All GI Flashcards by Rahim Akram

N+V anorexia myalgia lethargy RUQ pain

Questions may point to risk factors such as foreign travel or intravenous drug use.

Viral hepatitis

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The liver only usually causes pain if stretched.

In severe cases cirrhosis may occur.

One common way this can occur is as a consequence of …?

Congestive hepatomegaly

One common way this can occur is as a consequence of congestive heart failure.

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RUQ pain, intermittent, begins abruptly –> subsides gradually.

Attacks AFTER eating.

Nausea is common.

Female, Forties, Fat and Fair although this is obviously a generalisation.

Biliary colic

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Pain similar to biliary colic i.e.
(RUQ pain, fever intermittent, begins abruptly –> subsides gradually.

Attacks AFTER eating.

Nausea is common.

BUT more severe and persistent. The pain may radiate to the back or right shoulder.

Acute cholecystitis

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Charcot Triad of:
fever (rigors are common)
RUQ pain
jaundice

Ascending cholangitis -

infection of the bile ducts commonly secondary to gallstones

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Bowel obstruction secondary to an impacted gallstone.

Hx of RUQ pain colicky

X-ray = multiple dilated loops, air in biliary tree!!!

Abdominal pain, distension and vomiting are seen.

Gallstone ileus

It may develop if a fistula forms between a gangrenous gallbladder and the duodenum.

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Persistent biliary colic symptoms (i.e. RUQ pain, intermittent, begins abruptly –> subsides gradually. Attacks AFTER eating. Nausea is common.)

Assoc with anorexia, jaundice and WL.

A palpable mass in the right upper quadrant (What sign?)

periumbilical lymphadenopathy (Which node?)

left supraclavicular adenopathy (Which node?) may be seen

High bili, HIGH ALP

Cholangiocarcinoma

A palpable mass in the right upper quadrant (Courvoisier sign),

periumbilical lymphadenopathy (Sister Mary Joseph nodes)

left supraclavicular adenopathy (Virchow node) may be seen

Flukes clonorchis, primary sclerosing, nitrosamines

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Usually due to alcohol or gallstones

Severe epigastric pain

Vomiting is common

Examination may reveal tenderness, ileus and low-grade fever

Periumbilical discolouration (Which sign?) and flank discolouration (Which sign?)

Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign)

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Painless jaundice #classic

Anorexia and weight loss are common

Pancreatic cancer

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Malaise, anorexia and weight loss, mild RUQ pain

RIGHT lobe mass Fluid filled

Poor defined boundaries Anchovy paste @ aspiration

Amoebic liver abscess

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history of NSAID use or alcohol excess.

Which ulcers: more common?

Epigastric pain BETTER by eating

Epigastric pain WORSE by eating

Features of upper gastrointestinal haemorrhage may be seen (haematemesis, melena etc)

Duodenal ulcers: more common than gastric ulcers,

epigastric pain relieved by eating = duodenal

pain worsened by eating = gastric

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Pain initial in the central abdomen before localising to the right iliac fossa (RIF).

Anorexia, Tachycardia, low-grade pyrexia, tenderness in RIF

Which sign = more pain in RIF than LIF when palpating LIF?

Appendicitis

Rovsing

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Colicky pain typically in the LLQ

Diarrhoea, sometimes bloody.

Fever, raised inflammatory markers and white cells sudden onset profuse dark red rectal bleeding.

She was previously well.

How are the PR bleeds managed here?!?

Acute diverticulitis

Diverticula bleeds often settle SPONTANEOUSLY!!!

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History of malignancy (intraluminal obstruction)/previous operations (adhesions)Vomiting.

Not opened bowels recently

CENTRAL pain

constipation
sounds TINKLING!!!!
tumour tender
absent of flatus
n+v
distended

Ix??

Bowel obstuction

AXR
CT CONFIRM!!!

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Loin pain radiating to the groin

severe but intermittent.

Patient’s are characteristically restless.

Visible or non-visible haematuria may be present

Renal colic

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Loin pain + Fever and rigors are common

as is vomiting

Acute pyelonephritis

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Suprapubic pain common in men, who often have a history of benign prostatic hyperplasia

Urine retention

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RIF/LIF pain and a history of amenorrhoea for the past 6-9 weeks.

