (duodenum)
mean B12, folate and iron cannot be absorbed = anaemia
COELIAC DISEASE
Give 3 complications of Coeliac disease
- Osteoporosis
- Anaemia
- Increased risk of GI tumours
- secondary lactose intolerance
- T-cell lymphoma
OESOPHAGEAL CANCER
Give 3 causes of squamous cell carcinoma
- Smoking
- Alcohol
- Poor diet/obesity
- coeliac disease
OESOPHAGEAL CANCER
Name 2 types of Oesophageal cancer
- Adenocarcinoma - distal 1/3rd of oesophagus
2. Squamous cell carcinoma - proximal 2/3rds of oesophagus
OESOPHAGEAL CANCER
What can cause oesophageal adenocarcinoma?
Barrett’s oesophagus
GASTRIC CANCER
Give 3 causes of gastric cancer
- Smoked foods
- Pickles
- H. pylori infection
- Pernicious anaemia
- Gastritis
- family history
GASTRIC CANCER
Give 3 symptoms and signs of gastric cancer
- Weight loss
- Anaemia (pernicious)
- nausea and Vomiting
- Dyspepsia and dysphasia
- palpable epigastric mass
- Hepatomegaly, jaundice and ascites
- Enlarged supraclavicular nodes
- epigastric pain
GASTRIC CANCER
What investigations might you do in someone who you suspect has gastric cancer?
- gastroscopy - biopsy
- endoscopic USS - depth of invasion
- CT /MRI /PET
GASTRIC CANCER
what are the red flag signs for upper GI cancer?
For people with an upper abdominal mass consistent with stomach cancer:
- Dysphagia of any age
- Aged ≥ 55yr + weight loss with any of the following:
- Upper abdominal pain/(or)
- Reflux/ (or)
- Dyspepsia
APPENDICITIS
What investigations might be done in a patient you suspect has appendicitis?
- Blood tests = raised WCC,
- CRP, ESR
- USS
- CT - gold standard
GORD
Name 3 extra oesophageal symptoms of GORD
- Nocturnal asthma
- Chronic cough
- Laryngitis
- Sinusitis
CROHNS DISEASE
what are the microscopic features of crohns disease?
- transmural inflammation
- granulomas
- increase in inflammatory cells
- goblet cells
- less crypt abscesses
CROHNS DISEASE
what are the risk factors for crohn’s disease?
- genetic association - mutation on NOD2 (CARD15) gene on chromosome 16
- smoking
- NSAIDs
- family history
- chronic stress and depression
- good hygiene
- appendicectomy
COELIAC DISEASE
what are the risk factors for coeliac disease?
- HLA DQ2/DQ8
- other autoimmune diseases e.g. T1DM, thyroid disease, Sjogren’s
- IgA deficiency
- breast feeding
- age of introduction to gluten into diet
- rotavirus infection in infancy
OESOPHAGEAL CANCER
what are the risk factors for oesophageal cancer?
ABCDEF
- Achalasia
- Barret’s oesophagus
- Corrosive oesophagitis
- Diverticulitis
- oEsophageal web
- Familial
MALLORY-WEISS TEAR
what are the investigations for mallory-weiss tears?
Rockall score (assess blood loss: <3 = low risk)
FBC, U&E, coag studies, group & save
ECG & cardiac enzymes
endoscopy to confirm tear
MALLORY-WEISS TEAR
what is the treatment for mallory weiss tears?
- ABCDE
- Terlipressin + Urgent Endoscopy
- Rockall Score + Inpatient Observation
- Banding/clipping, adrenaline, thermocoag
VARICES
what are the main causes of gastroesophageal varices?
- alcoholism
- viral cirrhosis
- portal hypertension
VARICES
what are the risk factors for gastroesophageal varices?
- cirrhosis
- portal hypertension
- schistosomiasis infection
- alcoholism
VARICES
what is the treatment for gastroesophageal varices?
- ABCDE
- Rockfall Score (Prediction of Rebleeding and Mortality)
- Bleeding Varices - Terlipressin + Prophylactic Antibiotics (Ciprofloaxcin), Balloon tamponade (Sengstaken-Blakemore tube), Endoscopic Banding, TIPS
- Bleed Prevention - BB + Endoscopic Banding. Cirrhosis = screening endoscopy
VARICES
how can gastroesophageal varices be prevented?
