Gastrointestinal Flashcards
what is the treatment for ulcerative colitis
anti-inflammatory medication
removal of the colon
how can you diagnose ulcerative colitis
colonscopy- camera up your bum
ct scan, mri
xray
what causes ulcerative colitis
an autoimmune conditon that causes t-cells to destroy cells that line the walls of the large intestine
it affectsthe large intestine function
what is ulcerative colitis
condition that tends to form ulcers on the inner surface of the lumun in the large intestine
only happens in the large intestine
form of inflamtion bowel diesease
what are symptoms of inflammation bowel disease
pain in the right lower quadrant
diarrhea
blood in stool
what is the cause of inflammation bowel disease
gentics
gene mutation
explain the pathophysiology of inflammation bowel disease
a pathogen enters the body (epithelial cells are defected in inflammation bowel disease letting pathogens in easily)
the t-helper cells reassess a chemical that stimulates an inflammation response
this in inflammation bowel disease is a process with a dysfunction therefor their is a LOT of inflammation and immune response
this destroys healthy cells
the immune repsone contiunes to attack healthy cells leading to ulcers to form
what is the difference between chron’s disease and ulcerative colitis
chron’s disease affect anywhere in the go tract not just the large instestine
what are the two conditions that fall under inflammation bowel disease
chron’s disease
ulcerative colitis
what are the signs and symptoms of irritable bowel syndrome
Intermittent cramping abdo pain, often lower usually relieved by defecation
o Altered bowel function
o Flatulence, bloating, nausea
o Often accompanied by anxiety and depression
how to diagnose irritable bowel syndrome
criteria often continuous or recurrent symptoms of at least 12 weeks of abdo symptoms with two of three symptoms
explain the pathophysiology of irritable bowel syndrome
its a functional disorder- no physical changes but the bowel doesn’t work effectively with the communication between the gt and the central feverous system
this causes to hypersensitive where the brain tells the large intestine to move after or slower effecting how much water is absorbed
what is irritable bowel syndrome
chronic or recurrent abdominal pain with changes in bowel habits
how can you diagnose acute choleytitis
xray
what are the symptoms of a acute choleystits
pain in the epigastric area
nausea and vomiting
explain the pathophysiology of acute cholecystitis
individual has gallstones in the gallbalder
when the gallbladder is singled to contract and realise bile to help with digestion it loges one of the gallstones in the cystic duct
this blocked the bile flow- this irritates the mucus linning leading to it producing enzymes that promote inflammation
their is eventually a pressure build up, as well as this bacteria starts to grow causing an infection
what is the cystic duct
leaves the gallbladder and connects to the common bile duct
what is acute cholecystitis
inflammation of the gallbladder- due to gallstones being loved in the cystic duct
how can you diagnose gallstones
x-ray
what are the two types of gallstones
cholesterol stones- due to cholesterol breaking away from the bile this is due to high construction of bile
bilirubin stones- made when to much bilirubin is in the bile
what is the job of the gallbladder
store bile
send the small intestine bile to break down fatty foods
what is gallstones
hard solid masses formed in the gallbladder
can a diverticular be aysmptamitc
yes
what is diverticulitis
inflammation of a small bulges in the large intestine
explain the pathophysiology of diverticulitis
The outermost layer of colon tissue is made up of fibrous bands of muscle rapped around one another.
· The muscles become weakened with age, and the increased pressure of muscle spasms can cause the inner layers of tissue, the mucosa and submucosa, to herniate through the opening, forming diverticula.
· The diverticula then trap small amounts of faecal material, especially undigested seeds, etc, the trapped faeces can allow bacteria to grow and result in infection.
what are the treatments for diverticulitis
Diet
GP recommends to stick to fluid only diet for a few days
When recovering you should eat very low fibre diet
Medicine:
Treated at home with antibiotics prescribed from the GP.
More serious cases may need hospital treatment of IV and antibiotics.
