General GI Flashcards
(65 cards)
1
Q
What are some causes of abdominal distention?
A
ascites bowel obstruction peritonitis enlarged intra-abdominal organs obesity pregnancy volvulus
2
Q
What are some causes of ascites?
A
liver failure
nephrotic syndrome
malignancy
3
Q
What are some differentials of abdominal pain?
A
peptic ulcer disease biliary tract disease pancreatic disease endometriosis AAA ectopic pregnancy renal colic acute pyelonephritis diverticular disease appendiciti IBS mesenteric ischaemia intussuseption dysmenorrhoea
4
Q
What are some causes of change in bowel habit?
A
carcinoma of large bowel diverticular disease IBD toddler's diarrhoea IBS Diet infectious causes malabsorption/pancreatic
5
Q
What are some causes of diarrhoea?
A
infective IBD motility disorder GI malignancy malahsorption blind loop syndrome cholera
6
Q
What are some causes of haematemesis?
A
peptic ulcer disease oesophageal-gastric varices Mallory-Weiss tear gastritis (NSAIDs) malignancy bleeding disorders
7
Q
What are some causes of vomting, nausea or anorexia?
A
local cause (e.g. malignancy, gastritis, food poisoning) systemic (pregnancy, infectious) drug side effects CNS disroder (raised ICP, migraine) non-organic (anorexia, bulimia)
8
Q
What are some causes of abdominal mass?
A
heptamegaly, splenomegaly, enlarged kidneys bowel mass enlarged bladder AA uterine or ovarian masss abdominal wall hernia lymph nodes infective cause
9
Q
What are some causes of anorectal pain?
A
fissure-in-ano thrombosed haemorrhoids carcinoma fistuale pilonidal sinus/abscess perianal abscess rectal prolapse trauma
10
Q
What are some causes of constipation?
A
constitutional, dietary carcinoma of large bowel laxative abuse drug related e.g. opiates Hirschprung hypothyroid hyperparathyroidism
11
Q
What are some causes of dysphagia?
A
oesophageal cancer
gastro-oesophageal reflux disease
12
Q
What are some causes of rectal bleeding?
A
haemorrhoids fissure-in-ano cancer IBD angiodysplasia ischaemia colitis melaena
13
Q
What should be included in a history for dysphagia?
A
duration solids or liquids or both pain weight loss PMH meds cigarettes or alcohol cough, nasal regurg
14
Q
How would you treat dysphagia?
A
underlying cause
nutritional support if needed
15
Q
What are some causes of GI bleed?
A
oesophagitis peptic ulcer varices erosive duodenitis or gastritis mallory weiss tear malignancy vascular malformation
16
Q
What are some causes of diarrhoea?
A
surgical - ischaemic, diverticulitis medical - drugs, IBD travel gastroenteritis osmotic - lactose/fructose intolerance secretory - ion absorption malabsorption - pancreatic insufficiency, Crohn's, coeliac abnormal motility - post vagotomy, IBS, carcinoid
17
Q
What is achalasia?
A
lower oesophageal sphincter fails to open during swallowing
18
Q
What would you see on barium swallow for achalasia?
A
‘birds beak’ appearance
19
Q
What are some occult symptoms and test results of GI bleed?
A
fainting
nausea
high urea (not matched with creatinine)
low Hb
20
Q
What test is mandatory for gastric ulcers?
A
Repeat gastroscopy 6-8 weeks later
- benign ulcers can be early malignant ones
21
Q
What are the 4 classical symptoms of bowel obstruction?
A
vomiting abdo distention constipation abdo pain (colic)
22
Q
What happens in refeeding syndrome?
A
fluid-balance abnormalities
abnormal glucose metabolism
low phosphate, potassium, magnesium and thiamine
23
Q
What would cause the different colour of ascitic tap?
A
straw = cirrhosis, malignancy, TB
chylous (milky) = cirrhosis, obstruction of lymphatic duct
haemorrhagic = abdominal trauma, malignancy,ectopic pregnancy
24
Q
Waht are the 5 main types of malabsorption?
A
Defective intraluminal digestion (e.g. bacterial overgrowth) Insufficienct absorptive area (e.g. Crohn's) Lack of digestive enzymes (e.g. lactose intolerance) Defective transpot (e.g. primary bile acid malabsorption) Lymphatic obstruction
25
What are the 2 types of oesophageal cancer?
```
oesophageal adenocarcinoma (normal - metaplastic glandular - dysplastic - neoplastic)
squamous oesophageal cancer
```
26
What is diverticular disease?
pockets developing in the lining of the intestine which can become inflamed (diverticulitis)
27
How would you diagnose diverticular disease?
bariumenema, colonoscopy
28
How would you treat diverticular disease?
diet advice
antibiotics
IV fluids
bowel rest
29
What are some symptoms of oesophageal cancer?
dysphagia, vomiting, anaemia, weight loss, reflux, indigestion
30
How would you diagnose an oesophageal cancer?
endoscopy, and biopsy
31
How would you treat an oesophageal cancer?
surgery - resection, stent
| palliative
32
How would you test for coeliac disease?
bloods - EMA/tTG (HLA DQ2/HLA DQ8 antibodies)
| gold standard is duodenal biopsy and endoscopy showing villous atrophy and crypt hyperplasia
33
How would you stage gastric cancer?
early - submucosal (in lymph nodes), 90% 5 year survival
| late - invaded the muscle wall, 60% 5 year survival
34
How would you treat GORD?
