Digestive Flashcards
Layout of abdomen
Look at picture
Where is pain felt for an appendicitis?
diffuse pain umbilical region –> lower right quadrant
What is a hiatus hernia?
When stomach pushes up through diaphragm
-can contribute to acid reflux
Symptoms of GORD and what can it lead to?
What are risk factors?
Symptoms - Heartburn, regurgitation, may be worse after eating or lying down
Lead to - Can lead to barrets oesophagus - which is where squamous epithelium turns to gastric epithelium in oesophagus (increased risk in men over 50, big bmi and smoking)
- increased risk of adenocarcinoma (smoking, alcohol, diet)
What is pernicious anaemia
Caused by low b12 in the body (can result from antibodies against parietal cells - make IF, inadequate intake, ileal absorption function reduced)
- b12 needs IF to be absorbed, also needs acid to break it away from food in stomach
- low haemoglobin
- large mean cell volume
- shortness of breath, tired
Cure - give b12 intramuscular, supplements
Peptic ulcers - cause and drug names to cure
Symptoms -pain, bleeding, perforation
- Can be caused by helicobacter pylori - destruction of gastric lining, resulting in ulcers
- can increase risk of stomach cancer
- Treat - triple therapy antibiotics - omeprazole , clarithromycin, amoxycillin
- Also caused by aspirin and non-steroidal anti-inlfammatory drugs
What do Omeprazole, clarithromycin and amoxycillin in combination treat?
helicobacter pylori- stomach ulcers
- amoxycillin, omeprazole - proton pump inhibitors and decrease stomach acidity so not as much damage to stomach
- clarithromycin - antibiotic
Cirrhosis
- inflammation of liver (hepatitis) due to damage
- fibrous material, parenchymal nodules
- progress to fibrosis
- Can lead to portal hypertension cauasing - ascites, splenomegaly, portosystemic shunts
- liver enlarges then shrinks
- fibrosis is reversible, cirosis is nto
Ascites
abnormal fluid accumulation in abdomen - can result from portal hypertension (portal vien blockage to liver)
-increase hydrostatic pressure in portal vien - fluid moves out
splenomegaly
enlargement of spleen
can result from portal hypertension
Hep A
- virus
- benign, self limiting disease
- does not cause chronic hepatitis
- person to person
- asymptomatic or mild febrile ilness
- jaundice sometimes
Hep B
can get both acute and chronic hepatitis - may lead to cirrhosis
-blood borne
Hep C
- major cause of liver disease
- blood transfusions
- often develop cirrosis
- no injection
- injecting drug use most common cause
- antiviral agents cure
Alcoholic liver disease
- hepatic steatosis
- alcoholic hepatitis
- cirrhosis
Non-alcoholic fatty liver disease
- obesity, metabolic syndrome
- heptaic steatosis
- inflamation - cirrosis
Haemochromatosis
excessive accumulation of iron
-genetic defect - excessive iron absorption
AST, ALT
(inside liver) hepatic inflammation, hepatocellular injury viral hepatitis liver toxins/drugs cirrosis
ALP, GGT
Bile blockage (portal tract) - cholestasis (bile cannot flow from liver to gall bladder/duodenum) Gall stones , tumour
Jaundice
yellow coloured skin due to too much bilirubin in blood
albumin and clotting factors
liver is only source
decreases when there is decreased synthesis due to cirrhosis
-increased loss
-illness
both represent that liver not function properly to make these
globulins
reflect inflammation , high levels - chronic hepatitis , cirrhosis
gilberts syndrome
-bilirubin unconjugated, but other liver function tests normal
bilirubin
causes jaundice
biliary obstruction or heptocellular injury
Causes of portal hypertension
pre hepatic - portal vien thrombosis
Hepatic - cirrosis
post hepatic - hepatic vien thrombosis, right sided heart failure
hepatic encephalopathy
due to chronic liver failure - portal hypertension
- mood and personality change, drowsiness, coma
- chronic liver failure - unable to detoxify substances produced by bacterial metabolism - shunts stop blood going back to liver and by pass this and go to heart and so blood is not detoxified
- build up of amonia in blood - can pass blood brain barrier
- treat with lactulose - manages this
Main causes of pancreatitis?
Acute pancreatitis
where is pain felt? symptoms? how to solve
alcohol and gall stones
- autodigestion by pancreatic enzymes, cell injury response mediated by inflammatory cytokines
-from blockage so enzyme stay and damage, or from viruses, drugs ect that damage acinar cells
-felt in epigastric region
-nausea, vomiting, fever, tachychardia
-high white cell count, elevated serum lipase
Management - rest, dont eat, IV fluids
Chronic pancreatitis
repeated attacks of abdominal pain - often brought about by alcohol
-if ongoing - loss of exocringe function - malabsorption
cholelithiasis - gallstones
Risks -
- cholesterol stones
- calcium or bilirubin salts = pigment stones
Risks - increases with age, women, eostrogenic influences , family history
Cholecystitis -
obstruction of gallbladder (cystic duct) mainly gall stones
- RUQ abdominal pain and tenderness
- raised ALP, GGT, bilirubin if in main bile duct
Choledocholithiasis
stones in biliary tree
get jaundice
Cystic fibrosis
autosomal recessive
CFTR channel - CL- channel secretions become very thick from pancreas, also effect lungs - sticky mucus clogs passages
-also important for bicarb secretion
-can lead to pancreatic insufficiency as the pancreatic secretions become hyperviscous (too thick)
What is a polyp
growth or tumour which projects above the surrounding mucosa
non-neoplastic - benign , neoplastic = adenomas (can turn to carcinoma) - varying degrees of proliferation
Clinical features of colon cancer
Abdominal pain, mucous discharge, PR bleeding, change in bowel habit, bowel obstruction
- iron deficiencey anaemia
- weight loss
Familiar polyposis syndromes
- group of inherited polyposis syndromes - autosomal dominant
- may predispose to malignant transformation
How to determine IBS?
normally eliminate alarm signals - rectal bleeding, weight loss, anaemia, vomiting ect.
Chrons disease
chronic inflammatory disease,
-can get inflammation, stricturing, fistulising, perianal fissure
Ulcerative colitis
mucosal inflammation (inflammatory bowel disease)
Coeliac disease
Antibodies made in the body in response to a protein in gluten which cause an inflammatory response and damage villi
- can cause malabsorption if damage bad - iron deficiencey common , weight loss if severe
- genetic
- can test for the tissue transglutaminase antibody
H2 receptor antagonists
- stop gastric acid being produced by parietal cells
- antagonists compete with histamine
- rapid aciton
- used for peptic ulcer disease and acid reflux
e. g cimetidine . ramotodome
Omeprazole
proton pump inhibitor
- irreversible
- problems - can get bacterial outgrowth, malabsorption (b12), non sterilisation of food
- used for GORD or ulcer disease due to NSAIDs
gilberts syndrome
inherited condition
get yellowy tinge to skin (billirubin) - cannot process bilirubin in the liver
does not normally require treatment
Budd chiari syndrome
acute thormbosis of hepatic viens
outflow of blood from liver is obstructed
liver becomes acutely congested, hepatocellular damage
jaunice
cholesterol stones
pigment stones
cholesterol -
pigemnt - bilirubin and calcium salts
