1
Q
What is Oesophagitis?
A
inflammation of the inner lining of oesophagus
2
Q
What is the most common cause of Oesophagitis?
A
GORD
3
Q
What are the symptoms of Oesophagitis?
A
- Heartburn
- N + V
- Dysphagia
- Painful swallowing (w/o red flags)
- symptoms resolve spontaneously
4
Q
How to investigate Oesophagitis?
A
OGD - investigate severity
Barium swallow - r/o malignancy
5
Q
What is Mallory Weiss Tear?
A
- Tear along the right border or near the gastro-oesophageal junction
6
Q
What commonly causes Mallory Weiss Tear?
A
- Forceful bout of retching , vomitting, coughing,straining or even hicupping
7
Q
What are the symptoms of Mallory Weiss Tear?
A
- Haematemesis
- Dizziness
- abdo pain
- dysphagia
- Melaena (RARE)
(no systemic symptoms)
8
Q
How to investigate Mallory Weiss Tear?
A
- OGD: visualise tear
9
Q
What are the most common types of Oesophageal Cancer?
Identify their location.
A
- Squamous Cell Cancer
- Upper 2/3 of oesophagus - Adenocarcinoma
- Lower 1/3 near gastro-oesophageal junction
10
Q
What are some of the risk factors for adenocarcinoma (Oesophageal Cancer)?
A
- GORD
- Barrett’s oesophagus
- Obesity
11
Q
If alcohol caused Oesophageal Cancer, what would the blood findings be?
A
- Increased GGT
- Macrocytosis
12
Q
What are the symptoms of Oesophageal Cancer?
A
- Dysphagia
- anorexia + weight loss
- Vomiting
Other:
- Pain on swallowing
- Hoarseness
- acid reflux
- Melaena
13
Q
What investigation is use for diagnosis of Oesophageal Cancer?
A
Upper GI endoscopy with biopsy
14
Q
How is Oesophageal Cancer staged?
A
- CT scan : if metastatic
2. Endoscopic USS: no metastases, local staging
15
Q
When does a patient warrant an urgent endoscopy (2WW) for Oesophageal Cancer?
A
- Dysphagia
2. 55 year + upper abdo pain, reflux, dyspepsia
16
Q
What is Oesophageal Stricture?
A
Narrowing of the food pipe
17
Q
What causes Oesophageal Stricture?
A
- Scarring from acid reflux in persisitent GORD/
- carcinoma of oesophagus
18
Q
Whata are the symptoms of Oesophageal Stricture?
A
- Dysphagia
- Heartburn
- Weight loss
- Chest pain
19
Q
What signs can present with malignant Oesophageal Stricture?
A
- Lympadenopathy
20
Q
What investigations can be carried out for Oesophageal Stricture?
A
- CXR
- Endoscopy
- Barium swallow
- CT or endoscopic USS
21
Q
What is Oesophageal Varices?
A
- Dilated collateral blood vessels that develop as a complication of portal hypertension
22
Q
What causes Oesophageal Varices?
A
- Anything condition that causes portal hypertension
- Can be split into 2 categories:
- Pre-hepatic:
- Portal vein thrombosis
- Portal vein obstruction - Intra-hepatic:
- Cirrhosis
- Acute hepatitis
- Idiopathic portal hypertension - Post- hepatic:
- compression (tumour)
23
Q
What are the symptoms of Oesophageal Varices?
A
- Haematemesis
- Melaena
- Abdo pain
- Dyshpagia /pain on swallowing
- Ascites
- Jaundice
24
Q
What are signs of Oesophageal Varices?
A
- Spider naevi
- Caput medusa
- signs of chronic liver disease
- Hypotension
- Pallor
- Tachycardia
- Reduced GCS
25
How to investigate Oesophageal Varices?
- Diagnostic: endoscopy
| - Bloods: Hb (low), platelets (low)
26
What is Achalasia?
