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Diagnostic Sciences > Disturbance in digestion > Flashcards

Disturbance in digestion Flashcards

1
Q

eructation

A

burp

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2
Q

diarrhoea

A
  • increase in volume, fluidity, or frequency of bowel movements
  • relative to their usual
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3
Q

What factors are necessary for the formation or normal stools and normal defecation?

A
  • food quantity, quality, fluid
  • ability to swallow
  • integrity of all digestive system (liver, gall bladder and pancreas)
  • peristaltis, enzyme, hormone, surface area
  • blood supply, innervation (& spinal cord)
  • willingness to defecate
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4
Q

What are the common causes of diarrhoea?

A
  • laxative abuse
  • gastroenteritis (rotavirus, Campylobacter jejuni, Salmonella sp, Vibrio cholera, giardia, helminths)
  • food poisoning
  • coeliac, lactose
  • spurious (faecal impaction or obstruction)
  • IBS
  • drugs (magnesium containing antacids, antibiotics), diet, stress
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5
Q

What are some other less common causes of diarrhoea?

A
  • colonic causes (carcinoma of colon, diverticular disease, inflammatory bowel disease, dysentery, pseudomembranous colitis)
  • malabsorption states
  • endocrine (hyperthyroidism, diabetes mellitus, Addison’s disease, carcinoid syndrome, Zollinger-Ellison syndrome)
  • Non-Hodgkin’s lymphoma
  • AIDS
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6
Q

List the classifications of diarrhoea?

A

1) osmotic - lower water reabsorption
2) secretory - electrolytes
3) motor
4) exudative -movement of fluid and cells from wall

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7
Q

What is motor diarrhoea?

A

• increased motility of bowel

  • > faecal mater less time contact with bowel wall
  • > decreased water reabsorption

• drugs, infective, hyperthyroidism, IBS

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8
Q

What is osmotic diarrhoea?

A

• decreased water reabsorption into bowel wall

  • > more water in faecal material
  • > loose stools
  • less viable surface
  • excessive non-absorptive molecules in bowel lumen
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9
Q

What is secretory diarrhoea?

A

Increase secretion of electrolytes from bowel wall into lumen

  • > water follows electrolytes
  • > increased fluid in stools

• cholera

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10
Q

What is exudative diarrhoea?

A

Excessive movement of cells and fluid from the intestinal wall into the lumen
-> pus and excess fluid in faecal mater +/- blood

  • ulcerative colitis
  • shingellosis
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11
Q

Which electrolytes are usually measured in a standard biochemistry screen?

A
  • Sodium
  • Potassium
  • Chloride
  • Bicarbonate
  • Calcium (sometimes)
  • Urea (a waste product, not an electrolyte)
  • Creatinine (a waste product, not an electrolyte)
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12
Q

What is measured in “liver function tests”?

A
  • Bilirubin-total, con-/uncon-jugated
  • ALT
  • Alkaline phosphatase
  • Gamma-glutamyl transferase
  • Total protein and Albumin
  • prothrombin line
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13
Q

What are common causes of constipation?

A
  • Low fibre, fluid, exercise
  • Laxative abuse
  • Aged and invalids
  • Poor defecation habits
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14
Q

What are the other less common causes of constipation?

A
  • IBS, IBD
  • anxiety
  • drugs
  • acute diverticulitis
  • intestinal obstruction
  • neuromuscular disorders
  • painful defecation (haemorrhoids, anal fissures)
  • connective tissue disorders
  • electrolyte disturbances (hypokalaemia, hypocalcaemia, hypercalcaemia)
  • chronic lead poisoning
  • typhoid fever
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15
Q

What are the mechanisms by which constipation occurs?

A
  • diminished motility of colon (drug, hypothyroidism, low exercise)
  • pain with defecation-avoiding poop (anal fissure, haemorrhoids)
  • small faecal mass -> low stimulus by faeces on wall -> low defecation (low fibre)
  • hard dry stools -difficult elimination (low fluid)
  • repetitively delaying response to urge -> lower sensitivity of rectum receptors (kids)
  • mechanical blockage
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16
Q

What is a colonoscopy?

