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Kofi: Pure Clinical Sem 3 > GI: Abdominal Catastrophes > Flashcards

GI: Abdominal Catastrophes Flashcards

1
Q

What is clinical presentation of an AAA?

A
  • Sudden death
  • Sudden onset of severe abdominal and back/loin pain
  • Sudden collapse
  • Presents to the emergency department with shock. 83% mortality. Most patient die of multi-organ failure on the ITU
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2
Q

What are 2 common types of inflammatory bowel disease?

A
  • Crohn’s disease

- Ulcerative colitis

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3
Q

What are the gross pathological features of Crohn’s disease?

A
  • Affects anywhere in the GI tract. Ileum in most cases
  • Skip lesions
  • Cobblestone appearance
  • Transmural inflammation
  • Fistulae
  • Mucosal oedema
  • Discrete superficial ulcers
  • Thickening of bowel wall
  • Narrowing of lumen
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4
Q

What are the gross pathological features features of ulcerative colitis?

A
  • Begins in rectum
  • Can extend to involve entire colon
  • Continuous pattern
  • Mucosal inflammation
  • Loss of haustra
  • Pseudopolyps
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5
Q

What are the causes of intestinal inflammation and infection?

A
  • Genetic
  • Gut organism
  • Immune response (Triggered by Antibiotics, Infections, Diet, Smoking)
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6
Q

What is the presentation of Crohn’s disease?

A
  • Weight loss
  • Right lower quadrant pain
  • Joint pains
  • Young patient
  • Tender mass
  • Mild perianal inflammation/ulceration
  • Low grade fever
  • Mildly anaemic
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7
Q

What is the presentation of Ulcerative Colitis?

A
  • Bloody stool
  • Mucus in stool
  • Weight loss
  • Mild lower abdominal pain/cramping
  • Painful red eye
  • Mildly tender abdomen
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8
Q

What are microscopic features of Crohn’s disease?

A

-Granuloma formation

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9
Q

How is Crohn’s disease investigated?

A
  • Bloods (Anaemia)
  • CT/MRI scans (Bowel wall thickening, Obstruction, Extramural problems)
  • Barium enema/follow through (Used less, Strictures/fistulae, Colonoscopy)
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10
Q

What are microscopic features of Ulcerative colitis?

A
  • Crypt abscesses
  • Crypt distortion
  • Goblet cells
  • Chronic inflammatory infiltrate of lamina propria
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11
Q

How is ulcerative colitis investigated?

A
  • Stool cultures
  • CT/MRI – less useful in diagnosing uncomplicated UC
  • Plain abdominal radiographs
  • Bloods (Anaemia, Serum markers)
  • Barium enema (mild cases only)
  • Colonoscopy
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12
Q

What are radiological features of Crohn’s and Ulcerative Colitis?

A

Crohn’s
-String sign of cantor. Normal size lumen that becomes thinner due to strictures

Ulcerative colitis

  • Lots of ulceration between contrast
  • Loss of haustra leading to featureless colon. Lead pipe colon
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13
Q

What are the medical treatment options of inflammatory bowel diseases?

A
  • Aminosalicylates
  • Corticosteroids
  • Immunomodulators
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14
Q

What are the surgical treatment options of inflammatory bowel diseases?

A

Crohn’s

  • Not curative
  • Strictures/fistulae
  • As little bowel removed as possible

Ulcerative colitis

  • Curable (colectomy)
  • Inflammation not settling
  • Pre-cancerous changes
  • Toxic megacolon
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15
Q

What are the symptoms of peritonitis?

A
  • Severe pain all over abdomen which may refer to the shoulder tips
  • Rigid abdomen as diaphragmatic and abdominal wall movement greatly increases pain.
  • Shallow rapid breathing
  • Very tender on examination of abdomen
  • Rebound tenderness may occur in early stages
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16
Q

Describe the common life threatening events occurring in the abdominal cavity

A

Blood loss

  • Into the gut
  • Into the retro-peritoneum (AAA, patients on anticoagulants may bleed from torn retroperitoneal veins)
  • Into the peritoneal cavity

Perforation of a viscus
-Allows the outside world to enter the peritoneal cavity causing inflammation, hypovolaemia and sepsis

Autodigestion of the retroperitoneum due to acute pancreatitis

Acute cholangitis

Acute gut ischaemia

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17
Q

What is the clinical presentation of bowel perforation?

A
  • Severe generalised abdominal pain
  • Patient lies still, shallow breathing
  • Patients will be hypovolemic
  • Patient may be septic

Symptoms of peritonitis

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18
Q

What is the clinical presentation of bowel ischaemia?

