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Gastro-intestinal system (Den 303) > Gastro-intestinal disease > Flashcards

Gastro-intestinal disease Flashcards

1
Q

Function of the GI tract

A

Turns the food you eat into energy
Waste removal
Intake of water - hydration

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2
Q

GI tract components

A 
Oral cavity
-tongue
-tooth
Pharynx
Oesophagus
Stomach
Pancreas (tail)
Liver
Gall bladder
Duodenum
Transverse colon
Small intestine
Ascending colon
Descending colon
Cecum
Sigmoid
Appendix
Rectum
Anus
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3
Q

Symptoms of GI disease

A 
Vomiting
Haematemesis
Abdominal pain
Weight loss
Jaundice
Melaena
Diarrhoea
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4
Q

Dysphagia history

A 
Duration
Solids or liquids
Pain (odynophagia)
Weight loss
Previous medical history
Medications
Cigarettes and alcohol
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5
Q

Causes of dysphagia

A

1) Oropharyngeal problem
2) Oesophageal problem
3) Gastric problem

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6
Q

Dysphagia - oropharyngeal

A

Salivary gland
-Sogrens syndrome
Tongue
-amyloid, hypothyroidism, motor neurone disease
Palatal/ epiglottal/ upper oesophageal disorder
-cerebrovascular disease, MND, Parkinson’s disease

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7
Q

Dysphagia - oesophageal

A 
Benign mucosal disease
-benign peptic structure
-oesophageal web (Plummer Vinson syndrome)
-candidal oesophagitis
Malignant mucosal disease 
-carcinoma
Motility disorders
-oesophageal spasm
-achalasia
-oesophageal pouch
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8
Q

Pharyngeal pouch

A

Defect between the constrictor and the transverse cricopharyngeus muscle (DIAGRAM)

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9
Q

Stricture

A

Can be caused by scar tissue or polypoid carcinoma?

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10
Q

Dysphagia - gastric

A

Carcinoma
Outlet obstruction
-peptic ulceration

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11
Q

Management of dysphagia

A

Treat underlying cause
If nutritionally deplete, may require supplementation
-oral supplements
-nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) feeding

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12
Q

Indigestion causes

A

Upper abdominal discomfort
Gastro-oesophageal reflex disease (GORD)
Upper abdominal discomfort
Lower abdominal pain

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13
Q

GORD symptoms

A

Heartburn, epigastric pain, acid reflux, waterbrash. nausea, vomiting, tooth decay, asthma

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14
Q

GORD mechanism

A

Excessive relaxation of lower oesophageal sphincter and raised intra-abdominal pressure

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15
Q

Reflux

A

Multiple discrete erosions in mild oesophagitis
Confluent erosions in moderate oesophagitis
Circumferential erosive oesophagitis
Generalised haemorrhagic oesophagus near lumen?

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16
Q

Reflux - dental

A

Erosion - flattened cusps

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17
Q

Management GORD

A 
PPI 
-omeprazole
-lansoprazole
H2 antagonists
Lifestyle advice 
-weight loss
-smoking cessation
-reduce alcohol
Surgery 
-fundoplication
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18
Q

Hiatus hernias

A

A hiatus hernia is when part of your stomach moves up into your chest. It’s very common if you’re over 50
It doesn’t normally need treatment if it’s not causing you problems

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19
Q

Types of hiatus hernia

A 
A = normal
B = pre-stage
C = sliding hiatal hernia
D = paraoesophageal type
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20
Q

Oesophageal manometry

A

Oesophageal manometry is a test to measure the pressures in your oesophagus (gullet) and the valve. separating the stomach and oesophagus

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21
Q

Upper abdominal discomfort

A 
Peptic ulceration
Gastric carcinoma
Non-ulcer dydpepsia
Pancreatic carcinoma
Pancreatitis
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22
Q

Peptic ulceration - history

A

Epigastric pain, sometimes radiating into back, perhaps worsened by food and therefore associated with weight loss (gastric ulcer) or improved by eating (duodenal ulcer)
Vomiting/ Hematemesis (due to gastric ulcer or pyloric outlet obstruction due to duodenal ulceration)
May be complicated by bleeding or perforation
Due to Helicobacter pylori or non-steroidal anti-inflammatory drugs

