GI & GU SYSTEMS Flashcards
GI DISEASE - DEFINITION
- Gastrointestinal diseases affect the GI tract from the mouth to the anus
- There are 2 types: functional and structural
GI DISEASE - SIGNS AND SYMPTOMS
- Bloating
- Excess gas
- Constipation
- Diarrhoea
- Heart burn
- Nausea and vomiting
- Abdominal px
- Incontinence
- Weight loss
- Blood in stool
- Px
- Difficulty swallowing
- Changes in appetite
ABDOMINAL PAIN - SITE - DEFINITION
Abdominal px is px that is felt anywhere between the chest and groin
ABDOMINAL PAIN - SITE - GENERALISED
o Appendicitis
o Crohn’s disease
o Traumatic injury
o IBS
o UTI
o Flu
ABDOMINAL PAIN - SITE - LOWER ABDOMEN
o Appendicitis
o Intestinal obstruction
ABDOMINAL PAIN - SITE - LOWER ABDOMEN (FEMALES)
o Ectopic pregnancy
o Dysmenorrhea (severe menstrual px)
o Ovarian cysts
o Miscarriage
o Fibroids
o Endometriosis
o Pelvic inflammatory disease
ABDOMINAL PAIN - SITE - UPPER ABDOMEN
o Gallstones
o Heart attack
o Hepatitis
o Pneumonia
ABDOMINAL PAIN - SITE - CENTRAL ABDOMEN
o Appendicitis
o Gastroenteritis
o Injury
o Uraemia (build-up of waste products in the blood)
ABDOMINAL PAIN - SITE - LOWER LEFT ABDOMEN
o Crohn’s disease
o Cancer
o Kidney infection
o Ovarian cysts
o Appendicitis
ABDOMINAL PAIN - SITE - UPPER LEFT ABDOMEN
o Enlarged spleen
o Faecal impaction (hardened stool that can’t be eliminated)
o Injury
o Kidney infection
o Heart attack
o Cancer
ABDOMINAL PAIN - SITE - LOWER RIGHT ABDOMEN
o Appendicitis
o Hernia
o Kidney infection
o Cancer
o Flu
ABDOMINAL PAIN - SITE - UPPER RIGHT ABDOMEN
o Hepatitis
o Injury
o Pneumonia
o Appendicitis
ABDOMINAL PAIN - NATURE - TYPES
- Mild or severe
- Dull or sharp
- Burning or achy
- Crampy or colicky
- Constant or intermittent
- Localised (in one spot) or generalised (all over)
ABDOMINAL PAIN - NATURE - GENERALISED PAIN
- 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
ABDOMINAL PAIN - NATURE - LOCALISED PAIN
- Px found in only one area of your belly
- More likely to be a sign of a problem in an organ
ABDOMINAL PAIN - NATURE - CRAMPY PAIN
- 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
ABDOMINAL PAIN - NATURE - COLICKY PAIN
- Px that comes in waves
- Often starts and ends suddenly
- Often severe
- Kidney stones and gallstones are common causes of this type of px
ABDOMINAL PAIN - SPEED OF ONSET - SUDDEN
- 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
ABDOMINAL PAIN - SPEED OF ONSET - RAPID
- 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
ABDOMINAL PAIN - SPEED OF ONSET - GRADUAL
- 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
ABDOMINAL PAIN - 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?
