Gastroenterology Flashcards
Define adynophagia?
Difficulty swallowing entirely
Define dysphagia?
Problematic swallowing
What causes dysphagia?
STRUCTURAL ABNORMALITIES: pharyngeal pouch, oesophagitis, benign/ malignant strictures, extrinsic pressure (goitre)
MOTILITY DISORDERS: achalasia, oesophageal spasm, bulbar palsy, pseudobulbar palsy, systematic sclerosis
What is gastro - oesophogeal reflux disease (GORD)?
Dysfunction of lower oesophageal sphincter predisposing to the reflux of acid up into the oesophagus.
Associated with pregnancy, obesity, alcohol, smoking, hiatus hernia, helicobacter pylori
What are the symptoms of GORD?
heartburn, odynophagia, increased salivation, acid reflux, belching
How can GORD be managed?
LIFESTYLE - weight loss, smoking and alcohol cessation, raise head of bed, avoid eating before bed
MEDICATION - antacids (gaviscon), proton pump inhibitors (omeprazole), H2 antagonists (ranitidine)
GASTROSCOPY - if symptoms persist
What complications can occur with GORD?
Benign strictures
Barretts oesophagus
Oesophageal cancer
What is Barretts oesophagus?
Metaplastic change of the distal oesophageal epithelium from squamous to columnar type.
Results in an upward migration of squamocolumnar junction.
Increased risk of adenocarcinomas
If dysplastic changes are found, affected tissue is removed by oesophageal resection or mucosal ablation.
What is peptic ulcer disease?
A break in the lining of the stomach (most commonly in the lesser curve), first part of the small intestine, or occasionally the lower oesophagus.
What are the symptoms of peptic ulcer disease?
Epigastic pain after or before meals, relief with antacids Heartburn Belching Nausea Recent onset, progressive symptoms: Anaemia Weight loss Anorexia Difficulty swallowing Melaena or haematemesis
What causes peptic ulcer disease?
Infection by helicobacter pylori (increased gastric acid secretion, gastric metaplasia, immune response, mucosal defence systems)
Drugs - NSAIDs, steroids, bisphosphonates
Hormonal - Zollinger Ellison syndrome
Association with alcohol, smoking, stress, blood group O
What are the treatments for peptic ulcer disease?
Adjust lifestyle Cessation of causative medication H. pylori eradication Proton pump inhibitors H2 receptor antagonists
What are the 2 types of upper GI bleeding?
Haematemesis ( vomiting blood)
Melaena (blood in poo)
What are the causes of upper GI bleeds?
Oesophagitis Gastritis Peptic ulcer disease GI malignancy Bleeding disorders Angio dysplasia Drugs - NSAIDs, steroids, anticoagulants, thrombocytis
What supplies the liver with oxygen and nutrients?
25% from hepatic artery - supplies 02
75% from hepatic vein - supplies nutrients
How do you manage an upper GI bleed?
ABC + Urgent OGD
What is Coeliacs disease?
An automimmune condition in which there is inflammation of the proximal small bowel mucosa.
Improves when pt maintains gluten - free diet
More common in N. Europeans and mostly in 40’s
What are the clinical features of Coeliacs disease?
Diarrhoea steatorrhoea (fat in poo)
Abnormal pain and bloating
Weight loss
Oral ulceration and angular chelitis
What is the treament for Coeliac disease?
Maintain gluten free diet
What investigations can be done to diagnose Coeliacs disease and what pathology would you find?
INVESTIGATIONS - bloods, jejunal / duodenal biopsy
PATHOLOGY - villous atrophy, crypt hyperplasia, chronic inflammatory lymphocytic infiltration within the epithelium
What are the 2 types of Inflammatory bowel disease (IBD)?
Crohns disease
Ulcerative Colitis
What are the causes of IBD?
Thought to be 3 interactive factors:
genetic susceptibility
environmental factors
host immune response
What is Ulcerative Colitis?
One type of IBD that causes inflammation and ulcers in your digestive tract.
Inflamation can be in rectum alone (proctitis) or can extend to involve descending colon or whole colon.
More common in caucasions, males and onset 30 yrs old
What are the clinical symptoms of Ulcerative Colitis
Diarrhoea with blood and mucus Tenesmus (need for the toilet) Lower abdominal discomfort Malaise, anorexia, fever, lethargy Oral ulceration
How is IBD investigated (Ulcerative colitis and Crohns)?
Blood tests - iron deficiency, increase CRP/WBC Barium enema Colonoscopy MRI Biopsy
How do you manage Ulcerative colitis?
Aminosalicylates (eg. 5 ASA or axathiopine if resistant)
Rectal corticosteroid preparations as foam / enema
Oral cortcosteroids
Surgery - subtotal colorectomy with end ileostomy and preservation of rectum
What is Crohns Disease?
One type of IBD, a chronic inflammatory disease of the intestines, especially the ascending colon and terminal ileum, associated with ulcers and fistulae.
More commons in Caucasions and in females, 30 yrs onset
What is a skip lesion?
Occurs in Crohns Disease when multiple areas are affected and there are skip lesions with normal mucosa in between affected areas.
What are the clinical symptoms of Crohns Disease?
Abdominal pain
Diarrhoea
Weight loss
Oral lesions (labial swelling and ulcerations)
Perianal lesions ( fissures, skin tags, abscesses)
How do you manage Crohns Disease?
Smoking cessations Treat diarrhoea / anaemia Oral cortcaosteroids Azathioprine Biological agents - infliximab Surgery - stricturoplasty, resection with end to end anastomosis but recurrence rates high.
What are the similarities between Ulcerative colitis and Crohns Disease?
Both associated with arthropathy, uveitis (swelling in the eye), primary sclerosing, erythema, pyoderma gangrenosum (bacterial infection), increased risk of carcinoma
What are the differences between Ulcerative colitis and Crohns disease?
UC - limited to colon CD - any part of tract mouth to anus
UC - continuous inflammation CD - patchy inflammation
UC - mucosa and submucosa inflammations
CD - transmural inflammation
UC - superficial inflamation CD - deep ulcers, fistulae, abscesses and stricturing
UC - no granulomas CD - granulomas present
UC - polyps common CD - polyps rare
UC - smoking decreases risk CD - smoking increases risk
UC - blood diarrhoea most prominant
CD - abdominal pain most prominent
What is Irritable bowel syndrome (IBS)?
A functional bowel disorder in which no organic cause is known but likely to be a disorder of the intestinal mobility / enhanced visceral perception
Affects females more and roughly 20-40 yrs
What are the symptoms of IBS?
Abdominal bloating
Central and lower abdominal pain
Pain relieved by defecation
Altered bowel habits
What is the treatment for IBS?
Antispasmodics eg. mebeverine
Treat constipation and diarrhoea
Tricyclic antidepressants
What is constipation and what causes it?
Infrequent passage of hard stool with straining or discomfort during defecation
CAUSES - poor diet, dehydration, immobility, IBS, elderly
What is diarrhoea and what causes it?
Increased watery stools, increased frequency and looseness
Acute 14 days
Chronic > 3 months
CAUSES - gastroenteritis, IBS, IBD, coeliac disease, colorectal cancer, drugs (antibiotics, laxatives, proton pump inhibitors, NSAIDs)
