gi pathology Flashcards

Question

Gastro-Oesophageal Reflux Disease

Answer 1

GORD is a very common pathology, estimated to effect 13.98% of people worldwide (Nirwan et al., 2020). Pathophysiology is influenced by a variety of factors including laxity/compliance of the gastro-oesophageal sphincter, pressure across this sphincter and diet. Treatment can be via medicine to neutralise or reduce the quantity of stomach acid, or in severe cases there is a surgical approach called a “fundoplication”. (NHS, 2020) Complications include oesophagitis, ulceration, haemorrhage and aspiration pneumonia.

Answer 2

Gastric ulcers are ulcerations of the stomach for which there are a number of risk factors: H.Pylori Infection Taking regular NSAIDs Smoking Symptoms include: Abdominal pain Vomiting Loss of Appetite Weight Loss

Answer 3

Radiographic imaging is not routinely used to diagnose gastric ulcers. It can be visible on Ba meals. It is important to be aware of this pathology however, as it’s complications include: Perforation Upper GI bleeding Haematemisis Which may trigger an imaging request.

Answer 4

Radiographic imaging is not routinely used to diagnose gastric ulcers. It can be visible on Ba meals. It is important to be aware of this pathology however, as it’s complications include: Perforation Upper GI bleeding Haematemisis Which may trigger an imaging request.

Answer 5

Gastric Ulcers are treated depending on their severity and causes: Antibiotics for H.Pylori infections Proton Pump Inhibitor medication H2-receptor antagonist medication

Answer 6

Mechanical or physiological obstruction of small intestine. Comprises 80% of all bowel obstructions Wide variety of risk factors and underlying causes Symptoms Include: Abdominal pain Nausea and vomiting Distension of abdomen Unable to pass gas or stool

Answer 7

AXR poor sensitivity for SBO. (50-60%) Central dilated loops (>3cm) Visible valvulae conniventes Rarer- ‘string of pearls’ sign

Answer 8

Treatments: Varies with cause of SBO Correction of electrolyte balances Removal of fluid from dilated region via NG/NJ tube If SBO does not resolve, surgical resection Risk of perforation if not treated in a timely fashion

Answer 9

A mechanical or physiological obstruction of the large bowel LBOs comprise 20% of all bowel obstructions They are often secondary to another pathology such as colon cancer Symptoms include: Abdominal pain Nausea and vomiting Distension of abdomen Unable to pass gas or stool Dehydration

Answer 10

A mechanical or physiological obstruction of the large bowel LBOs comprise 20% of all bowel obstructions They are often secondary to another pathology such as colon cancer Symptoms include: Abdominal pain Nausea and vomiting Distension of abdomen Unable to pass gas or stool Dehydration

Answer 11

Dilated large bowel loops visible on AXR For erect imaging air-fluid levels are present

Answer 12

Treatment route depends on underlying cause, options include: Surgical resection Colonic stent Treatment of electrolyte imbalance Risk of perforation if not treated in a timely fashion

Answer 13

Pneumoperitoneum is the presence of air within the peritoneum. It can be an incidental finding if the patient has had very recent laparoscopic abdominal surgery. Pneumoperitoneum can also be indicative of a GI perforation, which is a medical emergency. Symptoms of GI perforation include: Sepsis Constipation Abdominal Bloating Nausea/Vomiting

Answer 14

Both AXR and erect CXRs are frequently used to diagnose pneumoperitoneum. For CXR, patients should be sat upright for at least 10 minutes prior to imaging. Following a diagnosis of pneumoperitoneum, patients will often undergo CT imaging to determine the cause and/or plan for surgery

Answer 15

Treatment depends on the cause of the perforation and the condition of the patient. Sometimes conservative management such as IV antibiotics is sufficient. Surgical treatment is also commonly utilised. Bowel perforations can lead to severe illness such as peritonitis and sepsis.

Answer 16

Volvulus from the Latin word “to roll” is a twisting of the intestines. There are two main forms of volvulus: sigmoid and caecal, depending on the anatomy that is affected. Risk factors include: Chronic constipation High fibre diet Congenital disorders Neurological conditions Abdominal tumours Symptoms include: Constipation Abdominal Bloating Nausea/Vomiting Can be acute or chronic

Answer 17

On plain film AXR the sigmoid volvulus presents as: Significantly dilated bowel “Coffee bean sign” No visible rectal gas

Answer 18

On plain film AXR the caecal volvulus will present with: Significantly dilated bowel Sometimes presents as an “embryo” sign. Where the dilated portion of bowel appears similar to the shape of an embryo.

Answer 19

Treatment depends on the cause and location of the volvulus. Complications include: Bowel ischaemia (lack of blood supply) Recurrence Treatments include: Sigmoid- repaired via endoscopic depression/ detorsion Caecal- laparotomy and relocation Sigmoid/caecal coloplexy (fixation) if recurrent If ischaemia occurs then surgical resection may occur