Term
| name urgent or easily missed medical causes of abdominal pain |
|
Definition
MI
DKA
lower lobe pneumonia
sickle cell
hypercalcemia
hereditary angioedema |
|
|
Term
| name urgent or easily missed gynae causes of abdominal pain |
|
Definition
ectopic
placental abruption: can be concealed bleeding
ovarian hyperstimulation syndrome during assisted conception |
|
|
Term
| name urgent or easily missed surgical causes of abdominal pain |
|
Definition
AAA dissection
bowel ischemia e.g. mesenteric ischemia: pain out of proportion to clinical signs
generalised peritonitis
obstruction
testicular torsion with referred pain to abdomen
urinary obstruction: can be missed if not palpated for enlarged bladder
abssess: subphrenic, pelvic or psoas |
|
|
Term
| always do vital signs in acute abdomen...subtle changes in vital sign can tell you a lot... in ectopic pregnancy what might you find in the vital signs? |
|
Definition
|
|
Term
| if the pt is shocked what can you do? |
|
Definition
| give fluids until radial pulse is palpable and get senior help |
|
|
Term
| list red flags and alerting features in chronic or subacute abdo pain |
|
Definition
age >60
anemia
FHx of ovarian bowel can or FAP
unexplained weightloss
repeated consultations
organomegaly or masses |
|
|
Term
| in which groups should you have a low threshold for referral and investigations? |
|
Definition
young
old
immunocompromised
learning difficulties |
|
|
Term
what do these pains suggest
colicky
constant sharp pain worse on movement and coughing
tearing pain
constant dull ache |
|
Definition
colicky = obstruction of a viscus
constant sharp pain worse on movement = peritonitis
tearing pain = aortic dissection or rupture
constant dull ache: inflammation eg appendicitis |
|
|
Term
| where might pain from aortic aneurysm, renal pain and pancreatitis radiate to? |
|
Definition
|
|
Term
| pain of renal colic may radiate to? |
|
Definition
|
|
Term
diaphragmatic irritation may cause pain where?
gallbladder pain may radiate to? |
|
Definition
diaphragmatic pain to shoulder tip
gallbladder pain referred to scapula |
|
|
Term
| associated symptoms with acute abdomen? |
|
Definition
systemic symptoms: fever weightloss
vomiting e.g with torsion of gastroenteritis or obstruction
bleeding: upper GI bleed
constipation/diarrhoea
PV bleeding |
|
|
Term
initial ix for acute abdomen in primary care
what would you do different in a and e |
|
Definition
pregnancy test to rule out ectopic
urinalysis to rule out infection
ECG to rule out MI
FBC to rule out occult bleed
ESR CRP to rule out infection and IBD
UandE
Glucose
Amylase
LFT
USS of abdomen and pelvis
in ED you can order a CXR erect to look for air beneath the diaphragm
you can cross match blood if you suspect blood loss
you can order CT |
|
|
Term
| common causes of abdo pain in the elderly |
|
Definition
peptic ulcer
AAA rupture
acute pancreatitis
cholecytitis
diverticulitis
constipation
bowel obstruction
urinary retention |
|
|
Term
| conditions in which mild-moderate immunosuppression occurs |
|
Definition
malnourished
steroids
elderly
diabetes
cancer
HIV with CD4 count >200 (when <200 they are severely immunocompromised) |
|
|
Term
| particular cause of abdo pain in immunosuppressed group |
|
Definition
gastritis: due to candia spp and CMV
cholecystitis with atypical pathogens
pseudomembranous colitis
typhlitis AKA neutropenic enterocolitis: fever and RIF pain
CMV colitis
abdominal TB
bowel obstruction |
|
|
Term
| what is the name of the neutropenic enterocolitis characterised by fever and abdo pain particularly RIF pain? |
|
Definition
|
|
Term
| prehospital acre of suspected abdomen |
|
Definition
NBM
oxygen if needed
IV fluids if needed, send blood for cross match G+S
consider NG tube if severe vomiting
opiate analgesics may be needed, do not withhold this
Abx if suspected sepsis |
|
|
Term
| when to admit pt for acute abdomen? |
|
Definition
if surgery is likely
pt unable to tolerate PO fluids
for pain control
if a medical cause is possible
if pt needs iV Abx |
|
|
Term
| red flags that raises suspicion of serious pathology |
|
Definition
hypotension
impaired consciousness/confusion
systemically unwell/septic looking
dehydrated
shock
rigid abdomen
pt lying very still
absent bowel sounds
associated testicular pathology
marked involuntary guarding
tenderness to percussion
hx of heamatemesis/malena
suspicion of medical cause for acute abdomen |
|
|
Term
| top 5 causes of acute abdomen in elderly |
|
Definition
inferior MI
PE /lower lobe pneumonia
DKA/HONK
Pyelonephritis
IBD |
|
|
Term
| name 3 things you should check for in acute abdomen that are commonly missed? |
|
Definition
failing to check from enlarged bladder
