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Human Diseases Yr2 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is dysphagia?

A

difficulty swallowing

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2
Q

What are some structural abnormalities which can cause dysphagia?

A
  • Pharyngeal pouch (outpouching of pharyngeal mucosa)
  • Oesophagitis
    >. reflux oesophagitis (acid reflux from stomach)
    > infective oesophagitis
  • benign strictures (scarring and narrowing of oesophagus making it difficult for food to pass down. Usually a complication of chronic reflux oesophagitis).
  • malignant strictures (oesophageal carcinoma)
  • extrinsic pressure
    > goitre, AA, Lung Ca, Lymph
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3
Q

What are some motility disorders which may cause dysphagia?

A

Achalasia - degeneration of myenteric plexus causing the LOS (lower oesophageal sphincter) to be constantly tensed. - tapered oesophagus

Oesophageal spasm - uncoordinated contraction of oesophagus. corkscrew appearance

Bulbar palsy - damage to motor neurones (can’t move facial muscles).

Pseudobulbar palsy (e.g. stroke)

Systemic sclerosis - fibrosis of sclera and connective tissues

Chagas’ disease - parasitic infection. systemic infection which damages parasympathetic nerve plexus which can cause reduced peristalsis

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4
Q

What are the structural abnormalities that cause dysphagia? (5)

A
  1. Pharyngeal pouch
  2. Oesophagitis
    > Reflux oesophagitis
    > Infective oesophagitis
  3. Benign strictures
  4. Malignant strictures
  5. Extrinsic strictures
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5
Q

What are the mobility disorders that cause dysphagia? (6)

A

a. Achalasia
b. oesophageal spasm
c. . bulbar palsy(e.g. MND)
d. pseudobulbar palsy (e.g. stroke)
e. systemic sclerosis
f. chagas’ disease

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6
Q

What is GORD?

Gastro-oesophageal reflux disease

A

Dysfunction of the lower oesophageal sphincter predisposing to the reflux of acid up into the oesophagus.

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7
Q

What are some risk factors of GORD?

A

associated with increased abdominal pressure

Pregnancy
Obesity
Alcohol
Smoking
Hiatus hernia
Helicobacter pylori
Anticholinergic medicine (causes relaxation of sphincter)
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8
Q

What are some symptoms of GORD? (5)

A 
> Heartburn
> Odynophagia
> Waterbrash (excessive salivation)
> Acid brash (acid/bile regurgitation)
> Belching
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9
Q

How can we manage GORD?

A

Lifestyle measurements:
> lose weight, stop smoking, alcohol cessation, small meals, raise head of bed.

Medication:
> OTC anacids i.e. gaviscon
> PPIs (proton pump inhibitors) i.e. omeprazole
> H2 antagonists i.e. ranitidine = H2 antagonists as H2 is responsible for secretion of stomach acid from parietal cells.

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10
Q

What are some complications of GORD?

A

benign strictures, Barrett’s oesophagus and oesophagus carcinoma.

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11
Q

What is Barretts oesophagus?

A

Metaplasia of the distal oesophageal epithelium from squamous to columnar epithelium.

Upward migration of squamocolumnar junction.

There is a significantly increased risk of adenocarcinoma development - hence yearly biopsy is required.

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12
Q

What are the symptoms of peptic ulcer diesases?

A

Pain after of before meals
Heartburn
Postprandial discomfort and fullness, belching, early satiety, nausea.

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13
Q

What are some causes of peptic ulcer disease?

A

Infection with helicobacter pylori

DRUGS: NSAIDS (including low dose aspirin) (they reduce prostaglandins by inhibiting cyclooxygenase), steroids, bisphosphonates

Hormonal

Alcohol, smoking, stress and blood group O related.

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14
Q

How does helicobacter pylori affect the intestinal and mucosal physiology?

A

increased gastric acid secretion
gastric metaplasia
immune response
mucosal defence mechanisms

ultimately causes inflammation and cell death in the gastric mucosa

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15
Q

What is the ALARM symptoms of peptic ulcer disease?

A 
Anaemia
Loss weight
Anorexia
Recent onset with progressive symptoms
Melaena
Swallowing difficulty
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16
Q

How can we investigate peptic ulcer disease?

A

Endoscopy (OGD)

Helicobacter pylori detection via breath test, stool antigen, serology, biopsy

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17
Q

How can we treat peptic ulcer disease?

A

H. pylori eradication

Cessation of causative medication (NSAIDS, bisphosphonates, steroids).

H2 Receptor antagonists (stop prod of gastric acid).

Lifestyle adjustment (stop smoking, lose weight).

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18
Q

What is an ulcer?

A

loss of surface epithelium on an organ

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19
Q

What is haematemesis?

A

vomiting blood (coffee ground vomit

common in upper GI malignancy, as malignant tumours bleed readily

20
Q

What is melaena?

A

black stools due to the inclusion of blood

21
Q

What are some causes of upper GI bleeds?

A

Mallory-Weiss tear - laceration in mucosa.
Oesophagitis
Gastritis
Peptic ulcer disease
Gi malignancy
Oesophageal varices (maybe second to liver cirrhosis)
Bleeding disorders (von willebrand disease, haemophilia A, thrombocytopenia)
Drugs (NSAIDS, steroids) (anticoagulants, thrombolytic)

22
Q

How do you manage upper GI bleeds?

