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GI Flashcards

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1
Q

Appendicitis

A

Inflammation of appendix

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2
Q

Appendicitis patho

A

Gut orgs invade appendix wall after lumen obstruction from:

  • lymphoid hyperplasia
  • faecolith
  • filarial worms
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3
Q

Appendicitis Px

A
  • Pain (umbilical -> RIF, McBurney’s point)
  • Oedema
  • Fever
  • Tachycardia
  • Anorexia
  • N+V
  • Constipation, maybe diarrhoea
  • RIF tenderness, guarding
  • Rovsing’s sign - pain greater in RIF than LIF when LIF pressed
  • Psoas sign - pain on extending hip if retrocaecal appendix
  • Cope sign - pain on flexion and internal rotation of hip (if appendix close to obturator internus)
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4
Q

Appendicitis DDx

A

Other causes of abdo pain - think systems (GI, urological, gynaecological…)

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5
Q

Appendicitis Ix

A

Bloods - raised WCC, CRP, ESR

USS

CT

Pregnancy test

Urinalysis (exclude UTI)

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6
Q

Appendicitis Mx

A

Laparoscopic appendectomy

IV ABs (metronidazole, cefuroxime)

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7
Q

Appendicitis Cx

A

Rupture -> peritonitis

Forms a mass

Abscess - after failure to resolve

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8
Q

Acute mesenteric ischaemia

A

Impaired blood flow gut (almost always SI)

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9
Q

AMI Causes

A

SMA thrombosis (commonest)

SMA embolism (eg AF)

Mesenteric vein thrombosis (hypercoagulable state)

Non-occlusive disease (low flow states, eg low CO)

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10
Q

AMI Px

A
  • acute severe abdo pain
  • no abdo signs
  • rapid hypovolaemia (shock - pale skin, weak rapid pulse, reduced urine output, confusion)
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11
Q

AMI Ix

A

CT angiography - shows vessel blockage

Bloods (lactate), AXR

Laparotomy (cut into abdo wall)

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12
Q

AMI Mx

A

Resus - fluids, O2

ABs - IV gentamicin, metronidazole

IV heparin

Surgery to remove dead bowel

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13
Q

AMI Cx

A

Bacterial translocation across dying gut wall - septic peritonitis, SIRS

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14
Q

Chronic mesenteric ischaemia

A

chronic atherosclerotic disease of vessels supplying intestine

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15
Q

CMI cause

A

atherosclerosis - low flow of blood

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16
Q

CMI Px

A
  • severe colicky post-prandial abdo pain (gut claudication)
  • decreased wt
  • upper abdo bruit (sounds), maybe PR (per rectum) bleeding

malabsorption, N+V, fear of eating, usually history of CVD

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17
Q

CMI Ix

A

CT angiography

CXR/AXR to exclude other stuff

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18
Q

CMI Mx

A

Stop smoking

Antiplatelet therapy

Surgery - angioplasty, stent

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19
Q

CMI Cx

A

malnutrition, reduced QoL from fear of eating

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20
Q

Ischaemic colitis

A

compromise of blood circulation supplying colon

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21
Q

IC patho

A

Causes - thrombosis, emboli, decreased CO, drugs (OCP), surgery, coagulation disorders

splenic flexure at risk - watershed between middle colic (SMA) and left colic (IMA)