- PROPRANOLOL - reduce resting pulse rate to decrease portal pressure
- variceal banding
- liver transplant
IBS
what are the extra-intestinal symptoms of IBS?
- painful periods
- urinary frequency, urgency, nocturia, incomplete bladder emptying
- back pain and joint hypermobility
- fatigue
IBS
what is the clinical presentation of IBS?
ABC
- A = abdominal pain/discomfort - relieved by defecation
- B = bloating
- C = change in bowel habit
2 or more of following
- urgency
- incomplete evacuation
- abdominal bloating/distention
- mucous in stool
- worsening of symptoms after food
IBS
what is the rome III diagnostic criteria for IBS?
- recurrent abdominal pain at least 3 days a month in last 3 months
- associated with 2 of following:
- onset associated with change in frequency of stool
- onset associated with change in form (appearance) of stool
DIARRHOEA
what is the management for diarrhoea?
- treat underlying causes
- bacterial treated with METRONIDAZOLE- oral rehydration therapy
- anti-emetics - METOCLOPRAMIDE
- anti-motility agents - LOPERAMIDE or CODEINE
GASTRITIS
what are the effects of helicobacter pylori?
- inflammation
- antral gastritis
- gastric cancer
- peptic ulcers
COLORECTAL CANCER
what is lynch syndrome?
hereditary non-polyposis colon cancer
autosomal dominant condition caused by mutation in hMSH1 or hMSH2 genes, in highly repeated short DNA sequences
DIVERTICULAR DISEASE
what are the investigations for diverticulitis?
BEDSIDE
- observations
- urine dip
- pregnancy test
BLOODS
- FBC, U&Es, LFTs amylase, CRP, group + save, clotting screen
CT abdomen + pelvis
DIVERTICULAR DISEASE
what is the management for diverticulitis?
ANTIBIOTICS
- 1st line = co-amoxiclav (if penicillin allergic = ciprofloxacin/metronidazole)
ANALGESIA
- paracetamol
SUPPORTIVE
- high fibre diet
SURGERY
VOLVULUS
what is the management for volvulus?
- endoscopic detorsion = rigid sigmoidoscopy and rectal tube
- surgical intervention
- fluid resuscitation
- pain management
IBD
what are the biliary complications of crohns disease vs ulcerative colitis?
crohn’s = gallstones
ulcerative colitis = primary sclerosing cholangitis
IBD
what is the appearance of crohn’s and colitis on X rays?
crohn’s = string appearance
colitis = lead-pipe sign
MESENTERIC ISCHAEMIA
what are the investigations for acute mesenteric ischaemia?
BLOODS
- FBC - leucocytosis and neutrophilia
- U&Es - pre-renal AKI (3rd spacing)
- ABG - raised lactate and metabolic acidosis
ECG - atrial fibrillation
CT angiogram
Erect pneumoperitoneum
DYSPHAGIA
what is the physiology of swallowing?
Tongue presses against hard palate and forces hard bolus of food into oropharynx
Tongue blocks off mouth and larynx and uvula rise to prevent food from entering lungs
Upper oesophageal sphincter relaxes allowing food to enter oesophagus
Constrictor muscles of the pharynx contract forcing food down
Food moves down by peristalsis
Gastroesophageal sphincter surrounding cardiac orifice opens and food enters stomach
ACHALASIA
what are the clinical features of achalasia?
dysphagia of both solids and liquids
regurgitation
heartburn
cough when lying down
weight loss
PHARYNGEAL POUCH
where do pharyngeal pouches occur?
Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
BARRETTS OESOPHAGUS
what is barrett’s oesophagus?
Metaplasia of the lower esophageal mucosa (stratified squamous to columnar epithelium with goblet cells)
BARRETTS OESOPHAGUS
what is the management for barrett’s oesophagus?
- Lifestyle: weight loss, smoking cessation, reduce alcohol, small reg meals, avoid hot drinks/alcohol/eating <3hrs before bed, avoid certain drugs (nitrates, anticholinergics, TCAs, NSAIDs, K+ salts, alendronate)
Endoscopic Surveillance with Biopsies
High Dose PPI
Dysplasia - Endoscopic Mucosal Resection, Radiofrequency Ablation
Severe: oesophagectomy
OESOPHAGEAL CANCER
which are the most common types of oesophageal cancer in the developing and developed world?
developing = squamous cell carcinoma
developed = adenocarcinoma
OESOPHAGEAL CANCER
where is adenocarcinoma of the oesophagus found?
lower 1/3 - near GO junction
OESOPHAGEAL CANCER
where is squamous cell carcinoma of the oesophagus found?
upper 2/3
GORD
what are the red flag symptoms for GORD that requires further investigation?
