GI Flashcards
What is an inflammatory bowel disease?
Inflammatory Bowel Disease: Autoimmune-mediated intestinal inflammation primarily due to either Crohn’s disease or ulcerative colitis.
What are the 2 types of inflammatory bowel disease
- Crohn’s
- Ulcerative colitis
Risk Factors for IBD
Signs and symtpoms for IBD
Differential diagnosis for IBD
Investigations for IBD
Pathology for IBD
Management of IBD
Complications and Prognosis of IBD
What is irritable bowel syndrome
Functional Disorder where there is recurrent abdominal pain + abnormal bowel motility causing constipation and/or diarrhoea
Symptoms of Irritable Bowel Syndrome
Abdominal pain, Bloating and Change in bowel habit are classic features of irritable bowel syndrome
Risk Factors for IBS
Differential diagnosis of IBS
Coeliac Disease
Lactose Intolerance
Inflammatory Bowel Disease - Crohn’s Disease or Ulcerative Collitis
Infective Colitis
Lymphocytic Collagenous Colitis
Colon cancer
Drug effects (e.g. Proton Pump Inhibitors, NSAIDS, metformin)
Choledocholithiasis
Investigations for IBS
Pathophysiology of IBS
The pathophysiology of IBS is unclear. There are no specific anatomical, endoscopic, microbiological or histological findings that indicate a clear pathophysiology.
According to current understanding, IBS arises due to multiple factors that contribute to alteration of:
The Brain-gut axis: Bidirectional communication between the brain and the GIT. Involves the ANS, the neuroendocrine system and neuroimmune pathways
Gut sensitivity: Sensation of the GIT.
Gut reactivity: Mobility and secretion of the GIT.
Psychological functioning
Treatment for IBS
Only a fraction of patients with IBS-like symptoms (∼50%) seek medical care
Education and reassurance
Dietary alterations
Pharmacotherapy
Behavioural and psychological therapy
What is coeliac disease
Inflammatory process which occurs in susceptible individuals in response to ingestion of wheat protein (gluten-gliaden)
Small Intestine: Anatomy and Physiology
-
Risk Factor for coeliac disease
Family history
IgA deficiency
Type 1 diabetes
Autoimmune diseases - autoimmune thyroid, Sjogren’s syndrome, Addison’s disease
Inflammatory Bowel disease
Genetic disorder - Down’s syndrome, Turners syndrome
Clinical Presentation of coeliac disease
A 30-year-old woman presents with foul smelling oily diarrhoea, abdominal bloating, fatigue and weight loss. On examination she has papulovesicular lesions on the extensor aspects of her arms - coeliac disease
Splenic atrophy may occur in coeliac disease together with the appearance of Howell-Jolly bodies in erythrocytes
Differential diagnosis for coeliac disease
Childhood other food-sensitive enteropathies (milk sensitivity)
Adults
Lymphoma
Whipple’s disease
Crohn’s Disease
Giardiasis
Irritable Bowel Syndrome
Investigations for coeliac disease
Gold Standard: Endoscopy
Management for coeliac disease
Management is ongoing
Gluten Free diet
Calcium Supplements
Iron Supplements
Vitamins
Coeliac Crisis Management:
Rehydration
Electrolytes
Corticosteroids
Pathology of coeliac disease
Complications of coeliac disease
Coeliac disease is most associated with osteomalacia, osteporosis, small bowel lymphoma, lactose intolerance
What type of HLA allele is most associated coeliac disease?
HLA-DQ2/DQ8
What is gastritis
Inflammation of the stomach lining that’s associated with mucosal injury.
isk Factors for Gastritis
H. Pylori infection
Alcohol
NSAIDs use
Previous gastric surgery
Autoimmune disease
Causes of gastritis
Caused by things that cause inflammation to stomach e.g -
H.Pylori - lives in gastric mucus
Autoimmune gastritis
Viruses e.g. CMV and HSV
Duodenogastric reflux
Crohn’s disease
Mucosal ischaemia
↑ Stomach acid
Aspirin and NSAIDs
Alcohol
Pathophysiology of Gastritis
Clinical manifestations for Gastritis
Key presentations: Epigastric pain, Recurrent upset stomach
Signs: Abdominal bloating, Haematemesis
Symptoms: Loss of appetite, Vomiting, Indigestion, Nausea
Investigations of gastritis
Differential Diagnosis of gastritis
Peptic Ulcer disease
GORD
Non-ulcer dyspepsia
Gastric lymphoma
Gastric carcinoma
Treatment for Gastritis
Complications gastrits
Achloridya
B12 deficiency
Peptic Ulcer disease
What is GORD
Gastric Oesphageal Reflux Disease
What are symptoms of GORD caused by?
