GI Flashcards
(228 cards)
1
Q
What is Oesophagitis?
A
inflammation of the inner lining of oesophagus
2
Q
What is the most common cause of Oesophagitis?
A
GORD
3
Q
What are the symptoms of Oesophagitis?
A
- Heartburn
- N + V
- Dysphagia
- Painful swallowing (w/o red flags)
- symptoms resolve spontaneously
4
Q
How to investigate Oesophagitis?
A
OGD - investigate severity
Barium swallow - r/o malignancy
5
Q
What medication can cause Oesophagitis?
A
Bisphosphonates
6
Q
Management of Oesophagitis
A
Medical:
- PPI (omeprazole) - 4 weeks
- -> if due to GORD - H2 recepto anatogonist
(ranitidine)
- -> 2nd line - Antacids - neutralise stomach acid
Conservative:
- weight loss
- allergen avoidance
7
Q
What is Mallory Weiss Tear?
A
- Tear along the right border or near the gastro-oesophageal junction
8
Q
What commonly causes Mallory Weiss Tear?
A
- Forceful bout of retching , vomitting, coughing,straining or even hicupping
9
Q
What are the symptoms of Mallory Weiss Tear?
A
- Haematemesis
- Dizziness
- abdo pain
- dysphagia
- Melaena (RARE)
(no systemic symptoms)
10
Q
How to investigate Mallory Weiss Tear?
A
- OGD: visualise tear
11
Q
Management of Mallory Weiss Tear
A
General:
- Ensure patient is stable : A-E approach
- fluids + blood transfusion : if a lot of blood is lost
- Observe BP + pulse
Medical:
- Pantoprazole: suppress acid to help heal the tear
- Endoscopy:
- haemoclipping
- band ligation
- (anti-emetic pre-endoscopy e.g promethazine)
Surgery:
1. Laparoscopic surgery
12
Q
What are the most common types of Oesophageal Cancer?
Identify their location.
A
- Squamous Cell Cancer
- Upper 2/3 of oesophagus - Adenocarcinoma
- Lower 1/3 near gastro-oesophageal junction
13
Q
What are some of the risk factors for adenocarcinoma (Oesophageal Cancer)?
A
- GORD
- Barrett’s oesophagus
- Obesity
14
Q
If alcohol caused Oesophageal Cancer, what would the blood findings be?
A
- Increased GGT
- Macrocytosis
15
Q
What are the symptoms of Oesophageal Cancer?
A
- Dysphagia
- anorexia + weight loss
- Vomiting
Other:
- Pain on swallowing
- Hoarseness
- acid reflux
- Melaena
16
Q
What investigation is use for diagnosis of Oesophageal Cancer?
A
Upper GI endoscopy with biopsy
17
Q
How is Oesophageal Cancer staged?
A
- CT scan : if metastatic
2. Endoscopic USS: no metastases, local staging
18
Q
Management of Oesophageal Cancer
A
Operable disease: surgical resection
19
Q
When does a patient warrant an urgent endoscopy (2WW) for Oesophageal Cancer?
A
- Dysphagia
2. 55 year + upper abdo pain, reflux, dyspepsia
20
Q
What is Oesophageal Stricture?
A
Narrowing of the food pipe
21
Q
What causes Oesophageal Stricture?
A
- Scarring from acid reflux in persisitent GORD/
- carcinoma of oesophagus
22
Q
Whata are the symptoms of Oesophageal Stricture?
A
- Dysphagia
- Heartburn
- Weight loss
- Chest pain
23
Q
What signs can present with malignant Oesophageal Stricture?
A
- Lympadenopathy
24
Q
What investigations can be carried out for Oesophageal Stricture?
A
- CXR
- Endoscopy
- Barium swallow
- CT or endoscopic USS
25
Management Oesophageal Stricture
Benign stricture = oesophageal dilation at endoscopy
Malignant stricture = oesophagectomy
26
What is Oesophageal Varices?
- Dilated collateral blood vessels that develop as a complication of portal hypertension
27
What causes Oesophageal Varices?