failure to check testicles and scrotum for associated testicular pathology
failure to check for hernia
also failure to do pregnancy check and failure to check vitals and do genital exam when required |
|
|
Term
| which analgesia is useful for renal colic? |
|
Definition
| diclofenac IM or suppository |
|
|
Term
| food ingestion improves the pain of a duodenal ulcer but worsens the pain of which ulcer? |
|
Definition
|
|
Term
| ix of choice to demonstrate ureteric stones? |
|
Definition
|
|
Term
| which imaging is used to exclude bowel obstruction, ileus and perf? |
|
Definition
|
|
Term
|
Definition
KUB
90% renal stones are radio opaque but uric acid stones may be missed. |
|
|
Term
| name 3 situations where you should admit someone with abdo pain? |
|
Definition
24 hours of unexplained pain
pain plus trauma/ injury
dehydration or shock |
|
|
Term
| on plain abdo X-ray what is the maximal normal diameter of the small bowel? |
|
Definition
35mm
there are also valvule conniventes that extend all the way across its diameter |
|
|
Term
| on plain abdominal X-ray what is the max normal diameter of the large bowel? |
|
Definition
| 5cm in addition hausta extend about 1/3 of the way across |
|
|
Term
| which psychiatric disorder has increased risk for megacolon and constipation? |
|
Definition
|
|
Term
| risk factors for small bowel obstruction |
|
Definition
previous surgery leading to adhesions
strangulated hernia
volvulus or malignancy: malignancy of ceacum as small bowel cancer is rare |
|
|
Term
| what is the main cause of large bowel obstruction? |
|
Definition
|
|
Term
| where is the most common site for volvulus? |
|
Definition
|
|
Term
| what is Ogilvie's syndrome? |
|
Definition
| intestinal pseudo obstruction that can occur in association with a number of conditions including MI, AKI, chest infection and stroke |
|
|
Term
| true or false in paralytic ileum there is no bowel movement or flatus? |
|
Definition
|
|
Term
| signs of dehydration in acute abdomen |
|
Definition
poor peripheral perfusion
hypotension
tachycardia
this may be due to unabsorbed water from obstruction in bowel or from vomiting. |
|
|
Term
|
Definition
|
|
Term
| how would small bowel obstruction be spotted on a plain abdo X-ray? |
|
Definition
| they show up as ladder like series of small bowel loops |
|
|
Term
| in paralytic ileum what is the function of a NG tube? |
|
Definition
|
|
Term
| when replacing fluids what can be used to measure the effectiveness ? |
|
Definition
|
|
Term
| in obstruction when is early surgery required? |
|
Definition
localised or generalised peritonitis
perforation
irreducible hernia |
|
|
Term
| in obstruction when is a more conservative approach acceptable? |
|
Definition
incomplete obstruction
previous surgery suggesting adhesions
advanced malignancy
indications that it may be pseudo obstruction |
|
|
Term
|
Definition
| conservative with sigmoidoscopy and passage of a flatus tube but if unsuccessful then operation is needed |
|
|
Term
|
Definition
fix fluids and electrolytes
cautiously use neostigmine and this might fix it.
colonoscopy for decompression. |
|
|
Term
|
Definition
peri umbilical pain initially due to visceral stretching
localises to RIF when parietal peritoneum involved
vomiting 1-2 times. marked vomiting is rare
low grade pyrexia. very high temperatures more likely to be mesenteric adenitis
there may be some loose stools
anorexia is very common, very unusual for those with appendicitis to be hungry |
|
|
Term
|
Definition
raised inflammatory markers
urine: leucocytosis but no nitrites
USS: presence of free fluid (always pathological in males) should raise suspicion |
|
|
Term
|
Definition
appendectomy
give metronidazole to reduce wound infection rates
copious abdominal lavage for those with perf |
|
|
Term
causes of acute pancreatitis
GET SMASHED |
|
Definition
gallstones
ethanol
trauma
steroid
mumps
autoimmune e.g polyarteritis nodosa
scorpion venom
hypercalcemia, hypothermia, hypertriglyceridemia
ERCP
drugs: azathiprine, mesalazine, sodium valproate, furosemide |
|
|
Term
|
Definition
peripancreatic fluid collections: cause pseudocysts
pseudocysts: these can be aspirated
pancreatic necrosis: of pancreatic parenchyma and surrounding fat
abscess : due to infected pseudocysts
haemorrhage : infected necrosis may involve vascular structures resulting in haemorrhage. if retroperotineal haemorrhage occurs you will see grey-turner sign |
|
|
Term
|
Definition
NBM with parenteral feeding
ABx therapy
surgery: if gallstones then cholecystectomy, ERCP if billary obstruction from stones, debridement of dead tissue or removal. |
|
|
Term
what scoring systems are used in assessment of pancreatitis?
