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Year 2 Medicine @ Lancaster Uni > 2.05 - Lower GI disorders and Surgery > Flashcards

2.05 - Lower GI disorders and Surgery Flashcards

1
Q

What is an aetiological surgical sieve?

A
  • An checklist of diseases that relate to symptoms
  • Allows for the exploration of differential diagnoses
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2
Q

What is an example of an aetiological surgical sieve?

A

V - Vascular - Ischemia, AAA, Dissection
I - Infectious/Inflammatory - C. Diff, GORD
N - Neoplastic - Cancers
D - Degen./Defici/Drugs - NSAID’s, antibiotics, constipation
I - Idiopathic/Iatrogenic - Surgery, IBS, torsiom
C - Congenital - Meckle’s, hernia, exomphalos
A - Autoimmune - Crohn’s, Coeliac, Diabetes, UC
T - Trauma - Blunt or penetrating trauma
E - Endocrine - DKA, Acidosis, Ketosis, Hyperglycaemia

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3
Q

Is is constant abdominal pain indicitive of?

A
  • Inflammation
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4
Q

What is colicky abdominal pain indicitive of?

A
  • Suggests blockage
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5
Q

What are the nine regions of the abdomen?

A
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6
Q

What are some differentials in the right hypochondrium?

A
  • Biliary colic
  • Cholecystitis
  • Cholangitis
  • Hepatitis
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7
Q

What are some differentials in the epigastric region?

A
  • Oesophagitis
  • Gastritis
  • Peptic ulcers
  • Pancreatitis
  • MI
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8
Q

What are some differentials in the left hypochondrium?

A
  • Gastritis
  • Splenomegaly
  • Splenic infarct
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9
Q

What are some differentials in the right lumbar region?

A
  • Pyelonephritis
  • Ureteric stone
  • Constipation
  • Bowel obstruction
  • Colitis
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10
Q

What are some differentials in the umbilical region?

A
  • Pancreatitis
  • Early appendicitis
  • Umbilical hernia
  • AAA
  • Constipation
  • Hernia
  • Colitis
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11
Q

What are some differentials in the left lumbar region?

A
  • Pyelonephritis
  • Ureteric stone
  • Constipation
  • Bowel obstruction
  • Colitis
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12
Q

What are some differentials in the right iliac fossa region?

A
  • Late appendicitis
  • Ectopic pregnancy
  • Ovarian cyst
  • Hernia
  • PID
  • Torsion
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13
Q

What are some differentials in the suprapubic region?

A
  • UTI
  • Urine retention
  • PID
  • Torsion
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14
Q

What are some differentials in the left iliac fossa region?

A
  • Diverticulitis
  • Ectopic pregnancy
  • Hernia
  • PID
  • Torsion
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15
Q

What is peritonitis?

A
  • Classified as inflammation of the peritoneum which is the lining of the abdominal cavity
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16
Q

What are the three parts of the peritoneum?

A
  1. Parietal peritoneum
  2. Visceral peritoneum
  3. Peritoneal cavity
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17
Q

How do patients with peritonitis usually present?

A
  • Acute, severe abdominal pain
  • Fever
  • Nausea/Vomiting
  • Systemic upset
  • Distended abdomen
  • Anorexia
  • Sweating
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18
Q

What are the clinical signs associated with peritonitis?

A
  • Rigidity
  • Guarding
  • Tenderness on palpation
  • Rebound tenderness
  • Tachycardia
  • Abnormal bowel sounds
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19
Q

When is generalised pain present in peritonitis?

A
  • Marks the initial inflammation of the visceral peritoneum
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20
Q

When is local pain seen in peritonitis?

A
  • Indicitive of inflammation of pareital peritoneum
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21
Q

How can the oesophagus cause peritonitis?

A
  • Trauma
  • Malignancy perforation
  • Boerhaave sign (Rupture)
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22
Q

How can the stomach cause peritonitis?

A
  • Ulcer perforation
  • Malignancy perforation
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23
Q

How can the pancreas cause peritonitis?