- Failure of oesophageal peristalsis and of relaxation of the LOS
27
What are the symptoms of Achalasia?
- Dysphagia (BOTH liquid + solid)
- gradual weight loss
- heart burn
- regurgitation of food
- -> may lead to cough, aspiration pneumonia
28
What is the diagnostic investigation for Achalasia?
Oesophageal manometry
| - assess motor function
29
What are other investigation carried out for Achalasia?
1. Barium swallow :
- 'bird's beak' appearance
2. CXR:
- wide mediastinum
30
What is GORD?
Reflux of gastric contents back into the oesophagus
31
What are the symptoms of GORD?
- Heartburn worse after meal or supine
32
What is the investigations for GORD?
- Hx is enough for diagnosis
33
What is gastritis?
histological presence of gastric mucosal inflammation
34
Most common cause of gastritis
Helicobacter pylori
Other:
- NSAIDs
35
What are the symptoms of gastritis?
- epigastric pain
- N + V
- Dyspepsia
- Fever
- loss of appetite
36
Signs of gastritis
- Epigastric tenderness
- glossitis
- halitosis
37
Investigations for gastritis
H.Pylori:
- Urea breath test
- faecal antigen histology
- rapid urease test
- Gastric muscosal histology
38
What is peptic ulcer disease?
A breach in the epithelium of the gastric or duodenal mucosa that penetrates the muscularis mucosa
39
What are the main causes of peptic ulcer disease?
1. H.pylori
| 2. Long-term NSAID use
40
What are the types of peptic ulcer disease and their symptoms?
Gastric ulcer:
- pain increases while eating
- weight loss
Duodenal ulcer:
- pain is eased by eating
- weight gain
General:
- epigastric pain
- nausea
- chest discomfort
41
If a patient has acute upper abdo pain, what investigation must be carried out?
Erect x-ray
42
What would you see in an x-ray when some one has perforated ulcer?
CXR: free air under diaphragm
43
What investigation should be carried out for peptic ulcer disease?
- H.pylori test
| - Upper endoscopy
44
What are the symptoms of gastric cancer?
- dysphagia
- pain
- acid reflux
- loss of appetite + weight loss
- anaemia
45
How to investigate gastric cancer?
- Diagnosis: Endoscopy + biopsy
- Staging : CT
- Bloods: anaemia
46
What are the red flag signs for stomach cancer?
- Abdo mass
- rebound tenderness with rigid abdomen
- absent bowel sounds
- acute pain + vomiting
- ecchymosis of flanks + abdo
47
What is the referral requirement for 2WW stomach cancer?
- upper abdo mass
48
What is the referral requirement for 2WW UGI endoscopy?
1. dysphagia
| 2. > 55 + upper abdo pain, reflux, dyspepsia
49
What is pyloric stenosis?
- Pylorus of the stomach is stenosed
| - does not allow the passage of food
50
What are the symptoms of pyloric stenosis?
* projectile vomiting* - typically 30 mins after feed
- constipation
- dehydration
- palpable mass (upper abdo)
51
What are the signs of pyloric stenosis?
- poor weight gain
| - hypokalaemic alkalosis
52
What investigation is diagnostic pyloric stenosis?
USS
53
What is Cholelithiasis?
A gallstone
| - solid deposit that forms within the bladder
54
What are the risk factors for gallstones?
5 F's
- Female
- Fat
- Fair
- Fertile
- Forty
55
What are the classic symptoms for Cholelithiasis?
1. Colicky RUQ pain - post prandially
- --> worse after fatty meal
- N + V
56
What is the diagnostic work up in suspected Cholelithiasis??
USS + LFT
57
What is acute cholecystitis?
- inflammation of the gallbladder
58
What are the signs for acute cholecystitis?
1. RUQ pain:
- radiate to right shoulder
- sudden onset
2. Fevers (systemic)
3. Possible jaundice
59
What are the signs for acute cholecystitis?