Dysphagia (difficulty swallowing) > 55yrs Weight loss Epigastric pain / reflux Treatment resistant dyspepsia Nausea and vomiting Anaemia Raised platelets
PEPTIC ULCERS
what is the difference in presentation of gastric ulcers vs duodenal ulcers?
gastric ulcers = epigastric pain worse after eating, eased by antacids. haematemesis, weight loss, heart burn
duodenal ulcers = epigastric pain before meals and at night, relieved by eating or milk. melaena, weight gain
DIVERTICULAR DISEASE
what will imaging show in diverticulitis?
Imaging May Show
Pneumoperitoneum
Dilated Bowel Loops
Obstruction
Abscess
DIVERTICULAR DISEASE
what are the causes/risk factors of diverticular disease?
low fibre diet
obesity
age >40
GASTRIC CANCER
what are the 2 different types of gastric cancer?
type 1 = intestinal / differentiated (70-80%) - found in antrum and lesser curvature
type 2 = diffuse / undifferentiated (20%) - found elsewhere
DIVERTICULAR DISEASE
what is the prevention for diverticulitis?
Regular exercise, avoid smoking, high-fibre diet, drink plenty of water
C.DIFF
what is the treatment for c.diff?
1st line = vancomycin orally for 10 days
2nd line = oral fidaxomicin
3rd line = oral vancomycin +/- IV metronidazole
ISCHAEMIC COLITIS
what are the risk factors for ischaemic colitis?
- age >60
- sex F>M
- factor V Leiden
- high cholesterol
- reduced blood flow - HF, low BP, shock, DM, RA
- previous abdominal surgery
- heavy exercise
- surgery on aorta
ISCHAEMIC COLITIS
what are the investigations for ischaemic colitis?
colonoscopy = gold standard
AXR - may show thumbprinting (due to mucosal oedema/haemorrhage)
ACHALASIA
what are the investigations?
- upper GI endoscopy
- oesophageal manometry (gold standard)
- barium swallow
ACHALASIA
what is the management?
- CCBs (nifedipine/verapamil)
- laparoscopic Heller’s cardiomyotomy
- botox to LOS
ANAL FISSURES
what are the different causes?
- primary (no clear underlying cause)
SECONDARY (associated with underlying cause)
- constipation
- IBD
- malignancy
- STI
- infections
- anal trauma
- pregnancy + childbirth
ANAL FISSURES
what is the most common location?
posterior midline of the anal canal
ANAL FISSURES
what is the management?
1st line:
- dietary modifications
- laxatives
- topical GTN ointment
- topical anaesthetics
2nd line
- lateral internal sphincterotomy
- botox injection
CONSTIPATION
what are the risk factors?
- increasing age
- lower socioeconomic status
- medications (opiates, CCBs, antipsychotics)
- metabolic (hypothyroidism, hypercalcaemia)
- neurological (parkinsons, spinal cord lesions)
- diabetes mellitus
- colonic disease
- IBS
- sedentary lifestyle
- reduced dietary fibre
CONSTIPATION
what is the management for short duration constipation (<3 months)?
1st line
- lifestyle advice (increase fibre, increase exercise, fluid intake)
- bulking laxative (ispaghula husk)
2nd line
- if hard stool, difficult to pass = osmotic laxative (macrogol, lactulose)
- if soft stool, inadequate emptying = stimulant laxatives (senna, bisacodyl)
CONSTIPATION
what is the management for faecal impaction?
1st line = osmotic laxative (macrogol) +/- stimulant laxative (senna)
2nd line = suppository (bisacodyl/glycerol)
3rd line = enema (sodium phosphate)
HAEMORRHOIDS
what are the different types of haemorrhoids?
internal = proximal to dentate line
external = distal to dental line
HAEMORRHOIDS
what is the dentate line?
divides the upper two-thirds of the anal canal from the lower third of the anal canal
- upper two-thirds = rectal columnar epithelium
- lower third = stratified squamous epithelium (highly innervated)
HAEMORRHOIDS
what is the pathophysiology?
Symptomatic haemorrhoids are thought to develop when supporting tissue with the anal cushions deteriorate
It is the abnormal downward displacement of these cushions that leads to venous dilatation
HAEMORRHOIDS
what are the risk factors?
