GI/GU Flashcards
S+S
- Bloating
- Excess gas
- Constipation
- Diarrhoea
- Heart burn
- Nausea and vomiting
- Abdominal px
- Incontinence
- Weight loss
- Blood in stool
- Px
- Difficulty swallowing
- Changes in appetite
Abdo P- P generalised throughout abdomen
o Appendicitis
o Crohn’s disease
o Traumatic injury
o IBS
o UTI
o Flu
Abdo P- lower abdominal
o Appendicitis
o Intestinal obstruction
Abdo P- reproductive organs in females
o Ectopic pregnancy
o Dysmenorrhea (severe menstrual px)
o Ovarian cysts
o Miscarriage
o Fibroids
o Endometriosis
o Pelvic inflammatory disease
Abdo P- upper
o Gallstones
o Heart attack
o Hepatitis
o Pneumonia
Abdo P- centre
o Appendicitis
o Gastroenteritis
o Injury
o Uraemia (build-up of waste products in the blood)
Lower left abdominal P
o Crohn’s disease
o Cancer
o Kidney infection
o Ovarian cysts
o Appendicitis
Upper left abdomen P
o Enlarged spleen
o Faecal impaction (hardened stool that can’t be eliminated)
o Injury
o Kidney infection
o Heart attack
o Cancer
Lower right abdominal P
o Appendicitis
o Hernia
o Kidney infection
o Cancer
o Flu
Upper right abdominal P
o Hepatitis
o Injury
o Pneumonia
o Appendicitis
Generalised P
- Means that the pt feels it in more than half of their abdomen
- This type of px is typical for
o Stomach virus
o Indigestion
o Gas - If the px becomes more severe it can be caused by a blockage of the intestines
Localised P
- Px found in only one area of your belly
- More likely to be a sign of a problem in an organ
Crampy P
- Most of the time not serious
- Likely due to gas and bloating and is often followed by diarrhoea
- More worrisome signs include px that
o Occurs more often
o Lasts longer than 24 hours
o Occurs with a fever
Colicky P
- Px that comes in waves
- Often starts and ends suddenly
- Often severe
- Kidney stones and gallstones are common causes of this type of px
Sudden onset
- Occurs within a second
- Pt will relate the time of onset at a precise moment, usually stating exactly what activity was going on at the time the px began
- Commonly associated with
o Perforation of the gastrointestinal tract from a gastric or duodenal ulcer
o A colonic diverticulum
o Foreign body
o Ruptured eptopic pregnancy
o Mesenteric infraction
o Ruptured aortic aneurysm
o Embolism of an abdominal vessel
Rapid onset
- Begins with a few seconds and increases in severity over the next several minutes
- Pt will recall the time of onset in general but without the precision noted in px of sudden onset
- Associated with
o Cholecystitis
o Pancreitis
o Intestinal obstruction
o Diverticulitis
o Appendicitis
o Ureteral stone
o Penetrating gastric or duodenal ulcer
Gradual onset
- Px that comes on slowly and becomes more severe after a number of hours or even days have elapsed
- Pt memory as to the time of onset of the px is vague; they can only pinpoint the day or maybe the week of onset
- Generally associated with
o Neoplasms
o Chronic inflammatory processes
o Large bowel obstructions
Progression
- Its of real diagnostic significance to determine the progression of the px over the interval of the time of onset until the pt seeks medical attention
o Has the px abated or increases?
o Have there been intervals of total absence of the px or has the px always been present, changing only in character?
