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Year 3 Gastro > Gastro Presentations > Flashcards

Gastro Presentations Flashcards

(75 cards)

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1
Q

Abdominal distention

A 
Coeliac disease
IBS
Volvulus
Hepatocellular carcinoma
Portal hypertension
Ascites
Intestinal ischaemia
Intestinal obstruction
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2
Q

Abdominal mass

A

Anal/PR

  • Colorectal cancer
  • Perianal abscess/fistulae

Epigastric/RUQ

  • Cholangiocarcinoma
  • Pancreatic cancer
  • Gastric cancer

Other

  • Appendicitis
  • Femoral hernias
  • Intestinal ischaemia
  • Intestinal obstrution
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3
Q

Common differentials for acute abdomen

A 
Adhesions
Incarcerated/strangulated hernia
Cholecystitis
Perforated gastric ulcer
Appendicitis
Ectopic pregnancy
Pelvic inflammatory disease
Acute pancreatitis
Acute diverticulitis
Ulcerative colitis
Crohn's disease
Cholelithiasis
Gastrointestinal malignancy
Mallory-Weiss tear
Diabetic ketoacidosis
Opioid withdrawal
Hepatitis
Gastroenteritis
Infectious colitis
Sickle cell crisis
Endometriosis
Testicular torsion
Kidney stones
Pyelonephritis
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4
Q

Common differentials for ascites

A 
Hepatitis C
Alcoholic liver disease
Congestive heart failure
Nephrotic syndrome
Pancreatitis
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5
Q

How does colonic bleeding typically present?

A

Bright red or dark red blood per rectum

Rarely meleaena

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6
Q

What does colonic bleeding rarely present as melaena?

A

Blood in the colon has a powerful laxative effect and is rarely retained long enough for transformation to occur

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7
Q

How can you generally differentiate between right-sided bleeds and left sided?

A

Darker coloured - right-sided

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8
Q

What are the presenting features of colitis?

A

Bleeding may be brisk in advanced cases, diarrhoea is commonly present. Abdominal x-ray may show featureless colon.

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9
Q

What are the presenting features of diverticular disease?

A

Acute diverticulitis often is not complicated by major bleeding and diverticular bleeds often occur sporadically.

75% all will cease spontaneously within 24-48 hours. Bleeding is often dark and of large volume.

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10
Q

What are the presenting features of colonic cancer?

A

Bleeding may be first sign of disease

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11
Q

What are the presenting features of hemorrhoidal bleeding?

A

Typically bright red bleeding occurring post defecation.

Although patients may give graphic descriptions bleeding of sufficient volume to cause haemodynamic compromise is rare.

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12
Q

What are the indications for surgery for a lower GI bleed?

A

Patients > 60 years
Continued bleeding despite endoscopic intervention
Recurrent bleeding
Known cardiovascular disease with poor response to hypotension

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13
Q

What is the surgical intervention for GI bleeds?

A

Selective mesenteric embolisation

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14
Q

What are the clinical features of an upper GI bleed?

A

Haematemsis (most common)
Melena
Raised urea

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15
Q

What are the presenting features of oesophageal varicies?

A

Usually a large volume of fresh blood.
Swallowed blood may cause melena.
Often associated with haemodynamic compromise.
May stop spontaneously but re-bleeds are common until appropriately managed.

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16
Q

What are the presenting features of oesophagitis?

A

Small volume of fresh blood, often streaking vomit. Malena rare.
Often ceases spontaneously.
Usually history of antecedent GORD type symptoms.

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17
Q

What are the presenting features of a Mallory-Weiss tear?

A

Typically brisk small to moderate volume of bright red blood following a bout of repeated vomiting. Malena rare. Usually ceases spontaneously.

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18
Q

What are the oesophageal causes of GI bleeds?

A

Oesophageal varicies
Oesophagitis
Cancer
Mallory Weiss Tear

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19
Q

What are the gastric causes of GI bleeds?

A

Gastric ulcer
Gastric cancer
Dieulafoy lesion
Diffuse erosive gastritis

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20
Q

What are the presenting features of gastric ulcers?

A

Small low volume bleeds are more common so would tend to present as iron deficiency anaemia.

