GI Disease Flashcards
Dysphagia
difficulty swallowing
caused by compression, GORD, parkinsons, lumps
GORD stands for
gastro-oesophageal reflux disorder
GORD symptoms
epigastric burning, worse lying down, dysphagia, GI bleexing, severe pain mimicking MI
GORD management
smoking cessation, stop excess coffee drinking, lose weight, avoid triggers, take antacids/H2
Hiatus hernia
part of stomach squeezes up into chest through opening in diaphragm
symptoms similar to GORD
medications to eliminate GI acid
antacid [rennies]
medications to reduce GI acid secretion
H2 receptor blockers, proton pump inhibitors
H2 receptor agonists
reduce acid production by preventing histammine activation of acid production
cimetidine
proton pump inhibitors
prevents action of acid secretion
omeprazole
peptic ulcer disease
discontinuationinner lining of GI tract due to gastric acid secretion or pepsin
aetiology of peptic ulcer disease
high acid secretion not neutralised, normal acid secretion without defence, drugs [NSAIDs]
helicobacter pylori
H.pylori + peptic ulcer disease
bacteria causing PUD. loss of mucus barrier, allowing acid to cause ulceration in gastric wall
signs/symptoms of PUD
asymptomatic, epigastric burning pain worse at meals/night
found with complications like bleeding
effects of PUD
inflammation of gastric mucosa, gastric ulcers, irritation, lymphoma
investigations for PUD
endoscopy, radiology barium meal, anaemia test, h.pylori test
complications of PUD
perforation in peritoneum, haemorrhage, stricture, malignancy
anaemia
treatment of PUD
lifestyle changes, stom smoking, small regular meals, surgical repair, vagotomy
medication to reduce acid secretion [H2 receptor blockers, proton pump inhibitors]
eliminate h.pylori
triple therapy
elimination of H.pylori
two week course of 2 antibiotics and a proton pump inhibitor [amoxycillin/mentronidazole + omeprazole]
surgery for PUD
bilroth - exision of stomach with ulcer, anastomosis of duodenum
vagotomy - dividing small branches in vagal trunk to stomach wall, acid secretion reduced
coeliac disease
immune system attacks your own tissue when eaten gluten
sensitivity to a-gliaden component of gluten
aetiolgoy of coeliac
a-gluten passed throug bowel and developing immune response, producing antibodies involving T cell and destruction of tissue
genetic susceptibility, environmental trigger
inflammatory changes causes reduction in surface area for absorption
symptoms of coeliac
weight loss, lack of energy, weakness, abdominal pain, diarrhoea, dysphagia
malabsoprtion issues - iron, folate, vitb12, fat
investigations for coeliac
antibody test, jejunal biopsy, faecal fat [increased if malabsoprtion], haematinics [b12, folate, ferrin]
management of coeliac
gluten free diet = reversal of jejunal atrophy, improved well being, reduced risk of lymphoma
coeliac skin disease
dermatitis herpetiformis
oral disease - ulceration/blisters
pernicious anaemia
decrease in red blood cells when intestines cannot absorb VitB12 properly
aetiology of pernicious anaemia
lack of vitb12 in diet, disease of gastric parietal cells, IBS, bowel cancer
diagnosis of pernicious anaemia
blood tests, histological confirmation, Schilling test [instrinsic factor/parietal cell antibodies]
treatment of pernicious anaemia
px responsibility in diet, arrange IM injections of VitB12
effects of pernicious anaemia
problems with nerve function and bone marrow production of RBC
taken seriously or nerve damage will occur
inflammatory bowel disease
chronic inflammation of GI tract
Crohn’s + ulcerative colitis
aetiology of IBS
cause unclear, food intolerance, persistent viral infections, smoking, genetics
Ulcerative colitis
continuous disease, superficial layers of gut wall, restricted to colon, rectum always involved
Crohn’s
discontinuous disease, full thickness of bowel, anywhere in GI tract, rectum involved 50%, oedema of bowel wall
UC symptoms
diarrhoea, abominal pain, PR bleeding
crohn’s symptoms
colonic disease, small bowel disease, orofacial granulomatosis
differences in UC and Crohn’s
UC -> continuous, colon only, rectum always
Crohn’s ->discontinuous, anywhere in GI, 50% rectum
IBS investigations
blood tests, faecal calprotectin, endoscopy, leukocyte scan, barium study
IBS complications
carcinoma, risk increases with time
[more likely in UC]
IBS treatment
medical - steroids, anti-inflammatory, immunosuppressants
anti TNFs therapy
IBS surgery
colectomy - cures UC, palliates Crohns symptoms [remove obstructed bowel segments, drain abscesses, clost fitula]
results in stoma
orofacial granulomatosis
histologically identical to crohn’s
cobblestone appearance, inflammation
lip and oral swelling
bowel cancer
colonic adenocarcinoma
second msot common in western world
bowel cancer screening from age 50
bowel cancer symptoms
usually none until tumour blocks bowel and px presents with blockage, reason for poor outcome
anaemia, rectal blood loss, unexplained weight loss, extreme tiredness
bowel cancer aetiology
polyps, arise from lumen, small growth on inner lining of large intestine/rectum
most carcinomas come fromhere
will bleed due to irritation/trauma, takes 5 years to progress to malignancy, if removed before cancerous it will not develop into cancer
bowel cancer risk factors
diet [high fibre/red meat/fat low veg], smoking, genetics, lack of exercise
syndromes associated with polypsis
small intestine = Peutz-Jehgers syndrome
large intestine = Gardiner’s + Cowden’ syndrome
what classification is used for colonic cancer staging
Dukes Classification
based on level of invasion on bowel wall
bowel cancer treatment
surgery, hepatic metastases, raiotherpay, chemotherapy, surgery [stoma]
bowel cancer screening
all adults over 50, faecal immunochemical test
2 year repeat, endoscopy if positive results