Associated features
- Symptoms that accompany abdominal px are important in making an accurate diagnosis
- Some of the most important symptoms are
o Nausea
o Vomiting
o Abdominal distention
o Diarrhoea
o Constipation
o Obstipation
o Tarry stools
o Chills
o Fever
o Urinating frequently
o Haematuria
o Jaundice
Gastroesophageal reflux disease
- Occurs when the acid from the stomach leaks up into the oesophagus
- Usually occurs as a result of lower esophageal sphincter weakness
GORD cause
Frequent acid reflux or non acidic content of stomach
- When you swallow, a circular band of muscle around the bottom of the oesophagus relaxes to allow food and liquid to flow into the stomach, the sphincter then closes again
- If the sphincter does not relax as it should or it weakens, stomach acid can flow back into the oesophagus
- This constant backwash of acid irritates the lining of the oesophagus, often causing it to become inflamed
GORD population
Young adults and teenagers
GORD risks
- Obesity
- Hiatal hernia
o Bulging of the top of the stomach up above the diaphragm - Pregnancy
- Connective tissue disorders, such as scleroderma
- Delayed stomach emptying
GORD aggravating factors
- Smoking
- Eating large meals or eating late at night
- Eating certain foods such as fatty or fried foods
- Drinking certain beverages, such as alcohol or coffee
- Taking certain medications, such as aspirin
GROD S+S
- Heart burn
o Usually after eating, which might be worse at night or while lying down - Regurgitation of food or sour liquid
o Backwash - Upper abdominal or chest px
- Dysphagia (trouble swallowing)
- Sensation of a lump in your throat
- If you have nighttime acid reflux other symptoms may be
o An ongoing cough
o Laryngitis (Inflammation of the vocal cords)
o New or worsening asthma
GORD prognosis
- Managed with OTC medications
o Antacids
o An H2 receptor blocker
o Proton pump inhibitor - If these don’t work a doctor can prescribe
o Sucralfate
o Metoclopramide - Often simple lifestyle changes help relieve symptoms
Peptic ulcer disease
- Peptic ulcers are sores that develop on the inside lining of your stomach and the upper portion of your small intestine
- Peptic ulcers include
o Gastric ulcers that occur on the inside of the stomach
o Duodenal ulcers that occur on the inside of the upper portion of your small intestine
Peptic ulcer disease cause
- Occur when the acid in the digestive tract eats away at the inner surface of the stomach or small intestine
- Common causes are
o A bacterium
Helicobacter pylori bacteria
o Regular use of certain pain relievers
Aspirin
NSAIDs
o Other medications
Steroids
Anticoagulants
SSRIs
Peptic ulcer disease population
Gastric ulcers- 60+, women
Duodenal- 30-50, men
Peptic ulcer disease risks
- These won’t cause stomach ulcers but they may make them worse and more difficult to heal
- Smoking
- Drinking alcohol
- Have untreated stress
- Eat spicy foods
Peptic ulcer disease S+S
- Burning stomach px
o Most common symptom
o This is made worse by stomach acid or having an empty stomach - Feeling of fullness, bloating or belching
- Intolerance to fatty foods
- Heartburn
- Nausea
- Many people with peptic ulcers don’t have any symptoms
- But sometimes people may experience severe symptoms, such as
o Vomiting or vomiting blood – which appear red or black
o Dark blood in stools, or stools that are black or tarry
o Trouble breathing
o Feeling faint
o Nausea and vomiting
o Unexplained weight loss
o Appetite changes
Peptic ulcer disease prognosis
- Prognosis is excellent after the underlying cause is successfully treated
- Recurrence may be prevented by maintaining good hygiene and avoiding alcohol, smoking and NSAIDs
- Recurrence is common with rates exceeding 60% in most cases
Diverticular disease
- Diverticula are small, bulging pouches that can form in the lining of the digestive system
- Found most often in the colon
Diverticular disease causes
- Diverticula usually develop when naturally weak placed in your colon give way under pressure
- This causes marble-sized pouches to protrude through the colon wall
- Diverticulitis occurs when diverticula tear, resulting in inflammation and in some cases infection
Diverticular disease population
40+
Diverticular disease risks
- Aging
- Obesity
- Smoking
- Lack of exercise
- Diet high in animal fat and low in fibre
- Certain medications
o Steroids
o Opioids
o NSAIDs
Diverticular disease S+S
- Px
o May be constant and persist for several days
o Lower left side of the abdomen is the usual site of px
