GI Flashcards
Define GORD?
When prolonged reflux of the stomach contents causes two or more hearburn episodes a week
Causes of GORD?
Oesophageal sphincter hypotension, sliding hiatus hernia, abdominal obesity, gastric acid hypersecretion and overeating
S&S of GORD?
Heartburn aggravated by lying down, belching, food/acid brash, water brash, odenophagia, chronic cough
Treatment for GORD?
Weight loss/smoking cessation, Antacids (e.g. magnesium trisilicate mixture), PPIs (e.g. lansoprazole), H2-receptor antagonists (cimetidine)
What is a Mallory-Weiss Tear?
A linear mucosal tear at the oesophagogastric junction produced by a sudden increase in intra-abdominal pressure (e.g. a bought of coughing/retching) - commonly affects males/alcohlics/those with eating disorders
S&S of Mallory-Weiss Tear?
Heamatemesis after vomiting, retching, dizziness and postural hypotension
Causes of Oesophageal cancer?
Adenocarcinoma = due to Barrett’s oesophagus (GORD), squamous cancer will be higher up.
Obestiy, smoking, alcohol excess
S&S of Oesophageal cancer?
Dysphagia, hoarse voice, vomiting after eating, weight loss, appetite loss and persistant indegestion
How are cancers often staged?
TNM staging.
T = size and extent of the primary tumour (0-4)
N = number of nearby lymph nodes affected (0-3)
M = metastasized? (0=no, 1=yes)
What is Dyspepsia?
One or more of post-prandial fullness, early satation and epigastric pain/burning for more than 4 weeks.
Patients may experience reflux when lying down, heartburn, bloating and indegestion also
Causes of Peptic Ulcers?
NSAIDs - COX is needed to synthesise prostaglandins and these are what produces mucous so mucosal defence is damaged
H.Pylori - cause the destruction of teh mucin protective layer and secreate urease (is basic so will increase gastric acid production), this will eventually become ammonium in the stomach which is toxic to the mucosal cells
S&S of Peptic Ulcers?
Reccurrent burning epigastric pain (worse when hungry in duodenal ulcers), nausea, (weight loss - especially in gastric ulcers).
If the ulcer progresses to the gastroduodenal artery = massive haemorrhage.
If the ulcer progresses to the peritoneum = peritonitis
Who should you perform an endocsopy in if peptic ulcers are suspected?
The over 55s (to check for cancer), stool antigen testing may be carried out to test for H.Pylori in everyone
How do you treat H.Pylori?
One of: lansoprazole/omeprazole
Two of: amoxicillin/metronidazole/clarithromycin
What is gastritis? and what causes it?
Inflammation associated with mucosal injury.
Due to mucosal ischaemia, NSAIDs, H.Pylori, Chron’s or autoimmune disease
S&S of gastritis?
Nausea, abdominal bloating, epigastric pain and haematemesis
What is Pernicious anaemia?
Not being able to absorb B-12 due to lack of intrinsic factor (this is as a result of the immune system attacking the parietal cells)
Causes of stomach cancer?
H.pylori infection, salt rich diet, being male, gastritis, pernicious anaemia
S&S of stomach cancer?
Dyspepsia, Dysphagia, vomiting, weight loss, anaemia
What is the difference between ulcerative colitits and chron’s disease?
UC = inflammation of the colonic mucosa only which begins in the rectum and expands up in a linear manner (never occurs above the ileocoecal valve). Smoking and appendicectomy are both protective. CD = transmural inflammation affecting any part of the gut (especially the proximal colon and terminal ileum), there will be unaffected skip lesions and smoking/appendicectomy increase the risk
S&S of Ulcerative Colitis?
Left lower quadrant pain, diarrhoea at night, bloody/mucous diarrhoea, cramps, clubbing, erythra nodusum
S&S of Chron’s Disease?
Right illiac fossa pian, diarrhoea with urgency, bleeding and pain on defecation, clubbing, tender abdomen
What test may help to distingusih between UC and CD?
Look for antibodies: pANCA = positive in UC, ASCA = positive in CD
Treatment of UC?
5-ASAs (e.g. mesalazine or olsalazine), then add oral steroids (e.g. prednisolone) if not responsive. If patients still relapse give azathioprine. Surgery can also be performed (colectomy with ileoanal anastomosis)
Treatment of CD?
Steroids (budesonide in mild attacks and prednisolone in severe attacks), if not responsive induce remission with anti-TNF antibodies (e.g. infliximab). Maintain remission with azathioprine. Surgery can also be performed
What is Irritable Bowel Syndrome?
A mixed group of symptoms/changes in bowel habits for which no organic cause can be found
What are the three types of IBS?
IBS-C (with constipation), IBS-D (with diarrhoea), IBS-M (with both consitipation and diarrhoea)
S&S of IBS?
