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Flashcards in GI Deck (38)
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1

Acute Cholangitis presentations

CHARCOT's triad:
Biliary pain (RUQ)
Fever
Jaundice

Pale stool, pruritus

2

Gold standard investigation for Acute Cholangitis

ERCP - endoscopic retrograde cholangiopancreatography + biopsy

3

Gold standard investigation for Primary Biliary Cholangitis

PBC-antibodies + elevated alkaline phosphatase.

Common Ab = AMAs (anti-mitochondrial)

4

Management of Primary Biliary Cholangitis

ursodeoxycholic acid
(bile acid analogue) + prednisolone

5

Management of Acute Cholecystitis

Early Laparoscopic Cholecystectomy (w/in 1 week)

6

Management of Acute Cholangitis

Abx + ERCRP drainage + decompression

7

Presentation of Acute Cholecystitis

Inflamed gallbladder, biliary pain >8hr. Murphy's sign.

RUQ/epigastric pain (radiating to right shoulder tip if the diaphragm is irritated)
Fever, N/V
Tender RUQ
Murphy's sign positive

8

Presentation of Choledocholithiasis

Colicky RUQ pain
Worse after eating
No fever
Murphy's sign negative

9

Chronic cholecystitis presentations

Flatulent dyspepsia
Minimal abd pain
Nausea
Bloating
Sometimes colicky pain

Worse after fatty meal

10

An X-ray demonstrating pneumobilia + dilated small bowel indicates...

Gallstone ileus

Complication: small bowel obstruction

11

Pt presents with dull, aching LUQ pain. They have a low-grade fever, feel nauseous and are vomiting. They've noticed abnormal bowel movements.

Likely cause?
Treatment?

Diverticulitis
- E coli
- B fragilis

Uncomplicated: Co-amoxiclav, ciprofloxacin + metronidazole

Complicated: piperacillin-tazobactam

12

Pt presents with faecal-like vomiting, constipation and abdominal pain + distension. They have a PHx of Crohn's.

Likely cause? Management?

Small Bowel Obstruction

Nasogastric decompression

IV Fluid

Laparotomy

13

Pt presents with rapid abdominal distention, and intermittent pain.

They have been unable to pass wind OR faeces.

Likely cause? Treatment

Large bowel obstruction

Nasogastric Compression

IV Fluid

Laparotomy

IV Neostigmine if CT finds pseudo-obstruction

14

Squamous Cell Carcinomas occur where in the oesophagus? What are the RFs for SSCs?

Upper 2/3

Alcohol, smoking

15

Adenocarcinomas occur where in the oesophagus? What are the RFs for Adenocarcinomas?

Lower 1/3

Barret's/ GORD, gland.

= most common!

16

Pt presents with lymphadenopathy and abdominal pain. They are being treated for Pernicious anaemia.

Likely cause? Other RFs?

Adenocarcinoma (epithelial) of the stomach.

RF: H pylori, N-nitroso, Pernicious anaemia

17

Who should undergo a prophylactic proctocolectomy?

Someone with an APC mutation - Familial Adenomatous Polyposis

Huge risk of developing colon cancer

18

What percentage of colorectal cancers occur in the colon vs rectum?

Colon - 71%

Rectum - 29%

19

What would a biopsy show in a pt with Barrett's oesophagous?

Lower 1/3 stratified squamous > stratified columnar.

Oesophagoscopy - salmon mucosa

20

Pt presents with upper web, post-cricoid dysphagia and is found to have iron-deficiency anaemia.

What is the diagnosis?

Plummer-vinson Syndrome (Squamous Cell Carcinoma)

21

GORD Management

PPI - Omeprazole

+/- Adjunct Famotidine (H2A)

22

Pt presents with upper abdominal pain which is worse when hungry, and eased with eating. They're also bloated and nauseous/ vomiting

They are taking aspirin, steroids, are on SSRIs and are Blood-type O.

Likely diagnosis?

DUODENAL Ulcer

23

Pt presents with upper abdominal pain which is worse when hungry, and eased with eating. They're also bloated and nauseous/ vomiting.

They were recently diagnosed with H pylori, and live a stressful lifestyle.

Likely diagnosis?

GASTRIC Ulcer

*Other RF include anything that delays gastric emptying + NSAIDs

24

Management of Peptic Ulcer Disease

ie duodenal/ gastric ulcers

4-8 wk PPI - Omeprazole

If H Pylori:
PPI + 2 ABx
- Amoxicillin + Clarithromycin 1wk

If penicillin allergy: Metronidazole + Clarithromycin

25

Ulcerative colitis endoscopy shows

Crypt abscesses

26

Crohn's endoscopy shows

NON-caseating TRANSMURAL inflammation in SKIP lesions

(Broad linear, transverse, longitudinal ulcerations + inflamed mucosa)

27

Coeliac disease endoscopy shows

Villous atrophy
Crypt hyperplasia
Lymphocytic infiltration

28

Extra intestinal symptoms of ulcerative colitis

Arthritis
Conjunctivitis
Clubbing
Pyoderma Gangrenosum

29

Pt presents with severe abdominal pain. The pain is episodic and exacerbated by eating. You suspect an ulcer.

Investigations?

1L
- 13c Urea Breath Test (H pylori?)
- Stool Antigen test

GOLD: Upper GI endoscopy

30

GORD Mx

1L: PPI - Lansoprazole

2L: H2 receptor blocker - Ranitidine