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IHD Part 2 306 > Gastro-intestinal system > Flashcards

Gastro-intestinal system Flashcards

1
Q

Pathogens of the GI tract: What is gastroenteritis?

A

Syndrome characterised by GI-symptoms including nausea, vomiting, diarrhoea and abdominal pain

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2
Q

Pathogens of the GI tract: What is dysentery?

A

Abnormal inflammation of GI-tract: often blood and pus in faeces and pain, fever, abdominal cramps- often disease of large intestine

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3
Q

Pathogens of the GI tract: What is enterocolitis?

A

Inflammation of mucosa of small and large intestine

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4
Q

Pathogens of the GI tract: What are the defences present in the mouth?

A

Flow of liquids, saliva (statherins, defensins), lysozyme, normal bacterial flora

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5
Q

Pathogens of the GI tract: What are the defences in the oesophagus?

A

Flow of liquids, peristalsis

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6
Q

Pathogens of the GI tract: What are the defences in the stomach?

A

Acidic pH

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7
Q

Pathogens of the GI tract:What are the defences in the small intestine?

A 
flow of gut contents
peristalsis
mucus
bile 
secretary IgA 
ymphoid tissue (Peter's patches)
shedding and replacement of epithelium
normal flora
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8
Q

Pathogens of the GI tract: What are the defences in the large intestine?

A

Normal flora
peristalsis
shedding and replication of epithelium
mucus

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9
Q

Pathogens of the GI tract: What two bacterium are common in causing food poisoning?

A

Staphylococcus aureus

Clostridium botulinum

Bacillus cereus - gram positive rod

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10
Q

Pathogens of the GI tract: how does helicobacter pylori resist stomach acid?

A

Produces Urease - produces ammonia cloud (neutralises acid) around organism that allows organism to survive and replicate

Protective cloud during transit to gastric mucin layer

can therefore inhabit gastric mucosa

bleeding/ulcers

Ammonia = basis of breath test

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11
Q

Pathogens of the GI tract: How is helicobacter pylori treated?

A

proton-pump inhibitor PLUS metronidazole/ amoxicillin and Clarithromycin

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12
Q

Pathogens of the GI tract: What is a major cause of diarrhoea?

A

E coli - gram neg rod

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13
Q

Pathogens of the GI tract: How is E coli detected in the lab?

A

macConkey agar

lactose fermentation - used for colour change when E coli grows

PCR and antigen tests used for serotypes

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14
Q

Pathogens of the GI tract: How does EPEC form attachments?

A

Bundle- forming pilli
needle injects toxins into host cell
sits on pedestal

has translocated intimin receptor (intimin mediates attachment to epithelial cells)

leads to watery diarrhoea

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15
Q

Pathogens of the GI tract: How does ETEC form attachments and what toxins does it produces?

A

via adhesive pilli
forms pedestals

Produce Heat Stable (ST) and Labile (LT) enterotoxins (cholera like) that cause diarrhoea

Produce Vero-toxin (Also called Shigella-like toxin)- STx
STx (verotoxin) is a potent diarrhoeal toxin (and has receptor on kidney cells ) acts via damaging cells directly, can damage blood vessels in kidneys

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16
Q

Pathogens of the GI tract: What organism can cause bacillary dysentry?

A

Shigella

low infectious dose - 10-100 cells needed

non lactose fermenters
common in poorer countries

spread faecal- orally

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17
Q

Pathogens of the GI tract: how is salmonella spread?

A

Spread from food- mainly chicken and dairy products, but also person to person

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18
Q

Pathogens of the GI tract: What cells does salmonella spread via?

A

Invade macrophages then to epithelium

doesn’t cause lactose fermentation

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19
Q

Pathogens of the GI tract: What is salmonella associated with?

A

S. Typhi - typhoid fever

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20
Q

Pathogens of the GI tract: Where does S. typhi reside?

A

Gall bladder

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21
Q

Pathogens of the GI tract: how is s.typhi transferred?

A

oral- faecal route during food prep

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22
Q

Pathogens of the GI tract: What is the most common cause of food poisoning?

A

Campylobacter - gram neg micro-aeophiles

Campylobacter jejuni most common
Acquired by ingestion of contaminated food

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23
Q

Pathogens of the GI tract: what type of bacterium is cholera?

A

motile Gram-negative comma-shaped bacterium

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24
Q

Pathogens of the GI tract:What does colonisation of cholera of the SI depend on?

A

Motility (polar flagella)
production of mucinase
attachment to specific receptors

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25
Q

Pathogens of the GI tract: What effect does the cholera toxin have?