- Murphy's sign : inspiratory arrest upon palpation of RUQ
60
What blood test findings may you have with acute cholecystitis?
- LFTs typically normal
61
What is the first investigation for acute cholecystitis?
Abdo USS
62
What is chronic cholecystitis?
- repeated attacks of biliary colic + permanent damage to the gallbladder
- gallbladder healing by fibrosis + shrinks in size
63
What are symptoms of chronic cholecystitis?
- RUQ pain after meals
| - fat intolerance
64
What investigative findings will you have for chronic cholecystitis?
AXR : porcelain gallbladder
65
Which finding on biopsy would be most consistent with a diagnosis of gastric adenocarcinoma?
signet ring cells
66
What are the causes of acute pancreatitis?
```
* GET SMASHED *
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hypercholesterolaemia
ERCP
Drugs
```
67
What are the symptoms of acute pancreatitis?
- Severe epigastric pain (radiate to back)
- vomiting
- low-grade fever
- sudden onset + short duration
68
What are the signs of acute pancreatitis?
- Epigastric tenderness
- low-grade fever
- Peri-umbilical discoloration (cullen's sign)
- Flank discolouration (grey-turner's sign)
69
How can you make diagnosis of acute pancreatitis be made without imaging?
If characteristic pain + amylase /lipase > 3 time upper limit of normal
70
What imaging is used in acute pancreatitis?
USS
Other : contrast - CT
71
What scoring systems may be used to identify severe pancreatitis?
- Ranson score
- Glasgow score
- APACHE II
72
What are the symptoms of chronic pancreatitis?
- pain : following meal
| - steatorrhea
73
What are the investigations for chronic pancreatitis?
- Abdominal x-ray: pancreatic calcification
| - CT : more sensitive to calcification
74
What is the most common type of pancreatic tumour?
Adenocarcinoma
75
What is the classic symptom of pancreatic cancer?
* Painless Jaundice *
76
What are the other symptoms of Pancreatic Cancer?
- Pale stools
- Dark urine
- Pruritus
Non-specific:
- anorexia
- weight loss
- epigastric pain
77
What is the diagnostic investigation for Pancreatic Cancer?
High-resolution CT scan
- definitve diagnosis require biopsy
- 'double duct' sign
Other:
USS
78
What is hepatitis?
Virus that infects the liver causing inflammation
USE NOTES (DEARSIM)
79
When does heptatitis become chronic?
If virus persists past 6 months
80
What are the symptoms of hepatitis?
- Fever
- RUQ pain
- Jaundice
- Dark urine
81
What are the signs of hepatitis?
- Rise in ALT + AST
| - Hepatomegaly
82
What are the different components of hepatitis serology?
1. HBsAg = surface antigen
- acute disease
2. Anti-HBs = implies immunity
3. Anti-HBc = previous or current infection
4. IgM anti-HBc = during acute or recent hep B infection
83
What is liver cirrhosis?
Scarring of the liver caused by long-term liver damage
84
What are the common causes of Liver Cirrhosis?
- Alcohol
- Non-alcoholic fatty liver disease (NAFLD)
- Viral Hepatitis
85
What are symptoms of Liver Cirrhosis?
Severe:
- jaundice
- abnormal bruising
- peripheral oedema
- ascites
High-Risk group:
- fatigue
- anorexia
- nausea
- weight loss
- muscle wasting
- abdo pain
86
What investigations are carried out for Liver Cirrhosis?
- Transient Elastography
- Traditionally : Liver biopsy
- NAFLD : use enhanced liver fibrosis score to screen for further testing
87
What further investigations can be carried out for Liver Cirrhosis?
- Upper endoscopy : check for varices
| - Liver USS: hepatocellular cancer
88
What are the most common Liver Tumours?
- Cholangiocarcinoma
| - Hepatocellular carcinoma
89
What are the symptoms of Liver Tumours?