A

• Uses a fibre-optic endoscope
• Can visualise as far as caecum
• Requires thorough preparatory bowel cleansing
• Can visualise, aspirate fluids, biopsy, perform endoscopic surgery etc
• Indications for use include the diagnosis of:
- Tumours of colon
- Inflammatory disorders of colon
- Source of GIT bleeding
- Diverticular disease

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17
Q

What is bilirubin?

A
  • breakdown product of haem
  • unconjugated is carried in plasma to the liver where it is conjugated to form ‘conjugated bilirubin’
  • then excreted in bile
  • gives colour
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18
Q

Nausea

A
  • unpleasant sensation vaguely referred in epigastrium and upper abdomen
  • unpleasant feeling of impending vomit
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19
Q

Vomit

A
  • forcible ejection of some digestive system contents (usually stomach) through the oesophagus and mouth
  • voluntary or involuntary
  • often associated with nausea
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20
Q

Explain the pathophysiology of jaundice by relating these to the possible disturbances in the bilirubin pathway?

A

Old RBCs + precursors in bone marrow + heme in liver

  • > biliverdin -> unconjugated bilirubin
  • > conjugated in canaliculi
  • > some excreted by kidney OR most excreted by liver via hepatic ducts
  • > common bile duct
  • > cystic duct OR small intestine
  • > cystic duct -> gall bladder -> bit excreted in urine
  • > small intestine -> deconjugated by flora -> excreted in faeces
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21
Q

What is the pathophysiology of nausea?

A

Subjective sensation due to:
• (-) stomach muscle tone and activity
• (+) duodenum muscle tone
• Reflex of chyme/juices from duodenum to stomach
• ANS activity (sweating, salivation, pallor, (-) HR, (-) BP)

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22
Q

What are the triggers of vomiting?

A

Triggered by any event or situation which stimulates the medullary vomiting centre, and may be from:

1) Digestive tract.
2) Cerebral cortex
3) Labyrinthine structures
4) Medullary chemoreceptor trigger zone (gets stimuli from whole body and drugs)

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23
Q

One there is a trigger for vomiting, then what happens?

A

• stimulus integrated within medullary vomiting centre
• transmission of nerve impulses via:
1) Phrenic nerve -> diaphragm contraction
2) Spinal nerves -> abdominal wall muscles contraction
3) Visceral efferent nerves -> pylorus contraction, and fundus & gastroesophageal sphincter relaxation
4) Inhibition of respiration
5) Elevation of the soft palate
6) Closure of the glottis

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24
Q

What are the possible causes of vomiting?

A
  • Disorders from the intra- abdominal structures
  • Intracranial disorders
  • Metabolic disorders and endocrine disorders
  • Motion sickness
  • Labyrinthine disorders
  • Pregnancy
  • Toxins: drugs, withdrawal, alcohol, poisons
  • Cardiovascular disorders
  • Psychogenic
  • Acute systemic infections
  • Intense pain
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25
Q

What section of the GIT does a colonoscopy see?

A

only up until ascending colon

-doesn’t see terminal ilium

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26
Q

How does the duration of a diarrhoea help find the diagnosis?

A
  • some diseases are self-limiting
  • cholera short duration
  • Crohn’s long duration
  • long duration gives chance to modify diet or find alleviating factors
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27
Q

What is the aetiology of diarrhoea within 6hrs of a “suspect” meal of dairy products, creamed fillings or mayonnaise?

A

staph aureus

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28
Q

What is the aetiology of diarrhoea at least 14hrs after eating eggs or poultry?

A

salmonella

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29
Q

What is the aetiology of diarrhoea at least 14hrs after eating seafood?

A

vibrila

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30
Q

What is the aetiology of diarrhoea 8-14hrs after eating meat kept warm for a long period of time?

A

clostridium

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31
Q

What is the possible cause of diarrhoea with mucus?

A
  • disentry type
  • salmonella
  • Crohn’s
  • ulcerative colitis
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32
Q

What is the possible cause of bloody diarrhoea?

A
  • crohn’s
  • ulcerative colitis
  • bleeding in GIT
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33
Q

What is the possible cause of diarrhoea appearing black?

A

melon from upper GIT

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34
Q

What is the possible cause of diarrhoea appearing green?

A

infective organism

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35
Q

What is a nervous colon?

A

spastic colon

IBS

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36
Q

What are the 2 types of colonoscopy?