- Anything condition that causes portal hypertension
- Can be split into 3 categories:
1. Pre-hepatic:
- Portal vein thrombosis
- Portal vein obstruction
2. Intra-hepatic:
- Cirrhosis
- Acute hepatitis
- Idiopathic portal hypertension
3. Post- hepatic:
- compression (tumour)
28
What are the symptoms of Oesophageal Varices?
- Haematemesis
- Melaena
- Abdo pain
- Dyshpagia /pain on swallowing
- Ascites
- Jaundice
29
What are signs of Oesophageal Varices?
- Spider naevi
- Caput medusa
- signs of chronic liver disease
- Hypotension
- Pallor
- Tachycardia
- Reduced GCS
30
How to investigate Oesophageal Varices?
- Diagnostic: endoscopy
| - Bloods: Hb (low), platelets (low)
31
Management of acute variceal haemorrhage
1. ABC - pt should be resuscitate prior to endoscopy
2. Correct clotting: FFP, vit K
3. Vasoactive agent: terlipressin
4. Prophylactic IV Abx : quinolones (ciprofloaxacin)
5. Endoscopy : band ligation
- both terlipressin + prophylactic abx
32
What is the prophylaxis management of varices?
1. Propanolol : reduce rebleed
2. Endoscopic variceal band ligation (every 2 week interval) : until all varcies eradiacted
3. PPI
33
What is Achalasia?
- Failure of oesophageal peristalsis and of relaxation of the LOS
34
What are the symptoms of Achalasia?
- Dysphagia (BOTH liquid + solid)
- gradual weight loss
- heart burn
- regurgitation of food
- -> may lead to cough, aspiration pneumonia
35
What is the diagnostic investigation for Achalasia?
Oesophageal manometry
| - assess motor function
36
What are other investigation carried out for Achalasia?
1. Barium swallow :
- 'bird's beak' appearance
2. CXR:
- wide mediastinum
37
What is the 1st line management of Achalasia?
pneumatic dilatation
38
What is GORD?
Reflux of gastric contents back into the oesophagus
39
What are the symptoms of GORD?
- Heartburn worse after meal or supine
40
What is the investigations for GORD?
- Hx is enough for diagnosis
41
Management of GORD
Medical:
- PPI (1 month)
- Anatacids
- H2 receptor anatogonist (famotidine)
Conservative:
- weight loss
- smoking cessation
- small regular meal
- avoid meals before sleep
- avoid: fizzy drinks etc
Surgery:
- long-term +failed medical management: fundoplication
42
What is gastritis?
histological presence of gastric mucosal inflammation
43
Most common cause of gastritis
Helicobacter pylori
Other:
- NSAIDs
44
What are the symptoms of gastritis?
- epigastric pain
- N + V
- Dyspepsia
- Fever
- loss of appetite
45
Signs of gastritis
- Epigastric tenderness
- glossitis
- halitosis
46
Investigations for gastritis
H.Pylori:
- Urea breath test
- faecal antigen histology
- rapid urease test
- Gastric muscosal histology
47
What is the management for gastritis?
```
H.Pylori eradication:
7-day course:
1. PPI - omeprazole
2. Abx - clarithomycin
3. Abx - amoxicillin/ metronidazole
```
48
What is peptic ulcer disease?
A breach in the epithelium of the gastric or duodenal mucosa that penetrates the muscularis mucosa
49
What are the main causes of peptic ulcer disease?
1. H.pylori
| 2. Long-term NSAID use
50
What are the types of peptic ulcer disease and their symptoms?
Gastric ulcer:
- pain increases while eating
- weight loss
Duodenal ulcer:
- pain is eased by eating
- weight gain
General:
- epigastric pain
- nausea
- chest discomfort
51
If a patient has acute upper abdo pain, what investigation must be carried out?
Erect x-ray
52
What would you see in an x-ray when some one has perforated ulcer?
CXR: free air under diaphragm
53
What investigation should be carried out for peptic ulcer disease?