what is used for biochemical scoring? |
|
Definition
glasgow
ranson
APACHE II
for biochemical scoring use CRP >150mg/L |
|
|
Term
| what are amylase levels like in acute pancreatitis. is there another enzyme that is more sensitive and specific? |
|
Definition
amylase levels are raised 3 or more times the normal limit
lipase is more sensitive and specific |
|
|
Term
| describe the Glasgow prognostic score for pancreatitis |
|
Definition
age > 55
WBC >15
urea>16
pO2 <8 kPa
glucose>10
LDH >600
albumin <32
calcium <2
AST/ALT >200
3 or more indicates severe pancreatitis associated with increased mortality |
|
|
Term
mx of mild pancreatitis
on ward |
|
Definition
pethidine or buprenorphine +/- IV BDZ. morphine CI due to spastic effect on sphincter of Oddi
IV fluids. NBM
if severe vomiting then NG tube
Abx for specific infections
no CT scan is necessary
if gallstones are the cause then consider common bile duct clearance and cholecystectomy |
|
|
Term
mx of severe pancreatitis
in ITU or HDU |
|
Definition
if severe pancreatic necrosis give iv Abx, Imipenam a beta lactam has been reported to reduce superinfection in necrotic tissue
enteral nutrition: place NG tube beyond ligament of treizt as feeding here is less likely to stimulate the diaphragm
early ERCP for those with cholangitis or biliary obstruction
necrosectomy and lavage
hyperbaric oxygen therapy:100% at 2.5 atmospheres for 90 mins BD for 5 days |
|
|
Term
| complications of pancreatitis |
|
Definition
necrosis and infected necrosis
abscess
acute fluid collections
pseudocysts
cholecystitis
pancreatic ascites
respiratory: pulmonary edema, effusions ARDS
metabolic: hypocalcemia |
|
|
Term
| risk factors for gallstones |
|
Definition
fat,fair, forty,female, fertile
rapid weight loss
part of metabolic syndrome
COCP
pregnancy
hyperlipidemia |
|
|
Term
| cholesterol stones form majority of the gallstones in the UK. infection with what would give you Brown pigment stones? |
|
Definition
|
|
Term
| what can gallstones cause? |
|
Definition
acute/chronic cholecystitis
acute/chronic pancreatitis
biliary colic
jaundice |
|
|
Term
| what are the 2 most common presentations of gallstones? |
|
Definition
| biliary colic then acute cholecystitis |
|
|
Term
| best imaging to demonstrate gallstones? |
|
Definition
|
|
Term
| in biliary colic or acute cholecystitis if pain persists for >24h or is accompanied by fever what should you do? |
|
Definition
|
|
Term
|
Definition
damage to bile duct
fat intolerance
post cholecystectomy syndrome: abdo pain, jaundice +/- dyspeptic symptoms |
|
|
Term
| which medication is given to high risk pts to stop gallstones from forming? |
|
Definition
|
|
Term
| what is Courvoisier's sign? |
|
Definition
| in a pt with painless enlarged gallbladder and mild jaundice the cause is unlikely to be gallstones. it is more likely to be pancreatic cancer or that of the biliary tree |
|
|
Term
|
Definition
RNA virus
mild self limiting
associated with travellers
feacal oral spread
no chronic disease
symptoms: flu, jaundice, mild hepatosplenomegaly
distaste for cigarettes
vaccine is available. |
|
|
Term
| which RNA virus is spread feacal oral route and affects pregnant women ?? |
|
Definition
|
|
Term
| epigastric pain and diarrhoea in a women with hyperparathyroid? |
|
Definition
| zollinger ellison syndrome |
|
|
Term
zollinger ellison syndrome
how is it diagnosed? |
|
Definition
epigastric pain and diarrhoea
multiple gastroduodenal ulcers are present
gastrin producing tumour of duodenum or pancreas
around 1/3 pts have MEN type I
dx: fasting gastrin levels is the single best screening test
also secretin stimulation test |
|
|
Term
MEN type I
what do people have? |
|
Definition
Parathyroid: hyperparathyroidism
Pituitary:
Pancreas: insulinoma, gastrinoma |
|
|
Term
anti nuclear and anti smooth antibodies
fever, malaise, jaundice
in a female. dx? |
|
Definition
|
|
Term
| which HLAs are associated with AI hepatitis? |
|
Definition
|
|
Term
primary sclerosing cholangitis(PSC)
is strongly associated with which IBD? |
|
Definition
Ulcerative colitis
PSC associated with ANCA and anti smooth antibodies |
|
|
Term
| ERCP shows multiple biliary strictures that give a beaded appearance. what is the diagnosis? |
|
Definition
| Primary Sclerosing Cholangitis. |
|
|
Term
| primary sclerosisng cholangitis increases risk to which 2 cancers? |
|
Definition
|
|
Term
| Kantor's string sign is seen in which IBD X-ray? |
|
Definition
Crohns disease
also rose thorn ulcers may be seen on imaging |
|
|
Term
barium enema of large bowel shows drain pipe colon with lost of haustra.