- Weight loss
- Jaundice
- Altered mental status
- itching
- pale stools + dark urine
- easy bruising
- Distended abdomen
90
What investigations are used for diagnosis of Hepatocellular Carcinoma?
- CT/MRI (usually both)
| * Avoid biopsy - seeds tumours cells*
91
What is the prognosis of Liver Tumours?
Poor
92
What investigations are used for diagnosis of Cholangiocarcinoma?
- LFT : obstructive picture
- CA 19-9, CEA + CA 123 elevated
- CT/MRI + MRCP
93
What score is used after endoscopy to asses rebleed and mortality ?
Rockall
94
What are the different types of hernia?
- Hiatus
- Icisional
- Inguinal
- Umbilical
- Ventral
95
What are the symptoms of hiatus hernia?
- Heartburn
- GORD
- Difficulty swallowing
96
What investigations can be carried out for hiatus hernia?
- Endoscopy
| - Barium studies
97
What are the 2 types of inguinal hernia?
1. Indirect = hernia through the inguinal canal
| 2. Direct hernia = through the posterior wall of the inguinal canal
98
What are the symptoms of inguinal hernia?
- groin lump
- -> disappear when lying down
- -> cough impulse
- discomfort + ache
- -> worse with activity
99
What is peritonitis?
- infection of ascitic fluid
100
What can cause peritonitis?
- perforated ulcer
- cirrhosis
- PID
101
What are the symptoms of peritonitis?
- Ascites
- Abdo pain
- Fever
- N + V
- Diarrhoea
102
What is the diagnostic test for peritonitis?
Paracentesis:
| --> Ascitic Fluid : neutrophil count > 250 cells/mm3
103
What are the clinical features of acute upper GI bleed?
- Haematemesis
- Melena
- Abdo pain
- Raised Urea
104
What is intra-abdominal abscess?
- a collection of pus or infected fluid that is surrounded by inflamed tissue inside the belly
105
What are the symptoms of intra-abdominal abscess?
- Fever
- Change in bowel habits
- N + V
106
What investigations are carried out for intra-abdominal abscess?
- Abdo CT
| - WBC count
107
What is constipation and faecal loading?
Constipation = infrequent stools, straining
Faecal Loading = retention of faeces to the extent that spontaenoes evacuation is unlikely
108
What symptoms indicate constipation?
1. Bowel movement < 3 times/week
2. Excessive straining
3. Lowe abdo pain, distension, bloating
109
What are some non-specific symptoms associated with constipation in elderly?
1. Confusion or delirium, functional decline
2. Nausea or loss of appetite
3. overflow diarrhoea
4. urinary retention
110
When do you suspect faecal loading?
- hard, lumpy stools : large + infrequent
- Manual method of extraction
- overflow faecal incontinence or loose stool
111
What examination do you carry out in constipation?
PR exam
112
What AXR finding would you have in constipation?
Sitzmarks
113
What symptoms are required for a diagnosis of IBS?
1. Abdo pain +/-
2. Bloating +/-
3. Change in bowel habit
114
What are other symptoms associated with IBS?
Positive diagnosis of IBS if:
abdo pain is relieved by defaction
or
altered bowel frequency stool form
+
2 of:
1. altered stool passage : straining, urgency, incomplete evacuation
2. abdo bloating, distension, tension or hardness
3. symptoms worse by eating
4. passage of mucus
115
What investigations should be carried in primary care for IBS?
FBC
ESR/CRP
Coeliac disease screen
116
What dietary advice would give for IBS?
1. regular meals
2. avoid missing meals or leaving long gaps between eating
3. drink at least 8 cups of fluid per day
4. reduce intake of alcohol and fizzy drinks
5. limiting intake of high-fibre food
6. limit fresh fruit to 3 portions per day
7. for diarrhoea, avoid sorbitol
117
What is the definition of diarrhoea?