A
  • Pancreatitis
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24
Q

How can the liver and gallbladder cause peritonitis?

A
  • Gallstones
  • Cholecystitis
  • Malignancy perforation
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25
Q

How can the small intestine cause peritonitis?

A
  • Ischaemic bowel
  • Strangulated hernia
  • Duodenal ulcer
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26
Q

How can the colon cause peritonitis?

A
  • Appendictis
  • Diverticultis
  • Colorectal cancer
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27
Q

What is primary peritonitis?

A
  • Spontaneous bacterial invasion of peritoneum
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28
Q

What is secondary peritonitis?

A
  • Infection due to a perforation
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29
Q

What is tertiary peritonitis?

A
  • Recurrent or persistent infection that results in peritonitis
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30
Q

What is dialysis associated peritonitis?

A
  • Seeding of peritoneum due to dialysis catheter or breaks in sterility
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31
Q

What investigation should be performed when peritonitis is suspected?

A
  • FBC
  • LFT’s
  • Renal profile
  • VBG/ABG
  • CRP
  • Coagulation cascade
  • Group & save +/- crossmatch
  • CT imaging
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32
Q

What is the management strategy used for peritonitis?

A
  • Urgent surgical exploration
  • IV antibiotics
  • Close monitoring
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33
Q

What are the complications associated with peritonitis?

A
  • Sepsis
  • Shock
  • Organ failure
  • Death
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34
Q

What do anaerobic bacteria produce?

A
  • They produce toxic metabolites that inhibit other organisms
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35
Q

What species of microbes are found in the nasopharynx?

A
  • Streptococci
  • Haemophilius
  • Neisseria
  • Mixed anaerobes
  • Candida
  • Actinomyces
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36
Q

What species of microbes are found in the small intestine?

A
  • Candida
  • Enterococci
  • Enterobacterideae
  • Streptococci
  • Clostridium
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37
Q

What species of microbes are found in the large intestine?

A
  • Bacteriodes
  • Bifidobacteria
  • Clostridium
  • Peptostreptococci
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38
Q

What species of microbes are found on the skin?

A
  • Staphylcocci
  • Streptococci
  • Corynebacteria
  • Proprionibacteria
  • Yeasts
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39
Q

What species of microbes are found in the vagina?

A
  • Lactobacilli
  • Streptococci
  • Candida
  • Corynebacteria
  • Actinomyces
  • Mycoplasma hominis
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40
Q

What staining type are bacteria found in the gut?

A
  • Gram positive
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41
Q

What is the most common bacteria found on the skin?

A
  • Staph. Aureus
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42
Q

What is the most common bacteria found in the gut?

A
  • Bacterioses fragilis
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43
Q

What happens to normal gut flora when antibiotics are taken?

A
  • They become suppressed
  • This allows for oportunisic colonisation and infection to occur
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44
Q

What is the surgical stress response?

A
  • The body’s mechanisms that try to maintain a normal environment in an abnormal situation?
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45
Q

What factors can affect the surgical stress response?

A
  • Trauma (Surgery)
  • Infection
  • Hyper/hypothermia
  • Cell death
  • Emotional factors
  • Chronic illness
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46
Q

Where does the stress response initially propagate from?

A
  • Paraventricular nucleus of hypothalamus
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47
Q

What are the three stages of the stress response?

A
  1. Secrete CRH -> Cortisol
  2. Cortisol activates the sympathetic NS -> Adrenaline
  3. Adrenaline stimulates posterior pituitary -> Increased ADH
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48
Q

What are some of the body’s immune responses to surgical stress?

A
  • Macrophage, neutrophil and NK cell migration
  • Cytokine release
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49
Q

In what cases can the surgical stress response be harmful?

A
  • In older patients and those with co-morbidities the stress response can cause more harm than good
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50
Q

What is utilised during surgery to alleviate some of the effects of the surgical stress response?

A
  • Triad of anaesthesia
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51
Q

What three elements make up the triad of anaesthesia?

A
  • Hypnosis (Sleep)
  • Analgesia (Pain relief)
  • Paralysis (Muscle relaxation)
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52
Q

What are the stages of the basic pain perception pathway?