Frequent urination/nocturia, Abdominal pain relieved by defecation or associated with change in stool form/frequency, mucus in stool, back pain, fatigue
What are the three types of bowel obstruction? And name causes
Direct lumen obstruction = carcinoma, diaphragm disease, gall stone ileus
Bowel wall obstruction = Chron’s disease, diverticulitis, tumours, Hirschprung’s disease (neonates)
Outised the bowel wall = Adhesions, vulvulus, tumours
S&S of SBO vs LBO?
Pain (higher in the abdomen but less constant in SBO)
Profuse faeculent vomiting (occurs earlier in SBO)
Abdominal distension (less in SBO)
In LBO if the ileocaecal valve is competent there will be caecum perforation, if it is incompetent there will be faeculent vomiting.
Treatment for bowel obstructions?
Fluid rescuitation (patients will be severly dehydrated), bowel decompression, analgesia, antiemetics and surgery
What is pseudo-obstruction?
Rapidly progressing abdominal distension and pain not due to an obstruction (due to intra-abdominal trauma, pneumonia, intra-abdominal sepsis, opiate withdrawal etc)
What is Coeliac Disease?
A T-cell mediated autoimmune disorder in which prolamin (found in gluten) causes inflammation of the upper small bowel leading to villous atrophy and malabsorption.
What is the test for Coeliac Disease?
MUST EAT GLUTEN FOR AT LEAST 6 WEEKS BEFORE TEST!!!
Duodenal biopsy will show villous atrophy, crypt hyperplasia and increased intraepithelial white cell count
S&S of Coeliac Disease?
Smelly/fatty stools, abdominal pain, D&V, weight loss, anaemia, osteomalacia, dermatitis hepetiformis
S&S of Colorectal Cancer?
Blood/mucous in stools.
Left sided = altered bowl habits, rectal mucous/bleeding, tenesmus, bowel obstruction
Right sided = weight loss, anaemia, blood mixed with poo
What is Hereditary Non-Polyposis Colorectal Cancer?
Autosomal dominant mutation to one of the DNA repair proteins. These patients are at much higher risk of cancer and do not respond to chemotherapy as they can’t recognise damaged cells so apoptosis isn’t activated.
What is Familial Adenomatour Polyposis?
Autosomal dominant condtion where thousands of polyps develop in the gut as a teenager due to a mutation in the GSK protein. GSK normally breaks down Beta-catenin and high levels casue epithelial cell proliferation so cells become cancerous - the colon must be removed
What are haemorrhoids? and what causes them?
Disrupted and dilated anal cushion tissue caused by swollen veins around the anus. Caused by constipation with prolonged straining, congestion from pregnancy/pelvic tumours and anal intercourse
What are the types of haemorrhoids?
Internal = originate ABOVE the dentate line.
1st degree= remain in the rectum
2nd degree = prolapse through the anus but spontaneously reduce
3rd degree = prolapse but can be manually reduced
4th degree = remain prolapsed
External = origninate BELOW the dentate line, may be extremley painful due to the sensory nerve supply
S&S of haemorrhoids?
Bright red rectal bleeding that coats the stools, mucus discharge, pruitus ani, severe anaemia and changes in bowl habits
Treatment of haemorrhoids?
1st degree = stool softener and topical analgesic
2nd/3rd degree = rubber band ligation or infra red coagulation
4th degree = surgery or staples
What is an anal fistula and what causes them?
An abnormal connection between the epithelised surface of the anal canal and the skin.
It is cuased by perianal sepsis, abscesses, chron’s, TB, rectal carcinoma and diverticular disease
S&S and treatment of anal fistuals?
Pain, discharge, pruritus ani and systemic abscesses (if infected)
Treat abcesses with draining and antibiotics and perform fistulotomy/excision
What is an anal fissure and what causes them?
A tear in the skin-lined lower anal canal.
It is casued by hard faces, childbirth (anterior tear), trauma, chron’s, syphillis and herpes
S&S and treatment of anal fissures?
Extreme pain and bleeding on defecation.
Treat with GTN ointment, topical diltiazem, increasig fluid/fibre intake and botox/surgery
What is the difference between a Perianal and a Pilonidal abscess?
A perianal abscess is found near the anus and is caused by anal sex.
A pilonidal abscess is found in the skin in the natal cleft caused by a hair follicle becoming stuck in the skin.
What causes appendicitis?
A blockage of the appendix e.g. due to faeces, a foreign body, cancer or infection
S&S of appendicits?
Preumbillical pain which will localise to the right illiac fossa (McBurney’s point), anorexia, constipation and Rovsing’s sign - CRP IS RAISED
What is diverticular disease/diverticulitis?
DIverticular disease is when a lack of fibre in the diet causes the mucosal lining of the gut to herniate through the diverticula (outpouchings in the gut wall for the blood vessels to go through).
If this becomes inflammaed/infected it will be diverticulitis.
What blood vessels supply the colon and what are the watershed areas?
