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Flashcards in GI Deck (87)
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1

What is peptic ulcer disease?

A break/ulceration in the mucosa of the stomach (gastric ulcer) or duodenum (duodenal ulcer) which are most common

2

What are the most common causes of peptic ulcer?

H. pylori infection - damages mucosal cells

Long term use of NSAIDS - makes gastric mucosa more susceptible to damage

3

What is the presentation of peptic ulcers?

-Epigastric pain
-Dyspepsia (indigestion)
-Haematemesis "coffee ground"
-Pain worsens when eating (Gastric ulcer)
-Pain before eating/relieved by eating (duodenal ulcer)

4

What can cause increased stomach acid secretion?

Alcohol, smoking, caffeine, spicy foods

5

How to diagnose peptic ulcers?

-Endoscopy and biopsy for visualisation of ulcer and exclude malignancy

-Urea breath test or stool antigen test for H. pylori

6

What is the Mx for peptic ulcers?

-Avoid trigger foods, limit caffeine and alcohol
-PPI to decrease stomach acid secretion e.g. lansoprazole
-Abx e.g. Clarithromycin (if allergic to penicillin offer metronidazole)
-Stop medications e.g. NSAID

7

What is bowel ischaemia?

Occurs when blood supply (mesenteric arteries) to the bowel is interrupted due to emboli

8

RF for bowel ischaemia?

Heart disease, AF, Valvular disease. elderly

9

Symptoms of bowel ischaemia?

Acute onset severe abdominal pain (generalised)

10

What are the common causes of small bowel obstruction?

Adhesions (Scar tissue from previous surgery causing kinks in bowel), second most common are hernias

11

What is the most common cause of large bowel obstruction?

Colorectal malignancies

12

What are volvulus and different types?

Twisting of bowel around itself and mesentery.
Sigmoid volvulus (coffee bean shaped)
Caecal volvulus (fetal lie)

13

What are the symptoms of bowel obstruction?

Increasing abdominal distention. diffuse pain, worsening abdominal pain

14

What is the Mx of bowel obstruction?

-NBM
-IV fluids

-Surgical resection (cutting out part of tissue)

15

What is constipation and faecal impaction?

Constipation is a variety of symptoms e.g. difficulty passing stools, incomplete emptying

Faecal impaction is retaining of faeces in body

16

What are the symptoms of constipation?

-sensation of incomplete defecation
-<3 bowel movements weekly
- difficult passing stools
-Faecal impaction: Hx of hard stools

17

What are the red flags symptoms?

-Weight loss
-Anaemia
-Mealena (digested blood on defecation)
refer urgently 2ww suspicious of colorectal malignancy

18

What is the Mx of constipation and faecal impaction?

-Increase dietary fibre intake
-Fluid intake
-Stop medications e.g. NSAIDS
-Bulk forming laxative e.g. isphagula husk for constipation
-Osmotic laxative e.g. bisacodyl for faecal impaction

19

What is ulcerative colitis?

Long lasting inflammation and ulcers in inner lining of colon and rectum

20

CLOSEUP acronym?

UC (CLOSE U-ulcerative)
-Continuous inflammation
-Limited to colon and rectum
-Only superficial mucosa
-Smoking is protective factor
-Excrete blood and mucus
-Use of amino salicylates
-Primary sclerosing cholangitis

21

NESTS acronym?

Crohns
-No blood/mucus
-Entire GI tract affected
-Skip lesions on endoscopy
-Terminal ileum most effected of small bowel
-Smoking is RF

22

RF for IBD?

<30 years, FHx

Smokers RF for Crohns but protective factor for UC

23

Symptoms specific to UC and CD?

Non specific - diarrhoea, abdo pain, weight loss,

UC- blood and mucus in stools

CD-acute exacerbations (feeling better then worse), erythema nodosum

24

Investigations for IBD?

-Faecal calprotectin - screening test specific to IBD
-Endoscopy and biopsy for diagnosis
-Abdo xray: lead piping, and toxic megacolon suggest chronic UC, thumbprinting suggest IBD
-CRP for inflammation
-Imagin will show cobblestone appearance and complications of Crohns

25

Mx of Crohns?

1st line
-Steroids e.g, oral prednisolone

26

Complications of Crohns?

-Anal fissures
-Fistulas (abnormal passageway between organs)
-Bowel obstruction

27

Mx of UC?

1st line
-Use of aminosalicylates e.g. mesalazine

28

What is achalasia?

Achalasia is a motility disorder of oesaphagus

29

Px of achalasia?

1. The oesophageal sphincter will not relax properly, and so food cannot pass into the stomach
2. The peristaltic contractions of the oesophagus do not propagate properly, and so the oesophagus will gradually become more and more dilated.

30

Investigations for achalasia?

Barium swallow will show birds beak appearance.