Abdominal + Digestive Disorders Flashcards
Describe the location of the abdomen
- anterior portion of the body between thorax and pelvis
- contains abdominal cavity
- separated from chest by diaphragm
- lined with peritoneum membrane
- contains stomach, large + small intestines, liver, spleen, pancreas, kidneys, gallbladder, urinary bladder and other structures
What are the nine regions of diagnosis and examination of the abdomen?
- right + left hypochondrium
- right + left lumbar
- right + left iliac
- epigastric
- umbilical
- hypogastrium/supra pubic
What is contained in the right hypochondriac region?
- liver
- right kidney
- gallbladder
- large/small intestine
What is contained in the left hypochondriac region?
- liver’s tip
- stomach
- pancreas
- left kidney
- spleen
- large/small intestine
What is contained in the epigastric region?
- liver
- stomach
- spleen
- duodenum
- adrenal glands
- pancreas
What is contained in the right lumbar region?
- ascending colon
- small intestine
- right kidney
What is contained in the left lumbar region?
- descending colon
- small intestine
- left kidney
What is contained in the umbilical region?
- duodenum
- small intestine
- transverse colon
What is contained in the right iliac region?
- appendix
- caecum
- ascending colon
- small intestine
What is contained in the left iliac region?
- sigmoid colon
- descending colon
- small intestine
What is contained in the hypogastric/supra pubic region?
- bladder
- sigmoid colon
- small intestine
- reproductive organs
Provide a definition of the gastrointestinal system
- ingestion of food is acted upon by physical and chemical means
- provides the body with absorbable nutrients
- excretes waste products
- in animals the system includes the alimentary canal extending from mouth to anus, the hormones and enzymes assisting digestion
What are the cardinal questions of the gastrointestinal system?
- do you have Abdominal pain?
- are you nauseous?
- are you vomiting blood?
- are you vomiting?
- do you have constipation, diarrhoea or faecal incontinence?
- is there blood in your stool?
- do you have anorectal pain?
- do you have any masses around your anus?
- do you have the sensation of incomplete emptying?
- has your weight changed unintentionally?
- do you believe your skin to be of a yellow colour?
- do you have problems swelling (Dysphagia)
- do you have pain on swallowing (odnophagia)
- do you have indigestion?
What are the signs and symptoms of GI Disorders?
- Dysphagia (difficulty swallowing)
- bleeding
- bloating
- constipation/diarrhoea
- heartburn/GERD
- incontinence
- nausea and vomiting
- pain in the abdomen
What is Dysphagia?
- defined as difficulty swallowing
Why is Dysphagia a serious symptom that requires investigation?
- to exclude neoplasm
- can lead to malnutrition
If the patient experiences a lump in the throat when they are not swallowing, what is the likely diagnosis?
- anxiety, so called Globus Hystericus
What are the causes of dysphagia?
- malignant stricture
- benign strictures
- extrinsic pressure
What are the malignant strictures of dysphagia?
- oesophageal cancer
- gastric cancer
- pharyngeal cancer
What are the benign strictures of dysphagia?
- oesophageal web/ring
- peptic stricture
What are the extrinsic pressures (outside growing in) of dysphagia?
- lung cancer
- retrosternal goitre - usually anteriorly C5/T1
- mediastinal cancers
- pharyngeal pouch
What does the word stricture mean?
- narrowing
What are the causes of dysphagia?
- Achalasia = failure of smooth muscle fibres to relax
- diffuse oesophageal spasm
- myasthenia gravis = long term neuromuscular function disease
- syringomyelia = neurological disorder in which a fluid-filled cyst (syrinx) forms within the spinal cord
- systemic sclerosis = hardening and tightening of the skin
- bulbar palsy = bilateral impairment of cranial nerves IX - XII
- oesophagitis
- infection (candida, herpes)
- reflux oesophagitis
What key questions should you ask for differential diagnosis of dysphagia?
- do you have difficulty swallowing liquids and soldes from the start (can’t swallow liquids = significant restriction => referral to A&E)
- is it difficult to make the swallowing movement?
- is swallowing painful?
- is the dysphagia intermittent or is it constant and getting worse?
- does the neck bulge or gurgle on drinking?
What is GERD?
Gastro esophageal reflux disease is a chronic + severe form of acid reflux
What is heartburn?
A symptom of acid reflux and GERD
What are the symptoms of GERD?
- chronic acid reflux
- painful burning sensation in the upper stomach, chest and throat
- dry coughing
- nocturnal cough
- nocturnal wheeze
- dysphagia (trouble swallowing)
- burning retrosternal discomfort from epigastrium to throat; worsens on stooping, lying, having a hot drink and relieved by antacids
What us the physiological cause of GERD?
- relaxation of the lower oesophageal sphincter (LES)
- if incompetent, then acid from stomach contents comes through LES into oesophagus, serosa tissue doesn’t have any protection against hydrochloric acid
What are the risk factors/causes of GERD (environmental/biomechanical)?