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22
Q

IC Px

A

signs
shock
signs of CVD

symptoms
abdo pain, sudden onset, lower left side
bright red blood +/- diarrhoea

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23
Q

IC DDx

A

other causes of acute colitis, eg IBD

dysentry, diverticulitis

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24
Q

IC Ix

A

CT

Colonoscopy and biopsy

Barium enema maybe

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25
IC Mx
Fluids ABs Surgical resection of bowel (could be gangrenous bowel) mitigate risk factors - smoking, antiplatelet therapy etc
26
Diverticulitis
Inflammation of diverticulum (outpouching of gut wall) diverticular disease - symptoms without inflammation
27
Diverticular disease patho
High intraluminal pressures (maybe lack of fibre), force mucosa to herniate through muscle layers of gut, usually near vessel entry sites Causes - lack of fibre, obesity, smoking, NSAIDs
28
Diverticulitis patho
faeces obstructs neck of diverticulum, bacteria multiply, inflammation
29
Diverticular disease Px
``` altered bowel habit left sided colic, relieved by defecation nausea flatulence pain/constipation (severe) ```
30
Diverticulitis Px
As diverticular disease ``` pyrexia tachycardic tenderness, guarding severe pain symptoms of peritonitis ``` similar to appendicitis, but on left side
31
Diverticulitis Ix
CT colonography Bloods - increased WCC, ESR, CRP AXR, barium enema
32
Diverticular disease Mx
High fibre diet antispasmodic - mebeverine maybe surgical resection
33
Diverticulitis Mx
Fluids, ABs (ciprofloxacin, metronidazole) Surgical resection
34
Diverticulitis Cx
perforation, fistula formation, intestinal obstruction, bleeding, mucosal inflammation, abscesses
35
Meckel's diverticulum
outpouching of distal ileum surgical removal
36
Oesophageal cancer
carcinoma of oesophagus squamous cell carcinoma (SCC) or adenocarcinoma (AC)
37
Oesophageal cancer patho
SSC in upper 2/3, AC lower 1/3 Barrett's: acid, stratified squamous epithelium -> simple columnar mucosa often presents late in disease
38
oesophageal cancer causes
``` alcohol achalasia (reduced peristalsis) smoking obesity GORD ```
39
oesophageal cancer Px
signs - lymphadenopathy - hoarseness, cough symptoms - dysphagia, progressive (solids, then liquids) - weight loss - anorexia - vomiting - pain
40
oesophageal cancer Ix
endoscopy barium swallow CT/MRI/PET - stage tumour
41
oesophageal cancer Mx
chemo resection palliative
42
Benign oesophageal tumour
1% oesophageal tumours, slow growing asymptomatic, dysphagia, pain, regurgitation endoscopy surgical removal
43
Gastric cancer
adenocarcinoma (epithelial tissue) of stomach
44
gastric cancer patho
Intestinal cancer - well formed, differentiated glandular structures Diffuse - infiltrative, undifferentiated, worse prognosis
45
gastric cancer causes
``` smoking H.pylori dietary factors genetics pernicious anaemia - atrophic gastritis ```
46
gastric cancer Px
advanced, metastases (bone, brain, lung) signs - anaemia from blood loss - jaundice (liver metastases) - palpable shoulder lymph node symptoms - epigastric pain, dyspepsia (indigestion) - N+V - anorexia - weight loss - dysphagia if tumour in fundus
47
gastric cancer Ix
gastroscopy and biopsy USS, CT, MRI, PET FBC, LFT
48
gastric cancer Mx
surgical resection chemo/radio treat symptoms
49
SI tumours
rare, AC most common, maybe lymphomas
50
SI tumours Px
signs - anaemia - palpable mass symptoms - pain - diarrhoea - anorexia - wt loss
51
SI tumours Ix
USS endoscopic biopsy CT
52
SI tumours Mx
radiotherapy surgical resection
53
Colonic polyps
abnormal growth of tissue from colonic mucosa adenoma/inherited
54
Colonic polyps Px
mostly asymptomatic signs - rectal polyps/masses symptoms - bleeding - diarrhoea, abdo pain, mucous discharge - obstruction - constipation, vomiting, peritonitis
55
colonic polyps Ix
colonoscopy with biopsy CT/MRI Genetic testing
56
Colonic polyps Mx
surgical removal
57
colorectal cancer
carcinoma of LI, usually AC
58
colorectal cancer patho
majority in distal colon normal epithelium -> adenoma -> colorectal adenocarcinoma -> metastatic (to liver, lung, brain) Genetics - familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer
59
colorectal cancer RFs
increasing age, low fibre, sat fats, red meat, sugar, polyps, alcohol, smoking, obesity, UC, FHx, genetics
60
colorectal cancer Px
