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2B - GRIND > GI > Flashcards

GI Flashcards

1
Q

S&S of GORD?

A

Heartburn (worse on lying/stooping), belching, acid/water brash, odonophagia and chronic cough

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2
Q

Tx of GORD?

A

Antacids e.g. magnesium trisilicate mixture or alginates e.g. gaviscon and PPIs

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3
Q

What are hiatus hernias?

A

Sliding hiatus hernia = the gastro-oesophagel junction slides up into the chest
Rolling hiatus-hernia = the gastro-oesophageal junction remains in the abdomen but some of the stomach herniates into the chest
Both cause GORD (especially sliding)

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4
Q

What is the main complication of GORD?

A

Normal stratified squamous epithelium of the distal oesophagus undergoes metaplasia to simple columnar epithelium (Barrett’s oesophagus). Increases risk of oesophageal cancer

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5
Q

S&S of peptic ulcers?

A

Epigastric pain related to hunger/time of day, heartburn and tender epigastrium

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6
Q

Tx of H.Pylori?

A

PPI and 2x Abx e.g. lansoprazole and clarithromycin and amoxicillin

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7
Q

Name 3 causes and 2 Sx of gastritis?

A

Alcohol, H.pylori and NSAIDs. Sx = epigastric pain and vomiting

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8
Q

What are oesophageal varices?

A

Swollen veins in the oesophagus which form as a result of reduced blood flow through the liver (in liver disease)

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9
Q

Sx of Coeliac disease?

A

Stinking stools which float in the pan, diarrhoea, weight loss, fatigue, abdo pain and bloating. Suspect if diarrhoea and weight loss/anaemia

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10
Q

Dx of Coeliac disease?

A

Anti-transglutaminase antibodies present (IgA) and duodenal biopsy whilst on gluten diet (look for villous atrophy)

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11
Q

What is the diagnostic criteria for IBS?

A

Recurrent abdominal pain associated with 2 of: relieved by defecation, altered stool form and altered bowel frequency

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12
Q

Tx IBS?

A

Control Sx:
Constipation = increase water and fibre uptake, laxatives
Diarrhoea = reduce fibre, avoid sorbitol sweeteners, loperamide
Pain = anti-spasmodics e.g. mebeverine

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13
Q

What are the most common casues of GI malabsorption in the UK? How may it present?

A

Coeliac disease, chronic pancreatitis and Crohn’s disease.

Weight loss, diarrhoea, anaemia, bleeding disorders, oedema and bone disease

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14
Q

What is the difference between UC and Crohn’s?

A 
UC = continuous inflammation limited to the mucosa which occurs from rectum up to the ileocoaecal valve
CD = transmural granulomatous inflammation affecting the whole gut from mouth to anus - skip lesions = unaffected areas between active disease
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15
Q

Sx of UC?

A

Diarrhoea (with blood and mucus), crampy abdo pain, urgency/tensesmus, clubbing, erythema nodosum and oral ulcers

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16
Q

Non-invasive Dx of GI inflammation?

A

Faecal calprotectin raised on blood test

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17
Q

Tx of UC?

A

5-ASA e.g. mesalazine to induce remission. THEN ADD corticosteroids e.g. prednisolone. THE ADD immunomodulators e.g. azathioprine.
Consider surgery

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18
Q

Sx of Crohn’s disease?

A

Diarrhoea, abdo pain, weight loss, perianal abscess/fistulae, clubbing, bowel and oral ulceration, failure to thrive

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19
Q

Dx of IBDs?

A 
UC = sigmoidoscopy and biopsy
CD = colonoscopy and biopsy
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20
Q

Tx of CD?

A

Steroids e.g. prednisolone, immunomodulation e.g. azathioprine and Anti-TNFalpha drugs e.g. infliximab

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21
Q

Non GI symptoms of IBDs?

A

Fatigue, fever, clubbing, skin/joint/eye problems

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22
Q

Name the most common viral/bacterial/parasitic causes of diarrhoea?

A 
Viral = norovirus, rotavirus, adenovirus and astrovirus
Bacterial = salmonella, campylobacter, E.coli and shigella
Parasitic = giardia, cryptosporidium and entamoeba histolytica
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23
Q

What is the difference between gastroenteritis and dysentery?

A 
Gastroenteritis = diarrhoea with/without vomiting due to an enteric infection
Dysentry = diarrhoea with blood e.g. due to salmonella or clostridium difficile
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24
Q

What is the commonest cause of travellers diarrhoea? How does it present?

A

Enterotoxigenic E.coli

Watery diarrhoea preceeded by cramps and nausea

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25
Q

What are the hereditary causes of colorectal cancer?

