Illness script - week 6 Flashcards
GIT disorders
31% _____ and 29% _____ are the most common causes to a GP for acute _____ pain
GIT disorders
31% appendicitis and 29% colics are the most common causes to a GP for acute abdomen pain
GIT disorders
hospital presentations most commonly for abdomen pain are _____ (34%), _____ (34%), and _____ (10%)
GIT disorders
Hospital presentations most commonly for abdomen pain are non-specific (34%), appendicitis (34%), and cholecystitis (10%)
Probability diagnosis of GIT
1) acute _____ and _____
2) _____
3) _____ _____ _____
4) _____ and _____ colic
Probability diagnosis of GIT
1) Acute gastroenteritis and appendicitis
2) Dysmenorrhoea
3) Irritable bowel syndrome
4) Biliary and renal colic
Pitfalls of abdominal pain
1) acute _____
2) _____ _____
3) _____ causes
4) _____
5) _____ _____
6) _____ _____
pitfalls of abdominal pain
1) acute appendicitis
2) myofascial tear
3) pulmonary causes
4) pneumonia
5) pulmonary embolism
6) faecal impaction
abdominal diagnostic testing
1) Blood: _____, _____ _____ _____ (ERS), _____ _____ (CRP)
2) Stools: _____ blood, _____ _____ and _____
3) ______
4) Radiology: _____ scan, _____, _____
5) Endoscopy: _____, _____ with _____
abdominal diagnostic testing
1) Blood: haemoglobin, Erythrocyte sedimentation rate (ERS), C-reactive protein (CRP)
2) Stools: occult blood, microscopic analysis and culture
3) Urine
4) Radiology: CT scan, MRI, Ultrasound
5) Endoscopy: colonoscopy, gastroscopy with biopsy
endoscopy diagnostic
Sigmodoidoscopy: helps exlude local _____, searching for abnormalities in _____, _____ and _____; __% usually occurs in the first __cm of the bowel
endoscopy diagnostic
Sigmoidoscopy: helps exclude local disease, searching for abnormalities in blood mucus and neoplasia; 60% usually occurs in the first 60 cm of the bowel
Appendicitis
The rodimentary part of the colon, it’s role in immunity becomes inflamed and is in risk of perforating leading to peritonitis
appendicitis
The _____ part of the colon, it’s role in immunity becomes inflamed and is in risk of perforating leading to _____
Appendicitis
life-time risk is 1 in __ for people in america, 1/__ of appendicitis presents to hospital with a _____ _____
appendicitis
life-time risk is 1 in 15 for people in america, 1/3 of appendicitis presents to hospital with a perforated appendix
Signs and symptoms of appendicitis
1) general _____ pain that is localised to the _____ _____ _____
2) _____
3) _____ and _____
signs and symptoms of appendicitis
1) general abdominal pain that is localised to the right iliac fossa
2) anorexia
3) Diarrhea and constipation
Diagnosing appendicitis
1) _____ _____ _____
2) _____ (last resort)
3) _____ or _____ scan
diagnosing appendicitis
1) Full blood count
2) Laporoscopy (last resort)
3) Ultrasound or CT scan
Treatment of appendicitis
1) Antibiotics: if it is _____ _____
2) _____ and antibiotics: if _____
treatment of appendicitis
1) Antibiotics: if it is low grade
2) Surgery and antibiotics: if perforated
Colic
Presents as rhythmical patterns of _____ ______
Biliary colic has smaller variations in ______
Ureteric colic and intestinal colic are more during _____ of _____
colic
Presents as rhythmical patterns of painful contractions
Biliary colic has smaller variations in wavelength
Ureteric colic and intestinal colic are more during periods of rest
Colic
Intensely painful: can be faked for _____ seeking behaviour
_____ on palpations
_____ or _____ scans used to find any obstructions
colic
Intensely painful: can be faked for opioid seeking behaviour
Tender on palpations
Ultrasound or CT scans used to find any obstructions
Cholelithiasis
_____ are hard, _____-like structures that obstructs the _____ _____
_____ are formed by presence of _____ _____ which is a mix of _____, ______ deposits and _____ crystals in the galbladder or biliary ducts
cholelithiasis
Gallstones are hard, pebble-like structures that obstructs the cystic duct
Gallstones are formed by presence of biliary sludge which is a mix of glycoproteins, calcium deposits and cholesterol crystals in the gallbladder or biliary ducts
