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Year 2 Conditions > GI > Flashcards

GI Flashcards

1
Q

What is a hernia?

A

A protrusion of abdominal contents beyond the confines of the abdominal wall

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2
Q

What are the symptoms of a hernia that isn’t stuck?

A

Fullness/swelling
Swelling that gets larger w/ increased intra-abdominal pressure eg coughing
Aches

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3
Q

What are the symptoms of an incarcerated hernia?

A

Pain
A swelling that won’t move
Nausea and vomiting
Systemic problems with ischaemia

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4
Q

What are the causes of a hernia?

A

Weakness in the cavity;
Congenital - patent processus vaginalis
Post surgery

Increased intra-abdominal pressure;
Obesity, weight lifting, chronic cough, chronic constipation

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5
Q

What are the borders of the inguinal canal?

A

Anterior: aponeurosis of external oblique

Roof: internal oblique, transversus abdominis

Posterior: transversalis fascia

Floor: inguinal ligament, lacunae ligament

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6
Q

What is Hesselbach’s triangle?

A

A point of weakness in the abdominal wall

Borders
Medial; lateral border of rectus abdominis
Lateral; inferior epigastric vessels
Inferior; inguinal ligament

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7
Q

What is the pathway of an indirect inguinal hernia?

A

Deep inguinal ring => inguinal canal => superficial inguinal ring

Can descend into scrotum with patent processus vaginalis

Lateral to epigastric vessels

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8
Q

What is the pathway of a direct inguinal hernia?

A

Hesselbach’s triangle => superficial inguinal ring

Medial to epigastric vessels

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9
Q

What is a femoral hernia?

A

A hernia through the empty space in the femoral canal

More common in females due to wider pelvises

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10
Q

What is an omphalocele?

A

A type of congenital hernia
Viscera are covered in peritoneum
Abdominal cavity may not have grown to correct size to accommodate viscera
High mortality as often associated w/ other genetic problems

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11
Q

What is gastroschisis?

A

A congenital hernia caused by a defect in the ventral body wall
Viscera don’t have a covering of peritoneum
Can often be closed at birth

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12
Q

What is an umbilical hernia?

A

Found in infants
Mostly leave alone as they close spontaneously by about 3 yrs
Presents as bulge at umbilicus

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13
Q

What is a para-umbilical hernia?

A

Acquired in adults
Hernia through linea alba in region of the umbilicus
More common in females
Happens as a result of increased intra-abdominal pressure
Risk of strangulation due to disrupted blood supply

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14
Q

What is GORD?

A

Persistent acid reflux

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15
Q

What are some symptoms and consequences of GORD?

A

Symptoms:
Chest pain, acid taste in mouth, cough

Consequences:
Oesophagitis, benign strictures, Barrett’s oesophagus => adenocarcinoma

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16
Q

How is GORD treated?

A

Lifestyle modifications; lose weight, change diet
Antacids
H2 antagonists
PPIs

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17
Q

What is acute gastritis?

A

Exposure of stomach mucosa to chemical injury => damaged epithelial cells and reduction in mucus production

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18
Q

What causes acute gastritis?

A

NSAIDs decreases prostaglandin synthesis, reduction in blood supply so epithelium can’t repair itself
Lots of alcohol dissolves mucus layer in stomach
Chemotherapy targets rapidly dividing cells
Bile reflux

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19
Q

What are symptoms and treatment of acute gastritis?

A

Symptoms:
Sometimes none
Abdo pain, nausea and vomiting
Sometimes bleeding

Treated by removing irritant

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20
Q

What causes chronic gastritis?

A

Same things as acute

H-pylori
Can lead to peptic ulcers, adenocarcinoma

Autoimmune
Antibodies to gastric parietal cells

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21
Q

How does helicobacter pylori cause gastritis?

A

Release of cytotoxins => direct epithelial injury
Release of enzymes
Urease => production of ammonia => toxic to epithelium

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22
Q

How does the location of H pylori determine the symptoms?

A

Antrum:
Increased gastrin secretion, increased parietal cell acid secretion, duodenal metaplasia => ulceration

Body:
Atrophy
Results in gastric ulcer

If present in antrum and body then there are no symptoms

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23
Q

What is peptic ulcer disease?

A

A defect in gastric or duodenal mucosa which extends through muscularis mucosa
Most commonly affects the duodenum, can also affect the lesser curve/antrum of stomach

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24
Q

What are the causes of mucosal injury leading to peptic ulcer disease?

A

Stomach acid
H-pylori
NSAIDs
Smoking

25
Q

What are some symptoms of peptic ulcer disease?

A

Epigastric pain/back pain following meal times, often at night
Bleeding and anaemia; Malaena, haematemesis
Early satiety
Weight loss

26
Q

What are some clinical consequences of peptic ulcer disease?

A

Contraction of scar tissue => pyloric stenosis
Perforation => peritonitis
Erosion into adjacent structure
Haemorrhage into adjacent blood vessels (left gastric artery, splenic artery) => haematemesis

27
Q

How is peptic ulcer disease managed?

A 
Lifestyle modification 
Stop NSAIDs
Test for H pylori and get rid of it 
PPIs 
Endoscopy => clips
28
Q

What is Zollinger-Ellison syndrome?

A

Non-beta islet cell gastrin secreting tumour of pancreas
Causes proliferation of parietal cells => lots of acid production => ulceration of stomach and bowel
Presents with abdo pain and diarrhoea

29
Q

Who is gastric pathology diagnosed?