depends on location signs - anaemia (bleeding) symptoms - blood and mucus - change in bowel habit - diarrhoea/constipation - wt loss - abdo pain (right sided) - thin altered stools - tenesmus (feeling of incomplete defecation) may present as emergency - obstruction jaundice/hepatomegaly - liver metastases
61
colorectal cancer DDx
haemorrhoids, anal fissure, prolapse, diverticular disease, IBD, GI bleed
62
colorectal cancer Ix
CT colonoscopy and biopsy FBC - anaemia barium enema MRI to determine spread classify - Dukes, TNM
63
colorectal cancer Mx
radio/chemo surgery - resection, stenting
64
GORD
reflux of stomach acid/bile
65
GORD causes
- LOS hypotension - hiatus hernia (rolling/sliding) - obesity - overeating - smoking - alcohol - pregnancy - drugs
66
GORD Px
signs - chronic cough (aspiration of stomach contents) - sinusitis - weight loss - haematemesis - anaemia symptoms - heartburn - belching - food/acid brash - water brash - odynophagia (painful swallowing) alarm bell signs wt loss, haematemesis, dysphagia
67
Dyspepsia ALARMS symptoms
``` Anaemia Loss of weight Anorexia Recent onset / progressive of symptoms Melaena / haematemesis Swallowing difficulty ```
68
GORD DDx
``` peptic ulcer disease malignancy NSAIDs infection cardiac disease oesophageal spasm ```
69
GORD Ix
clinical dx endoscopy if alarm bell signs, >55yo, tx not working, palpable mass barium swallow - hiatus hernia
70
GORD Mx
lose weight, stop smoking, small meals, avoid hot drinks, spicy food, raise bed head antacids - magnesium trisillicate mixture, gaviscon PPI - lansoprazole H2 receptor antagonist - cimetidine, ranitidine Nissen fundoplication - surgically increase resting LOS pressure (only in severe GORD)
71
GORD Cx
Barrett's oesophagus - metaplasia from stratified squamous to columnar Peptic stricture - inflammation Mallory-Weiss tear, iron deficiency, ulcers
72
Ulcerative Colitis
chronic inflammatory disorder of colonic mucosa (an IBD)
73
UC patho
Inappropriate immune response to colonic flora in genetically susceptible individuals Only involves mucosal layer Starts in rectum, extends proximally (stops at SI) Smoking is protective
74
UC Px
signs - during attack - fever, tachycardia, tender distended abdo, anorexia, malaise, wt loss - extraintestinal signs - clubbing, oral ulcer, erythema nodosum, inflammatory pustule, conjunctivitis, episcleritis, iritis, large joint arthritis, ankylosing spondylitis, primary sclerosing cholangitis symptoms - episodic/chronic diarrhoea +/- blood, mucus - bowel urgency - tenesmus - crampy abdo discomfort
75
UC Ix
Bloods - FBC, ESR, CRP, U+E, LFT, culture Stool MC&S Faecal calprotectin - test for GI inflammation AXR - no faecal shadows, mucosal thickening, colonic dilatation Lead-pipe colon on barium X ray Lower GI endoscopy
76
UC Mx
Avoid foods that cause flare ups mild 5-ASA - mesalazine/mesalamine topical steroid - hydrocortisone/prednisolone moderate oral prednisolone 5-ASA severe IV fluids IV steroids Azathioprine, ciclosporin (DMARD), infliximab Surgery - colectomy
77
UC Cx
Colonic cancer, venous thromboembolism, toxic dilatation of colon
78
Crohn's
chronic inflammatory disease of GI tract characterised by transmural granulomatous inflammation
79
Crohn's patho
Can affect any part of gut Skip lesions Inappropriate immune response to gut flora in genetically susceptible individuals Most commonly affects terminal ileum (bile salts and B12 absorbed here)
80
Crohn's Px
signs - bowel ulceration - abdo tenderness - perianal abscess/fistulae - mouth ulcers - finger clubbing - conjunctivitis, episcleritis, iritis - associated with spondyloarthropathies symptoms - diarrhoea - abdo pain - wt loss - fatigue, fever, malaise, anorexia
81
Crohn's Ix
``` Bloods MC&S Faecal calprotectin Colonoscopy, bowel biopsy Capsule endoscopy - swallow small camera MRI to assess Cx String sign on barium x ray ```
82
Crohn's Mx
Stop smoking, optimise nutrition Oral prednisolone Severe - IV fluids, IV steroids Azathioprine (immunosuppressant) Infliximab Surgery - not curative
83
Crohn's Cx
SI obstruction, toxic dilatation, abscess formation, fistulae, cancer, malnutrition
84
Intestinal obstruction
arrest/blockage of onward propulsion of intestinal contents
85
paralytic ileus
loss of peristalsis, caused by abdo surgery commonly, absent bowel sounds, less pain
86
intestinal obstruction patho
Intraluminal - tumour, fibrous diaphragm formation, meconium ileus (sticky bowel contents), gallstone Intramural - inflammatory (Crohn's, diverticulitis), tumours, neural (Hirschprung's) Extraluminal - adhesions, volvulus, tumour