A
  1. Noxious stimuli
  2. Nociceptor activation
  3. 1st order neurones to dorsal horn
  4. Synapse with 2nd order in spinothalamic tract
  5. Synapse with 3rd order in thalamus
  6. 3rd order travels to primary sensory centre
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53
Q

Where do local anaesthetics target?

A
  • Peripheral nerve endings
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54
Q

What blocks pain perception in the spinal cord?

A
  • Opioids
  • Magnesium
  • Neuroaxonal block
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55
Q

What is the definition of pain?

A
  • “An unpleasant sensory/emotional experience associated with or resembling that associated with actual or potential tissue damage”
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56
Q

What is nociception?

A
  • PNS + CNS information about the internal/external environment by nociceptor activation
  • Can occur in the absence of pain
  • With pain = noxious stimuli
  • Pain can also be felt without nociception
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57
Q

When is pain felt?

A
  • When the stimulus exceeds the normal nociceptive threshold
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58
Q

What are examples of mechanical nociception?

A
  • Pressure
  • Swelling
  • Incision
  • Abscess
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59
Q

What are examples of thermal nociception?

A
  • Scalding
  • Heat
  • Burning
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60
Q

What are examples of chemical nociception?

A
  • Prostaglandins seen in infection and ischaemia
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61
Q

How do mechanical nociceptors work?

A
  • Stimulated by intense pressure which gives rise to sharp, fast pain
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62
Q

How is mechanical pain conducted?

A
  • Conducted by A-delta fibres which are large bore and are myelinated
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63
Q

How do thermal nociceptors work?

A
  • Stimulated by the extremes of hot and cold environments
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64
Q

How is thermal pain conducted?

A
  • Conducted by C fibres which are unmyelinated and have a small diameter
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65
Q

How do polymodal nociceptors work?

A
  • Stimulated by multiple stimuli including molecules, examples:
  • ATP
  • Prostaglandins
  • Histamine
  • Serotonin
  • Bradykinin
  • Substance P
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66
Q

How is polymodal nociception conducted?

A
  • Conducted via C fibres which are unmyelinated and have a small diameter
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67
Q

What type of pain do A-delta fibres transmit?

A
  • Bright, sharp, stabby pain
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68
Q

What type of pain do C fibres transmit?

A
  • Dull, throbbing, aching pain
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69
Q

In which ways can pain be classified in terms of duration?

A
  1. Nociceptive - Brief
  2. Prolonged - Prevents injury
  3. Chronic/Neuropathic - Pain after healing (2-3 months +)
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70
Q

What is somatic pain?

A
  • Pain that originates from the muscle, bone, joints, tendons and vessels
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71
Q

What is visceral pain?

A
  • Pain that originates from the internal organs
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72
Q

What is superficial pain?

A
  • Pain that originates from the skin (a type of somatic pain)
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73
Q

What is cancerous pain?

A
  • Pain that results from compression or infiltration by a tumour
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74
Q

What is psychogenic pain?

A
  • Pain that is caused by psychological factors such as stress
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75
Q

What is referred pain?

A
  • Pain that orginates from another part of the body
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76
Q

What is the function of the ascending spinal tracts?

A
  • Carry sensory information in afferent pathways from the body to the brain
  • Peripheral nerves -> Cerebral cortex
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77
Q

What is the function of the DCML tract?

A
  • Responsible for vibration, proprioception and fine touch
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78
Q

What are the two sections of the DCML?

A
  • Fasiculis gracilis - Medial - Below T6/T8
  • Fasiculis cuneatus - Lateral - Above T6/T8
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79
Q

What is the function of the anterior spinothalamic tract?

A
  • Responsible for crude touch and pressure
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80
Q

What is the function of the posterior spinothalamic tract?

A
  • Responsible for pain and temperature
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81
Q

What are the four spinocerebellar tracts?

A
  • Dorsal spinocerebellar
  • Cuneocerebellar
  • Ventral spinocerebellar
  • Rostral spinocerebellar
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82
Q

What is the function of the spinocerebellar tracts?

