Gastrointestinal Flashcards
Digestive Processes
Ingestion
Peristalsis
Digestion (chemical and mechanical)
Absorption
Defecation
How long is the oesophagus
25cm long tube
Oesophagus has 3 narrowing at the point of ?
Aortic arch
Left main bronchus
Diaphragm
The oesophagus passes through C6 - T11. It passes through the diaphragm at
T10
In Gastro-oesophageal reflux, irritation of mucosal lining leads to:
• oesophagitis
• Strictures of ulceration
• Barrett’s oesophagus
Mallory-Weiss Tear accounts for what percentage of GIbleeds?
3% - 15% of patients
What is Mallory-Weiss Tear?
A tear of the tissue (mucous membrane) of the lower oesophagus which leads to bleeding
What are the causes of Mallory-Weiss Tear?
• Violent coughing, retching, vomiting and/or straining (common cause)
• Hiatal hernia (rare)
• Childbirth (rare)
Signs and symptoms of Mallory-Weiss Tear
• Haematoemesis vomiting or bright red or coffee grounds blood
• Melaena (stool with blood)
• dysphasia/odynophagia
• Anaemia
• Fatigue, dizziness and fainting
• shortness of breath
• Abdominal or chest pain
Diagnosis or Mallory-Weiss Tear
• sign and symptoms
• stool test
• upper GI endoscopy
Treatment of Mallory-Weiss Tear
• self limiting in 80-90% of cases (stop bleeding and heal on its own)
• injection or a heat treatment to stop bleeding
• surgical repair (rare)
What is a Hiatus Hernia
Part of the stomach moves up through a small opening (hiatus) in the diaphragm into the chest
How many people and age range are diagnosed with hiatus hernia
1 out of 3 people over the age of 50
Risk factors for Hiatus Hernia
• age related changes in diaphragm (over 50)
• pregnancy
• obesity
• exercising and heavy weight lifting
• severe coughing
• severe Vomiting
• straining during bowel movements
Types of Hiatus Hernia
• sliding hiatus hernia (moves up and down, in and out of the chest)
• parapesophageal hiatus hernia
Signs and symptoms of Hiatus Hernia
• heartburn
• shortness of breath
• regurgitation of food or liquid into mouth
• burping and feel bloated
• feeling full soon after eating
• nausea and vomiting
• dysphagia
• vomiting of blood or passing of black stool
Treatment of Hiatus Hernia
• lifestyle changes: eating habits, avoid laying down at least 3 hours after eating or drinking, stop smoking
• treating heartburn symptoms
• keyhole surgery (laparoscopy)
Diagnosis of Hiatus Hernia
• X-ray
•Endoscopy
Functions of the stomach
• Mechanical digestion
• Chemical digestion
• Absorption
Components of gastric juice (chemical digestion)
• hydrochloric acid
• pepsin
• mucus
• intrinsic factor
• gastrin hormone
Name salivary glands
Parotid
Sublingual
Submanibular
Where does chemical digestion start
In the mouth- amylase
Role of Hydrochloric acid in digestion
Antibacterial, and converts pepsinogen to pepsin
What enzyme breaks down proteins in the stomach
Pepsin
Role of intrinsic factor
Absorption of B12
Define Achlorhydria
Reduction of production of Hydrochloric acid
Location of Peptic Ulcers
Oesophagus
Stomach
Duodenum
Causes of peptic ulcer
Weakness in gastric mucosal barrier
Gastritis
Helicobacter Pylori (H-Pylori) bacterial infection
NSAIDs use
Pathophysiology of NSAID-induced Ulcers
NSAIDs inhibit COX-1 enzyme,
Resultant reduction of prostaglandin production- responsible for mucus and bicarbonate production in stomach
Define Gastroparesis
Paralysis of the stomach- failure to empty stomach contents into the intestine
Causes of Gastroparesis
Diabetes
Neurological disorders- MS, Parkinson’s
Connective Tissue Disorders
Post Surgical complications
Signs and symptoms of Gastroparesis
Abdominal pain
Bloating
Heartburn
Nausea and vomiting
Feeling full quickly
Malnourishment
Dehydration
Weight loss
Fatigue
Diagnosis of Gastroparesis
Gastric Emptying Study
Upper Endoscopy
Barium X-rays
Wireless motility capsules
How many liver lobes
4
Names of the liver lobes
Left Lobe
Right Lobe
Caudate
Quadrate
Functions of the Liver
Breakdown old RBC
Iron Storage
Production of Bile
Removal of bacteria by Kupffer cells
Production of clotting factors
Lipid metabolism
Carbohydrate storage
Storage of fat soluble vitamins
Metabolic detoxification
What is Jaundice
Elevated levels of plasma bilirubin
Causes of hepatic jaundice
Viral hepatitis
Toxic Hepatitis- drugs, alcoholtoxins
Cirrhosis
Complication of portal vein hypertension
Oesophageal varices
Define Ascites
Presence of fluid within peritoneal cavity
Define Cholelithiasis
Gall stones due to supersaturation of bile with cholesterol
Symptoms of cholelithiasis
Pain in upper right quadrant of abdomen after eating fatty food
Referred pain in right shoulder blade
Fever and chills
Tachycardia
Tachypnoea
Jaundice
Itchy skin
Loss of appetite
Treatment of cholelithiasis (Gallstones)
Medications
Endoscopic Retrograde Cholangio-pancreatography (ERCP)
Surgical gallbladder removal
Enzymes secreted by the pancreas
Amylase
Proteases
Lipase
Organs of the Right upper quadrant
Liver
Gall bladder
Colon
R kidney
Pancreas
Organs of the Left Upper Quadrant
Stomach
Spleen
Colon
L Kidney
Pancreas
Organs of the Right Lower Quadrant
Appendix
Colon
Bladder
(Ovaries)
Organs of the Left Lower Quadrant
Colon
(Ovaries)
Causes of abdominal pain: Right Hypochondriac Region
Costochondritis
Cholelithiasis
Gall bladder infection
Muscular
Hepatitis
Kidney Stone
Pneumonia
Causes of Pain: Epigastric Region
Acid Reflux
Heartburn
Heart attack
Gastritis
Stomach Ulcer
Duodenal Ulcer
Pancreatitis
Epigastric Hernia
Causes of Pain: Left Hypochondriac region
Pneumonia
Costochondritis
Spleen infection
Splenomegaly
Hepatitis
Kidney Stone
Constipation
Wind
Location of pain from cholecystitis
Right upper quadrant
Symptoms of IBS
Abdo pain that is relieved after opening bowels
Spider Naevi indicates
Chronic liver disease
How much kidney function loss is classed as chronic kidney failure
75% +
Disorders of the pancreas
Pancreatitis
Carcinoma of the pancreas
Tumours of the islets
What is appendicitis
• Appendix swelling.
• Mucosal secretions increase intraluminal pressure.
• Pressure exceeds capillary perfusion, causing venous and lymphatic obstruction
How does the appendix get blocked
• lymphoid hyperplasia
• infections (parasitic)
• faecaliths
• tumours
Symptoms of appendicitis
• vague epigastric pain (first symptom)
• pain becomes more localised and moves to right lower quadrant
• flank tenderness
• nausea, vomiting and diarrhoea
• low-grade fever
Types of bowel obstruction
• hernia
• adhesions
• intussusception
• volvulus
• bowel cancer
Bowel obstruction symptoms:
• nausea and vomiting, bile/faecal vomit
• fever
• tachycardia
• weight loss/loss of appetite
• abdominal pain
• constipation or diarrhoea
• distended abdomen
• bloody stools
• may be haemodynamically unstable