The inferior and superior mesenteric arteries supply the colon. Watershed areas are areas with dual blood supply from the distal vessels and are the splenic flexure and caecum. These are most susceptible to ischaemia in systemic hypoperfusion.
What causes acute mesenteric ischaemia?
SMA thrombosis/embolism, mesenteric vein thrombosis and non-occlusive disease
S&S of acute mesenteric ischaemia?
Acute severe central/right iliac fossa abdominal pain, no abdominal signs, rapid hypovolaemia leading to shock (pale skin, weak pulse, reduced urine output and confusion)
NORMALLY AFFECTS THE SMALL BOWEL
What are the causes of Ischaemic Colitis (chronic colionic ischaemia)?
IMA thrombosis/embolism, vasculitis, surgery, coagulation disorders, drugs such as oestrogen/vasopressin
S&S of ischaemic colitis?
Sudden onset lower left side abdominal pain, passage of bright red blood with or without diarrhoea, shock (pale skin, weak pulse, reduced urine output and confusion)
What is gangrenous ischaemic colitis?
A complication of ischaemic colitis presenting wit peritonitits and hypovolaemic shock. It requires prompt resucitiation followed by surgical resection of the affected bowel - has a very high mortality rate.
Treatment for oesophageal cancer?
Stage 1-3 = oesophagectomy, chemotherapy and radiotherapy
Stage 4 = palliative chemotherapy and radiotherapy
Treatment for dyspepsia?
Reassurance, dietary review and antidepressants such as citalopram to reduce gullet sensitivity
Causes of oesophago-gastric varices?
Thrombosis in the portal/splenic vein (pre-hepatic)
Cirrhosis, Schistosomiasis, sarcoidosis and conjenital hepatic fibrosis (intra-hepatic)
Budd-Chiari syndrome, Right heart failure and constrictive pericarditis (post-hepatic)
S&S of a ruptured varices
Heamatemesis, abdominal pain, shock, fresh rectal bleeding, hypotension, tachycardia and pallor
Treatment of rupture varices
Blood/vitamin K/platelet transfusion, terlipressin (causes vasoconstriction), prophylaxis antibiotic and variceal banding
What is Achalasia?
Failure of the lower oesophageal sphincter to relax upon swallowing due to the degeneration of the mesenteric plexus of the oesophagus.
S&S of achalasia?
Dysphagia of fluids and solids, regurgitation of food at night, substernal cramps, spontaneous chest pain and slight weight loss
Treatment for achalasia?
There is no cure.
Nifedipine/nitrates can help to relax the LOS.
Heller’s cardiomyotomy followed by PPIs
Botox injections
Tests for swallowing problems?
Chest x-ray, barium swallow and manometry
How does scleroderma affect swallowing?
Oesophageal smooth muscle is replaced with fibrous tissues leading to reduced oesophageal clearance leads to dysphagia. LOS pressure is also decreased so can lead to GORD/heartburn
Name 2 H2 antagonists and explain how they can assist the treatment of peptic ulcers?
Ranitidine and Cimetidine. These reduce acid release in the stomach by blocking histamine from stimulating the parietal cells
What is gastropathy? and what causes it?
Epithelial cell damage and regeneration WITHOUT inflammation - it is generally due to NSAIDS
Treatment for stomach cancer?
Gastrectomy (partial or total), endoscopic mucosal resection and combination chemotherapy
Causes of SBO?
Adhesions (in the devloped world), hernia (in the developing world), malignancy and chron’s
Causes of LBO?
Colorectal malignancy and volvulus
Causes of colorectal cancer?
> 50, smoking, alcohol, red meat rich diet, polyposis, HNPCC, UC and Coeliac’s
What is Duke’s staging of colorectal cancer?
A = growing in teh inner most bowel lining/slight pretrusion into the muscle wall B = grown through the muscle wall C = spread to at least 1 lymph node near the bowel D = spread somewhere else in the body
Treating colorectal cancer?
Adenoma = endoscopic resection
Colorectal adenocarcinoma = surgical resection
Metastatic = palliative chemo
What is Tropical Sprue?
Severe malabsorption (of 2 or more substances) accompanied by diarrhoea and malnutrition/weight loss.
How can you tell between Tropical Sprue and Coeliac’s on biopsy?
The jejunum mucosa in Tropical Sprue will have partial villous atrophy where as in Coeliac’s it will be full villous atrophy
Treatment of infected Perianal/Pilonidal Abseces?
Both may become infected resulting in pain and discharge so should be treated with excision, drainage and antibiotics.
Treatment for Acute mesenteric ischaemia?
Fluid resucitation, antibiotics, IV heparin and surgery to remove dead bowel
What are complications ofacute mesenteric ischaemia?
Septic peritonitis and systemic inflammatory response syndrome
Treatment for ischaemic colitis?
Fluid replacement and anitibiotics
