GI pathology Flashcards
What is constipation?
Retention of faecal material for long period of time.
What are symptoms associated with constipation?
Headaches
Nausea
Loss of appetite
Abdominal distension
What is diarrhoea?
The too frequent passing of liquid stool.
What are some causes of diarrhoea?
Entertoxigenic bacteria Stress Food Protozoans Nervousness Viruses Toxins
What are some examples of enterotoxigenic bacteria?
Vibrio cholerae
Escherichia coli
What is a possible treatment for diarrhoea?
Need to rehydrate so give patient a sodium/glucose solution to drive water absorption. The continued secretions then wash away the bacteria.
What is hepatitis?
Inflammation of the liver.
What are the differences between the different types go hepatitis?
Hepatitis A - usually no long term effects, contracted by consuming foods/water containing faecal matter. Not common. in UK.
Hepatitis B - blood borne virus usually spread from infected mother to baby. Common in Southeast Asia and Subsaharan Africa. If chronic may case cirrhosis and liver failure.
Hepatitis C - Blood borne virus. Common in uk and spread vis the sharing of needles. Creates flu like symptoms and may remain in body for years - cirrhosis and liver failure.
Hepatitis D - needs individual to be infected with hep B to survive. Blood borne or sexual contact. Chronic infection may cause cirrhosis and liver failure.
Hepatitis E - usually no long term effects. Causes acute hepatitis. Contracted by eating raw meat or shellfish.
What is fatty change?
Any abnormal accumulation of fat in parenchymal cells, usually related to excessive drinking or obesity.
What is pre-hepatic jaundice?
Excessive red blood cell breakdown within the spleen leaving the unconjugated bilirubin to remain in the bloodstream.
What is hepatic jaundice?
There is a dysfunction of the liver itself causing unconjugated and conjugated bilirubin to remain in blood.
What is post-hepatic jaundice?
There is an obstruction in the biliary tree that causes bilirubin to be reabsorbed and circulated in the enter-hepatic system.
What are the characteristics of Clostridium Difficile?
Gram positive spore forming bacteria.
Releases enterotoxins A &B.
Robust spores that can survive >40days.
Common cause of antibiotic associated diarrhoea.
What are the risk factors for c.diff diarrhoea?
Antibiotics - clindamycin,cefs, augmenting, quinolones.
Increasing age.
Hospitalisation.
Proton Pump Inhibitors.
How does c.diff diarrhoea present clinically?
Asymptomatic
Mild diarrhoea
Colitis with or without pseudomembranes.
Fulminant colitis (sudden/severe onset).
What is Pseudomembranous Colitis?
Colitis commonly caused by c.diff that has pseudomembranes (yellow plaques) and severe systemic symptoms.
How is c.diff diarrhoea treated?
Stop causative antibiotic
Avoid antidiarrhoeals and opiates.
Enteric precautions.
Metronidazole 400mg 1st line, 10-14 days.
Vancomycin 2nd line, 10-14days.
Vancomycin if severe.
Urgent colectomy if toxic megacolon, increased lactate dehydrogenase (LDH), deteriorating condition.
What is Lactate dehydrogenase?
LDH is an enzyme found in most tissues used to help convert sugar into energy. Levels are normally low within the blood but can become raised if there is tissue damage.
What is toxic megacolon?
Inflammation of the colon causing gas to become trapped. The colon becomes very enlarged and swollen with the risk of rupture. Complication of ulcerative colitis.
What are the causes of constipation?
OPENED IT
O- obstruction; adhesions, hernia, inflammatory strictures, pelvic mass.
P- pain; anal fissure, proctalgia fugax
E- endocrine/electrolytes; decreased T4 thyroid hormone, decreased calcium, decreased potassium, uraemia.
N- neuro; MS, myelopathy, cauda equina syndrome.
E- elderly
D- diet/dehydration
I- IBS
T- toxins; opioids, Anti-mACh.
How is constipation managed?
Drink more Increase dietary fibre Lactulose MgSO4 Liquid parafin softeners Phosphate enemas Glycerol suppository.
What is meant by IBS?
Irritable Bowel Syndrome is a group of disorders that present with bowel symptoms for which no organic cause can be found.
What is peptic ulcer disease?
Having 1 or more ulcers within the stomach (gastric ulcers) or duodenum (duodenal ulcers).
Ulcers are small round punched out looking sores which are a break in the membrane.
What are some causes of Peptic Ulcers?