- smoking
- alcohol
- fat
- coffee
- obesity
- tight clothes
- big meals
- hiatus hernia
- medication
- systemic sclerosis
- nutritional allergies
What are the complications of GERD?
- oesophagitis
- ulcer
- anaemia
- Barrett’s oesophagus (cells in the lining of the oesophagus start to change -> cancer)
What is another name for a peptic ulcer?
- stomach ulcer
What are the two different types of peptic ulcers?
- duodenal ulcer
- gastric ulcer
What is the most likely presenting symptom of a peptic ulcer?
- dyspepsia (indigestion)
What are the causes of duodenal ulcers?
- significant association with helicobacter pylori (90%)
- the rest are NSAID related
What is the relieving factor of a duodenal peptic ulcer?
- relieved by eating
Where do gastric ulcers most likely occur?
- lesser curvature of the stomach
What sign is associated with a gastric ulcer?
- weight loss
What aggravates a gastric ulcer?
- worsened by food
What are the complication of peptic ulcers?
- haemorrhage (loss of blood from a damaged blood vessel)
- perforation (lining of stomach splits open)
- pyloric stenosis (narrowing between stomach and small intestine)
- penetration through the serosa (erosion through bowel wall without perforation; contents leak into peritoneal cavity)
Which 2 diseases are encompassed by Inflammatory Bowel Disease (IBD)?
- Ulcerative colitis (UC)
- Crohn’s disease
Which medical syndrome should IBD not be confused with?
- irritable bowel syndrome
What is the definition of Ulcerative colitis (UC)?
- recurrent inflammatory disease of large bowel which always involves the rectum
- never spreads beyond the ileocaecal valve
Which is more common UC or Crohn’s Disease?
- UC
In what population is UC more common?
- non-smokers
What are the symptoms of UC?
- bloody diarrhoea
- dehydration
- abdominal pain
- rectal bleeding
- weight loss
- fever
What are the complications of UC?
- haemorrhage (rupture of a blood vessel)
- dehydration
- toxic dilation and perforation (toxic megacolon => deep inflammation disables the muscles in your colon => substances (food and gas) to build up in your colon while the walls weaken, stretch and widen (dilate) => build up of toxins inside your colon => leak through the weakened walls into your bloodstream => this causes systemic toxicity)
- colon cancer
What is Crohn’s Disease?
- chronic inflammatory disease affecting any part of the gut from mouth to anus
What are unaffected areas between bowel areas of active disease called?
- skip lesions
What are the signs + symptoms of Crohn’s Disease?
- diarrhoea
- malabsorption
- cramping abdominal pain
- rectal bleeding
- weight loss
- fever
What are the complications of Crohn’s Disease?
- strictures/GI obstruction
- fistulas (abnormal passage way in the GI tract)
- renal disease
- large and small bowel cancer
You are taking a case history from your seventy eight year old new patient when she mentions that she has difficulty swallowing … what further questions would you ask to determine whether she is appropriate for osteopathic care?
- did you have difficulty swallowing liquids and solids from the start?
- is it difficult to make the swallowing movement?
- is swallowing painful?
- is the dysphagia intermittent or is it constant and getting worse?
- does the neck bulge or gurgle on drinking?
You are taking a case history from your seventy eight year old new patient when she mentions that she has difficulty swallowing … what tests/examinations would you perform in your practice?
- palpation of the area distally first and then proximally (feeling for obstruction)
- ask patient to swallow and observe movement
- ausculate throat, trachea and lungs to hear for any obstruction
- cranial nerve test
Name three differences between UC and Crohn’s disease
- Crohn’s disease can affect anywhere between the mouth and the anus, UC does not go past the ileocecal valve
- UC symptoms include dehydration, Crohn’s disease does not
- UC can result in haemorrhage and toxic megacolon, Crohn’s disease can result in fistulas, renal disease, strictures/GI obstruction
Why would GERD cause a nocturnal cough or wheeze?
- while lying flat the LES relaxes and opens, resulting in stomach content coming into the Oesophagus => natural reflex to cough
Which parts of the digestive system are in the epigastric region of the abdomen?
- liver
- pancreas
- duodenum
- stomach
- adrenal glands
- spleen
Explain the terms Achalasia, oesophageal web/ring and Bulbar palsy
- Achalasia => oesophageal muscles don’t contract properly (almost like a bulging area in the oesophagus) => ‘not’ + ‘relaxation’
- Oesophageal web/ring => smooth muscle extensions of the oesophagus that can result in dysphagia as liquid/solids become trapped (more likely around postcricoid area)
- Bulbar palsy => bilateral impairment of lower cranial nerves from 9-12 due to lower motor neuron lesion
How would Achalasia lead to dysphagia?
- fluid gets caught in the oesophageal area where the Achalasia is; if this is above the LES, it results in the sphincter being on ‘tension’ all the time and not able to empty content into stomach => back up of contents up the oesophagus
How would oesophageal ring/web lead to dysphagia?
- narrowing of oesophageal wall, resulting in a blockage where food cannot be swallowed