A

AIRWAY
BREATHING - high flow O2
CIRCULATION - 2 large-bore cannulae, IV fluid resus, blood transfusion, correct any clotting abnormalities with vitamin K and FFP.
Urgent OGD

23
Q

What is coeliac disease?

A

Immune mediated condition in which there is inflammation of the proximal small bowel mucosa, that improves when the patient maintains a gluten-free diet, and relapses when gluten is reintroduced.

Genetic susceptibility (DQ2, DQ8)

Associated with dermatitis herpetiformis (a very itchy skin rash)

24
Q

What are the clinical features of coeliac disease?

A

Diarrhoea/steatorrhea
Abdominal pain and bloating
Weight loss
Oral ulceration and angular cheilitis

25
Q

What are the investigations to detect coeliac disease?

A

Bloods

Jejunal/duodenal biopsy

26
Q

What is the treatment of coeliac disease?

A

Gluten free diet

27
Q

What is the pathology of coeliac disease? (3)

A

Villous atrophy
Crypt hyperplasia
Chronic inflammatory lymphocytic infiltrate within the epithelium

28
Q

What are two inflammatory bowel diseases?

A

Ulcerative colitis

Crohn’s disease

29
Q

What are the three factors which may make a person more susceptible to IBD?

A

Genetic susceptibility

Environmental factors: smoking, high fat and sugar intake, intestinal microflora)

Host immune response: defects in immunoregulation or barrier function

30
Q

What is the epidemiology of ulcerative colitis?

A

500 per 100,000
more common in caucasian
slightly higher in males
age of onset 15-40yrs

31
Q

What part of the bowel does UC affect?

A

Can affect rectum alone, or extend proximally to involve the sigmoid/descending colon or the whole colon.

Affects colon only.

32
Q

What are some clinical features of ulcerative colitis?

A 
Diarrhoea with blood and mucus 
Urgency
Abdominal discomfort
Malaise, lethargy, anorexia
Oral ulceration (usually aphthous-like ulcers)and angular cheilitis
33
Q

What is the epidemiology of Crohn’s disease?

A

300 per 100 000 prevalence
more common in caucasian
slightly higher female prevalence
15-40 yrs onset

34
Q

What parts of the GI tract may be affected by Crohn’s disease?

A

Any part of bowel from mouth to anus, however a tendency to affect terminal ileum and ascending colon.

If multiple areas are affected, there are often ‘skip lesions’ where normal mucosa is found btw affected mucosal areas.

35
Q

What are some clinical features of Crohn’s disease?

A

Abdominal pain
Weight loss
Diarrhoea
Malaise, lethargy, anorexia, low-grade fever

Oral lesions: labial swelling, ulceration, angular cheilitis, cobblestoning

Perianal lesions: fissures, skin tags, perianal abscesses

36
Q

How can we investigate IBD?

A

Blood tests: iron deficiency anaemia, raised CRP/WBC, hypoalbuminaemia

Faecal calprotectin (look at neutrophils in stool)

Barium enema

Endoscopy

CT/MRI

Biopsy

37
Q

Does ulcerative colitis have skip lesions?

A

no only in Crohn’s disease

38
Q

Are pseudopolyps a feature of ulcerative colitis?

39
Q

compare crohn’s disease to ulcerative colitis?

A

CD: mouth to anus, however commonly terminal ileum. UC: limited to colon

CD: patchy inflammation (skip lesions) UC: continuous proximal extension of inflammation

CD: transmural inflammation UC: mucosal and submucosal inflammation only

CD: deep. ulcers crossing muscularis mucosae with fissures, fistulae, abscesses and stricturing UC: superficial ulceration only

CD: granulomas present. psuedopolyps rare UC: no granuloma. pseudopolyps common

CD: smoking increases risk UC: smoking reduces risk

CD: abdominal pain most prominent feature UC: blood diarrhoea most prominent feature

CD and UC: associated with arthropathy, uveitis, primary sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum and increased risk of adenocarcinoma

40
Q

Does smoking increase or decrease the risk of UC?

41
Q

What is the most common feature of Crohns?

A

Abdominal pain

42
Q

What is the most common feature of UC?

A

Blood diarrhoea

43
Q

Which one has oral involvement; Crohn’s or UC?

44
Q

What is IBS? irritable bowel syndrome

What is the symptoms and what are the treatments?

A

disorder of Intestinal motility or enhanced visceral perception.

Symptoms include:

  • abdominal bloating
  • abdominal pain
  • mucus
  • altered bowel habits

Treatments:

  • antispasmodics
  • treatment of constipation.
  • tricyclic antidepressants
45
Q

What is diarrhoea?

A

Increased stool water, causing stool frequency and looseness

common causes are IBD, coeliac disease, colorectal cancer

46
Q

What is constipation?

A

the infrequent passage of hard stool, often with straining or discomfort during defecation.

47
Q

What are some oral manifestations of Crohn’s disease?

A

Angular cheilitis
Ulceration
Labial swelling
Buccal cobblestoning

Human Diseases Yr2 (20 decks)

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