Gastro Intestinal Disease Flashcards
What is the function of the GIT?
Turns food into energy
Waste removal
Intake of water - hydration
Symptoms that arise from the GIT?
Vomiting Weight loss Jaundice Melaena (blood in stools) Hematemesis (vomiting blood) Abdominal pain Diarrhoea
What is dysphagia?
Difficulty swallowing
When taking a GI history, what questions should you ask?
Duration Solids or liquids Pain Weight loss Previous med history Medications Cigarettes and alcohol
What may dysphagia due to?
Oropharyngeal problem
Oesophageal problemG
Gastric problem
Oropharyngeal problems?
Salivary gland
-Sjogrens syndrome
Tongue
- amyloid, hypothyroidism, motor neurone disease
Palatal/epiglottal/upper oesophageal disorder:
- Cerebrovascular disease, MND, Parkinson’s disease
Oesophageal problems?
Benign mucosal disease
- Benign peptic stricture, oesophageal web, candidal oesophagitis
Malignant mucosal disease
- Carcinoma
Motility disorders
- Oesophageal spasm, achalasia, oesophageal pouch
What is a pharyngeal pouch?
Defect between the constrictor and the transverse cricopharyngeus muscle
Gastric problems?
Carcinoma
Outlet obstruction - peptic ulceration
How to manage dysphagia?
Treat underlying cause
If nutritionally deplete - supplementation - oral supplements, NG, PEG feeding
How does gastro-oesophageal reflux disease (GORD) cause upper abdominal discomfort?
Gastro-oesophageal reflux disease (GORD)
- Heartburn, acid reflux, nausea, vomiting, caries, asthma
- Excessive relaxation of lower oesophageal sphincter and raised intra-abdominal pressure
How to manage gastro-oesophageal reflux disease?
PPI (omeprazole)
H2 antagonists
Lifestyle - weight loss, smoking, reduce alcohol
Surgery - fundoplication
Peptic ulceration symptoms?
Epigastric pain - sometimes radiating into back - worsened by food = weight loss (gastric ulcer) or improved by eating (duodenal ulcer)
Vomiting/hamatemesis
May be complicated by bleeding or perforation
What causes peptic ulceration?
Helicobacter pylori or non-steroidal anti-inflammatory drugs
Symptoms of gastric carcinoma? (upper abdominal pain)
Epigastric pain, weight loss, vomiting
Must be suspected in anyone over 50yrs with new onset symptoms
How to manage a gastric carcinoma? Treatment?
OGD to investigate
Treatment - surgery - gastrectomy
What else could cause upper abdominal pain/discomfort?
Non-ulcer dyspepsia
- Upper abdominal discomfort, nausea, bloating
- Motility disturbance
Pancreatic carcinoma
- unremitting pain, often radiating to back, weight loss, jaundice
Pancreatitis
- Acute inflam of pancrease = severe pain, vomiting
- Chronic relapsing pain
- Commonest cause alcohol, the gallstones, then pancreatic trauma, drugs, lipidaemia
Acute abdominal pain causes?
Upper left - Acute cholecystitis
Upper middle: myocardial infarction, acute cholecystitis
Upper right = ruptured spleen, gastric ulcer
Lower left: appendicitis, ruptured ectopic pregnancy
Lower right: Sigmoid diverticulitis , Acute pancreatitis, Intestinal obstruction
How to manage acute abdominal pain?
Surgical referral
Usually kept NBM
IV antibiotics
Imaging - CT scan /USS (universal spine system)
When does acute abdominal pain become chronic? Features and management of chronic abdominal pain?
If more than 6 weeks
Organic vs inorganic
Investigate
Management - analgesics, surgery
What causes vomiting?
Systemic illness (bac, viral, diabetic ketoacidosis)
Drugs, alcohol
Centrally mediated
- Middle ear disease, cerebellar disease, brain stem disease
- Raised intracranial pressure (tumour, haemorrhage)
Psychiatric disorders (bulimia)
Oesophageal disease
Gastric disease
Small bowel disease
Colonic disease
How to manage vomiting?
Identify underlying cause
Antiemetics
PPI
Cognitive behavioural therapy
What causes acute diarrhoea?
Infection (gastroenteritis: bacterial or viral)
Drugs - antibiotics, alcohol
Food allergy/intolerance
What causes chronic diarrhoea?
