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RAD415 PT2 > gastrointestinal pathology > Flashcards

gastrointestinal pathology Flashcards

1
Q

what is peptic ulcer disease

A
  • upper abdominal (epigastric) pain
  • characterized by discontinuation in the inner lining of the gastrointestinal (GI) tract because of gastric acid secretion or pepsin
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2
Q

what are 3 signs that one could have peptic ulcer disease

A
  • haematemesis
  • melaena
  • iron deficiency anemia
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3
Q

what is haematemesis

A

vomiting blood

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4
Q

what is malaena

A

black stools from digested blood

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5
Q

what is gastritis

A

inflammation of the lining of the stomach

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6
Q

what are some symptoms of gastritis

A
  • heaviness
  • pain
  • heartburn
  • nausea and vomiting
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7
Q

what are bacteria causes peptic ulcer disease

A
  • Helicobacter pylori
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8
Q

what are non pathological causes of peptic ulcer disease

A
  • stress
  • alcohol
  • meds such as NSAIDS, corticosteroids
  • bad eating habits
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9
Q

because peptic ulcer disease can be caused by H.pylori, what does this mean about its treatment

A
  • you can use antibiotics to treat it as it is a bacteria residing in the stomach
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10
Q

despite strong acidity in stomach, how is H pylori able to survive in the stomach

A
  • colonisation in gastric mucus
  • creating alkaline ammonia from urea
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11
Q

what scan can be used to identify peptic ulcer disease when red flags are raised

A

oesophagogastroduodenoscopy

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12
Q

when might you start to suspect cancer from suspected peptic ulcer disease

A
  • unexplained IDA
  • weight loss
  • epigastric mass
  • blood loss
  • dysphagia
  • persistent vomiting
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13
Q

what are the conservative and medical treatments for peptic ulcer disease

A

conservative = lifestyle changes, removing contributing meds

medical = proton pump inhibitor, antibiotics if h.pylori is the cuase

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14
Q

how would proton pump inhibitors help treat peptic ulcer disease

A

by reducing the amount of acid your stomach produces, preventing further damage to the ulcer as it heals naturally.

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15
Q

peptic ulcer disease can cause barretts oesophagus, what is this

A

turning columnar to squamous epithelia in oesophagus (increases risk of cancer)

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16
Q

why are squamous cells more prone to developing cancer than others e.g columnar

A
  • mutations occur in squamous cells and likely lead to overdevelopment of them = tumour
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17
Q

how would peptic ulcer disease lead to IDA

A
  • causes upper GI bleed
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18
Q

peptic ulcer could cause a perforated oesophagus if theres continuous vomiting, what is this known as

A

boerhaaves syndrome

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19
Q

as a result of boerhaaves syndrome, what can this lead to

A

pneumomediastium

  • air in the mediastinum
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20
Q

what is appendicitis/what causes it

A
  • inflammation of appendix
  • caused obstruction of appendix lumen by faecolith ( a mass of an accumulation of hardened fecal matter)
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21
Q

how might appendicitis become deathly

A
  • obstruction causes increased intraluminal pressure
  • liminal diameter rises and appendices wall stretches
  • perforation/burst can occur leaking faecal contents into peritoneal space and causes spesis
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22
Q

what area is appendicitis pain usually felt after progression

A

right iliac fossa

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23
Q

where is appendicitis pain felt in the beginning before progression and why

A
  • in central abdomen as visceral peritoneum is inflamed and the brain interporates visceral stimuli from midgut coming from here
  • known as ‘ referred pain ‘
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24
Q