Cholelithiasis
More common in adults __-__% between __-__ years old
Ages <40 Males to females __:__
Over >40 Males to females __:__
Relationship between _____ and high diet of _____ _____
cholelithiasis
More common in adults 10-15% between 18-65 years old
Ages <40 Male to females 1:3
Over >40 Males to females 1:1
Relationship between disease and high diet of refined sugar
cholecystitis
almost always associated with obstruction of gallbladder or cystic duct by a gall stone, the obstruction may be from mucus, parasitic worm or bile tumour
the initial inflammation is _____ induced and leads to _____ damage which releases _____ and _____
cholecystitis
almost always associated with obstruction of gallballder or cystic duct by a gallstone, the obstruction may be from mucus, parasitic worm or bile tumour
the initial inflammation is chemically induced and leads to mucosal damage which releases phosphollipase and lysolecithia
Dsypepsia
_____ _____ _____ most common cause
__% of population experienced at some point, but not all are caused by _____ _____
__% develops into _____ _____ _____, __ - __% of chronic _____ users have peptic ulceration
Dsypepsia
Gastoesophagal reflux disease most common cause
80% of population experienced at some point, but not all are caused by hiatal hernia
10% Develops into peptic ulcer disease, 10-20% of chronic NSAIDs users have peptic ulceration
Gastroesophageal reflux disease
when _____ _____ is exposed to gastric contents for prolonged periods
factors such as delayed _____, increased _____-_____ pressure or abnormal lower _____ _____ function can lead to GORD
gastroesophagel reflux disease
when oesophageal mucus is exposed to gastric contents for prolonged periods
factors such as delayed emptying, increased intra-abdominal pressure or abnormal lower esophageal sphincter function can lead to GORD
GORD
Can develop into _____ oesophagus a pre-malignant lesion that can lead to _____ _____
GORD
Can develop Barret oesophagus a pre-malignant lesion that can lead to oesophageal adenocarcinoma
Treating GORD
1) _____: for rapid relief but is ineffective for long term treatment
2) _____-_____ _____ (PPI): 4 weeks
3) _____-_____ _____: 8 weeks
Treating GORD
1) Antacids: for rapid relief but is ineffective for long term treatment
2) Proton-pump inhibitior (PPI): 4 weeks
3) H2-receptor antagonists: 8 weeks
Peptic ulcer
Strong associated with _____; _____ like to borrow in _____ which stimulates the chronic _____ by stimulating local inflammatory repsonse
peptic ulcer
Strongly associated with H.pylori; H.pylori like to borrow in mucosa which stimulates the chronic gastritis by stimulating local inflammatory response
Peptic ulcer
_____ can impair muscosal defence which inhibits the _____ and __ (_____, _____); they are _____ that protect the function of gut _____
__% of the population is affected
peptic ulcer
NSAIDs can impair mucosal defence which inhibitis the COX1 and 2 (voltaren, ibuprofen); they are enzymes that protect the function of gut mucosa
2% of the population is affected
Treating peptic ulcer
1) _____ _____ with heater probe and low _____ injection
2) IV _____/_____ or _____
3) _____ is also an option
treating peptic ulcer
1) endoscopic haemostasis with heater probe and low adrenaline injection
2) IV omeprazole/esomeprazole or pantroprazole
3) Surgery is also an option
Histamine H2 receptor antagonists
_____, _____ and _____: these medications are less likely to affect _____ of other medications; they can be administered without food and patients are advised to avoid _____ _____ and _____
Histamine H2 receptor antagonists
Ranitidine, nizatidine and feimotidine: these medications are less likely to affect metabolism of other medications; they can be administered without food and patients are advised to avoid spicy foods and caffeine
Proton-pump inhibitor (PPI)
Inhibits _____ _____ _____, it is more potent than _____ _____ _____ and managing conditions associated with _____
_____ is the most common medication
Proton-pump inhibitor (PPI)