- H.pylori test
| - Upper endoscopy
54
Management of uncomplicated peptic ulcer disease?
1. H.pylori positive = eradication therapy
2. H.pylori negative= PPI until ulcer is healed
- -> full dose PPI : 4-8 weeks
3. Repeat endoscopy : confirm healing in all pt with proven gastric ulcer
55
What are the symptoms of gastric cancer?
- dysphagia
- pain
- acid reflux
- loss of appetite + weight loss
- anaemia
56
How to investigate gastric cancer?
- Diagnosis: Endoscopy + biopsy
- Staging : CT
- Bloods: anaemia
57
Management of gastric cancer
Surgery:
- endoscopic mucosal resection
- partial gastrectomy
- total gastrectomy
Chemotherapy
58
What are the red flag signs for stomach cancer?
- Abdo mass
- rebound tenderness with rigid abdomen
- absent bowel sounds
- acute pain + vomiting
- ecchymosis of flanks + abdo
59
What is the referral requirement for 2WW stomach cancer?
- upper abdo mass
60
What is the referral requirement for 2WW UGI endoscopy?
1. dysphagia
| 2. > 55 + upper abdo pain, reflux, dyspepsia
61
What is pyloric stenosis?
- Pylorus of the stomach is stenosed
| - does not allow the passage of food
62
What are the symptoms of pyloric stenosis?
* projectile vomiting* - typically 30 mins after feed
- constipation
- dehydration
- palpable mass (upper abdo)
63
What are the signs of pyloric stenosis?
- poor weight gain
| - hypokalaemic alkalosis
64
What investigation is diagnostic pyloric stenosis?
USS
65
What is the management of pyloric stenosis?
* Ramstedt pyloromyotomy*
- -> H2-anatognoists or PPI
- IV resuscitation : fluid and electrolyte replacement
66
What is Cholelithiasis?
A gallstone
| - solid deposit that forms within the bladder
67
What are the risk factors for gallstones?
5 F's
- Female
- Fat
- Fair
- Fertile
- Forty
68
What are the classic symptoms for Cholelithiasis?
1. Colicky RUQ pain - post prandially
- --> worse after fatty meal
- N + V
69
What is the diagnostic work up in suspected Cholelithiasis??
USS + LFT
70
What is the management of asymptomatic gallstones?
No treatment required
71
What is the management of asymptomatic gallstones in CBD?
referral for bile duct clearance + laparoscopic cholecystectomy
72
What is the management of symptomatic gallstones?
* Laparoscopic cholecystectomy *
- Mild pain : Paracetamol /NSAIDs
- Sever pain : Diclofenac (IM)
73
What is acute cholecystitis?
- inflammation of the gallbladder
74
What are the signs for acute cholecystitis?
1. RUQ pain:
- radiate to right shoulder
- sudden onset
2. Fevers (systemic)
3. Possible jaundice
75
What are the signs for acute cholecystitis?
- Murphy's sign : inspiratory arrest upon palpation of RUQ
76
What blood test findings may you have with acute cholecystitis?
- LFTs typically normal
77
What is the first investigation for acute cholecystitis?
Abdo USS
78
What is the management of acute cholecystitis?
- IV Abx
| - Early lap chole (witihin 1 week of diagnosis)
79
What is chronic cholecystitis?
- repeated attacks of biliary colic + permanent damage to the gallbladder
- gallbladder healing by fibrosis + shrinks in size
80
What are symptoms of chronic cholecystitis?
- RUQ pain after meals
| - fat intolerance
81
What investigative findings will you have for chronic cholecystitis?
AXR : porcelain gallbladder
82
What is the management of chronic cholecystitis?
Cholecystectomy
83
Which finding on biopsy would be most consistent with a diagnosis of gastric adenocarcinoma?
signet ring cells
84
What are the causes of acute pancreatitis?
```
* GET SMASHED *
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypercholesterolaemia
ERCP
Drugs
```
85
What are the symptoms of acute pancreatitis?
