GIT Flashcards
(48 cards)
appendicitis
RF younger
Sx anorexia, fever, rif pain
OE rosvig pos, psoas and obturator, mcburny point tenderness.
Ix: USS,
Dx: clinica/imaging
Rx: OT.
ascending cholangitis - biliary tree bact infection secondary to statis of some form.
RF: >50, stones, primary/secondary cclorosing cholangitis, stricture of biliary tree. injury to bile duct (OT)
** Sx/OE: fever, ruq pain, jaundice.
Ix inflam markers, elevated bili/GGT/ALP; uSS/CT to identify cause of obstruction
Dx Sx and evidenc einflam (imaging/bloods)
Rx urgent OT, ERCP. amp/gent/met
cholecystitis
RF aging, FHx same, obesity, sudden weight changes, DM , pregnancy, ocp.
Sx severe RUQ pain, radiatse to back/shoudler, n/v/fever. often w colic sx
** OE (differentiates from colic), local peritonism. murphy pos. fever
Ix: USS, CBD > 6mm wall.. ECG/amylase.CXR for ddx, LFT but non specific.
Dx uss
Rx admit, lap chole, abx.
diveritculitis
RF age, smoking, obesity, low fibre diet
Sx LLQ pain, change in bowel habit, previous hx of same, n/v/fever/pr bleeding
OE usually LLQ tender, clinical sx cosntipation
Ix CT A/P w contrast
Dx CT/hx.
Rx :
- mild: tol PO intake and no comrobidity: bowel rest, simple anagliesa, low fibre diet 2-3 days.
- > 48 hours ongoing/worsenning/red sided Sx or immunosup: Aug DF BD 5 days, if severe then hospital iv gent/met/amp.
food intol: non immune mediated. ?sensitised nerve fibres.
RF: BS, hedaches…
Sx: any age, hours - days. variable reaction.
- bowel irritation, headaches, fatigue, mouth ulcers, sinus cnogestion, hives/swelling, sometimes eczema/rash
- often dose dependent…
- commonly: MSG, food additives, cereals, dairy.
Ix: elimination diet. no specific testing required.
Dx: clinical
Rx: dietary modification.
DDx oral allergy syndrome (raw fruit/veg w perioral sx/rhinitis), coeliac, tick bite (mammalian meat allergy), exercise induced food dept. allergy.
food alergy : igE mediated
RF IBS
Sx: childhood onset. allergenic reaction immediately (mins - hours), reproducible.
- rash aroudn mouth, urticaria, angioedema, vomitting, sob, anaphlyxais (varies on scale)
- commonly eggs milk peanut tree nut sesame crustaceans, wheat. soy.
Ix: skin prict tests, IgE specific allergenic test (RAST)
Dx: hx/ix.
Rx
- complete avoidance.
- non treanut/seafood allery improve w age.
- anaphylaxis managment plan.
- loratiadine vs. nocte doxylamine.
- consider referral for desensitisation.
DDx coleaic, tick bite (mammalian meat allergy), exercise induced food dept. allergy.
food allergy: non Ige mediated/mixed food allergy
coeliac
eosinophillic oesophagitis
FPIES. (food protein induced enterocollitis syndrome)
- cows milk, fish, chikcen, rice) - recurrent vomitting 1-4 hours after eating.
intersusseption
- invagination of bowel onto itself
- sequalae BO, congestion of mesenteric vessels, ischaemia of bowel wall.
RF: 2 months - 2 yeras. recent intussusception, meckels diveritumul, HSP, lymphoma, recent rotavirus vaccine, recent bowel surgeyr,.
Sx: intermittent abdo pain/distress (increases 12-24 hours), well between episodes. palpable abdo mass. red current jelly stools.
OE: sausage shaped mass in R abdomen. shock, peritonitis if per, distended if obstructed.
Ix: USS, can do AXR is BO/perf. but not diagnostic.
Dx: USS/clasically sx/age
Rx: analgesia, fluid bolus, NGT if BO, IV amox/gent/met, Surg review w NBM (can self reduce)
DDx
ischaemic colitis
- chronic ischaemic ischaemia = low flow to artery in mesentry, mild to gangrenous colitis/acute.
RF: vasc RF. AF. age.
Sx: severe abdo pain, bloody diarrhoea, unwell. shock. RLQ usually.
OE: degree of illness out of proprtion to clinical signs.
Ix CT, colonoscopy /biopsy gold standard.
Dx colonoscopy urgent.
IBD extraarticualr
Ank Spond
uveitis
pyoderma gangrenosum
erythema nodosum
apthous ulcers
primary sclerosis cholangitis
vte
coelaic
Ix
- TTG, IgA level . +/- EMA
anti gliadin antibody is less specific.
Mx:
- scope to confirm + repeat at 12 months post diagnosis
- bloods repeat at 6-12 months post GF diet to see if resolved.
- monitor b12/folate/TSH/vit D + BMD consideration.
- screen family members
- consider PTH/zinc.
- DT
watch for lymphoma. adenocarcinoma. IBD, primary billiary cirrhosis, dermatitis herpetiformus.
join coeliac society.
IBS Dx/OE
cause not clear - visceral hypersensitivity/diet/gut micro/stress.
Ddx: functional; bact.overgrowth (if bloating/flat main issue)
Dx: abdo pain/discomfort > 3 / month, for 3 months, w > 2:
1) improvement w defecation
2) onset of Sx associated w change in bowel frequency
3) onset of Sx associated w change in stool appearance.