bloody diarrhoea and primary sclerosing cholangitis is also present in the pt what is the dx? |
|
Definition
|
|
Term
a jejunal biopsy shows macrophages containing PAS (periodic acid schiff) granules.
what is the diagnosis? |
|
Definition
|
|
Term
symptoms of diverticulitis
what might the pt have?
risk factor: increasing age more than 50 years, obesity in the young people and low fibre diet |
|
Definition
altered bowel habit
bleeding
abdo pain: colicky left sided
they may have a hx of constipation and a bad diet i.e lack of fibre |
|
|
Term
| what classification system is used for severity of diverticulitis? |
|
Definition
HInchey severity classificiation
there are grades 1 to 4
1 = para colonic abscess
2 = pelvic abscess
3 = purulent peritonitis
4 = fecal peritonitis; requires resection and stoma |
|
|
Term
|
Definition
high fibre diet
mild attack: Abx
peri colonic abscess can be drained radiologically
recurrent episodes of diverticulitis requiring hospital administration are relative indication for segmental resection |
|
|
Term
| define diverticulosis, diverticular disease and diverticullitis |
|
Definition
diverticulosis = presence of asymptomatic diverticula
diverticular disease = diverticula associated with symptoms
diverticulitis = evidence of diverticula inflammation (fever tachycardia) |
|
|
Term
| elderly people with diverticulitis are also at risk for ischemic colitis. name 2 features that would point towards ischemic colitis? |
|
Definition
thumb printing on abdominal radiograph
passage of heamatochezia (fresh blood pr)
both point towards ischemia |
|
|
Term
|
Definition
co-amoxiclav
OR if penicillin allergic
ciprofloxacin and metronidazole for 7 days |
|
|
Term
| what is Hartmann's procedure? |
|
Definition
| formation of end colostomy with oversewing of the rectal stump. |
|
|
Term
| complications of diverticulitis |
|
Definition
peritonitis from perf
obstruction
peri colonic abscesses
hemorrhage and blood loss needing transfusion
colovesical or colovaginal fistulas |
|
|
Term
|
Definition
| permanent and irreversible dilatation of blood vessel by at least 50% of expected diameter. |
|
|
Term
| most AAA arise from the level ..... the level of the renal arteries |
|
Definition
|
|
Term
|
Definition
atherosclerotic damage to aorta wall
increasing age
smoking
FHx
HTN
COPD
hyperlipidaemia
CT disorders e.g Marfans |
|
|
Term
| AAA can rupture into the peritoneal cavity or retroperitoneal space. which one is worse? |
|
Definition
| peritoneal cavity is worse. pt usually dies before reaching hospital |
|
|
Term
a man with AAA undergoes CT scan of abdomen. The operator reports a 'crescent sign'
what does this mean
and what does this suggests? |
|
Definition
| this crescent sign means there is blood within the thrombus and it predicts imminent rupture. |
|
|
Term
| what is the cut off for small aneurysms? |
|
Definition
5.5cm
if larger than 5.5cm they should be considered for surgery
those < 5.5.cm are generally monitored |
|
|
Term
| medical management of AAA depends on the size of the aneurysm when it is found. describe the sizes and frequency of USS that accompanies it. an aneurysm is defined as 3 cm or more, normal diameter for aorta is 2cm. |
|
Definition
3-4.4cm = annual USS
4.5- 5.4cm = 3 monthly USS
> 5.5cm = consider surgery and 3monthly USS |
|
|
Term
| two types of surgical AAA repair, what are they? |
|
Definition
open surgery: need to cross clamp aorta and iliac arteries,
EVAR endovascular aneurysm repair: introduce stent graft system through femoral arteries. |
|
|
Term
| advantages and disadvantages of EVAR |
|
Definition
advantages: avoids open abdo surgery and close clamping
disadvantages: need to survey endo graft with USS or CT
the graft may fail
higher risk of re intervention and aneurysms rupture with EVAR |
|
|
Term
| screening for AAA in NHS? |
|
Definition
offer a single scan to men aged 65
if negative then rules out AAA for life. |
|
|
Term
| list causes of Upper GI bleeding |
|
Definition
oesophagitis
oesophageal varices
mallory weiss tear
cancer |
|
|
Term
| list causes for gastric bleeding |
|
Definition
gastric ulcer
gastric cancer
diffuse erosive gastritis: underlying cause such as recent said usage
Diuelafoy lesion : due to AV malformation |
|
|
Term
|
Definition
admit to hospital
FBC, LFT, UE, Clotting minimum, cross match is ongoing blood loss
ABC and those with varicose should be given terlipressin before endoscopy |
|
|
Term
| when should endoscopy ideally be done in those admitted with upper GI bleed? |
|
Definition
within 24 hours
if severe UGIB then endoscopy should be done immediately after resuscitation |
|
|
Term
|
Definition
banded or sclerotherapy
if this is not possible then use sengaksten-blakemoore/minnoseta tube. this needs to be deflated 12 hours later to prevent necrosis |
|
|
Term
| mx for oesophagitis or erosive gastritis? |
|
Definition
|
|
Term
| true or false: mallory weiss tears typically resolve spontaneously |
|
Definition
|
|
Term
surgical management for duodenal ulcer. where are most of them commonly sited?
