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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
Q

Gastric carcinoma management

A

OGD to investigate

26
Q

Gastric carcinoma treatment

A

Surgery if possible (gastrectomy)

27
Q

Non-ulcer dyspepsia

A

Upper abdominal discomfort, nausea, eructation, bloating

Motility disturbance

28
Q

Pancreatic carcinoma

A

Unremitting pain, often radiating to back and associated with weight loss and may cause jaundice

29
Q

Pancreatitis

A

Acute inflammation of pancreas causing severe pain, vomiting
Chronic relapsing pain (chronic pancreatitis)
Commonest cause alcohol > gallstones > pancreatic trauma, drugs, hypercalcamia / lipidaemia, familial

30
Q

Lower abdominal pain

A

Acute
Chronic
***

31
Q

Management of acute abdominal pain

A

Surgical referral
Usually kept NBM
IV antibiotics
Imaging - USS/ CT scan

32
Q

Chronic abdominal pain > 6 weeks

A 
Organic vs inroganic
Investigate as previous
Management 
-frequently difficult
-analgesics
-surgery
33
Q

Vomiting causes

A

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
Q

Management of vomiting

A 
Identify causes
Antiemetics 
-e.g. cyclizine, metaclopramide
PPI
Cognitive Behavioural therapy
35
Q

Acute diarrhoea

A 
Infection (gastroenteritis: bacterial or viral)
-campylobacter
-salmonella
-shigella
-E. coli
Drugs
-antibiotics
-alcohol
Food allergy/ intolerance
36
Q

Chronic diarrhoea (> weeks)

A

Small bowel disease
Pancreatic disease
Colonic disease

37
Q

Diarrhoea - small bowel disease

A

Lactase deficiency
Coeliac disease
Crohn’s disease

38
Q

Diarrhoea - pancreatic disease

A

Pancreatic insufficiency
Pancreatic carcinoma
Cystic fibrosis

39
Q

Diarrhoea - colonic disease

A

Ulcerative colitis
Crohn’s disease
Carcinoma

40
Q

Ceoliac disease - definition

A

abnormal proximal small intestinal mucosa that improves morphologically on a gluten free diet (GFD) and relapses when gluten is reintroduced

41
Q

Coeliac duodenal mucosa

A

Increased IELs
Crypt hyperplasia
Villous atrophy

42
Q

Prevalence of coeliac disease in UK

A 
1 in 100
Age 40-60 years
9x more adult presentations than child
Normal weight or overweight
Subtle symptoms
43
Q

Mode of presentation of coeliac disease

A

Iron deficiency anaemia
Neuro dysfunction
Fatigue

44
Q

Signs/ symptoms of coeliac disease

A 
Diarrhoea
Abdo pain
Bloating and flatulence
Dermatitis herpetiformis
Vomiting
Peripheral neuropathy
Ataxia and oedema
45
Q

Diarrhoea caused by bowel/ pancreatic

A

Pale, floating, difficult to flush
Throughout day
Pain variable timing
Pain not relieved by defaecation

46
Q

Diarrhoea caused by colonic

A

Blood and mucous
Often in morning
Pain related to defaecation
Pain relieved by defecaetion

47
Q

Crohn’s disease

A

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
Q

Ulceratice colitis

A

Chronic inflammatory disease invariably affecting the rectum and extending more proximally to involve all or part of the colon

49
Q

Crohn’s disease location

A

40% rectum??
30% duodenum
25% large intestine
5% upper abdominal tract and stomach

50
Q

Crohn’s disease symptoms (most to least common)

A 
Pain
Diarrhoea
Weight loss
Anorexia	
Fever				
Vomiting				
Lassitude				
Nausea				
Acute abdomen			
Nutritional disturbance		
Fistula				
Miscellaneous
51
Q

Ulcerative colitis symptoms

A

Diarrhoea
Rectal bleeding
Pain
Weight loss

52
Q

Associated diseases

A 
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
Q

Colon cancer symptoms

A 
None 
-bowel cancer screening - FOB
Rectal bleeding
Altered bowel habit
Lethargy/ weight loss
54
Q

Colon cancer epidemiology

A

Each year 35,000 people in Britain are diagnosed with cancer of the bowel
Polyos - cancer

55
Q

Colon cancer investigations

A

Colonoscopy/ Barium enema

CT

56
Q

Colon cancer management

A

Evaluate extent of disease
If limited disease to colon - surgical resection possible
If not - chemo/ radiotherapy

57
Q

Post hepatic jaundice

A

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
Q

Hepatic jaundice

A

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
Q

Pre-hepatic jaundice

A 
Haemolytic anaemia (hereditary spherocytosis, G6PD deficiency, sickle disease)
-anaemia, jaundice, gallstones, splenomegaly, leg ulcers
60
Q

Chronic liver disease signs and symptoms

A 
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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