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2a RRS > GI > Flashcards

GI Flashcards

1
Q

what is malabsorption

A

failure to fully absorb nutrients due to epithelium destruction or a prblem in the lumen so food is not digested
weight loss despite adequate food intake

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2
Q

3 CFs of malabsorbtion

A

weight loss
steatorrhoea
anaemia

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3
Q

causes of malabsoption

A 
poor intake
defective epithelial tranpsort
decreased surface area
lymphatic obstruction
surgery
lack of digestive enzymes
poor intraluminal digestion
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4
Q

causes of a decrease in SA causing malbsorption

A

coeliac = villous atrophy
extensive parasites - giardia
bowel resection
crohns

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5
Q

causes of lymphatic obstruction = malabsorption

A

TB

lymphomas

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6
Q

causes of surgery causing malabsoption

A

small intestine resection of bypass

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7
Q

e.g of lack of digestive enzymes causing malabsorption

A

lactose intolerance

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8
Q

e.g of poor intraluminal digestion causing malabsorption

A 
pancreatic insuffic  (pancreatitis, CF)
defective bile secretion (gall stones)
bacterial overgrowth = brush border damage
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9
Q

what is peritonitis

A

inflam of the peritoneum assos with the rupture of an internal organ

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10
Q

what is the peritoneum

A

a serous membrane lining the cavity of the abdomen and covering abdominal organs

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11
Q

what is the peritoneal cavity

A

a closed sac lined by mesothelial cells that secrete surfactant

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12
Q

causes of peritonitis

A

perforation of GI tract (trauma, peptic ulcer)
autoimmune - SLE
primary = spontatneous bacterial infections
secondary = localised = acute inflam - acute appendicitis, acute cholecystitis
generalized = irritation due to infection (E. coli)/chem irritants due to intest contents leakage (peptic ulcer)

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13
Q

RF of peritonitis

A

peritoneal dialysis, ascites

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14
Q

what is spontaneous bacterial peritonitis

A

neutrophils in ascitic fluid when ascites is secondary to a chronic liver disease assos with E. coli and S. pneumonia

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15
Q

CFs of peritonitis

A 
borderline rigitidiy
guarding
fever
abdo pain exab by movement and coughing (hence lay still)
n+v
tender hard abdo
perforation = sudden onset = shock 
SEPSIS if low bp
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16
Q

what is characteristic of the abdo pain in peritonitis

A

exab by movements and coughing, relieved staying still

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17
Q

signs of peritonitis

A

fever
tender hard abdo
tachycardia
guarding

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18
Q

symptoms of peritonitis

A

nausea and vomiting

severe abdo pain - exab by movement and coughing (LAY STILL)

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19
Q

Dx of peritonitis

A

erect CXR = gas under diaphragm
ascitic tap = culture
bloods - rule out pancreatitis

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20
Q

Mx of peritonitis

A

broad spec antibiotics

percutaneous catheter drainage

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21
Q

what is IBS

A

group of abdominal symptoms for which no organic cause can be found - diagnosis by exclusion

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22
Q

3 types of IBS

A

IBS-D
IBS - M
IBS - C

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23
Q

epdiemiology of IBS

A

female
stress
western world
less than 40

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24
Q

Triggers of IBS

A

depression, anxiety, psychological stress/trauma
gastrointestinal infection
eating disorder
pelvic surgery

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25
Q

cancer red flag symptoms when patient for IBS

A 
over 50 yo with change in bowels
unexplained WL
PR bleed
rectal/abdo mass
anaemia
fam histroy of ovarina/bowel cancer
increased inflam markers
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26
Q

CFs of IBS main one

A

abdo pain releived on passing stool

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27
Q

CFS of IBS

A 
abdo pain relieved on passing stool 
\+2 of;
altered stool passage
bloating
mucus in stool 
poor sleeping
painful periods (dysmenorrhoea)
symptoms worse on eating
lethargy, back ache, nausea
bladder symptoms (urgency, nocturia)
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28
Q

what exabberates IBS

A

stress
menstruation
gastroenteritis

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29
Q

Dx of IBS

A

exclude other causes
FBC - anaemia
colonoscopy - crohns UC colorectal cancer
serology - coeliac - tTG and EMA antibodies
ESR and CRP - inflam
stool sample - faecal calprotectin (IBD)