Surgery – In rare cases surgery may be needed in certain cases which involves removing the infected section of the large intestines. This is known as colectomy
what are the complications of diverticulitis
If tears become large enough they can spill bowel consents into the abdominal lining leading to infection called peritonitis.
what are the signs and symptoms of diverticulitis
Normally unnoticeable Symptoms normally develop after the age of 40 and include… Diarrhoea Constipation Fever Chills Abdominal tenderness in illac fossa/ hypogastric regions (mainly in the left lower side of abdomen. Blood in stool Rectal bleeding Inflammation
explain the pharyngeal phase of swallowing
epiglottis closes the airway and upper oesophageal spinchtor relaxes to allow food to move into the oesophagus
explain the oral phase of swallowing
food is prepared into a bolus and acts of swallowing occur where food safely enters the oropharynx
what is somatic pain
Sharp pain caused when the somatic nervous system detects stimuli such as touch, temperature, or bodily fluids such as blood, pus or gastrointestinal contents.
explain the pathophysiology of referred pain
Pain that is felt at a site away from the pain stimulus.
This is due to the convergence of many different nerve fibres from wide areas of the body into small areas of the spinal cord.
explain the pathophysiology of visceral pain
These pain signals travel along nerves which enter the spinal column at various levels, meaning that visceral pain usually is not localised to any one specific area
As the pathology progresses, this pain may become parietal in nature
The body responds to this vague pain with sympathetic stimulation that causes nausea and vomiting, diaphoresis (sweating) and tachycardia.
explain the pathophysiology of somatic pain
The pain signals travel along definite neural routes to the spinal column, meaning that the pain identified as being from a particular region or area.
what causes oesophageal dysphia
internal obstruction
forgien bodies
what is oesophageal dysphia
able to do the first process of swallowing but feel discomfort in the mid and lower stream
what is the management of dyspina
treating underlying causes
dietary changes
swallowing exercises
what are the causes of oropharyngeal dysphia
tremor in tonsils
peritonsillar obscess
or
stroke
ms
Parkinson’s disease
what is oropharyngeal dysphia
pt unable to transfer food to upper oesophagus by swallowing
what is the two types of dysphagia
oropharyngeal and oesophageal and can either be structural or neurological
what is the oesophageal phases of swallowing
oesophagus relaxes to receive the food and is helped by the peristalsis wave
what are the three process of swallowing
oral phase and pharyngeal phases and oesophageal phase
what is swallowing
process that food transported from mouth to the stomach
what is dysphasia
difficulty and abnormality of swallowing
what are the factors the causes heartburn
large meals coughing allchol medication previous surgery
what causes symptoms of oesphagitis
back flow of gastric acid into oesophagus due to an incompetent barrier
what Is oesophagitis
heartburn
musclualis mucosa
Smooth muscle that contracts and breakdown food
what is a lamina propria
made of blood and lymph tissues
what is the epithelial layer
absorbs and recreates mucus and digestive enzymes
what is a peptic ulcer
a break in the membrane in the stomach
what are the causes of peptic ulcers
infection from h.pylori bacteria- due to it colonising at the gastric mucusa causing damage which over time gets deeper and deeper causing ulcers
NSAID’s anti inflammatory drugs
what does prostaglandin do
increases mucus and bicarbonate production in the stomach
inhibits acid secretion in the stomach
why does nsaid’s anti inflammatory drugs causes peptic ulcers
the inhibit the cox-1 which produces prostaglandin this causes it to become reduced
explain what causes a GI obstruction
Blockages of the hollow space, or lumen, within the small and large intestines.
Bowel obstruction is either due to a mechanical blockage (adhesions, intussusception, tumour / faeces, hernia, volvulus) or due to other factors that affect the muscular wall of the bowel (myopathy) or the nerve supply to the bowel (neuropathy) which would affect its ability to perform peristalsis.
The end result of either cause is the food gets stuck and then the problems start.
explain what causes a GI obstruction
Blockages of the hollow space, or lumen, within the small and large intestines.
Bowel obstruction is either due to a mechanical blockage (adhesions, intussusception, tumour / faeces, hernia, volvulus) or due to other factors that affect the muscular wall of the bowel (myopathy) or the nerve supply to the bowel (neuropathy) which would affect its ability to perform peristalsis.
