GI Flashcards
(142 cards)
1
Q
What is a hernia
A
Protrusion of viscus through a defect in the wall
2
Q
Comps of hernias
A
Irreducitlbe
obstruction
incarcerated
strangulated
3
Q
RFs for inguinal hernia
A
obesity, constipation, chronic cough, male, heavy lifting
4
Q
Types of inguinal hernia?
Where through?
Which is most likely to strangulate?
A
Indirect - through deep inguinal ring (most likely to strangulate)
Direct - through post wall of inguinal canal
5
Q
Ix if unsure about hernia
A
USS
6
Q
Usual pres of hernia
A
Lump +/- pain (if incarcerated)
7
Q
Mx of small hernia
A
W+W
wt loss
8
Q
Pres of femoral hernia?
Where?
A
Lump in groin
Inf + lat to pubic tubercle
9
Q
DDx of femoral hernia in men?
How to differentiate?
A
Hydrocele - can get above this on examination
Cant get above hernia
10
Q
Comp of femoral hernias?
A
high strangulation rate
11
Q
Pres of strangulated hernia?
A
red, tender, tense, irreducible +/- colicky abdo pain + vomit + distension –> = obstruction (EMERGENCY)
12
Q
Red flags of dyspepsia?
A
ALARMS Anaemia Lost weight Anorexia Recent onset (in >55yo) Melaena Swallowing difficulty
13
Q
Causes of dyspepsia?
A
Functional
PUD
Oesophagitis
14
Q
Dx of functional dyspepsia?
A
Rome Criteria
6m post-pranidal fullness
Early satiety
Epigastrci pain/burn
No structural abnorm
15
Q
Drugs causing dyspepsia?
A
Nitrates
bisphosphonates
corticosteroids
NSAIDs
16
Q
Mechanism of PPIs?
A
Decrease expression of H+/K+ antiporter on luminal memb of parietal cells
decreased stomach acid
17
Q
Ix in dyspepsia?
A
FBC
H. pylori [urea breath test, stool antigen]
+/- endoscopy
barium
18
Q
Lifestyle for dyspepsia
A
stop drugs stop smoking avoid aggravating foods weight loss antacids [gaviscon]
19
Q
Stomach cells + function?
A
chief cells - pepsinogen G-cells - gastrin parietal cells - IF, HCl D-cells - somatostatin Goblet cells - mucus, bicarb
20
Q
What stops acid prod?
A
somatostatin
21
Q
what is h pylori?
A
gram -ve
curved bacillus
22
Q
sx of PUD?
A
fullness
bloating
early satiety
epigastric pain/burn
23
Q
Anaemia in PUD?
A
iron deficiency (bleeding ; h pylori uses Fe for growth)
24
Q
mx of h pylori
A
Triple therapy
PPI + amox + clarithromycin/metronidazole
25
pain in DU vs GU
DU - post prandial (1-3h) relieved by eating
GU - on eating
26
Zollinger-Ellison syndrome?
gastrin-secreting tumour --> overprod of acid so recurrent peptic ulcers
27
mx of PUD?
PPI / H2RA
28
GORD?
reflux of acidic contents into oesophagus
29
What does GORD cause?
oesophagitis, ulceration, stricture, Barrett's
30
Epithelial change in Barretts?
metaplasia
| squamous --> glandular
31
RFs for GORD
```
pregnancy
obesity
smoking
alcohol
fatty foods
```
32
pres of GORD?
```
Heartburn - related to meals, posture
Water brash - excess salivation
Acid brash - retrostern discomfort, regurg
Odynophagia
Belching
```
33
Ix in GORD
Gold standard = endoscopy
FBC
Barium swallow
34
Red flag sx in dyspepsia
```
ALARMS
Anaemia
Lost weight
Anorexia
Recent onset (in >55yo)
Malaena
Swallowing difficulty
```
35
Drugs affecting oesophageal motility?
nitrates
anticholinergics
TCA
36
Drugs that damage gastric mucosa?
NSAID
| bisphosphonates
37
Mx of oesophagitis?
PPI 2m
38
Surgical mx of GORD
Laparoscopic fundoplication
39
Pres of hiatus hernia
GORD
| due to incompetent LOS
40
ix for hiatus hernia
CXR
barium study
endoscopy
41
mx of hiatus hernia
lifestyle
PPI
surgery (gastropexy)
42
ix for Barrett's?
endoscopy
| biopsy
43
mx of barretts?
Low grade?
High grade?
Low -lifestyle, PPI +/- ablation
High - oesophagectomy
44
Type of ca in oesophagus?
SCC (upper 2/3)
Adenocarinoma (lower 1/3)
45
Pres of oesophageal Ca?
```
Dysphagia (solids>liquids)
Vomiting
Anorexia
Wt loss
Hiccups + retrosternal pain
hoarseness + cough
```
46
ix in oesophageal Ca?
FBC, U+E, LFT, CRP
Endoscopy + biopsy
CT/MRI
Barium swallow
47
DDx of dysphagia?