Vaginal bleeding may be present

Ectopic

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Central abdominal pain radiating to the back:

catastrophic (e.g. Sudden collapse) or
sub-acute (persistent severe central abdominal pain with developing shock)

Patients may be shocked (hypotension, tachycardic)

Patients may have a history of cardiovascular disease

Rupt AAA

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Central abdominal pain

History of atrial fibrillation or other cardiovascular disease

Diarrhoea, rectal bleeding may be seen

A metabolic acidosis is often seen (due to ‘dying’ tissue)

Mesenteric ischaemia

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Projectile, non-bilious vomiting, olive mass @ RUQ, HYPO-nat/kal/chlor ALKalosis

Pyloric stenosis USS/test feed

PyloroMyoTomy

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Drawing knees up; COLICKY, D+V, sausage mass, red currant poo; telescoping bowel USS - target mass

IntuSuscepTionReduction + Air inflation

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FHx, Abdo distensin, Meconium delay, constipated from birth

Hirchsprung’s gangilionic dx @ Rectal biopsy

Rectal washouts -> anorectal pull-through anastomosis

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PREMATURE, abdo distension, bloody pooX-ray - pneumatosis + intestinalis + free air #footballSx

NEC

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Scaphoid (sucked in) abdo + BILIOUS vomiting; High cecum @midline; assoc with diaphragmatic hernia/omphalocele/duod atresia

Malrotation Upper GI contrast + USS to confirm Laparotomy

itchy perianal area, particularly PM Sellotape perianal area, microscopy to see eggs

Threadworm For kid AND family= >6m = mebendazole+hygiene for 2w <6m=hygiene measures for 6w #rigorous (handwash, nails, shower, linen, nightwear)

Umbilical discharge of small bowel content Can get persistence of part of the duct (Meckel's diverticulum).

Persistent vitello-intestinal duct Contrast study to confirm

Central abdo pain and URTI

Mesenteric adenitis AB's conservative mx

chronic diarrhoea = see undigested food in POO

Toddler's

Jaundice > 14d; high biliruin

Biliary atresia

choking + cyanotic spells; TracheoOesophagFistula + polyhydramnios; vacterl assocV - ``` Vertebral anomalies A - Anorectal malformations C - Cardiovascular anomalies T - Tracheoesophageal fistula E - Esophageal atresia R - Renal (Kidney) and/or radial anomalies L - Limb defects ```

Oesophageal atresia

Bouts of crying, pull legs up, worse in PM (i.e. distress during spasm)

infantile colic

crying, which stops abruptly, child draws chin into his chest, throws his arms out, relaxes and starts crying again (distress between spasms)

infantile spasm - do EEG

Red lesions around umbilicus, bleed on contact, purulent discharge chemical cautery + top silver nitrate to treat

Umbilical granuloma

umbilical infection = s.aureus; risk of portal bacteraemia, thrombosis tx with topical and systemic AB's

Omphalitis

Premature neonate, spontaneously close 1-3yrs

Umbilical hernia

Linea alba defect, close to umbilicus; more defined compared to umbilical hernias

Paraumbilical hernia

Pee from umbilicus

Persistent urachus

Asymptomatic rectal bleed; Rule of 2 RIF pain Bleeding and ulcer due to ectopic gastric epithelium

Meckel diverticulum

Viral gastroenteritis -> 4-5 loose stools/day Remove lactose few months

Transient lactose intolerance

abdo pain, bloating, constipation, N+V; NO blood Which one? (chagas, old, neuroPsych dx); LBObst=large dilated loops + COFFEE bean sign #air-fluidlevel; Which one? (all ages, preggers) small bowel obstTx?????

Volvulus sigmoid (chagas, old, neuroPsych dx); Sigmoid=LBObst=large dilated loops + COFFEE bean sign #air-fluidlevel; Caecal (all ages, preggers) Caecal=small bowel obst Sig: rigid sigmoidoscopy + rectal tube insert Cecal: right hemicolect If obstruction cstand then.... LAPARATOMY!!!