The end result of either cause is the food gets stuck and then the problems start.
why can a Gi obstruction be dangerous
- Bacteria in the gut will multiply when food gets stuck because of the extra nutrition available to them.
- They produce gas which accumulates in the bowel causing distension
- Pressure on the bowel wall reduces its blood supply
- Cells begin to die in the bowel wall and it can perforate causing peritonitis
- The bacteria can enter the blood and cause sepsis
- Fluids leak from the bowel causing hypotension
- Brain initiates vomiting to shift the blockage which adds to fluid loss and Hypotension
- Shock can result from sepsis and/or hypovolaemia = death
what is. ulcerative colitis
chronic inflammatory disorder that starts in the rectum and spreads proximally in a continuous manner effecting the mucosa manifesting in inflammation and ulceration with no segments of normal tissue
this leads to damage epithelial barrier leads to increased permeability due to the reduction and alteration of the surfactant and increases the permeability of the mucosa leading to the immue system mistaking good bacteria for bad causing an immune response leading to ulcerations.
what is a volvulus
• A volvulus is when a loop of intestine twists around itself resulting in a bowel obstruction
what is an abdominal hernia
- Abdominal hernia occurs when bowel passes through a weakening in the muscle wall that enclose the abdominal cavity.
- The intestine/bowel that bulges through the weak area may be at risk of ‘strangulation’ and become ischaemic
what is a intussusception
- Part of the intestine slides into an adjacent part of the intestine. This “telescoping” often causes obstruction.
- Can cut off the blood supply to the bowel (ischaemia)
- Can result in perforation or tissue death
what is bowel adhesions
common after surgery
bands of fibrous tissues form between the abdominal tissues causing them to stick together
how does a GI obstruction occur
sequestration of fluids and gas proximal to obstruction
dilation of bowel and abdominal distension
fluid shifts out of bowel into peritoneum
irritation occurs in the peritoneum
vascular shift into peritoneal cavity
hypovolaemia, dehydration, shock
what is the signs and symptoms for ulcerative colitis
Diarrhoea that can contain blood, mucus or pus Abdominal pain Need to empty bowels frequently Extreme fatigue Loss of appetite Weight loss
what are the factors that can play a role in who gets ulcerative colitis
Genes.You may inherit a gene from a parent that increases your chance.
Other immune disorders.If you have one type ofimmune disorder, your chance for developing a second is higher.
Environmental factors.Bacteria
what is the cause of ulcerative colitis
overactive immune system
what is ulcerative colitis
that theimmune system mistakes “friendly bacteria” in the colon, which aid digestion, as a harmful infection, leading to the colon and rectum becoming inflamed.
what are the complications of diverticulitis
If tears become large enough they can spill bowel consents into the abdominal lining leading to infection called peritonitis.
Bowel obstruction
what are the symptoms of diverticulitis
Normally unnoticeable Symptoms normally develop after the age of 40 and include… Diarrhoea Constipation Fever Chills Abdominal tenderness in illac fossa/ hypogastric regions (mainly in the left lower side of abdomen. Blood in stool Rectal bleeding Inflammation
what causes diverticulitis
by perforation of one of sacs in the sigmoid colon.
Mainly painful when stool can’t pass through the colon
what is diverticulitis
Diverticular disease is the general name for a common condition that involves small bulges or sacs called diverticula that form from the wall of the large intestine (colon).
where is diverticulitis found
Diverticulitis is mainly found in the sigmoid colon but can be present throughout the large and small bowel.
What’s the name for the movement of stuff along the digestive tract
Peristalsis
What is peristalsis
A series of wave like muscles contraction that moves food through the digestive tract
Where can you find Segmental mixing movement
Small intestine
What is intussuspetion
Part of the intestine slides inside itself causing an obstruction
What does intussusuption lead to
Can lead to iscemia and tissue death which can cause a perforation
What age is intussusception common in
Children below age 3
How can you tell if someone has intussusception
Still like red current jelly
What are the signs and symptoms of a bowel obstruction
Nausea and vomiting (bile and fractal vomit) Fever and tachycardia Loss of appetite and weight loss Abdominal pain Constipation Distended abdomen Diarrhoea Bloody stool
Why does a bowl obstruction lead to diarrhoea
Only the liquid with go around the blockage as the food the is being digested
Due to an overflow of fluids
Describe the appendix
Blind ended worm shaped tubed, about 9cm long. Attached to your cacum
What is your cacum
A pouch that form the first part of your large intestine
What is a appendicitis
Due to the appendix swelling
inflammation of the wall in the appendix.