Helicobacter Pylori - most common cause. It is a gram negative bacteria that releases adhesions and proteases which damage the mucosa and eventually lead to ulceration.
NSAIDs - inhibit enzyme cyclooxygenase which is involved in the synthesis of prostaglandins. The prolonged decrease of prostaglandins makes the mucosa susceptible to damage.
Zollinger-Ellison syndrome - caused by the tumour, Gastrinoma. Creates abnormal gastrin levels which in turn create excess HCl levels which damage mucosa.
What are some complications of Peptic ulcers?
Perforation - Ulcer erodes all the way through the wall of the stomach/duodenum.
Gastric contents then enters into the peritoneal space. Air collects under the diaphragm which irritates the phrenic nerve and can present as referred shoulder pain.
Haemorrhage
Obstruction of pyloric sphincter.
How do peptic ulcers present?
Epigastric pain - gastric ulcers pain gets worse on eating. Duodenal ulcer pain gets better when eating.
Gastric ulcers are associated with weight loss. Duodenal ulcers are associated with weight gain.
Bloating
Belching
Vomitng
What are the investigations for peptic ulcer diagnosis?
Bloods - FBC, urea
C13 breath test.
Upper endoscopy
Biopsy.
What are the management options for Peptic ulcers?
Conservative - lose weight, stop smoking, avoid hot drinks/spicy food, stop NSAIDs and steroids.
Medical- Antacids e.g Gaviscon, Mg trisilicate.
Full dose acid suppression for 1-2 months using PPIs e.g Iansoprazole or H2RAs e.g ranitidine
Surgery in extreme cases.
Antrectomy
Vagotomy
Subtotal gastrectomy
What is GORD?
Gastro-oesophageal Reflux Disease is when acid leaks from the stomach up tiny the oesophagus usually as a result of lower oesophageal sphincter dysfunction.
What are the risk factors for GORD?
Hiatus hernia Smoking Alcohol Obesity Pregnancy Drugs - anti-AChm, nitrates, CCBs, TCAs.
What are the symptoms for GORD?
Heartburn Belching Acid/water brash (heartburn) Odynophagia (pain on swallowing). Can also get nocturnal asthma, chronic cough, laryngitis or sinusitis.
What are some complications of GORD?
Ulceration
Benign stricture
Barrett’s oesophagus
Oesophageal adenocarcinoma.
What are the investigations of GORD?
Endoscopy Barium swallow or meal 24hr pH monitoring Manometry Blood tests
What are the treatment options for GORD?
Conservative - Lose weight, raise head of bed, small regular meals, stop smoking and decrease alcohol, avoid hot drinks and spicy food, stop NSAIDs, steroids, CCBs and nitrates.
Medical - OTC Antacids e.g Gaviscon, Mg trsilicate.
1st line - full-dose PPI for 1-2months e.g Lansoprazole.
2nd line - Double dose of PPI.
3rd line - add an H2RA e.g ranitidine.
Surgical - Nissen Fundoplication. Mobilises gastric fundus and wraps it around lower oesophagus. Closes any hiatuses.
What is a Hiatus Hernia?
When abdominal organs slip through the diaphragm innate the chest cavity.
What are the different types of hiatus hernia?
Sliding (80%) - gastro-oesophageal junction slides up into chest. More common in GORD.
Rolling (15%) - gastro-oesophageal junction remains in abdomen but bulge of stomach rolls into chest. Can lead to strangulation.
What are the investigations for a hiatus hernia?
Chest x-ray - gas bubbles and fluid in chest.
Barium swallow - diagnostic.
Gastroscopy.
24hr pH and manometry - to exclude dysmotility or achalasia.
What is Achalasia?
Muscles of the oesophagus don’t contract properly and the LOS doesn’t open properly or at all. Causes difficulty/pain when swallowing.
What is the treatment for Hiatus Hernia?
Lose weight
Treat reflux
Surgery if intractable symptoms despite medical treatment - should always surgically repair rolling hernias as they can cause strangulation.
What is the differential diagnosis for haematemesis (vomiting blood)?
VINTAGE
V- varices
I - inflammation - ulcers/itis
N- neoplasia - oesophageal/gastric cancer
T - trauma - mallory-weirs tear, Boerhaave’s syndrome.
A - angiodysplasia
G- Generalised bleeding diathesis - warfarin. thrombolytics, CRF.
E- epistaxis.
What is a Mallory Weiss tear?