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30
Q

DDx of IBS

A

lactose intol
caeliac
IBD - crohns UC
colorectal cancer

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31
Q

Mx of IBS

A

lifestyle modifications
pain/bloat - antispasmodic - buscopan / mebeverine
constip = laxitive - senna
diarrhoea - loperamide (antimobility)
pain - low dose tricyclic antidepressant = amitriptyline

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32
Q

antispasmodic for treating IBS

A

buscopan, mebeverine

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33
Q

antimotility for IBS Mx

A

Loperamide (for diarrhoea)

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34
Q

drug for constipation in IBS

A

laxative = Senna

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35
Q

pain relief in IBS

A

amitriptyline

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36
Q

life style modifications for IBS

A 
FODMAP diet
small regular meals
avoid alcohol and caffiene
avoid fizzy drinks
increase fibre - soluble fibre softens stool insol increases gut motility
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37
Q

what does FODMAP stand for

A

fermentable, oligosaccharides, disacharides, monosacharides, polyols

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38
Q

what is crohns disease

A

transmural granulomatous inflammation in any part of the GI tract - chronic XS immune response to an unknwon trigger

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39
Q

where is Crohns most likely to affect in the GI tract

A

terminal ileum to proximal colon

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40
Q

RFs for crohns

A

smoking, appendectomy,
fam history
genetic

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41
Q

microscopic features of Crohns

A

no crypts absesses,
goblet cells present
transmural.
granulomas w langerhans giant cells

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42
Q

what is a granuloma

A

Aggregate of epitheliod Histyocytes - noncaesating

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43
Q

macroscopic features of crohns

A

skip lesions
cobblestone appearance due to deep ulcers and fissures
thickened and narrowed bowel
anywhere from oesophagus to anus

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44
Q

MNEUMONIC for crohns

A 
driving CROHN for CHRISTMAS
Cobble stone
High temp
Reduced lumen (obstruction)
Intestinal fistuale (complic)
Skip lesions
Transmural
Malabsorption
Abdo pain /anal (peri) lesions
Submucosal fibrosis
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45
Q

how to Dx crohns

A

colonoscopy and biopsy - transmural inflam, goblet cells, granulomas
bloods - anaemia - Fe and folate defic, increase CRP,
barium swallow - strictures and bowel shortening
stool sample - faecal calprotectin, infection

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46
Q

Mx of crohns

A 
smoking cessation
induce remission (glucocorticoid) PREDNISOLONE
add on - athioprine
if severe = infliximab
surgery
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47
Q

the corticosteroid with crohns

A

prednisolone

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48
Q

Ulcerative colitis what is it

A

autoimmune inflam disease triggered by colonic bacteria causing inflam in the colonic mucosa only
Relapsing and remitting inflammatory disorder of the COLONIC MUCOSA .

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49
Q

what causes Crohns disease pathophysiology

A

trigger = Th cells relase inflam cytokines = INFLAM - further mediators (free radicals, proteases), unregulated = increase in inflam and tissue destroyed and invade intestineal mucosa - ULCER and GRANULOMA - TRANSMURAL - fistulae/narrowing

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50
Q

complications of crohns

A

obstruction, enteric fistulae, perforation = major bleed

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51
Q

symptoms of Crohns

A

abdo pain (RLQ if ileum)
fatigue
weight loss
N and V

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52
Q

signs of crohns

A 
fever
pyrexia
dehydration
aphthous mouth ulceration
abdo tenderness/mass (if inflamed loops)
arthritis 
uveitis
perianal (skin tags)
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53
Q

causes of UC

A

CD8+ cell activation destroying cells in the mucosal submucosa colonic layers
assos w p.ANCA

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54
Q

where does UC affect

A

never spreads proximal to the ileocaecal valve

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55
Q

what is UC called if only affects rectum

A

proctitis (50%)

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56
Q

what si UC called if affects rectum and extends to sigmoid and desc colon

A

L sided colitis (30%)

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57
Q

what is UC called if affects whole COLON

A

extensive colitis (20%)

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58
Q

RFs for UC

A 
stress
infection
NSAIDS
genetic 
NOT SMOKING NOT APPENDICECTOMY
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59
Q

peak incidence for UC

for crohns

A

UC - 15-25 then 55-65

Crohns - 20-40

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60
Q

Ethnic group at risk in IBD

A

Jewish

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61
Q

Macroscopic features of UC

A

mucasa red and inflamed = friable
continuous
circumferential inflam
severe - ulcers and pseudopolyps

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62
Q

mircoscopic features of UC

A

superficial mucosal inflam - mucosal layer only
no granulomas
goblet cell depletion
crypt abssesses

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63
Q

what characteristic of UC on a colonoscopy

A

drainpipe mucosa (lack of haustrations)

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64
Q

stools test in UC - why?