A
  • Transmit proprioceptive signals
  • Information regarding muscle stretch and rate of stretch
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83
Q

What is the function of descending spinal tracts?

A
  • They carry motor information in efferent fibres from upper motor neurons to lower motor neurons and eventually to effector muscles
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84
Q

Where are upper motor neurons found?

A
  • Brain and brainstem -> Ventral horn of spinal cord
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85
Q

Where are lower motor neurons found?

A
  • Ventral horn -> Peripheral muscles
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86
Q

What are the two types of motor tracts?

A
  • Pyramidal - Conscious control of muscles
  • Extra-pyramidal - Unconscious, reflexive or responsive
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87
Q

What are the two pyramidal tracts?

A
  • Corticospinal
  • Corticobulbar
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88
Q

What is the function of the corticospinal tracts?

A
  1. Primary motor cortex - Precentral gyrus, movement execution
  2. Premotor cortex - Responsible for behaviour, control, trunk
  3. Supp. motor cortex - Stabilisation and co-ordination
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89
Q

What is the function of the corticobulbar tracts?

A
  • The UMN provide bilateral innervation to head and neck structures
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90
Q

Where do pyramidal tracts pass through?

A
  • Pass through the pyramids of the medulla oblongata
91
Q

Where do the extra-pyramidal tracts originate and pass through?

A
  • All originate from the brainstem and DO NOT pass through the pyramids
92
Q

What is the general function of the extrapyramidal tracts?

A
  • Allow for unconscious, reflexive or responsive movement
  • Allow control of balance, locomotion, posture and tone
93
Q

What are the features and functions of the reticulospinal tracts?

A
  • Do not decussate
  • Medial - from pons, voluntary movements and tone
  • Lateral - from medulla, inhibition of voluntary, decrease tone
94
Q

What are the features and functions of the vestibulospinal tracts?

A
  • Do not decussate
  • Control anti-gravity muscles via LMN’s
  • Medial - controls ipsilateral posture and tone
  • Lateral - controls ipsilateral posture and tone
95
Q

What are the features and functions of the rubrospinal tracts?

A
  • Do decussate
  • Begins in the red nucleus
  • Supply upper limb and trunk flexors
  • Disinhibition = flexion
  • Inhibition = extension
96
Q

What are the features and functions of the tectospinal tracts?

A
  • Does decussate
  • Begins in tectum
  • Allows for reflexive localisation of stimuli
97
Q

How does an UMN lesion and LMN lesion effect tone?

A
  • UMNL = Hypertonia
  • LMNL = Hypotonia
98
Q

How does an UMN lesion and LMN lesion effect fasciculations?

A
  • UMNL = Absent
  • LMNL = Present
99
Q

How does an UMN lesion and LMN lesion effect atrophy?

A
  • UMNL = Minimal atrophy
  • LMNL = Marked atrophy
100
Q

How does an UMN lesion and LMN lesion effect paralysis?

A
  • UMNL = Spastic
  • LMNL = Flaccid
101
Q

How does an UMN lesion and LMN lesion effect reflexes?

A
  • UMNL = exaggerated
  • LMNL = diminished
102
Q

How does an UMN lesion and LMN lesion effect the presence of Babinski’s sign?

A
  • UMNL = Present
  • LMNL = Absent
103
Q

What is Babinski’s sign?

A
  • Stimulation of the lateral plantar aspect of the foot (S1 dermatome) normally leads to plantar flexion of the toes (due to stimulation of the S1 myotome)
  • Integrity of corticospinal tract
104
Q

What is CN I and where does it pass through?

A
  • Olfactory
  • Cribiform plate
105
Q

What is the modality and fucntion of CN I?

A
  • Sensory
  • Smell
106
Q

What is CN II and where does it pass through?

A
  • Optic
  • Optic canal
107
Q

What is the modality and function of CN II?

A
  • Sensory
  • Vision
108
Q

What is CN III and where does it pass through?

A
  • Oculomotor
  • Superior orbital fissure
109
Q

What is the modality and function of CN III?