What is the common age for a appendicitis
Males more common
Common in age 20-30
What causes a appendicitis
Blockage of the appendix
What is a Lymphoid hyperplasia
Buick growth and multiplication of the lymphoid cells
What causes a appendix
Lymphoid hyperplasia
Infection
Feacalities
Tumour
what causes an appendicicites
the tube connecting to the appendices can get twisted
what is the lymphoid hyperplasia
essential to the appendicitis, it is the quick growth or multiplication of normal lymphocytic cells that look like lymph tissues
Why does an infection in the appendix cause an appendicitis
The infection causes swelling in the appendix leading to a preferartion
What is a faecalities
Poo stones
Fractal matter gets compacted and as it’s passing through the cucem and breaks away and dropped in the appendix
What is the most common cause of a surgical emergency
Appendicitis
What’s the first sign and symptoms to a appendicitis
Vague epicanthic area
Can be described a cramping then overtime pain becomes more localised and moves to the right lower quadrant
What are the signs and symptoms of appendicitis
Flank tenderness Nausea and vomiting Diarrhoea Low grade fever (not above 39) Rebound tenderness
What is rosving sign
When you palpate left lower quadrant and they feel pain in the right lower quadrant
What are the atypical presentation of an appendicitis to consider
Appendic can move with pregnancy
Males can get testicular pain and urinary symptoms
Appendix may be in a different place due to developing differently
What is a grumbling appendix
A chronic appendicitis and isn’t a surgical emergency
They are also different in pain, pain gradually increased and is not a sudden onset of pain. It’s mild and occurs gradually
What organs are in the abdomen
Stomach Liver Kidneys Pancreas’s Small and large bowl Appendix Gall bladder Spleen
What are the three types of abdo pain
Visceral pain
Parietal / somatic pain
Referred pain
What is visceral pain
A vague, centralising pain which can be caused by inflammation
What is ingestion
The process of taking food or drink by swallowing or absorbing
What is peristalsis
The involuntary constriction and relaxation of muscles in the intestine
What is Digestion
Chemical and mechanical break down of food
What is absorption
The process by which one thing absorbs/state of being engrossed
What is Defecation
Discharge of feaces from the body
How long is the oesophagus
25cm Long
What part of the spine is the oesophagus parallel too
C6-t11 and passes through the diaphragm at t10
Has 3 narrowing points
Aortic arch
Left main bronchus
Diaphragm
What is Gastro-oesophageal reflux
Heart burn
How does Gastro-oesophageal reflux happen
- Relaxed lower oesophageal sphincter
- gastric contents enter oesophagus
- Irritation of mucosal lining
What can Gastro-oesophageal reflux lead too
Oesophagitis
Ulcerations
Barrett’s oesophagus
What is a Weiss tear
Accounts for 3-15% of all patients GI bleeds
It’s a tear of a tissue(mucous membrane) or lower oesophagus which leads to bleeding
Causes of a Weiss tear
Violent coughing, retching, vomiting or straining (common)
Healed hernia(rare)
Childbirth(rare)
Signs and symptoms of a Weiss tear
Vomiting of bright red or coffee ground blood Melena(stools with blood) Dysphasia(painful swallowing) Anemia Fatigue,dizziness,faintness Shortness of breath Chest pain or abdo pain
Diagnosis of a weiss tear
Signs and symptoms
Stool test
Upper GI endoscopy
What is a Hiatus hernia
A small part of the stomach moves up from a small opening in the diaphragm into the chest
Estimated 1/3 of people over 50 have a Hiatus hernia
Risk factors of a hiatus hernia
Age related factors- changes in diaphragm Pregnancy Obesity Exercising and heavy weight lifting Persistent and intense pressure on surrounding muscles Coughing Vomiting Straining
Types of hiatus hernia
Sliding hiatus hernia-moves up and down in and out of the chest
More then 80% of cases