- Severe epigastric pain (radiate to back)
- vomiting
- low-grade fever
- sudden onset + short duration
86
What are the signs of acute pancreatitis?
- Epigastric tenderness
- low-grade fever
- Peri-umbilical discoloration (cullen's sign)
- Flank discolouration (grey-turner's sign)
87
How can you make diagnosis of acute pancreatitis be made without imaging?
If characteristic pain + amylase /lipase > 3 time upper limit of normal
88
What imaging is used in acute pancreatitis?
USS
Other : contrast - CT
89
What scoring systems may be used to identify severe pancreatitis?
- Ranson score
- Glasgow score
- APACHE II
90
What is the management of acute pancreatitis?
1. Fluid resuscitation : crystalloid
2. Analgesia
3. DO NOT offer prophylactic abx
4. NBM
Surgery:
- Cholecystectomy : if due to gallstone
- Early ERCP : if obstructed biliary system
91
What are the symptoms of chronic pancreatitis?
- pain : following meal
| - steatorrhea
92
What are the investigations for chronic pancreatitis?
- Abdominal x-ray: pancreatic calcification
| - CT : more sensitive to calcification
93
Management of chronic pancreatitis
- pancreatic enzyme supplements
| - analgesia
94
What is the most common type of pancreatic tumour?
Adenocarcinoma
95
What is the classic symptom of pancreatic cancer?
* Painless Jaundice *
96
What are the other symptoms of Pancreatic Cancer?
- Pale stools
- Dark urine
- Pruritus
Non-specific:
- anorexia
- weight loss
- epigastric pain
97
What is the diagnostic investigation for Pancreatic Cancer?
High-resolution CT scan
- definitve diagnosis require biopsy
- 'double duct' sign
Other:
USS
98
What is the management of Pancreatic Cancer?
- Whipple resection
- Adjuvant chemotherapy
- ERCP with stenting (palliation)
99
What is hepatitis?
Virus that infects the liver causing inflammation
USE NOTES (DEARSIM)
100
When does heptatitis become chronic?
If virus persists past 6 months
101
What are the symptoms of hepatitis?
- Fever
- RUQ pain
- Jaundice
- Dark urine
102
What are the signs of hepatitis?
- Rise in ALT + AST
| - Hepatomegaly
103
What are the different components of hepatitis serology?
1. HBsAg = surface antigen
- acute disease
2. Anti-HBs = implies immunity
3. Anti-HBc = previous or current infection
4. IgM anti-HBc = during acute or recent hep B infection
104
1st line management of hepatitis?
- Pegylated interferon-alpha
Other antiviral = tenofovir
105
What is liver cirrhosis?
Scarring of the liver caused by long-term liver damage
106
What are the common causes of Liver Cirrhosis?
- Alcohol
- Non-alcoholic fatty liver disease (NAFLD)
- Viral Hepatitis
107
What are symptoms of Liver Cirrhosis?
Severe:
- jaundice
- abnormal bruising
- peripheral oedema
- ascites
High-Risk group:
- fatigue
- anorexia
- nausea
- weight loss
- muscle wasting
- abdo pain
108
What investigations are carried out for Liver Cirrhosis?
- Transient Elastography
- Traditionally : Liver biopsy
- NAFLD : use enhanced liver fibrosis score to screen for further testing
109
What further investigations can be carried out for Liver Cirrhosis?
- Upper endoscopy : check for varices
| - Liver USS: hepatocellular cancer
110
What is the management of Liver Cirrhosis?
- Hepatology specialist
111
What are the most common Liver Tumours?
- Cholangiocarcinoma
| - Hepatocellular carcinoma
112
What are the symptoms of Liver Tumours?
- Weight loss
- Jaundice
- Altered mental status
- itching
- pale stools + dark urine
- easy bruising
- Distended abdomen
113
What investigations are used for diagnosis of Hepatocellular Carcinoma?
- CT/MRI (usually both)
| * Avoid biopsy - seeds tumours cells*
114
What is the treatment for Liver Tumours?
