Gastro Flashcards

Question

Management of Coeliac disease?

Answer 1

1. Investigate for micronutrient deficiencies - (Iron, B12, folate, calcium, magnesium, phosphate, zinc, vitamin D) and treat any that are found. 2. Gluten Free Diet - educate patient about the same, provide resources and refer to dietician for assistance with dietary choices. 3. Referral to Coeliac Society of Australia (needs GP letter) and Gastrointestinal society of Australia for focussed resources. 4. Dexa Scan - to screen for osteoporosis. 5. Calcium and Vitamin D supplementation 6. Pneumococcal vaccination (As splenic atrophy can occur) 7. Screen for other autoimmune diseases - Thyroid, Type 1 DM, B12 deficiency anaemia, 8. Monitor for complications including Psychological -eg depression, neuropathy 9. Screen all first degree relatives 10. Repeat coeliac serology and bloods in 6 months then 12 monthly follow up.

Answer 2

Pseudomembranous colitis Check C. Diff toxin Metronidazole 400mg TDS for 10 days. 10mg/kg for child

Answer 3

1. Augmentin Duo Forte (Amoxycillin 875, clavulanate 125) BD for five days 2. Liquid diet for 7 to 10 days 3. Paracetamol 1g qid prn for pain 4. Review in 48 hours 5. Explain red flags and when to go to ED 6. Explain the diagnosis

Answer 4

Diverticulitis WITH - positive blood culture perforation peritonitis sepsis bowel obstruction abcess larger than 5cm diameter - Require admission, IV Abx, IV fluids and bowel rest (surgery considered if perforation, obstruction, severe abcess)

Answer 5

Investigation of choice is abdominal CT scan with oral and IV contrast BLoods: FBE, UEC LFT Urine MCS Pregnancy test in females Stool studies only if dx is not clear

Answer 6

Colovesical fistula CT abdomen and pelvis Surgical management

Answer 7

High Fibre diet

Answer 8

Antiplatelet - eg aspirin Anticoagulant - warfarin, noac NSAIDS SSRI can reduce platelet

Answer 9

1. Secure airway, breathing, circulation. 2. Obtain IV access with a large guage cannula 3. Administer 20ml/kilo fluid bolus of Normal Saline 4. Arrange emergent transfer to hospital via ambulance for urgent endoscopic evaluation and definitive management.

Answer 10

1. Bowel Ca 2. Appendicular Abcess 3. Chrons disease with Ileal disease 4. Ovarian Ca or benign cyst 5. PID

Answer 11

In Australia, bowel cancer has the second highest mortality rate of all cancers. However, if detected early, 90% of cases can be successfully treated.

Answer 12

Unintentional weight loss (\>10% in three months) Rectal bleeding (in the absence of documented haemorrhoids or anal fissure); melena Symptom (eg altered bowel habit) onset after 50 years of age Severe or worsening gastrointestinal symptoms Family history of organic gastrointestinal disease Positive faecal occult blood test Palpable abdominal mass Iron deficiency anaemia (unexplained) Nocturnal diarrhoea

Answer 13

Have any of your close relatives had heart disease before 60 years of age? ‘Heart disease’ includes cardiovascular disease, heart attack, angina and bypass surgery . Have any of your close relatives had diabetes? ‘Diabetes’ is also known as type 2 diabetes or non-insulin dependent diabetes. Do you have any close relatives who had melanoma? Have any of your close relatives had bowel cancer before 55 years of age? Do you have more than one relative on the same side of the family who had bowel cancer at any age? Please think about your parents, children, brothers, sisters, grandparents, aunts, uncles, nieces, nephews and grandchildren.\* Have any of your close male relatives had prostate cancer before 60 years of age? Have any of your close female relatives had ovarian cancer? Have any of your close relatives had breast cancer before 50 years of age? Do you have more than one relative on the same side of your family who has had breast cancer at any age? Please think about your parents, children, brothers, sisters, grandparents, aunts, uncles, nieces, nephews and grandchildren.\*

Answer 14

Such individuals require a referral to a familial cancer clinic for more intensive screening

Answer 15

The iFOBT test kits include **two collection tubes, a ziplock bag, two toilet liners, an instruction sheet, a personal information form and a pre-paid envelope.** The test involves very simple steps that can be done conveniently and privately at home. **Two samples are required from two separate bowel movements,** which ideally are collected as close together as possible (on the same day or the following day).15 The **patient writes their name, date of birth and the date of the sample on the label of the collection tube.** After urinating and flushing the toilet, they should **place one of the toilet liners on the water in the toilet bowl; this will catch the faeces.** Once the patient completes their bowel movement, _they open the collection tube and scratch the tip of the cap over different areas of the faeces on the toilet liner. Only a tiny amount is needed (smaller than a grain of rice). The patient places the cap on top of the collection tube and presses until they hear a click. The collection tube should be shaken several times before being placed into the ziplock back_. Samples are ***returned for testing in the reply-paid envelope with a completed patient information form. Results are typically received in two weeks.*** Further information regarding the test can be obtained by calling 1800 930 998 or visiting Cancer Institute NSW’s **‘Do the test’ website.**

Answer 16

bleeding requiring intervention (1.4:1000) colon perforation (0.68:1000) reactions to anaesthetic agents including breathing and cardiac complications severe abdominal pain poor reaction to bowel preparation death (0.08:1000).

