Gastroenterology Flashcards
(33 cards)
Abdominal Migraine
Children
Nausea, vomiting, migraine and abdo pain
Tx: triptans
Referral for diarrhoea?
> 4wks
No cause found
Treatment of diarrhoea with antidiarrhoeal (loperamide-opioid) agents should never be given to?
Children
Children with diarrhoea and blood in stool?
Haemolytic uraemic syndrome
*May occur after gastroenteritits
Transient Lactose intolerance may occur?
Following GE in children
Constipation definition?
> /= 2 of the following >/= 3mnths;
- straining at defeacation for >/=25%
- = 2 bowel movements per week
- A sensation of incomplete evacuation (tenesmus) >/= 25%
- Lumpy +/- Hard stool >/= 25%
Constipation Referral?
> 6wks
Occult presentation of constipation
Common in Elderly;
Confsuion Urinary Retention Abdominal Pain Overflow Diarrhoea Loss of appettite and nausea
Which drugs predispose to constipation?
opioids Antacids- calcium or aluminium Antidepressants Iron Antiparkinsonian drugs Anticholinergics Anticonvulsants Antihistamines Calcium antagonists
Urgent Referral to GI team specializing in malignancy?
Upper GI Symptoms
- Dysphagia
- Unexplained upper abdo pain + weight loss +/- back pain
- Upper abdo mass w/t dyspepsia
- Obstructive Jaundice (narrowed bile/pancreatic duct)
Consider:
- persistent vomiting and weight loss in the abscence of dyspepsia
- Unexplained worsening of dyspepesia and barretts oesophagus; known dysplasia, atrophic gastritis, intestinal metaplasia, or peptic ulcer surgery >20yr ago
Urgent specialist referral/ urgent endoscopy?
Upper GI Symptoms
> 55yr with unexplained cause, persistent, recent-onset dyspepsia alone
- don’t allow symptoms to persist >4-6wks
- H.pylori status should not affect decision to refer
Consider: Dyspepsia w/t;
- Chronic GI bleeding
- Dysphagia
- Progressive unintentional weight loss
- Persistent Vomiting
- Iron deficiency anameia
- Epigastric Mass
- Suspicious barium meal result
Refer urgently to a lower GI malignancy team if?
Lower GI Symptoms urgent referral <2wks
Any age;
- Right lower abdo mass consistent with large bowel involvement
- Palpable rectal mass
- Unexplained iron deficiency anaemia
> 40yrs;
Rectal Bleeding w/t change of bowel habit- looser or increased stool frequency >6wks
> 60yrs;
Rectal Bleeding >6wks without symptoms
-Change in bowel habit- looser or increased stool frequency > 6wks without rectal bleeding
Functional Dyspepsia
Non Ulcer Dyspepsia
Before Testing for H.Pylori you should?
Tests: Serology, Urea Breath test, Faecal Antigen Test
“wk washout PPI period before testing
Triple Therapy Includes?
PPI (Omeprazole) + Amoxicillin + Clarithyromycin/ Metronidazole
Medications causing dyspepesia?
CCB Nitrates (angina) Theophyllines (Resp) Bisphosphonates (Bone) Corticosteroids NSAIDS SSRIs
Drugs causing GORD
NSAIDS TCAs SSRIs Iron supplements Anticholinergics Nitrates Alendronic Acid
Management GORD
- Lifestyle advice
- PPI double dose if remains symptomatic for further 1mnth
- H2 Receptor antagonist (ranitidine)
- +/- prokinetic (domperidone) for 1mnth
Acute Gastritis
Type A: Entire stomach, pernicious aneamie, pre-malignant
Type B: antrum +/- duodenum, H.pylori
Type C: Irritants e.g NDSAIDS, alcohol
Acute Gastritis Management
Treat the cause
Acid Suppression- H2 antagonist or PPI 4-8wks
Treatment of peptic ulcers in patients taking NSAIDS
- Stop NSAIDS or switch to paracetamol, lower dose
- Gastric Protection: PPI or Misoprostol (PG)
- Full dose PPI or H2 2 mnths
Zollinger Ellisson Syndrome
Gastrin-secreting pancreatic adenoma
ass. w/t peptic ulcers
Suspect: multiple drug resistant peptic ulcers ass. w/t staetorrhoea +/- diarrhoea
Duodenal vs gastric ulcers
Duodenal : relieved by food, worse at night, weight gain, waterbrash (saliva fills mouth)
Gastric: worse after food, Relieved by antacids or lying flat, weight loss
Appendicitis during pregnancy?
Appendix displaced- pain paraumbilical region/ subcostally
If suspect, admit immediately