- Surgical resection
| - Liver transplantation
115
What is the prognosis of Liver Tumours?
Poor
116
What investigations are used for diagnosis of Cholangiocarcinoma?
- LFT : obstructive picture
- CA 19-9, CEA + CA 123 elevated
- CT/MRI + MRCP
117
What score is used after endoscopy to asses rebleed and mortality ?
Rockall
118
What are the different types of hernia?
- Hiatus
- Icisional
- Inguinal
- Umbilical
- Ventral
119
What are the symptoms of hiatus hernia?
- Heartburn
- GORD
- Difficulty swallowing
120
What investigations can be carried out for hiatus hernia?
- Endoscopy
| - Barium studies
121
What is the management of hiatus hernia?
- Asymptomatic : no treatment
- Symptomatic : PPI
- Severe GORD : Laparoscopic fundoplication
122
What is the management of incisional hernia?
- Surgical repair
| - Open mesh repair
123
What are the 2 types of inguinal hernia?
1. Indirect = hernia through the inguinal canal
| 2. Direct hernia = through the posterior wall of the inguinal canal
124
What are the symptoms of inguinal hernia?
- groin lump
- -> disappear when lying down
- -> cough impulse
- discomfort + ache
- -> worse with activity
125
What is the management of inguinal hernia?
- Mesh repair
| - weight loss
126
What is the management of umbilical hernia?
- Typically resolves by 3 y/o
127
What is peritonitis?
- infection of ascitic fluid
128
What can cause peritonitis?
- perforated ulcer
- cirrhosis
- PID
129
What are the symptoms of peritonitis?
- Ascites
- Abdo pain
- Fever
- N + V
- Diarrhoea
130
What is the diagnostic test for peritonitis?
Paracentesis:
| --> Ascitic Fluid : neutrophil count > 250 cells/mm3
131
What is the management of peritonitis?
- IV Cefotaxime
Discharge:
- Abx prophylaxis: ciprofloxacin
132
What is the management of GI ulcer perforation?
- surgical intervention
133
What are the clinical features of acute upper GI bleed?
- Haematemesis
- Melena
- Abdo pain
- Raised Urea
134
What scores are used in the management of upper GI bleed?
1. Glasgow- blatchford: 1st assessment
- outpatient or inpatient
2. Rockall
- used after endoscopy
- rebleed + mortality risk
135
What is the treatment algorithm for upper GI bleed?
1. Resuscitation
- ABC
- Platelet transfusion: active bleed + platelet count < 50
- FFP
- Prothrombin complex concetrate : pt on warfarin + active bleed
2. Endoscopy
- immediately after resuscitation
- within 24 hours
- do not prescribe PPI before endoscopy
3. Further bleed
- Repeat endoscopy
- Interventional radiology + surgery
4. Long-term
- Give PPI
136
What is intra-abdominal abscess?
- a collection of pus or infected fluid that is surrounded by inflamed tissue inside the belly
137
What are the symptoms of intra-abdominal abscess?
- Fever
- Change in bowel habits
- N + V
138
What investigations are carried out for intra-abdominal abscess?
- Abdo CT
| - WBC count
139
What is the first line management for intra-abdominal abscess?
- CT or USS guided percutaneous drainage
140
What is constipation and faecal loading?
Constipation = infrequent stools, straining
Faecal Loading = retention of faeces to the extent that spontaenoes evacuation is unlikely
141
What symptoms indicate constipation?
1. Bowel movement < 3 times/week
2. Excessive straining
3. Lowe abdo pain, distension, bloating
142
What are some non-specific symptoms associated with constipation in elderly?
1. Confusion or delirium, functional decline
2. Nausea or loss of appetite
3. overflow diarrhoea
4. urinary retention
143
When do you suspect faecal loading?
- hard, lumpy stools : large + infrequent
- Manual method of extraction
- overflow faecal incontinence or loose stool
144
What examination do you carry out in constipation?
PR exam
145
What is the management of constipation?