A

disruption of ADP-ribosylation of G-protein signalling pathways causes increased secretion of Chloride ions

This prevents influx of Sodium ions into cells

Results in rapid loss of water from tissue- massive diarrhoea

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26
Q

Pathogens of the GI tract: What is the treatment for cholera?

A

Rapid fluid and electolyte replacement required or dehydration and death result

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27
Q

Pathogens of the GI tract: What are the symptoms of cholera?

A 
absent tears
very dry mouth and tongue
lethargic/ unconscious
sunken and dry eyes
drinks poorly or not able to drink
skin pinch goes back slowly
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28
Q

Pathogens of the GI tract: how can cholera be prevented?

A

Vaccines

best - improvement of water system and sanitation

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29
Q

Pathogens of the GI tract: What % of gastroenteritis cases are viral?

A

20

30
Q

Pathogens of the GI tract: What is a rotavirus?

A 
Wheel-like viral particle
 Diarrhoea caused by tissue  damage in small intestine
 Dehydration main risk
 Very low-infectious dose
 Very contagious
 V resistant to celaining products
31
Q

Pathogens of the GI tract: What is the most common gI infection causing virus?

A

Noro virus

32
Q

Pathogens of the GI tract: What type of bacteria generally cause diarrhoea and gastro enteritis?

A

gram negative

33
Q

GI disease medicine: What are the functions of the GI tract?

A

Turns the food you eat into energy

Waste removal

Intake of water - hydration

34
Q

GI disease medicine: What are some symptoms of GI diseases?

A

Vomiting, weight loss, jaundice, malaena, diarrhoea, abdominal pain, hematemesis

35
Q

GI disease medicine: What questions would you ask for someone who has dysphagia?

A 
Duration
Solids or liquids
Pain (odynophagia)
Weight loss
Previous medical history
Medications
Cigarettes and alcohol
36
Q

GI disease medicine: What 3 areas could dysphagia be a problem of?

A

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

37
Q

GI disease medicine: What oropharyngeal problems cause difficulty swallowing?

A

Salivary gland
- Sjogrens syndrome

Tongue
- amyloid, hypothyroidism, motor neurone disease (not strong enough or doesn’t co-ordinate properly - spasticity)

Palatal / epiglottal / upper oesophageal disorder
- cerebrovascular disease, MND, Parkinson’s disease

38
Q

GI disease medicine: What oesophageal problems cause difficulty swallowing?

A

Benign mucosal disease
benign peptic stricture (gullet narrows due to acid reflux), oesophageal web (Plummer Vinson syndrome), Candidal oesophagitis - thrush infections of the gullet if inhaler swallowed incorrectly

Malignant mucosal disease
Carcinoma

Motility disorders
oesophageal spasm, achalasia, oesophageal pouch

39
Q

GI disease medicine: What is a pharyngeal pouch?

A

Defect between the constrictor and the transverse cricopharyngeus muscle.

40
Q

GI disease medicine: What gastric problems cause difficulty swallowing?

A

Carcinoma

Outlet obstruction
- peptic ulceration

41
Q

GI disease medicine: How is dysphagia managed?

A

Treat underlying cause

If nutritionally deplete, may require supplementation – oral supplements, NG, PEG feeding

balloon dilation
cancer treatment

42
Q

GI disease medicine: What are the causes of GORD?

A

Excessive relaxation of lower oesophageal sphincter and raised intra-abdominal pressure (diaphragm damaged so stomach able to extend up- hiatus hernia)

43
Q

GI disease medicine: What are the symptoms of GORD?

A

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

44
Q

GI disease medicine: What is the management of GORD?

A

PPI (omeprazole, lansoprazole)

Histamine- 2 antagonists

Lifestyle advice (weight loss, smoking cessation, reduce alcohol and caffeine) - first 
raise the head of the bead so gravity can push acid back down

Surgery - fundoplication - tie the loose bit of the stomach

45
Q

GI disease medicine: What is a hiatus hernia?

A

Top bit of the stomach pushes into the thorax

46
Q

GI disease medicine: What are the types of hiatus hernia?

A

A= normal

B= pre- stage

C= sliding hiatal hernia

D= paraoesophageal type (most painful)

47
Q

GI disease medicine: What is a oesophageal Manometry?

A

tube down pt’s nose, sits in the back of gullet and measures acid going up or down

48
Q

GI disease medicine: What is the history for a peptic ulceration?

A

malaena, haematemesis and pain - 3 pain symptoms of ulcers

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 e.g. ibuprofen not good as causes further ulceration in the small bowel

49
Q

GI disease medicine: How are peptic ulcers managed?

A

proton pump inhibitors

clips

adrenaline injections to cause vasoconstriction

surgery if bleeding

50
Q

GI disease medicine: What are the causes of upper abdominal discomfort/pain?