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23
Q

Pepptic ulceration - endoscopic appearances

A

Clean ulcer
Adherent clot
Visible vessel

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24
Q

Gastric carcinoma

A

Epigastric pain, weight loss, vomiting

Must be suspected if anyone >50 with new onset symptoms

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25
Gastric carcinoma management
OGD to investigate
26
Gastric carcinoma treatment
Surgery if possible (gastrectomy)
27
Non-ulcer dyspepsia
Upper abdominal discomfort, nausea, eructation, bloating | Motility disturbance
28
Pancreatic carcinoma
Unremitting pain, often radiating to back and associated with weight loss and may cause jaundice
29
Pancreatitis
Acute inflammation of pancreas causing severe pain, vomiting Chronic relapsing pain (chronic pancreatitis) Commonest cause alcohol > gallstones > pancreatic trauma, drugs, hypercalcamia / lipidaemia, familial
30
Lower abdominal pain
Acute Chronic ***
31
Management of acute abdominal pain
Surgical referral Usually kept NBM IV antibiotics Imaging - USS/ CT scan
32
Chronic abdominal pain > 6 weeks
``` Organic vs inroganic Investigate as previous Management -frequently difficult -analgesics -surgery ```
33
Vomiting causes
Systemic illness (viral, bacterial, diabetic ketoacidosis) Drugs, alcohol Centrally mediated -middle ear disease, labyrinthitis (infection), cerebellar disease, brain stem disease (cerebrovascular or tumour) - > intracranial pressure (tumour, haemorrhage, hydrocephalus) Psychiatric disorders (psychogenic vomiting, Bulimia) Oesophageal disease Gastric disease Small bowel disease Colonic disease -obstruction due to tumours, volvulus
34
Management of vomiting
``` Identify causes Antiemetics -e.g. cyclizine, metaclopramide PPI Cognitive Behavioural therapy ```
35
Acute diarrhoea
``` Infection (gastroenteritis: bacterial or viral) -campylobacter -salmonella -shigella -E. coli Drugs -antibiotics -alcohol Food allergy/ intolerance ```
36
Chronic diarrhoea (> weeks)
Small bowel disease Pancreatic disease Colonic disease
37
Diarrhoea - small bowel disease
Lactase deficiency Coeliac disease Crohn's disease
38
Diarrhoea - pancreatic disease
Pancreatic insufficiency Pancreatic carcinoma Cystic fibrosis
39
Diarrhoea - colonic disease
Ulcerative colitis Crohn's disease Carcinoma
40
Ceoliac disease - definition
abnormal proximal small intestinal mucosa that improves morphologically on a gluten free diet (GFD) and relapses when gluten is reintroduced
41
Coeliac duodenal mucosa
Increased IELs Crypt hyperplasia Villous atrophy
42
Prevalence of coeliac disease in UK
``` 1 in 100 Age 40-60 years 9x more adult presentations than child Normal weight or overweight Subtle symptoms ```
43
Mode of presentation of coeliac disease
Iron deficiency anaemia Neuro dysfunction Fatigue
44
Signs/ symptoms of coeliac disease
``` Diarrhoea Abdo pain Bloating and flatulence Dermatitis herpetiformis Vomiting Peripheral neuropathy Ataxia and oedema ```
45
Diarrhoea caused by bowel/ pancreatic
Pale, floating, difficult to flush Throughout day Pain variable timing Pain not relieved by defaecation
46
Diarrhoea caused by colonic
Blood and mucous Often in morning Pain related to defaecation Pain relieved by defecaetion
47
Crohn's disease
Chronic inflammatory disease affecting any part of the GI tract, from mouth to perineum May be discontinuous (i.e. affect several different parts of the GI tract at the same time, with normal gut in between)
48
Ulceratice colitis
Chronic inflammatory disease invariably affecting the rectum and extending more proximally to involve all or part of the colon
49
Crohn's disease location
40% rectum?? 30% duodenum 25% large intestine 5% upper abdominal tract and stomach
50
Crohn's disease symptoms (most to least common)
``` Pain Diarrhoea Weight loss Anorexia Fever Vomiting Lassitude Nausea Acute abdomen Nutritional disturbance Fistula Miscellaneous ```
51
Ulcerative colitis symptoms
Diarrhoea Rectal bleeding Pain Weight loss
52
Associated diseases
``` Skin -erythema nodosum -pyoderma gangrenosum Mouth -ulcers Crohn's -lips -buccal mucosa Joints -arthritis -ankylosing spondylitis Eyes -episcleritis -uveitis Vascular -thromboses Vascular -thromboses Liver -cirrhosis -CAH -pericholangitis Ulcerative colitis -primary sclerosing cholangitis ```
53
Colon cancer symptoms
``` None -bowel cancer screening - FOB Rectal bleeding Altered bowel habit Lethargy/ weight loss ```
54
Colon cancer epidemiology
Each year 35,000 people in Britain are diagnosed with cancer of the bowel Polyos - cancer
55
Colon cancer investigations
Colonoscopy/ Barium enema | CT
56
Colon cancer management
Evaluate extent of disease If limited disease to colon - surgical resection possible If not - chemo/ radiotherapy
57
Post hepatic jaundice
Gallsteons (choledocholithiasis) -biliary colic, fever, fluctuating jaundice Malignancy (pancreatic carcinoma, cholagiocarcinoma) -constant pain radiating to back -weight loss Benign biliary stricture (post operative, sclerosing cholangitis) -cholangitis (fever and pain)
58
Hepatic jaundice
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
59
Pre-hepatic jaundice
``` Haemolytic anaemia (hereditary spherocytosis, G6PD deficiency, sickle disease) -anaemia, jaundice, gallstones, splenomegaly, leg ulcers ```
60
Chronic liver disease signs and symptoms
``` Palmar erythema Spider nevi Ascites Face Jaundice May be dark urine and pale stool ```

Gastro-intestinal system (Den 303) (3 decks)

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