- Stop any causative drugs, dietary advice
Acute:
1st line: Bulk-forming laxative e.g., ispaghula
2nd line: osmotic laxative e.g., macrogol
3rd line: stimulant laxative
Opioid-induced constipation – X bulk-forming laxative, offer an osmotic laxative
146
What AXR finding would you have in constipation?
Sitzmarks
147
What symptoms are required for a diagnosis of IBS?
1. Abdo pain +/-
2. Bloating +/-
3. Change in bowel habit
148
What are other symptoms associated with IBS?
Positive diagnosis of IBS if:
abdo pain is relieved by defaction
or
altered bowel frequency stool form
+
2 of:
1. altered stool passage : straining, urgency, incomplete evacuation
2. abdo bloating, distension, tension or hardness
3. symptoms worse by eating
4. passage of mucus
149
What investigations should be carried in primary care for IBS?
FBC
ESR/CRP
Coeliac disease screen
150
What is the pharmacological treatment for IBS?
First line:
- pain: antispasmodic agent
- constipation: laxatives (avoid lactulose)
- diarrhoea : loperamide
2nd line:
- low-dose tricyclic antidepressants (amitriptyline)
151
What are the non-pharmacological treatments for IBS?
1. Psychological interventions = after 12 months of pharmacological options
2. complementary or alternative medicine
152
What dietary advice would give for IBS?
1. regular meals
2. avoid missing meals or leaving long gaps between eating
3. drink at least 8 cups of fluid per day
4. reduce intake of alcohol and fizzy drinks
5. limiting intake of high-fibre food
6. limit fresh fruit to 3 portions per day
7. for diarrhoea, avoid sorbitol
153
What is the definition of diarrhoea?
Passage of 3 or more loose stools per day
154
What are the different classifications of diarrhoea?
- Acute diarrhoea < 14 days
- Persistent diarrhoea > 14 days
- Chronic diarrhoea > 4 weeks
155
What are the different causes of diarrhoea?
Bacterial:
- salmonella
- campylobacter jejuni
- shigella
- E.coli
Drugs:
- laxatives
- allopurinol
- ARB
- Abx
- Chemo
- NSAID
- PPI
- SSRI
156
What investigation is carried for infectious diarrhoea?
- Stool sample
157
When should a pt be admitted with diarrhoea?
- Vomiting + unable to retain oral fluids
| - sever dehydration or shock
158
When should a pt be referred for diarrhoea?
> 40 y/o + :
- Weight loss
- Abdo pain
> 50 y/o + rectal bleeding
> 60 y/o iron deficiency anaemia
159
What medication can be used for diarhoea?
- Loperamide
160
What medications can affect can affect urea breath test?
- Abx : within 4 weeks of test
| - PPI : within 2 weeks of test
161
When do you offer prophylactic abx in peritonitis?
| What abx?
- Cirrhosis + ascites
- -> until ascites has resolved
Oral ciprofloxacin
162
Which type of H.Pylori test is used to check eradication?
Urea breath test
163
What is the strongest risk factor for Barrett's Oesophagus?
GORD
164
What is diverticular disease?
Diverticula causes symptoms (intermittent lower abdo pain) without inflammation or infection
165
What are the symptoms of diverticulitis?
- left iliac fossa pain + tenderness
- bloating
- anorexia
- diarhoea or constipation
Infection:
- pyrexia
- raised WBC + CRP
166
What is the management of diverticulosis?
Increase dietary fibre intake to minimise symptoms
167
What investigations can be carried out for diverticulitis?
1. FBC : raised WCC
2. Raised CRP
3. CT: suspected abscess
4. Colonoscopy : initially avoided due to risk of perforation
168
Management of diverticulitis?
1. Mild : oral abx
2. Severe: Hospital
- NBM
- IV fluids
- IV Abx (cephalosporin + Metronidazole)
3. Managing in primary care:
- co-amoxiclav 5-day course
- review in 48 hours
4. Surgery:
- Resection
- drainage of abscess
169
Which side of the lung is aspiration pneumonia more common in?