Paracosophegeal hiatus hernia- oesophagus and stomach stay in the same location however part of the stomach pushes through the hole and ends up next to the oesophagus
Signs and symptoms of hiatus hernia
Heartburn Shortness of breath Regurgitation of food Burping and feeling bloated Feeling full when eating Nausea and vomiting Difficulty swallowing Vomiting blood Black stools
Treatment for Hiatus hernias
Life style changes
Changing eating habits
Stop smoking
Keyhole surgery
Diagnosis for hiatus hernia testing
X-ray and endoscopy
What is Mechanical digestion
Churning movement
What is Chemical digestion
Gastric juices
What is absorption
Very little absorption takes place in the stomach
Coverts the bolis to a semi liquid mass called chyme
What is the role of gastric mucosal barrier
- Luminal membrane impermeable to hydrochloric acid
- Tight junctions towards epithelial cells
- Mucas layer
What is a peptic ulcer
Can occur in oesophagus,stomach or duodenum
Weakness in gastric mucosal barrier
Gastritis
Pepsin and hydrochloric acid erode the stomach wall
90% are caused by acid resistant bacterial
What is Gastric mortality dysfunction
Paralysis of the stomach, fails to empty into the intestine
Causes of gastric mortality dysfunction
Diabetes
Neurological disorders such as MS
Connective tissue disorder
Post surgical complications
Signs and symptoms of gastric mortality dysfunction
Stomach/abdo pain Bloating Heartburn Nausea and vomiting Malnutrition Weight loss
Diagnosis of gastric mortality dysfunction
Gastric emptying study
Upper endoscopy
X-ray
Wireless motility capsules
gastric mortality dysfunction treatments
Dietary changes
Medication to increase motility
Symptom management medications
Surgery’s
How many lobes make up the Liver structure
Left lobe
Right lobe
Canidate lobe- behind right lobe
Quartlate lobe- behind left lobe
What is the liver functional unit called
Lobule
What does each hexagonal liver lobe contain in its structures
Hepatic artery branch
Hepatic portal vein branch
Bile duct branch
What is the functions of the liver
Breakdown of old erythrocytes Iron storage Protection of bile Removal of bacteria by kipffer cells Synthetics of clotting fibres Lipid metabolism Carbs storage Detoxification
Blood supply to the liver
Blood enters through the hepatic vein(carry’s oxygen and supports liver growth)
Blood also enters through the portal vein( this carrier blood and nutrientes from the intestine and deliver them to the liver cells (hepatocytes) which performs specific liver functions
How does blood leave the liver
The blood leaves through the hepatic vein, bile from the liver transferred to the gall bladder and duodenum through the bile duct
What shape are the lobiles
Hexagonal
What is Jaundice
Elevated levels of bilirubin in plasma
It is deposited in tissues causing discolouration
Causes of jaundice
Pre hepatic
Hepatic
Post hepatic
Hepatic jaundice
Due to liver tissue damage
Unable to deal with Normal levels of bilirubin
Possible causes of jaundice
Viral hepatitis- mild/severe damage to hepatic cells
Toxic hepatis-abuse over exposure of drugs or Alcohol
Cirrhosis-permanent damage to liver cells which replaced by fibrosis tissues
Gallstone process
Bile leaves the liver via the common hepatic duct which fuses with the cystic duct from the gallbladder
Secreted pancreatic enzymes into small intestine(amalyse,protease,liapase)
What is Gastritis
Sudden inflammation of the stomach lining
Pathphyisiology of gastritis
Disruption to protective mechanism of the stomach—>leads to epiphilium, cells in direct contact with substances i stomach eg acids—>inflammation occurs(attracting white blood cells)—>if damage is severe it can cause erosion damage—>permanent damage to protective mechanisms
Causes of gastritis
Infection
Alcohol
Smoking
Food allergies
Signs and symptoms of gastritis
Burning sensation
Epigastric pain
Nausea and vomiting
Bloating and bleaching
Complications: can lead to a GI bleed
Diagnosis:endoscope and stool samples