o Sometimes the right side of the abdomen is more painful, especially in people of Asian descent - Nausea
- Vomiting
- Fever
- Abdominal tenderness
- Constipation
- Diarrhoea (less common)
Diverticular disease prognosis
- Treatment is
o Oral antibiotic, such as amoxicillin
o Rest
o Over the counter medicines for pain relief
o Low-fiber diet or liquid diet - Surgery is also an option
- Recurrence rate is about 20%
IBS
- A common disorder that affects the stomach and intestines
IBS cause
- Causes aren’t fully known
- Muscle contractions in the intestine
- Nervous system
o Poorly coordinated signals between the brain and intestines can cause your body to overreact to changes that typically occur in the digestive process - Severe infection
o Can develop after a severe bout of diarrhoea caused by bacteria or a virus
o May also be associated with a surplus of bacteria in the intestines - Early life stress
o People exposed to stressful events, especially in childhood, tend to have more symptoms of IBS - Changes in gut microbes
- Triggers
o Food
o Stress
IBS population
Female under 50
IBS risks
- Younger people
o Under 50 - Sex
o Women affected more than men - Have a family history of IBS
- Have anxiety, depression or other mental health issues
IBS S+S
- Symptoms vary but are usually present for a long time
- Abdominal px, cramping or bloating that is related to passing a bowel movement
- Changes in appearance of bowel movement
- Changes in how often you are having a bowel movement
- Diarrhoea
- Constipation
- Other symptoms include
o Sensation of incomplete evacuation
o Increased gas
o Mucus in the stool
IBS prognosis
- IBS does not shorten the lifespan of affected individuals or lead to major life-threatening complications in most patients
- Most serious symptoms can be avoided through a controlled diet and avoiding stressful situations
IBD
A term that describes disorders including chronic inflammation of tissues in your digestive tract
Crohns and ulcerative colitis
Crohns
Inflammation of tissues in digestive tract
Crohns cause
Unknown
Diet and stress, aggravate but don’t cause
Immune system- virus/bacteria can trigger
Hereditary
Crohns population
White people under 30
Crohns risks
Age- before 30
White people
Family Hx
Smoking
NSAIDs
Crohns S+S
Mild- severe
Usually develop gradually
Diarrhoea
Fever
Fatigue
Abdominal P and cramping
Blood in stool
Weight loss
Severe symptoms of Crohns outside intestinal tract
Inflame or skin, eyes and Jts
Inflame of liver and bile ducts
Kidney stones
Anaemia
Delayed growth or sexual development in children
Crohns prognosis
No cure
Treatment and lifestyle changes help disease in remission and prevent complications
Ulcerative colitis
Inflammation and ulcers in digestive tract
Ulcerative colitis cause
Unknown
Diet and stress are aggravators
Immune system malfunction
Hereditary
Ulcerative population
Pre 30s
Ulcerative colitis risks
Before 30
White people
Family Hx
Types of ulcerative colitis
Ulcerative proctitis
Proctosigmviditis
Left-sided colitis
Pancolitis
Ulcerative proctitis
Inflame is confined to rectum
Rectal bleeding may be only sign
Proctosigmviditis
Inflame involved rectum and sigmoid colon
Symptoms- bloody diarrhoea, abdominal P and cramps, inability to move bowels despite urge to do so
Left sided colitis
Inflam extends from rectum through sigmoid and descending portion of colon
Bloody diarrhoea, abdominal cramping, P on left side, urgency to defecate
Pancolitis
Often entire colon
Blood diarrhoea, abdominal cramps + P, fatigue, significant weight loss
S+S IBD
Innermost lining of large intestine and rectum
Variable, depends on severity of inflammation
Diarrhoea- often with blood or pus
Rectal bleeding
Abdominal cramping/P
Weight loss
Fatigue
Prognosis of IBD
No treatment
Can treat complications rather than disease
Around 10% get better after 1 attack
More likely to have flare ups though life
Appendicitis
Inflame of appendix
Appendicitis cause
Blockage in lining of appendix resulting in infection
Bacteria multiplies rapidly and become inflamed, swollen and filled with pus
Appendicitis population
10-30
Appendicitis risks
Family Hx
Male
In children, CF inc risk
Appendicitis presentation
Sudden P that begins on right side of lower abdomen
P that worsens if you cough, walk or make other jarring movements
Nausea and vomiting
Loss of appetite
Constipation or diarrhoea
Bloating
Appendicitis prognosis
If not treated promptly, can rupture
Surgery
Pancreatitis