Oesophageal [GORD, oesophagitis, oesophageal Ca]
Neuro [CVA, achalasia, MS, MND]
Other [pharyngeal pouch, compression, scleroderma]
48
Achalasia?
Disorder of motility of LOS
49
Ix in achalasia? What would you see?
CXR - dilated oesophagus behind heart
Barium swallow - bird's beak
Manometry
50
Mx of achalasia?
CCB/nitrates
+/- surgery
51
GI features of scleroderma?
reflux oesophagitis, delayed gastric emptying, watermelon stomach
52
Autoantibodies in scleroderma?
anti-topoisomerase 1
anti-centromere
anti-RNA polymerase 3
53
Mx of scleroderma GI?
lifestyle
PPI
Pro-motility [metoclopramide, domperidone]
Dilatation of oesophageal strictures
54
DDx of upper GI bleed?
PUD, mallory weiss, malignancy, varices
55
Haematemesis?
| Red vs coffee ground?
Red = fresh, above stomach, active haemorrhage
Coffee ground = stomach/below
56
Cause of mallory weiss?
persistent vomiting/wretching
57
ix of mallory weiss?
endoscopy, FBC, U+Es
58
comps of mallory weiss?
aspiration pneumonia
mediastinitis
hypovolaemic shock
59
oesophageal varices?
dilated veins at junction between portal and systemic circulation
60
cause of varices?
chronic liver disease --> portal HTN
61
ix in varices?
endoscopy, FBC (Hb + haematocrit), clotting, U+Es, LFTs
62
ix in upper GI bleed?
Endoscopy (within 24h - post resus)
FBC, coag, LFTs, U+Es
crossmatch
CXR
63
Mx of upper GI bleed?
fluid resus + high flow O2
2 wide bore cannula + send bloods
(FBC/UE/LFT/crossmatch/coag)
Transfuse with blood/platelets according to major haemorrhae protocol
64
Mx of UGI bleed?
Mechanical clips
Thermal coagulation with adrenaline
FIbrin/thrombin with adrenaline
65
Mx of oesophogeal variceal bleed?
Band ligation
| Endoscopic injection of N-butyl-2-cyanoacrylate
66
Pres of bowel obstruction
N+V
pain
failure to pass bowel movements
distension
67
Bowel sounds in obstruction?
High pitched
68
Silent bowel sounds?
ileus
69
ix in obstruction?
FBC, U+Es, group, crossmatch
fluid charts
AXR - supine + erect
70
AXR in obstruction?
Distended loops of bowel proximal to obstruction
71
AXR in paralytic ileus?
fluid levels + distended small bowel throughout
72
AXR in perforation?
gas under the diaphragm
73
mx of uncomplicated obstruction?
fluid resus
correct electrolytes
intestinal decompression (NG tube)
74
If no diagnosis in obstruction, what do you do?
laparotomy
| consent for stoma
75
Cause of sigmoid volvulus?
chronic constipation
76
complication of sigmoid volvulus?
venous infarction --> perforation, faecal peritonits
77
AXR of sigmoid volvulus?
| What other ix do you do?
Coffee bean sign
| CT - assess bowel wall ischaemia
78
Mx of sigmoid volvulus?
Urgent admission + decompression (sigmoidoscope + flatus tube)
If recurrent - resect sigmoid colon
79
Paralytic ileus?
| who does it occur in?
no peristalsis
elderly with lots of co-morbs
80
mx of paralytic ileus?
resus, bowel decompression (NG tube)
81
Pres of pseudo obstruction?
absence of mechanical obstruction
abdo pain, bloating, N+V, obstipation, massive distension
82
AXR of pseudo-obsruction?
Megacolon
83
Mx of pseudo-obstruction?
```
treat cause
IV fluids
Endoscopic decompression (NG tube)
Metoclopramide (prokinetic + antiemetic)
IV neostigmine
```
84
Hirschprungs?
Abscence of PSNS ganglion cells in myenteric + submucosal plexus of rectum
85
Pres of Hirschprungs?
failure to pass meconium within 48h
| abdo distension
86
ix in hirschprungs?
Rectal biopsy
AXR - dilated lower bowel
anal manometry in older children
87
pres of intra abdo abscess?
fever + pain
swinging pyrexia
palpable mass
88
pres of peritonitis?
```
pain
anorexia
N+V
high fever
tachycardia
rebound tenderness
guarding
```
89
ix in peritonitis?
FBC, U+E, LFT, amylase, lipase, blood cultures
peritoneal fluid [culture+amylase]
AXR, CXR (air under the diaphragm)
90
mx of abdo abscess?
metronidazole + 3rd gen ceph + surgical drainage
91
mx of peritonitis?
