Gastrointestinal Flashcards
what can cause GORD
poor lower oesophageal sphincter
increased pressure in stomach with reduced clearing
hiatus hernia
what might be complication of GORD
barrett’s oesophagus - metaplasia of the epithelial lining of stomach, to withstand acid, pre-neoplastic
what medications may patients with GORD be on
proton pump inhibitors - prevent production of acid by pp in parietal cells - omeprazole
antacid - convert acid to salt - rennies
H2 receptor agonist - rinitidine
what are the different types of mouth ulcers
minor aphthae, major aphthae or herpetiform aphthae
what is orofacial granulomatos
when macrophages engulf cells but cannot break them down, forms giant multi-nucleated cells. these then block the lymphatic ducts and prevent drainage. granuloma production with giant cells and fluid
what is a hiatus hernia
when part of the stomach herniates - either into oesophagus (sliding) or as a separate thing (rolling). severe GORD can be seen in sliding as every time the diaphragm contracts, the stomach and acid goes into the oesophagus
what is peptic ulcer disease
ulceration of lining caused by perforation by stomach acid
what causes peptic ulcer disease
over production of acid - acid into small intestine where the lining cannot withstand
normal production but not normal mucous production, so the stomach lining is not protected
helicobacter pylori - bacteria that causes inflammation of lining at pylorus at stomach. chronic inflammation can result in lymphoma
what complications can occur with peptic ulcers
can perforate through lining, right through to muscle and eventually cause a complete perforation into peritoneum, may get haemorrage or peritonitis.
what are signs and symptoms of peptic ulcer disease
normally none until it has perforated through
what investigations can be done into peptic ulcer disease
endoscopy, blood test for anaemia if bleeding, can check for antibodies to h pylori
how can peptic ulcer disease be treated
if reversible - medication such as PPI, antacid but if perforated may need surgery
what are possible causes for inflammatory bowel disease
psychological - stress and anxiety
immune system - over reaction to non threatening things
genetic
what are the differences between crohns disease and ulcerative colitis
crohns disease - can affect anywhere in tract, discontinuous, transmural (the whole way through), granulo formation cobble stone appearance, non vascular
UC - vascular appearance, mucosal ulcers, serosa not involved, continuous disease
what investigations can be done for IBD
faeces - calprotectin suggest inflammation
for a child - measuring their growth, make sure it isnt halted by malnutrition. blood test for anaemia markers, barium studies and endoscopy
what treatment is available for IBD
steroids if an immune reaction but not good long term
anti-tnf - directly attack, can get surgery to remove part for bowel but may result in stoma bag which has social implications
if a patient is presenting with recurrent oral ulcers what might you suspect
anaemia - may be due to malabsorption and inflammatory bowel disease
what can malabsorption result in
weight loss, diarrhoea, sterrohea, pernicious anaemia
what is the aetiology of coeliac disease
sensitivity to alpha gliaden which is in gluten. causes immune system to produce cytokines and attack villi, resulting in villous atrophy and an inability for absorption
what investigations can be done for coeliac disease
blood test for haemantics, endoscopy with biopsy, can be done before and after period with no gluten to check for improvement, faeces to check for fat in stool
describe the screening tool used for colon cancer
every person over the age of 50 sends a faecal sample in the post, its then check for blood, if none detected, nothing for the next 5 years. polyps cause bleeding and can turn neoplastic within 5 years
what is a polyp
a growth on the mucosal lining, as food passes through, it is irritated and can cause the mucosa to bleed, if left, likely to turn into malignant cancer, but can be removed easily
what can increase the likelihood of polyps
ulcerative colitis, smoking, low fibre high fat diet,
what is jaundice
excess unconjugated billirubin deposited on skin
what is billirubin
product of breakdown of RBC, especially haem group
how are RBC broken down
broken down by bone marrow to produce unconjugated billirubin. this then goes to liver where it can be conjugated for excretion from kidneys or git
what are the 3 ways jaundice can occur and give examples of when this would happen
pre-hepatic - build up of rbc breakdown, too many RBC, mismatch blood transfusion or maternal blood in fetus
hepatic - problem with hepatocytes conjugating bilirubin, cirrhosis
post-hepatic - blockage in bile duct, preventing bilirubin being cleared, backs up into vein - gall stones
how can the colour of urine or faeces tell what type of jaundice it is
if urine is normal colour - conjugated bilirubin into blood to get to kidney - pre or post but not hepatic
if faeces is normal colour - conjugated bilirubin into GIT, cannot be hepatic or post, must be pre
how can jaundice be treated
light therapy in neonate, but not much can do other than let it pass. ursodeoxycholic acid can be used to prevent build up of bile acid in post
what is acute cholecysitis
inflammation of bile ducts due to blockage from a gall stone
how can bile ducts be investigated
ultrasound to check dilation
endoscopy retrograde cholangiopancreatography, done through to small intestine then up through bile duct to check for blockage - can put in stent while there to open up but if cancer - need more treatment
how can gall stones be treated
lithotripsy - breaking up with sound waves then vaccuming up or removal of gall bladder
what are the types of liver failure
acute - sudden damage to liver with alcohol or drugs
chronic - constant damage to liver, as it tries to repair, lays down fibrotic tissue, any hepatocytes produced, dont link to bile ducts
what causes cirrhosis
alcohol, drugs, primary biliary sclerosis, infection
what are the functions of liver
metabolic - metabolise drugs, toxins, RBC
synthetic - synthesis clotting factors and plasma proteins
what are some signs and symptoms of liver failure
ascites - build up of pulmonary pressure in abdomen due to reduced drainage in liver, also not producing plasma proteins so lower oncotic pressure, results in oedema in abdomen
oesophageal varices - pressure through to oesophagus, cause dilation can rupture
what tests can be done to check liver function
should be doing what it is - INR check production of clotting factors
who are more at risk of C diff infections
those on antibiotics - clears good bacteria, these normally protect and prevent others from colonising
those immunosuppressed
how is norovirus transmitted
oro-faecal route
what are symptoms of norovirus
fever, abdominal pain, diarrhoea, vomitting
how is norovirus treated
electrolyte and water rebalance, can be done at home
describe c diff bacteria
anaerobic gram positive bacilli producing spores that are resillient in the environment - can last up to 5 months
how does c diff spread
healthcare workers - faecal to oral, contaminating surfaces
what are symptoms of c diff
fever, nausea, loose stool
what are treatments of c diff
antibiotics, probiotics, faecal transplant, rehydration