- constipation
- prolonged straining
- diarrhoea
- pregnancy
- increasing age
- prolonged sitting
- anticoagulation use
- pelvic tumours
HAEMORRHOIDS
what is the management?
LIFESTYLE
- high fibre diet
- adequate water intake
- toilet training
- analgesia (NSAIDs)
- laxatives (bulk, stimulant, osmotic or softeners)
MEDICAL
- topical agents (anaesthetic + steroids)
- venoactive agents
- antispasmodic agents
SURGERY
- rubber band ligation
- sclerotherapy
- infrared coagulation
- haemorrhoidectomy
HIATUS HERNIA
what are the clinical features?
- epigastric pain
- heartburn
- dysphagia
- N+V
- post-prandial fullness
- bowel sounds audible on chest auscultation
HIATUS HERNIA
what is the management?
LIFESTYLE
- small frequent meals
- stop smoking
- avoid lying down after eating
MEDICAL
- PPI e.g. omeprazole
SURGERY
- laparoscopic repair
- Nissen’s fundoplication
MALABSORPTION
what are the risk factors?
- systemic disease
- GI disease (IBD, coeliac)
- pancreatic disease
- surgery (bowel resection, pancreatectomy)
- radiotherapy
- trauma
- parasitic infection
- drugs
- congenital (biliary atresia)
- alcohol excess
MALNUTRITION
what are the clinical features of vitamin A deficiency?
night blindness
immune deficiency
MALNUTRITION
what are the clinical features of iodine deficiency?
- hypothyroidism
- growth restriction
- impaired cognitive development
MALNUTRITION
what are the clinical features of zinc deficiency?
- delayed wound healing
- impaired taste
- hair loss
- immune deficiency
MALNUTRITION
what are the components of a MUST score?
- BMI
- amount of unplanned weight loss in past 3-6 months
- acute disease effect
MALNUTRITION
what is the criteria for malnutrition?
any of the following:
- BMI <18.5
- unintentional weight loss >10% in last 3-6 months
- BMI <20 and unintentional weight loss >5% in last 3-6 months
ANAL FISTULA
what are the different types according to the Parks classification?
- extrasphincteric = outside sphincter complex
- suprasphincteric = runs over the top of the puborectalis
- trans-sphincteric = passes through external sphincter
- intersphincteric = rns through the intersphinteric plane
ANAL FISTULA
how are the different types categorised?
- using Parks classification
ANAL FISTULA
what are the risk factors?
- history of anorectal abscess
- chronic diarrhoea
- IBD (crohns)
- prior anorectal surgery
- hydradentitis suppurativa
- diverticulitis
ANAL FISTULA
what is the management?
CONSERVATIVE
- sitz baths
- analgesia for pain control
MEDICAL (for crohns)
- infliximab
- if symptomatic = metronidazole
SURGERY
- seton technique
- fistulotomy
PERITONITIS
what is tertiary peritonitis?
recurrent or persistent infection of the peritoneal cavity that typically occurs after secondary peritonitis.
Less well defined and usually seen in patients who are immunocompromised
PERITONITIS
what is the most common cause?
gastrointestinal perforation due to appendicitis, peptic ulcers, diverticulitis
PERITONITIS
what is the management?
- urgent surgical exploration
- IV antibiotics (co-amoxiclav, gentamicin, cefuroxime or metronidazole)
MESENTERIC ISCHAEMIA
how would you treat mesenteric ischaemia?
INITIAL
- bowel rest (nil by mouth, NG tube)
- IV fluids
- IV broad spectrum abx
- IV unfractionated heparin
- prompt laparotomy
DEFINITIVE
- endovascular revascularisation (embolectomy/angioplasty)
- laparotomy (open embolectomy, arterial bypass, resection)
MESENTERIC ISCHAEMIA
what are the clinical features?
SYMPTOMS
- abdominal pain
- N+V
- diarrhoea +/- rectal bleeding
- fever
- weight loss
SIGNS
- absence of bowel sounds (late sign)
- epigastric bruit on auscultation
- rectal bleeding on PR
- hypotensive and tachycardic
MESENTERIC ISCHAEMIA
what are the risk factors?
