GI FCM

Question 1

How would acute cholecystitis present?

Answer 1

murphy’s sign - pain radiates to back or right shoulder
fever
nausea & vomiting

Question 2

How would cholelithiasis present?

Answer 2

RUQ pain - severe pain
nausea and vomiting
similar to acute cholecystitis

look out for:
evidence about stones
female obese/overweight in her 40s

Question 3

How would you investigate cholecystitis?

Answer 3

Bloods - CRP, WCC, Bilirubin, LFTs

Abdominal ultrasound

Question 4

How would you manage acute cholecystitis?

Answer 4

fasting to help relieve the gallbladder and allow it to heal the gallbladder
pain for analgesia
IV fluids and antibiotics

Question 5

How would you manage gallstones/cholelithiasis?

Answer 5

diclofenac for severe pain or IM opioid

removal of stones laparoscopic cholecystectomy

Question 6

What are key things in a Hepatitis presentation

Answer 6

dark urine/pale stools
abdo pain 
loss of appetite
jaundice 
high alcohol consumption 
patient has had a scan

Question 7

How is hepatitis investigated?

Answer 7

Bloods - LFTs, FBC, CRP/ESR
abdo US
liver biopsy/serology

Question 8

How is hep A managed?

Answer 8

No Tx necessary
bedrest, hydration & pain relief
metoclopramide for N&V
itching relieved by using chlorphenamine or corticosteroids

Question 9

How is Hep B managed?

Answer 9

pain relief & hydration
antiemetics
chlorapenamine/corticosteroids for itching
anti-viral if chronic

vaccinations act as a preventative measure

Question 10

How is Hep C managed?

Answer 10

antiviral medications to treat both acute and chronic hepatitis C

Question 11

How is Hep D managed?

Answer 11

a-interferon can be used to treat HepD

prevented through vaccinated against HepB

Question 12

How is autoimmune hepatitis managed?

Answer 12

corticosteroids like prednisolone/budesonide used to treat autoimmune hepatitis
Azathioprine (Imuran) - suppresses immune system
other immunosuppressive drugs such as mycophenolate, tacrolimus and cyclosporin

Question 13

How does cirrhosis present?

Answer 13

Jaundice - sclera
abnormal bruising 
peripheral oedema 
ascites 
variceal bleeding 
confusion - hepatic encephalopathy
spider navei 
palmar erythema and muscle wasting

Question 14

Things to look out for in cirrhosis history?

Answer 14

chronic alcohol abuse
overweight/obese
having viral hepatitis

Question 15

How is cirrhosis managed?

Answer 15

Tx for alcohol dependency 
weight loss & BM control 
antivirals if viral hepatitis present 
pain relief 
chloraphenamine/corticosteroids for itch

Question 16

How does hepatic neoplasms present?

Answer 16

jaundice 
pale stools 
ascites 
unintentional weight loss 
loss of appetite 
upper abdo pain 
nausea & vomiting

Question 17

How is hepatic neoplasms investigated?

Answer 17

Blood tests - LFTs
Liver biopsy
imaging - US/CT

Question 18

What does management of hepatic neoplasms involve?

Answer 18

surgery - remove tumour if the liver is still functional and the cancer hasn’t metastasised
- liver transplant if too severe

localised treatments - chemo/radiotherapy, immunotherapy and palliative care

Question 19

How does acute pancreatitis present?

Answer 19

epigastric abdo pain - worse after eating and radiated to your back - worse when moving and better when in the fetal position
nausea and vomiting
abdominal tenderness - rebound/guarding
Abdominal distension
Cullen’s signs = bluish colour around umbilicus
tachycardia and hypotension - due to shock

Question 20

How is A.pancreatitis investigated?

Answer 20

blood test - elevation of lipase and amylase

Imaging such as CT and MRI or US

Question 21

How is A.pancreatitis managed?

Answer 21

Initial Tx

• rescusitation with IV fluids
• supplemental O2
• pain relief
• Abx if infection is suspected
• Early nutritional support - enteral feeding
• endoscopic retrograde cholangiopancreatography or cholecystectomy

Question 22

What does the presentation of pancreatic neoplasms include?

Answer 22

painless jaundice 
itchy skin 
weight loss 
light stools and dark urine 
fatigue and weight loss

Question 23

How are pancreatic neoplasms investigated?

Answer 23

Ultrasound imaging
tissue biopsy
blood tests - amylase and lipase levels and CA19-9

Question 24

How are pancreatic neoplasms managed?

Answer 24

surgery to remove the tumour

chemo/radiotherapy (prior/adjunct and post surgery)

Question 25

How does a hiatus hernia present?

Answer 25

``` chest/epigastric pain - worse when lying down or leaning forward difficulty swallowing belching vomiting SOB ```

Question 26

How is hiatus hernia investigated?

Answer 26

X-ray of upper GI tract - barium enema Upper GI endoscopy oesophageal manometry

Question 27

How is hiatus hernia managed?

Answer 27

omeprazole, H2-receptor blockers and PPIs laparoscopic surgery may be required lifestyle changes

Question 28

what is Gastritis presentation like?

Answer 28

burning sensation/pain nausea and vomiting belching/indigestion weight loss/loss of appetite

Question 29

Investigations of gastritis?

Answer 29

H.pylori testing stool tests endoscopy blood test - FBC (check for anaemia)

Question 30

How is gastritis managed?

Answer 30

lifestyle changes - avoid alcohol, salt, caffeine and change eating habits and smoking cessation medications - omeprazole - stop NSAIDs

Question 31

what is most characteristic of peptic ulcer disease?

Answer 31

dypepsia symptoms - bloating/belching/nausea&vomiting | melena stools

Question 32

What is the management of peptic ulcer disease?

Answer 32

Omeprazole If H.pylori present - give eradication therapy cytoprotective agents - misoprostol and sucralfate

Question 33

Gastric neoplasms presentation

Answer 33

``` haematemesis nausea and vomiting fevers and weight loss unexplained weight loss dyspepsia jaundice in some cases ```

Question 34

How are gastric neoplasms investigated?

Answer 34

Upper GI endoscopy biopsy of stomach CT/X-rays (masses and any metastasis) bloods