GI Core Conditions Flashcards

Question

Differentials for upper GI bleeds?

Answer 1

``` Gastric varices Mallory-Weiss tears Neoplasm Benign tumour Cirrhosis ```

Answer 2

Endoscopy | LFTs, FBC, coag, cross match, Ca and Gastrin levels

Answer 3

``` Stop NSAIDs, warfarin, aspirin Give O2 Saline if not shocked, blood if shocked Omeprazole for ulcer patients Monitor for signs of rebleed ```

Answer 4

``` Elderly Coagulopathy Anticoagulated Liver disease NSAIDs GORD Gastritis Colorectal cancer ```

Answer 5

Blood in stool (maroon --> bright red) Abdo/rectal pain Diarrhoea Mucous (IBD in the young, ischaemic colitis in the old) Blood drops in toilet (fissures/haemorrhoids) Massive haemorrhage presents with systolic <90mmHg and Hb<6g/dL

Answer 6

``` Colorectal cancer Diverticulosis Angiodysplasia Proctitis Infective/ischaemic colitis ```

Answer 7

Colonoscopy Faecal occult blood test Angiography (for angiodysplasia)

Answer 8

O2, vital signs monitor, IV fluids, surgery or endoscopic haemostasis

Answer 9

Younger people Women>Men People of Jewish heritage

Answer 10

Genetics Immune system disruption Environmental (disease f the west) Mycobacterium avium paratuberculosis

Answer 11

``` Western diet Younger age (more aggressive disease) Smoking FHx Intestinal parasite exposure Long term use of OCP Caucasian/Jewish ```

Answer 12

``` Diarrhoea Abdo pain Weight loss Malaise Lethargy Nausea/vomiting Fever RIF pain Aphthous ulcers Skip lesions ```

Answer 13

``` Coeliac disease Lactose intolerance UC Functional diarrhoea GI infection (TB) Colorectal malignancy Anorexia nervosa Appendicitis Diverticulosis Gastroenteritis ```

Answer 14

``` Serum B12 FBC, inflammatory markers, LFTs, blood cultures pANCA -ve Saccaromyces cerevisiae Ab PRESENT Stool cultures Radiology ```

Answer 15

Control diarrhoea (loperamide or codeine phosphate) Glucocorticosteroids (budenoside) Enteral nutrition Aminosalicylates (azathioprine) Immunosuppression with monoclonalAbs (infliximab) Surgical resection

Answer 16

People of Jewish heritage

Answer 17

Genetics Immune system Environmental

Answer 18

``` Western diet Younger age (more aggressive) FHx NSAIDs Intestinal parasite exposure ```

Answer 19

``` Diarrhoea with blood/mucous Malaise Lethargy Anorexia + weight loss Proctitis + blood in stool Urgency and tenesmus Distended abdomen PR may show blood ```

Answer 20

``` Crohn's Functional diarrhoea GI infections Malignancy Diverticulitis Polyps IBS ```

Answer 21

FBC, LFTs, U+Es, CRP Faecal calprotectin pANCA +ve Saccharomyces cerevisiae Ab possible Stool cultures Sigmoidoscopy (rigid) shows inflamed, bleeding, fraible mucosa AXR - lead piping (chronic) and thumbprinting (exacerbation)

Answer 22

Oral aminosalicylate (azathioprine) and steroids, Ciclosporin (cannot be used long term) Infliximab Surgery

Answer 23

A bout of gastroenteritis

Answer 24

Unknown Changes in gut bacteria/digestive ability More sensitive to gut pain Psychological factors Post food poisoning Certain foods (caffeine, fatty foods etc)

Answer 25

Acute GI infection/inflammation Young Female FHx

Answer 26

``` Diarrhoea Constipation Abdo pain Bloating Worse on eating Relieved on defaecation Lethargy Nausea Backache Bladder symptoms ```

Answer 27

``` IBD Colonic cancer Coeliac disease Gastroenteritis Diverticular disease Endometriosis Ovarian tumours Anxiety/depression Somatisation ```

Answer 28

``` FBC, inflammatory markers Coeliac serology Lactose intolerance testing Stool culture Colonoscopy (malignancy suspected) Faecal calprotectin CA125 (if concerned about ovarian cancer) ```

Answer 29

``` Diet change Exercise Laxatives Antidepressants Hypnotherapy Probiotics Smooth muscle relaxants (alverine) ```

Answer 30

Adenovirus/rotavirus

Answer 31

Anyone (mainly children) Travel to foreign countries Infants in day care Elderly

Answer 32

Norovirus Rotavirus Adenovirus

Answer 33

``` Campylobacter E coli (esp O157) Salmonella Shigella Staph aureus toxins Bacillus cereus C perfringens ```