A

to exclude C difficile

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65
Q

what does bloods show in UC

A

p-ANCA POSITIVE (neg in crohns)
ESR CRP increased
normochromic/cytic anaemia of chronic disease (iron and b12 defic)

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66
Q

symptoms of UC

A 
diarrhoea as cant absorb water
bloody and mucous
lower abdo discomfort (LL quadrant)
WL
Fatigue
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67
Q

signs of UC (intestinal)

A

pyrexia
dehydration
abdo tenderness/distentsion
tachycardia

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68
Q

extra intestinal signs of UC

A

clubbing
oral ulcers
erythema nodosum (red lumps under skins)

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69
Q

Complications of UC

A 
toxic megacolon
fatty liver changes
erythema nodosum on skin
increased colon cancer risk
arthritis = joints
uveitis = eyes
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70
Q

what is toxic megacolon

A

non obstruction, dilatation of think walled colon = gas filled - emergency
fever hypotension and tachycardia

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71
Q

which is smoking protective for in IBD

A

UC

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72
Q

Mx of UC

A

5ASA (aminosalicyclic acid) - induction and maintanence
acute relapses - corticosteroid - prednisolone
suregery (curative)
Mx complications
INFLIXIMAB - biologics - severe

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73
Q

what is the drug used in UC for induction and maintenence

A

5ASA - aminosalicyclic acid

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74
Q

what used to manage acute relapses of UC and Crohns

A

corticosteroid - prednisolone

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75
Q

what biologic used for UC and Crohns

A

infliximab

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76
Q

in UC how to differenciate between proctitis or L sided/extensive

A

proctitis - freq blood and mucus with urgency and tenesmus

l sided or extensive collitis - bloody diarrhoea. urgency /incontinence at night. 10-0 LIQUID stools/day

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77
Q

which IBD has pseudo polyps

A

UC

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78
Q

which IBD has granulamtous inflam

A

Crohns

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79
Q

what is GORDS

A

prolonged or recurrent reflux of gastric contents into oesophagus

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80
Q

pathophysiology of GORDS

A

LOS loses tone and increased freq of LOS transient relaxations and so gastric contents reflux into oesophagus - prolonged contact with LO mucosa (has greaer sensitivity to gastric acid and decreased clearance

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81
Q

causes of GORDS

A 
pregnancy (increased abdo pressure)
decrease in pressure of LOS - LOS hypotension
LOS dysfunction
antireflux mechanism impairment - hiatus hernias
slow gastric emptying
drugs - nitrates, tricyclics, 
gastric acid hypersecretion
alcohol 
smoking 
overeating - spicy foods
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82
Q

what is a cause of antireflux mechanism impairment

A

hiatus hernia

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83
Q

drugs that cause GORDS

A

nitrates, tricyclics,

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84
Q

CFs of GORDS

A 
food/acid brash =- regurg
heart burn - worse lying down, hot drinks, alcohol
odynophagia - painful swallowing
chronic cough
laryngitis
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85
Q

what is characterisitc of heart burn in GORDS

A

worse on lying down, alcohol and hot drinks

86
Q

Dx of GORDS

A

oesophago-gastroduodenoscopy if red flags new onset heart burn and over 45yo
treat based on history

87
Q

alarm signs in GORDS - get oesophagogastroduodenoscopy

A 
ALARM Help!
Anaemia 
Loss of weight 
Anorexia
Rapid onset of symptoms
Melaena

Help! ( haematemesis)

88
Q

Lifestyle modifications for GORDS

A

stop smoking
less alcohol
sleep w head raised at night (extra pillow)

89
Q

Mx of GORDS

A

lifestyle mod
anatacids - alginate containing - gaviscon/rennie (magnesium trisilicate)
PPIs - omeprazole - blocks gastric acid secretion
H2 recp antagonist - rinetidine - blocks histamine recep - no acid release