Erosion into a significant vessel may produce considerable haemorrhage and haematemesis.

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21
Q

What are the presenting features of gastric cancer?

A

Frank haematemesis or altered blood mixed with vomit

Prodromal features of dyspepsia and may have constitutional symptoms

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22
Q

What is a dieulafoy lesion?

A

An arteriovenous malformation typically found in the stomach

Presents with haematemesis and melena

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23
Q

What are the presenting features of diffuse erosive gastritis?

A

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

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24
Q

What are the duodenal causes of GI bleeds?

A

Duodenal Ulcer

Aorto-enteric fistula

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25
Where are duodenal ulcers found? Why does this cause bleeding?
Posteriorly sited and may erode the gastroduodenal artery
26
What are the presenting features of duodenal ulcers?
haematemesis, melena and epigastric discomfort pain occurs several hours after eating
27
What is an aorto-enteric fistula?
In patients with previous abdominal aortic aneurysm surgery aorto-enteric fistulation remains a rare but important cause of major haemorrhage associated with high mortality.
28
How can you risk assess upper GI bleeding?
use the Blatchford score at first assessment, and | the full Rockall score after endoscopy
29
What is taken into account in the Blatchford score?
Urea 'protein' Haemoglobin low BP low Pulse high
30
How are GI bleeds managed?
Wide-bore IV access Platelet transfusion if actively bleeding FFP if low fibrinogen or high PT/APTT Endoscopy after resuscitation (within 24 hours)
31
How do you manage variceal bleeding?
Prophylactic Abs Band ligation and injections of N-butyl-2-cyanoacrylate Transjugular intrahepatic portosystemic shunts (TIPS)
32
What can cause dark stool?
GI bleeding | Vitamin K deficiency
33
What can cause pale stools?
Hepatitis | Obstructive jaundice
34
What are the presenting features of PUD? Duodenal
Epigastric pain relieved by eating
35
What are the presenting features of PUD? Gastric
Epigastric pain worsened by eating
36
What are the presenting features of appendicitis?
Pain initial in the central abdomen before localising to the right iliac fossa Anorexia is common Tachycardia, low-grade pyrexia, tenderness in RIF Rovsing's sign: more pain in RIF than LIF when palpating LIF
37
What are the presenting features of acute pancreatitis?
Usually due to alcohol or gallstones Severe epigastric pain Vomiting is common Examination may reveal tenderness, ileus and low-grade fever Periumbilical discolouration (Cullen's sign
38
What are the presenting features of biliary colic?
Pain in the RUQ radiating to the back and interscapular region May be following a fatty meal Obstructive jaundice may cause pale stools and dark urine Female, forties, fat and fair
39
What are the presenting features of acute cholecystitis?
History of gallstones symptoms Continuous RUQ pain Fever, raised inflammatory markers and white cells Murphy's sign positive (arrest of inspiration on palpation of the RUQ)
40
What are the presenting features of diverticulitis?
Colicky pain typically in the LLQ | Fever, raised inflammatory markers and white cells
41
What are the presenting features of AAAs?
Severe central abdominal pain radiating to the back Presentation may be catastrophic (e.g. Sudden collapse) or sub-acute (persistent severe central abdominal pain with developing shock)
42
What are the presenting features of intestinal obstruction?
History of malignancy/previous operations Vomiting Not opened bowels recently 'Tinkling' bowel sounds
43
Define constipation
Infrequent stools (< 3 times weekly), difficult stool passage (with straining or discomfort), or seemingly incomplete defecation
44
What are the possible complications of constipation?
overflow diarrhoea acute urinary retention haemorrhoids
45
What are some causes of constipation?
``` IBS Rectal prolapse Volvulus (absolute) Obstruction (absolute) Appendicitis ```
46
What can cause reduced appetite?
``` Hepatocellular carcinoma Depression Medication side effect Stomach ulcers Crohn's UC Coeliac disease Gastroenteritis ```
47
What are some causes of groin masses?