A
  • Motor
  • Eye muscles except SO4 and LR6
110
Q

What is CN IV and where does it pass through?

A
  • Trochlear
  • Superior orbital fissure
111
Q

What is the modality and function of CN IV?

A
  • Motor
  • Superior oblique muscle of the eye
112
Q

What are the three branches of the trigeminal nerve?

A
  1. Opthalmic
  2. Maxillary
  3. Mandibular
113
Q

What is CN V(1) and where does it pass through?

A
  • Opthalmic
  • Superior orbital fissure
114
Q

What is the modality and function of CN V(1)?

A
  • Sensory
  • Provides sensation to scalp and forehead
115
Q

What is CN V(2) and where does it pass through?

A
  • Maxillary
  • Formane rotundum
116
Q

What is the modality and function of CN V(2)?

A
  • Sensory
  • Sensation to cheeks, lips and teeth
117
Q

What is CN V(3) and where does it pass through?

A
  • Mandibular
  • Foramen ovale
118
Q

What is the modality and function of CN V(3)?

A
  • Both sensory and motor
  • M = Muscles of mastication
  • S = ant. 2/3 of tongue
119
Q

What is CN VI and where does it pass through?

A
  • Abducens
  • Superior orbital fissure
120
Q

What is the modality and function of CN VI?

A
  • Motor
  • Lateral rectus muscle of the eye
121
Q

What is CN VII and where does it pass through?

A
  • Facial
  • Stylomastoid foramen/Internal acoustic meatus
122
Q

What is the modality and function of CN VII?

A
  • Both sensory and motor
  • M = muscles of expression
  • S = facial sensation
123
Q

What is CN VIII and where does it pass through?

A
  • Vestibulocochlear
  • Internal acoustic meatus
124
Q

What is the modality and function of CN VIII?

A
  • Sensory
  • Involved in hearing and balance
125
Q

What is CN IX and where does it pass through?

A
  • Glossopharyngeal
  • Jugular foramen
126
Q

What is the modality and function of CN IX?

A
  • Both sensory and motor
  • S = Sinus and parotid gland
  • M = Stylopharangeus
127
Q

What is CN X and where does it pass through?

A
  • Vagus
  • Jugular foramen
128
Q

What is the modality and function of CN X?

A
  • Both sensory and motor
  • M = Pharynx and larynx
  • S = GIT
129
Q

What is CN XI and where does it pass through?

A
  • Spinal accessory
  • Jugular foramen
130
Q

What is the modality and function of CN XI?

A
  • Motor
  • Trapezius and sternocleidomastoid
131
Q

What is CN XII and where does it pass through?

A
  • Hypoglossal
  • Hypoglossal canal
132
Q

What is the modality and function of CN XII?

A
  • Motor
  • Intrinsic and extrinsic tongue muscles
133
Q

Where is the demarcation between the midgut and hindgut?

A
  • 2/3 along the transverse colon
134
Q

Which artery supplies the midgut?

A
  • Superior mesenteric artery
135
Q

Which artery supplies the hindgut?

A
  • Inferior mesenteric artery
136
Q

What are the features of the Jejunum?

A
  • Thick wall
  • Longer vasa recta
  • Less arcades
  • Red in colour
  • Defined mucosal folds
  • Brunner’s glands
  • Nutrient absorption
137
Q

What are the features of the ileum?

A
  • Thin wall
  • Short vasa recta
  • More arcades
  • Pink in colour
  • Peyer’s patches
138
Q

What are the cells that are found in the crypts of lieberkuhn?

A
  1. Stem cells
  2. Paneth cells
  3. Enteroendocrine cells (I, S, K and enterochromaffin)
139
Q

What is the function of paneth cells?

A
  • Secrete lysozymes that help to kill bacteria
140
Q

What the different types of enteroendocrine cells?

A
  • I cells
  • S cells
  • Enterochromaffin cells
  • K cells
141
Q

What is the function of I cells?

A
  • Secrete CCK which stimulates gallbladder contraction
142
Q

What is the function of S cells?