Inhibits gastric acid secretion, it is more potent than H2 receptor antagonist and managing conditions associated with hyperacidity
Omeprazole is the most common medication
Recurrent abdominal pain
3 distinct _____ over __ months, occurs in __% of school children
__-__% are diagnosed by organic causes, the other are psychological and emotional
recurrent abdominal pain
3 distinct episodes over 3 months, occurs in 10% of school children
5-10% are diagnosed by organic causes, the other are psychological and emotional
Inflammatory bowel disease (IBD)
abnormal host response to an _____ trigger, causes the gut _____ and release of inflammatory mediators that cause _____ _____
Inflammatory bowel disease (IBD)
abnormal host response to an environment trigger, causes the gut inflammation and release of inflammatory mediators that cause tissue damage
IBD
Ulcerative colitis: __/100,000
Chrohn’s disease: __/100,000
IBD
Ulcerative colitis: 9.8/100,000
Chrohn’s disease: 6.3/100,000
Chrohn’s disease
More common in terminal _____ and right side of _____; the entire walls thicken and deep _____ create linear _____
This may ulcerate and form fistulas with _____, _____ and bowel
Chrohn’s disease
More common in terminal ileum and right side of colon; the entire walls thicken and deep ulcers create linear fissures
This may ulcerate and form fistulas with bladder, uterus and bowel
Ulcerative colitis (UC)
involves _____ and _____ colon or even _____ colon; inflammation is confluent and affects the _____
ulcerative colitis (UC)
involves rectum and signoid colon or even whole colon; inflammation is confluent and affects the mucosa
Treating IBD
1) _____, _____, _____ for treating UC
2) _____: for acute flares
3) _____ drugs for severe attacks: _____, _____
4) _____ agents: _____
treating IBD
1) Sulfasalazine, olsalazine, mesalazine for treating UC
2) Corticosteroid: for acute flares
3) Immunomodifying drugs for severe attacks: azathiopine, cyclosponn
4) Biological agents: infliximab
Irritable bowel syndrome (IBS)
__-__% worldwide: most common functional GI disorder caused by _____ and _____ (__% triggered by food)
_____-_____ breath test
Irritable bowel syndrome (IBS)
7-21% worldwide: most common functional GI disorder caused by malabsorption and FODMAPs (90% triggered by food)
Hydro-methane breath test
Treating IBS
1) Regular _____ pattern
2) No _____, _____, _____ and _____
3) High _____, low _____ and a lot of _____
4) Avoid _____
treating IBS
1) Regular eating pattern
2) No smoking, alcohol, laxatives and codeine
3) High fibre, low carbs and a lot of water
4) Avoid FODMAPs
Diverticulitis
long-life and _____ deficient diet; small stools require higher _____-_____ pressure resulting in herniation of the _____
diverticulitis
long-life and fibre deficient diet; small stools require higher intra-colic pressure resulting in herniation of the mucosa
diverticulitis
<40 years old: __%
>80 years old: __%
~__% of patients have at least 1 _____
diverticulitis
<40 years old: 10%
>80 years old: 70%
~20% of patients have at least 1 recurrence
Colon cancer
Common GIT _____, second most common cause of _____ in western society; Males >50 years old (__%)
Mortability rate is __%, _____ prognosis if diagnosed early
colon cancer
Common GIT malignancy, second most common cause of death in western society; Males >50 years old (90%)
Mortality rate is 60%, good prognosis if diagnosed early
Duke stages
~__ year survival
A-cancer: limited to _____ and _____ __%
B-cancer: extends into _____ or _____ __%
C-cancer: involves regional _____ _____ __%
D-distant _____ 7%
Duke stages
~5 year survival
A-cancer: limited to mucosa and submucosa 88%
B-cancer: extends into muscularis or terosa 70%
C-cancer: involves regional lymph nodes 43%
D-distant mestastses 7%
diagnosing colon cancer
1) _____ _____ _____ _____ (FOBT): if results are positive, _____ or _____
2) _____ scan
3) _____ every __ years after 50 years old
diagnosing colon cancer
1) Full occult blood test (FOBT): if results are positive, colonscopy or sigmoidoscopy
2) PET scan
3) FOBT every 2 years after 50 years old