which artery is most likely invaded if there dis a lot of bleeding? |
|
Definition
sx: laparotomy, duodenotomy and under running of ulcer
most DU are posteriorly sited and invaded gastroduodenal artery |
|
|
Term
| what is the Blatchford score used for? |
|
Definition
used to determine the need for admission and timing of endoscopy.
it uses: Hb, urea, BP and pulse rate.
scores of 0 = low risk
all other scores are high risk. they need admission and endoscopy. |
|
|
Term
| following endoscopy after upper GI bleed, which score is used to calculate rate of re bleeding and mortality? |
|
Definition
The Rockall score.
score of 3 or < associated with a 4% rebreeding risk. This is a low risk of mortality and pts in this group are suitable for discharge. |
|
|
Term
| why does colonic bleeding rarely present as malena type stool? |
|
Definition
| because blood in colon has a laxative effect and is rarely retained for long enough for transformation to occur. |
|
|
Term
| what can diagnose haemorrhoids? |
|
Definition
| proctoscopy or proctosigmoidoscopy |
|
|
Term
|
Definition
1st line is supportive ABC
then colonoscopy or CT angiogram |
|
|
Term
| reasons to consider admission in lower GI bleed |
|
Definition
age > 60
profuse bleeding: heamodynamically unstable or profuse PR bleed
co morbidities
use of NSAIDs/aspirin |
|
|
Term
| which people should you refer under 2 week rule for cancer exclusion? |
|
Definition
aged 40 or > with abdo pain and unexplained weight loss
aged 50 or > with unexplained rectal bleeding
aged 60 or > with change of bowel habit or Fe deficiency anaemia |
|
|
Term
| symptoms that are more likely associated with cancer |
|
Definition
blood mixed with stool
positive FHx for CRC
age more 50
unexplained weight loss
Fe deficiency anaemia
change in bowel habit |
|
|
Term
| what is a Diuelafoy lesion? |
|
Definition
submucosal ectatic artery in GI tract
most commonly in stomach
usually larger than the surrounding vessels
causes brisk bleeding with little or no surrounding ulceration. abdo pain in uncommon |
|
|
Term
| which one is common upper GI bleeding or lower GI bleeding? |
|
Definition
| Upper GI bleeding is 4x common than lower GI bleeding |
|
|
Term
| in UGIB NICE recommend using 2 scores before and after endoscopy. what are they? |
|
Definition
Blatchford score before
Rockall score after endoscopy |
|
|
Term
| what is the Rockall score out of? |
|
Definition
11
a score of 3 or less indicates 4% chance of rebleed and mortality. these pts can be discharged home.
a score of 8 or > associated with high mortality |
|
|
Term
| can low dose aspirin be continued in a pt who has had an upper GI bleed? |
|
Definition
yes so long as you have achieved homeostasis
other NSAIDS including COX2 inhibitors should be stopped during acute phase of UGIB |
|
|
Term
| mx for oesophageal varices |
|
Definition
terlipressin
Abx therapy
Band ligation or minesota tube for 12 hours then deflated
if these fail then TIPS stent can be placed. |
|
|
Term
| in what kind of varices is an injection of N-butyl 2 cyanoacrylate offered? |
|
Definition
gastric varices.
if this fails then you can do TIPS |
|
|
Term
| what should you give to a pt prior to endoscopy who is suspected of having oesophageal vatical bleed? |
|
Definition
terlipressin
do not give this if pt is severely hypovolemic or have severe CVS disease |
|
|
Term
explain what the Senstaken-Blakemoore tube is
where should it be kept
how is the procedure done? |
|
Definition
it is used as a temporary salvage rx in vatical haemorrhage.
should be refrigerated to stiffen the rubber and make passage easier.
inserted via mouth into stomach. there are 2 balloons a gastric and an oesophageal one. inflate gastric balloon first and pull up against oesophageogastric junction. this compresses submucosal varicose and bleeding should stop.
