Gastrointestinal Flashcards

(51 cards)

1
Q

What are oesophageal varices?

A
  • dilated veins at sites of portosystemic anastomosis
  • left gastric and inferior oesophageal veins
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2
Q

Causes of oesophageal varices

A

pre-hepatic

  • portal vein thrombosis
  • portal vein obstruction

hepatic

  • cirrhosis
  • schistosomiasis

post hepatic

  • Budd Chiari
  • RHS HF
  • constructive pericarditis
  • compression
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3
Q

Presentation of oesophageal varices

A
  • haematemesis and/or melena
  • epigastric discomfort
  • sudden collapse → haemodynamic instability
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4
Q

Investigations for oesophageal varices

A
  1. urgent endoscopy
  2. FBC, U&E, clotting (INR) LFTs
  3. chest xray/ascitic tap
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5
Q

Management of oesophageal varices

A
  • ABCDE
  • Rockall score

bleeding varices

  • terlipressin
  • prophylactic Abs → ciprofloaxcin
  • balloon tamponade
  • endoscopic banding
  • TIPS

bleeding prevention

  • beta blocker
  • endoscopic banding
  • cirrhosis = screening endoscopy
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6
Q

What is a Rockall score?

A

prediction of rebleeding and mortality

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7
Q

What is a Mallory Weiss tear?

A

haematemesis from tear in oesophageal mucosa

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8
Q

Risk factors for Mallory Weiss tear

A
  • alcoholism
  • hyperemesis gravidarum
  • gastroenteritis
  • bulimia
  • chronic cough
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9
Q

Presentation of Mallory Weiss tear

A
  • haematemesis
  • melena
  • symptoms of hypovolaemic shock
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10
Q

Investigations for Mallory Weiss tear

A
  • Rockall score
  • FBC, U&E, coagulation studies
  • ECG, cardiac enzymes
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11
Q

Management of Mallory Weiss tear

A

most resolve spontaneously

  • ABCDE
  • terlipressin and urgent endoscopy
  • Rockall score
  • inpatient observation
  • banding/clipping
  • adrenaline
  • thermocoagulation
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12
Q

What is Boerhaave syndrome?

A
  • oesophageal rupture

Mackler triad

  • vomiting
  • chest pain
  • subcutaneous emphysema
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13
Q

What are the two types of oesophageal cancer?

A

adenocarcinoma

  • more common in developed world
  • lower 1/3 → near GO junction

squamous

  • more common in developing world
  • upper 2/3
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14
Q

Risk factors of adenocarcinoma

A
  • GORD
  • Barrett’s oesophagus
  • smoking
  • achalasia
  • obesity
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15
Q

Risk factors for squamous oesophageal cancer

A
  • smoking
  • alcohol
  • achalasia
  • obesity
  • low fruit/veg/fibre/vitA,C
  • hot drinks
  • Plummer-Vinson syndrome
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16
Q

Symptoms of oesophageal cancer

A
  • vomiting
  • progressive dysphagia
  • anorexia and weight loss
  • odynophagia
  • hoarseness
  • malaena
  • cough
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17
Q

Typical presentation of oesophageal cancer

A

ALARMS

  • anaemia
  • loss of weight
  • anorexia
  • recent onset progressive symptoms
  • malaena/haematemesis
  • swallowing difficulties eg dysphagia
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18
Q

Investigations for oesophageal cancer

A
  1. upper GI endoscopy and biopsy
    - CT scan/endoscopic US → staging
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19
Q

Management of oesophageal cancer

A
  • operable disease → surgical resection, adjuvant chemo
  • palliation
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20
Q

What are the two types of gastric cancer?