Lump in Inguinal groin area Reducible disappears when laying flat scrotum fine Black kid symmetrical bulge under umbilicus

Congenital inguinal hernia – paediatric surgery ASAP incarceration risk <6w - surg <2d <6m - surg <2w <6y - surg <2m Infanta umbilical hernia resolve <5yrs

Female midcycle pain Two weeks after last menstrual period Suprapubic pain Resolve after about 1–2 days Normal FEC normal dipsticks

Mittelschmerz

Sudden epigastric pain Before = upper abdo pain, Now generalised abdominal pain CXR show free air under the diaphragm

Perforated peptic ulcer

Explain: Rovsing Murphy sign Colin sign - periumbilical bruise Grey-turner - flank bruise

Rovsing - press RLQ hurt in LLQ Murphy sign - press RUQ -> breath in -> stops breathing in -> repeat on LUQ Colin sign - periumbilical bruise = pancreatitis Grey-turner - flank bruise = pancreatitis Guarding, rovsing, obturator IRot, Psoas, Extra sx etc Child vague Retrocecal/colic = RFlankPain, Psoas positive Preg - RUQ insead of RLQ Subcolic/pelvic = suprapubic/freq inc, vag/anal pain, diarrhoea tenesmus

26-year-old female with a history of constipation, episodic abdominal pain and bloating.

Irritable bowel syndrome

Dukes colorectal Mucosa, wall, nodes, mets

mucosa, bowel wall, LN met, distant Dukes' A Tumour confined to the mucosa 95% Dukes' B Tumour invading bowel wall 80% Dukes' C Lymph node metastases 65% Dukes' D Distant metastases

Kid has Down’s syndrome PROJECTILE vomiting Bilious vomiting poss/not poss Soft non-distended abdomen Double bubble sign on x-ray

Duodenal atresia

Child left testicle present in scrotum Right testicle absent Sometimes palpable when bathe child

Crypto organism undescended testicle Orchidopexy = 6+m Orchidectomy = 2+ yr

RUQ and malaise/feverUSS = daughter/sand cysts No epithelial lining Grow <20cm Thick walled + external laminated hilar membrane Internal enucleated GERMINAL later Echinococcus infection

Hyatid cysts Mebendazole

Fever RUQ jaundice Cos of biliary sepsis > portal venous dx USS = fluid cavity; hyperechoic walls

Liver abscess Ecoli adults Staph kids Amox/Cipro/Metra

HYPERECHOIC USS liver Ring of fibrous tissue Red/purple vasc lesion OCP use -> sharply demarcated No fibrous capsule Mixed echoity Congenital benign KIDS

Hemangioma Liver cell adenoma Hamartoma

Usually history of antecedent vomiting. followed by the vomiting of a small amount of blood. There is usually little in the way of systemic disturbance or prior symptoms.

Mallory-Weiss Tear

Often longstanding history of dyspepsia, patients are often OVERWEIGHT. What should NOT be associated with dysphagia or haematemesis.

Hiatus Hernia Uncomplicated hiatus hernias should not be associated with dysphagia or haematemesis.

Suspect in patients with severe chest pain without cardiac diagnosis AND signs suggestive of pneumonia without convincing history, where there is history of vomiting. Erect CXR shows infiltrate or effusion in 90% of cases

Oesopghageal rupture - Complete disruption of the oesophageal wall in absence of per-existing pathology. Left postero-lateral oesophageal is commonest site (2-3cm from OG junction).

Progressive dysphagia + WLUsually little or NO history of previous GORD type symptoms.

Squamous cell carcinoma of the oesophagus

Progressive dysphagia, may have previous symptoms of GORD or Barretts oesophagus.

Adenocarcinoma of the oesophagus

Longer history of dysphagia, often not progressive. Usually symptoms of GORD. Often lack systemic features seen with malignancy

Peptic stricture

May have dysphagia that is episodic and non progressive. Retrosternal pain may accompany the episodes.

Dysmotility disorder

riad of: dysphagia (secondary to oesophageal webs) glossitis iron-deficiency anaemia Treatment includes iron supplementation and dilation of the webs

Plummer-Vinson syndrome

Severe vomiting → painful mucousal lacerations at the gastroesophageal junction resulting in haematemesis. Common in alcoholics

Mallory-Weiss syndrome

Severe vomiting → oesophageal rupture

Boerhaave syndrome

Painful, bright red rectal bleeding post defecation Poss skin tag at 6/12 o clock midline position Assoc with Crohns/UCBelow dentate line

Fissure in ano Stool softeners, topical CCB dili/GTN, botulinum toxin, Sphincterotomy

Painless, bright red rectal bleeding ppst defecation and bleeds onto the toilet paper and into the toilet pan Constipation Hx poss!

