Gastrointestinal Conditions Flashcards
(109 cards)
1
Q
Who is typically affected by acute pancreatitis?
A
ELDERLY
MIDDLE AGED
MALE
2
Q
What are the most common causes of acute pancreatitis
A
GALLSTONES
ALCOHOL
3
Q
Main risk factors to worry about in acute pancreatitis
A
TRAUMA- (endoscopic procedures, surgery, blunt abdo trauma)
INFECTION- (mumps, cosackie B4, m.pneumonia)
IATROGENIC- (thiazide diuretics, azathioprine, tetracyclines, oestrogens, valproic acid)
AUTOIMMUNE- (systemic lupus erythematous, Sjorgen’s syndrome)
4
Q
What is the key symptom for acute pancreatitis?
A
EPIGASTRIC PAIN WITH SUDDEN ONSET which becomes continuous. It RADIATES TO THE BACK.
WORSENS WITH MOVEMENT
ALLEVIATED BY FOETAL POSITION
5
Q
Clinical Signs for acute pancreatitis
A
Jaundice
Ecchymosis
Abdo tenderness and distension
Tachycardia/Hypotension
6
Q
Main Differentials for acute pancreatitis
A
Perforated peptic ulcer Bowel obstruction Ischaemic Bowel Ruptured AAA Biliary colic, acute cholecystitis, cholangitis, viral hepatitis Gastroenteritis Diabetic Ketoacidosis
7
Q
Investigations for suspected acute pancreatitis
A
BLOOD- serum amylase, FBC, glucose, CRP
IMAGING- abdo X-ray, CT scan, USS, laparoscopy
8
Q
Treatments for acute pancreatitis
A
PAIN RELIEF- benzodiazepine, buprenorphine, pethidine (NOT MORPHINE) REMOVE GALLSTONES LIFESTYLE MANAGEMENT- alcohol management ANTIBIOTICS- tazocin SURGICAL- cholecystectomy
9
Q
What are the complications if acute pancreatitis goes untreated
A
Pancreatic necrosis, infected necrosis, acute fluid collections, pancreatic abscess, acute pseudo-cyst, pancreatic ascites, acute cholecystitis
SYSTEMIC- pulmonary oedema, pleural effusions, ARDS, hypovolaemia, shock, hypocalcaemia, hypomagnesaemia, hyperglycaemia.
10
Q
Who is typically affected by chronic pancreatitis?
A
MIDDLE AGED MEN
45-54 YEARS
11
Q
What is the most common cause?
A
ALCOHOL (in 70-80%)
12
Q
Key risk factors associated with chronic pancreatitis
A
LIFESTYLE- SMOKING as it inhibits exocrine pancreatic secretion
GALLSTONES/PANCREATIC DUCT STRICTURES, IBD, PRIMARY BILIARY CIRRHOSIS
IATROGENIC- (thiazide diuretics, azathioproine, tetracyclines, oestrogens, valproic acid)
AUTOIMMUNE: Sjorgen’s
13
Q
What are some of the key symptoms for chronic pancreatitis?
A
severe DULL, EPIGASTRIC PAIN that can radiate to the BACK and can LOCALIZE to the UPPER QUADRANTS
Relieved by SITTING UPRIGHT, LEANING FORWARD
Precipitated by EATING
STEATORRHOEA
WEIGHT LOSS
14
Q
Clinical signs for chronic pancreatitis
A
Epigastric tenderness Jaundice Chronic liver disease Raised pituitary hormone Positive secretin stimulation test Calcification on CT Speckled calcification on abdominal x-ray Raised blood glucose
15
Q
What are some differentials for chronic pancreatitis
A
Acute pancreatitis Peptic ulcer disease and IBS AAA MI Biliary colic and acute choleycystitis Gastroparesis
16
Q
What investigations should be done in suspected chronic pancreatitis?
A
BLOODS- serum amylase, FBC, U+Es, glucose, CRP, LFTs
IMAGING- abdo x-ray, CT scan, USS, laparoscopy
17
Q
What is the treatment for chronic pancreatitis?
A
Pain relief- paracetamol and NSAIDs
Creon- to reduce pain and replace pancreatic enzymes for malabsorption
SURGERY- pancreatic resection
18
Q
What are the main causes of an acute GI bleed?