you need to decompress after 12 hours or maybe before to reduce risk of necrosis. |
|
|
Term
| summary of oesophageal varicose mx |
|
Definition
ABC, vit k, FBC, FFP and check clotting
Terlipressin before endoscopy
quinilone abx prophylaxis
band ligation.
sengstaken-blakemoore tube if unsuccessful with band ligation
TIPSS if above measures fail.
prophylaxis: after endovascular band ligation give propanalol to prevent rebleed and PPI to prevent ulcers from band ligation |
|
|
Term
| red flag symptoms in dyspepsia |
|
Definition
GI bleed
dysphagia
recurrent vomiting
unintentional weight loss |
|
|
Term
|
Definition
| pain or discomfort in the upper abdomen |
|
|
Term
|
Definition
peptic ulcer
oesophagitis
fx dyspepsia |
|
|
Term
| what should you do in pts who are 55 years or > with recent onset unexplained dyspepsia? |
|
Definition
| refer urgently for endoscopy |
|
|
Term
| alarm symptoms for dyspepsia that should prompt you to free under 2 week rule |
|
Definition
chronic GI bleed
progressive unintended weight loss
progressive dysphagia
persistant vomiting
fe deficiency anemia
epigastric mass
suspicious barium meal |
|
|
Term
for those with GORD how long should they take PPI for?
for those with severe oesophagi tis diagnosed on endoscopy how long should they take PPI for? |
|
Definition
4-8 weeks for GORD
8 weeks for severe oesophagitis |
|
|
Term
most antacids contain a mixture of aluminium hydroxide and magnesium hydroxide
what are the side effects of these? |
|
Definition
aluminium hydroxide: constipation
magnesium hydroxide: diarrhoea |
|
|
Term
|
Definition
| GI disturbance, headache, C diff, hypo magnesia that can cause tetany and ventricular arryhtmias, arthalgia, myalgia, taste disturbance |
|
|
Term
| omeprazole reduces anti platelet effect of which drug? |
|
Definition
|
|
Term
| SE of h2 antagonists e.g. ranitidine |
|
Definition
| diarrhoea, constipation, headache, dizziness |
|
|
Term
how are PPI mostly metabolised
what does this mean? |
|
Definition
hepatic metabolisation
dose adjusted needed in severe liver failure |
|
|
Term
| pts with which risk factors have a higher risk of malignancy so your suspicious threshold for referring should be lowered |
|
Definition
pernicious anemia
FHx of upper GI cancer
Barratts oesophagus
peptic ulcer surgery over 20 years ago
knonw dysplasia, atrophic gastritis or intestinal metaplasia |
|
|
Term
| if you want quantitive information about the amount of fluid refluxed what ix would you do? |
|
Definition
| oesophageal impedance testing |
|
|
Term
| what grading systems are available to grade oesophagitis endoscopically? |
|
Definition
Savary-Miller grading system 1-5
and the
Los Angeles grading system A- D |
|
|
Term
| someone presents with dysphagia on swallowing. what do you do? |
|
Definition
| refers urgently for upper GI cancer tests |
|
|
Term
| dyspepsia at any age age combined with any one of which alarm symptoms should prompt you to refer under cancer 2 week rule? |
|
Definition
weigh loss
proven anaemia
persistant vomiting |
|
|
Term
| list common drugs that affect oesophageal motility |
|
Definition
nitrates
anti cholinergics
TCA |
|
|
Term
| common drugs that affect oesophageal mucosa |
|
Definition
NSAIDs
potassium salts
alendronate |
|
|
Term
|
Definition
| magnetic bead band around LOS of oesophagus |
|
|
Term
| causes for narrowing of the oesophagus |
|
Definition
strictures: malignant or benign
webs: mucosal or submucosal
rings:mucosa, submucoa and muscle
external compression from neck or mediastinum structures |
|
|
Term
| out of endoscopy and barium swallow when investigating a stricture which one should you do first and why? |
|
Definition
| do barium swallow first to assess the length of the stricture before passing the scope through |
|
|
Term
| cause of benign strictures |
|
Definition
GORD chronic
medications: alendronate, NSID, potassium chloride, iron |
|
|
Term
oesophageal webs
contain just mucosa or submucosa
which syndrome in post menopausal women with iron deficiency are these found in? |
|
Definition
|
|
Term
oesophageal rings are classed as A, B or C. multiple rings are found in which sex?
what layers of the oesophagus do they contain?