Tear in the lining of the upper gastrointestinal tract. The tear usually occurs at the gastro-oesophageal junction or within the lining of the fundus.
What are the causes of a Mallory-Weiss tear?
Anything that causes a sudden rise in pressure , either in the stomach or lower part of the oesophagus.
- Repeated vomiting
- Violent coughing
- Excessive straining
- Idiopathic.
What are the risk factors for a Mallory-Weiss tear?
Hiatus hernia
Alcohol
Pregnancy
Bulimia nervosa.
What are the symptoms of a Mallor-Weiss tear?
Bright red blood in vomit (haematemesis)
Melena
Epigastric pain
What investigations would you carry out for a Mallory-Weiss tear?
Gastroscopy.
Bloods - anaemia, clotting factors.
Angiography.
What is the treatment for a Mallory-Weiss tear?
May resolves by itself.
Treat reflux, anaemia, coagulation.
if still bleeding may surgically treat via endoscope - haemoclipping, ligation, adrenaline injection.
What is Boerhaave’s Syndrome?
Full thickness tear of the oesophagus 2cm proximal to the LOS.
Usually caused by the forceful ejection of gastric contents against a closed glottis.
What are the symptoms of Boerhaave’s Syndrome?
Haematemesis Chest pain Subcutaneous emphysema Epigastric pain Back pain Dyspnoea Shock
What are the investigations and treatment used in Boerhaave’s syndrome?
CXR
Fluroscopy
CT
Surgery is gold standard but oesophageal stunting may be used as a conservative method.
What is Angiodysplasia?
Vascular abnormality where there is a formation of artery-venous malformations. Usually presents as a small tuft of dilated vessels. Can be acquired or congenital.
How does Angiodysplasia present?
Angiodysplasia can affect anywhere along the GI tract so symptoms vary depending on location of bleed.
Haematemesis Rectal bleeding Anaemia Asymptomatic Melena
What investigations would you carry out for Angiodysplasia?
FBC U&Es LFTs Clotting factors Endoscopy Colonoscopy Angiography
What is the treatment for Angiodysplasia?
Endoscopic Ablation therapy.
Mesenteric angiography - catheterisation and embolisation of vessel.
Surgery.
What is Hereditary Haemorrhagic Telangiectasia (HHT)?
Inherited genetic recessive disorder where your blood vessels don’t develop properly, making them susceptible to bleed. Symptoms usually start in child/teen years.
What are the symptoms of HHT?
Nose bleeds Visible red spots across body. Anaemia. Haematemesis Rectal bleeding
What is the treatment for HHT?
No cure but good prognosis with management.
Iron supplements.
Laser treatment.
Embolisation.
Radiotherapy.
Treatment depends on the location of the bleed.
What is Dieulafoy lesion?
Rupture of a large arteriole in the stomach or other bowel.
What is epistaxis?
Nosebleed.
What is the differential diagnosis of rectal bleeding?
DRIPING A
D- Diverticulae R- rectal haemorrhoids I- Infection P- polyps I- inflammation - UC/Crohn's N - neoplasia G - gastric-upper bleed A - angio - HHT, ischaemic colitis, Angiodysplasia.
What is Diverticular disease?
Development of diverticula = small bulge for pockets that develop within the lining of the bowel.
What is diverticulitis?
Inflamed or infected diverticula.
What are the symptoms of diverticular disease and diverticulitis?
Usually asymptomatic Lower left flank pain - gets worse during/just after eating. Bloating Constipation Diarrhoea Mucus in stool Rectal bleeding Pyrexia Nausea Vomiting Fatigue Malaise
What are the investigations for diverticular disease and diverticulitis?
Need to rule out IBS, coeliac, bowel cancer.
Bloods
Colonoscopy
CT
What is the treatment for Diverticular disease?
High fibre diet (30g per day for an adult).
Paracetamol, aspirin or ibuprofen to ease pain.
Colectomy if very severe.
What is the treatment for diverticulitis?
Fluid only diet for a few days as symptoms recover.
Gradually build fibre back into diet until 30g per day is achieved.
Paracetamol - NO aspirin or ibuprofen as they can cause stomach upsets.
Antibiotics.
Colectomy if severe.
What are some common organisms that cause infection of the bowel and subsequently rectal bleeding?
Campylobacter Shigella, E.coli C.diff Amoebic dysentry.
What are polyps?
Small growths on the inner lining of the GI tract. Most commonly in bowel and rectum.
