GI Flashcards
Peptic ulcer disease - Types, RF, Sy, Ix, Comp, Mx, Zollinger-Ellison syndrome
T - Gastric - worse when eating, older patient, normal or low acid secretion. Duodenal - hunger pains esp at night, younger, most have H pylori, high acid secretion.
RF - Alcohol, smoking, NSAIDs.
Sy - nausea, epigastric pain, distension if obstruction.
Ix - gastroscopy and urease test on biopsy or CO2 breath test (using radioactive C in urea) for H Pylori.
Comp - acute bleeding, Fe def anaemia, perforation, obstruction due to scarring.
Mx - lifestyle, PPI, antacids, eradicate H pylori (metronidazole, PPI, clarithromycin).
Zollinger-Ellison - Gastrinoma, gastrin-secreting tumor of the duodenum or pancreas. Ix - fasting gastrin levels, ocreotide scan. Mx - ocreotide and surgery.
Hiatus hernia - def, Ix, Mx.
D - part of the stomach in the thorax. Usually sliding (both sides pop up, causes GORD) can be rolling (one side of stomach causes hiccough, volvulus, obstruction).
Ix - Endoscopy or CT if acute.
Mx - lifestyle, PPI, surgery if treatment-resistant or emergency.
GORD - Sy, Complications, Mx.
Sy - dyspepsia, acid in pharynx, worse at night, after large meals and when lying down.
C - Oesophagitis - causes irritation and erosion progressing to ulcers and strictures. Barett’s oesophagus - metaplasia normal squamous is replaced by columnar causing pre-malignant change.
Mx - Treat with PPI for one month, if doesnt improve, consider stool/breath test sample for H pylori (no PPI for 2wks and Abx for 4wks). Refer if new onset and old. Can do Nissen’s fundoplication to reinforce LOS.
Gastric cancer - Histology, RF, Sy, Ix, Mx
H - Adenocarcinoma.
RF - Nitrosamines (fish), chronic atrophic gastritis, blood group A, H pylori.
Sy - new/worsening dyspepsia, weight loss, anorexia, lethargy, anaemia, upper GI bleed. Palpable epigastric mass, Trosier’s sign (L supraclavicular lymph node).
Ix - Gastroscopy, CT.
Mx - If early can be resected with chemo, often presents late and will be palliative.
Upper GI bleeding - Causes and features, RF, Ix, Mx.
Peptic ulcer - fresh red blood with clots. Requires endoscopic coagulation.
Oesophageal varices - copious dark red vomiting caused by caput medusa portal HTN. Require endoscopic banding or IR.
Mallory-Weiss tear - trauma following vomiting/retching.
Also - vascular malformations, cancer, aortoenteric fistula.
RF - NSAIDs, steroids, alcohol, anticoagulants.
Ix - Endoscopy. Immidiately after recuss if unstable, within 24hrs if stable.
Mx - ABCDE recussitation, urgent OGD +- angiography. Varices - give terlipressin (constricts gut vessels) and Abx. Band ligation at endoscopy. Sengstaken-Blakemore gastro-oesophageal tube can be life saving.
Appendicitis - Sy, Si, comp, Ix, DDX, Mx.
Sy - Central pain moving to RIF (McBurney’s point). Peritonism suggests perforation, Malaise, anorexia, fever, diarrhoea. Palpation of LIF causes pain in right Rovsing’s sign.
Comp - Perforation, mass, abscess.
Ix - CT. USS if ovarian pathology suspected.
DDx - Children - Mesenteric adenitis (post-viral), Meckel’s diverticulitis, gynae. Adults - IBD Meckels diverticulitis, gastoenteritis, renal colic, gynae, tumours.
Mx - IV access, bloods, IV Abx. If sy settle do interval appendectomy after 6wks, if not do acutely, abscess can be drained via CT.
Fe deficiency anaemia - cause, Sy, Ix, Mx
Cause - blood loss (menstruation/GI), poor diet in children, malabsorption, hookworm in tropics.
Sy - SOB, fatigue. Koilonychia, glossitis, angular chelosis, post-cricoid webs (Plummer-Vinson syndrome).
Ix - microcytic hypochromic anaemia, confirmed by low ferritin.
Mx - treat cause, PO iron (SE nausea, abdo discomfort, Diarr/cons, black stools). Give IV in renal failure.
Diverticular disease (not diverticulitis) - def, Ix, Sy, Mx
Def - outpouching of bowel wall at site of perforating arteries, usually in sigmoid, very common. Associated with constipation. Diverticulosis=exist, diverticular disease=sy, diverticulitis=inflammation.
Ix - Often incidental at colonoscopy if done to exclude cancer.
Sy - Altered bowel habit, left sided colic releived by passing stool/flatulence.
Mx - high fibre diet and antispasmodics (mebeverine).