backflow of gastric acid and other gastric contents into oesphagus due to incompetent barriers at the gastroesophageal junction
Anatomy of oesphagus
What factors contribute to GORD
Decrease in oesphageal sphincter tone
Increase in intra-gastric volume pressure
What factors increase intra-gastric volume pressure
Cough
Large meals
Delayed gastric emptying
What factors decrease oesophageal sphincter tone
Alcohol
Drugs: Tricyclic antidepressants
Previous surgery
Peptic strictures
Pathological Features of GORD
By reflux oesphagitis: develops when mucosal defences are unable to counteract the damage done by acid pepsin and bile. This causes inflammation
Oesphageal strictures: results from fibrosis that causes luminal constriction. Occur in 10% of patients with untreated GORD and distal oesphagous near the squamous columnar junction
Clinical Presentation of GORD
Heart Burn: after meal, lying
Acid Brash
Water Brash
Ooynophagia
Chronic cough
Laryngitis
Sinusitis
Investigations-Diagnosis of GORD
Young <40
PPI trial
Elderly/not received by medication
1. Endoscopy
2. Barium Swallow
3. 24hr pH monitoring
Lifestyle management for GORD
1.weight loss
2. smoking cessation
3. small regular meals
4. avoid meals before sleep
5. avoid:
fizzy drinks
alcohol
coffee
citrus fruits
spicy foods
Pharmacological management for GORD
Proton Pump Inhibitor
Antacids
H2 Receptor Blocker
Surgical Management for GORD
Only if medical management has failed
1. Nissen’s operation
Complications of GORD
Oesophagitis -> metaplasia/dysplasia (Barrett’s oesophagus) -> Adenoma
What is peptic ulcer disease
Defect which develops in the mucous membrane of the stomah or duodenum
What are peptic ulcers
Having one or more sores in the stomach (gastric ulcers), or in the duodenum (duodenal ulcers)
Stomach: Anatomy and Physiology
Risk Factors for peptic ulcer disease
H. pylori
NSAIDs
Smoking
>Age
History of peptic ulcer
Family History of peptic ulcer
Alcohol
Patient in ICU on mechanical ventilation or with coagulopathy
Chronic obstructive lung disease
Chronic renal insufficiency
Causes of peptic ulcer disease
- H.Pylori Bacterial infection:
- NSAIDs
3.Zollinger-Ellison Syndrome
Differential diagnosis for peptic ulcer disease
Oesophageal Cancer
Gastric Cancer
GORD/GERD
Gallstone Disease
Acute Pancreatitis
Coeliac Disease
Irritable Bowel Syndrome
Pericarditis
Lower lobe Pneumonia
Achalasia
Investigations peptic ulcer disease
H.pylori breath test or stool antigen test
Upper Gastro endoscopy
FBC
Fasting serum gastrin level – hypergastrinaemia in Zollinger-Ellison syndrome
Abdominal X-ray
Abdominal CT
Pathophysiology of peptic ulcer disease
Complication of peptic ulcer disease
Management peptic ulcer disease
Symptoms for peptic ulcer disease
What is appendicitis
Inflammed appendix
Affects 10% of population
Signs and symptoms of appendicitis
Differential Diagnosis of appendicitis
Investigations of appendicits
Management for Appendicitis
Complication for appendicitis
Perforation
Appendix mass
Appendix abscess
Portal Venous thrombosis
Liver Abscess
Bacteraemia - sepsis
Fistula
Pyelonephritis
PE/DVT following hospitalization
What is diverticular disease
What is diverticula/diverticulum?
abnormal sac-like protrusion from the wall of a hollow organ
Diverticulosis
Diverticulosis: presence of multiple diverticula, not symptomatic
Diverticulitis:
inflammation of diverticula
Diverticular Disease:
Complication of diverticulosis
What are a true diverticula?
