Gastroenterology notes detailing gastric and hepatic pathologies and conditions for medical school examinations. Notes made from multiple resources such as oxford handbook, question banks, university lectures and UK guidelines.
Look at specialty section and content list for the summary contents ...
Description
Nausea and Vomiting (N&V) can be serious if occurs in large amounts, leading to dehydration and electrolyte
dysregulation quickly. N&V can have many causes from infections to migraines. If presenting always consider
pregnancy risk were appropriate, independent of timing (morning sickness can occur at any time of day).
Presentation Investigations
- Contents of vomiting are important; - FBC: Normocytic anaemia if acute GI bleed
o Coffee-grounds appearance: GI bleeding - Amylase: Pancreatitis
o Recognisable food: Gastric stasis; Achalasia - ABG: Hypochloraemic alkalosis (HCl loss) ➔ ↓ K+
o Feculent: Small bowel obstruction - AXR: Screens for bowel obstruction
- Timing and nature of N&V; - Endoscopy: If suspicious of GI bleed
o Morning: Pregnancy or ↑ ICP Management
o 1-Hour post-food intake: Stasis; Gastroparesis (DM) - IV Fluids: Corrects dehydration
o Relieves pain on vomiting: Peptic ulcer - K+ Replacement: Prevents hypokalaemia
o Loud gurgling: GI obstruction
Causes
- Iatrogenic: Anaesthesia; Chemotherapy
- Physiological: Pregnancy
- Pathological: Gastroenteritis; Migraines
Antiemetics
Receptor Antagonist Route Dosage Notes
Metoclopramide PO / IV / IM 10 mg/8 hr GI disorders; Prokinetic drug
PR 60 mg/12 hr
Domperidone GI disorders; Prokinetic drug
PO 20 mg/6 hr
D2
IM 12.5 mg
Prochlorperazine Vestibular disturbances; GI disorders
PO 5 mg/8 hr
Haloperidol PO 1.5 mg/12 hr Chemical causes (e.g. opiates)
Cyclizine PO / IV / IM 50 mg/8 hr GI disorders; Prokinetic drug
H1
Cinnarizine PO 30 mg/8 hr Vestibular disorders
5HT3 Odansetron IV 4-8 mg/8 hr ↑ Dose for emetogenic chemotherapy
Hyoscine Hydrobromide SC / IM 200-600 mcg Antimuscarinic (do not prescribe with a prokinetic drug)
Others Dexamethasone PO / SC 6-10 mg/d Unkown MOA
Midazolam SC 2-4 mg/d Unkown MOA
,Dysphagia
Description
Diseases of the oesophagus are typically seen with dysphagia (difficulty swallowing) ± odynophagia (pain on
swallowing). Dysphagia can be caused by either a functional or mechanical origin. Functional involves abnormalities in
neuromusculature of the oesophagus effecting its motility while mechanical involves an obstruction which can be
either foreign, benign or malignant. The most common causes of dysphagia is Gastroesophageal Reflux Disease
(GORD), causing reflex oesophagitis. Other common causes are Achalasia, Malignancies of the GIT and other forms of
oesophagitis.
Presentation Investigations
- Features: Odynophagia; Anorexia; Cachexia - Difficulty swallowing solids + liquids in beginning
- Malabsorption: Anaemia o Yes – Motility disorder
Causes o No – Solids then liquids suspect stricture
- Mechanical blockage - Difficulty initiating swallowing
o Malignant: Pharyngeal; Oesophageal; Gastric o Yes – Suspect bulbar palsy
o Benign: Oesophageal web; Peptic stricture - Odynophagia
o Pressure: Lung Ca; LA enlargement; Lymph nodes o Yes – Suspect ulceration or spasm
o Pharyngeal pouch: Zenker’s diverticulum - Intermittent/ constant / Progressive dysphagia
- Motility disorders o Intermittent – Suspect oesophageal spasm
o Achalasia: Oesophageal sphincter cannot open o Constant / worsening – Suspect malignancy
o Diffuse oesophageal spasm: Uncoordinated - Neck bulging / gurgling on drinking
o Scleroderma: Muscle weakness o Yes – Suspect pharyngeal pouch
o Bulbar palsy: CNIX ➔ CNXII Palsies - Specific tests
- Other o Endoscopy: Contrast swallow for pouching
o Oesophagitis: Long standing GORD o Video Fluoroscopy: Neurogenic causes
o Globus: ‘Lump in throat’ feeling o Manometry: Dysmotility causes
, Causes of Dysphagia
Cause Features Notes
Weight loss PMHx of Barrett's; GORD
Oesophageal Cancer Anorexia SHx of Smoking or
Vomiting Alcoholism
Odynophagia
Oesophagitis No Weight loss PMHx of Heartburn
Systemically well
PMHx of HIV
Oesophageal Candidiasis Candida infeciton
MHx of Steropid inhalers
Fluids and solids
Achalasia Heartburn -
Regurgitation of food
Commoner in Older men
Regurgitation
Herniation between
Pharyngeal Pouch Aspiration + Cough
thyropharyngeus +
Halitosis
cricopharyngeys m.
CREST Syndrome
Calcinosis Oesophageal sphincter is
Raynaud's decreased unlike in
Systemic Sclerosis (Scleroderma)
Esophageal dysmotility Achalasia where it is
Sclerodactylyl increased
Telangiectasia
Extraocular muscle weakness
Myasthenia Gravis Ptosis -
Solids → Liquids
Usually painless
Globus Hystericus Sx intermittent PMHx of Anxiety
Sx relieved on swallowing
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