A
Peptic Ulcer Gastritis Varices Oesophagitis Mallory-Weiss Tear Erosive Duodenitis Haemorrhoids Anal Fissure Colon Polyps Colorectal Cancer Ulcerative Colitis Crohn's Disease
19
Q
What are some of the risk factors that lead to an acute GI bleed?
A
Alcohol abuse Chronic Renal Failure NSAID use High age Low socio-economic class
20
Q
The main symptoms of acute GI bleeds:
A
PAIN- especially in conjunction with gallstones and alcohol abuse.
BLEEDING- bright red/black (coffee-ground) vomit, melaena (black tarry stools).
SYNCOPE/SHOCK- due to loss of blood
21
Q
Clinical signs of an acute GI bleed?
A
Shock
Anaemia
Dehydration
Liver Pathology signs- spider naevi, gynaecomastia, flap
Dyspepsia
Weight loss (which could signify malignancy)
Jaundice (Seen in portal hypertensive gastropathy and varices)
22
Q
What are some of the differentials for acute GI bleeds?
A
AAA
OESOPHAGEAL- Barrett’s, cancer, varices, -itis.
GASRTIC- outlet obstruction, cancer, -itis, PUD
Merkel’s
Small Bowel Ulceration
23
Q
What are key investigations in suspected acute GI bleed?
A
BLOODS- FBC, U+E, glucose, CRP
IMAGING- Endoscopy, USS, laparoscopy, CT scan, CXY, erect and supine AXR
24
Q
What is the best treatment for acute GI bleeds?
A
Fluid resuscitation- correct all of the fluid that has been lost
stop NSAIDs if necessary
Potential treatment for H.Pylori- Lansoprazole, Amoxicillin, Clarithromycin
25
Who is most affected by acute hepatitis?
Children and young adults
26
What are the main causes of acute hepatitis?
VIRAL- Hep A-E and cytomaegalovirus
NON-VIRAL INFECTION- toxoplasma gondii, Coxiella burnetti (Q-fever)
ALCOHOL
DRUG- paracetamol OD, halogenated anaesthetics, Anti TB
PREGNANCY
POISION
WILSONS DISEASE
27
What are the main risk factors associated with acute hepatitis
Alcohol abuse
| Ingesting contaminated food/drink
28
What are some symptoms associated with acute hepatitis
PAIN AND PRESSURE IN THE RIGHT HYPOCHONDRIUM
tiredness, malaise, light fever
poor appetite, change in taste
skin rash
29
Clinical signs associated with acute hepatitis?
Tender enlargement of the liver
Splenomegaly
Lymphadenopathy
Liver failure
30
What are the main differentials for acute hepatitis?
HEPATIC- Liver abscess, autoimmune hepatitis, hepatocellular cancer
PANCREATIC- cancer, -itis
GALLBLADDER- cholecystitis, cholelithiasis
GASTRIC- PUD
Small bowel obstruction
AAA
31
What investigations should be used for suspected acute hepatitis?
BLOODS- FBC, ESR, CRP, LFTs, serum AST, ALT, bilirubin, serum antibodies
32
What treatment is used for acute hepatitis?
Mostly symptom management (fluids, antiemetics, rest)
| Hep C - Interferon alfa
33
What complications can arise from untreated acute hepatitis?
Chronic hepatitis
| Liver failure
34
Who is most affected by appendicitis?
Early teens
Those in their late 40s
Males
35
What are the main causes of appendicitis?
INFECTION- parasites, infection secondary to obstruction of appendix lumen, bacterial overgrowth
STRUCTURE- tumour, faecolith, fragments of indigestible food, raised intraluminal pressure
Mucus
Ischaemia
Necrosis of the appendix
36
What are the main risk factors associated with appendicitis?
AGE
GENDER (male)
FREQUENT ANTIBIOTIC USE
SMOKING
37
What are the common symptoms of appendicitis?