A
  • Secrete secretin
  • Secretin -> Increases HCO3- secretion
143
Q

What is the function of enterochromaffin cells?

A
  • Releases serotonin
  • Which acts on the ENS
144
Q

What is the function of K cells?

A
  • Secretes GIP which in turn stimuates the release of insulin
145
Q

What cell type is found in the colon?

A
  • Simple columnar epithelium
146
Q

Which parts of the colon are retroperitoneal?

A
  • Ascending and Descending
147
Q

Which parts of the colon are intraperitoneal?

A
  • Transverse and sigmoid
148
Q

What supplies and drains the ascending colon?

A
  • Right colic artery
  • Right colic vein
149
Q

What innervates the ascending colon?

A
  • Superior mesenteric plexus
150
Q

What supplies/drains the transverse colon?

A
  • Superior/Inferior mesenteric artery
  • Middle colic vein
151
Q

What innervates the transverse colon?

A
  • Superior and inferior mesenteric plexus
152
Q

What supplies/drains the descending colon?

A
  • Left colic artery
  • Left colic vein
153
Q

What innervates the descending colon?

A
  • Inferior mesenteric plexus
154
Q

What supplies/drains the sigmoid colon?

A
  • Sigmoid arteries
  • Sigmoid veins
155
Q

What innervates the sigmoid colon?

A
  • Inferior mesenteric plexus
156
Q

In what ways is the colon structurally different to the small intestine?

A
  • No villi
  • No plicae circularis
  • Wall is sacculated with haustra
  • No endocrine secretions
157
Q

What are the three layers of abdominal fascia?

A
  1. Skin
  2. Camper’s (Fatty)
  3. Scarpa’s (Membranous)
158
Q

What are the flat muscles of the abdominal wall?

A
  1. External oblique
  2. Internal oblique
  3. Transversus abdominis
159
Q

What is the function of the transversus abdominus?

A
  • Compression of abdomen
160
Q

What innervates the transversus abdominus?

A
  • T7-T12
  • Lumbar plexus
161
Q

What is the function of the internal obliques?

A
  • Unilateral or bilateral contraction
162
Q

What innervates the internal obliques?

A
  • T7-T12
  • Lumbar plexus
163
Q

What is the function of the external obliques?

A
  • Contralateral rotation
164
Q

What innervates the external obliques?

A
  • T7-T12
165
Q

What are the two flat muscles of the abdomen?

A
  1. Rectus abdominus
  2. Pyramidalis
166
Q

What is the function of the rectus abdominus?

A
  • Compression of viscera
  • Stabilisation of the pelvis
167
Q

What innervates the rectus abdominus?

A
  • T7-T11
168
Q

What is the function of the pyramidalis?

A
  • Tenses the linea alba
169
Q

What innervates the pyramidalis?

A
  • T12 (Subcostal nerve)
170
Q

What is diverticulitis?

A
  • Inflammation of a diverticula outpouching
  • Can either be congenital (all layers of bowel) or acquired (lacks muscular propria)
171
Q

What is the pathophysiology around diverticulitis?

A
  • Faeces enters pouch which causes obstruction
  • This leads to stricture and inflammation
172
Q

What are the causes behind diverticulitis?

A
  • Low fibre diet
  • Obesity
  • Family history
  • Medications (NSAIDs etc)
173
Q

What are the clinical signs associated with diverticulitis?

A
  • Abdominal tenderness
  • Guarding
  • Tachycardia
174
Q

What are some symptoms that are associated with diverticulitis?

A
  • LLQ pain
  • Nausea
  • Anorexia
  • Inability to empty rectum
  • Change in bowel habit
175
Q

What investigations are performed in suspected diverticulitis?

A
  • Colonoscopy
  • CT abdo/pelvis
  • Bloods
176
Q

What management should be used in diverticulitis?

A
  • 7-10 day antibiotic treatment
  • Analgesia
  • If obstruction -> Laxative
  • Safety netting if symptoms progress
177
Q

Where in the colon is most affected by diverticulitis?

A
  • Sigmoid colon
178
Q

What is pseudomembranous colitis?