A

Non-ulcer dyspepsia

  • upper abdominal discomfort, nausea, eructation, bloating
  • motility disturbance

Pancreatic carcinoma
- unremitting pain, often radiating to back and associated with weight loss and may cause jaundice

Pancreatitis

  • acute inflammation of pancreas causing severe pain, vomiting
  • chronic relapsing pain (chronic pancreatitis)
  • commonest cause alcohol > gallstones > pancreatic trauma, drugs, hypercalcamia / lipidaemia, familial
51
Q

GI disease medicine: What are the two most common causes of pancreatitis?

A

Gall stones and alcohol

52
Q

GI disease medicine: How do you manage acute abdominal pain?

A

Surgical referral

Usually kept NBM nil by mouth

IV antibiotics??

Imagaing - USS/ CT scan

53
Q

GI disease medicine: When does abdominal pain become chronic?

A

more than 6 weeks

54
Q

GI disease medicine: What are some causes of vomiting?

A 
Systemic illness (viral, bacterial, diabetic ketoacidosis)
Drugs, alcohol

Centrally mediated
- middle ear disease, labyrinthitis (infection), cerebellar disease, brain stem disease (cerebrovascular or tumour)
raised intracranial pressure (tumour, haemorrhage, hydrocephalus)

Psychiatric disorders (psychogenic vomiting, Bbulimia)
Oesophageal disease
Gastric disease
Small bowel disease
Colonic disease 
- obstruction due to tumours, volvulus
55
Q

GI disease medicine: What is the management for vomiting?

A

Identify underlying cause

Antiemetics (eg. cyclizine, metaclopramide)
PPI
Cognitive Behavioural therapy

56
Q

GI disease medicine: What are some causes of acute diarrhoea?

A

Infection (gastroenteritis: bacterial or viral)
- Campylobacter, Salmonella, Shigella, E. Coli

Drugs
- antibiotics, alcohol

Food allergy / intolerance

57
Q

GI disease medicine: What are some chronic causes of diarrhoea?

A

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
  • carcinom
58
Q

GI disease medicine: whAT IS Coeliac disease?

A

immunological response to gliadin

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

increased IEL’s, crypt hyperplasia, villous atrophy

59
Q

GI disease medicine: how is the diarrhoea affected by small bowel/pancreatic or colonic involvement? - SORT OUT

A

Small bowel / pancreatic

Pale, floating, difficult to flush

Blood and mucus
Throughout day Often in morning

Pain variable timing Pain related to defaecation
Pain not relieved by defaecation Pain relieved by defaecation

60
Q

GI disease medicine: What is Crohn’s disease?

A

Chronic inflammatory disease affecting any part of the gastrointestinal 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).

61
Q

GI disease medicine: What is ulcerative colitis?

A

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

62
Q

GI disease medicine: What are the symptoms of Crohn’s disease and ulcerative colitis?

A 
Crohn's 
Pain				
Diarrhoea			
Weight loss		
Anorexia			
Fever				
Vomiting				
Lassitude				
Nausea				
Acute abdomen			
Nutritional disturbance		
Fistula				
Miscellaneous
ulcerative colitis 
diarrhoea 
rectal bleeding
pain
weight loss
63
Q

GI disease medicine: What associated diseases are there with Crohn’s and ulcerative colitis?

A

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

64
Q

GI disease medicine: What are the symptoms of colon cancer?

A 
Symptoms:
None!! (Bowel Cancer Screening – FOB)
Rectal Bleeding
Altered Bowel Habit
Lethargy/ Weight Loss

polyps - cancer

65
Q

GI disease medicine: How would you investigate colon cancer?

A

Colonoscopy/ Barium enema

CT

66
Q

GI disease medicine: How would you manage colon cancer?

A

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

67
Q

GI disease medicine: What are the causes of post hepatic jaundice?

A

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) - inflammation of the biliary tree

68
Q

GI disease medicine: What are the hepatic causes of liver failure?

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

69
Q

GI disease medicine: What are the pre-haptic causes of jaundice?

A 
Haemolytic anaemia (hereditary spherocytosis, G6PD deficiency, sickle cell disease)
- anaemia, jaundice, gallstones, splenomegaly, leg ulcers
70
Q

GI disease medicine: What is the most common cause of chronic liver disease in the UK and worldwide?

A

alcohol

hepatitis (infection) = B

moving more towards non alcoholic fatty liver disease - metabolic syndrome

71
Q

GI disease medicine: What is the most common cause of chronic liver disease in the UK and worldwide?

A

alcohol

hepatitis (infection) = B

moving more towards non alcoholic fatty liver disease - metabolic syndrome (when it causes irreversible damage - cirrhosis)

IHD Part 2 306 (23 decks)

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