Answer 17

abstaining from **smoking** limiting **alcohol consumption** maintaining a **healthy BMI** eating a healthy diet – evidence suggests diets **low in animal fats and high in fibre such as fruits, vegetables and whole grains** may reduce the risk of CRC20 consider taking a **low-dose aspirin (100 mg daily)** – currently, level I evidence suggests that regular consumption of aspirin can reduce the incidence of and mortality from CRC. Evidence also supports the use of low-dose aspirin as chemoprophylaxis. It is recommended that GPs discuss commencing low-dose aspirin (100–300 mg) as a form of chemoprophylaxis with all people aged 50–74 years regardless of their risk level, unless there are any contraindications.20–22 Some higher-risk groups have different recommendations; for example, L**ynch syndrome carriers are recommended to start aspirin from approximately 25 years of age.**22

Answer 18

Studies have shown that gastrointestinal bleeding, dyspepsia, peptic ulcers and haemorrhagic stroke are associated with long-term use of aspirin, and aspirin should be avoided when the patient has documented allergic reactions to aspirin or renal impairment.

Answer 19

Diarrhoeal frequency Less than 4/day mild 4-6 mod Over 6 severe Systemic symptoms - Tachycardia/Hypotension/Fever is an indicator of severity

Answer 20

**Fatigue** **Abdo pain** **Weight loss** **Fevers** **Diarrhoea** - fluctuating - Inflammation of terminal ileum (bile reabsorption affected) - bile salt diarhhoea - Bacterial overgrowth (due to dysregulated gut microbiome) - Excessive fluid secretion (secretory diarrhoea) **Cx** - bowel obstruction fistulae perianal disease - skin tags/fissures toxic megacolon - colon \> 6cm due to fulminant colitis peritonitis (UC symptoms - bleeding/perforation can also occur in Chrons)

Answer 21

1. Oral ulcers 2. Erythema nodosum 3. Large joint arthritis 4. Eye disease - episcleritis/uveitis 5. Primary sclerosing cholangitis (UC) 6. Ankylosing spondylitis 7. Pyoderma Gangrenosum 8. Kidney stones 9. Gallstones

Answer 22

1. Usually Spares rectum 2. causes fistulae 3. skip lesions 4. Can cause strictures and bowel obstruction

Answer 23

Stool: MCS/ fecal multiplex PCR Calprotectin - VERY SENSITIVE (not specific) so if its positive needs to have a colonoscopy Inflammatory markers: WCC/Platelets ESR and CRP Micronutrients: Iron, Vitamin D and B12, CMP, Albumin Metabolic: TSH, LFT, UEC Gen: HLAB27 IMAGING Barium enema or CT Abdomen ENDOSCOPY - Colonoscopy

Answer 24

Continuous (Chrons is patchy with skip lesions) from rectum proximally - does not extend beyond ileocecal valve

Answer 25

**General** Vitals: HR, BP, Temp WEIGHT, BMI, waist circumference Signs of anaemia and dehydration **ABDO** = palpable masses? Tenderness? Distension? Perianal region: Fissure, skin tags, abcess, fistulae DRE **Oral** inspection **Eyes, Joints, Skin** - for extraintestinal manifestations

Answer 26

1. Exclusion of infectious causes on stool testing. 2. Characteristic appearance on endoscope and histology GRANULAR RED PROCTITIS on colonoscopy/proctosigmoidoscopy +/- contact bleeding

Answer 27

Acute severe UC is (Trulove/witts criteria) *_6 or more bloody stools per day_* **+** **one or more of the following:** Temp more than 37.8 degrees C HR over 90 bpm HB less than 105 ESR over 30 **So any UC patient with over 6 bloody stools with tachy cardia or Fever - send to ED For emergency admission** **IV steroids/Fluids** - +/- emergency surg salvage treatment or colectomy or DO NOT give antidiarrhoeals, opioids or anticholinergic drugs in severe as it can precipitate TOXIC mega colon

Answer 28

Fecal calprotectin - very sensitive characterisitc appearance on barium enema Colonocopy - cobble stone appearance Tends to be more focal and transmural than UC

Answer 29

1. Check Unconjugated - if greater than 70% then likely Gilberts If billi is rising - then check for haemolysis - LDH, retics, bloods film and haptoglobin

Answer 30

So dont do it acutely - as risk of perforation with CO2 insufflation Wait six to 8 weeks after acute attack

Answer 31

Fever or elevated white cell count give Augmentin DF 875/125 bd for five days

Answer 32

Hosptial admission IV antibiotics Bowel rest Surgical review May require CT guided percutaneous drainage or other surg proc

Gastro Flashcards

(57 cards)