Gastroenterology Flashcards
(20 cards)
Give differentials for a patient presenting with epigastric pain, nausea & vomiting and heartburn
Dyspepsia
Peptic ulcer disease
GORD
How can we differentiate between a patient with dyspepsia and GORD?
A patient with GORD may have a cough or complain of throat symptoms
How can we differentiate between duodenal and gastric ulcers?
Duodenal ulcers are relieved by eating but gastric ulcers are worsened - this may lead to weight gain/loss respectively
How can we manage dyspepsia?
Conservative - lifestyel advice, medications review
Medical - PPI or H2 antagonist
When should we test for H.pylori infection?
If there is a non-healing peptic ulcer, a patient is less than 55y/o and nothing is seen on OGD
What test is used to test for H.pylori?
13C breath test (or stool antigen test)
How can we differentiate between UC and Crohns?
UC - PR bleeding
Crohn’s - very very rarely involves PR bleeding
Give differentials for this presentation - acute abdominal pain, diarrhoea and weight loss
Crohn’s
UC
Bowel obstruction
Colorectal cancer
How does UC present?
Mucusy loose stools, abdo pain, PR bleeding, tenesmus, diarrhoea
How should you investigate potential UC?
FBC - look for anaemia, raised WCC ESR/CRP - raised Faecal calprotectin pANCA +ve AXR Sigmoidoscopy & biopsy
How does the treatment differ for UC and Crohns?
Biological therapy is not indicated for UC
Surgery is not indicated for Crohn’s
Prednisolone is preferred to 5-ASA for Crohn’s whereas it’s the other way around for UC
What is the acute management for IBD?
IV fluids, IV corticosteroids, elemental diet
What is the name of the criteria used to assess severity of acute pancreatitis?
Glasgow criteria
What is the name of the criteria used to assess the severity of UC?
Truelove & Witts criteria
Give some example of systemic features of IBD
Arthritis, episcleritis, erythema nodosum, VTE, osteoporosis, uveitis, PSC
Give some differentials for this presentation - R sided abdo pain, nausea & vomiting, fever
Appendicitis
Pyelonephritis
Cholangitis
Name some differentials for epigastric pain
Perforated ulcer Peptic ulcer disease Acute pancreatitis Cholecystitis Early appendicitis
How do the locations of abdo pain differ between cholecystitis and cholangitis?
Cholecystitis - epigastric OR RUQ
Cholangitis - usually RUQ
If epigastric pain is relieved by leaning forward, what is the likely diagnosis?
Acute/chronic pancreatitis
What are the complications associated with IBD?
UC - adenocarcinoma, PSC, toxic megacolon
Crohn’s - malabsorption, obstruction