Answer 34

Cryptosporidium spp Entamoeba histolytica (amoebiasis) Giardia lamblia

Answer 35

Poor hygeine/sanitation Compromised immune system (HIV/AIDs) Achlorydia (esp for salmonella and campylobacter ) Food poisoning

Answer 36

V+D, abdo pain Blood suggests E coli, E. histolytica or if from exotic location - salmonella Pyrexia and fatigue in adults suggests invasive organism

Answer 37

``` Travellers diarrhoea Volvulus UTI Constipation with overflow gastritis NSAID or alcohol abuse IBD Addison's (Pre) eclampsia ```

Answer 38

Stool microscopy, culture and sensitivity (if blood/mucous in immunocomp pts) Bloods in patient is unwell Bowel distention = imaging

Answer 39

ORS for the frail/elderly Small light meals Prevent infection spread (avoid work until 48 hours post diarrhoea) Loperamide for adults with normal diarrhoea (no blood, mucous, pyrexia) Abx for bacterial/protozoal infections (metronidazole or oral vancomycin)

Answer 40

Alcohol abuse

Answer 41

a) 38 | b) 69

Answer 42

``` Gallstones Alcohol Infections (mumps, coxsackie B) Pancreatic tumours Drugs (valproate, corticosteroids) Ischaemia Trauma ```

Answer 43

``` Anatomical or functional disorders (sphincter of Oddi dysfunction) SLE Alcohol abuse Hypercalcaemia Hyperparathyroidism Vasculitis Hyperlipidaemia ```

Answer 44

Epigastric pain N+V Radiates to back Tenderness and guarding Reduces/absent bowel sounds in late stages Severe necrotising pancreatitis leads to Cullen's (periumbilical) and grey Turner's (right flank) Jaundice/cholangitis if gallstones

Answer 45

``` Acute mesenteric ischaemia Cholangitis Cholecystitis Ectopic pregnancy Diabetic ketoacidosis Perforated duodenal ulcer Atypical MI ```

Answer 46

``` Serum amylase (3x normal levels = diangosis) Serum lipase FBC, LFTs, U+Es, inflammatory markers CXR Abdo US CT/MRI ```

Answer 47

``` Normal ward Pain relief IV fluids NBM Abx if specific infection No imaging ```

Answer 48

``` STEP UP TO HDU Necrosis = IV Abx Enteral nutrition Surgery if necrosis Percutaneous catheter to drain Hyperbaric O2 therapy ```

Answer 49

M>F, >40 years old

Answer 50

Reduced bicarb excretion --> activation of pancreatic enzymes Genetic Autoimmune (PBC and sjorgens have assocaiteions) Abnormal pancreas Biliary tract disease

Answer 51

``` Alcohol Smoking Anatomical or function disorders SLE Hypercalcaemia Hyperparathyroidism Vasculitis ```

Answer 52

``` Epigastric pain Radiates to back N+V Anorexia Severe weight loss Exocrine ad endocrine insufficiency Cholangitis and jaundice ```

Answer 53

``` Cholangitis Cholecystitis Crohn's Gastritis Mesenteric artery ischaemia Peptic ulcers Pneumonia MI AAA Acute hepatitis ```

Answer 54

``` Serum amylase. serum lipase, LFTs, FBC, inflammatory markers, BM, creatinine CXR Abdo US CT/MRI Faecal elastase levels PABA test Secretin stimulation test Diagnostic ERCP ```

Answer 55

``` Stop drinking alcohol Stop smoking Analgesia - amitriptylline Enzyme replacements if malabsorption occurs Restrict fat in diet if steatorrhoea is present Insulin if diabetes develops Vitamin supplements may be needed Surgery ```

Answer 56

Cholesterol (80% in the Western world) Pigment Mixed

Answer 57

``` Fat Female Fertile Forty Fair ```

Answer 58

Lack of melatonin | Melatonin inhibits cholesterol secretion and enhances its conversion to bile

Answer 59

``` Increasing age Female FHx Multiparity Obesity Rapid weight loss High fat, low fibre diet OCP DM Cirrhosis ```

Answer 60

``` Asymptomatic Biliary colic Crescendoing abdo pain Worse on eating fatty foods Epigastric pain --> shoulder tip N+V Cholecystitis = +ve Murphy's sign ```

Answer 61

``` Reflux IBS Pancreatitis Right colon cancer Atypical peptic ulcers Renal colic ```

Answer 62

``` LFTs, FBC ECG CXR Abdo US Biliary scintigraphy using technetium derivatives of iminodiacetate (outlines the biliary tree apart from in acute cholecystitis) ```

Answer 63

Cholecystectomy Stone dissolution Stone wave lithiotripsy

Answer 64

Hepatitis A

Answer 65

Faecal-oral

Answer 66

2-6 weeks, most infectious 2-3 weeks post infection

Answer 67