Passage of 3 or more loose stools per day
118
What are the different classifications of diarrhoea?
- Acute diarrhoea < 14 days
- Persistent diarrhoea > 14 days
- Chronic diarrhoea > 4 weeks
119
What are the different causes of diarrhoea?
Bacterial:
- salmonella
- campylobacter jejuni
- shigella
- E.coli
Drugs:
- laxatives
- allopurinol
- ARB
- Abx
- Chemo
- NSAID
- PPI
- SSRI
120
What investigation is carried for infectious diarrhoea?
- Stool sample
121
When should a pt be admitted with diarrhoea?
- Vomiting + unable to retain oral fluids
| - sever dehydration or shock
122
When should a pt be referred for diarrhoea?
> 40 y/o + :
- Weight loss
- Abdo pain
> 50 y/o + rectal bleeding
> 60 y/o iron deficiency anaemia
123
What medication can be used for diarhoea?
- Loperamide
124
What medications can affect can affect urea breath test?
- Abx : within 4 weeks of test
| - PPI : within 2 weeks of test
125
When do you offer prophylactic abx in peritonitis?
| What abx?
- Cirrhosis + ascites
- -> until ascites has resolved
Oral ciprofloxacin
126
Which type of H.Pylori test is used to check eradication?
Urea breath test
127
What is the strongest risk factor for Barrett's Oesophagus?
GORD
128
What is diverticular disease?
Diverticula causes symptoms (intermittent lower abdo pain) without inflammation or infection
129
What are the symptoms of diverticulitis?
- left iliac fossa pain + tenderness
- bloating
- anorexia
- diarhoea or constipation
Infection:
- pyrexia
- raised WBC + CRP
130
What investigations can be carried out for diverticulitis?
1. FBC : raised WCC
2. Raised CRP
3. CT: suspected abscess
4. Colonoscopy : initially avoided due to risk of perforation
131
Which type of H.Pylori test is used to check eradication?
Urea breath test
132
What is the strongest risk factor for Barrett's Oesophagus?
GORD
133
Which side of the lung is aspiration pneumonia more common in?
Right lower lobe
134
What are the symptoms of appendicitis?
- Periumbilical pain which worsens and migrates to RIF
(24-48 hours)
- Pain worse by movement
- Low-grade fever
- Nausea
- Constipation
135
What are the examination findings for appendicitis?
- Tenderness in the RIL
- -> maximal tenderness over 'McBurney's point'
- Rosving's sign
- Psoas sign
136
How is appendicitis diagnosed?
Raised inflammatory markers + history + examination findings is enough to justify
137
What is intussusception?
- Invagination of one portion of bowel into the lumen of adjacent bowel.
138
What is the most common site for intussusception?
- ileo-caecal region
139
What are the symptoms of intussusception?
- Paroxysmal abdominal colic pain
- vomiting
- * red-currant jelly* (late sign)
- sausage-shaped mass in RUQ
140
What is the investigation of choice for intussusception?
USS
| - target-like mass
141
What is ischaemic bowel disease?
- Interruption/loss of blood supply to the bowel
142
What are the symptoms of ischaemic bowel disease?
- Sudden onset abdo pain
- -> reaches peak very quickly
- Melaena
- Diarrhoea
- fever
143
What is the diagnostic investigation for ischaemic bowel disease?
- CT angio
144
What blood findings may you see for ischaemic bowel disease?
- Elevated WCC
| - Lactic acidosis
145
What is bowel obstruction?
- Passage of food, fluids and gas becomes blocked
146
What are the symptoms of bowel obstruction?
- Abdominal pain (diffuse + central)
- N + V (bilious vomiting)
- Constipation (lack of flatulence)
- Abdo distension
147
What examination findings may you see with bowel obstruction?
- tinkling bowel sounds
148
What is the 1st line investigation for bowel obstruction?
Abdo X-Ray
| - dilated bowel > 3 cm
149
What is the definitive investigation for bowel obstruction?
