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)