GU & GI conditions Flashcards
gi diseases
=diseases that affect the gastrointestinal (GI) tract from the mouth to the anus. There are two types: functional and structural
functional–> the GI tract looks normal when examined, but doesn’t move properly. They are the most common problems affecting the GI tract (including the colon and rectum). Constipation, irritable bowel syndrome (IBS), nausea, food poisoning, gas, bloating, GERD and diarrhea are common examples
structural–> where your bowel looks abnormal upon examination and also doesn’t work properly. Common examples of structural GI diseases include strictures, stenosis, hemorrhoids, diverticular disease, colon polyps, colon cancer and inflammatory bowel disease.
risk factors: Eating a diet low in fiber, Not getting enough exercise, Traveling or other changes in routine, Eating large amounts of dairy products, Stress, Resisting the urge to have a bowel movement, possibly because of hemorrhoids, Overusing anti-diarrheal medications that, over time, weaken the bowel muscle movements called motility, Taking antacid medicines containing calcium or aluminum, Taking certain medicines (especially antidepressants, iron pills and strong pain medicines such as narcotics), Pregnancy.
s&s: A change in normal bowel habits, Blood on or in the stool that is either bright or dark.
Unusual abdominal or gas pains, Very narrow stool, A feeling that the bowel has not emptied completely after passing stool, Unexplained weight loss, Fatigue, Anemia (low blood count)
treatment: Resting and drinking plenty of fluids.
Following the BRAT diet – bananas, rice, applesauce and toast – all of which are easy on the stomach and beneficial in their own way. At the same time, avoid things like dairy, grease and spices, as they can aggravate your digestive system.
Taking over-the-counter medications to ease symptoms (for example, laxatives for constipation).
Upon being examined by a medical provider, medications could be prescribed to control symptoms such as nausea to provide comfort and aid in the ability to rehydrate. When appropriate, anti-nausea medications and/or IV rehydration may be administered.
abdominal pain
defined by: Site, Nature of Pain, Speed of Onset, Progression, Associated Features
caused by: constipation, irritable bowel syndrome, food allergies, lactose intolerance, food poisoning, and a stomach virus. Other, more serious, causes include appendicitis, an abdominal aortic aneurysm, a bowel blockage, cancer, and gastroesophageal reflux.
risk factors: Older age, Prior abdominal surgery, History of bowel disorders, Exposure to stomach virus.
s&s: Severe pain, Fever, Bloody stools, Persistent nausea and vomiting, Weight loss, Skin that appears yellow, Severe tenderness when you touch your abdomen, Swelling of the abdomen.
treatment: Bowel rest. Stop eating, or only eat easy-to-digest foods like crackers or bananas, Hydration, Heat therapy
need to treat cause of abdominal pain
Gastro-oesophageal reflux disease (GORD)
=a common condition, where acid from the stomach leaks up into the oesophagus
caused by: Increased abdominal pressure (pregnancy), Low LOS (lower oesophagus sphincter) pressure, Delayed gastric emptying (stomach takes too long to empty its contents), Nocturnal reflux (acid reflux during night-time that feels like heartburn), Mechanical or functional aberrations associated with a hiatus hernia (when part of the stomach squeezes up into the chest through an opening (“hiatus”) in the diaphragm), Obesity, Systemic sclerosis, Certain drugs (nitrates, tricyclics)
patho: complex and involves several factors, such as an incompetent lower oesophageal sphincter, or LOS, which is the muscle that acts as a valve between the oesophagus and the stomach. When this valve does not close properly, stomach acid can travel back up into the oesophagus, causing a burning sensation commonly referred to as heartburn. Additionally, other factors such as increased intra-abdominal pressure, hiatal hernia, and certain medications can contribute to the development of GERD.
pop: 10-20% of population, More common in older adults, affecting 25-35% of adults aged over 60
risk factors: Overweight, obese, Pregnant women, Diabetes and asthma, Smoking, alcohol
s&s: Heartburn is the major symptom, OverRegurgitation (the spitting up of food from the esophagus or stomach without nausea or forceful contractions of the abdominal muscles), Odynophagia (a painful sensation in the oesophageal region that occurs in relation to swallowing), Cough and nocturnal asthma can occur from aspiration of gastric contents into the lungs
treatment: lifestyle changes, proton pump inhibitors, Alginate-containing antacids, H2-receptor antagonists, surgery
peptic ulcer disease
=an ulcer of the mucosa in or adjacent to an acid-bearing area. Most occur in the stomach or proximal duodenum.
