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Year 5 Notes > Gastroenterology > Flashcards

Flashcards in Gastroenterology Deck (81):
1

Dyspepsia (new):
Management

>55 OR
Anaemia
Loss of weight
Anorexia
Recent onset
Melaena/haematemesis
Swallowing problems
--> refer for upper GI endoscopy

2

H pylori regimes

PPI + 2 abx

PAC500
PMC250
Bd for 7 days

Review after 4w

3

Melaena:
Causes

Peptic ulcers
Mallory-Weiss
Varices
Drugs (NSAIDs)
Dudodenitis
Malignancy

4

Appendicitis:
Presentation

Periumbilical pain moves to RIF (guarding, rebound)
anorexia
Vomiting
Constipation
Fever
Tachycardia

5

Leukoplakia

Oral musical white patch
Does NOT rub off

Refer - premalignant

6

Oral hairy leukoplakia

Shaggy patch on sides of the tongue
In HIV
caused by EBV

7

Sliding hiatus hernia

GOJ slides up into chest
Reflux as LES becomes less competent
Diagnose - barium swallow
Tx - lose weight, treat reflux, surgery last line

8

Rolling hiatus hernia

GEJ remains in abdo, but stomach herniated into stomach alongside esophageal
Less common to have bad GORD
Diagnose - barium swallow
Tx - lose weight, GORD Tx, surgery last line

9

Pancreatitis:
Symptoms and signs

Gradual or sudden severe central abdominal pain
Radiates to back
Alleviated sitting forward
Vomiting
Tachycardia
Fever
Jaundice
Rigid tender abdo
Cullen's sign
Grey Turners sign

10

Cullen's sign

Peri umbilical bruising - sign of pancreatitis

11

Grey turners sign

Flank bruising - in pancreatitis

12

Pancreatitis:
Ix

Serum amylase >1000 (but can be normal)
Serum lipase raised
ABG - monitor O2 and acidosis
AXR - no psoas shadow
CXR - can exclude other causes eg perforation
CT/MRI to assess severity
ERCP is deteriorating LFTS

13

Pancreatitis:
Management

Fluids
Analgesia
Monitor closely
ERCP + gallstone removal if progressive jaundice
Retreat imaging to monitor progress

14

Pancreatitis:
Complications

Pancreatic necrosis +pseudocyst
Access
Bleeding/thrombosis
Bowel fistulae
Recurrent pancreatitis

15

Glasgow Criteria for pancreatitis

To assess severity PANCREAS

PaO2 55
Neutrophilia
Calcium
Renal function
Enzymes
Age
Sugar

16

Ulcer pain relieved by eating

Duodenal

17

Skip lesions

Crohn's disease

18

Painless jaundice+steatorrhea

Pancreatic cancer

19

Post-splenectomy vaccines

Hib
Pneumococcal
Meningococcal
Pen V (2 years to life)
Medicard

20

Peritonitis signs

T tenderness and tachycardia
R reflex and rigidity
A absent bowel sounds
P pyrexia
P percussion pain
E extremely unwell
R rovsing sign

21

Gout:
Acute management

NSAIDS (colchicine if ulcer etc)
Intraarticular steroid injection
Oral steroids if above CI
If already taking allopurinol then continue

22

Gout:
Allopurinol prophylaxis

Not until 2w after attack has settled
Initially 100mg then titration, aim for Uric acid

23

Gout:
Allopurinol indications

Recurrent attacks
Tophi
Renal disease
Uric acid stones
Prophylaxis if on gout causing meds

24

Ginigivitis:
Causes

Pregnancy
AML
Vit C deficiency
Phenytoin, cicoosporin, nifedipine

25

Gastric ulcer

Worse when eating, relieved by antacids
Weight loss
Need to biopsy if worried gastric ca

26

Duodenal ulcer

Same risk factors as gastric
Relieved by eating or drinking milk

27

Portal hypertension:
Causes

Prehepatic: thrombosis
Hepatic: cirrhosis, schistosomiasis
Post hepatic: buds chiari, right heart failure

28

Varicies:
Prophylaxis

Primary: propanalol, band ligation
Secondary: TIPS, banding

29

Varicies:
Acute bleed management

Fluid resus
Vit K if abnormal clotting, FFP, platelets
IVI terlipressin
Banding/ balloon compression

30

Hepatorenal syndrome

Cirrhosis+ascites+renal failure

Liver failure causes renal vasoconstriction even though all others are vasodilation

31

Spontaneous Bacterial Peritonitis

Sudden deterioration of patient with ascites
E. coli, klebsiella, strep
Broad spec ABx

32

Haemochromatosis:
Signs and symptoms

Tiredness
Joint pain
Grey skin
Signs if liver disease
Diabetes
Hypogonadism

33

Haemochromatosis:
Blood results

Raised LFTS
Raised serum ferritin
High glucose

34

Primary billiary Cirrhosis:
Signs and features

Lethargy
Pruritis
⬆️ alk phos
AMA +ve
Jaundice
Pigmented skin
Hepatosplenomegaly
Hyperlipidaemia

35

Primary billiary cirrhosis:
Blood results

⬆alk phos
️⬆GGT️
Mildly⬆ AST, ALT
⬇️albumin
️⬆Billirubin
⬆PT, immunoglobulins, cholesterol

36

Primary billiary cirrhosis:
Management

Treat pruritis and diarrhea
Give vitamin DAK
Osteoporosis prophylaxis
Eventually liver transplant

37

PBC vs PSC

PSC affects intra and extra hepatic bile ducts
Only PBC has AMA
PSC 90% have IBD
PSC mainly men can also be children, PBC only adults
PSCcan cause various malignancies