``` Poor sanitation Men who have sex with men Sexual practices with oro-anal contact Sweage/lab workers HIV Travel to high risk areas Receiving factor VIII and IX Not vaccinated ```

Answer 68

Flu-like prodrome (precedes icterus phase) Poor appetite Pressure/pain from enlarged liver Skin rash More developed stages: jaundice, dark urine, pale stools, abdo pain, pruritus

Answer 69

``` Drug induced liver injury Ischaemic hepatitis HIV CMV Other forms of viral hepatitis ```

Answer 70

IgM Ab for HAV appears with symptoms and persists for 3-6 months IgG appears soon after IgM and persists for years (indicates previous infection or immunisation) LFTs, PTT US if concern about cause

Answer 71

Immune system can deal with it Analgesia Fluids Admit if vomiting/systemically unwell

Answer 72

Africa Middle East Far East

Answer 73

Parenterally | Vertical transmission is common

Answer 74

High replication rates | More infectious disease

Answer 75

2-3 months

Answer 76

``` Alcohol use Poor sanitation Needle sharing MWHSWM HIV +ve Sexual contact Liver disease O-A contact Lab/sewage workers ```

Answer 77

``` Anorexia/nausea RUQ ache Insidious onset Malaise, fatigue Slight fever Aching joints/muscles Headache More advance = jaundice ```

Answer 78

``` Drug induced Ischaemic Wilson's Acute fatty liver of pregnancy Other forms of hepatitis ```

Answer 79

``` HBsAg HBeAg Anti-HBe Anti-HBs Anti-HB core Quantitative Hep B viral DNA HBV genotype HDV serology LFTs, FBC Autoantibody screen Check for HCV ```

Answer 80

Stop alcohol Stop unnecessary drugs Pts with E Ag HBV or decompensated liver disease get 48 weeks of peginterferon alpha-2a

Answer 81

Parenteral transmission

Answer 82

``` IVDU Male >40 (worse prognosis) Drink alcohol Co-infection with HIV, HBV Immunosuppressed Obese DM ```

Answer 83

3 Genotype 1 requires most treatment Can be cross infected

Answer 84

``` IVDU Blood transfusions Pregnancy/BF Sexual intercourse (rare) Needlestick Non-sterile piercings/tattoos/medical equipment ```

Answer 85

Often asymp Chronic infections --> malaise, lethargy, weakness, anorexia Acute: jaundice and deranged LFTs 75% --> chronic (cirrhosis + HCC)

Answer 86

``` Drug induced Ischaemic Wilson's Acute fatty liver of pregnancy Other hepatitis types ```

Answer 87

``` Anti-HCV serology (+ve 3 months post exposure) HCV RNA (shows ongoing activity) Anti HCV Abs (remain for life) Baseline US Biopsy LFTs ```

Answer 88

Uncomplicated + acute = supportive Early interferon may prevent complications (unlicensed) Peginterferon alpha 2-a (SC, weekly) Daily (oral) ribavirin Genotype 1 requires bocepavir and telaprevir

Answer 89

5% of HBV carriers | IVDUs

Answer 90

Parenterally

Answer 91

A defective single strand RNA that requires the presence of HBsAg to replicate

Answer 92

``` Co-infection = acquired at the same time Superinfection = HBV acquired first then subsequent HDV infection ```

Answer 93

Sharing neeldes MWHSWM HIV Blood transfusions

Answer 94

``` Anorexia Nausea RUQ ache Insidious onset Malaise, lethargy Fever Aching muscles/joints Headaches Skin rash Later = jaundice ```

Answer 95

Anti-HDV Ab LFTs Hep B investigations

Answer 96

Interferon a and lamivudine | Transplantation

Answer 97

Pregnancy and intrauterine infections

Answer 98

Faecal-oral route

Answer 99

``` Alcohol Poor sanitation Needle sharing MWHSWM HIV Oral-anal contact Lab/sewage workers Liver disease ```

Answer 100

``` General malaise Slight fever Nausea Anorexia Taste changes RUQ ache Aching joints/muscles Headache Skin rash More developed = jaundice ```

Answer 101

``` Drug induced Wilson's Ischaemic hep Acute fatty liver of pregnancy Other hep causes ```

Answer 102

IgM anti-HEV Ab | HEV RNA can be detected in serum or stools

Answer 103

Supportive | No documented cases of chronic infection

Answer 104

Appendicitis

Answer 105

Mainly teenagers and young adults More common in the West M>F (slightly)

Answer 106

Faecal matter trapped in appendix causing blockage and allowing bacteria to multiply IBD