caused by: Helicobacter pylori (H. pylori) infection and NSAIDs are the most common cause. Co-administration of corticosteroids and NSAIDs, reduction of gastric mucosal resistance, Aspirin and NSAIDs cause ulcers, at least in part, by reduced production of prostaglandins (through inhibition of cyclooxygenase-1) which provide mucosal protection in the upper gastrointestinal tract, Hyperparathyroidism, Zollinger-ellison disease (a rare digestive disorder that results in too much gastric acid), vascular insufficiency, Sarcoidosis (a rare condition that causes small patches of swollen tissue, called granulomas, to develop in the organs of the body), Crohn’s disease (swelling of the tissues (inflammation) in your digestive tract)
patho: sores form in the lining of the stomach or small intestine. It is caused by an imbalance between digestive juices and the protective lining of the digestive tract, which can lead to inflammation, irritation, and erosion of the mucous membranes, resulting in the formation of ulcers
pop: common in the elderly
risk factors: Certain medications (NSAIDs), Smoking and alcohol, Diabetes and asthma, Stress and anxiety, Diet high in fatty or spicy foods
s&s: burning epigastric pain is most common, Nausea, Heartburn, Flatulence (farting), Perforation (a hole through the organ), Painless haemorrhage (loss of blood through an organ or vessel)
treatment: Smoking cessation,H. pylori-negative peptic ulcers are usually associated with aspirin or NSAID ingestion. Treatment is with PPIs (proton pump inhibitors) and stopping aspirin/NSAID, Follow-up endoscopy plus biopsy is performed for all GUs to demonstrate healing and exclude malignancy, Surgery is now rarely necessary
ddx: gastroesophageal reflux disease (GORD), Esophagitis, Gastritis, inflammatory bowel disease (IBD), peptic stricture, Mallory-Weiss tear, Zollinger-Ellison syndrome
Diverticular disease
= presence of diverticula (small bulges or pockets that can develop in the lining of the intestine). Diverticulitis implies inflammation, which occurs when faeces obstruct the neck of the diverticulum
caused by: related to the low-fibre diet eaten in Western populations; insufficient dietary fibre leads to increased intracolonic pressure, which causes herniation of the mucosa at sites of weakness
patho: mall pouches, called diverticula, form in the lining of the colon. These pouches can become inflamed and painful due to the buildup of gas and stool in them. The pathophysiology of diverticular disease is complex and involves a number of factors, such as changes in the structure and function of the muscular wall of the colon, weakening of the muscle layer, weakening of the connective tissue between the colonic muscles, and changes in the composition of the colonic microbiota. Additionally, certain lifestyle factors, such as low fiber intake, can increase the risk of developing diverticular disease.
pop: 50% of the population over 50 years of age
risk factors: Old age, low fiber intake, non-steroidal anti-inflammatory drugs (NSAIDs), diabetes and obesity, smoking and alcohol use, Stress and anxiety can also be a contributing factor
s&s: It is asymptomatic in 95% and usually discovered incidentally when a barium enema or colonoscopy is performed for other reasons, Pain and constipation, Bleeding which may be massive, Diverticulitis (left iliac fossa pain), fever, nausea and may result in perforation (leading to abscess formation or peritonitis), fistula formation into the bladder or vagina (an abnormal connection between an organ, vessel, or intestine and another organ, vessel or intestine, or the skin), intestinal obstruction
treatment: Acute attacks are treated with antibiotics (cephalosporin and metronidazole). Surgery is indicated rarely for complications and for frequent attacks of diverticulitis.
ddx: Crohn’s disease, ulcerative colitis, ischemic colitis, Appendicitis, colorectal cancer, intestinal obstruction, Volvulus
IBS
=common disorder that affects the GI tract
caused by: muscle contractions in the intestine, nervous system issues, severe infection, early life stress, Changes in gut microbes
triggers: food (including wheat, dairy products, citrus fruits, beans, cabbage, milk and carbonated drinks) and stress
symptoms: Abdominal pain, 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
risk factors: people under 50, female, family history of IBS, anxiety, depression or other mental health issues
treatment: Avoid foods that trigger your symptoms, Eat high-fiber foods, Drink plenty of fluids, Exercise regularly, Get enough sleep
medications–> fiber supplements, laxatives, Anti-diarrheal medications, Anticholinergic medications, Tricyclic antidepressants, SSRI antidepressants, pain medications
Crohn’s disease
=type of inflammatory bowel disease (IBD), where part(s) of the gut become swollen, inflamed, and ulcerated. Crohn’s is characterised by periods of remission and exacerbation
caused by: unknown. may be caused by a combination of environmental, immune, and bacterial factors in genetically susceptible individuals
patho: armless bacteria are mistaken for foreign invaders and the immune system starts an immune response. The inflammation in the GI tract does not go away as the immune response does not stop. This leads to chronic inflammation, ulceration, thickening of the intestinal wall, and eventually symptoms of Crohn’s disease.