A
  • Inflammation of the colon due to overgrowth of c.diff bacteria
179
Q

What is the pathophysiology around pseudomembranous colitis?

A
  • C.diff releases A+B toxins in the colon which causes an inflammatory response by cytokines
180
Q

What are some of the causes of pseudomembranous colitis?

A
  • Antibiotics
  • Hospitals
  • Increased age
  • Immuncompromised
  • Recent abdo surgery
181
Q

What are some symptoms associated with pseudomembranous colitis?

A
  • Watery diarrhoea
  • Stomach cramps
  • Pus/mucus in stool
  • Nausea
  • Dehydration
182
Q

What are the clinical signs associated with pseudomembranous colitis?

A
  • Abdominal tenderness
  • Fever
  • Pyrexia
183
Q

What investigations should be done in suspected pseudomembranous colitis?

A
  • Obs
  • Stool samples (CD testing, virology etc.)
  • Bloods
  • CT abdo/pelvis
  • Colonoscopy
184
Q

What are the general management options for pseudomembranous colitis?

A
  • Correction of fluid loss
  • Nutritional support
  • Antibiotics
185
Q

Which antibiotics are given in mild pseudomembranous colitis?

A
  • Metronidazole or Vancomycin
186
Q

Which antibiotics are given in severe pseudomembranous colitis?

A
  • Vancomycin or fidaxomicin
187
Q

Which antibiotics are given in fulminant pseudomembranous colitis?

A
  • Vancomycin AND metronidazole
188
Q

What is appendictis?

A
  • Inflammation of the appendix
  • Is a surgical emergency due to risk of perforation
189
Q

What is the pathogenesis behind appendicitis?

A
  • Obstruction of lumen causes stasis and bacterial overgrowth
  • Increase in luminal pressure which compromises blood supply -> Perforation
190
Q

What are some causes of appendicitis?

A
  • Hard collections of stool
  • Lymphoid hyperplasia
  • Fibrous stricture
  • Carcinoid tumours
191
Q

What are the symptoms associated with appendicitis?

A
  • Migratory abdominal pain from periumbilical -> RIF
  • Nausea
  • Vomiting
  • Anorexia
  • Constipation
192
Q

What are the clinical signs seen in appendicitis?

A
  • RIF rebound tenderness
  • Guarding
  • Pyrexia
  • Rovsing’s sign
  • Obturator sign
  • Psoas sign
193
Q

What is Rovsing’s sign?

A
  • Palpate LIF, causes pain in RIF = positive sign
194
Q

What is the obturator sign?

A
  • Flex right hip and knee and rotate externally
  • If pain is present = positive
195
Q

What is the psoas sign?

A
  • Extending the right hip causes RIF pain
196
Q

What investigations are performed in suspected appendicitis?

A
  • Bloods
  • Abdominal XR
  • Endoscopy (To rule out other causes)
  • USS to look for fluid accumulation
197
Q

What are the management options for appendicitis?

A
  • Immediate surgery to remove appendix
198
Q

What is coeliac disease?

A
  • Autoimmune disease triggered by the ingestion of gluten peptides found in wheat, rye and barley
199
Q

What is seen on a histology slide that would confirm coeliac disease?

A
  • Crypt hyperplasia
  • Villous atrophy
  • Intraepithelial cells
200
Q

What other diseases is coeliac disease linked to?

A
  • Dermatitis herpetiformis
  • Anaemia
  • Osteoporosis
201
Q

What is the pathophysiological process behind coeliac disease?

A
  • HLA-DQ2 (95%) and HLA-DQ8 (5%) are the response prolamins
  • This causes a CD4+ T lymphocyte response -> Inflammatory response
202
Q

What are the symptoms associated with coeliac disease?

A
  • Weight loss
  • Fatigue
  • Bloating
  • Diarrhoea
  • Abdominal pain
203
Q

What are the clinical signs associated with coeliac disease?

A
  • Mouth ulcers
  • Angular stomatitis
  • Abdominal distension
  • Eccymosis (Brusing)
  • Muscle wasting
  • Neuropathy
204
Q

What are the investigations used in suspected coeliac disease?