Contain all layers of the colonic wall, often right-sided (i.e Merkel’s Diverticulum)
False diverticulum
False (acquired) diverticuli: contain mucosa and submucosa, often left-sided (highest pressure)
Merkel’s Diverticulum:
A true diverticulum, it is a reminant of proximal part of the yolk-stalk. May present with symptoms in a small majority of patients.
What are most colonic diverticula
False
Colon Anatomy and physiology
Risk Factor for diverticular disease
Age >50
Low fiber diet
Western diet
Obesity
NSAIDs
Signs and symptoms of diverticular disease
Clinical Presentation of Diverticular Disease, one of four: Asympstomatic (majority), Painful Diverticular Disease, Bleeding Diverticular Disease or Diverticulitis
Differential diagnosis for diverticular disease
Ectopic Pregnancy
Colorectal Cancer
Meckel’s diverticulum
Appendicitis
Inflammatory Bowel Disease
Mesenteric Ischaemia
Pyelonephritis
Urinary Tract infection
Pelvic Inflammatory Disease
Irritable Bowel Syndrome
Investigations for diverticular disease
Investigations depend on suspected complication and for diagnosis of diverticular disease. Diverticulosis may be an incidental finding on colonoscopy. Laboratory tests include FBC and CRP to check for bleeding and signs of inflammation/infection/malignancy. CT scan can help identify complications. A Chest x-ray can also be used which may reveal free air under the diaphragm (sign of perforation)
Pathophysiology of diverticular disease
Management for diverticular disease
Complications of diverticular disease
What is Merkels diverticulitis
Meckel’s diverticulum is the remnant of the vitellointestinal duct of the embryo. It lies on the antimesenteric border of the ileum and, as an approximation, occurs in 2% of the population, arises 55cm (2 feet) from the caecum, and averages 5 cm (2 inches) in length.
Remember Merkel’s Diverticulum is a true diverticulum
Right Lower-quadrant pain common differential
Difference between diverticula vs diverticulosis, diverticultis
What is Helicobacter Pylori (H.Pylori)
Helicobacter pylori is a Gram-negative bacteria associated with a variety of gastrointestinal problems, principally peptic ulcer disease.
How is H.pylori infection spread?
Pathology of H.pylroi infection
Association of H.pylori
Consequence of H.pylori infection
Clinical presentation of H.pylori
Diagnosis of H.pylori infection
Treatment for H.pylori infection
Clarithromycin
Amoxycillin
PPI
What is intestinal obstruction
A condition that comes from either a mechanical blockage of the bowels or a functional issue (Pseudo) where the bowels no longer propel digested content properly through the G.I tract
Several categories have been used to classify differences in the various presentations of intestinal obstruction. Ask yourself:
Cardinal features of bowel obstruction present?
Degree of obstruction to flow (partial or complete)
Site of obstruction (small bowel or large bowel)
Mechanical obstruction or ileus?
Absence or presence of intestinal ischemia (simple or strangulated).
Cardinal features of bowel obstruction
Colicky abdominal pain
Distension
Absolute constipation/obstipation
Nausea and Vomiting
Pathophysiology of intestinal obstruction
Disruption of the normal flow of intestinal contents leading to proximal dilatation and distal decompression may take 12-24 h to decompress. Therefore passage of faeces and status may occur and the onset of obstruction. Bowel ischemia may occur if blood supply is strangulated or if the bowel wall in ammation leads to venous congestion, bowel wall oedema, and disruption of normal bowel absorptive function can lead to increased intraluminal uid and transudative fluid loss into the peritoneal cavity, electrolyte disturbances.
Is it a partial or complete bowel obstruction?
Partial Obstruction - still can pass gas +/- diarrhoea
Complete Obstruction - can not pass gas or poo
Is it obstruction of the small or large bowel?
Mechanical obstruction or ileus?
Radiography Bowel obstruction
Treatment for intestinal obstruction
Bowel obstruction table
What is diarrhoea
Loose stools 3< Times per day. 200g/24hr (Not commonly used)
Classifications of diarrhoea
How to distinguish between functional/organic diarrhoea
Small Bowel vs Large Bowel diarrhoea
What do you do once you have identified small bowel vs large bowel and Organic vs Functional diarrhoea
Types of diarrhoea based on pathophisiology
Gastric cancer
Gastric cancer accounts for around 2% of all cancer diagnoses in the developed world, making it much less common than colorectal and slightly less common than oesophageal cancer. It is a cancer of older people (half of patients are > 75 years) are has a male predominance (2:1).
