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GI system > PBL week 2 > Flashcards

PBL week 2 Flashcards

1
Q

when do gallstone symptoms occur?

A

don’t usually cause symptoms but of they block one of the bile ducts it causes sudden severe abdominal pain = biliary colic

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2
Q

biliary colic

A

severe sudden abdominal pain that lasts for 1-5 hours
pain felt in centre of abdomen just under ribs on right and spreads to side and shoulder blade
referred pain to C4 dermatome
pain is constant and not relieved by urination, defecation, vomiting or passing wind
pain can be triggered by eating fatty foods
can occur at any time of day and may cause waking during night
pain is infrequent

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3
Q

other symptoms of gallstones

A 
sweating 
vomiting
can cause more severe problems if block bile flow for long periods of time or move to other organs 
- pyrexia 
- more persistent pain
- tachycardia 
- jaundice
- itchy skin
- diarrhoea 
- chills/ shivering attacks 
- confusion
- loss of appetite
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4
Q

causes of gallstones

A

imbalance in chemical make up of bile in gallbladder
high cholesterol in gallbladder is most common cause
bilirubin in gallbladder
these substances build-up and crystallise

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5
Q

risk factors for gallstones

A 
female 
overweight/ obese
>40
conditions that affect bile flow
crohn's disease 
IBS
family history
recent weight loss - dieting or surgery 
taking ceftriaxone antibiotic
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6
Q

female risk factors

A

having had children
taking combined contraceptive pill
undergoing high-dose oestrogen therapy

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7
Q

what conditions affect bile flow?

A

cirrhosis
primary sclerosing cholangitis
obstetric cholestasis

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8
Q

diagnosis of gallstones

A 
often diagnosed when looking for other conditions 
murphy's sign test 
blood tests
liver function tests
ultrasound 
MRI
cholangiography 
CT scan - looks for complications
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9
Q

Murphy’s sign test

A

hands/ fingers on upper right quadrant and ask patient to breathe in
if this is painful = inflammation

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10
Q

cholangiography

A

x-ray with dye in bloodstream or administered via endoscope

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11
Q

when to treat gallstones?

A

depends on symptoms and if they affect quality of life
active monitoring required if asymptomatic
need treatment if patient has a condition increasing risk of developing complications - cirrhosis, portal hypertension or diabetes
needed if there are high levels of calcium in gallbladder as can cause cancer

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12
Q

how to treat gallstones?

A

analgesics
healthy diet
cholecystectomy - removal of gallbladder
endoscopic retrograde cholangio-pancreatography
medication to dissolve gallstones

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13
Q

cholecystectomy

A

can be laparoscopic
single incision
keyhole surgery
open surgery

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14
Q

endoscopic retrograde cholangio-pancreatography

A

removal of gallstones from bile duct

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15
Q

medications to dissolve gallstones

A

ursodeoxycholic acid tablets

not that effective and need to be taken for a long time

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16
Q

what are the possible complications of gallstones?

A 
acute pancreatitis 
acute cholecystitis 
jaundice
acute cholangitis 
gallbladder cancer 
gallstone ileus
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17
Q

acute pancreatitis

A

inflammation of pancreas

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18
Q

acute cholecystitis

A

inflammation of gallbladder

if bile duct becomes blocked causing a build-up of bile inside

19
Q

acute cholangitis

A

bile duct infection

20
Q

gallstone ileus

A

bowel obstruction caused by gallstones caused by fistula

21
Q

heartburn

A

burning feeling in chest caused by stomach acid travelling up to throat
when it occurs repetitively = gastro-oesophageal reflux disease
common - often no obvious reason for it

22
Q

causes/ risk factors of acid reflux

A 
certain foods and drinks 
overweight
smoking
pregnancy
stress/ anxiety
some medicines - NSAIDs
hiatus hernia 
eating close to bedtime
23
Q

what foods/ drinks increase risk of acid reflux?

