Gastro Flashcards

Question

What is the investigation and management of pyloric stenosis?

Answer 1

It is investigated with ultrasound and treated with a laproscopic pylomyotomy This involves an incision into the smooth muscle to widen the canal

Answer 2

Usually in early childhood but can present at any age

Answer 3

Anti ttg and anti endomysial (anti-EMA) They target epithelial cells leading to inflammation They rise and fall with disease activity

Answer 4

``` Can be asymptomatic Failure to thrive Diarrhoea Fatigue Weight loss Anaemia Dermatitis herpetiformis - itchy blistering rash on abdomen ```

Answer 5

Coeliac as commonly linked

Answer 6

``` Crows NESTS No mucus in stool Entire GI tract Skip lesions Transmural Smoking is a risk factor ```

Answer 7

``` U C CLOSEUP Continous inflammation Limited to colon and rectum Only superficial mucosa Smoking is protective Excrete blood and mucus Use aminosalicylates Primary sclerosing cholangitis ```

Answer 8

``` Clubbing Erythema nodosum Pyoderma gangrenosum Episcleritis and iritis Inflammatory arthritis Primary sclerosing cholangitis ```

Answer 9

Bloods for anaemia, infection, thyroid, CRP for active inflammation, kidney and liver function Faecal calprotectin 90% sensitive and specific in adults Endoscopy with biopsy gold standard Imaging with ultrasound, CT and MRI for complications

Answer 10

Inducing remission: -1st line steroids - oral pred or IV hydrocortisone -Can add immunosupression e.g. azathioprine or methotrexate Maintaining remission: -1st line - azathioprine or mercaptopurine -Alternatives - Methotrexate or infliximab Surgical resection

Answer 11

Inducing remission: Mild - aminosalicylates e.g. mesalazine oral or rectal -2nd line pred Severe - IV hydrocort or IV ciclosporin Maintaining remission: -Aminosalicylates or azathioprine Surgery - removing colon and rectum (panprotocolectomy)

Answer 12

It is a conginital narrowing or absence of the bile duct | This leads to cholestasis and prevention of excretion of conjugated bilirubin

Answer 13

It presents with persistent jaundice in a newborn. | It should be investigated after 2 weeks in term babies and 3 weeks in preterm babies

Answer 14

Look at conjugated and unconjugated bilirubin levels | There will be a high proportion of conjugated bilirubin as it is being conjugated but can't be excreted

Answer 15

It is managed with a kosai procedure in which the biliary tree is attached directly to the GI tract Most patients will require liver transplantation to fully resolve the problem

Answer 16

Bilious vomiting with bright green bile and absolute constipation - no passage of wind or stools high pitched bowel sounds can be heard then absent

Answer 17

``` Meconium ileus Hirschsprungs disease Oesophageal atresia Duodenal atresia Intussuception Imperforate anus Volvulus stangulated hernia ```

Answer 18

With an abdo xray showing dilated bowel loops and absence of air in the rectum

Answer 19

Keep them nil by mouth Insert an NG tube to drain stomach and prevent further vomiting Provide IV fluids to correct dehydration and electrolyte imbalances

Answer 20

Congenital absence of ganglion cells in the distal colon and rectum This means the bowel does not relax and causes obstruction

Answer 21

Downs syndrome and neurofibromatosis

Answer 22

``` Severity and age varies in individuals Delay in passing muconium >24hrs Chronic constipation Abdo pain and distension Vomiting Poor weight gain and failure to thrive ```

Answer 23

Inflammation and obstruction that occurs in 20% of hirschsprungs patients Presents at 2-4weeks Have fever, diarrhoea, distension and can have sepsis Can lead to toxic megacolon and perforation Requires urgent antibiotics and decompression

Answer 24

Abdo x ray to show obstruction | Rectal biopsy shows absence of ganglionic cells

Answer 25

Surgical resection of aganglionic bowel section

Answer 26

This is when the bowel telescopes into itself causing obstruction

Answer 27

In 6 months to 2 years | More common in boys

Answer 28

Concurrent viral illness Henloch scholein purpura Cystic fibrosis Meckel diverticulum

Answer 29

Present with obstruction RUQ Sausage shaped mass in abdo Redcurrent jelly stool Vomiting

Answer 30

Therapeutic ememas with water or air to force bowel back into normal shape Surgical reduction may be required if this does not work

Answer 31

10-20 years

Answer 32

There is generalised tenderness that moves to the RIF | Tenderness at McBurney's point, one third of the distance from ASIS to umbilicus

Answer 33

Usually in the first few months Diarrhoea after being fed with formula for a few months Reflux