Risk Factors of gastric cancer
- Age - Median age 70
- Sex - 2:1 Male: Female
- Helicobacter Pylori infection- 60%
- Smoking
- Alcohol
- Obesity
- Diet - Pickled/cured/processed
- Family History: 10%, 1% syndromic: hereditary diffuse gastric cancer
- Pernicious anaemia
- Gastritis
Most common sites of gastric cancer
Most common types of gastric cancer
95%: Adenocarcinoma
5%: Lymphoma, carcinoid, stromal tumours
Signs and symptoms of gastric cancer
abdominal pain
typically vague, epigastric pain
may present as dyspepsia
weight loss and anorexia
nausea and vomiting
dysphagia: particularly if the cancer arises in the proximal stomach
overt upper gastrointestinal bleeding is seen only in a minority of patients
if lymphatic spread:
left supraclavicular lymph node (Virchow’s node)
periumbilical nodule (Sister Mary Joseph’s node)
Investigations of gastric cancer
Endoscopy + Biopsy are the gold standard
CT imaging
Diagnosis: oesophagus-gastro-duodenoscopy with biopsy
signet ring cells may be seen in gastric cancer. They contain a large vacuole of mucin which displaces the nucleus to one side. Higher numbers of signet ring cells are associated with a worse prognosis
staging: CT.
How to identify different stages of gastric cancer
Stage 3 is most common
Survival of gastric cancer
West - 30% 5 Year survival
Japan/Korea - 45% 5 Year survival
*Stage 0/1 5 Year survival is ~90%
Treatment for gastric cancer
surgical options depend on the extent and side but include:
endoscopic mucosal resection
partial gastrectomy
total gastrectomy
chemotherapy
Colorectal cancer significance
Colon cancer is the second most commonly diagnosed cancer. 1/12 people will develop bowel cancer before the age of 85. However, there are Survival rates are increasing. Early bowel cancer is cured by surgery alone (screening is important!!). If untreated, or diagnosed when distance metastases are present, >98% pf patients die in <5 years.
Cancer of the colon and/or rectum usually at an advanced age. It is an adenoma and the primary site of metastasis is the liver.
Risk Factors for Large Bowel Cancer
Diet Poor in fiber
Age
Male
Smoking
Family History
Polyposis syndrome: FAP, HNPCC
History of polyps
History of colon cancer
Ulcerative colitis
Crohn’s
Differential diagnosis of colorectal cancer
Clinical Presentation of Colorectal Cancer
Clinical Examination
Anaemia
Palpable mass on abdominal examination
Palpable nodular liver (metastasis)
Pigmentation (Peutz-Jeghers syndrome)
Discrete black brown lesion on lips
Pathology of Large Bowel Cancer
Pathology Colorectal cancer are primarily adenocarcinoma. Coloncancer can be polyploid, ulcerative, stenosing or infiltrative.
Remember Blumer’s shelf: A firm lump felt in the perirectal pouch on rectal examination. It is a rare physical finding in patients with metastatic adenocarcinoma from the GIT usually the stomach.
Investigations for large bowel cancer
Rectal examination
FBC
Faecal occult blood testing (not done if symptomatic)
Tumour markers
CT imaging
Colonoscopy
Investigation
Remember Screening for colon cancer is available: FOBT. Done yearly after 50yo (Australia).
Diagnosis Colon cancer is usually diagnosed with colonoscopy and biopsy (takes 1-2 days for pathology results)
Investigations for staging large bowel cancer
Treatment for Large bowel cancer
Complications and prognosis of colorectal cancer
What is oesophageal cancer, and what are the different types
Until recently, oesophageal cancer was most commonly due to squamous cell carcinoma, but the incidence of adenocarcinoma is rising rapidly. Adenocarcinoma is now the most common type of oesophageal cancer and is more likely to develop in patients with a history of gastro-oesophageal reflux disease (GORD) or Barrett’s.
The majority of adenocarcinomas are located near the gastroesophageal junction, whereas squamous cell tumours are most commonly found in the upper two-thirds of the oesophagus.