A
  1. intestinal/differentiated → more common
  2. diffuse/undifferentiated
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21
Q

Risk factors of intestinal gastric cancer

A
  • male
  • h.pylori
  • chronic gastritis
  • atrophic gastritis
  • older age
22
Q

Features of intestinal gastric cancer

A
  • histology → glandular
  • appearance →large, irregular
  • locations → antrum, lesser curvature
23
Q

Risk factors of diffuse gastric cancer

A
  • blood type A
  • genetic
  • younger age
24
Q

Features of diffuse gastric cancer

A

histology

  • poorly differentiated
  • signet ring cells

appearance

  • gastric linitis → submucosa invasion
  • no movement on barium swallow = progressed

location = anywhere esp cardia

25
Red flags for upper GI cancer
upper abdominal mass consistent with stomach cancer and: - dysphagia of any age - age 55+ and weight loss with: upper abdominal pain or reflux or dyspepsia 2 week wait for endoscopy
26
What symptoms qualify for non-urgent endoscopy?
- haematemesis - treatment resistant dyspepsia - upper abdominal pain - anaemia
27
Presentation of gastric cancer
- often late presentation - anorexia - weight loss - anaemia - dysphagia - N&V - epigastric pain → better with antacids - paraneoplastic syndromes - metaplastic signs
28
Investigations for gastric cancer
- gastroscopy → 8-10 biopsies - endoscopic US → depth of invasion - CT/MRI/PET
29
Management of gastric cancer
- nutritional support → fruit/veg/folate/fibre - surgical resection - chemo
30
Risk factors for colon cancer
- family history - hereditary conditions → FAP - IBD - diet → high fat/red meat, low fibre/folate/Ca2+ - DM - lifestyle - history of bowel/endometrial/breast/ovarian cancer - later first pregnancy/early menopause
31
Symptoms of colon cancer
depends on location - pain - palpable mass - bleeding - change in bowel habit - weight loss - vomiting - obstruction
32
Diagnosis of colon cancer
faecal occult blood test - \>50 and bowel habit change/iron deficient anaemia - \>60 and anaemia colonoscopy and biopsy flexible sigmoidoscopy/barium enema/CT colonoscopy
33
Management of colon cancer
- surgical resection - depends on site of cancer - normally anastomosis required
34
What are the key hereditary causes of colon cancer?
- familial adenomatous polyposis - hereditary nonpolyposis colorectal cancer - Lynch syndrome
35
What are bowel obstructions?
an arrest on the onward propulsion of intestinal contents
36
What are the types of bowel obstructions?
- small bowel → most common - large bowel - psudeo
37
Causes of SBO
- adhesions → previous abdominal/pelvic surgery or previous abdominal infections - hernias - malignancy - Crohn's
38
Clinical presentation of SBO
- pain → initially colicky then diffuse, high in abdomen - profuse vomiting following pain (earlier than LBO) - less abdominal distention than LBO - tenderness = strangulation/risk of perforation - constipation = late in SBO - increased bowel sounds → tinkling
39
Diagnosis of SBO
1. abdominal xray → central gas shadows, distended loops, fluid levels - examination of hernia orifices and rectum - FBC GOLD STANDARD = non-contrast CT → locates obstruction
40
Management of SBO
- aggressive fluid resuscitation - decompression of bowel - analgesia and anti-emetics - Abs - surgery to remove obstruction → laparotomy
41
What is involved in decompression of the bowel?
- IV fluids with nasogastric tube - always try before surgery
42
Causes of LBO
- malignancy - volvulus - diverticulitis - Crohn's - intussusception
43
What is volvulus?
- rotation/twisting of bowel on mesenteric axis - commonly in sigmoid colon
44
What is intussusception
- bowel roles inside of itself - almost only in neonates/infants → softer bowels
45
Clinical presentation of LBO
- abdominal pain → more constant and diffuse than SBO, lower abdomen - more abdominal distention than SBO - palpable mass eg hernia - vomiting → later than SBO - constipation → earlier than SBO - normal bowel sounds then louder then silent
46
Diagnosis of LBO
1. abdominal xray - FBC - digital rectal exam → empty rectum, hard/compacted stools, blood GOLD STANDARD = CT
47
What can be seen on an abdominal xray in LBO?
- peripheral gas shadows proximal to blockage - caecum and ascending colon distended
48
Management of LBO
same as SBO
49
What are the two types of diarrhoea?
- acute → \<2 weeks - chronic → \>2 weeks
50
Causes of diarrhoea
viral → majority - children = rotavirus - adults = norovirus bacterial - campylobacter jejuni - bloody diarrhoea - - e.coli - - salmonella - - shigella parasitic - giardia lamblia
51
Management of diarrhoea
- treat underlying cause → bacterial = metronidazole - oral rehydration therapy - anti-emetics agents eg metoclopramide - anti-motility agents eg loperamide self-limiting