GI Tract Flashcards
Mechanism of h2 receptor antagonists and examples
Decrease acid production by preventing histamine activation of acid production
(Limited benefit as alternative pathways still open- acetylcholine and gastrin)
Cimetidine- many drug interactions
Ranitidine- safer for clinical use
3 proton pump inhibitors
Omeprazole
Pantoprazole
Lansoprazole
Name 3 upper GI oral diseases
Recurrent oral ulceration
Lichen planus
Orofacial granulomatosis
Name 3 upper GI oesophageal disorders
Dysphagia
Dysmotility disorders
GORD (gastro oesophageal reflux disease)
3 mains causes of GORD
Defective lower oesophageal sphincter
Impaired lower clearing
Impaired gastric emptying
3 effects of GORD
Ulceration
Inflammation
Metaplasia (abnormal change in nature of tissue)
4 signs/symptoms of GORD and their causes
Epigastric burning
- worse lying down, bending over, pregnant
Dysphagia
- oesophagitis (inflammation of oesophagus)
- stricture (fibrosis and scarring narrow oesophagus)
- dysmotiity
GI bleeding
Severe pain
- mimics MI
- oesophageal muscle spasm
Define Barretts oesophagus
Recurrent acid reflux into lower part of oesophagus resulting in metaplasia of oesophagus lining into gastric type mucosa
- protects mucosa from damage
- increased risk of carcinoma
Define Hiatus Hernia
Part of stomach protrudes through diaphragm opening (hiatus) into thorax
5 ways to manage GORD
Stop smoking- improves sphincter (increased muscular tone)
Lose weight and avoid triggering activities
Antacids
H2 blockers and PPIs
Improve GI motility and gastric emptying
2 functions of medicines used in upper GI tract
Examples
Eliminate formed acids
-antacids
Reduce acid secretion
- H2 receptor blockers
- proton pump inhibitors
Where can peptic ulcer disease (PUD) occur?
Any acid affected site
- oesophagus, stomach, duodenum
3 causes of PUD
Drugs (NSAIDs, steroids)
Excessive acid
Decreased protective barrier (usually H. Pylori involvement)
Signs/symptoms of PUD
Asymptomatic Epigastric burning - worse before/just after meal - worse at night - relieved by food, alkali and vomiting Usually no physical signs (only when complications e.g. Bleeding)
4 investigations for PUD
Endoscopy
Radiology (barium meal)
Anaemia (FBC, FOB)
Test for H. Pylori
4 local complications of PUD
Perforation
Haemorrhage
Stricture
Malignancy
Systemic complication of PUD
Anaemia
4 treatments for PUD if it is a reversible problem, H. Pylori present
Stop smoking
Small, regular meals
Eradication therapy
Ulcer healing drugs
3 PUD treatments if there is stricture, acute bleeding, perforation or malignancy
Endoscope
Surgical and repair (gastrectomy- whole or part of stomach removed)
Vagotomy (cutting of branches of vagus nerve)
2 ways medication can treat PUD and examples
- Reduce acid secretion
- h2 receptor blockers
- protein pump inhibitors - Improve mucosal barrier- eliminate H. Pylori- inhibit prostaglandin removal (involved in mucous production)
: Reduce NSAID and steroid use
What is triple therapy?
Eliminates helicobacter pyloris
Two week course of:
2 antibiotics (amoxycillin and metronidazole)
Protein pump inhibitor (omeprazole)
3 lower GI diseases that affect the small bowel
Pernicious anaemia
Coeliac disease
Crohn’s disease
Where does Crohn’s occur?
Anywhere on GI tract
4 clinical presentations of Crohn’s
Discontinuous ‘skip’ lesions
Some rectal involvement (50%)
Transmural- penetrates full thickness of wall
Cobblestone appearance
6 symptoms of Crohn’s and where in GI tract they occur
Colon area:
Diarrhoea
Abdominal pain
PR bleeding (rectal)
Small bowel:
Intestinal obstruction
Malabsorption
Mouth:
Orofacial granulomatosis
4 treatments for Crohn’s
Systemic steroids e.g. Prednisolone
Local steroids
Anti inflammatory drugs
Palliative - remove obstructed bowel segments
drain abscesses2 microscopic features of Crohn’s
Granulomatous
Oedematous (fluid retention)
Site of ulcerative colitis
Colon (large intestine)
3 clinical presentations of UC
Continuous
Rectum always involved
Mucosal inflammation and swelling
3 UC symptoms
Diarrhoea
Abdominal pain
PR bleeding
4 treatments of UC
Systemic steroids e.g. Prednisolone
Local steroids
Anti inflammatory e.g. Sulphasalazine
Surgery- colectomy (remove part causing disease)
6 clinical features of orofacial granulomatosis
Lip swelling Angular cheilitis Cobblestoning Gingivitis Ulceration Microscopic granulomas
Define pernicious anaemia
Inability to absorb vitamin B12
Receptors only in terminal ileum
Cause of pernicious anaemia
Failure to produce intrinsic factor, which is needed to absorb vitamin B12
3 causes of Vit b12 deficiency
Pernicious anaemia
Low dietary intake
Disease of terminal ileum (Crohn’s disease)
Define coeliac disease
Sensitivity to α-gliaden component of gluten
8 symptoms of coeliac disease
Weight loss Lassitude (lack of energy) Weakness Abdominal pain/swelling Diarrhoea Aphthae (small ulcer)/glossitis (inflammation of tongue) Steatorrhoea (fatty stools) Dysphagia