Right lower lobe
170
What are the symptoms of appendicitis?
- Periumbilical pain which worsens and migrates to RIF
(24-48 hours)
- Pain worse by movement
- Low-grade fever
- Nausea
- Constipation
171
What are the examination findings for appendicitis?
- Tenderness in the RIL
- -> maximal tenderness over 'McBurney's point'
- Rosving's sign
- Psoas sign
172
How is appendicitis diagnosed?
Raised inflammatory markers + history + examination findings is enough to justify
173
What is the management of appendicitis?
- Appendicectomy
| - Prophylactic IV abx
174
What is intussusception?
- Invagination of one portion of bowel into the lumen of adjacent bowel.
175
What is the most common site for intussusception?
- ileo-caecal region
176
What are the symptoms of intussusception?
- Paroxysmal abdominal colic pain
- vomiting
- * red-currant jelly* (late sign)
- sausage-shaped mass in RUQ
177
What is the investigation of choice for intussusception?
USS
| - target-like mass
178
What is the management of intussusception?
1st line: Reduction by air insufflation (via radiology)
- Laparotomy if above fails or signs of peritonitis
179
What is ischaemic bowel disease?
- Interruption/loss of blood supply to the bowel
180
What are the symptoms of ischaemic bowel disease?
- Sudden onset abdo pain
- -> reaches peak very quickly
- Melaena
- Diarrhoea
- fever
181
What is the diagnostic investigation for ischaemic bowel disease?
- CT angio
182
What blood findings may you see for ischaemic bowel disease?
- Elevated WCC
| - Lactic acidosis
183
What is the management for ischaemic bowel disease?
Surgery:
- laparotomy
- endovascular therapy +/- open embolectomy
- Resuscitation + supportive measure (oxygen, fluids, inotropes)
- Abx: ceftriaxone + Metronidazole
184
What is bowel obstruction?
- Passage of food, fluids and gas becomes blocked
185
What are the symptoms of bowel obstruction?
- Abdominal pain (diffuse + central)
- N + V (bilious vomiting)
- Constipation (lack of flatulence)
- Abdo distension
186
What examination findings may you see with bowel obstruction?
- tinkling bowel sounds
187
What is the 1st line investigation for bowel obstruction?
Abdo X-Ray
| - dilated bowel > 3 cm
188
What is the definitive investigation for bowel obstruction?
CT
189
What is the management of bowel obstruction?
Initial steps:
- NBM
- IV fluid
- NG tube with free drainage
Conservative management for upto 72 hours if cause does not require surgery
- surgery
IV Abx if:
- perforation
- surgery
190
What is toxic megacolon?
- Acute form of colonic distension
191
What are the features of toxic megacolon?
- Segmental
- non-obstructive dilation of the colon > 6 cm diameter
- system toxicity
192
What are the symptoms of toxic megacolon?
- Abdo pain (diffuse, relieved by bowel movement)
| - dairrhoea > 1 week
193
What investigation if carried out for toxic megacolon?
Abdo x-ray : dilated bowel
194
What is the management of toxic megacolon?
1. Treat underlying cause
2. supportive care in ICU
- -> NBM
- -> NG tube
3. Surgery
- if less invasive treatment don't work within 2/3 days
195
What is Inflammatory Bowel Disease?
2 types:
- Crohn's
- Ulcerative Colitis
196
What is Corhn's?
Chronic inflammatory disease
| - Mouth --> anus
197
What is Ulcerative Colitis?
Relapsing, remitting autoimmune condition
- Rectum + sigmoid colon (proctitis)
- Not beyond ileocaecal valver
198
What are the symptoms of Crohn's?
1. Diarrhoea
2. Weight
3. Abdo pain (RLQ)
4. Mouth ulcers
199
What are the symptoms of Ulcerative Colitis?
1. Bloody diarrhoea (mucus)
2. Abdo pain (LLQ)
3. fatigue
4. Fever
200
What are the signs of IBD (both)?
1. Erythema nodosum
| 2. Uveitis
201
What investigation can distinguish between IBD + IBS?