``` Herniae Lipomas Lymph nodes Undescended testis Femoral aneurysm Saphena varix ```
48
What are key questions to ask when investigating a groin lump?
Cough impulse? Pulsatile and expansile? Are both testes intrascrotal? Signs of malignancy/infection? (lymph nodes)
49
How would a lipoma present?
Soft, small, superficial lump
50
How are groin lumps diagnosed normally?
Clinically | If not clear then via US
51
When is an urgent surgical assessment necessary for a groin lump?
Suspected: Strangulation of hernia Pseudoaneurysms of the femoral artery
52
How many lymph nodes are present in the groin region?
1-2 deep inguinal lymph nodes | Roughly 11 superficial
53
What medications can cause meleana?
Blood thinners e.g Warfarin or Asprin | Iron tablets
54
What are the 2 general mechanism of nausea and vomiting?
Neurological | Peripheral
55
What are the features of neurological nausea?
Stimulation of area postrema that sense noxious chemical agents Evokes nausea Co-ordinates the emesis reflex OR Diseases of the CNS e.g. infection or tumour evoke N+V via vagal pathways
56
What are the features of peripheral nausea?
Diseases etc. that originate in peripheral organ systems e.g. GI tract Again stimulate vagal efferent motor nuclei
57
What are common differentials for nausea and vomiting?
``` Gastritis GORD PUD Acute gastroenteritis Food poisoning Chronic post-viral Migraine Motion sickness BPPV Stroke Hypercalcaemia Hypothyroidism Small bowel/colon obstruction Choledocholithiasis Cholecystitis Post-GI surgery Severe constipation Irritable bowel syndrome Anorexia/Bullimia nervosa Pregnancy Drug-induced ```
58
What are urgent presentations of splenomegaly?
Sudden pain Splenic sequestration crisis of sickle cell anaemia Splenic/Portal vein thrombosis
59
What are some common differentials for splenomegaly?
``` Alcohol induced Hepatic steatosis Primary biliary cholangitis Haemochromatosis Hodgkin's lymphoma AML CML Polycythemia Vera RA Malaria Thalassaemias ```
60
Define pruritus
an unpleasant sensation that causes a desire to scratch
61
What defines chronic pruritus?
Pruritus lasting >6 weeks is defined as chronic pruritus
62
What are some common differentials for pruritus?
``` Atopic dermatitis Urticaria Insect bite Psoriasis CKD Depression Schizophrenia ```
63
What is rectal prolapse associated with?
Associated with childbirth and rectal intussceception. May be internal or external
64
What is rectal prolapse?
e last part of the rectum or bowel | becomes stretched and protrudes (bulging) from the bottom (anus)
65
What are the 3 types of rectal prolapse?
Full thickness - protrusion of the full thickness of the rectal wall through the anus. Mucosal prolapse - the rectal mucosa (not the entire wall) from the anus. Internal prolapse - a part of the intestine which folds into the section next to it.
66
What can cause rectal proplase?
``` age chronic constipation straining pregnancy / child birth poor bowel control neurological disorders, for example, Dementia weakness of the pelvic floor ```
67
What are the symptoms of rectal prolapse?
``` mucus discharge bulging on straining sensation of incomplete bowel motion faecal incontinence anal pain constipation rectal bleeding ```
68
What is the mangement for rectal prolapse?
Delorme's procedure
69
Define dysphagia
difficulty with the act of swallowing solids or liquids
70
What are common differentials for dysphagia?
``` Pharyngitis (throat pain) Oesophageal candidiasis Stroke Oesophageal spasm GORD Hiatus hernia ```
71
What are the 2 mechanisms of N+V?
Neurological | Peripheral
72
What causes neurological N+V?
Stimulation of the area postrema, which 'senses' noxious chemical agents Stimulates the vagal nuclei which evokes the emesis reflex
73
What causes peripheral N+V?
Peripheral disorders e.g. GI stimulate vagal or spinal afferent nerves that conect with the vagal sensory Tumours, infections, drugs
74
What are some common differentials for vomiting?
``` Gastritis GORD PUD Gastroenteritis Food poisoning Post-viral Migraine Motion sickness BPPV Storke Hypercalcaemia Cholecystitis IBS Anorexia/Bulimia ```
75
What can be the consequence of a misplaced NG tube?
Aspiration pneumonia and death many hospitals now require a radiologist to report on these x-rays before the NG tube can be used

Year 3 Gastro (39 decks)

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