ABDOMINAL PAIN - 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 (GORD) - DEFINITION
- Occurs when the acid from the stomach leaks up into the oesophagus
- Usually occurs as a result of the ring of muscle at the bottom of the oesophagus becoming weakened
GASTROESOPHAGEAL REFLUX DISEASE (GORD) - CAUSE
- Caused by frequent acid reflux or reflux of nonacidic content of the 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
GASTROESOPHAGEAL REFLUX DISEASE (GORD) - POPULATION AFFECTED
Younger adults and teenagers
GASTROESOPHAGEAL REFLUX DISEASE (GORD) - RISK FACTORS
- 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
Factors that can aggravate acid reflux include - 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
GASTROESOPHAGEAL REFLUX DISEASE (GORD) - CLINICAL PRESENTATION
- 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
GASTROESOPHAGEAL REFLUX DISEASE (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 - DEFINITION
- 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 AFFECTED
- Gastric ulcers
o Tend to occur later in life, after 60, and affect more women than men - Duodenal ulcers
o Tend to appear between 30 and 50 and affect more men than women
PEPTIC ULCER DISEASE - RISK FACTORS
- 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 - CLINICAL PRESENTATION
- 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 - DEFINITION
- Diverticula are small, bulging pouches that can form in the lining of the digestive system
- Found most often in the colon
DIVERTICULAR DISEASE - CAUSE
- 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 AFFECTED
Over 40s
DIVERTICULAR DISEASE - RISK FACTORS
- 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 - CLINICAL PRESENTATION
- Pain
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%
INFLAMMATORY BOWEL SYNDROME - DEFINITION
A common disorder that affects the stomach and intestines
INFLAMMATORY BOWEL SYNDROME - 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
INFLAMMATORY BOWEL SYNDROME - POPULATION AFFECTED
Females under 50
INFLAMMATORY BOWEL SYNDROME - RISK FACTORS
- 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
INFLAMMATORY BOWEL SYNDROME - CLINICAL PRESENTATION
- 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
INFLAMMATORY BOWEL SYNDROME - 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
CROHN’S DISEASE - DEFINITION
Type of inflammatory bowel disease that causes inflammation of the tissues in your digestive tract
CROHN’S DISEASE - CAUSE
- Exact cause is unknown
- Previously diet and stress were suspected but now its known these aggravate but don’t cause
- Immune system
o Its possible a virus or bacterium may trigger Crohn’s
o But such a trigger is yet to be identified - Heredity
o More common in people who have family members with the disease so genes may play a role in making people more likely to have it
CROHN’S DISEASE - POPULATION AFFECTED
White people under 30
CROHN’S DISEASE - RISK FACTORS
- Age - More likely to develop the condition when you are young
o Before 30 - Ethnicity - White people are most likely
- Family history
- Smoking
- NSAIDs
CROHN’S DISEASE - CLINICAL PRESENTATION
- Symptoms can range from mild to severe
- They usually develop gradually and sometimes suddenly, without warning
- Diarrhoea
- Fever
- Fatigue
- Abdominal px and cramping
- Blood in stool
- Mouth sores
- Reduced appetite
- Weight loss
- Px or drainage near or around the anus due to inflammation from the tunnel into the skin
- People with severe Crohn’s disease may also experience symptoms outside of the intestinal tract
o Inflammation of the skin, eyes and jts
o Inflammation of the liver or bile ducts
o Kidney stones
o Iron deficiency (anaemia)
o Delayed growth or sexual development in children
CROHN’S DISEASE - PROGNOSIS
- Most people enjoy healthy active lives
- There isn’t a cure
- Treatments and lifestyle changes can help keep the disease in remission and prevent complications
- Lifestyle changes include changing diet
ULCERATIVE COLITIS - DEFINITION
Inflammatory bowel disease that causes inflammation and ulcers in your digestive tract
ULCERATIVE COLITIS - CAUSE
- Exact cause is unknown
- Previously diet and stress were thought to be the causes but they are now known to be aggravators rather than causes
- Immune system malfunction could be a cause
- Hereditary also seems to play a role
ULCERATIVE COLITIS - POPULATION AFFECTED
Adults before 30
ULCERATIVE COLITIS - RISK FACTORS
- Age - Usually before 30 but can be any age
- Race or ethnicity - White people at highest risk of developing
- Family history - Higher risk if you have a close relative, such as a parent, sibling or child with the disease
ULCERATIVE COLITIS - TYPES - ULCERATIVE PROCTITIS
o Inflammation is confined to the rectum
o Rectal bleeding may be the only sign of the disease