GI Differentials Flashcards by Lorna Chapman

What are the differentials to conside in haematemesis?

Oesophageal varicies
peptic ulcer
malignancy
bleeding disorderr
mallory-weiss tear

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What are important things to consider in haematemesis?

ODP, Ass, ICE, PMHx, DHx, FMHx, SHx
- had they just had a nosebleed?
- ?BLOOD THINNERS- this is an option in any bleeding presentation
any acute bleeding - ABCDE approach
cross match in case of further haemorrhage

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In a haematemesis history, what will examination/hx finding show if there are oesophageal varicies?

What Ix should be done?

PMHx - liver cirrhosis, portal hypertension

SHx - heavy alcohol consumption

Ass q’s: Malena

Ix:

Bloods: FBC, INR, LFTs

Imaging: OGD - distended veins in lower oesophagus

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In a haematemesis Hx, what will examination/Hx finding show if it is a peptic ulcer?

What Ix will be useful?

Abdominal pain
NSAID use
Smoker
PMHx of Peptic ulcer

Worse with food = gastric

better with food = duo

Ix finding:

FBC

Urea breath test: positive for H. Pylori

H. Pylori is the most common cause of duo and gastric ulcers; nsaids more gastric

Upper Gi endoscopy

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In a haematemesis Hx, what will examination/Hx finding show if it is a malignancy?

What Ix will be useful?

dysphagia (discomfort/difficulty swallowing), PMHx, FHx, drinker and smoker

Weight loss, early satiety,

fever, night sweats, weight loss

Ix: Upper GI endoscopy

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In a haematemesis Hx, what will examination/Hx finding show if it is a bleeding disorder?

Medication Hx - warfarin
PMHx e.g.
- haemophilia (lack of CF - particulerly #8),
- von williebrand (missing or VWF that + F8, and platelets in blood vessel walls, –>platelet plug)
  *

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In a haematemesis Hx, what will examination/Hx finding show if it is a mallory-weiss tear?

What Ix would be useful?

Hx of retching, vomiting, coughing or straining
light headedness or dizziness

Ix: OGD: visible red longitudinal defect (tear)

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What are the different ddx for a presentation of diarrhoea?

Gastroenteritis (norovirus or campyloacter - jejuni or coli)
- a few days Hx
IDB
- ~18y/o male w/ chronic diarrhoea
IBS
- 20y/o female. diarrhoea + STRESS
Diverticular disease
- Middle aged, RF: obesity and low fibre diet
Colorectal cancer
- 55y/o male w/blood in loose stools

Importnant to consider: ODP Ass - follow the GI tract down, then screen for red flags, PMHx, travel, FHx, SHx

?Dehydration –> do they need fluids set up

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In a diarrhoea Hx, what will examination/Hx finding show if it is gastroenteritis?

What investigations would be useful?

profuse WATERY diarrhoea
fever
Hx: foreign travel or eating poorly cooked foods
other family/household members sick

Ix:

stool MC&S
if concerned about parasites: serodiagnosis

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In a diarrhoea Hx, what will examination/Hx finding show if it is IBD?

What investigations would be useful?

Ulcerative collitis
- blood and mucus
- crampy abdo pain
- urgency
- tenesmus (rectal involvement)
Crohns
- mucus
- colicky abdo pain
BOTH:
- fever
- weight loss
Ix:
FBC, CRP and ESR
Colonoscopy and biopsy
- malaise

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In a diarrhoea Hx, what will examination/Hx finding show if it is IBS?

What investigations would be useful?

triad:
constipation/diarrhoea mix
bloating
relief on defecation

Ix: its a functional disorder, rule out other things

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In a diarrhoea Hx, what will examination/Hx finding show if it is diverticular disease?

What investigations would be useful?

bloody diarrhoea
abdo pain in LIF
- if its diverticulitis:
  - __fever, nausea and vomiting

Ix: fbc, contrast enema (barium enema) [x-ray study that useing a water solublecontrast agent containing iodine or barium to show the structure of the rectum/colon/large intestine.

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In a diarrhoea Hx, what will examination/Hx finding show if it is CRC?

What investigations would be useful?

RED FLAG SYMPTOMS - abdominal pain, change in bowel habit, weight loss and iron-deficiency anaemia.

~tenesmus, haematochezia - bloody stools, in or with (diarrhoea normally LS)

PMHx of malignancy, IBD or coeliacs

Ix:

Blood: FBC (anaemia) CRP, ESR, U&Es(Ca2+ ~ constipation and abdo pain + polydipsia and polyurea)

Colonoscopy and biopsy

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What are the the Ddx for jaundice?