what are the 5 different positions the appendix can be found

A
  • retrocecal (most common)
  • postileal
  • preileal
  • subsecal
  • pelvis
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25
what might appendicitis look like on imaging
- widened appendix lumen (over 6mm) - increased thickness of appendices wall (thin if prerupture) - appendices fat stranding - faecolith visible
26
as the appendix is harder to be seen on pregnant women using ultrasoun, what is the preferred imaging modality
MRI
27
what is diagnostic laparoscopy
Diagnostic laparoscopy (keyhole surgery) is a procedure that allows a doctor to look directly at the contents of the abdomen or pelvis.
28
what must be done to the abdomen before insertion of laparoscope
- ensure the abdomen is gas filled
29
what is the main treatment for appendicitis
appendicectomy
30
what are the 2 types of inflammatory bowel disease
- crohns disease - ulcerative colitis
31
what is the difference between crohns and ulcerative colitis
crohns = transmural inflammation that can occur anywhere in GI tract ulcerative colitis = superficial inflammation limited to colon
32
what are some symptoms of ibd
- bloody diarrhoea - increased still frequency - colicky abdominal pain - tenesmus - joint pains - fever - weight loss - skin lesions
33
what is tenesmus
- feeling of incomplete emptying after defecation
34
what is the most common way of diagnosing IBD
- Biopsy via endoscopy
35
what is the radiographic sign of crohns / ibd
fat halo sign thumbrinting penematosis intestinalis
36
what is penematosis intestinalis
air in bowel wall
37
what are the main treatments for IBD
- corticosteroids - immunosuppression - biological agents (e.g monoclonal antibodies) - colectomy
38
as a result of ibd, it can cause toxic megacolon, what is this
extreme inflammation and distention of the colon - colonic diameter over 6cm or - caecal diameter over 9cm
39
IBD can lead to stoma formation, what is this
- removed of some parts of the bowel (commonly the colon) - requires ileostomy (ileum connected to the skin)
40
what is the increased risk for patients who have stomas
parastomal hernias
41
what is a fistula
abnormal connection between 2 epithelial lined organs
42
what is a common fistula caused due to IBD
perianal fistula
43
what might you spot on double contrast barium enema to identify IBD
- ulcers - pseuopolyps - thickened haustra or lack of haustra (pouches not he bowel)
44
why would you not give double contrast barium enema to a patient with acute severe disease
increased risk of perfortation
45
someone with IBD can have reduced vitamin d, this along with prescription of corticosteroids can affect the bones in what way
- causing increased risk of osteoporosis (decrease density of bones, more fragile)
46
increased inflammation and turnover of gut lining increases risk of bowel cancer
47
what are common causes of small bowel obstruction
- adhesion (small bowel sticking to itself) - hernias - ibd - carcinoid
48
dilated loops of the small bowel can be identified as small bowel obstruction, what is the size range to be classified as such
- over 2.5-3cm
49
what does small bowel obstruction look like on abdominal x ray
- central location of valvulae conniventes (stacked pennies look) - dilated loops
50
what is the treatment used for small bowel obstruction
- drip and suck - drip = IV fluids to replace losses - suck = nasogastric tube to decompress faecal contents in stomach
51
what are the common symptoms of large bowel obstruction
- colicky lower abdominal pain - lack of passing flatus (gas) - abdominal distension - potentially nausea and vomiting
52
what are main causes of large bowel obstruction
- colonic carcinoma - volvulus - ischaemic stricture - faecal impaction - hernia (uncommon)
53
what is the main sign of large bowel obstruction on a radiograph
- increased gas proximal to obstruction - little to no gas post obstruction - enlarged bowel
54
symptoms of colonic carcinoma differ depending on if it is found on the left or right side of the colon, give the differences
left sided = - change in bowel habit - colicky pain - PR bleeding - obstruction right sided = - weight loss - anamia - mass in abdomen
55
what screening is done to check for large bowel obstruction
faecal occult blood test
56
according to NICE 2WW referral criteria, what are the symptoms for age groups that require doctor to check for colonic cancer
age 40+ = unexplained weight loss and abdominal pain age 50+ = unexplained rectal bleeding age 60+ = iron deficiency or changes in bowel habit
57
what imaging is done to identify suspected colonic carcinoma
- colonoscopy
58
what is the TNM classification of cancer
- tumour (layer of invasion) - nodes (involvement of local lymph nodes) - mets (distant metastases)
59
what is a bowel resection
- surgery to remove part of bowel different types = - right/left hemicolectomy - ap resection - high anterior resection - low anterior resection
60
what is a volvulus
occurs when a loop of intestine twists around itself and the mesentery that supports it, causing bowel obstruction.
61
what are symptoms of volvulus
- lack of flatus - abdominal pain - vomiting in severe disease
62
what can be seen on exam as a result of volvulus
- abdominal distension - hyperactive bowel sounds - tinkling bowel sounds
63
what is a typical structural sighting of volvulus on a radiograph
- coffee bean
64
what is the difference between treatment of a sigmoid and caecal volvulus
sigmoid = flatus tube and maybe surgery if reoccurent caecal = surgery
65

RAD415 PT2 (14 decks)

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