90
Q

complications of GORDS

A

BARRETTS OESOPHAGUS
peptic stricture
premalig for adenocarcinoma

91
Q

e.g of a h2 recp anatagonist used in GORDS

A

rinetidine

92
Q

e.g of PPI used in gords

A

omeprazole

93
Q

e.g of anatacids used in gords and SE

A

magnesium trisilicate - Mg and Al
SE- Mg = diarr
Al= constip
(gavison, rennies)

94
Q

how does an antacid work in gords

A

forms a protective foam layer over the gastric contents

95
Q

what is a peptic ulcer

A

a break in superficial epithelial cells pentrating down to the muscualris mucosa of the stomach or duodenum
assos with chronic gastritis
>5mm in diameter

96
Q

what do fovela cells secrete and where

A

mucous in cardia

97
Q

what do parietal cells secrete n where

A

HCl (H+) in the fundus and body

98
Q

what do chief cells secrete and where

A

pepsinogen in the body and fundus

99
Q

what do g cells secrete and where

A

gastrin in duodenum and pancreas

100
Q

what does gastrin do

A

stimulate parietal cells to secrete HCL

101
Q

what does brunner glands in duodenum do

A

secrete mucus rich in bicarb to prevent self digestion from acid

102
Q

what do prostaglandins do

A

stim mucous and bicarb

vasodilate BV nearby increasing blood flow promoting epithelial cell growth and inhib acid secretion

103
Q

what is the cause of peptic ulcer disease

A 
HELIOBACTER PYLORI
NSAIDS
smoking
alcohol
mucosal ischaemia
104
Q

how does H. pylori cause peptic ulcers

A

colonizes the gastric antrum mucosa and increases gastric acid secretion and decreases duodenal bicarb secretion
produces ammonia so able to survive the acidic conditions
lives in crypts next to acid sensors and alters feedback mechanisms = XS acid produced
causes localised inflam

105
Q

why do NSAIDs cause peptic ulcers

A

inhib COX1 which reduces prostaglandin synthesis

106
Q

why does a decrease in prostaglandin synthesis mean peptic ulcers form

A

postaglandins inhibit ECL and so decreases histamine production. less HCl from parietal cells.
less prostaglandin therefore = more HCl

107
Q

why does smoking cause PUD

A

decrease prostaglanding synth which is a mucosal protective

108
Q

why does mucosal ischaemia cause PUD

A

less mucin so less protection = mucosa damaged causing an ulcer
(due to atherosclerosis)

109
Q

symptoms of PUD

A 
epigastric pain - Gastric ulcers = worse on eating hence weight loss
duodenal ulcers = improves on eating 
N and V
bloating
haematemesis and melaena
dyspepsia (indigestion)
heart burn 
aneamia symptoms - fatigue,m dizziness
110
Q

complications of Duodenal ulcers

A

perforation - peritonitis
haemorrhage
gastric outlet obstruction

111
Q

which type of ulcers is worse on eating

A

gastic - hence weight loss

duodenal relieved

112
Q

diagnosis of peptic ulcers

A

H PYLORI BREATH TEST - urea breath - C13
endoscopy
stool antigen test - H. Pylori
bloods - FBC (anaemia)

113
Q

explain how to test for H. pylori as cause of Peptic ulcers

A

H. pylori breath test = positive = urea breath
H. pylori converts urea to ammonia and co2. as it secretes urease
use C 13
stool antigen test also
rapid urease test on a stomach biopsy

114
Q

specific clinical features of duodenal ulcers

A

epigastric pain 2-5hrs after eating - radiate to back in panreas affected
more common

115
Q

specific clin features of gastric ulcers

A

epigastic pain 1-2 hrs after eating

haematesis or melaena

116
Q

signs of PUD

A

melaena
haematesis
epigastic tenderness

117
Q

Mx of PUD

A 
lifestyle
eradicate cause (H. pylori - using triple therapy - (PPI + Amoxicillin + Clarithromycin)
PPIs - omeprazole
h2 recep antagonists - rantidine
STOP NSAIDS
118
Q

how treat PUD if H pylori the cause

A

triple therapy =

PPI + amoxicillin + clarithromycin

119
Q

what PPI use in PUD

A

omeprazole

120
Q

what is coeliac disease

A

gluten sensitive enteropathy

= t cell mediated condition in response to prolamin == malabsoption

121
Q

what does coeliac disease result in histologically

A

villous atrophy
crypt hyperplasia
intraepithelial lymphocytosis (increased lymphocytes in lamina propria)