Alcoholic liver disease (alcoholic hepatitis)
Viral hepatitis (A, B, C)
Primary biliary sclerosis
Choleliathiasis
- Female, Fat, Forty and Fertile
Pancreatic adenocarinoma (head of panc)
- usually present with symptoms of mets, but in some cases ~jaundice
Chronic pancreatitis
- 50 y/o alcoholic presents with jaundice and bloating
heamolytic anaemia
- malaria, G6DP def, sickle cell

Important to consider: Red flags – PAINLESS JAUNDICE

always do an alcohol hx + CAGE

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In a jaundice Hx, what will examination/Hx finding show if it is alcoholic liver disease (alcoholic hepatitis)?

What Ix would be useful?

Chronic alcoholic
pain
ascites
bruising
RUQ pain
Jaundice was rapid onset

Ix finding: LFTs - AST>ALT

[in alcoholism AST:ALT raised over 1.5. + GGT + icHDL are signs too]

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In a jaundice Hx, what will examination/Hx finding show if it is Viral hepatitis?

What investigations would be useful?

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Flu-like symptoms
IVDU
unprotected sex
tattoos
piercings
blood transfusions
travel

Ix: IgM anti- HAV

IgM anti-HBV

In a jaundice Hx, what will examination/Hx finding show if it is primary biliary sclerosis?

What investigations would be useful?

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PMHx of ulcerative collitis

Ix: ERCP - beads on a string

p-ANCA abs found (vasculitis abs)

In a jaundice Hx, what will examination/Hx finding show if it is choleliathiasis?

What investigations would be useful?

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Four F’s: Female, fat, forty and fertile
colicky abdominal pain,
pale stools dark urine
pruritus
pain after eating fatty meal

Ix: USS

In a jaundice Hx, what will examination/Hx finding show if it is pancreatic adenocarcinoma?

What investigations would be useful?

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painless obstructive jaundice
(and palpable gall bladder- murphys sign)
symptoms consistent with mets to lymph, liver, lungs

Ix:

Bloods: FBC, amylase, raised bilirubin and ALP (biliary tree–> check GGT too); CA199

Imaging: USS

In a jaundice Hx, what will examination/Hx finding show if it is chronic pancreatitis?

What investigations would be useful?

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Jaundice and bloating
steatorrhoea
weight loss and anorexia
boring pain- relieved on leaning forward
Chronic alcoholic

Ix: on AXR- calcification of the pancreas

In a jaundice Hx, what will examination/Hx finding show if it is haemolytic anaemia?

What investigations would be useful?

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recent travel (malaria)
FHx (sickle cell, G6DP)
PMHx

Ix:

FBC
Direct coombs test (autoimmune haemolytic anaemia)
blood film

What are the Ddx for an abdominal distention (bloating) history?

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Ovarian carcinoma
- post memopausal women presents with feeling bloated for ~>3 weeks
Pregnancy
IBS
Liver disease
Medication
Bowel obstruction
- acute onset
Chronic pancreatitis

Important to consider: ODP, Ass, PMHx and PSHx, DHx and SHx

past surgical history is important
in Social Hx - inlude and signpost for last menstrual period

In a boating/abdo distention Hx, what will examination/Hx finding show if it is ovarian carcinoma?

What investigations would be useful?

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post menopausal women presents with feeling bloated for ~3 weeks or more
Exam/Hx
- loss of appetite
- increased urgency and freiquency
- bloating, ascites, pelvic or abdo mass
- back pain
ix:
bloods: FBC, CA125
Imaging: USS
invasive: frozen section biopsy

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is primary biliary sclerosis?

What investigations would be useful?

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Last menstural period

Ix: preg test

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is IBS? What investigations would be useful?

* bloating * constipation/diarrhoea * relief of pain on defecation Ix: diagnosis of exclusion

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is liver disease? What investigations would be useful?

* jaundice * portal hypertension * varicies * chronic alcohol use * IVDU * travel Ix: Bloods: FBC, LFTs, INR, ESR, viral screen, MC&S urine and blood, ascited LFTs: AST\>ALT (alcohol) ALT \>AST = other cause of liver damage [if ratio below 1 then liver]

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is medication? What investigations would be useful?

* normally associated with constipation too * aspirin, opioids, antacids, iron supplements

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is bowel obstruction? What investigations would be useful?

Small bowel: 1. pain **and vomiting** 2. distension 3. constipation Large bowel: 1. pain **and constipation** 2. distention 3. vomiting * **past surgical history** Ix: AXR - distended bowel loops

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is chronic pancreatitis? What investigations would be useful?

* jaundice * steatorrhoea * anorexia * weight loss * boring pain relieved on leaning forward Ix: AXR -calcification of the pancreas

What should be considered in a dysphagia history?

* timeline * no fluid or solid whole time - ?oesphageal achalasia * solids--\>fluids --\> ?oesophageal cancer

What is are the criteria for OGD?

ALARMS-55 * anaemia * loss of weeight * appetite * recent onset of progressive symptoms * malena * swallowing difficulties * over 55?

What are the red flags for colon/endoscopy?

BOWELS - endoscopy * bloating * owch * weight loss * exhaustion * lasting urge (tenesmus) * swallow

GI Differentials Flashcards

(32 cards)