Small bowel disease
- lactose deficiency
- coeliac disease
- crohns disease
Pancreatic disease
- pancreatic insufficiency
- pancreatic carcinoma
- cystic fibrosis
Colonic disease
- ulcerative colitis
- crohns
- carcinoma
Define coeliac disease
Abnormal proximal small intestinal mucosa that improves morphologically on a gluten free diet and relapses when gluten is introduced
How does the coeliac duodenal mucosa differ from the normal mucosa?
Increased inflam cells (lymphocytes), crypt hyperplasia and villous atrophy
Background of coeliac disease?
1 in 100
40-60yrs old
Normal weight or overweight
9x more adult presentations than child
Symptoms of diarrhoea: small bowel/pancreatic derived and colonic derived?
Small bowel/pancreatic:
Pale, floating, difficult to flush
Throughout day
Pain variable timing
Pain not relieved by defaecation
Colonic:
Blood and mucus
Often in morning
Pain related to defaecation
Pain relieved by defaecation
What is Crohn’s disease?
Chronic inflam disease affecting any part of the gastrointestinal tract, from mouth to perineum
May be discontinuous
What is ulcerative colitis?
Chronic inflam disease invariably affecting the rectum and extending more proximally to involve all or part of the colon
How does coeliac disease present?
GI Iron def anaemia Neuro dysfunction Fatigue Vit B12 def Osteoporosis
Symptoms of crohn’s?
Pain Diarrhoea Weight loss Anorexia Fever Vomiting Lassitude Nausea Acute abdomen Nutritional disturbance
Symptoms of ulcerative colitis?
Diarrhoea
Rectal bleeding
Pain
Weight loss
Associated diseases?
Skin - erythema nodosum, pyoderma gangrenosum
Mouth - ulcers. Crohn’s: lips, buccal mucosa
Joints - arthritis, ankylosing spondylitis
Eyes - episcleritis, uveitis
Vascular - thromboses
Liver - cirrhosis, CAH, pericholangitis. U.C: primary sclerosing cholangitis
Colon cancer prevalence?
35,000 a yr diagnosed in UK
Symptoms of colon cancer?
None
Rectal bleeding
Altered bowel habit
Lethargy/weight loss
How to investigate and manage colon cancer?
Colonoscopy
CT
Manage:
- Evaluate extent of disease
- If limited disease to colon - surgical resection possible
- If not - chemo/radiotherapy
Jaundice - post hepatic causes?
Gallstones (choledocholithiasis):
- Biliary colic, fever, fluctuating jaundice
Malignancy (pancreatic carcinoma, cholangiocarcinoma)
- Constant pain radiating to back
- Weight loss
Benign biliary stricture (post operative, sclerosing cholangitis)
- cholangitis (fever and pain)
(summary - gallstones, external compression - pancreatitis, lymphadenopathy, pancreatic tumour)
Jaundice - hepatic causes?
Infection (hepatitis A,B,C, EBV)
- Malaise, lethargy, anorexia, distaste for cigarettes, jaundice, pale stools, dark urine, right upper quadrant discomfort
Alcoholic hepatitis
- above, plus history of excess alcohol
Drugs
- augmentin, flucloxacillin, many others
Decompensated chronic liver disease (alcoholic cirrhosis, haemachromatosis, PBC, CAH, Chronic hepatitis B or C, Wilson’s disease)
- jaundice, ascites, varices, hepatic encephalopathy
(Summary - cirrhosis, infil of liver by tumours, acute hepatitis)
Jaundice: pre hepatic causes?
Haemolytic anaemia (hereditary spherocytosis, G6PD deficiency, sickle cell disease) - anaemia, jaundice, gallstones, splenomegaly, leg ulcers
(summary - haemolysis)
Signs of chronic liver disease?
Nail clubbing
Spider blood vessels on skin
Fluid within abdominal cavity
(spider naevi, palmer erythema, enlarged breasts in men, white nails from low albumin, clubbing, jaundice, ascites)
What is the function of the liver?
Synthetic
- Clotting factors - prothrombin time (INR)
- Proteins - albumin
- Bile
Metabolic (detoxification of blood)
- Excretion of nitrogenous compounds - NH3
- Excretion of some drugs/metabolites
Immune funcs
Energy storage (Fat and glycogen)
Fat and CHO metabolism
What are the types of hiatus hernias?
Sliding = adjoining section of oesophagus and stomach breach the diaphragm wall
Paraoesophageal = fundus of stomach is breached by diaphragm wall. No tx - prevention (e.g. do not lie down immediately after food)