A

Endoscope up anus: examen and take specimen

Swallow camera: virtual colonoscopy

37
Q

What is the meaning of stools that are frothy and watery?

A

osmotic diarrhoea -> lactose intolerance

38
Q

What is the significance of a healthy appetite BUT weight loss?

A

malabsorption, maldigestion, malmetabolism

39
Q

What are the possible causes of alternating diarrhoea and constipation?

A
  • IBS
  • Crohn’s
  • colon or rectum carcinoma
  • diverticular disease
  • faecal impaction
  • laxative abuse
40
Q

What is the significance of angular stomatitis and diarrhoea?

A

vitamin deficiency

41
Q

What is the significance of smooth red tongue and diarrhoea?

A

vitamin deficiency

42
Q

What is the significance of oedema with diarrhoea?

A

Decreased absorption albumin

  • > low serum albumin
  • > low osmotic pressure
  • > oedema
43
Q

What are the possible causes of protuberant abdomen?

A
  • fat
  • flatus
  • faeces
  • fulminating neoplasm
  • foetus
  • fluid
44
Q

Which diseases have diarrhoea and anal lesions?

A

Crohn’s

ulcerative colitis

45
Q

What does a prolonged prothrombin time mean?

A

bleeding tendency

46
Q

What are the big 2 causes of constipation in elderly adults ?

A
  • colorectal cancer

* diverticular disease

47
Q

What are the pros and cons of a colonoscopy in the elderly?

A

Pros:
• prove diverticular disease
• find early carcinoma

Cons:
• very invasive
• elders most likely have many comorbidities

Depends on mental state and health of patient

48
Q

What is hydrochlorothiazide?

A

diuretic medication to treat hypertension

49
Q

What are the types of jaundice?

A

Pre-hepatic
• hypersplenism

Hepatic
• obstruction of canaliculi
• from swelling of liver

Post-hepatic
• obstruction of common bile duct

50
Q

Why do we ask a patient with jaundice about arthritis, pruritus, urticaria?

A

looking for systemic causes of the jaundice

51
Q

Explain the pathophysiology of dark urine and pale stools in jaundice?

A

Bilirubin gets conjugated by canaliculi, but it is blocked by swelling of hepatocytes

  • > can’t be excreted by hepatic duct into common bile duct into small intestine
  • > most excreted into urine
52
Q

asterixis

A

flapping wrist extension

53
Q

Babinski sign

A

sign of UMN lesion

54
Q

How do you get Hepatitis A?

A

faecal oral

55
Q

What are the clinical features of chronic liver failure?

A
  • glucose intolerance
  • steatorrhea
  • hepatic encephalopathy
  • bleeding tendency
  • ascites, oedema
  • jaundice (dark urine, pale stools)
  • vitamin deficiencies (swollen tongue, angular stomatitis)
  • mineral deficiencies
  • excess hormones (spider nave, palmar erythema, testicular atrophy, gynaecomastia, menstrual irregularities)
  • excess glucocorticoids (cushings like symptoms)
  • excess mineralocorticoids (salt and water retention)
  • increase drug side effects
  • infections
  • portal hypertension (hematemesis)
  • clubbing
56
Q

What is hepatic encephalopathy?

A
  • sign of chronic liver failure

* buildup of ammonia -> changes blood pH -> damages brain

57
Q

What are the possible causes of hepatomegaly?

A
  • vascular congestion (H failure)
  • biliary duct obstruction
  • infiltration: leukaemia, lymphoma, fat, amyloid, iron, granuloma (TB)
  • cysts
  • inflammatory or infective: hepatitis, mono, typhoid fever, abscess, crohn’s
  • cirrhosis
  • tumours: hepatoma, metastatic from bowel
58
Q

What is the consequence of laxative abuse on bowel habits?

A

diarrhoea but can also be constipation if stopping after long term abuse

59
Q

What is the consequence of painful anal lesions on bowel habits?

A

constipation -because unwilling to defecate to avoid pain

60
Q

What is the consequence of drugs on bowel habits?

A

constipation or diarrhoea

61
Q

What is the consequence of IBS on bowel habits?

A

alternating constipation and diarrhoea

62
Q

What is the consequence of AIDS on bowel habits?