PAIN- PERIUMBILICAL/EPIGASTRIC pain that is constant and sharp that radiates to the RIGHT ILIAC FOSSA
worsened by movement and driving over speed bumps
ANOREXIA, NAUSEA, VOMITING, CONSTIPATION
38
Clinical signs of appendicitis include:
ABDO TENDERNESS- on percussion, maximum at McBurney's point
facial flushing, halitosis
ROSVING'S SIGN- (palpation of the left lower quadrant increases pain on right lower quad)
PSOAS SIGN- (extension of right thigh elicits pain in right lower quad)
OBTURATOR SIGN- (internal rotation of flexed right thigh elicits pain in right lower quad)
39
Differential Diagnoses for appendicitis include:
GI- gastroenteritis, perforated peptic ulcer, acue cholecystitis, diverticulitis, pancreatitis
URO- right ureteric colic, right pyelonephritis, UTI, renal caliculi
GYNAE- ectopic pregnancy, ruptured ovarian follicle, torted ovarian cyst, salpingitis
OTHER- pneumonia, mesenteric adenitis, rectus sheath haematoma, diabetic ketoacidosis, shingles, porphyria.
40
What investigations are appropriate for suspected appendicitis?
BLOODS- FBC, LFTs, CRP
| OTHER- pregnancy test, urine dipstick
41
Treatment for appendicitis?
SURGICAL- appendectomy
| ANTIBIOTICS
42
What are the main complications of untreated appendicitis?
PERFORATION AND RUPTURE
| septicaemia, ileus
43
Who is typically most affected by femoral hernias?
WOMEN
| middle age and elderly
44
Who is typically affected by inguinal hernias?
MEN
| middle age and elderly
45
What is the cause of hernia development?
Weakening of the abdominal wall, allowing fatty tissue or bowel to protrude through the inguinal or femoral canal.
46
What are the risk factors associated with hernias?
Obesity, constipation, chronic cough, heavy lifting, past ABDO surgery.
47
What symptoms are present in hernias?
```
Reducible lump
Pain in the scrotum
Sudden and intensifying pain in the inguinal region
Visible hernia bulge
Palpable impulse
```
48
How can you differentiate between indirect and direct hernias
Palpate the lump during coughing. Reduce the lump, then occlude the deep inguinal ring. Ask the patient to cough/stand. If the hernia remains restrained, it is direct.
49
Differentials for hernias?
```
These include:
UNDESCENDED TESTES
VARICOCELE
HYDROCELE
BLEEDING
ABSCESS
```
50
What investigations are best for suspected hernia?
IMAGING: USS, CT, MRI
51
Treatment for hernias?
SURGERY- reinforcement of the abdominal wall. Usually using mesh and done laparoscopically.
52
Who is typically affected by gallstones?
WOMEN
| and those of INCREASING AGE
53
What are the main causes of gallstones?
IMBALANCE of the chemical composition of BILE which leads to precipitation.
CHOLESTEROL
PIGMENTED
MIXED
54
What key risk factors are associated with gallstones?
LIFESTYLE- obesity, smoking, weight cycling
PMH: Diabetes, Crohn's, high serum triglycerides and low HDLs
IATROGENIC- oral contraceptives, HRT
NON-MODIFYABLES: Ethnicity, gender (female), genetic factors, increasing age.
55
What symptoms are typically seen in gallstones?
PAIN- Biliary colic, pain in the upper abdo/ right upper quadrants. The pain is more than 30mins and less than 8 hours. Worse on inspiration.
JAUNDICE
PYREXIA, TACHYCARDIA
LOSS OF APPETITE
56
Clinical signs of gallstones?
Murphy's sign
Cholangitis
Acute cholecystitis
57
What are the differential diagnoses for gallstones?
PUD, gastritis, IBS, gastro-oesophageal reflux, empyema, pancreatitis, tumour of the gallbladder. liver, stomach or gut.
acute hepatitis, IBD, bile duct stricture
58
What investigations are appropriate in suspected gallstones?
BLOODS: LFTs, AlkPh
IMAGING: USS
59
What is the best form of management for gallstones?
SURGICAL- cholecystectomy, cholecystotomy
60
Who is more affected by gastro-oesophageal reflux?
MEN and OBESE
61
What is the cause of gastro-oesophageal reflux?
Weakening of the LOWER OESOPHAGEAL sphincter which allows stomach acid to pass back up into the oesophagus
62
What are the main risk factors associated with reflux?
LIFESTYLE- Obesity, fatty foods, excessive alcohol consumption, coffee, chocolate, smoking, stress, tight clothing.
PMH: Hiatus hernia, pregnancy
IATROGENIC- calcium blockers, NSAIDs, nitrates
63
What are the symptoms of gastro-oesophageal reflux?
