Patho Gastro Flashcards
What are the different quadrants for the abdoman
What is GORD
Gastroesophageal Reflux Disease.
This is transient relaxation of weak esophageal sphincter causing backflow of gastric contents.
Pain is usually in the epigastric & retrosternal area, may radiate to throat or shoulder
This may be misdiagonosed with angina & reflux could oesophageal mucosal leading to oesphagaitis
What is reflux oesophagitis
This is mainly occuring with conditions such as GORD because reflux can cause inflammation, this leads to barrett’s oesophagus
Barett’s oesophagus - results persistent reflux, causing mucosal damage. (this can increase the risk of oesophageal cancer)
What is a Hiatus Hernia
This is a protrusion of the stomach through the oesophageal hiatus
There are two patterns for this condition
Sliding/axial (95% of cases) this is a bell shaped protrusion of stomach
Paraesophageal/non-axial - seperate portion of stomach enters thorax though widened opening
What are oesophageal varices
This occurs from gradual obstruction of the venous blood flow in the liver leading to portal hypertention.
Commonly due to cirrhosis
The blockage causes collateral circulation to take the blood back to the vena cava
The pressure increase leads to varicosities
Subject to rupture causing massive haemorrhage
What is gastritis
This is inflammation of the gastric mucosa
Acute: its usually inflammatory transient response
Accompanied with emesis (vomiting), pain, in severe cases, haemorrhage & ulceration
Common causes include a certain bacterial infection aswell as asprin/ NSAIDs and alcohol
Frequent cause of acute GI bleed
Chronic
Can cause long term damage to the stomach epithelium
What is a peptic ulcer
What is gastroenteritis
This is an acute ilness with a primary manifestation of diarrhoea/vomiting
could be accompanied by nausea, fever, abdo pain & malaise (uncomfort)
This usually lasts more than 7 days but no longer than 14 days
Associated with fluid shifts - dehydration, shock
What is IBS
Irritable Bowel Syndrome
This can have a variable combination of chronic & recurrent intestinal symptoms including
Abdo pain
Altered bowel function
Flatulance
Bloating
Nausea
Anorexia
Constipaton/diarrohea
Anxiety
This is usually resolved with bowel movments & accociated with change in consistency/frequency
What is Crohn’s disease
Cause unknown can be genetic
This is slow, progressive & recurrent inflammation of any section of the GI tract (most commonly in the small intestine)
What is Ulcerative colitis
This is a non-specific continuous inflammatory condition.
This is normally isloated to the rectum & large intestine
Inflammation causes oedema and ulceration can appear on the base of the mucosal layer
Bowel wall thickens with repeated episodes and impairs absorption of fluid and electrolytes. In severe cases it can affect peristalsis and increase the risk of colon cancer
What is Diverticular Disease
Diverticulum: is a herniation or outpouching of the mucosa through the muscle layer of the colon wall
Diverticula: Multiple pouches (patient will often present with many)
Diverticulosis: diverticular are present but asymptomatic
Diverticulitis: when the pouches become inflamed or perforate.
This can lead to chronic constipation and hypertrophy in the colon
What is so dangerous about diverticulitis
Faeces or bacteria can be caught in these herniations which can accumulate and harden. This can lead to a possible obstruction or a perforation of the diverticula causing a GI bleed, infection leading to sepsis or a possible obstruction.
What symptoms is this associated with?
Left lower quardrant pain, nausea, vomiting & fever
What is Appendicitis
This is caused by a primary obstruction of the appendix causing inflammation
a common obstruction is from a calcified stone made of faeces, gallstones, tumors, parasites, or lymphatic tissue
Symptoms usually abrupt & onset pain due to stretching of appendix. progressive inflammation leads to pain in Lower right quadrant.
Normally associated with nausea & increasing pain.
Usually seen in aged 5-30 years but it can occur at any age
What is the inflammatory response for appendicitis
This causes continued production of mucus which increases pressure in the lumen of the appendix.
This results in occlusion of small blood vessels leading to ischemia
Bacteria begins to leak in the dying walls
Appendiceal rupture can cause peritonitis, which may lead to sepsis
What is a bowel, intestinal obstruction
This refers to the lack of the intestinal contents.
It is more common in the small instestine due to the smaller lumen.
This can be acute or progressive.
Mechincal obstruction: adhesions, strangulated hernia, forgein bodies, tumours,
Functional (adynamic): Obstruction results from a neurologic impairment such as a spinal cord injury or lack of propulsion in the intestine
What is peritonitis
This is acute or chronic inflammation of normally sterile peritoneum
Develops with ethier chemical or bacterial invasion
Chemical peritonitis will develop into bacterial peritonitis as it causes inflammation of the intestinal wall leading to increased permeability of intestinal bacteria
Some causes of chemical peritinitis could be perforated ulsa, ruptured gall bladder, pancreatitis, ruptured bladder, ruptured spleen
Can peritonitis lead to hypovolemic shock
yes! This is because of the increased vasodilation due to the inflammation response
What is a hernia
This is a proportion of the internal organ protrudes through the wall of the cavity surrounding it.