A

diarrhoea

63
Q

What is the presentation of acute appendicitis?

A
  • acute onset of umbilical colicky pain
  • vomiting, anorexia, fever
  • migrates to R iliac fossa, worse over McBurney’s point
  • rebound tenderness
  • pain becomes constant
  • if retrosecal -> psoas and obturator tests
  • high HR, fever
64
Q

What are the causes of paralytic ileum?

A
  • spinal cord trauma
  • drugs
  • peritonitis
65
Q

What is important to think of about the 75 year old demographics?

A
  • malignancies
  • degenerative (cardiovascular, joints, brain)
  • lifestyle diseases (diabetes, smoking, obesity, alcohol)
  • organs not working as well anymore
  • more than one problem at once
  • ADLs, independence
66
Q

What is the DDx of a 42yr old male with a 10 year Hx of constipation with intermittent diarrhoea?

A
  • IBS
  • Coeliac disease
  • Lactose intolerance
  • Crohn’s
  • Ulcerative colitis
67
Q

What is the DDx of a 39yr old thin female with a 20yr Hx of intermittent diarrhoea with occasional blood?

A
  • Crohn’s
  • Ulcerative colitis
  • (NOT IBS because of the blood)
68
Q

How can you tell the difference between Crohn’s and ulcerative colitis?

A

colonoscopy

69
Q

What is the possible cause of watery diarrhea following use of antibiotics, plus abdominal pain?

A
  • overgrowth of pathogenic bacteria

* pseudomembranous colitis

70
Q

What is the possible cause of diarrhoea with fever?

A
  • infective cause

* neoplastic or ischaemic origin

71
Q

What is the possible cause of chronic diarrhoea with peri-anal lesions?

A

Crohn’s

72
Q

What is the possible cause of diarrhoea with blood and mucus?

A
  • ulcerative colitis

* chronic gastroenteritis

73
Q

What is the possible cause of diarrhoea with abdominal pain and flatus, relieved by defecation?

A
  • IBS

* distal colon disorder

74
Q

What is a complication of chronic diverticular disease?

A

colorectal cancer

75
Q

What is under the R hypochondrium?

A

liver

gallbladder

76
Q

What is the presentation of Hep A?

A
  • spreads by fecal oral route
  • starts as a GIT illness
  • fever
77
Q

Compare the presentation of Hep A and mono

A

Mono:
• looks like Hep A
• BUT starts as URT issue and not GIT

78
Q

What investigations can we do to confirm a suspected hep A infection?

A
  • urine test for bilirubin
  • full blood count (high lymphocytes)
  • liver function test (high AST and ALT)
  • serology for antibodies against hep A
79
Q

How can you differentiate which hepatitis it is?

A

serology for antibodies against that type of hep in the blood

80
Q

What are the effects of alcohol abuse on the GIT?

A
  • acute gastritis
  • increased chance of GIT carcinoma
  • fatty liver, cirrhosis, liver failure
  • acute or chronic pancreatitis
81
Q

Which hepatitis may become chronic?

A

all except for hep A

82
Q

How do you get Hep B?

A
  • piercing
  • unprotected sex
  • needle sharing
83
Q

What are the potential causes of episodic vague upper abdominal pain?

A

Stomach: diet, GORD, reflux, idigestion

Gallbladder
Pancreatic cancer
Ovarian cancer

84
Q

What are the potential causes of fainting?

A
  • psychogenic
  • pain
  • low BP, glucose, O2
  • drugs
  • alcohol
  • seizure
  • transient ischaemic attack
  • arrhythmia
85
Q

What can cause upper GI bleed?

A
  • peptic ulceration
  • oesophageal varices
  • malignancy
  • poison
86
Q

What is the possible significance of dark red blood mixed with the stools?

A

upper colon bleed

87
Q

What is the possible significance of bright red blood found on the surface of the stools?

A

rectum-sigmoid colon bleed

88
Q

What is the possible significance of bright red blood, predominantly found on toilet paper, rather than stools?

A

anal lesions

fissure of haemorrhoids

89
Q

What is orthostatic hypotension and what causes it?

A
  • when blood pressure drops from prone to siting or standing

* dehydration is common cause

Diagnostic Sciences (7 decks)

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