A 
coffee
alcohol
chocolate
fatty foods
spicy foods
24
Q

hiatus hernia

A

part of stomach moves up into chest

25
Q

example of PPI

A

omeprazole

26
Q

how do PPIs work?

A

reduces stomach acid production
irreversible covalently binds to H+/K+ ATPase pump blocking gastric proton pump of parietal cells
proton pump is the final stage of gastric acid secretion as it secretes H+ ions into the gastric lumen
given in an inactive form so can cross cell membranes into acidic environments
protonated intracellularly to give active form

27
Q

Ranitidine

A

currently unavailable due to possible risk with ingredients

H2 blocker - antagonist

28
Q

how does Ranitidine work?

A

competitive, reversible inhibitor of histamine 2 receptors, preventing histamine binding at gastric parietal cells
reduces H+/K+ pump action
histamine normally stimulates gastric secretion
decreased gastric acid secretion

29
Q

symptoms of acid reflux

A 
heartburn
unpleasant sour taste in mouth - caused by stomach acid
cough
recurring hiccups 
bad breath
bloating 
nausea
dysphagia 
weight loss
30
Q

what makes acid reflux symptoms worse?

A

after eating
lying down
bending over

31
Q

diagnosis of acid reflux

A 
history 
generally diagnosed by symptoms and assessment of risk factors 
elimination of other more serious diagnoses 
barium swallow - oesophagram 
oesophageal manometry
pH monitoring 
endoscopy
biopsy
x-ray with contrast 
gastroscopy
32
Q

oesophageal manometry

A

measures rhythmic muscle contractions of oesophagus during swallowing

33
Q

treatments for acid reflux

A 
antacids 
PPIs
H2 antagonists 
metoclopramide 
surgery to repair lower oesophageal sphincter
34
Q

antacids

A 
aluminium hydroxide 
magnesium carbonate
magnesium trisilicate 
magnesium hydroxide
calcium carbonate
sodium bicarbonate
can be bought OTC
35
Q

PPIs

A

omeprazole

lansoprazole

36
Q

H2 antagonists

A

Ranitidine

37
Q

metoclopramide

A

empty stomach quicker

38
Q

uses/ pros of endoscopy

A 
evaluate stomach pai
evaluate ulcers, gastritis or difficulty swallowing 
investigate GI bleeding 
investigate changes in bowel habits 
diagnose polyps or growths in colon
biopsy - prevents surgery 
safer 
minimally invasive 
can be used for treatments 
allows for descriptive and photographic description of lesions
39
Q

cons/ limitations of endoscopy

A 
cannot detect functional disease 
cannot estimate luminal diameter
invasive 
sedation required 
cannot detect disease in most small intestine 
cannot detect disease in deep submucosa, muscularis or serosa 
not appropriate for bowel perforation 
cannot assess or biopsy lymph nodes 
some risks
40
Q

risks of endoscopy

A

GI perforation
laceration of major blood vessels or organs
decreased venous return/ hypoxia if stomach overinflated
bradycardia due to vasovagal reflex from over distension
mucosal bleeding
bacteraemia

41
Q

indigestions

A

used to describe a wide range of digestive issues

discomfort in upper abdomen

42
Q

what does indigestion cause?

A 
heartburn 
feeling full or bloated
nausea
belching 
flatus 
bringing up food or bitter tasting fluids in mouth 
symptoms occur after eating or drinking
43
Q

causes of indigestion

A 
overeating
eating too quickly 
fatty/ greasy/ spicy foods
smoking 
too much caffeine
too much chocolate
too many carbonated beverages 
anxiety
certain antibiotics 
certain analgesics
certain iron supplements
44
Q

what conditions cause indigestion?

A 
gastritis
peptic ulcers
celiac disease
gallstones
constipation
pancreatitis 
stomach cancer
intestinal blockage 
intestinal ischaemia

GI system (2 decks)

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