Squamous cell carcinoma orginates
in squamous epithelium
Risk Factors of squamous cell carcinoma
Alcohol
Smoking
Hot fluids
Squamous cell carcinoma mutations occur in
Adenomcarcinoma
Originates in columnar glandular epthelium
Affects lower 1/3 of oesphagus
Consequence of GORD
Risk Factors of oesphageal cancer
Symptoms of oesophageal cancer
dysphagia: the most common presenting symptom
anorexia and weight loss
vomiting
other possible features include: odynophagia, hoarseness, melaena, cough
Diagnosis of oesophageal cancer
Upper GI endoscopy with biopsy is used for diagnosis
Endoscopic ultrasound is the preferred method for locoregional staging
CT scanning of the chest, abdomen and pelvis is used for initial staging
FDG-PET CT may detect occult metastases if metastases are not seen on the initial staging CT scans.
Laparoscopy is sometimes performed to detect occult peritoneal disease.
Treatment for oesophageal cancer
The operable disease is best managed by surgical resection - the most common procedure is an Ivor-Lewis type oesophagectomy.
The biggest surgical challenge is an anastomotic leak, with an intrathoracic anastomosis resulting in mediastinitis.
In addition to surgical resection, many patients will be treated with adjuvant chemotherapy.
What is Meckel’s Diverticulum
Abnormal pouch on antimesenteric side of ileum
Complications of Meckel’s Diverticulum
Diverticulitis
Signs and symptoms of Meckel’s Diverticulum
Usually asymptomatic
Abdominal pain/distension, melena, vomiting, constipation
Diagnosis of Meckel’s Diverticulum
Treatment for Meckel’s Diverticulum
What is achalasia?
Rare disorder that results from progressive destruction of the ganglion cells in the myenteric plexus in the oesphogeal wall.
The destruction of these cell leads to the inability of the lower oesphageal sphincter to relax and leads to the loss of peristalsis of the distal oesphagus
What is the result of achalasia
Dilatation of the distal oesphagus
Clinical Presentation of achalasia
dysphagia of BOTH liquids and solids
typically variation in severity of symptoms
heartburn
regurgitation of food
may lead to cough, aspiration pneumonia etc
malignant change in small number of patients
What is a misdiagnosis for achalasia
Gastrooesophageal reflux
Aetiology of achalasia
1.Idiopathic
2.Viral/parasitic cause
3.Autoimmune
4.Neurodegenerative disorder
5.Trypanoma cruzi -> Chagos disease
6.Antibodies against:
-HSV
-HPV
-Rubeola
Remember : Both myenteric antibodies and HSV-1 infection were found in 100% of patients with achalasia
Investigations for achalasia
1.oesophageal manometry
excessive LOS tone which doesn’t relax on swallowing
considered the most important diagnostic test
2.barium swallow
shows grossly expanded oesophagus, fluid level
‘bird’s beak’ appearance
3.chest x-ray
wide mediastinum
fluid level
Pseudo achalasia
Due to an obstructed distal oesophagus from causes other than destruction of the myenteric plexus at the distal oesophagus.
Due to obstruction by a malignant mass, scleroderma, strictures, toxins, reflux malignancies.
Also due to lymphoma, oesophageal carcinoma, gastric carcinoma
Investigations include:
CT
Endoscopic ultrasound
Treatment for achalasia
1.pneumatic (balloon) dilation is increasingly the preferred first-line option
less invasive and quicker recovery time than surgery
patients should be a low surgical risk as surgery may be required if complications occur
2.surgical intervention with a Heller cardiomyotomy should be considered if recurrent or persistent symptoms
3.intra-sphincteric injection of botulinum toxin is sometimes used in patients who are a high surgical risk
4.drug therapy (e.g. nitrates, calcium channel blockers) has a role but is limited by side-effects
What is intestinal ischaemia
group of conditions where there is inadequate blood flow to large or small intestine
Classifications of intestinal ischaemia
Ischaemic collitus: affects large intestine
Acute/Chronic mesenteric ischaemia: Affects small intestine
Areas most prone to intestinal ischaemia
Splenic Flexture (Griffiths point)
Rectosigmoid junction (Sudeck’s point)
Causes of intestinal ischaemia
Acute mesenteric ischemia can result from occlusion of a mesenteric vessel arising from an embolus, which may emanate from an atheroma of the aorta or cardiac mural thrombus, or primary thrombosis of a mesenteric vessel, usually at a site of atherosclerotic stenosis. Embolic occlusion is more common in the superior mesenteric artery than the celiac or inferior mesenteric artery, presumably because of the less acute angle of the superior mesenteric artery of the abdominal aorta.