which type is AKA Schatzki ring? |
|
Definition
multiple rings found in men
contain mucosa, submucoa and muscle
type B is AKA schatzki ring |
|
|
Term
| mx of benign strictures and rings? |
|
Definition
oesophageal dilatation at endoscopy
if unsuccessful you can used endoscopic incisional therapy
long term PPI seem beneficial |
|
|
Term
| mx of malignant strictures |
|
Definition
oesophagectomy OR
palliative oesophageal stent |
|
|
Term
| common causes for rectal bleeding |
|
Definition
fissure in ano
haemorrhoids
Crohns
UC
rectal cancer |
|
|
Term
| proctoscopy can be used to diagnose? |
|
Definition
|
|
Term
| baseline investigations in those who present with rectal bleeding? |
|
Definition
digital rectal exam
procto-sigmoidoscopy |
|
|
Term
|
Definition
1st line = GTN ointment or diltiazem cream
2nd = botulum toxin for those who fail to respond
3rd line = if botox fails then consider internal sphincterotomy |
|
|
Term
|
Definition
lifestyle advice
band ligation
sclerotherapy
external haemorrhoids: hemorrhoidectomy,
other: HALO procedure and staple hemorrhoidectomy |
|
|
Term
3, 7 and 11 o'clock positions in the ass what am i?
6 o clock and 12 o clock positions in the ass, what am i? |
|
Definition
haemorrhoids found at 7, 11 and 3 o clock positions
fissure in ano at 6 and 12 o clock |
|
|
Term
| common causes of constipation |
|
Definition
low fibre diet
immobility
inadequate fluid intake
elderly age
post op pain
haemorrhoids
anal fissure
CRC |
|
|
Term
| metabolic and endocrine causes of constipation |
|
Definition
hypercalcemia
hypothyroid
hypokalemia
lead poisoning
porphyria |
|
|
Term
| drugs that can cause constipation |
|
Definition
opioids
anticholinergics eg TCA
iron |
|
|
Term
| NEUROMUSCULAR CAUSES OF CONSTIPATION |
|
Definition
diabetic neuropathy
systemic sclerosis
spinal or pelvic nerve injury
HIrsprungs disease |
|
|
Term
| isphagula husk and methyl cellulose are examples of ? |
|
Definition
bulk forming laxatives
they increase feacal mass, this stimulates peristalsis
they need to be taken with plenty of water
CI: intestinal obstruction |
|
|
Term
| senna and bisacodyl are stimulant laxatives what is their mode of action? any contra indications? |
|
Definition
increase intestinal motility
do not use in intestinal obstruction |
|
|
Term
| name a rectal stimulant that is given PR? |
|
Definition
|
|
Term
| arachis oil enema is an example of? |
|
Definition
a stool softner,
docusateis a softener and a stimulant laxative |
|
|
Term
| osmotic agents retain fluid in the bowel. give an example of an osmotic laxative |
|
Definition
|
|
Term
|
Definition
diarrhoea
aluminium salts cause constipation |
|
|
Term
| Prucalopride 5HT4 agonist, a pro kinetic used for chronic constipation in women. what are the requirements? |
|
Definition
pt must have used 2 classes of laxatives at the highest tolerated dose for 6 months and been unsuccessful
if using this for 4 week yields no results the women should be reassessed to determine whether to continue with the medication |
|
|
Term
| name 2 types of screening available for bowel cancer |
|
Definition
faecal occult blood testing every 2 years in women and men aged 60-74.
BOWEL SCOPE: one off test offered to those aged 55 where doctor or nurse examine you with a thin scope. |
|
|
Term
IBS features for diagnosis
they are needed for at least 6 months |
|
Definition
abdominal pain and/or
bloating and/or
change in bowel habit |
|
|
Term
| in IBS what does defection do to the abdo pain? |
|
Definition
|
|
Term
| to make a positive diagnosis of IBS you need to have symptoms for 6months, shitting should relieve your pain and then you need 2 of the following 4..... |
|
Definition
passage of mucus
symptoms made worse by eating
abdo bloating, distension, tension or hardness
altered stool passage |
|
|
Term
| red flag features that should made you think its not IBS |
|
Definition
onset after aged 60
FHx of bowel or ovarian cancer
unexplained, unintentional weight loss
rectal bleeding |
|
|
Term
| mx of IBS. what would you give for spasms, diarrhoea and constipation? |
|
Definition
buscopan for spasms
loperamide for constipation
laxatives but not lactulose for constipation
2nd line treatment: low dose TCA and CBT |
|
|
Term
Crohns disease features
macro feature: cobble stone appearance |
|
Definition
mouth to anus but can be skip lesions, there may be mouth ulcers,
affects transmurally: all layers
histology: granulomas with giant Langerhans cells |
|
|
Term
UC features
macro features: bleeds on contact |
|
Definition
starts at rectum and affects that and colon
continuos lesions
superficial inflammation
histology: crypt abscess and inflammatory cells in lamina propia |
|
|
Term
UC peak incidence is 15-25 then 55-65 years
name some initial presenting symptoms |
|
Definition
bloody diarrhoea
urgency
tenesmus
left lower quadrant abdo pain
primary sclerosing cholangitis and uveitis more common in UC
increased risk of CRC |
|
|
Term
| features of Crohns disease |
|
Definition
non bloody diarrhoea
weight loss
abdo pain
may be mass in right side of abdomen
skip lesions
string of Kantor sign
fistulas and bowel obstruction are a complication |
|
|
Term
| features common to Crohns and UC |
|
Definition
diarrhoea
arthritis
erythema nodosum
pyoderma gangrenosum |
|
|
Term
pathology of UC
findings on barium enema |
|
Definition
red raw mucosa that bleeds easily
widespread superficial ulceration
inflammatory cells in lamina propria
crypt abscesses caused by migrating neutrophils
granulomas are infrequent
findings on barium enema: loos of hausta
superficial ulcerations 'psuedopolyps'
in longstanding disease, the colon is short and narrow called drainpipe colon. |
|
|
Term
how is UC categorised?