pop: most often diagnosed in adolescents and adults between 15 and 35 years old. More common among those of Eastern European backgrounds
risk factors: genetics, Caucasian or Jewish descent. Living in a developed country, Northern climates, Smoking, Antibiotics, Contraceptive pill
s&s: iarrhoea (Which may come on suddenly), stomach aches and cramps (Most often in the lower-right part of the stomach, blood in faeces, fatigue, weight loss
treatment: steroids, liquid diet, immunosuppressants, methotrexate, Biological medicines, surgery
ulcerative colitis
=long-term condition where the colon and rectum become inflamed
caused by: unknown. possibly immune system malfunction, hereditary
risk factors: before 30, white- of Ashkenazi Jewish descent, family history
s&s: Diarrhea, often with blood or pus, Rectal bleeding — passing small amount of blood with stool, Abdominal pain and cramping, Rectal pain, Urgency to defecate, Inability to defecate despite urgency, Weight loss, Fatigue, Fever, In children, failure to grow
treatment: anti-inflammatory medications (e.g. corticosteroids), immune system suppressants, biologics, Anti-diarrheal medications, Pain relievers, Antispasmodics, Iron supplements, surgery to remove colon and rectum, a pouch, cancer surveilance
Appendicitis
= condition where the appendix, a small pouch attached to the large intestine, becomes inflamed and filled with pus
caused by: not known, but it is believed to be related to an obstruction in the appendix, often caused by a fecalith (a small, hardened piece of stool) or swollen lymphoid tissue
pop: 7% of the general population, individuals between the ages of 10 and 30, more common in males than females.
risk factors: a family history of the condition, a history of gastrointestinal infections, and certain medical conditions, such as cystic fibrosis
s&s: severe pain in the lower right abdomen, Nausea, Vomiting, loss of appetite, fever. pain may start around the belly button and migrate to the lower right abdomen, and may be worsened by movement
treatment: ypically involves surgery to remove the inflamed appendix, although in some cases antibiotics may be used to treat the condition without surgery. If left untreated, appendicitis can lead to a ruptured appendix, which can cause a potentially life-threatening infection in the abdomen.
Pancreatitis
=a condition where the pancreas, a gland located behind the stomach, becomes inflamed
caused by: heavy alcohol consumption, gallstones, high levels of triglycerides in the blood, infections, and certain medications
pop: 10-50 cases per 100,000 individuals per year. It is more common in individuals who are heavy drinkers or who have a history of gallstones
risk factors: heavy alcohol consumption, a history of gallstones, high levels of triglycerides in the blood, certain medications, certain medical conditions, such as cystic fibrosis or autoimmune pancreatitis.