An inguinal hernia - is the most common and is where the portion of the intestine protrudes into the inguinal cavity
What is cerosis
This is liver failure
if 80 - 90% of hepatic capacity is lost when liver failure occurs
Manifestations reflect synthesis, storage metabolic & elimination functions of the liver
Why can liver faliure lead to hypoglycemic events
This can lead to hypoglycemic events because there can be a decrease in glycogen stores in the liver meaning that we can not break glycogen into glucose
How can liver faliure affect the blood
If liver faliure occurs it can affect the amount of B12 vitamin stored. This is essential for the make up of blood, leading to oedema and acites. It can also affect the clotting factors (this is a disorder of synthesis and storage)
How can liver faliure affect cholesterol and bile salts
Since cholesterol is stored in the liver faliure can affect the amount of cholesterol in the blood.
A decrease production of bile salts means that we can not synthesis fats as easily therefore leading to deficiency of fatty vitamins and the potential for the patient to be losing alot of weight
What is included in the disorder of metabolic and excretory functions in liver faliure
Impaired conversion of amino acids
Increased aldosterone & androgens/oestrogens
Drug interactions and toxicities
Hyperbillirubinemia
What is Cholelithiasis
This is another name for gall stones
This is where there are abnormalities in the composition of bile & inflammation of the gall bladder.
The stones can be made up of primarily cholesterol or bilirubin
This condition can be hereditary, and is associated with obesity and pregnancy
This is usually asymptomatic until the stones obstruct bile flow or cause inflammation
What can small stones present with?
Stones <8mm can pass into the common duct with symptoms of indigestion and biliary colic (symtoms of a dull pain in the middle/upper right area of the abdo)
What are larger gall stones more likley to present with
Larger stones are more likley to obstruct flow causing jaundice, they also present with a abrupt onset of pain in the upper right quadrant and epigastric area
Pain can increase and is persisting 30mins - 5hrs
What is Cholecystitis
Acute cholecystitis is a diffuse inflammation of the gallbladder usually secondary to an obstruction of the outlet.
85%-90% of cases are associated with gallstones with the remainder linked to sepsis, severe trauma, or infection of the gall bladder
Chronic cholecystitis occurs with repeating acute cholecystitis or chronic irritation of the gallbladder with gallstones
What is pancreatitis
This is inflammation of the pancreas
Acute - Auto - digestion of pancreatic tissue by prematurely activated pancreatic enzymes
Chronic - persistent inflammation causes irreversible change to pancreatic structure & function
What are the 2 main reasons for pancreatitis to be present
Alcohol abuse
Gall stone obstruction which obstructs the flow of bile an pancreatic secretion into the duodenum cause relfux of bile into the pancreatic duct
How can chronic pancreatitis cause diabetes
Proteins harden and block the pancreaic duct, to counter act this pancreatic glands enlarge causing more inflamation.
This can put pressure on the islets of langerhans leading to diabetes because of the decrease output of insulin
What is a UTI
Urinart Tract Infection
This is one of the most common reasons for abdo pain in all ages and frequent cause of sepsis
Can a kindey stone cause ambo pain
YES this is known as renal colic and non-colicky renal pain
Colic pain is mostly commonly in the flank of a patient and the pain is often described as the worst pain
Non-colic pain is described as a dull deep pain in the flank or back that varies in intensity
What is the Aetiology of a Abdo Haemorrhage
Trauma
Perforation secondary to ulceration or bowel obstruction
Ectopic pregnancy
Aneurysm
What are some symptoms of a abdo bleed
Diarrhoea: may be associated with frank (bright red) blood and could indicate a lower abdo bleed
Melena: dark, tar-like indicating a high abdo bleed
Haematemesis: Vomiting of bright red blood indicating a bleed proximal to the stomach
Coffee ground vomit: Indicate a lower GI bleed
What is a Ectopic pregancy
This is where the embryo implants itself outside of the uterus. Most commonly it is in the fallopian tubes
Some factors that put people at risk for this are
scarring of fallopian tubes due to PID (Pelvic Inflammatory disease), previous ectopic pregnancy, previous pelvis or tubal surgery
Other factors include endometriosis or use of intrauterine devices (IUD)
Can a ectopic pregnancy be life threatening?
YES
Patients will often need to have surgery
this condition usually occurs before 12 weeks gestation
