some random GI stuff Flashcards
risk factors for Coeliac disease
Irish
female
HLA DQ2 gene
pathology of Coeliac disease
reaction to gliadin - T cell mediated
villous atrophy and malabsorption of bile acids and crypt hyperplasia
signs of Coeliac disease
diarrhoea that smells offensive bloating abdominal pain nausea and vomiting aphthous ulcers weight loss angular stomatitis fatigue
complications of Coeliac disease
osteoporosis malignancies (if pt does not adhere to diet)
diagnosis of coeliac disease
jejunal and duodenal biopsies
serology - tissue transglutaminase and anti-endomysial antibodies
gastroscopy
treatment of coeliac disease
gluten free diet
risk factors for oesophageal reflux
hiatus hernia
gastric surgery
increased abdominal pressure
symptoms of oesophageal reflux
heartburn (acid reflux)
complications of oesophageal reflux
Barrett’s oesophagus
carcinomas
hyperplasia
metaplasia
diagnosis of oesophageal reflux
endoscopy
GI bleeding
pH monitoring
treatment of oesophageal reflux
antacids (magnesium trisilicate mixture) PPIs (omeprazole) H2RA (ranitidine) weight loss meal planning dietary restraint
risk factors for peptic ulcers
inappropriate NSAID use
peptic ulcers
pathology of peptic ulcers
ulceration in gastric mucosa, usually due to a pH decrease
signs of peptic ulcers
haematemesis
melaena (dark, sticky faeces)
weight loss
epigastric pain
complications of peptic ulcers
peritonitis if perforation
pancreatitis
haemorrhage
diagnosis of peptic ulcers
endoscopy
H.pylori test
treatment for peptic ulcers
triple therapy: PPI, clarithromycin, amoxiclav
stop NSAIDs
stop smoking
what normally protects gastric cells from acid?
mucin
mesenteric ischaemia risk factors
chronic renal failure past MI AF heart failure thrombophilia
pathology of mesenteric ischaemia
restriction of blood flow to mesentery (acute or chronic)
what are the phases of mesenteric ischaemia?
hyper-active phase
paralytic phase
shock phase
what happens in the hyper-active stage of mesenteric ischaemia?
severe abdominal pain
bloody stools
many patients get better after this stage
what happens in the paralytic phase of mesenteric ischaemia?
abdominal pain more widespread more tenderness bowel motility decreases abdominal bloating absent bowel sounds
what happens in the shock phase of mesenteric ischaemia?
fluids start to leak through damaged colon lining –> shock and metabolic acidosis with dehydration
low bp
fast heart rate
confusion
patients are critically ill and require intensive care
diagnosis for mesenteric ischaemia
FBC test for lactic acid in blood CT XR colonoscopy angiography
treatment of mesenteric ischaemia
resection of bowel if necrotic
medicines for blood pressure
risk factors for Mallory Weiss tear
alcohol excess chronic cough hyperemesis gravidarum bulimia gastroenteritis
pathology of Mallory Weiss tear
haematemesis due to oesophageal tear or prolonged vomiting
signs of Mallory Weiss tear
melaena
haematemesis
hypovolaemia/shock
complications of Mallory Weiss tear
shock
diagnosis of Mallory Weiss tear
endoscopy
risk factors for haemorrhoids
hard stool
straining
pregnancy
pathology of haemorrhoids
congested vascular cushions
dilated venous component
signs of haemorrhoids
painless bleeding
blood coated stool
pain when pooing
diagnosis of haemorrhoids
proctoscopy
endoscopy
FBC
treatment of haemorrhoids
sclerotherapy
risk factors for fistulae
perianal sepsis
rectal carcinoma
TB
Crohn’s
pathology of fistulae
a track communicates between skin and anal canal
blockage of deep intramuscular gland ducts - formation of abscesses
symptoms of fistulae
inflammation
pain
pus secretion
pruritus ani - itching
complications of fistulae
active infection
diagnosis of fistulae
MRI
endoanal USS
anoscopy
treatment of fistulae
fistulostomy and excision
low ones are laid open to healing
high ones are sutured tight
risk factors for fissure
hard faeces
anal cancer
rectal artery spasm causing ischaemia
anal sex
pathology of fissure
tear in squamous lining (usually on posterior wall of lower anal canal)
symptoms of fissure
pain after defecation
treatment of fissure
5% lidocaine ointment stool softener dietary fibre topical GTN surgery if needed
risk factors for pilonidal sinus/abscess
obesity
family history
prolonged sitting
greater amounts of hair
risk factors for perianal abscess
Crohn’s
malignancy
fistulae
pathology of perianal abscess
abscess usually caused by gut organisms, usually E.coli
symptoms of perianal abscess
palpable mass near the anus
pain
constipation
fever
treatment of perianal abscess
incise and drain under GA
pathology of pilonoidal sinus/abscess
ingrown hair in central superior portion of bum crack, sweat can fill space –> anaerobic bacteria grow