122
Q

causes of coeliac disease

A

genetic - HLA DQ2 or DQ8

123
Q

HLAs assoc with coeliac disease

A

HLA DQ2 or DQ8

124
Q

what is it that triggers the immune response in coeliac disease

A

gliaden = toxic component in gluten resistent to digestion by pepsin and chymotypsin so remains in intestinal lumen

125
Q

what happens to gliaden in the gut

A

gliaden peptides pass through epithelium via TFR receptor and get DEAMINATED by TISSUE TRANSGLUTAMINASE (increases immunicity)
they bind to antigen presenting cells and interact w CD4+ cells via HLA class 2 molecules
produces pro inflam cytokines (INF-gamma, TNF)
B cells secrete anti EMAs anti gliadin and anti itTG
activates T nat killer cells causing villous atrophy
gaps in epithelial cells widen = more gliadin IN

126
Q

what antibodies on serology for coeliac

A 
IgA tTG (tissue transglutaminase)
IgA EMA (anti-endomysial antibodies)
127
Q

what found on bloods of coeliac disease

A

anaemia (folate and iron defic)

128
Q

how to Dx coeliac

A

serology - IgA tTG, anti-endomysial antibodies
intestinal biopsy
HLA typing - HLA DQ2 or DQ8

129
Q

symptoms of Coeliac

A

diarrhoea/ constip and steatorrhoea
WL
X to thrive in children
fatigue

130
Q

signs of coeliac

A

mouthulcers, angular stomatitis, abdo distenstion

131
Q

complication of coelica

A 
dermatitis herpeti formis = skin rash due to antibodies
Iron deficiency anaemia
osteoporosis
vit deficiency (vit D, ADEK, iron)
MALIGNANCY (small bowel lymphoma..)
132
Q

what is dermatitis herpeti formis

A

skin rash die to antibodies found in coeliac disease

133
Q

how to treat coeliac

A

strict gluten free diet
monitor complications
i.e DEXA scan for osteoporeosis
vit supplements

134
Q

what causes acute appendicitis

A

obstruction by a faecalith

135
Q

Cfs of appendicitis

A

central periumbilical pain radiating to R iliac fossa
ANOREXIA
N&V
rebound tenderness and muscle guarding in RIF
diarrhoea
tender mass if appendix abbsess
R shoulder pain if diaphragm irritation

136
Q

where is the pain in appendicitis

A

central periumbilical radiating to RIF

R shoulder pain if diaphragm irritation

137
Q

what is the point of abdo pain called in appendicitis

A

Mcburneys point (REBOUND = pain)

138
Q

why do you get abdo pain in appendicitis

A

increased pressure in appendix due to faecalith plug but mucus production still continues.
enlarges and presses on visceral nerve fibres

139
Q

why do u get a fever in appendicitis

A

appendix obstructed by faecalith
stasis causes bacterial overgrowth (e.coli)
increaseing WBC and pus accumulates causing a fever

140
Q

patho of ischaemia in appendicitus

A

faecalith blockage
stasis
bacterial overgrowth- WBC and pus increases pressure further
compromises blood supply and therfeore no oxygen = ischaemia

141
Q

how can appendicitis lead to peritonitis

A

iscahemia of appendix wall = weakens = prone to rupture
releasing bacteria into peritoneum
=rebound tenderness and abdo guarding

142
Q

Dx of appendicitis

A

clin exam
bloods - increased WBC, increase C reactive protein, ESR
CT and US

143
Q

Mx of appendicitus

A

appendectomy

ABX (IV Metronidazole + cefuroxime)

144
Q

CI of appendicectomy

A

IBD involving the caecum

145
Q

what causes gastroenteritis (general)

A 
viral
bacterial
parasitic
fungal
antibiotic assos
146
Q

viral causes of infective diarr

A

rotavirus (children)
norovirus (winter vomiting, carehomes)
adenovirus

147
Q

bacterial causes of infective diarr

A

campylobacter jejuni,
E. coli,
Salmonella (animals),
shigella (blood)

148
Q

parasitic cause of infective diarr

A

Giardia lamblia (travel history)

