Patho Gastro

Question 1

What are the different quadrants for the abdoman

Answer 1

Question 2

What is GORD

Answer 2

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

Question 3

What is reflux oesophagitis

Answer 3

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)

Question 4

What is a Hiatus Hernia

Answer 4

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

Question 5

What are oesophageal varices

Answer 5

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

Question 6

What is gastritis

Answer 6

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

Question 7

What is a peptic ulcer

Answer 7

Question 8

What is gastroenteritis

Answer 8

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

Question 9

What is IBS

Answer 9

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

Question 10

What is Crohn’s disease

Answer 10

Cause unknown can be genetic
This is slow, progressive & recurrent inflammation of any section of the GI tract (most commonly in the small intestine)

Question 11

What is Ulcerative colitis

Answer 11

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

Question 12

What is Diverticular Disease

Answer 12

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

Question 13

What is so dangerous about diverticulitis

Answer 13

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.

Question 14

What symptoms is this associated with?

Answer 14

Left lower quardrant pain, nausea, vomiting & fever

Question 15

What is Appendicitis

Answer 15

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

Question 16

What is the inflammatory response for appendicitis

Answer 16

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

Question 17

What is a bowel, intestinal obstruction

Answer 17

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

Question 18

What is peritonitis

Answer 18

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

Question 19

Can peritonitis lead to hypovolemic shock

Answer 19

yes! This is because of the increased vasodilation due to the inflammation response

Question 20

What is a hernia

Answer 20

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

Question 21

What is cerosis

Answer 21

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

Question 22

Why can liver faliure lead to hypoglycemic events

Answer 22

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

Question 23

How can liver faliure affect the blood

Answer 23

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)

Question 24

How can liver faliure affect cholesterol and bile salts

Answer 24

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

Question 25

What is included in the disorder of metabolic and excretory functions in liver faliure

Answer 25

Impaired conversion of amino acids
Increased aldosterone & androgens/oestrogens
Drug interactions and toxicities
Hyperbillirubinemia

Question 26

What is Cholelithiasis

Answer 26

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

Question 27

What can small stones present with?

Answer 27

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)

Question 28

What are larger gall stones more likley to present with

Answer 28

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

Question 29

What is Cholecystitis

Answer 29

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

Question 30

What is pancreatitis

Answer 30

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

Question 31

What are the 2 main reasons for pancreatitis to be present

Answer 31

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

Question 32

How can chronic pancreatitis cause diabetes

Answer 32

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

Question 33

What is a UTI

Answer 33

Urinart Tract Infection

This is one of the most common reasons for abdo pain in all ages and frequent cause of sepsis

Question 34

Can a kindey stone cause ambo pain

Answer 34

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

Question 35

What is the Aetiology of a Abdo Haemorrhage

Answer 35

Trauma
Perforation secondary to ulceration or bowel obstruction
Ectopic pregnancy
Aneurysm

Question 36

What are some symptoms of a abdo bleed

Answer 36

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

Question 37

What is a Ectopic pregancy

Answer 37

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)

Question 38

Can a ectopic pregnancy be life threatening?

Answer 38

YES
Patients will often need to have surgery
this condition usually occurs before 12 weeks gestation