38

Primary sclerosing cholangitis:
Features

Pruritis
Fatigue
Often IBD
Liver disease
Male
Ascending cholangitis

39

Primary sclerosing cholangitis:
Blood results

⬆️alk phos
⬆️bilirubin
Hypergammaglobuminaemia

40

Primary sclerosing cholangitis:
Management

Management pruritis
Liver transplant for end stage
ABX for bacterial cholangitis

41

NAFLD:
Presentation

Middle aged
Obese
Women
DM, dislipidaemia
Amiodarone, methotrexate, tetracycline
Raised LFTs with fatty liver on USS

42

Never proximal to ileocaecal valve

UC

43

Inflammation of entire colon

UC

44

UC:
Presentation

Diarrhoea +- blood, mucus
Cramps
Frequency/urgency/tenesmus
Attacks: fever, malaise, anorexia, weight loss
Aphthous ulcers
Conjunctivitis/episcleritis/arthritis/ank spond

45

Goblet cell depletion
Mucosal ulcers
Crypt abscesses
Inflammatory infiltrate
Mucosal thickening/islands

UC

46

AXR findings for UC

No face cal shadows
Mucosal thickening/islands
Colonic dilatation

47

Colonoscopy findings for UC

Inflammatory infiltrate
Goblet feel depletion
Glandular distortion
Mucosal ulcers
Crypt abscesses

48

Complications of UC

Toxic dilation
Venous thrombosis when inpatient
Malignancy - needs regular colonoscopy

49

UC:
Treatment

5ASAs - sufalazine
Steroids - pred (oral/suppositories for mild, enema mod)
IV hydrocortisone for severe (or rectal)
Ciclosporin or infliximab
Immunomodulation last line - azothiaprine, methotrexate

50

GI inflammation anywhere from mouth to anus

Crohns

51

Not continuous - areas of unaffected in between bowel inflammation - skip lesions

Crohns

52

Crohns:
Symptoms

Diarrhea
Urgency
Weight loss
Fever malaise anorexia
Aphthous ulcers
Abdo tenderness
Perianal abscess or fistula

53

Crohns:
Complication

Toxic dilatation
Small bowel obstruction
Access
Fistulae
Peroration
Rectal haemorrhage
Cancer

54

Barium enema findings for Crohns

Cobblestone
Rose thorn ulcers
Colon strictures

55

Crohns:
Treatment

Pred
Or hydrocortisone if severe
Metronidazole
Infliximab
Azothiaprine/sufalazine

56

Painless obstructive jaundice

Carcinoma of pancrea

57

No inflammation beyond submucosa

UC

58

Acute cholecysitis:
Presentation

Continuous epigastric or RUQ pain
Vomiting
Fever
Local peritonitis
GB mass

59

Acute cholecysitis vs billiary colic

AC is inflammatory - so raised WCC, fever, local peritonism

60

Murphys sign

Fingers over RUQ ask patient to breathe in, they stop breathing due to pain as inflamed gallbladder hits your fingers
Only positive if same in LUQ doesn't hurt
+ve shows acute cholecysitis

61

Acute cholecysitis:
Ix

Bloods show raised WCC
USS shows thick walled shrunken GB, pericholecystic fluid, stones,

62

Acute cholecysitis:
Treatment

NBM
Pain relief
Broad spec eg cefuroxime

63

Chronic cholecysitis:
Presentation

Chronic inflammation
Colic
Flattening dyspepsia
Abdo distention
Fat intolerance

64

Billiary colic:
Presentation

RUQ pain radiating to back +-jaundice

65

Cholangitis:
Presentation

RUQ pain, jaundice, rigors

66

Billiary colic vs acute cholecysitis vs cholangitis

Billiary colic: RUQ pain
Acute cholecysitis: RUQ pain + fever⬆️WCC
Cholangitis: RUQ pain + fever⬆️WCC + jaundice

67

Boerhaave syndrome

HSevere vomiting --> esophageal rupture

68

Plummer-Vinson syndrome

Triad of
Dysphasia (from esophageal webs) + glossitis + IDA

69

Mesenteric ischemia:
Presentation

Elderly patient
Vascular history/risk factors
Abdo pain, rectal bleeding, diarrhea, fever
Metabolic acidosis

70

Rovsing sign

Pressing left lower quadrant causes pain in right lower quadrant
Appendicitis

71

Hirschprungs disease

failure of mesenteric plexus to develop
Neonate so fail/delay to pass meconium or older children constipated
More common in males and downs

72

Budd-Chiari syndrome

Hepatic vein thrombosis
Usually from haematological or coagulation disorder
E.g polycythaemia, pregnancy, COCP

Sudden severe abdo pain, ascites, tender hepatomegaly

73

Cholangiocarcinoma

Persistent biliary colic symptoms
Jaundice, anorexia, weight
Palpable gallbladder (Courvosier)

74

Kantors string sign

Crohns

75

Gallstones ileus

Small bowel obstruction secondary to impacted gallstone

Abdo pain, distention, vomiting +- hx of gallstones

76

Most common travelers diarrhea
Watery stools
Cramps and nausea

E. coli

77

Infective diarrhea, prolonged non bloody

Giardia

78

Infective diarrhea
Bloody diarrhea, vomiting and Abdo pain

Shigella

79

Infective diarrhoea
Flu symptoms then cramps Abdo pains, fever, diarrhoea
Can cause GBS

Campylobacter

80

C diff treatment

Metronidazole

81

Barium enema with loss of hays teal markings creating lead pipe colon

Ulcerative colitis