Gastro intestinal disease/medicine Flashcards
functions of GI tract
1) turns food into energy
2) waste removal
3) intake of water – hydration
key symptoms associated with GI disfunction
vomiting haematemesis weiht loss jaundice melaena diarrhoea abdominal pain
dysphagia
difficulty in swallowing
dysphagia problem types
oropharyngeal
oesophageal
gastric
history of dysphagia
duration solids or liquids pain weight loss previous MH medications SH
oropharyngeal dysphagia
difficulty initiating swallowing
difficulty with choking, nasal regurgitation
drooling, hardness etc
after initiation of swallowing at pharynx and upper oesophageal spincter
what can cause oesophageal dysphagia
benign musocsal disease (reflux may be benign peptic structure) or maligant or motility disorder (oesophageal spasm , achalasia, oesophageal pouch)
gastric dysphagia
carcinoma
outlet obstruction
peptic ulceration
pharyngeal pouches
defect between constrictor and transverse cricopharyges muscle
- due to incoordiantion of swallowing in pharynx, leads to herniation through cricopharyngeal muscle leading to formation of pouch
diagnosis oh pharyngeal poiches
barium swallow
management of dysphagia
treat underling cause
if nutritionally deplete may need supplementation
what leads to upper abdominal discomfort and cause
gastro oesophageal reflux disease
- excessive relaxation of lower oesophageal sphincter and raised intra abdominal pressure
symptoms of gastro oesophageal reflux discomfort
- heartburn
- epigastric pain
- acid reflux
- waterbrash
- nausea
- vomiting
- tooth decay
- asthma
management of pts with reflux
lifestyle advice (avoid late meals, sleep upright, weight loss, smoking cessation, reduction in alcohol
surgery
H2 agonist (release symptoms)
PPI
PPI examples
proton pump inhibitors
omeprazole
lansoprazole
hiatus hernia
pressure lost between the abdonomal and thoracic cavities
leads to reflux
types of hiatus hernia
prestage
sliding hiatal hernia
paraoesophageal
sliding hiatial hernia
- gastrooesophageal junction and the abdominal part of the oesophagus and cardia of stomach move upwards through diaphragmatic hiatus into the thorax
paraoesophageal hiatal hernia
- upward movement of gastric fundus, normal positioned junction (gastric oesophageal)
i. e. not all of it moves up, pouch forms above where It should be
diagnosis of peptic ulcers + treamtnet
1) test for H pylori and then treat
2) treat patients with active suppression therapy
3) endoscopic therapy if bleeding
4) surgical intervention
types of ulcers and distinguishing
gastric- associated with weight loss, worsened by food
haemataesis
duodenal - improve with eating, vomiting
what can ulcers be due to
helicobacter pylori
non steroidal anti inflammatory drug s
what can upper abdominal discomfort be due to
gastric carcinoma ulcer non ulcer dyspepsia pacreatic carcinoma pancreatitis
gastric carcinoma history, management and treatment
- epigastric pain, weight loss, vomiting
- OGD to investigate
- take biopsies from any areas
- imaging to stage and assess
Treatment - surgery if possible (gastrectomy)
- chemotherapy
- pallative care
pancreatic caricnoma
unremitting pain
radiates to back
associated with weight loss smoking
may cause jaundice
pancreatitis and treatment
- acute inflammation of pancreas causing severe pain, vomiting
- chronic relapsing pain (chronic pancreatitis)
long term opioids
management of acute lower abdominal pain
1) surgical referral
2) usually kept NBM
- pts may need surgical intervention
3) IV antibiotics
4) Imaging – USS and CT scan
- assess cause of acute pain
what can acute lower abdominal pain be due to
- inflammation (pain develops gradually, diffuse until becoming localised eg acute appendicitis)
- perforation (starts abruptly, severe and can lead to generalised peritonitis)
- obstruction (colicy? pain)
chronic lower abdominal pain
more than 6 weeks
investigate like acute
management analgesics/sugery
vomiting causes
systemic illness drug/alcohol centrala mediated psychiatric disorders gastric disease small bowel disease colonic diease
definition of diarrhoea
3 or more loose stools per day/change to normal bowel habit
acute causes of diarhoea
1) infection
- gastroenteritis: bacterial/viral
- eg campylobacter, salmonella, E coli
- should not last more than 10 days
2) drugs
- antibiotics
- alcohol
3) food allergy/intolerance
chronic causes of diarrhoea
• Small bowel disease – lactase deficiency – Coeliac disease – Crohn‘s disease • Pancreatic disease – pancreatic insufficiency – pancreatic carcinoma – cystic fibrosis • Colonic disease – ulcerative colitis – Crohn’s disease – carcinoma
coeliac disease
hyperplasia
increased lymphocytes
management
blood test
serology tests to look for ab (when on normal gluten diet)
dermatitis herpetiformis
ulcers on the body
features when being a coeliac
types of diarrhoea and symptoms associated
Small bowel/pancreatic - pain, floating, difficult to flush - throughout day - pain variable timing - pain not relieved by defecation Colonic - blood and mucus - often in the morning - pain related to defecation and relieved on defecation
inflammatory bowle diseases
crohns disease
ulcerative colitits
crohns disease
chronic inflammatory disease
affects any part of GI tract
from mouth to perineum
discontinuous
ulcerative colitis
chronic inflammatory disease invariably affecting the rectum and extending proximal to involve all or part of the colon
continuous inflammation
ulcerative colitis symptoms
diarrhoea
rectal bleeding
pain
weight loss
crohns disease symptoms
pain diarrhoea weight loss fever vomiting nausea
associated diseases of inflammatory 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 symptoms
- none (bowel cancer screening)
- rectal bleeding
- altered bowel habits
- lethargy/weight loss
risk factors for cancer seen in the Bowles (colon cancer)
polyps
investigation and management of colon cancer
Investigations - colonoscopy - barium enema - CT Management - evaluate extent of disease - if limited to colon – surgical resection possible - if not – chemo/radiotherapy - Pala
haemorrhoids
rectal bleeding
bright red
history of constipation
lasts few days /weeks
what is jaundice due to
high bilirubin levels
post hepatic causes of jaundice
gall stones
malignancy
benign biliary structure
hepatic causes of jaundice
infection
alcohol hepatitis
drugs
decompensaties chronic liver disease
pre hepatic causes of jaundice
isolated higher bilirubin level
haemolytic anaemia,
chronic liver disease signs
clubbing palmar ertyhema spider naevei asicties tanned appearance
