GI 2 - Basics + Common diseases Flashcards
Where does peptic ulceration commonly occur?
- Lesser curve @ angulus
- Proximal 1/4 of duodenum
Why is the proximal 1/4 of the duodenum more likely to ulcerate than the rest of the duodenum?
It is before the major duodenal papilla where the alkaline pancreatic juice and bile neutralise the acidic gastric contents.
- Therefore the proximal 1/4 of the duodenum is constantly exposed to gastric acid which can erode the mucosal lining of the duodenum
What are the common symptoms of peptic ulceration?
- Burning/gnawing epigastric pain between meals or at night, relieved by eating
- Heartburn
- Bloating
- Nausea/vomiting
What are the complications of a perforated duodenal ulcer?
- Think anterior vs posterior perforation *
Anterior perforation = Peritonitis
Posterior perforation = Erode in gastroduodenal artery = haemorrhage: haematemesis, malaena, hypovolaemic shock
What are the complications of a gastric ulcer perforating posteriorly?
If erodes into the Splenic artery = haemorrhage: haematemesis, malaena, hypovolaemic shock
What are the common causes of an obstructed bile duct?
- Gallstones
- Pancreatitis
- Malignancy (of liver/pancreas/bile duct/duodenum)
What are the symptoms of an obstructed bile duct?
- Jaundice
- Dark urine
- Steatorrhoea
- Pruritus
- Abdo pain in RUQ
What is Coeliac disease?
- Autoimmune response to Gliadin (in gluten)
- Resulting in mucosal lesions in upper small intestine
What microscopic changes to the intestinal mucosa are caused by Coeliac disease?
In upper part of small intestine:
- Villous atrophy
- Crypt hyperplasia
What are the symptoms of coeliac disease?
- Diarrhoea
- Fatigue
- Weight loss
- Abdominal pain
- Bloating
- Iron-deficiency anaemia
- Osteoporosis
- Dermatitis herpetiformis
- Mouth ulcers
- Hyposplenism
- Acid reflux
What is Zollinger-Ellison syndrome?
Diarrhoea and peptc ulcers, caused by a gastrin-secreting tumour of the pancreas (stimulating over-production of gastric acid from parietal cells)
What are the symptoms of appendicitis?
- Dull umbilical pain which sharpens and locates to RIF
- Nausea
- Vomiting
- Loss of appetite
- Bloating
What is a pseudo diverticulum?
A protrusion of a wall which doesn’t contain all layers of the wall. ie may only contain mucosa
Are colonic diverticula ‘true’ or ‘pseudo’ diverticula?
Pseudo, as only herniation of mucosa and submucosa, not all layers of the gut wall
What are the risk factors for colonic diverticula?
- Increasing age
- Low fibre diet
- Obesity
- Little physical activity
- NSAIDs
- Alcohol
- Smoking
What are the risk factors for colorectal cancer?
- Age
- Familial adenomatous polyposis
- Crohn’s
- Ulcerative colitis
- Diabetes type II
- Obesity
- Heavy drinking
What is the most common type of colorectal cancer?
Adenocarcinoma
What tumour marker is sometimes released by colorectal carcinomas?
CEA - Carcinoembryonic antigen
Where does colorectal cancer often metastasise to?
- Liver
- Lung
- Peritoneum
What type of colorectal cancers affect above and below the dentate line?
Above dentate line = adenocarcinoma
Below dentate line = squamous cell carcinoma
What are haemorrhoids?
Dilations of superior rectal veins
What can cause haemorrhoids?
- Straining
- Constipation
- Obesity
- Pregnancy
- Anal sex
- Low fibre diet
At which point do haemorrhoids become extremely painful?
Begin above dentate line. If they extend below the dentate line, somatic innervation = pain
What is a Meckel’s diverticulum?
Vestigial remnant of vitelline duct
What is the rule of 2’s associated with Meckel’s diverticula?
- Detected in under 2’s
- 2:1 M:F ratio
- ~2% population
- 2ft from ileocaecal valve
- 2” long
What are the symptoms of a Meckel’s diverticulum?
- Loss of appetite
- Nausea
- Vomiting
- Malaena
What is a sigmoid volvulus?
Large sigmoid loop full of faeces and distended with gas, twisted on its mesenteric pedicle to create a closed-loop obstruction