A
  • Measuring of autoantibody IgA and anti-TGA
  • Total IgA levels
  • Histology
205
Q

What is the definitive management for coeliac disease?

A
  • Avoidance of gluten
  • Lifestyle adjustments
206
Q

What is crohns disease?

A
  • Inflammatory bowel disease
  • Anywhere in GI and can skip lesions
  • Affects mucosa and submucosa
207
Q

What is the pathogenesis behind the development of crohns?

A
  • Immunes system mounts an attack against intestinal microbes which leads to inflammation
  • Dysbiosis is a a key trigger
  • Granuloma formation is seen
208
Q

What are the symptoms seen in crohns?

A
  • non-bloody diarrhoea, N&V, fatigue, weight loss, RLQ pain, Perianal disease
  • C - Cobblestone appearance
  • R - Rosethorn ulcers
  • O - Obstruction
  • H - Hyperplasia of lymph nodes
  • N - Narrowing of lumen
  • S - Skip lesions
209
Q

What are the clinical signs seen in crohns disease?

A
  • Rashes
  • Pyrexia
  • Oral aphthous
  • Kidney stones
  • Arthritis
  • Gangrenous skin
210
Q

What are the common causes of crohns disease?

A
  • Disrupted gut flora immune response (Th1>Th2)
  • Genetic - Polygenic disease
  • Environmental - Alteration in bacterial flora
211
Q

What are the investigation used in crohns disease?

A
  • Bloods
  • Endoscopy
  • Abdominal XR
212
Q

What is the management used in crohns disease?

A
  • Thiopurines - Azathiopurine and Mercaptopurine
  • Immunosupressives
  • Methotrexate - Inhibits dihydrofolate reductase -> Immunomodulatory and anti-inflammatory
213
Q

What is a complication that can arise from crohns disease?

A
  • Kidney stones transmural damage = less calcium absorption = calcium builds up in ureters
214
Q

What is ulcerative colitis?

A
  • An inflammatory bowel disease that is continous and affects the large bowel only
215
Q

What histological features are seen in ulcerative colitis?

A
  • Affects all layers of the GI (transmural)
  • Deep ulcerations
  • Crypt abscesses
216
Q

What are the main pathophysological process behind ulcerative colitis?

A
  • Proctitis (50%)
  • Left-sided colitis (30%)
  • Pan-colitis (20%)
217
Q

What are some come common causes of ulcerative colitis?

A
  • Genetic
  • Environmental
  • Autoimmune
  • Disruption of microflora
218
Q

What symptoms are associated with ulcerative colitis?

A
  • Bloody diarrhoea
  • Weight loss
  • Fatigue
  • LLQ pain
  • Tenesmus
219
Q

What clinical signs are seen in ulcerative colitis?

A
  • Abdominal tenderness
  • Dehydration
  • Primary sclerosing cholangitis
  • Tachycardia
  • Arthritis
  • Anaemia
  • Oral apthous ulcers
220
Q

What is a protective factor in ulcerative colitis?

A
  • Smoking
221
Q

What investigations are performed in suspected cases of ulcerative colitis?

A
  • Bloods
  • C.diff toxin screens and stool cultures
  • Imaging - to identify dilation and/or perforation
  • Endoscopy (Carries risk of perforation in acute flare ups)
222
Q

What medications are given in the management of ulcerative colitis?

A
  • Thiopurines (Azathioprine and Mercatopurine)
  • TNF-A inhibitors (Infliximab/Adalimumab)
  • A4-B7 integrin inhibitor (Vedolizumab)
  • JAK inhibitor (Tofacitinib)
223
Q

What are some complications that can arise from ulcerative colitis?

A
  • Severe bleeding/dehydration
  • Toxic megacolon
  • Colon perferation
  • Systemic inflammation
  • Increased risk of colon cancer
  • Osteoporosis
  • Increased risk of blood clots
224
Q
A

Year 2 Medicine @ Lancaster Uni (15 decks)

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