Remember: AF with abdominal pain think mesenteric ischaemia.
Signs and symtoms of intestinal ischaemia
Depends on severity and time of occlusion
- Abdominal pain (95%)
-Disproportionate to exam
-Widespread as ischaemia progresses - Nausea/Vomiting
- Diarrhoea (Constipation is rare)
- Rectal Bleeding
Can be sequence to the symptoms (see pic)
Chronic symptoms
-Slower onset
-Pain 30min after eating: Fear of eating & Weight loss
Risk Factors for intestinal ischaemia
1.Atherosclerosis
2.Age
3.smoking
4.atrial fibrillation
5.hypercoagulability
6.chronic organ failure
Diagnosis for intestinal ischaemia
1.HIstory + Physical Exam
2.Lab markers: Leukocytosis, Raised lactate
3.imaging:
-CT (intramural gas, portal venous gass, free air)
-Angiogrpahy
-X-Ray
-Endoscopy
Treatment for intestinal ischaemia:
What is pseudomembranous Colitis
Swelling or Inflammation of the large intestine due to disturbance of normal bacterial flora of the colon and an overgrowth of Clostridium difficile (C.diff) bacteria
What is pseudomembranous Colitis a common cause of
Diarrhoea after antibiotic use
Pseudomembranous colitis infection causes
Antibiotics: ampicillin, cindamycin, fluoroquinolone, cephalosporins
Healthcare workers: as infection is spread by faeces
What is C.difficle bacteria
Spore forming, anaerobic, gram positive bacilus.
Pathogenic C.difficile strains produce multiple toxins e.g entertoxins and cytotoxins both of which produce diarrhoea and inflammation in infected patients
Pathophysiology of C.difficile
anaerobic gram-positive, spore-forming, toxin-producing bacillus
transmission: via the faecal-oral route by ingestion of spores
releases two exotoxins (toxin A and toxin B) that act on intestinal epithelial cells and inflammatory cells resulting in colitis
Symptoms of pseudomembranous colitis
diarrhoea
abdominal pain
a raised white blood cell count (WCC) is characteristic
if severe toxic megacolon may develop
Investigations for Pseudomembranous colitis
Management of pseudomembranous colitis
What is an anal fissure
A superficial linear tear in the anoderm distal to the pectinate line (dentate line) commonly caused by passage of hard stool
Clinical Presentation of an anal fissure
Risk Factors for anal fissure
Low intake of dietary fiber
Differential diagnosis for an anal fissure
Pathophysiology of an anal fissure
Anal fissures usually occur in the anterior or posterior parts of the anus and underlies the internal anal sphincter. Muscles spasm are due to contraction of the internal anal sphincter causing ischaemia → pain
Complications for an anal fissure
Faecal incontinence due to sphincterotomy
Signs and symptoms of an anal fissure
Diagnosis of an anal fissure
History, examination of anal region/rectum
Treatment of an anal fissure
What is an anal fistula
abnormal connection of the anorectal epithelial surface to the perineal or vaginal skin.
