Gastrointestinal Flashcards
Abdominal pain - Epigastric region conditions
Heartburn/indigestion
Pancreatitis
Stomach ulcer
Epigastric hernia
Abdominal pain - Umbilical region conditions
Pancreatitis
Stomach ulcer
Inflammatory bowel
Umbilical hernia
Abdominal pain - Hypogastric region conditions
Urine infection
Diverticular disease
Pelvic pain (gynae)
Abdominal pain - Right hypochondrium region conditions
Gall stones
Abdominal pain - Right flank region conditions
Kidney stones
Abdominal pain - Right iliac region conditions
Appendicitis Groin pain (inguinal hernia) Pelvic pain (gynae)
Abdominal pain - Left hypochondrium region conditions
Stomach ulcer
Duodenal ulcer
Abdominal pain - Left flank region conditions
Kidney stones
Abdominal pain - Left iliac region conditions
Pelvic pain (gynae) Groin pain (inguinal hernia)
Gastro-oesophageal reflux disease (GORD) - Pathophysiology
Lower oesophageal sphincter relaxes independently of a swallow, leading to reflux of gastric acid, bile and duodenal contents back into oesophagus
Gastro-oesophageal reflux disease (GORD) - Risk factors
Increased abdo pressure (pregnancy)
Obesity
Smoking
Hiatus hernia
Gastro-oesophageal reflux disease (GORD) - Symptoms
Heartburn
Acidic taste in mouth
Gastro-oesophageal reflux disease (GORD) - Management
Oral antacids - Gaviscon
PPI - Lansoprazole (inhibit gastric hydrogen release, preventing gastric acid production)
Gastro-oesophageal reflux disease (GORD) - Complication
Barret’s oesophagus (oesophageal epithelia changes from squamous to columnar)
Peptic ulcers - Pathophysiology
A break in epithelium which penetrates down to the mucosa
Peptic ulcers - 2 Types
Duodenal ulcer
Gastric ulcer
Peptic ulcers - Causes
Helicobacter pylori
NSAID use
Peptic ulcers - Investigation
Urea breath test
Serology
Stool antigen test
Peptic ulcers - Treatment
PPI (Lansoprazole)
2 Antibiotics - Metronidazole and clarithromycin
Coeliac disease - Pathophysiology
T helper cells release inflammatory cytokines and stimulate B cells, causing gut damage
Coeliac disease - Investigation
Duodenal biopsy Blood test (IgA-tTG)
Coeliac disease - Symptoms
Bloating
Diarrhoea
Dermatitis herpetiformis
Malabsorption - Causes
Poor intake Lack of digestive enzymes Defective epithelial transport Reduced surface area Poor intraluminal digestion
Malabsorption - Symptoms
Weight loss
Anaemia
Steatorrhoea (excess fat in faeces)
Crohn’s disease - Pathophysiology
Transmural, granulomatous inflammation affecting any part of the gut
Macroscopic - thickened and narrowed
Microscopic - Granulomas, goblet cells
Crohn’s disease - Signs and symptoms
Signs - Mouth ulcers, tenderness in RLQ
Symptoms - Diarrhoea, RLQ abdo pain, weight loss
Crohn’s disease - Risk factors
Smoking
Chronic stress
Crohn’s disease - Investigations
Colonoscopy
Stool sample (to rule out infectious causes)
FBC - Raised ESR/CRP (inflammation), low Hb (anaemia)
Crohn’s disease - Management
Oral corticosteroids
Infliximab (Anti-TNF antibodies)
Methotrexate
IV hydrocortisone (severe flare ups)
Ulcerative colitis - Pathophysiology
Inflammatory condition of colon mucosa
Macroscopic - Continuous inflammation, ulcers
Microscopic - Mucosal inflammation, no granulomata, depleted goblet cells
Ulcerative colitis - Signs and symptoms
Signs - Fever
Symptoms - LLQ pain, bloody diarrhoea with mucus
Ulcerative colitis - Investigations
FBC - Raised ESR/CRP
Stool sample to rule our infectious diseases
Ulcerative colitis - Management
Prednisolone
Colectomy (severe UC)
Differences between crohn’s and UC
Crohn’s - Anywhere in gut, skip lesions, granulomas, goblet cells, transmural (all layers), cobblestone appearance
UC - Only colon affected, no skip lesions, no granulomas, goblet cells depleted, mucosa only layer affected, no cobblestone appearance