- older age
- female
- AF
- atherosclerosis (HTN, smoking, hypercholesterolaemia, DM)
- previous MI
- hypercoagulable state
- infective endocarditis
- vasculitis
- hypoperfusion
GI PERFORATION
what are the common causes of small intestinal perforation?
- crohns disease
- cancer
- trauma
GI PERFORATION
what are the common causes of large intestinal perforation?
diverticulitis
cancer
trauma
GI PERFORATION
what are the risk factors?
- trauma
- instrumentation
- infection
- malignancy
- ischaemia
- obstruction
GI PERFORATION
what are the investigations?
- AXR = pneumoperitoneum, air under diaphragm, air on both sides of bowel
- USS abdomen = free fluid
- CT scan = pneumatosis intestinalis (gas in wall of bowel)
- FBC/CRP
- sepsis 6
ABDOMINAL WALL HERNIAS
what are the different types of hernia?
- inguinal hernia
- femoral hernia
- umbilical hernia
- paraumbilical hernia
- epigastric hernia
- incisional hernia
- obturator hernia
ABDOMINAL WALL HERNIAS
where are inguinal hernias found?
above + medial to pubic tubercle
ABDOMINAL WALL HERNIAS
where are femoral hernias found?
why are they dangerous?
below + lateral to pubic tubercle (more common in women)
are at high risk of strangulation
CROHN’S DISEASE
what is the management for maintenance of remission in crohn’s disease?
- 1st line = azathioprine or mercaptopurine
- 2nd line = methotrexate
- post surgery = consider azathioprine +/- methotrexate
STOP SMOKING
IBD
what should you test before starting treatment with azathioprine or mercaptopurine?
+ TPMT activity
ULCERATIVE COLITIS
what is the management for the maintenance of remission in UC?
MILD-MODERATE
- proctitis + rectosigmoid = topical ASA / topical ASA + oral ASA / oral ASA
- left-sided + extensive = low dose oral ASA
SEVERE (severe exacerbation or >2 exacerbations
- oral azathioprine or oral mercaptopurine
C.DIFF
what is the management of recurrent infection?
within 12 weeks of symptom resolution = oral fidaxomicin
after 12 weeks of symptom resolution = oral vancomycin or oral fidaxomicin
C.DIFF
what is the management of life-threatening infection?
ORAL vancomycin + IV metronidazole
PARALYTIC ILEUS
what are the investigations?
it is important to check electrolytes (potassium, magnesium + phosphate) post-op as they can contribute to ileus
PARALYTIC ILEUS
what is the management?
- nil-by-mouth initially
- NG tube if vomiting
- IV fluids
- correct electrolyte disturbances
- TPN (occasionally required for prolonged/severe cases)
GIARDIASIS
what is it caused by?
giardia lamblia
GIARDIASIS
what are the risk factors?
- foreign travel
- swimming/drinking water from a river or lake
- male-male sexual contact
GIARDIASIS
what are the clinical features?
- often asymptomatic
- non-bloody diarrhoea
- steatorrhea
- bloating
- abdominal pain
- lethargy
- flatulence
- weight loss
- malabsorption and lactose intolerance can occur
GIARDIASIS
what are the investigations?
- stool microscopy for trophozoite and cysts
- stool antigen detection test
GIARDIASIS
what is the management?
metronidazole
BACTERIAL GASTROENTERITIS
what is the typical presentation of e.coli infection?
- common amongst travellers
- watery stools
- abdominal cramps and nausea
BACTERIAL GASTROENTERITIS
what is the typical presentation of giardiasis?
prolonged non-bloody diarrhoea
BACTERIAL GASTROENTERITIS
what is the typical presentation of shigella infection?
- bloody diarrhoea
- vomiting and abdominal pain
BACTERIAL GASTROENTERITIS
what is the typical presentation of staph aureus infection?
- severe vomiting
- short incubation period
BACTERIAL GASTROENTERITIS
what is the typical presentation of campylobacter?
- flu-like prodrome followed by crampy abdominal pains, fever and diarrhoea which may be bloody
- may mimic appendicitis
BACTERIAL GASTROENTERITIS
what is the typical presentation of b.cereus infection?
two types of illness are seen
- vomiting within 6 hrs
- diarrhoeal illness occurring after 6 hrs
BACTERIAL GASTROENTERITIS
what is the most common cause of travellers diarrhoea?
e.coli
BACTERIAL GASTROENTERITIS
what are the most common causes of acute food poisoning?
- s.aureus
- b.cereus
- clostridium perfringens