Inflammation of pancreas
Tucked behind stomach in upper abdomen
Acute or chronic
Pancreatic cause
When digestive enzymes become activated while still in pancreas, irritating cells of pancreas causing inflammation
Repeated bouts of acute pancreatitis can become chronic
Poorly functioning pancreas can cause digestion problems and diabetes
Conditions that lead to- gallstones, alcoholism, CF, infection, obesity, trauma
Pancreatitis population
Can affect anyone, mostly commonly middle-aged and elderly people
Men more likely to develop alcohol-related pancreatitis
Women more likely to develop it from gallstones
Pancreatitis risk
Excessive alcohol consumption
Smoking
Obesity
Diabetes’s
Family Hx
Pancreatitis presentation
Upper abdominal P
P radiation to back
Tenderness in abdomen
Fever
Rapid pulse
Nausea/vomiting
Chronic- upper abdominal P, losing weight without trying, smelly stools
Pancreatitis prognosis
10-20 year survival rates estimated at 70%
Liver cirrhosis
Late stage of scarring on liver caused by many forms of liver disease and conditions such as hepatitis and chronic alcoholism
Liver cirrhosis cause
Chronic alcohol abuse
Chronic viral hepatitis (B, C or D)
Non-alcoholic fatty liver disease
CF
Poorly formed bile ducts
Genetic digestive disorder (Alagille syndrome)
Medication, including methotrexate or isoniazid
Liver cirrhosis population
Alcoholics, people with viral hepatitis and people who are overweight
Liver cirrhosis risk
Drinking too much alcohol
Overweight
Viral hepatitis
Liver cirrhosis presentation
No signs or symptoms till extensive liver damage
Easy bleeding or bruising
Oedema
Weight loos
Spiderlike blood vessels on skin
Redness in palms
Loss of period, unrelated to menopause
Confusion/drowsiness
Nausea
Liver cirrhosis prognosis
Damage generally can’t be undone
If diagnosed early and cause treated, further damage is limited
Cut out salt
Take diuretic meds
Hep A
Highly contagious infection
Causes inflammation to liver, affecting its ability to function
Hep A causes
Virus that affects liver cells inflammation
Virus spreads when infected stool enters mouth to another person, e.g., through infected food/drink
Drinking contaminated water
Eating food washed in contaminated water
Eating raw shellfish from sewage polluted water
Having sexual contact with someone who has the virus
Hep A risk
Travel or work to areas where hep A is common
Living with someone with hep A
Sexual contact
HIV +ve
Recreational drugs
Hep A S+S
Appear after few weeks of virus infection
Unusual tiredness and weakness
Sudden nausea, vomiting and diarrhoea
Clay or grey coloured stool
Jt P
Dark urine
Jaundice (yellow skin/eyes)
Hep A prognosis
Does not cuase long-term liver damage, doesn’t become chronic
Can cause sudden loss of liver function, especially in older adults
Hep B
Tends to last less than six months
Can become chronic
Inc risk of developing liver failure, liver cancer or cirrhosis
Hep B cause
Passed through blood, semen, or other bodily fluids
Sexual contact
Sharing of needles
Mother to child
Hep B risks
Having unprotected sex with someone who is infected
Share needles during IV drug use
Living with someone who has chronic HBV
Infant born from infected mother
Hep B presentation
Abdominal P
Dark urine
Fever
Jt P
Loss of appetite
Nausea and vomiting
Weakness/fatigue
Jaundice symptoms
Hep B prognosis
Most adults fully recover
Infants/children likely to develop long-lasting hep B infection
Vaccine prevents hep B
No cure
Hep C
Liver inflammation liver damage
Hep C cause
Spreads when blood contaminated with virus enters bloodstream of uninfected person
Exists in several distinct forms, known as genotypes
Seven distinct HCV genotypes and more than 67 subtypes have been identified
Hep C risk
Health care worker exposed to infected blood
Have HIV
Piercing/tattoo from unclean enviro
Mother to baby
Hep C S+S
Usual silent for many years, until liver damage is enough to cause signs and symptoms of liver damage
Bleeding/bruising easily
Fatigue
Poor appetite
Dark-coloured urine
Oedema
Weight loss
Confusion/drowsiness
Spiderlike blood vessels in skin
Hep C prognosis
Curable with oral medication taken everyday for 2-6 months (direct-acting antiviral tablets)
Usually goes away undiagnosed
Hep D
Can get it if you have hep B
Hep D causes
Exchange if infected blood or bodily fluid
Can only infect you if you have hep B, hep D needs B strain to survive
Happens in two ways
1. Co-infection- contract HBV and HDV at same time
2. Super-infection- become unwell with hep B then later develop hep D