OE: not much to find - rule out ddx: coeliac (EMA/antiTTG)/ibd (calprotectin)/pancreatic insuf (fecal elastase)
- often associated: migraines, dysmenorrhoea, FM, anxiety/dept/reflux/urinary frequ
no specific Ix for Dx.
IBS Mx
Mx:
- non pharma:
- reassure no long term sequalae, explain aeitology
- often food intolerance related: exclusion diet, gradual reintroduce once found trigger. (DT)
- stop smoking
- weight reduction
- optimise diet
- reduce gums/fizzy drinks
- reduce etOH
- regular meals/sleephygiene
if diarrhoea PRN loperamide
if constipatino gentle fibre - metamucila good option, avoid bran.
if abdo pain; buscopan.
+/- SSRI.
Crohns (IBD)
PC: 20s usually.
mouth to anus, skip lesions. get fistulas/perianal disease.
Sx: abdo pain, diarrhoea, weight loss, mailaise, anorexia, obstructive/fistla/blood diarrhoea. nutritional def.
NOCTURNAL BO = IBD.
clue for Dx: pos faecal calprotectin. (elevated CRP, low labumin, iron def anaemia)
Dx : scopes
IBD Mx
RF for poor outcome:
- > 5kg weight loss, unable to manage ADLs, steroids at first presentation, not eating, longterm reliance on opioids for pain.
Mx:
- no cure, goal to treat active disease/improve wellbeing/maintain steroid free remission/prevent complications.
1) sulfasalazine, c/sterods for flare; with GE
metro for fistula flares.
2) regular review for sx severity/condition review
3) annual colonoscopic surveillance if high risk; otherwise 3-5 yearly.
4) DEXA
5) monitor bloods
6) PCV, HPV/HBV. avoid live if immunosuppressed.
7) 1-3 yearly CST if on immunomodulators.
8) quit smoking
9)psychological impact.
UC
PC: large intestine/retrograde from rectum. continuous.
commonly bloody diarrhoea.
- watch for toxic megacolon complication
Mx: as above, also consider surgical removal of large intestine if severe/refractory.
localised enemas w mesalazine/PR steroid etc. THEn PO
IBD e/articular Sx
- large joint arthorpathy
- ank spond
uveitis
iritis
episcelritis
conjunctivitis
pyoderma gangrenosum (ulcer)
erthema nodosum (painful)
apthous ulcers
primary sclerosing cholangitis
VTE
gallstones
lactase def
frothy, watery, explosive diarrhoea - soon after ingestion of lactose.
most commonly associated w acute GI post infection / loss of enzyme, can go on for 1-2 weeks.
- ddx: zollinger eliison syndrome/sensory loss w Dm arthroapthy, progressive diasabiltiy w CF, whipples, tropical sprue, HIV enetropathy, coealiac spru.
barrets
relative risk increased for adenocarinoma oesphagus
absolute risk < 2% life time risk.
RF: central obesity, smoking, fhx cancer, sex,a ge, hx GORD.
Dx: endsocopy - metaplasia from squamous to columnar
Mx:
endoscopy screening program. modify RF w lifestyle changes.
consider PPI - wont regress but helps symptomatically.
PPI SFX
long term:
micronutrient def - b12/folate
OP
infections such as GE
hypomagnesemia
alopecia
photosesitivity
impaired LFTs
EoE
same as GORD; but intermittent bolus obstructions.
specific food trigger often.
RF male > female, atopic hx
Dx: endoscopic appearans/histo findings. peristent gastric eosinophillia after PPI trial (GORD will improve)
if severe: risk boerhaave syndrome.
Mx:
NON PHARMA
-dietary exclusion - consider allergy patch testing
-6 food elimination: milkd, wheat, egg, soy, nuts then reintroduce.
PHARMA
-topical fluticasone (swallow MDI rather than inhale, 2 puffs BD)
-SFX: candidiasis.
final: dilatataion
GORD red flags
red flags
- dyaphagia, odonyphagia
- haematemeis
- weight loss
- > 55
- iron def +/- anaemia
- nocturnal abdo pain
- persistent
- FHx?Phx barrets/GI maliganncy
- new or changing Sx, particularly in older person
- inadequate reponse to PPI.
GORD Ix + HPylori
only Ix if red flags/Sx refractory to Rx/diagnosis unclear.
1) endoscopy, 2/4 patients will have negative endoscopye.
2) consider HPylori - post Rx confirm if negative at 6 weeks.
- do for all < 55 yo. or if any RF: (lower SES, migrant/refugee, fhx PUD/gastric cancer)
Dx otherwise based on therapeutic trial of PPI 2weeks.
- if no red flags, and improved w PPI, then reduce to prn
GORD Mx
Non pharma
- raise bed head, weight loss, smoking cessation, small/regular meals,. avoid acidic foods/hot drinks, avoid lying down after eating, fluid in between meals not prior, eat > 3 hours until bed.
Pharma
- cease nsaids/bisphosphonates, avoid drugs relaxing LOS: ccb/nitrates/cholinergics
- Rx Hpylori (calrithro/amoxyl/ppi), if pos (2 weeks better)
- PRN gastrogel 10-20mL/ H2 receptor antag ranitidine 150mg,
+ PPI 20 –> if insuff 20 BD –> 40 BD if ongoing but refer at this point.
- trial PPI for 4-8 weeks; then down titrate slowly then PRN only.