Heartburn
Oesophagitis
Bloating, nausea
Tooth disease/decay and sore throat
64
Differential diagnoses for gastro-oesophageal reflux are:
```
Peptic ulcer disease
Oesophagitis
GI cancer
Non-ulcer dyspepsia
Oesophageal spasm
Infection- CMV, herpes, candida
```
65
What investigations are most appropriate for suspected gastro-oesophageal reflux?
BLOODS
IMAGING- Endoscopy, barium swallow, barium meal test, manometry
pH monitoring
66
What is the best treatment for gastro-oesophageal reflux?
```
Antacids, alignates
low dose PPIs, (-azoles)
H2 receptor antagonists
LNF- Laparoscopic nissen fundoplication
Gastroplasty
```
67
Who is most likely to be affected by infective gastroenteritis?
CHILDREN
| HOSPITAL WARDS
68
What is the most common cause?
INFECTION of various types
VIRAL- rotavirus, norovirus, adenovirus (R.N.A)
BACTERIAL- campylobacter, e.coli, salmonella, shigella, yersinia enterocolitica (CESSY)
PARASITES- cryptosporidium, entamoeba histolytica, giardia. (CEG)
TOXINS- staph. aureus, bacillus cereus, c. perfringens
69
What are the common symptoms associated with infective gastroenteritis?
```
DIARRHOEA
NAUSEA, SUDDEN VOMITING, LOSS OF APPETITE
BLOOD/MUCUS IN STOOL
fever/malaise
headaches
muscle pain
dehydration
```
70
What are the main clinical signs of infective gastroenteritis?
Parasites/ova found in stool
Signs and dehydration
Low BP (below 90mmHg)
71
Differential diagnoses for infective gastroenteritis include:
Systemic Infections
GI conditions- traveller's diarrhoea, IBS, UC, Crohn's, Hirschprung's, Short bowel syndrome, food-sensitive enteropathy, coeliac disease
Side effects from medication
Endocrinopathy- diabetes, hyperthyroidism, congenital adrenal hyperplasia, addison's, hypoparathyroidism
Non- enteral infections- HIV/AIDS
Secretory tumours- carcinoid tumours
72
What investigations would be necessary for suspected infective gastroenteritis?
BLOODS- FBC, renal function and electrolytes
STOOL SAMPLE
IMAGING
73
What is the management for infective gastroenteritis?
Good fluid intake
| Antibiotics if the specific microbe has been identified
74
Who is most typically affected by Crohn's disease?
Peaks ages 15-30 and 50-70
75
Who is most typically affected in Ulcerative Colitis
Peak incidence 15-25 and 55-65
76
What is the cause for Crohn's?
Environmental factors with immunological factors with strong ties to genetic associations.
77
What is the main cause for Ulcerative Colitis?
Environmental factors with immunological factors. It is an autoimmune condition triggered by colonic bacteria causing inflammation (interferon gamma and TNF alpha) in the GI tract.
78
What are the main risk factors for Crohn's?
NON MODIFIABLE- family history
LIFESTYLE- smoking
PMH- appendectomy
IATROGENIC- NSAIDs, oral contraceptives
79
What are the main risk factors for UC?
NON MODIFIABLE- family history
LIFESTYLE- not smoking
IATROGENIC- oral contraceptives
80
What are the main signs and symptoms of Inflammatory Bowel Disease (UC + Crohn's)
BLOODY DIARRHOEA
COLICKY ABDO PAIN in the right iliac fossa
PAIN on defecation
WEIGHT LOSS
NIGHT SWEATS
SYSTEMIC ILLNESS- fever, malaise
EXTRA-INTESTINAL MANIFESTATIONS- Pauci-articular arthritis, Erythema Nodosum, Apthous ulcers, Episcleritis, Metabolic bone disease
81
What are the clinical signs for IBD?
Tachycardia
Hypotension
Abdo tenderness/ palpable masses
Mouth ulcers (Crohn's)
82
What are the differential diagnoses for IBD?
```
Infective colitis
Colorectal cancer
Diverticular disease
Coeliac disease
Anal fissure
Pseudomembranous colitis
Ischaemic colitis
Malignancy
Behcet's
IBS
```
83
What would be the investigations for IBD?
BLOODS- FBC, CRP, ESR, U+E, LFTs
STOOL SAMPLE
TISSUE TRANSGLUTAMINASE
84
What is the best management for Crohn's disease?