87
Intestinal obstruction DDx
SBO / LBO SBO - vomiting earlier, less distension, pain higher in abdo LBO - pain more constant ileus / mechanical obstruction ileus - bowel sounds absent, pain tends to be less simple / closed loop / strangulated simple - one obstruction point, no vascular compromise closed loop - obstruction at two points, eg sigmoid volvulus - perforation risk strangulated - blood supply compromised, more pain, fever, peritonism
88
SBO
mechanical most common distension above blockage obstruction -> ischaemia, necrosis, perforation Causes - adhesions, hernia, malignancy, Crohn's
89
SBO Px
signs - distension (more distal, more distension) - tenderness -> ?strangulation - increased bowel sounds symptoms - pain, initially colicky, then diffuse - vomiting - nausea, anorexia - constipation, no wind
90
SBO Ix
AXR, CT
91
SBO Mx
Drip and suck - NGT to suck out bowel contents, IV fluids Analgesia, antiemetic, ABs Surgery
92
SBO Cx
Ischaemia, perforation, necrosis
93
LBO
25% of all intestinal obstruction Proximal dilatation Bacterial translocation -> sepsis Colonic volvulus -> sigmoid Cancer most common cause
94
LBO Px
signs - abdo distension - bowel sounds normal, then increased, then quiet - palpable mass symptoms - abdo pain - late vomiting (faecal) - constipation - fullness/bloating/nausea
95
LBO Ix
DRE - empty rectum, hard stools, blood AXR, CT
96
LBO Mx
much same as SBO Surgery
97
Pseudo-obstruction
clinical picture mimics obstruction, but no mechanical cause likely a Cx of other things: trauma, fractures, post-operation, drugs Px - abdo distension, worsening pain Ix - x-ray - large gas-filled bowel Mx - tx underlying condition, correct fluids/electrolytes, IV neostigmine promotes colonic motility
98
IBS
mixed group of abdo symptoms, no organic cause constipation, diarrhoea, both
99
IBS patho
dysfunction in brain-gut axis, abnormal smooth muscle activity
100
IBS RFs
stress, menstruation, depression/anxiety, GI infection, abuse, eating disorders
101
IBS Px
signs - urinary freq, urgency, nocturia, incomplete bladder emptying - joint hypermobility symptoms - abdo pain/discomfort, relieved by defecation - bloating - change in bowel habit - painful period - back pain - fatigue, nausea - symptoms worsen after food
102
IBS DDx with IBD
IBS: ``` normal Ix results fever not likely no extraintestinal symptoms no blood in stool no melaena no wt loss no mouth ulcers constipation more common bloating more common ```
103
IBS Ix
Rule out differentials Bloods Faecal calprotectin (raised in IBD) Colonoscopy (rule out colorectal cancer)
104
IBS Mx
Regular/small meals, fluids, reduce caffeine, alcohol IBS-D and bloating - reduce insoluble fibre Wind/bloating - increase soluble fibre Low FODMAP diet Pain/bloating - antispasmodic (mebeverine/buscopan) Constipation - laxative (eg mavicol) Diarrhoea - loperamide TCA (amitriptyline), SSRI CBT
105
IBS - cancer red flags
``` wt loss unexplained PR bleed FHx change in bowel habit and +50yo nocturnal symptoms mass anaemia raised inflammatory markers ```
106
Mallory-Weiss tear
Linear mucosal tear at oesophageal gastric junction - upper GI bleed
107
MW tear causes
forceful vomiting, retching, coughing, straining NSAID abuse peptic ulcers - majority RFs - alcohol, conditions predisposing to vomiting, chronic cough, hiatus hernia, trauma
108
MW tear Px
signs postural hypotension ``` symptoms vomiting haematemesis retching dizziness / syncope ```
109
MW tear DDx
gastroenteritis, peptic ulcer, cancer, varices
110
MW tear Ix
endoscopy FBC, coagulation studies, renal function...
111
MW tear Mx
ABCDE, O2, fluids Endoscopy - banding/clipping
112
MW tear Cx
vomiting - hypokalaemia, metabolic distubances bleed - hypovolaemic shock
113
Achalasia
oesophageal aperistalsis, impaired relaxation of LOS
114
Achalasia cause
unknown, though to be abnormal psym innervation
115
Achalasia Px
- dysphagia - food regurgitation, esp at night - substernal cramps - wt loss - spontaneous chest pain
116
Achalasia DDx
other causes of dysphagia - cancer, stricture, GORD
117
Achalasia Ix
CXR - dilated oesophagus Barium swallow - lack of peristalsis Manometry - shows aperistalsis CT, oesophagoscopy - rule out carcinoma
118
Achalasia Mx
Relieve symptoms Tx to relax LOS - nifedipine, nitrates, sildenafil Surgical - balloon dilation to open LOS, division of LOS, botox injection to relax it
119
Achalasia Cx
aspiration pneumonia
120
Gastritis
inflammation of stomach mucosa
121
Gastritis causes