CT
150
What is toxic megacolon?
- Acute form of colonic distension
151
What are the features of toxic megacolon?
- Segmental
- non-obstructive dilation of the colon > 6 cm diameter
- system toxicity
152
What are the symptoms of toxic megacolon?
- Abdo pain (diffuse, relieved by bowel movement)
| - dairrhoea > 1 week
153
What investigation is carried out for toxic megacolon?
Abdo x-ray : dilated bowel
154
What is Inflammatory Bowel Disease?
2 types:
- Crohn's
- Ulcerative Colitis
155
What is Crohn’s?
Chronic inflammatory disease
| - Mouth --> anus
156
What is Ulcerative Colitis?
Relapsing, remitting autoimmune condition
- Rectum + sigmoid colon (proctitis)
- Not beyond ileocaecal valver
157
What are the symptoms of Crohn's?
1. Diarrhoea
2. Weight
3. Abdo pain (RLQ)
4. Mouth ulcers
158
What are the symptoms of Ulcerative Colitis?
1. Bloody diarrhoea (mucus)
2. Abdo pain (LLQ)
3. fatigue
4. Fever
159
What are the signs of IBD (both)?
1. Erythema nodosum
| 2. Uveitis
160
What investigation can distinguish between IBD + IBS?
Faecal calprotectin
| elevated in IBD
161
What are the histological differences in IBD?
Crohn's
1. inflammation in all layers
2. increased goblet cells
3. granulomas
UC:
1. no inflammation beyond submucosa
2. decreased goblet cells
3. no granulomas
162
What investigation is carried out for IBD?
Colonoscopy:
Crohn's :
1. 'Cobble-stone appearance (skip lesions)
UC:
1. biopsy needed for diagnosis
2. appearance of polyps (pseudopolyps)
Abdo X-Ray:
UC : lead Pipe radiological appearance
163
Symptoms of haemarrhoids
- painless rectal bleeding
- feeling like you still need to open bowel after going
- lumps around the anus
164
What are the 2 types of haemorrhoids?
Internal - originate above the dentate line , do not generally cause pain
External- originate below the dentate line, may be painful as prone to thrombosis
165
Grading of haemorrhoids
1: do not prolapse out of the anal canal
2: prolapse on defecation but reduce spontaneously
3: can be manually reduced
4: cannot be reduced
166
What is an anal fissure?
a tear or ulcer in the lining of the anal canal which causes pain on defecation
167
How can anal fissures be classified?
Acute - <6 weeks
Chronic - >6 weeks
Primary - no underlying cause
Secondary - underlying cause (e.g constipation, STI, IBD, colorectal cancel)
168
Clinical features of anal fissure
anal pain on defecation (with or without bleeding) and anal spasm
169
When would you refer in case of anal fissure?
if a serious underlying cause is suspected (rectal cancer or IBD)
170
When should adults with anal fissure be reviewed?
primary anal fissure - reviewed at 6-8 weeks or sooner if necessary
171
Sx of Anorectal abscess
painful, hardened tissue in the perianal area
discharge of pus from the rectum
fever
constipation or pain with bowel movements
172
Caustive bacteria of Anorectal abscess
E.coli, staph aureus
173
Ix for Anorectal abscess and anal fistula
DRE
174
What is an Anal fistula
a small tunnel that connects an infected gland inside the anus to an opening on the skin around the anus
175
What causes an Anal fistula
Usually due to previous ano-rectal abscess
176
What is pilonidal disease?
sinuses and cysts form near the upper part of the natal cleft of the buttocks
177
Clinical features of Pilonidal disease
recurrent episodes of natal cleft pain with discharge
178
Ix for Coeliac disease
1st line = tissue transglutaminase (TTG) antibodies (IgA)
| Gold standard/confirm diagnosis = Endoscopic intestinal biopsy
ICM Matrix
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