Medix

  Upper GI bleed Causes By frequency (can be multiple causes): Peptic ulcer disease (PUD) (50%): ulcer erosion into blood vessel. Commonly posterior duodenal ulcer. Inflammation: oesophagitis (25%), gastritis (25%), or duodenitis (15%). Oesophageal or gastric varices (15%). Mallory-Weiss tear (5%) following severe vomiting. Upper GI cancer (5%). Signs and symptoms Epigastric pain and/or diffuse abdo pain. Haematemesis: red if active, coffee-ground if settled. Melena: black and foul smelling stool. Can also be caused by ascending colon cancer. Iron therapy can cause black stool, but it is less foul-smelling. Shock Investigations Bloods: ↓Hb. May be normal before fluid resus. Cross-match and coag. ↑Urea due to GI absorption and metabolism of blood. LFTs Imaging: Erect CXR and abdo XR. Consider CT abdo-chest. Risk assessment Blatchford score  at first assessment: considers bloods (urea, Hb), obs (SBP, HR), symptoms (melena, syncope), and co-morbidities (liver disease, HF). Score ...

  Background Pathophysiology 95% are adenocarcinomas, the rest lymphoma or squamous cell. Often the result of a mutation in the WNT/β-catenin pathway. Includes sporadic mutations of APC which reduce its inhibition of β-catenin, an activator of protein synthesis. Usually develop from adenomatous polyps. Commonest sites are rectum (25%), sigmoid (25%), and caecum (15%). Staging TNM. T refers to depth, not size. Dukes': A confined to mucosa; B through muscle; C lymph nodes; D distant mets. Epidemiology 4th commonest cancer in UK, after breast, prostate, and lung: 1/15 (men) or 1/20 (women) lifetime risk. Signs and symptoms PR bleeding, anaemia. Mass felt PR or abdominally. Distal cancer: blood and mucous PR, altered bowel habits (especially diarrhoea), tenesmus. More likely than proximal cancer to present with obstruction as the stool is more solid here and thus the flow more easily blocked. Proximal cancer (up to splenic flexure): weight loss, anaemia, right iliac fossa pain. Risk fa...

  Oesophageal cancer Pathophysiology Either adenocarcinoma (⅔ of cases), occurring in the lower third of the oesophagus, or squamous cell carcinoma (⅓), which can occur at any level. Risk factors Lifestyle and demographic: male, obesity, alcohol, high fat diet, smoking. GORD and Barrett's oesophagus (intestinal metaplasia). Achalasia, strictures. H. pylori  may reduce the risk. Signs and symptoms Dysphagia and/or odynophagia. Difficulty with solids first, then liquids. Weight loss. Retrosternal pain. If in the upper third: hoarse voice (recurrent laryngeal nerve palsy), cough during eating (may lead to aspiration pneumonia). Investigations FBC may show microcytic anaemia. Diagnosis: endoscopy and biopsy. Staging: CT and endoscopic US. Consider PET to increase sensitivity for metastases. Management Curative: ⅓ are potentially resectable, using open or laparoscopic oesophagectomy plus lymphadenectomy. Neoadjuvant chemotherapy (cisplatin + 5FU) then remove tumour and anastomose r...

  Background Pathogens Viral:  Norovirus  (with  Norwalk virus  being the only species),  Rotavirus ,  Astrovirus ,  Adenovirus . Bacteria:  Campylobacter jejuni ,  Salmonella  (usually  S. enteritidis ),  Shigella ,  E. coli ,  Vibrio cholera ,  Clostridioides difficile . Protozoa:  Giardia ,  Cryptosporidium ,  Cyclospora ,  Entamoeba . See  protozoal infections . Transmission Most are faecal-oral, and can be person-to-person, foodborne, or waterborne. Some are zoonotic e.g. 1/4  Salmonella  cases in kids are from pet reptiles. Campylobacter ,  Shigella , and  Giardia  can be sexually transmitted, especially in men who have sex with men. Signs and symptoms Overview: Acute diarrhoea and/or vomiting is the cardinal feature. Anorexia, malaise, fever, and weight loss are also common. Reliably determining the etiologic agent from clinical history is not usually ...