``` H.pylori Autoimmune gastritis Aspirin, NSAIDs Viruses Duodenogastric reflux Ischaemia Increased acid - eg stress Alcohol ```
122
Gastritis Px
signs - abdo bloating symptoms - N+V - recurrent upset stomach - epigastric pain - indigestion - haematemesis
123
Gastritis DDx
peptic ulcers, GORD, dyspepsia, carcinoma
124
Gastritis Ix
Endoscopy Biopsy H.pylori urea breath test, stool antigen test
125
Gastritis Mx
``` Remove cause - eg stress, alcohol H.pylori - PPI + 2 ABs H2 antagonist - ranitidine, cimetidine PPI - lansoprazole/omeprazole Antacid ```
126
Peptic ulcer disease (PUD)
break in superficial epithelial cells down to muscularis mucosa in stomach/duodenum
127
PUD Patho
ulcers -> gastritis NSAIDs inhibit COX1, prostaglandin synthesis, mucous secretion H.pylori urease - urea -> CO2 + ammonia ammonium toxic to mucosa - less mucous produced inflammation ischaemia of gastric cells produce less mucin overproduction of acid overwhelms mucin
128
PUD causes
``` H.pylori NSAIDs smoking alcohol bile salts steroids stress ```
129
PUD Px
``` burning epigastric pain nausea oral flatulence epigastric tenderness duodenal ulcer - worse several hours after eating, relieved by eating ``` ``` ALARMS anaemia loss of weight anorexia recent onset / progressive sym melaena / haematemesis swallowing difficulty ```
130
PUD DDx
cancer, gastric outlet obstruction, non-ulcer dyspepsia, duodenal Crohn's, GORD
131
PUD Ix
FBC - iron-deficiency anaemia H.pylori tests C-urea breath test - measure CO2 in breath after ingesting C-urea IgG serology detection Stool antigen test Endoscopy
132
PUD Mx
Reduce stress, irritating foods, smoking, alcohol Stop NSAIDs PPI - lansoprazole H2 antagonist - ranitidine/cimetidine Surgery - for Cx, eg bleed endoscopic intervention for bleeding ulcers
133
H.pylori Mx
PPI 2 ABs - metronidazole, clarithromycin (high resistance), amoxicillin (low res), tetracycline (low), bismuth Quinolone, eg ciprofloxacin, where normal tx fails
134
PUD Cx
Cancer, haemorrhage (duodenal ulcer erodes to gastroduodenal artery), peritonitis, acute pancreatitis
135
Haemorrhoids
dilated anal cushions due to swollen veins internal/external internal categorised by degree it prolapses
136
haemorrhoids causes
constipation, prolonged straining diarrhoea congestion from pelvic tumour, pregnancy, portal HTN anal intercourse
137
haemorrhoids Px
signs - severe anaemia symptoms - bright red rectal bleeding - mucus discharge, pruritus ani (itchy bottom) - wt loss, changes in bowel habit - pain (external)
138
haemorrhoids Ix
abdo exam - rule out other disease PR exam proctoscopy (rectal scope) sigmoidoscopy
139
haemorrhoids Mx
1st degree - increase fluid, fibre, topical analgesic, stool softeners 2/3 - rubber band ligation, infrared coagulation 4 - surgery to remove
140
Anal fistula
track communicates between skin and anal canal
141
anal fistula causes
``` perianal sepsis abscesses Crohn's TB diverticular disease rectal carcinoma ```
142
anal fistula Px
pain discharge (bloody/mucus) pruritus ani systemic abscess if infected
143
anal fistula Ix
MRI | endoanal USS
144
anal fistula Mx
surgical - fistulotomy, excision | drain abscess, ABs if infected
145
anal fissure
tear in squamous skin-lined lower anal canal
146
anal fissure causes
hard faeces STI, trauma, Crohn's, cancer 90% posterior, anterior follows childbirth
147
anal fissure Px
extreme pain, esp on defecation | bleeding
148
anal fissure Ix
Dx often on history perianal inspection PR exam often not possible due to pain
149
anal fissure Mx
increase fluids, fibre - make stools soft Lidocaine ointment, GTN ointment, topical diltiazem (promotes healing) Botox injection Surgery - sphincterotomy
150
anorectal abscess
collection of pus in anal/rectal region RFs - DM, immunocompromised, anal sex
151
anorectal abscess Px
painful swellings tender pus discharge
152
anorectal abscess Ix
DRE MRI endoanal USS
153
anorectal abscess Mx
surgical excision | drainage with ABs
154
Pilonidal sinus
hair follicles get stuck under skin in butt crack, irritation/inflammation, leads to small tracts that can become infected (abscesses)
155
pilonidal sinus Px
asymptomatic painful swelling, tender pus, foul smell from abscess systemic signs of infection chronic - 4/10 recurrent
156
pilonidal sinus Ix
clinical examination
157
pilonidal sinus Mx
surgery - excise sinus tract, drain pus ABs pre-op painkillers hygiene and hair removal advice

Phase 2a Concise (9 decks)

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