Irritable bowel syndrome - Pathophysiology
Group of abdominal symptoms without any causes
Irritable bowel syndrome - Risk factors
Female>male
Stress
Irritable bowel syndrome - Symptoms
Abdo pain relieved by defecating
Bloating
Alternating bowel habits
Irritable bowel syndrome - Management
Buscopan (pain)
Senna - laxative (constipation)
Loperamide - anti-motility (diarrhoea)
Infective diarrhoea - Risk factors
Foreign travel
Poor hygiene
new/different foods
Infective diarrhoea - Causes
Viral - Rotavirus (children), norovirus, adenovirus
Bacterial - E.coli, salmonella, shigella, campylobacter jejuni
Parasites
Clostridium difficile
Infective diarrhoea - Symptoms
Blood in diarrhoea Vomiting Fever Fatigue Headache Muscle pains
Infective diarrhoea - Investigation
Stool sample (culture) Sigmoidosopy Blood sample
Infective diarrhoea - Treatment
Rehydration
Antibiotics
Loperamide (ant-motility)
Antiemetics
Intestinal obstruction - Lumen causes
Tumours
Gallstone
Intestinal obstruction - Wall causes
Tumours
Crohn’s
Intestinal obstruction - Outside
Tumours (peritoneal)
Adhesions (fibrosis after surgery)
Mesentery
Hernia - Pathophysiology
A protrusion of organ/tissue out of the body cavity that it normally lies
Hernia - Causes
Muscle weakness (age, trauma) Body strain (heavy lifting, pregnancy, chronic cough)
Inguinal hernia - Pathophysiology
Protrusion of abdominal cavity contents through the inguinal canal
Inguinal hernia - 2 Types
Direct - Protrudes directly into inguinal canal, medial to inferior epigastric vessels
Indirect - Protrudes through the internal inguinal ring, Lateral to inferior epigastric vessels
Hiatus hernia - Pathophysiology
Part of stomach herniates through the oesophageal hiatus of the diaphragm
Hiatus hernia - 2 Types
Sliding - Oesophageal-gastric junction slides through the hiatus and lies above the diaphragm (reflux symptoms present)
Para-oesophageal - Gastric fundus rolls up through hiatus alongside oesophagus (treated via surgery)
Appendicitis - Pathophysiology
1) Gut flora multiplies (E.coli) in appendix
2) Increased pressure
3) Inflammation
Appendicitis - Symptoms
Acute pain (umbilicus to RIF)
Nausea/vomiting
Fever
Appendicitis - Treatment
Appendicectomy
Peritonitis - Pathophysiology
Inflammation of peritoneum due to entry of blood, air, bacteria or GI contents (faeces/bile)
Peritonitis - Symptoms
Dull pain that becomes sharp
Pain worse on coughing/moving
Peritonitis - Causes
Appendicitis Ectopic pregnancy TB infection Obstruction Ulcer
Peritonitis - Investigations
Abdo exam AXR - Dilated bowel Bloods - FBCs, U&Es, LFTs, clotting Ascitic tap - Raised neutrophils Low BP (Sepsis)
Pancreatitis - Pathophysiology
Pancreatic enzymes destroy pancreas and nearby blood vessels
Pancreatitis - Signs and symptoms
Signs - Tachycardia
Symptoms - Nausea/vomiting, epigastric pain radiating to back (relieved by sitting forwards), cullens/grey turner’s (bruising around umbilicus and flank)
Pancreatitis - Causes
Idiopathic Gall stones Alcohol Trauma Malignancy Autoimmune Scorpion stings
Pancreatitis - Investigations
Bloods - Raised amylase and lipase
AXR
CT abdo
Pancreatitis - Treatment
IV fluids (maintain electrolyte balance) Analgesic
Ischaemic colitis - Pathophysiology
Low flow in inferior mesenteric artery
Ischaemic colitis - Symptoms
LLQ pain
Bloody diarrhoea
Ischaemic colitis - Investigation
Colonoscopy
Acute mesenteric ischaemia - Pathophysiology
Low flow in superior mesenteric artery
Acute mesenteric ischaemia - Symptoms
Acute severe abdo pain
Acute mesenteric ischaemia - Investigation
Laparotomy
Acute mesenteric ischaemia - Treatment
Surgery to remove dead bowel
Fluid resus
Antibiotics