149
Q

fungal cause of infective diarr

A

histoplasmosis

150
Q

antibiotic assoc infective diarr causes

A

(= C DIFFICILE)
ciprofloxacin
clindamycin

151
Q

RF for gastroenteritis

A

forgein travel
poor hygiene
over crowding
new/diff foods

152
Q

who is at risk for gasteroentertisi

A 
immunosuppresed
young
old
decreased gastric acid secretion
travellers
153
Q

clinical features of infective diarrhoea

A 
blood in stool (=suggests bacterial)
vomiting
fever
fatigue
headache
muscle pains
154
Q

Diagnosis of infective diarrhoea

A

history (eating habits, occupation, travel)
stool culture
C. diff assay
chronic = sigmoidoscopy

155
Q

Mx of gastroenteritis

A

rehydration
antibiotics (empirical) for infective
antimobility (loperamide)
life style = wash hands,exclude from work etc

156
Q

what is C difficile

A

gram positive spore forming anaerobic bacteria ingested faeco orally

157
Q

what causes C. diff assos diarhoea

A

broad spec antibiotics

158
Q

RFs for C diff assos diarrhoea

A 
age and co morbidities, 
ABX
PPIs
long HOSPITAL admission
NG tube fed
immunocomp
159
Q

pathology of C. diff assos diarrhoea

A

colonises stool then to patient (asympt)
when normal colonic microbiota is altered by ABX
environ then favours proliferation
inflamed and ulcerated and a pseudo membrane on endoscopy (inflam exudate)

160
Q

what see on endoscopy of C diff ass diarrhoea

A

pseudo membrane

161
Q

abx assos with C diff diarrhoea

A 
rule of "C"
Clindamycin
ciprofloxacin
cephalosporins
ciprofloxacin
co-amoxiclav
162
Q

how to diagnose C diff diarrhoea

A

stool sample - toxin A or B

163
Q

clin features of C diff diarrhoea

A

abdo pain and watery stools

collitis

164
Q

what conditions make up ischaemia of the colon

A

acute mesenteric
chronic mesenteria
ischaemic colitis

165
Q

what is the pathophysic behind acute mesenteric ischaemia

A

low flow in the superior mesentery artery

166
Q

causes of acute mesenteric ischaemia

A

SMA thrombosis or embolism (AF)
mesenteric vein thrombosis
non occlusive diesease ( i.e low flow and poor cardiac output)

167
Q

CFs of acute mesenteric ischaemia

A

acute severe abdo out of proportion with signs

rapid hypovolaemia – shock

168
Q

Dx of acute mesenteric ischaemia

A

ABG - metabolic acidosis and high lactate (due to intestinal hypoxia - increased lactic acid)
Bloods - Leukocytosis
laparotomy- cut into abdo wall = diagnosis

169
Q

Mx of acute mesenteric ischaemia

A

surgery - remove dead bowel
fluid resus
antibiotics - IV gentamicin, IV metronidazole
IV heparin to reduce clotting

170
Q

Complications of acute mesenteric ischaemia

A

septic peritonitis

systemic inflamm response syndrome (SIRS)

171
Q

what is systemic inflam response syndrome

A

multiple organ dysfunction syndrome mediated by bacteria translocation across dying gut wall

172
Q

pathophysiology of acute mesenteric ishaemia

A 
sudden interuption of SMA 
intestinal hypoxia (metabolic acidosis due to increase lactic acid)
haemorrhagic infarction and necrosis
disrupts mucosal barrier +perforation
bacteria and toxins, ROS released
sepsis
Systemic inflam response sydrome
173
Q

what is ischaemic colitis

A

low flow in inferior mesenteric artery resulting in ischaemia of the colon

174
Q

Cx of ischaemic colitis

A

low flow in IMA underlying atherosclerosis and vessel obstruction

175
Q

Rf of ischaemic colitis

A

cotraceptive pill
thrombophillia
vasculitis
nicorandil drug

176
Q

Cfs of ischaemic colitis

A

BLOODY diarrhoea

LLQ pain

177
Q

complications of ischaemic colitis

A

perforation
sepsis
peritonitis

178
Q

Dx of ischaemic colitis

A

colonoscopy (when recovered to exlcu strictures)
urgent CT to excl perforation
barium enema - thumb printing of submucosal swelling at splenic flexure

179
Q

Mx of ischaemic colitis

A

conservative

if gangrenous - resus and bowel resection (peritonitis and hypovolaeimic shock)