A

HNPCC = AD due to mutations in the mismatch repair genes. Require regular screenings (most common)
Familial adenomatous polyposis = mutation in a tumour suppresent gene leading to many coloretal adenomas which may become malignant. Prophylaxis surgery <25

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26
Q

Sx of colorectal cancer?

A

Abdominal mass or haemorrhage.
Left sided = Bleeding/mucous PR, altered bowel habit and obstruction
Right sided = weight loss, anaemia and abdominal pain

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27
Q

What is Dukes’ classification of bowel cancer?

A 
A = inner lining of the bowel/slightly into muscularis mucosa
B = extended through the muscularis mucosa
C = spread to a regional lymph node
D = metastasised to another part of the body
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28
Q

Sx of bowel obstruction?

A

Vomiting, nausea, anorexia, constipation, abdominal distension and tinkling bowel sounds.
Pain is higher up in the abdomen and nausea/vomiting occurs earlier in SBO
Pain is more constant and distension is worse in LBO

29
Q

What are the different types of bowel obstruction?

A

Simple = one obstructing point and no vascular compromise
Closed loop = obstruction at 2 points leading to bowel loop distension (risk of perforation)
Strangulated = compromised blood supply (pain is sharper and more localised)

30
Q

What are the most common casues of bowel obstruction?

A 
SBO = adhesions and herniation
LBO = colon cancer, constipation, volvulus, diverticular disease
31
Q

How can hernias be classified?

A 
Reducible = contents can be pushed back
Irreducible = contents can not be pushed back into place
Obstructed = bowel contents can not pass (causes BO)
Strangulated = ischaemia occurs
Incarceration = contents of the hernial sac become stuck by adhesions - type of irreducible
32
Q

What are the types of ingunial hernia?

A

Direct hernias = push their way through the posterior wall of the inguinal canal (medial to the inferior epigastric vessels)
Indirect hernias = enters the inguinal canal via the deep inguinal ring (lateral to the inferior epigastric vessels) - commoner and more likely to strangulate

33
Q

What is a femoral hernia?

A

Bowel enters the femoral canal through the femoral ring and presents as a mass in the upper medial thigh. These are more common in females and are more likely to be irreducible/strangulate

34
Q

Sx of acute mesenteric ischaemia?

A

Acute severe and constant abdominal pain (central or around the right IF), no abdominal signs and rapid hypovolaemia leading to shock. The degree of illness is often far out of proportion with the clinical signs.

35
Q

Which part of the bowel is affected in acute mesenteric ischaemia? How do you treat?

A

This nearly always affects the small bowel and is due to SMA issues.
IV fluids, antibiotics and LMW heparin

36
Q

Sx of chronic mesenteric ischaemia?

A

Severe colicky post-prandial abdominal pain (gut claudication), weight loss (as it hurts to eat) and an upper abdominal bruit. There may also be PR bleeding, malabsorption and vomiting

37
Q

Sx of iscahemic colitis?

A

Aka chronic colonic ischaemia.
Lower left sided abdominal pain and bloody diarrhoea. If it becomes gangrenous there will be hypovolaemic shock and peritonitis.

38
Q

Which part of the bowel is affected in ischaemic colitis? How do you treat?

A

Most commonly affects the splenic flexure and is due to IMA issues
IV fluids and antibiotics. If gangrenous get the patient stable and then ressect the bowel

39
Q

Sx of appendicitis?

A

Pain in the umbilical region which localises to McBurney’s point. Tenderness and guarding of the RIF. Rovsig’s sign positive.
Fever, anorexia and tachycardia

40
Q

Sx of pertionitis?

A

Severe abdominal pain which is worse on movement - the patient will sit very still. Abdominal tenderness and guarding.
Minimal urine output, anorexia, fevers and fatigue

41
Q

What are the types of gall stones?

A

Cholesterol gall stones = large and solitary

Bile pigment gall stones = small, irregular and friable. May be black or brown

42
Q

Sx of biliary colic?

A

Sudden onset severe epigastric pain which radiates over the right shoulder/scapula and to the back, nausea and vomiting.
May be jaundice (depends on the stones location)

43
Q

Sx of acute cholecystitis?

A

Continuous RUQ pain reffered to the right shoulder, vomiting. Inflammation = fever, local peritonism (abdominal tenderness with guarding and rigidity) and raised WCC.
Murphy’s sign positive

44
Q

What is Murphys sign?

A

Used to confirm a diagnosis of acute cholecystitis. Lay 2 fingers over the RUQ, ask the patient to breath in - this will cause pain and arrest of inspiration.
Only positive if this does NOT occur in the LUQ.

45
Q

Sx of ascending cholangitis?

A

RUQ pain reffered to the right shoulder, fever and cholestatic jaundice (dark urine, pale stools and itching of the skin)

46
Q

What is the general treatment for biliary tract disease?