```
lifestyle
PPI e.g. lansoprazole
antacids
H2 receptor blockers e.g. ranitidine
Nissen fundoplication (reinforces LOS)
```
35
What are some complications of GORD?
Barrett's oesophageus
aneamia
LOS stricture
36
What are some symptoms of IBS?
abdominal pain, bloating, change in bowel habit
| - one day a week for at least 3 months
37
Why does IBS occur?
nerves from embryonic neural crest form the gut and the brain - link between brain and bowels
38
How would you treat ulcerative colitis?
```
aminosalicylates e.g. mesalazine
corticosteroids
immunosuppressants e.g. azathioprine, cyclosporin
infliximab
surgery
```
39
How would you treat gastric cancer?
surgery (Roux-en-Y)
laproscopic
pre-op chemo
analgesia, physio, fluid balanced, feeding tube
40
Which genetic factors increase risk of colorectal cancer?
familial adenomatous polyposis
HNPCC
family clustering
41
What is a pilonidal sinus and its symptoms?
ingrown hair follicle in natal cleft
| = foul smelling discharge, acute pain, pus
42
What are the symptoms of ascites?
distended abdomen, dull percussion, shifting dullness
43
How would you test for ascites?
history
US of liver
ascitic tap - transudate/exudate
44
How would you treat oesophageal varices?
prevention - BB, elastic bands
Bleeding - elastic bands decrease blood to portal vein so blood is shunted away from it
Restore blood volume
prevent infection
45
What is a volvulus?
twisting of sigmoid colon on its mesentry
| looks like coffee bean on XR
46
How would you treat a volvulus?
decompression by sigmoidoscope and insertion of a flatus tube
sigmoid colectomy
47
What is the difference in treatment for the 2 types of inguinal hernias?
Reduce both
Indirect (from deep to external ring) stays in when cough after reduction
Direct (from posterior canal) is easier to reduce, strangulates less often
48
What are the common mechanisms for formation of gastric ulcer?
```
mucosal ischaemia
increased acid
drugs - e.g. aspirin, NSAIDs
bile reflux
helicobacter pylori
```
49
What is the treatment for a gastric ulcer?
PPI
| H2 blockers
50
How would you diagnose pancreatitis?
serum amylase and lipase
| CT, XR, US
51
How would you treat pancreatitis?
anaglesia, catheterise, drain, antibiotics, surgery, bowel rest
52
What are some causes of pancreatitis?
GET SMASHED
| gallstones, ethanol, trauma, steroids, mumps, autoimmune, scorpion stings, hyperlipidaemia, ERCP, drugs
53
What is the treatment for IBS?
education - diet (low FODMAP), triggers, exercise
antispasmodics, laxatives, anti-motility
antidepressants
psychological therapies
54
What are the 5 main different diagnosis of IBS?
```
coeliac disease
IBD
lactose intolerance
bile malabsorption
colorectal cancer
```
55
How would you test for peritonitis?
```
history
bloods
XR of chest and abdo
B-HCG
ECG
```
56
How would you treat peritonitis?
ABCDE
treat underlying cause
primary - broad spectrum antibiotics
call surgeon
57
What is the difference between Crohn's and ulcerative colitis?
UC: colon only, inflammation of mucosa only, continous ulceration
CD: all of GI tract, inflmmation of entire gut wall (mucosa, muscle, adventitia), skip lesions, gramulomatous
58
How would you treat Crohn's disease?
```
lifestyle
corticosteroids
aminoscalicylates
immunosuppressants
biological therapies
surgery
```
59
How would you stage colorectal cancer?
```
Duke's
A - not in wall
B - penetrates muscle
C - in lymph nodes
D - metasteses
```
60
What are the classifications of hiatus hernias?
sliding - stomach pulled through diaphragm at site of oesphagus
Rolling - stomach pulled through diaphragm at seperate site to oesophagus
61
What is peritonitis?
infection of peritoneal cavity
62
What are some common causes of peritonitis?
```
surgery
spontanous
secondary to dialysis
ectopic pregnancy
abdominal TB
```
63
How do oesophgeal varices form?
portal hypertension causes blood to enter back into systemic blood whenever possible causing oesophageus and rectum to be overloaded
64
How common is GORD and what are some risk factors?
30% of population
| RF: hiatus hernia, diet (fat, chocolate), alcohol, obesity, smoking, dysfunctional LOS
65
What is achlasia?
lower oesphageal sphincter fails to close
| = dysphagia, regurgitation, substernal cramps, weight loss