Answer 107

``` Age (11-20) Male Low fibre, high refined carbs FHx GI infections (amoebiasis) Bacterial gastroenteritis Mumps Adenovirus ```

Answer 108

Abdo pain that begins paraumbilical and then localises to the RIF (McBurneys point) N+V Anorexia Rebound tenderness due to localised peritonitis Fever + tachycardia suggest peritonitis

Answer 109

``` Bowel obstruction Strangulated hernia Perforated ulcer Acute terminal ileus due to Crohn's Pancreatitis Diverticulitis Ruptured ectopic Ovarian torsion Ovarian cyst rupture Testibular torsion Renal calculi UTI ```

Answer 110

``` Abdo exam US and CT Urinalysis FBC, inflammatory markers Cross match and coag screen ```

Answer 111

Open/laproscopic appendectomy | Abx to prevent infection

Answer 112

Often seen in those with dementia, MS, Parkinson's, quadreplegia

Answer 113

``` Adhesions Hernias Crohn's Intussusception (children) Malignancy ```

Answer 114

``` Paralytic ileus Intestinal pseudo-obstruction (Ogilive's syndrome) Post-operative ileus/strictures Congenital GI malformations Meconium ileus in CF Hirschsprung's Malignancy (rare - would be in caecum) ```

Answer 115

``` Abdo colic Abundant vomiting Late = absolute constipation Quickly progressing Severe pain + tenderness suggests perforation Distention Visible peristalsis ```

Answer 116

``` Gastroenteritis Ischaemia of the gut Pancreatitis Perforation Peptic ulcers LBO Consider MI ```

Answer 117

``` Abdo exam Check for femoral hernias AXR FBC, U+E, creatinine, cross match CT + US ```

Answer 118

IV fluids Decompression Laparotomy with removal of obstruction if gangrenous tissue is present

Answer 119

Colorectal cancers

Answer 120

>70 years old

Answer 121

Carcinoma Sigmoid volvulus Diverticular disease

Answer 122

``` Colorectal cancers Paralytic ileus Intestinal pseudo-obstruction Post-operative ileus Congen GI malformations Meconium ileus in CF Hirschsprung's ```

Answer 123

``` Pain Tenderness Tinkling bowel sounds Absolute constipation Distention Severe pain + tenderness suggest perforation ```

Answer 124

``` Gastroenteritis D+V tinkling Ischaemia of the gut Perforation Pancreatitis Peptic ulcers Consider ovarian carcinoma ```

Answer 125

``` Abdo exam AXR US + CT FBC, U+E cross match, creatinine Enema if suspicious of low level obstruction Water soluble enema for adhesions ```

Answer 126

``` IV fluids Decompression Colorectal stents Defunctioning colostomy Sigmoid volvulus may be managed with a flexible sigmoidoscope or rectal tube Persistent volvulus = RESECTION ```

Answer 127

Parous women, middle aged/elderly

Answer 128

``` Chronic constipation Chronic cough Heavy lifting Obesity Straining to urinate (enlarged prostate) ```

Answer 129

Obesity | Smoking

Answer 130

Lump in groin, lateral and inferior to the pubic tubercle (large may bulge over the inguinal ligament) Cough impulse Reduces when relaxed/supine Can be reducible/non-reducible/strangulated/obstructed

Answer 131

``` Inguinal hernia Lymph node in groin Ectopic testes Psoas abscess Psoas bursa Li[oma Hydrocele Varicocele ```

Answer 132

Mainly clinical exam Exploration at surgery Herniography may be performed for groin pain

Answer 133

Surgery (low, transinguinal or high approach) that involves dissecting the sac and reducing its contents, ligating the sac and closing the inguinal and pectineal ligaments LA or GA Laproscopic studies seem promising

Answer 134

``` Chronic constipation Chronic cough Heavy lifting Obesity Straining to urinate ```

Answer 135

``` Infants (male, premature) Male Obese Constipation Chronic cough Heavy lifting ```

Answer 136

Swelling in groin Severely painful Cough impulse May be reducible Enlarges with time due to fibrous adhesions (may stop being reducible) Examine standing and supine, ask to cough Can become strangulated Congenital inguinal hernias need urgent surgical repair

Answer 137

``` Femoral hernia Hydrocele Varicocele Spermatic cord hydrocele Lymph node Abscess Bleeding Undescended testes ```

Answer 138

US | Herniography with XR contrast in peritoneum

Answer 139

Small = none More complicated = reduction/excision of sac and closure of defect Lapro if bilateral/recurrences Surgery can be day case Avoid driving/lifting for 7 days post-repair In children herniotomy (ligation and excision of patent processus vaginalis) is performed