A
  • Severe abdominal pain
  • Tender over ischaemic gut
  • Becomes rapidly toxic and hypotensive
  • Very high white cell count
19
Q

What is the clinical presentation of pancreatitis?

A
  • Significant dehydration due to vomiting and fluid sequestration in retroperitoneum
  • Raised serum amylase
20
Q

What is the clinical presentation of cholangitis?

A 
Charcots triad
-Jaundice
-Fever
-Right upper quadrant pain
May also have Reynold pentad
-Hypotension 
-Confusion
-Rigors
21
Q

How can a patient with cholangitis develop Septic Shock?

A

May develop septic shock due to the bile duct being blocked by bacteria. This leads to canaliculi backing up into the central vein and this is a huge area of contact between the infected area and the blood.

22
Q

What is the underlying pathology in relation to abdominal aortic aneurysm?

A

-Sudden Blood loss

23
Q

What is the underlying pathology in relation to bowel perforation?

A
  • Perforated peptic ulcer can leads to chemical peritonitis. 10% mortality
  • Perforated diverticular disease can lead to peritoneal sepsis and septicaemia. 50% mortality
  • Posterior perforation of gastric ulcer initially allows gastric contents to enter the lesser sac. Thereafter the fluid can track into the greater sac via the epiploic foramen.
  • Faecal peritonitis can occur with perforation of large bowel
24
Q

What is the underlying pathology in relation to bowel ischaemia?

A

-Embolism (atrial fibrillation)

25
Q

What is the clinical presentation of bleeding oesophageal varices?

A
  • Haematemesis

- Malaena

26
Q

What is the clinical presentation of bleeding peptic ulcer disease?

A
  • Haematemesis

- Malaena

27
Q

What is the clinical presentation of bleeding diverticular disease?

A

-Bright red bleeding per rectum (haematochezia)

28
Q

What is malaena?

A
  • Melaena is due to alteration of blood by digestive enzymes and can occur with bleeding from anywhere from the mouth to caecum
  • Patients taking oral iron can have black stools. The smell reveals the difference
29
Q

What is haematemesis?

A

Vomiting blood

30
Q

What is the significance of urea measurement for GI bleeds?

A
  • Bleeding from the stomach or oesophagus presents with a large protein meal to the small bowel.
  • The protein is converted by the liver into urea.
  • Rise in blood urea in patient with oesophageal/gastric bleeding will help indicate (if the creatinine is normal) source of bleeding and size of the bleed
31
Q

Describe an clinical approach, with regard to history, examination and investigation of a patient presenting with gastroenteritis

A
  • History
  • Physical examination of hydration status
  • Abdominal examination
  • Take appropriate samples and request right test
32
Q

What is the main example of a viral cause of gastroenteritis?

A
  • Norovirus
  • Peak incidence in the winter and affects all ages
  • Immunity is short-lived and reinfections can occur
  • Resits freeing, disinfection with alcohol and temperature up to 60 C
33
Q

How is norovirus transmitted?

A
  • Faeco-oral person to person transmission
  • 24 hour incubation period
  • Viral particles shed in stool and vomit and fomites can contaminate environment
34
Q

What is route of infection for shigella infection?

A
  • Faecal oral route

- Direct person to person

35
Q

Describe Shigella.

A
  • Gram negative facultative anaerobic
  • Rod shaped
  • Non-spore forming
  • Non motile
36
Q

What are the virulence factors of Shigella?

A
  • Plasmid

- Shinga toxin (exotoxin)

37
Q

How does shigella cause diarrhoea?

A
  • Enters the interstitial epithelial cells by endocytosis
  • Escapes from the endocytic vesicle and multiplies inside the cell
  • Mucosal abscesses from leading to cell death and this results in diarrhoea with blood and mucus
38
Q

Describe the key features of Cryptosporidium

A

-Microscopic parasite

39
Q

What is the route of infection for cryptosporidium?

A

-Faecal oral route

40
Q

How can salmonella cause

A
  • Salmonella invade epithelial cells of the small intestine.
  • Disease may remain localized or become systemic, sometimes with disseminated foci.
  • The organisms are facultative, intracellular parasites that survive in phagocytic cells
41
Q

Describe salmonella

A
  • Gram negative baccili
  • Spore forming
  • Motile
42
Q

What are some virulence factors of salmonella?

A
  • Endotoxins

- Fimbraie

43
Q

Recognise and describe the importance of infection prevention and infection
control measures with regard to GI infections

A
  • Handwashing
  • Isolation
  • Environmental cleaning
  • 48 hour rule especially for healthcare professional, childcare, schools and food handlers
44
Q

How are GI infections treated?

A
  • Fluid resuscitation
  • Antibiotics if immunocompromised
  • Treatment of underlying conditions

Kofi: Pure Clinical Sem 3 (44 decks)

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