Glucocorticosteroid
Infliximab and adalimumab mediate in Crohn's.
Smoking cessation
Azathioprine
85
What is the best management for Ulcerative Colitis?
```
Aminosalicylates (Mesalazine, 5-ASA)
Corticosteroids
Thiopurines
Ciclosporin
Infliximab
Stool bulking agents
```
86
What are some of the complications of IBD?
Colorectal cancer
| Osteoporosis
87
Who is most commonly affected by IBS?
WOMEN
| Commonly affects 20-30yrs of age
88
What is the cause of IBS?
Some of the suggested underlying processes include: abnormal GI motility, visceral hypersensitivity, abnormal GI immune function, abnormal autonomic activity, abnormal CNS modulation
89
What are the risk factors of IBS?
NON-MODIFIABLE- female, age, family history
90
What are the symptoms of IBS
A.B.C
Abdo pain/discomfort
Bloating
Change in bowel habit
Altered stool passage/bowel frequency, passage of mucus
Symptoms made worse by eating.
91
What are some of the differential diagnoses for IBS?
SYSTEMIC- Unintentional/ unexplained weight loss,
UPPER GI- coeliac disease, GORD, PUD, gallstones, chronic pancreatitis
LOWER GI- rectal bleeding, abdo/rectal mass, functional/drug-induced constipation, IBD, laxative abuse, antibiotic associated diarrhoea (c.diff colitis), diverticular disease.
92
What are the best management options for IBS?
LIFESTYLE- Identify a source of stress and advise relaxation, reduced fibre intake, regular meals and eat slowly, physical activity, probiotics.
ANTI-MOTILITY- Loperamide
93
Who is most likely to be affected by peptic ulcers?
MEN
| Elderly
94
What is the main cause of peptic ulcer disease?
H.PYLORI infection
| Also NSAIDs
95
What are the main risk factors associated with peptic ulcers?
MODIFIABLE- smoking, alcohol, stress, steroids
| NON-MODIFIABLE- pepsin, bile acid
96
What are the main symptoms of peptic ulcers?
PAIN- epigastric
| bloating, heartburn, nausea/vomiting
97
What are the main differential diagnoses for peptic ulcers?
AAA, GORD, gastric cancer, CHD, IBD, drug induced dyspepsia, hepatitis, zollinger-ellison syndrome, diverticular disease, chronic pancreatitis, gallstones.
98
What are the best investigations needed for peptic ulcers?
BLOODS- FBC
IMAGING- endoscopy in iron deficiency anaemia, chronic blood loss, weight loss, progressive dysphagia, persistent vomiting, an epigastric mass.
TESTING for H.PYLORI
99
What is the main treatment for peptic ulcer disease?
STOP NSAIDs if these are causing the PUDs
| Administer PPI treatments (LAC)- lansoprazole, amoxicillin, clarithromycin.
100
Who is most affected by small and large bowel obstructions?
MEN
101
What is the cause for small bowel obstruction?
Mostly due to ADHESIONS, strangulated hernia, malignancy or volvulus
102
What is the cause for large bowel obstruction?
Mostly due to colorectal malignancies found in patients over 70.
103
Cause of paralytic ileus?
Lack of peristalsis
104
What are the some of the risk factors of small and large bowel obstruction?
Alzheimer's, Parkinson's, MS, quadriplegia, schizophrenia, gallstone, body packers of drugs, Hirschsprung's disease
105
What are the symptoms of small and large obstruction?
PAIN
LACK OF BOWEL MOVEMENT
DYSPHAGIA
NAUSEA/VOMITING (faecal vomiting usually means lower obstruction)
106
Clinical signs of small and large bowel obstruction include?
Distended abdomen
Active and tinkling bowel sounds
Signs of dehydration
107
What are some of the differential diagnoses associated with small and large bowel destruction?
Bowel ischaemia, gastroenteritis, pancreatitis, PUD, diverticular disease
108
What investigations are necessary for suspected bowel obstruction?
BLOODS- FBC, U+Es, creatinine
| IMAGING- CT, X-RAY
109
What is the treatment necessary for bowel obstruction?
MEDICAL- Fluid resuscitation, electrolyte replacement, intestinal decompression
SURGERY- Endoscopic self- expanding stents, resections
IMAGING- Sigmoidoscopy