Types of anal fistula
Signs & Symptoms of anal fistula
Differential diagnosis of an anal fistula
Anal Abscess
Anal fissure
Anal ulcer or sores (secondary to another disease or infection)
Crohn disease
Diagnosis of anal fistula
Pathophysiology of an anal fistula
Treatment for anal fistula
Complication of an anal fistula
Recurrence
Faecal incontinence from surgery
What is a haemorrhoid
collections of submucosal, fibrovascular, arteriovenous sinusoids that are part of the normal anorectum
Types of haemorrhoid
Risk factors for haemorrhoid
Constipation, a low fibre diet, a high Body Mass Index, pregnancy, and a sedentary lifestyle
Complications with haemorrhoid
Anaemia
Pain
Heavy bleeding
Chronic unremitting prolapse of mucosal tissue
Strangulation
Ulceration
Thrombosis
Signs and symptoms of a haemorrhoid
Diagnosis of a haemorrhoid
Treatment of haemorrhoids
What is an anorectal abscess
Collection of pus in the anal/rectal region
Usually an invasion of normal rectal flora
Signs and symtpoms of an anorectal abscess
Investigations for anorectal abscess
Diagnosis of anorectal abscess
Pathophisiology of anorectal abscess
Usually originates from an infected anal crypt gland
1.Infection of crypts
2.spread through anal duct and gland
3.Infection spreads:
-Submucosal
-Subcutaneous
-Transsphincter
Surrounding tissue
the abscess collects in which ever anatomical space between the gland terminates or whichever path of least resistance is
Differential diagnosis of an anorectal abscess
Management of an anorectal abscess
Complications of an anal abscess
What is pilonidal sinus
Obstruction of natural hair follicles above the anus
Clinical Presentation of pilonidal sinus
Pilonidal sinus pathophisiology
Aetiology of pilonidal sinus
Congenital
Diagnosis of pilonidal sinus
Diagnosis of observation
Treatment for a pilonidal sinus
Complication of pilonidal sinus
Infection
Venn Diagram comparing IBD
a 20-year-old woman presents with recurrent episodes of abdominal pain associated with bloating. The pain is relieved on defecation. She normal passes 3 loose stools with mucous in the mornings
IBS
Table comparing diff between IBD
Diverticulitis classical presentation is:
left iliac fossa pain and tenderness
anorexia, nausea and vomiting
diarrhoea
features of infection (pyrexia, raised WBC and CRP)
Mesenteric ischaemia: Key question features (lower gastrointestinal disorders)
abdominal pain, rectal bleeding, metabolic acidosis
Stereotypical histories Crohn’s disease
a 20-year-old woman presents with diarrhoea. Over the past few months she has lost weight and suffered with recurrent abdominal pain and mouth ulcers
An elderly man complains of dysphagia, halitosis, regurgitation and cough is a stereotypical history for:
Pharyngeal pouch
Which antibody is most associated with ulcerative colitis?
P-ANCA
Palpation in LLQ causes pain in RLQ
acute appendicitis
What type of cancer is most associated with Helicobacter pylori?
B cell lymphoma of MALT tissue
What type of cancer is most associated with Helicobacter pylori?
B cell lymphoma of MALT tissue
Strong family history of colorectal and endometrial cancer in a question is most likely to indicate:
Hereditary non-polyposis colorectal carcinoma
Which one of the following tumour markers is most associated with colorectal cancer?
Carcinoembryonic antigen
A 17-year-old boy is admitted to hospital with suspected appendicitis. He is found to be maximally tender at McBurney’s point. Where is this located?
McBurney’s point is found 2/3rds of the way along an imaginary line that runs from the umbilicus to the anterior superior iliac spine on the right-hand side. The other options do not locate this anatomical site.
Pathophysiology of a Mallory-Weiss tear
Severe vomiting → painful mucosal lacerations at the gastroesophageal junction resulting in haematemesis. Common in alcoholics
Mallory Weiss tear
Oesphogeal Varices
Definition
Epidemiology
Aetiology
Risk Factors
Pathophysiology of oesphogeal varices
@ oesophagogastric junction, rectum and anterior wall - portal and systemic
capillary beds meet
If portal hypertension, then blood takes path of least resistance i.e. through
systemic circulation - bypasses liver and into heart
∴ causes detoxification and nutrition issues
As portal pressure ↑, can cause oesophagogastric varices to form and rupture
∴ massive haemorrhage
—
As these vessels are not thin, not meant to transport higher pressure blood
∴ rupture
(∴ haematemesis)
(if blood digested = melaena)
Clinical Manifestations and Investigations for oesphageal varices
Differential diagnosis for oesphageal varices
Gastroenteritis
Peptic ulcer
Cancer
Mallory-Weiss tear
Management for oesphageal varices
Blood transfusion if anaemic
Beta blocker to reduce CO ∴ ↓ portal pressure
Nitrate to cause vasodilation ∴ ↓ portal pressure
Terlipressin (ADH analogue) ∴ ↓ portal pressure
Trans-jugular intrahepatic portoclaval shunt (TIPS)
Correct clotting abnormalities w/ vit K and platelet transfusion
Variceal banding - band put around varice using endoscopy
