GI Disorders (Tutorial) Flashcards
Can a person survive without their stomach and with no support?
Yes
What is the surgery to remove the entirety of the stomach called? How is it done?
Why can we live without a stomach?
Total gastrectomy
Because no absorption occurs in the stomach
Can a person survive without their small bowel and without support?
No
What is the minimum number of cm a person needs of small bowel before they require support?
Required length varies - generally about 150-200 cm (given that their large bowel is fully intact)
Without a large bowel = at least 2m of small intestine needs to be preserved
What is short bowel syndrome? (SBS)
What are the physiological problems associated with SBS?
A symptom complex which occurs in adults who have <200 cm of combined jejunum-ileum
SBS = less absorption of nutrients. Therefore, lack of absorption of food and nutrients = malnourishment, diarrhoea
Can a person live without their large bowel and without support?
Yes
Describe what is meant by each of these terms below:
Haemorrhagic gastritis: haemorrhagic = bleeding, gastritis = inflammation of the stomach
Oesophageal varices = enlarged veins in the oesophagus, often due to obstructed blood flow through the portal vein (coming from the pancreas, intestines and spleen to the liver)
Mallory-Weiss tear = tear at the gastroesophageal junction, often results in severe bleeding, common in elderly women esp.
Meckel’s diverticulum = from embryology, during development the beginning and end of the gut join together un-aligned, forming a small pouch at the end of the small intestine that can get inflammed
Ischaemic small bowel = clot in the vessel supplying the small bowel with blood
Intussuception = common in kids, polyp stuck to gut wall induces peristalsis mechanism to the point where the polyp along with the wall is forced along the GI tract
Colonic cancer = cancer in the colon
Rectosigmoid cancer = cancer in the sigmoid or rectum
Diverticulitis = inflammation of the abnormal pouch in the intestine
Inflammatory bowel disease = chronic inflammation of the digestive tract
Angiodysplasia = small vascular malformation of the gut, more common in the small bowel
Duodenal ulcer = ulcer in the duodenum
Anal fissure = tear or ulcer that develops in the large intestine, near the anus
Haemorrhoids = also known as Piles, swellings containing enlarged blood vessels that are found inside the rectum or anus
Gastric ulcer = open sores (ulcers) that develop on the lining of the stomach
Fill in the blank labels on the diagram below:
Case 1: (info card)
Mr Floyd Pepper, a previously fit and well 67-year old man, has presented with sudden onset of massive bright red bleeding per rectum (PR). He also reports colicky abdominal pain. On clinical examination he is cold and clammy to the touch, tachycardic (pulse 140bpm), and hypotensive (BP 80/40 mmHg).
What immediate management should be instigated on Mr Pepper?
Check ABC:
A = airways
B = breathing
C = circulation
What questions could be asked to Mr Pepper to help establish a diagnosis?
Where is the bleeding coming from? is the ultimate question - can be investigated by asking:
Have you had any weightloss? - e.g. colonic cancer
Do you have diarrhoea? Or constipation? e.g. colonic cancer
What is your lifestyle?
Do you drink too much?
Have you even had angiodysplasia?
Have you had any GI disorders in the past?
Have you been abroad recently? - e.g. gastroenteritis
Do you have any epigastric pain? - e.g. ulcer
Do you smoke? e.g. ischaemia
Do you have high BP? e.g. ischaemia
Do you have an cardiovascular issues / have had any in the past? e.g. ischaemia
Do you have anaemia?
What are the commonest causes of massive PR bleeding (as opposed to low volume bright red bleeding)?
PR bleeding = rectal bleeding
Oesophageal varices, duodenal ulcers, diverticulitis, angiodysplasia (bleed extremely badly, difficult to control)
What investigations could be requested to find the source of the bleeding?
How can the bleeding be treated?
What is the last line of treatment, if the source of the bleeding cannot be found?
Endoscopies - require both, colonoscopy or the one from the mouth (OGD). High resolution CT scan / CT angiogram - inject contrast into arteries, to look for angiodysplasia
Embolisation - put metal up blood vessel against the bleed to induce embolisation.
If you cannot figure out where the bleeding is - do a total colectomy, take out the whole of the large bowel
Are there any possible complications associated with embolising the arterial supply to the duodenum, small bowel or large bowel?
Complications:
Small intestine - can embolise, many different blood supplies so fewer complications with embolising / blocking off one blood supply
Duodenum - can embolise
Large bowel - can embolise but v. difficult and often results in many complications as it has fewer blood supplies so blocking off / embolising one of the them can result in ischaemia and necrosis
If the bleed is in the small intestine, and all measures have been taken but the source still cannot be found, what is the final line of treatment?
Last, final resort = surgery
Divide the small intestine into two halves, the half that continues bleeding is removed. SB = 6m long, therefore, taking out half still leaves 3m for the person to live