Diverticulitis - Sy, Ix, Mx, Comp
Sy - LIF pain, pyrexia, peritonism.
Ix - CT best in acute flare, colonoscopy may rupture bowel.
Mx - Analgesia, NBM, IV fluids, Abx, CT guided drainage if abscess.
Perforation - ileus, gen peritonitis and shock. Mx - laparotomy and Hartmann’s
Haemorrhage - usually sudden and painless. Mx bed rest, may need transfusion or surgery.
Fistulae - surgery.
Abscess - swinging fever, localising signs. Mx - abx and drainage.
Appendicitis - Def, Sy, Si, Ix, Mx
Def - most common surgical emergency, usually in 10-20yrs, gut organisms invade appendix wall after lumen obstruction (foecolith, lymph).
Sy - periumbilical pain migrating to LIF (McBurneys point), anorexia, N/V, fever.
Si - Rosving’s sign - pain LIF>RIF when RIF pressed. Psoas sign (pain on extending hip), Cope sign (pain on flexing and internally rotating hip). Rebound and percussion tenderness.
Ix - bloods and CT.
Mx - Abx - metronidazole and cefuroxime and emergency appendicectomy.
RUQ pain DDX
Acute cholecystitis Duodenal ulcer Hepatitis Pyelonephritis Appendicitis RLL pneumonia
LUQ pain DDX
Ruptured spleen Gastric ulcer AAA Pyelonephritis LLL pneumonia
Epigastric pain DDX
Pancreatitis
MI
Peptic ulcer
Cholecystitis
RLQ pain DDX
Appendicitis Salpingitis Ovarian abscess Ectopic - sudden, shock Renal stone - loin to groin Strangulated hernia Mesenteric adenitis - post-viral Epiploic appendagitis - mild pain Meckels diverticulum - child Crohns - blood and mucus PR
LLQ pain DDX
Diverticulitis Salpingitis Ovarian abscess Ectopic - sudden, shock Renal stone - loin to groin Strangulated hernia Crohns - blood and mucus PR UC
Umbilical pain DDX
Obstruction Pancreatitis Early appendicitis Mesenteric thrombus AAA Diverticulitis
Bowel obstruction - Cardinal si, cause large and small, sy, Ix, Mx
Cardinal - vomiting, colicky pain, absolute constipation, distension.
Cause - Small - adhesions, hernias, interssusception. Large - Colon ca, constipation, diverticular strictures, volvulus (sigmoid or caecal).
Sy - NV, anorexia, faeculent vomiting, tinkling bowel sounds.
Ix - AXR, CT. Small bowel valvulae conniventes completely cross the lumen, large bowel haustra do not.
Mx - drip and suck (IVI and NG). Strangulation and closed loop obstruction require emergency surgery. Avoid operating in small bowel obs due to adhesions. In sigmoid volvulus do sigmoidoscopy and flatus tube.
Inguinal/femoral hernia - def, Indirect inguinal, direct inguinal, femoral, Ix, Mx
D - protrusion of a viscus. Irreducible=cant be pushed back. Incarcerated=contents stuck inside by adhesions. Strangulated=ischaemia occurs, requires emergency surgery.
Indirect inguinal - Most common, can strangulate, go straight through inguinal canal. Ix - reduce and then cover deep ring (mid inguinal lig), then stand and cough and it won’t move.
Direct - less common, reduce easily and rarely strangulate.
Femoral - more common in females, frequently irreducible and strangulate. Point down the leg (rather than into groin) and tend to be more inferior and lateral.
Ix - difficult to distinguish direct from indirect unless mid op, matters little as same management.
Mx - surgical repair with mesh.
Colorectal Ca - Path, RF, Sy, Ix, classification, Mx
Path - adenocarcinoma. Rectum, sigmoid and caecum most common.
RF - Polyps, IBD, genetics (FAP, HNPCC), low fibre red meat diet, alcohol, smoking.
Prevention - 75mg/d aspirin.
Sy - Left sided - bleeding/mucus PR, CIBH, obstruction, tenesmus, mass PR. Right - Weight loss, anaemia, abdo pain.
Ix - Colonoscopy and CT. Screening = FOB (every 2yrs 60-75, flexi sig at 55).
Classification - dukes A=local, B=muscularis mucosae, C=regional LN, D=distant mets.
Mx - Surgery - sigmoid colectomy, anterior resection (low sig/high rectum), AP resection (low rectum), left hemi, right hemi or Hartmann’s in obstruction. Radio in palliative and chemo in palliative or adjuvant.
Polyps - Types, Ix, Mx
Inflammatory - IBD causes lymphoid hyperplasia. Hamartomatous - juvenile polyps seen in Peutz-Jeghers syndrome. Neoplastic - tubular or villous adenomas have malignant potential esp if >2cm.
Ix - colonoscopy.
Mx - Neoplastic should be removed and biopsied on colonoscopy.