180
Q

what is gastritis

A

inflamm assos with mucosal injury

181
Q

what protective mechanism to gastric cells have in the stomach

A

secrete mucin to protect from low pH in stomach

182
Q

Cx of gastritis main one

A

Heliobacter pylori infection

183
Q

causes of gastritis (detailed)

A

H. pylori
autoimmune gastritis (vs parietal cells and IF = pernicious aneamia)
duodenogastric reflux - bile salts enter and damage mucin production)
granulomas (crohns, sarcoidosis)
viruses - herpes simplex
mucosal ischaemia ( low blood supply less mucins = more acid)
chemical - NSAIDs aspirin alcohol ( inhib prostaglandins which stim mucous production)

184
Q

causes of gastritis menumonic form

A 
DRAG HIV
Drugs (NSAIDs, aspirin, alcohol)
Reflux (duodenogastric)
Autoimmune
Granuloma (crohns)

H pylor
Ischaemia of mucosa
Virus (herpes simplex)

185
Q

Cfs of gastritis

A

N+V
abdo bloat
haematemesis

186
Q

Prevention of gastritis

A

PPIs alongside NSAIDs ( to prevent bleeding from actue stress ulcers and gastritis

187
Q

Tx of gastritis

A

etradicate h pylori if positive - triple therapy (PPI and 2 of metronidazole, bismuth, amoxicillin, tetracycline)
decrease stress
remove Cx agents
PPI or H2 receptor antagonists

188
Q

complications of H pylor gastitis infection

A

GASTRIC CANCER
peptic ulcers
inflam and metaplasia

189
Q

Dx of gastritis

A

endoscopy

biopsy

190
Q

DDx of gastritis

A

GORDs
peptic ulcer disease
gastric carcinoma

191
Q

how to confirm cause of gastritis is H. pylor

A

urea breath test

foeacal antigen test

192
Q

how does H pylori cause gastritis

A

colonises mucous layer in gastric antrum
adhers to epithelial cells in gastric pits under MUCOUS LAYER SO PROTECTED
damages by enzyme release -
urease converts urea to ammonium = toxic to gastric mucosa so less mucous produced
chem mediators produced = induce inflam = ulcers and more acid

193
Q

why can H pylori survive in stomach

A

adherres to epithelium UNDER mucus layer so is protected

194
Q

what is a hernia

A

protrusion of organ or tissue out of the body cavity it normally lies

195
Q

Causes of hernias

A 
muscle weakness (age trauma)
body strain - pregnancy contsipation heavy lifting, chronic cough
196
Q

what is an inguinal herna

A

protusion through the inguinal canal

197
Q

2 types of inguinal hernia and the difference

A

indirect and direct
direct = MEDIAL to inferior epigastric vessels
indirect = LATERAL to inferior epigastric vessels and protrudes through the INTERNAL INGUINAL RING (follows spermatic cords path)

198
Q

which hernia can go to the scrotum

A

indirect inguinal hernia

199
Q

which hernia lies LATERAL to inferior epigastric vessels

A

indirect

200
Q

which hernia lies medical to inferior epigastric vessels

A

direct

201
Q

CFs of an inguinal hernia

A

visible lump

pain/ache on exertion

202
Q

Mx of inguinal hernia

A

surgery

203
Q

Rfs of inguinal hernais

A

male smoker,

history of hernias (weak abdo wall)

204
Q

2 types of hernias

A

hiatus and inguinal

205
Q

what is a hiatus hernia

A

part of the stomach herniates through the oesohphageal hiatus of the diaphragm

206
Q

2 types of hiatus hernai

A

rolling and sliding

207
Q

what is a sliding hiatus hernia

A

gastro oesophageal junction slides up into the chest

get gastric acid reflux as LOS less competent

208
Q

what is a rolling hernia

A

gastro oesopheal junction remains in the abdo but bulge of stomach herniates into chest alongside oesophagus = still intact hence no gross acid reflux

209
Q

which hernia causes acid reflux and why

A

sliding hiatus hernia - gastro - oesp junction slides up into chest so LOS less competent
rolling, it remains in the abdo below diaphragm

210
Q

in which hiatus hernia does the gastro oespho junction remain below the diaphragm

A

rolling

211
Q

CFs of hiatus hernias

A

rolling - none as no reflux, pain if severe due to strangulation
sliding - acid reflux

2a RRS (26 decks)

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