A 
Upper GI endoscopy 
Urease breath test (from H pylori)
Erect CXR (pneumoperitoneum)
Blood test (anaemia)
30
Q

What are inflammatory bowel disease?

A

A group of idiopathic conditions causing inflammation of the GI tract
Affecting function of the gut

31
Q

What is Crohn’s disease?

A

Inflammation of the GI tract, can occur anywhere from mouth to anus
Most commonly affects the ileum
Transmural - extends throughout the whole bowel wall

32
Q

How does Crohn’s disease present?

A 
Generally affects younger people 
Hx of loose non-bloody stools multiple times a day 
Weight loss 
Right lower quadrant pain 
Peri-anal inflammation eg fistulas 
Anaemia due to lack of IF
33
Q

What gross pathology is seen in Crohn’s?

A 
Skip lesions
Hyperaemia
Mucosal oedema 
Discrete superficial and deeper ulcers 
Cobblestone appearance
34
Q

What is seen microscopically in Crohn’s?

A

Epithelioid granuloma

35
Q

What investigations are done for Crohn’s?

A

Bloods - anaemia, CRP
CT/MRI - bowel wall thickening, obstruction
Barium swallow - shows structures and fistulas
Colonoscopy- shows gross morphological changes

36
Q

How is Crohn’s managed?

A

Target immune system with immunosuppression

Surgery isn’t curative as can occur anywhere along the GI tract

37
Q

What is ulcerative colitis?

A

Inflammation beginning in the rectum and moving proximally
Can extend to involve the whole colon
Typically confined to large bowel, but could involve terminal ileum

38
Q

Who does ulcerative colitis present?

A 
Affects younger people
Hx of bloody stools multiple times a day, can also have mucus 
Weight loss 
Lower abdo pain and cramping 
No perianal disease
39
Q

What is the gross pathology of ulcerative colitis?

A

Pseudopolyps which develop as a result of repeated inflammation
Loss of haustra

40
Q

What is the microscopic pathology of ulcerative colitis?

A

Chronic inflammatory infiltrate of lamina propria
Crypt abscesses
Crypt distortion - irregular shape w/ dysplasia, risk of colon ca
Reduced number of goblet cells

41
Q

What investigations are done for ulcerative colitis?

A

Bloods - anaemia and serum markers
Stool cultures
Colonoscopy
Barium enema CT/MRI

42
Q

How is ulcerative colitis managed?

A

Immunosuppression

Surgery can be curative - colectomy done when inflammation doesn’t settle or there are pre-cancerous changes

43
Q

What are haemorrhoids?

A

Symptomatic anal cushions

44
Q

What causes internal haemorrhoids?

A

Loss of connective tissue support
Occurs above the dentate line so relatively painless
Can enlarge and prolapse
PR bleeding

45
Q

What are external haemorrhoids?

A

Occurs when anal cushions enlarge then thrombosis

Occur below dentate line so v painful

46
Q

What are anal fissures?

A

Linear tear in the anoderm, usually in posterior midline
Occurs after passing hard stool
V painful when passing stool => haematochezia

47
Q

What causes anal fissures?

A

High anal sphincter tone and reduced blood flow to anal mucosa

48
Q

What bacteria cause gastroenteritis?

A 
Salmonella
Campylobacter
Shigella 
Enterotoxigenic E. coli 
C. diff
49
Q

What type of bacteria is salmonella, and how does it cause infection?

A

Gram negative rod

1) Gain access to enterocytes via endocytosis
2) Move to submucosa via macrophages
3) Transfer to RES => multiple in cells
4) Causes lymphoid hyperplasia
5) Re-enter gut via liver

50
Q

What are the symptoms of salmonella?

A

Nausea, vomiting, non-bloody diarrhoea, fever, abdo cramps

Self limiting in 2-3 days

51
Q

What are the symptom of a campylobacter infection?

A

Fever, abdo cramps, diarrhoea - can be bloody
Can last days to weeks, generally self limiting
Abx required if diarrhoea is bloody

52
Q

What type of bacteria is shigella and how does it cause infection?

A

Gram negative rod

Invades large intestine colonocytes then multiplies in cells
Invades neighbouring cells
Kills colonocytes
Forms abscesses

53
Q

What are the symptoms of a shigella infection?

A

Bloody diarrhoea

Abdo cramps

54
Q

What type of bacteria is E. coli and how does it cause infection?

A

Gram negative rod

Invades enterocytes and produces enterotoxins
Causes hypersecretion of Cl- => Na+ follows => water follows => diarrhoea

55
Q

What type of bacteria is C. diff and how does it cause infection?

A

Gram positive

Spreads via spores
Releases toxins
Toxin A - enterotoxin => excess secretion of Cl- and inflammation
Toxin B - cytotoxin

56
Q

What does a C diff infection cause?

A

Varying degrees of diarrhoea, can be bloody
Abdo cramping

Rarely results in pseudomembranous colitis or toxic megacolon

57
Q

What viruses can cause gastroenteritis?

A

Rotavirus

Norovirus

58
Q

Who does rotavirus commonly affect?

A

Children < 5yrs

Adults are rarely affected as immunity lasts throughout adulthood

59
Q

How does rotavirus cause diarrhoea?

A

Increased Cl- secretion => Na+ follows => water follows

SGLT1 disruption => Na+ and glucose remain in lumen

Reduced brush border enzyme function => general malabsorption

Year 2 Conditions (3 decks)

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