Hep D risk
Having hep B
Inject drugs
Have sex with someone with hep B or D
Have HIV and hep B
Hep D presentation
Jaundice
Stomach upset
P in belly
Vomiting
Fatigue
Jt P
Dark urine
Light-coloured stool
Symptoms may be worsened if you have hep B
Hep D prognosis
Can lead to lifelong liver damage and even death
No cure yet, prescribe drugs to alleviate symptoms
Pegylated interferon alpha- 48 weeks
Hep E
Most common cause of acute hepatitis in UK
Hep E cause
Consumption of raw or undercooked pork metal or offal, also with wild boar, venison and shellfish
Through faeces
Hep E risk
Poor hygiene
Drinking/eating from contaminated source
Hep E presentation
Mild fever
Fatigue
Reduced hunger
Vomiting
Belly P
Dark urine
Light-coloured faeces
Hep E prognosis
Generally mild and short-term (4-6 weeks)
Does not require extra treatment
Can be serious in people with weakened immune systems
No vaccine, prevent by practicing good health and hygiene
S+S GU
Frequent UTIs
Pain in pelvic/groin area
Bladder incontinence
P or discomfort whilst urinating
Blood in urine
Bad or strong-smelling urine
Reduced urine output
Visually abnormal or malformed genitals
UTI
Infection in any part of urinary system
Kidneys, ureters, bladder and urethra
Most involve lower urinary tract (bladder and urethra)
UTI cause
When bacteria enter urinary tract through urethra and begins to spread to bladder
Infection of bladder- Escherichia coli (E.coli), commonly found in GI tract, sometimes other bacteria can cause. Having sex can lead to bladder infection. In women, urethra being closest to anus, which makes it easier for bacteria to travel to bladder
Infection of urethra- happens when Gi bacteria spreads from anus to urethra,
UTI risk
Female anatomy
Sexual activity + new sexual partners
Certain type of birth control + spermicidal agents
Menopause- post-menopause cases decline in circulating oestrogen changes urinary tract, inc risk of UTI
UTI presentation
Strong urge to urinate that doesn’t go away
Burning sensation when urinating
Urinating often
Urine appears red, bright pink or brown- signs of blood in urine
Strong-smelling urine
Pelvic P in women- especially in centre of pelvis and around pubic bone
Kidney UTI
Back or side P
High fever
Shaking and chills
Nausea/vomiting
Bladder UTI
Pelvic pressure
Lower belly discomfort
Frequent, painful urination
Blood in urine
Urethra UTI
Burning with urination
Discharge
UTI prognosis
Serious problems can result if UTI spreads to kidneys
Often treated with ABs
Overactive bladder
Causes frequent and sudden urge to urinate that may be difficult to control
Overactive bladder cause
Occurs when bladder starts to contract on their own even when the volume of urine in bladder is low, called involuntary contractions, create urgent need to urinate
Neurological disorders- e.g., strokes, MS
UTI can cause similar symptoms
Hormonal changes during menopause
Conditions affecting bladder, such as tumours or bladder stones
Factors that get in the way or urine leaving bladder, e.g., enlarge prostates, constipation or previous surgery to treat incontinence
Overreactive bladder risks
Advancing age- higher risk of conditions which can interfere with excretion
Cognitive decline- e.g., from stroke
Bowel control problems
Overreactive bladder prognosis
Can be managed with dietary changes (reduce caffeine and alcohol), time voiding and bladder-holding techniques using pelvic floor muscles
Interstitial cystitis
Chronic condition causing bladder pressure, P and plvic P
Mild severe P
Signals get mixed up in relation to when bladder is full and needs to excrete urine, leading to more frequent urination and smaller volumes of urine
Interstitial cystitis cause
Unknown
Factors that influence:
o Defect to epithelium of bladder- leak may allow toxic substances in urine to irritate bladder wall
o Autoimmune reaction
o Hereditary
o Infection or allergy
Interstitial cystitis population
Most commonly affects women
Interstitial cystitis risk
Women
30+
Having chronic P disorder- e.g., IBS or fibromyalgia
Interstitial cystitis presentation
Variable
Gradual progression
Flare ups triggered by menstruation, sitting for too long, stress, exercise, and sexual activity
P in pelvis or between vagina and anus in women
P between scrotum and anus in men
Chronic pelvic P
Persistent, urgent need to urinate
P or discomfort while bladder
Interstitial cystitis prognosis
Can have long lasting effects on QOL
No cure, but medication and therapies to relieve