clue: mild, mod and severe |
|
Definition
MILD <4 stools little blood
moderate 4-6 stools varying amounts of blood
Severe > 6 bloody stools per day and systemic upset e.g pyrexia anorexia |
|
|
Term
|
Definition
1st : topical or PO aminosalicylates e.g. mesalazine try for 4 weeks
2nd : PO prednisolone
severe colitis: IV steroids in hospital |
|
|
Term
| maintaing remission in UC |
|
Definition
PO aminosalicylates e.g. mesalazine
azathioprine and mercaptopurine
MTX NOT recommended for mx of UC unlike in Crohns. |
|
|
Term
| prone to strictures, fistulas and adhesions....UC or crohns? |
|
Definition
|
|
Term
| in which disease UC or Crohns is weight loss more prominent? |
|
Definition
|
|
Term
| Gallstones are more common in UC or Crohns? |
|
Definition
Chrons
Primary Sclerosing Cholangitis more common in UC |
|
|
Term
| in which condition Crohns or UC is there an increase in goblet cells and granulomas? |
|
Definition
|
|
Term
strictures seen as Kantors sign
ulcers seen as rose thorns
proximal bowel dilatation and fistulae
which condition am i? |
|
Definition
|
|
Term
| extra intestinal manifestations of Crohns? |
|
Definition
iritis
pyoderma gangrenosum
erythema nodosum
arthritis |
|
|
Term
peaks of incidence in Crohns
does smoking affect Crohns? |
|
Definition
15-30 largest peak
50-70 second peak
smoking increases Crohns risk 3-4 fold |
|
|
Term
| factors exacerbating Crohns |
|
Definition
smoking
intercurrent illness eg URTI
NSAIDs |
|
|
Term
| inducing remission in crohns NICE guidelines |
|
Definition
| mono therapy with prednisolone, methylprednisolone or IV hydrocortisone. if they cannot tolerate this or decline use 5-ASA |
|
|
Term
| which add on treatments could you consider if the person had 2 or more flare ups of their crohns in 12 months? |
|
Definition
| azathioprine or mercaptopurine. if this is unsuitable offer MTX. |
|
|
Term
| what is recommended to be used in fistulating Crohns disease? |
|
Definition
|
|
Term
| how do infliximab and adalimumab work? |
|
Definition
| they block the action of cytokine TNF-alpha. this mediates inflammation ins crohns disease. these meds are recommended in disease that is severe and active that has not responded to conventional therapy. for fistulating crohns disease Infliximab is recommended. |
|
|
Term
| rx to maintain remission in Crohns |
|
Definition
azathiprine or mercaptopurine
or
if they needed MTX to induce remission then offer MTX to maintain remission |
|
|
Term
| which 2 ABx can improve symptoms of fistulating Crohns disease? |
|
Definition
| Metronidazole and Ciprofluoxacin |
|
|
Term
| what type of stones does Crohns predispose you to? |
|
Definition
|
|
Term
| what is the Truelove and Witts severity index used to measure and in which disease? |
|
Definition
measure severity of UC
mild: <4 stools small amounts of blood
moderate 4-6 stool with varying amounts of blood and no systemic features
severe > 6 blood stools and systemic upset |
|
|
Term
| pouchitis is a complication of ileal pouch surgery for UC what can this be treated with? |
|
Definition
| Metronidazole and Ciprofloxacin for 2 weeks |
|
|
Term
chronic pancreatitis effects endo and exocrine fx of the pancreas
list some features |
|
Definition
80% due to alcohol
pain wrose 15-30 mins following a meal
steatorrhoea 5-25 years after onset of pain
DM around 20 years after onset of symptoms
CT can show pancreatic calcification
feacal elastase can be used as a marker of pancreatic exocrine function
mx: pancreatic enzyme supplements and analgesia |
|
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