Effect of gluten free diet on coeliac disease
Reversal of jejunal atrophy (malabsorption goes away)
Improved well being
Decreased risk of lymphoma
Symptoms of colonic carcinoma
None
Anaemia
Rectal blood loss
4 ways to screen for colonic carcinoma
FOB (faecal occult blood test) - all over 50s invited Barium enema Endoscopy CT/MRI scan
Aetiology of colonic carcinoma (9)
Diet: Decreased fibre Increased fat Increased meat Decreased veg
Smoking Lack of exercise Genetics Ulcerative colitis Intestinal polyps
What causes most colonic carcinomas
Arise in polyps
Most will bleed due to irritation and trauma
Usually takes 5 yeRs to progress to malignancy
3 treatments for colonic carcinoma
Surgery
Radiotherapy
Chemotherapy
3 ways to diagnose helicobacter pylori
Endoscopy and biopsy
Breath test
Serology
Define gastroenteritis
A non-specific term for various pathological states of the GI tract
Primary manifestation of gastroenteritis and possible accompanying symptoms
Diarrhoea
Nausea
Vomiting
Abdominal pain
5 key viral symptoms of gastroenteritis
Abdominal cramps Vomiting Profuse WATERY stools Fever Headaches
4 key bacterial dysentery symptoms of gastroenteritis
Small volume stools
Fever
BLOODY mucoid stools
Supra pubic pain
Define norovirus and how it’s transmitted
Highly contagious non-enveloped ss RNA virus
Transmitted faecal to oral route
Clinical features of norovirus
Abrupt onset of vomiting and watery diarrhoea
+/- Fever and abdominal pain
Management of norovirus
Correct fluid/electrolyte balance
3 types of salmonella
Gastroenteritis
Enteric Fever (typhoid)
Bacteraemia
4 symptoms of salmonella
Cramps
Watery or bloody diarrhoea
Fever, sometimes vomiting
Lasts 1-4 days
2 treatments for salmonella
Supportive (IV hydration)
Antibiotics
Define clostridium difficile
Gram positive, spore forming, anaerobic bacillus
Carried by domestic animals
4 treatments for C. Diff
Oral rehydration
Antibiotics
Colectomy
Faecal transplants
Ways to prevent C. Diff infection
No vaccine
Food hygiene Decrease likelihood of contamination - adequate food and storage - segregation - licensed premises
3 ways to prevent GI infections
Safe food handling and hand washing
Infection control
Surveillance
Name 4 liver issues
Viral liver disease
Jaundice
Cirrhosis
Liver failure
Define jaundice
Accumulation of bilirubin in the skin due to excess bilirubin in blood
What is conjugated bilirubin
Soluble bilirubin
Define pre-hepatic jaundice
Jaundice due to factors before liver metabolism
What usually causes pre-hepatic jaundice and give 3 examples
Usually excessive quantities of RBC breakdown products
- haemolytic anaemia (RBC destruction)
- post transfusion (bad match)
- neonatal (maternal RBC induced)
What causes jaundice in haemolysis
Increased bilirubin production beyond livers capacity to conjugate it
What causes jaundice in Gilberts disease
Decreased bilirubin uptake by liver cells
What causes hepatic jaundice
Due to ‘liver failure’
- cirrhosis
- drug induced liver dysfunction
Prevents metabolism of RBC breakdown products
How does secretion failure cause jaundice
Defective secretion of conjugated bilirubin from liver cells (e.g. Back into bloodstream)
Define canaliculus
Channels in liver that transport bile to gall bladder
What causes post-hepatic jaundice
Obstruction to bile outflow
Clinical feature of jaundice
Conjugated bilirubin is excreted in urine and faeces
- colour changes
- pale stool and dark urine suggest POST HEPATIC cause (conjugated bilirubin)
- normal urine and faeces in HAEMOLYTICS (excess bilirubin unconjugated)
Define acute cholecystits
Inflammation of gall bladder
4 gall bladder symptoms
Pain in SHOULDER tip
Abdominal pain right side- radiates to back
Pain brought on by eating fatty food- stimulates bile release by contraction of gall bladder
Usually gall stones
5 population traits for gallstone
Fair Fertile Female Fat Forty
3 ways jaundice patients are imaged
Ultrasound- detects dilated bile channels within liver
Plain radiographs- show RADIOPAQUE gall stones
ERCP- endoscopic retrograde cholangio pancreatography
Management of prehepatic jaundice
Identify and treat cause
Management of post hepatic jaundice
Remove obstruction
- gall stones via ERCP/ ultrasound
- force channel open with stent
3 ways to prevent gall stone recurrence
Remove gall bladder (cholecystectomy) Prevent build up of bile acid - ursodeoxycholic acid - low calorie, low cholesterol diet Prevent bile acid reabsorption from GIT
Define kernicterus
Brain damage from bilirubin build up in new born
Define cirrhosis
Mixed picture of damage, fibrosis and regeneration of liver structure
6 causes of cirrhosis
Alcohol Primary biliary cirrhosis Viral disease- chronic active hepatitis Autoimmune chronic hepatitis Haemochromatosis (excessive absorption and storage of iron) CF
5 signs/symptoms of cirrhosis
Acute bleed Jaundice Oedema and ascite (abdominal fluid) Encephalopathy (toxic substances affect brain) Spider naevi, palmar erythema