A

NBM. IV fluids and antibiotics, opiate analgesia (with anti-emetics) and gall bladder removal (if GB issues are symptomatic).
Cholesterol stones can be dissolved with ursodeoxycholic acid.

47
Q

Sx of acute hepatitis?

A

Cholestatic jaundice (dark urine, pale stools and itching), tender hepatomegaly, malaise, myalgia, GI upset and RUQ pain

48
Q

Main casues of acute hepatitis?

A

Viral hepatitis (mainly A&E - the rest can be acute or chronic), herpes simplex viruses (e.g. EBV, CMV and VZV), alcohol, toxins, hereditary and autoimmune

49
Q

How are the viral hepitits’ spread?

A 
A&amp;E = Faeco-oral
B/C/D = Blood-bourne (D can ONLY occur in the presence of HBV)
50
Q

What are the general symptoms of a viral hepatitis infection?

A

Fever, malaise, nausea, anorexia, arthralgia. THEN jaundice. THEN hepatosplenomegaly.
Hep B also cause urticaria
Hep C is often asymptomatic until much later on when it presents as cirrhosis

51
Q

Which hepatitis’ is there a vaccine available for?

A

A and B. E can be vaccinated in china but not europe

52
Q

What are the treatment options available for chronic viral hepatitis?

A

SC pegylated-interferon-alpha-2A

HCV add oral ribavirin

53
Q

Sx of liver cirrhosis?

A

Leuconychia, Spider navei, clubbing, palmar erythema, dupuytren’s contracture, xanthelasma, gynaecomastia, loss of body hair, ascites, hepatosplenomegaly

54
Q

What are the main complications of cirrhosis?

A

Coagulopathy, encephalopathy, hypoalbuminaemia (leading to oedema), sepsis, SBP, hypoglycaemia and increased cancer risk

55
Q

Sx of liver failure?

A

Jaundice, hepatic encephalopathy (drowsiness, confusion, slurred/incoherent speech, personality changes and asterixis), fetor hepaticus and constructional apraxia

56
Q

Sx of haemochromatosis?

A

Bronze skin pigmentation/slate grey skin, DM, tiredness, arthralgia, hypogonadism (loss of libido or erectile dysfunction/amenorrhoea), dilated cardiomyopathy = arrhythmias and hepatomegaly

57
Q

Tx of haemochromatosis?

A

Life long venesection and iron chelation therapy e.g. with desferrioxamine

58
Q

Sx of wilson’s disease?

A

Children = liver disease (hepatitis/cirrhosis/liver failure)
Young adults = CNS signs (tremor, dysarthria, dysphasia and dyskinesia)
Depression, decreased cognition and kayser-fleischer rings

59
Q

Tx of wilson’s disease?

A

Copper chelating agents e.g. penicillamine

60
Q

Sx of alpha-1-antitrypsin deficiency?

A

Liver issues = cirrhosis, hepatitis, cholestatic jaundice

Lung issues = dyspnoea and emphysema

61
Q

Sx of alcoholic hepatitis?

A

Malaise, anorexia, D&V, tender hepatomegaly, jaundice, bleeding, ascites, increased temperature/pulse rate/resp rate.
Jaundice, encephalopaty and ascites = severe hepatitis

62
Q

Tx of alcohol hepatitis and alcoholics?

A

DETOX - NO ALCOHOL!
Chlordiazepoxide for withdrawal symptoms
Vitamin K (stop excessive bleeding) and thiamine (stop wernicke’s encephalopathy)
Optamize nutrition

63
Q

Sx of withdrawal?

A

Increased pulse rate, decreased blood pressure, tremour, confusion, fits and hallucinations (delirium tremens)

64
Q

Sx of acute pancreatitis?

A

Severe abdominal pain which radiates to the back and is relieved by sitting forward, vomiting, tachycardia, fever, jaundice, shock, abdominal rigidity with local guarding and tenderness, Cullen’s sign and Grey Turner’s sign

65
Q

Dx of pancreatitis?

A

Raised serum amlyase and lipase

66
Q

Sx of hepatocellular carcinoma? What are the 2 biggest causes?

A

Jaundice, ascites, anorexia, weight loss, RUQ pain, fatigue, enlarged liver which may be irregular
HBV and liver cirrhosis

67
Q

Where are the common sites for secondary liver cancers to have metastasized from?

A

Stomach, colon, lung, breast and uterus

68
Q

Sx of pancreatic carcinoma?

A

Painless obstructive jaundice (if the tumour occurs in the pancreatic head), anorexia, weight loss, diabetes, acute pancreatitis, ascites

69
Q

What is primary biliary cholangitis? (PBC)

A

Formaly known as priamry biliary chirrhosis it is an autoimmune condition which leads to the destruction of the small bile ducts causing a build up of toxins in the liver (cholestasis)

2B - GRIND (11 decks)

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