GI Flashcards
What are different types of vomiting associated with?
Haematemesis- vomiting blood from the stomach
Large volumes- intestinal obstruction
Faeculent vomit- low intestinal obstruction, gastrocolic fistula
Projectile vomit- gastric-outflow obstruction
Chronic nausea and vomiting with no abdominal symptoms- psychological
Early morning vomiting- pregnancy, alochol dependence, metabolic disorders (uraemia)
What is upper abdominal pain due to?
Peptic ulcer disease
Dyspepsia
High hypochondrial- gallbladder, hepatitis, peptic ulcer, functional bowel disorder
What is lower abdominal pain due to?
LIF- colonic (acute diverticulitis)
Gynaecological
Proctalgia
What causes abdominal wall pain?
Nerve entrapment
External hernias
Entrapment of internal viscera (ommentum)
When is oral ulceration seen?
Crohn's, UC, coeliac disease Lupus Neutropenia Immunodeficiency disorders Iron, folic acid or vitamin B12 disorders Herpes simplex Coxsackie Antimalarials, methyldopa, tolbutamide, pencillamine
What causes oral white patches?
Candida
SLE
Following antibiotics or steroid use
Alcohol and smoking (leukoplakia)
What causes xerostomia (dry mouth)?
Sjogen's Radiotherapy Psychogenic Dehydration, shock, renal failure Drugs (anticholinergic, antiparkinsonian, antihistamines, antidepressants)
What are the major oesophageal symptoms?
Dysphagia
Heartburn
Acid regurgitation
Ordynophagia
What are the causes of dysphagia?
Tonsilitis Pharyngeal disorders Bulbar palsy Motility disorders- Achalasia, Scleroderma, Oesophageal spasm, Presbyoesophagus, Diabetes, Chagas' Mediastinal glands Goitre Enlarged left atrium Foreign body Stricture Benign- peptic, corrosive Malignant- carcinoma Lower oesophageal rings Oesophageal web Pharyngeal pouch
What are the investigations for oesophageal disorders?
Barium swallow and meal
Oesophagoscopy
Manometry- (catheter passed through nose into the oesophagus and measure the pressures generated in the LOS)
pH monitoring- (used to identify reflex episodes pH <4)
Radioisotope studies- (study reflux)
Bernstein test
What is a sliding hiatus hernia?
Gastro-oesophageal junction slides through the hiatus so that it lies above the diaphragm
30% of people who are 50
Doesn’t produce symptoms
Symptoms occur because of associated reflux
What is a para-oesophageal/rolling hernia?
Small part of the funds of the stomach rolls up through the hernia alongside the oesophagus
Sphincter remains below the diaphragm and remains competent
Occasionally produces severe pain and requires surgical treatment for gastric volvulus or strangulation
What are the mechanisms behind GORD?
Transient LOS relaxations
Low resting LOS tone which fails to increase when the patient is lying flat
LOS tone fails to increase when intra-abdominal pressure is increased by tight clothing or pregnancy
Increased oesophageal mucousal sensitivity to acid
Which factors are associated with increased GORD?
Pregnancy or obesity Fat, chocolate, coffee or alcohol ingestion Large meals Cigarette smoking Drugs- anticholinergic, calcium-channel blockers, nitrates Systemic sclerosis After treatment for achalasia Hiatus hernia
What are the complications of GORD?
Peptic stricture- over 60s, intermittent dysphagia over a long period, treated by dilating the stricture
Barrett’s oesophagus- Long standing reflux, columnar epithelium with intestinal metaplasia, common in middle aged men, premalignant for adenocarcinoma
Adenocarcinoma