IV fluids
IV abx [metronidazole + cefotaxime]
surgery
92
what is Rovsings sign
palpation of LLQ increases pain in RLQ --> appendicitis
93
ddx appendicitis
```
GI obstruction
constipation
perforation
diverticulitis
crohs
testicular torsion
ectopic
DKA
```
94
ix in appendicitis
UTI, pregnancy test, FBC, CRP, USS
95
mx appendicitis
appendicectomy
IV fluids
analgesia
IV metronidazole + cefotaxime
96
what is deverticulum?
herniation of mucosa through think colonic muscle
97
mx of diverticulitis
coamoxiclav
| +/- surgery
98
mx ischaemic bowel
Resus - O2, IV fluids
Papaverine relieves spasm
Heparin if thrombosis
surgery
99
pres of chronic mesenteric ischaemia?
AKA intestinal angina
wt loss, postprandial pain, fear of eating
100
RFs for chronic mesenteric ischaemia
smoking, HTN, DM, hyperlipidaemia
101
ix for chronic mesenteric ischaemia
angiography
| FBC, LFT, U+Es
102
mx of chronic mesenteric ischaemia
nitrates
anticoag
bypass surgery
103
causes of malabsorption
coeliac
Crohns
CF
104
ix of malabsorption
```
FBC, LFT, ESR, CRP
iron studies
folate
b12
clotting
auto-antibodies (tTG)
faecal elactase
ileocolonoscopy + biopsy
```
105
genetics in coeliac
HLA-DQ2
106
histology coeliac
villous atrophy
| crypt hyperplasia
107
pres of coeliac
```
IBS
chronic fatigue
diarrhoea
wt loss
anaemia
```
108
skin features of coeliac
dermatitis herpetiformis
109
antibodies in coeliac
tTG IgA
| EMA IgA
110
mx of coeliac
lifelong gluten free diet
Ca/vit D supplements
Annual r/v
111
similar disease to coeliac? whats the difference on biopsy?
tropical sprue (incomplete villous atrophy)
112
mx of tropical sprue
fluid replacement
| tetracycline 6-12m
113
Node indicates gastric ca
virchow's node
114
ix in gastric cancer?
FBC, LFT, flexible endoscopy/gastroscopy + biopsy
| CT abdo for mets
115
mx of gastro Ca
surgery
chemo
nutrional support
116
MALT lymphoma?
mucos-assosciate lymphoid tissue
Subtype of NHL
117
assosciations with MALT tumours?
H.pylori
| C.jejuni
118
mx of MALT
eradicate H. pylori --> can cause remission in early disease
119
mx of advanced MALT?
eradicate H pylori
rituximab
chemo
surgery
120
ix in carcinoid tumour?
plasma chromogranin A
24h urinary 5-HIAA
endoscopy
CT/MRI
121
medical mx of carcinoid tumour
octreotide
| radio/chemo
122
genetic causes of colorectal ca
FAP
HNPCC
123
ix in colorectal ca
PR + colonoscopy + biopsy
FBC, LFT, CEA, FOB, CT
124
screening for colorectal ca
60-75
| 2 yearly FOB; if +ve then colonoscopy
125
Dx of IBS
6m history of ABC (abdo pain, bloating, changed habit)
| relieved by defecation
126
Ix of IBS
r/o DDx
```
FBC, ESR, CRP
coeliac screen
Ca-125
faecal calprotectin
FOB
```
127
mx of IBS
lifestyle, diet, destress
diarrhoea - loperamide
bloating - peppermint oil
constipation - ispaghula
abdo pain - buscopan
128
UC vs Crohns?
UC [continuous disease, ulcers, polyps, confined to mucosa and submucosa]
Crohns [rectal sparing, skip lesions, mucus cobblestone, transmural granulomatous inflam]
129
Non- GI manifestations of Crohns?
```
erythema nodosum
pyoderma gangrenosum
arthritis
iritis
conjunctivitis
```
130
pres of Crohns?
Diarrhoea (>6w) +/- blood
abdo pain
wt loss
131
ix in Crohns
FBC, U+Es, LFT, ESR/CRP
faecal calprotectin
stool MC+S
ileocolonoscopy + biopsy
132
mx of Crohns?
induce remission --> oral pred
maintain remission --> azathioprine
smoking cessation
133
UC ix?
```
FBC, U+Es, LFT, ESR/CRP
faecal calprotectin
stool MC+S
sigmoidoscopy + biopsy
p-ANCA
```
134
mx of UC?
induce remission --> mesalazine +/- pred
maintain remission --> oral mesalazine
135
mx of severe exacerbation of UC?
admit + IV hydrocortisone + IV fluids
| +/- IV ciclosporin
136
types of laxative?
bulk forming - ispaghula
softener - arachis oil
stimulant - senna, docusate
osmotic - lactulose
137
Which toxin --> HUS
shiga
138
Xray signs of small bowel obstrucion
central
multiple bowel loops
ladders
139
xray signs of large bowel obstruction
1 big loop
peripheral
haustrations
140
Boars sign?
pain under R scapula in cholectystitis
141
ix in acute pancreatitis?
serum lipase
142
ix in chronic pancreatitis?
urine amylase