Faecal calprotectin
| elevated in IBD
202
What are the histological differences in IBD?
Crohn's
1. inflammation in all layers
2. increased goblet cells
3. granulomas
UC:
1. no inflammation beyond submucosa
2. decreased goblet cells
3. no granulomas
203
What investigation is carried out for IBD?
Colonoscopy:
Crohn's :
1. 'Cobble-stone appearance (skip lesions)
UC:
1. biopsy needed for diagnosis
2. appearance of polyps (pseudopolyps)
Abdo X-Ray:
UC : lead Pipe radiological appearance
204
What is the management of Crohn's ?
Conservation:
- smoking cessation
Medical:
- Corticosteroids (prednisolone)
- azathioprine
- methotrexate
- infliximab
Surgery:
- removes strictured or obstructed region of bowel
205
What is the management of Ulcerative Colitis?
Conservative:
- Smoking is protective but not advised
```
Medical:
- Corticosteroids (prednisolone)
- azathioprine
- 5-aminosalicylic acid (5-ASA) analogues
(sulfasalazine, mesalazine)
- 6-mercaptopurine
```
Surgery:
- Colectomy
206
Symptoms of haemarrhoids
- painless rectal bleeding
- feeling like you still need to open bowel after going
- lumps around the anus
207
What are the 2 types of haemorrhoids?
Internal - originate above the dentate line , do not generally cause pain
External- originate below the dentate line, may be painful as prone to thrombosis
208
Grading of haemorrhoids
1: do not prolapse out of the anal canal
2: prolapse on defecation but reduce spontaneously
3: can be manually reduced
4: cannot be reduced
209
How are haemorrhoids managed?
- Increased dietary fibre and fluid intake to soften stools
- topical local anaesthetics and steroids
- rubber band ligation if outpatient treatment recommended
- Haemorhoidectomy for large haemorrhoids if outpatient treatment does not work
210
What is an anal fissure?
a tear or ulcer in the lining of the anal canal which causes pain on defecation
211
How can anal fissures be classified?
Acute - <6 weeks
Chronic - >6 weeks
Primary - no underlying cause
Secondary - underlying cause (e.g constipation, STI, IBD, colorectal cancel)
212
Clinical features of anal fissure
anal pain on defecation (with or without bleeding) and anal spasm
213
When would you refer in case of anal fissure?
if a serious underlying cause is suspected (rectal cancer or IBD)
214
Management of anal fissure
- high fibre and increased fluid intake
- analgesia or topical anaesthetics
- 6-8 week course rectal GTN if symptoms persist for >1week
- manage underlying cause
215
When should adults with anal fissure be reviewed?
primary anal fissure - reviewed at 6-8 weeks or sooner if necessary
216
How should patients with unhealed anal fissures after lifestyle interventions be managed?
referred to general/colorectal surgeon
217
What is an Anorectal abscess
a collection of pus under the skin in the area of the anus and rectum due to infection of glands
218
Sx of Anorectal abscess
painful, hardened tissue in the perianal area
discharge of pus from the rectum
fever
constipation or pain with bowel movements
219
Caustive bacteria of Anorectal abscess
E.coli, staph aureus
220
Ix for Anorectal abscess and anal fistula
DRE
221
Tx of Anorectal abscess
surgical drainage and analgesia
222
What is an Anal fistula
a small tunnel that connects an infected gland inside the anus to an opening on the skin around the anus
223
What causes an Anal fistula
Usually due to previous ano-rectal abscess
224
Management of anal fistual
Fistulotomy
225
What is pilonidal disease?
sinuses and cysts form near the upper part of the natal cleft of the buttocks
226
Epidemiology of pilonidal disease
common in men around 20yo
227
Clinical features of Pilonidal disease
recurrent episodes of natal cleft pain with discharge
228
Management of pilonidal disease
asymptomatic - conservative and local hygiene
symptomatic
- acute: incision and drainage
- chronic : excision of pits and obliteration of underlying cavity