Haemorroids

May initially present with an abscess and thennnnnnnnnpersisting discharge onto the perineum, separate from the anus!!!! How best visualised???

Fistula in ano MRI!!!!!! For anal fistula!!!!

Peri anal swelling and surrounding erythema Ssevere pain in Ano-rectum + fever

Peri anal/ano-rectal abscess Incision and drainage, leave the cavity open to heal by secondary intention

frank haematemesis/altered blood MIXED with vomit. Usually prodromal features of dyspepsia and may have constitutional symptoms. Amount of bleeding variable but erosion of major vessel may produce considerable haemorrhage.

Gastric cancer

Often NO prodromal features prior to haematemesis and malaena, but this AVM may produce quite considerable haemorrhage and may be difficult to detect endoscopically

Dieulafoy Lesion

Usually haematemesis and epigastric discomfort. Usually there is an underlying cause such as recent NSAID usage. Large volume haemorrhage may occur with considerable haemodynamic compromise

Diffuse erosive gastritis

Small low volume bleeds = more common so would tend to present as iron deficiency anaemia. Erosion into a significant vessel may produce considerable haemorrhage and haematemesis. PAIN @ eating

Gastric ulcer

Difficulty swallowing, dysphagia to both liquids and solids and sometimes chest pain Usually caused by failure of distal oesphageal inhibitory neurones Diagnosis is by pH and manometry studies together with contrast swallow and endoscopy Treatment is with either botulinum toxin, pneumatic dilatation or cardiomyotomy

Achalasia WL Regurg Dysphagia Manometry contrast swallow = dilated tapered oesophagus Balloon Endo dilation – > cardio myotomy + PPI

Symptoms include dysphagia, retrosternal discomfort and dyspepsia May show 'nutcracker oesophagus' on barium swallow

Diffuse oesophageal spasm Spectrum of oesophageal motility disorders Caused by uncoordinated contractions of oesphageal muscles

Tearing interscapular pain Discrepancy in arterial blood pressures taken in both arms May show mediastinal widening on chest x-ray

Dissection of thoracic aorta

Symptoms of obstructed pooing Assoc with childbirth and rectal intususception Either int/ext

Rectal prolapse/intussusception

Bright red rectal bleed Hx of IBS Associated with chronic straining and constipation. Histology shows mucosal thickening, lamina propria replaced with collagen and smooth muscle Fibromuscular obliteration @ sigmoidoscopy

Solitary rectal ulcer syndrome

Odynophagia Poss dyspepsia Hx

Oesophagitis

Duke's colorectal classification MWND

Mucosa, Bowel wall, LNmets, Distant Dukes' A Tumour confined to the mucosa 95% Dukes' B Tumour invading bowel wall 80% Dukes' C Lymph node metastases 65% Dukes' D Distant metastases

Rectal Bleeding +altered bowel habit, malaise, history of fissures (especially anterior) and abscesses Perineal inspection may show fissures or fistulae. Proctoscopy = indurated mucosa and possibly strictures. Skip lesions may be noted at colonoscopy. poss surg @ RIGHT SIDE

Crohns disease

Bright red bleeding often mixed with stool Diarrhoea, WL, NOCTURNAL incontinence,passage of mucous PR Proctitis is the most marked finding. Peri anal disease is = ABsent. Colonoscopy will show continuous mucosal lesion.

Ulcerative colitis

sudden onset profuse dark red rectal bleeding. She was previously well.

Diverticular bleed

Hernia seen in older patients | (the aponeurotic layer between the rectus abdominis muscle medially and the semilunar line laterally)

Spigelian hernia A hernia through the spigelian fascia (the aponeurotic layer between the rectus abdominis muscle medially and the semilunar line laterally)

Hernia in females and typical presents with bowel obstruction

Obturator hernia - A hernia which passes through the obturator foramen. More common in females and typical presents with bowel obstruction

hernia can present with strangulation WITHOUT symptoms of obstruction

Richter hernia - A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect Richter's hernia can present with strangulation without symptoms of obstruction

All GI Flashcards

(83 cards)