s&s: severe abdominal pain that may radiate to the back, Nausea, Vomiting, fever, The pain is often described as a dull, persistent ache that is worsened by eating. In severe cases, pancreatitis can cause organ failure and can be life-threatening
treatment: depends on cause of inflammation. pancreatitis may resolve on its own with supportive care, such as rest and intravenous fluids. In more severe cases, treatment may include hospitalization, medications to control pain and inflammation, and, in rare cases, surgery. Complications of pancreatitis can include infection, bleeding, and organ failure, and in some cases, the condition can be life-threatening
Liver cirrhosis
=Late stage of fibrosis of the liver caused by liver disease. When the liver gets injured, it tries to repair itself leading to scar tissue formation making it difficult for the liver to function, causing cell death and inflammation. The scar tissue leads to reduced blood flow affecting the liver’s ability to process nutrients, hormones, drugs and natural toxins
caused by: Alcohol abuse, Viral hepatitis B,C,D, Fat accumulation in the liver, Using shared needles, Diabetes, Iron builds up in liver, Autoimmune hepatitis, Destruction of bile ducts, Heart failure
risk factors: 45-54+, Diabetes, Cystic fibrosis, Wilson disease, Inherited disorder, Infection, Meds, Obesity, Unprotected sex
s&s: Fatigue, Easy bleeding and bruising , Nausea, Loss of appetite, Swelling of the legs, ankles and feet, Weight loss, Itchy skin, Jaundice, Fluid accumulation in abdomen, Redness of the hand palms, Loss of periods/ premature menopause, Loss of sexual drive, breast enlargement and testicular atrophy (males), Confusion, Blood in stool, Light-colored stool, Brown urine, Slurred speech
treatment: no cure. Healthy lifestyle- manage drinking and diet, exercise regularly, stop smoking, reduce cholesterol, Low sodium diet, Blood pressure med- if caused by heart failure, Antibiotics- if caused by hepatitis, Surgery, Diabetes management- if caused by diabetes, Beta blockers- lower blood pressure
ddx: Cancer, Vein thrombosis, Fructose intolerance, Drug reactions
Hepatitis A
causes: faeco-oral rout (Ingestion of contaminated food or water), Saliva, Sexual intercourse
patho: Picornavirus–> Replication of virus in liver
Excreted Commoin bile ad faeces for–> 2 weeks before onset of clinical illness, 7 days after onset of clinical illness
Maximally infectious just before onset of jaundice
pop: Most common acute hepatitis, Worldwide, Commonly arises in autumn, Affects children and young adults
predisposing factors: Overcrowding and poor sanitation, Young age
s&s: feeling unwell, Non-specific symptoms (Nausea, Anorexia), Jaundice after 1-2 weeks, If symptoms persist hospitalisation is necessary, Dark urine and pale stool due to deepened jaundice, Enlarged liver, Palpable spleen
treatment: No specific treatment, Lasts approximately 3-6 weeks
hepatitis B
caused by: Vertical transmission (Mother to child in utero, During parturition or soon after birth), Horizontal transmission (Particularly in children, Minor abrasions or close contact to other children), Can also be transmitted intravenous way or sexual intercourse(Particularly men having sex with men, Saliva)
patho: Hepadna virus, Very high replication levels, Virus attaches onto hepatocytes receptors and is transported to the nucleus of the cell, Replication takes place in endoplasmic reticulum, Liver damage occurs due to immune response, Poor cell response leads to asymptomatic, inactive, chronic infective state, Good cell-mediated response results in continuing hepatocellular damage with development of chronic hepatitis
pop: Worldwide, Estimate of 220 million carriers, Higher carrier rate in parts of Africa and Middle and Far East
predisposing factors: Family history, Poor sanitation
s&s: If acquired perinatally it usually develops into chronic hepatitis, In adults acute infection is common, Clinical features are the same as in type A but may be more severe
treatment: Medication for very ill or persistently symptomatic people, Vaccination is obligatory in most developed countries
hepatitis C
caused by: Blood/blood products, Genetics, Saliva, Sexual intercourse
patho: Flaviviridae virus, Rapid changes within make up of virus make it difficult to develop a vaccine
pop: Estimate of 240 million carriers, 0.4-3% in Europe, 6% in Africa
predisposing factors: Common in people with haemophilia, Intravenous drug users, Homosexual men, Sex workers
s&s: Most acute infections are asymptomatic, 10% have mild influenza-like illness, Jaundice, Rise in serum aminotransferases, Most patients will not be diagnosed until evidence of abnormal transferase values, Chronic liver disease
Chronic–> Non specific malaise and fatigue, Arthritis, Cryoglobulinemia, Glomerulonephritis, Increases risk of diabetes, Slowly progressive fibrosis leading after decades to cirrhosis
treatment: period of monitoring for a few weeks with serial assessments of HCV RNA, If the viral load is falling, treatment may not be required, observed for several months to confirm true viral clearance, If the HCV RNA level does not decline, then therapy with interferon
hepatitis D
caused by: Blood/blood products, Genetics, Sexual intercourse
patho: Deltaviridae virus, The virus is an incomplete RNA particle, Virus is unable to replicate on its own, Gets activated through presence of HBV.
pop: Common in eastern Europe, north America and Brazilian rainforest
predisposing factors: Family history, HBV infection
s&s: Can lead to acute hepatic failure–> Especially after co-infection with HBV
If chronic HDV–> 60-70% develop cirrhosis
treatment: pegylated interferon-alfa-2a for 12 months
