The Physiology of GI Disorders Flashcards
What is sialorrhea
- Drooling or excessive salivation
- Can be caused by cerebral palsy qnd complex neurodisability
What can be used to treat sialorrhea?
- Anticholinergic medications
- Applied transdermally
- Transdermal scopolamine patches
What are the side effects of anticholinergics?
- Drowsiness or sedation
- Blurred vision
- Dizziness
- Urinary retention
- Confusion or delirium
- Hallucinations
- Dry mouth
- Constipation
- Reduced sweating and elevated body temperature
How are transdermal scopolamine patches applied?
- This technique consists of the application of a skin patch behind the ear at the level of the mastoid process
- The patch releases a sustained dose of 0.5 mg of scopolamine (hyoscine) per day and must be changed every 72 hours, alternating between right and left sides at each change
What does -tomy stand for?
Surgeon cutting something
What does -ectomy stand for?
Cutting something out
What does -ostomy stand for?
Surgeon making an opening
What does -plasty stand for?
Changed the shape of something
What does -pexy stand for?
Surgeon moved organ to the right place
What does -rraphy stand for?
Surgeon sewed something up
What does -desis stand for?
Surgeon made 2 things stick together
What is a gastrostomy?
artificial external opening into the stomach for nutritional support or gastric decompression. Typically this would include an incision in the patient’s epigastrium
What is coeliac disease?
- Auto-immune disease
- SI becomes inflamed when patient eats gluten
- Symptoms can be similar to IBS
- Patients can develop anaemia, lose weight, or have ongoing tiredness, thinning bones, reproductive problems, or problems affecting growth and/or puberty, tooth enamel loss, autoimmune thyroid disease, unexplained iron, vit B12, or folate deficiency
What percentage of people with coeliac disease are undiagnosed?
~ 80%
Describe the serological testing required to diagnose Coeliac disease?
- Total immunoglobulin A and and IgA tissue transglutaminase (IgA tTG) for serological testing
- A +ve serological result id=s an unequivocally raised IgA tTG
- If IgA tTG is weakly +ve or total IgA is deficient the labratory should automatically carry out supplementary tests
- Can give false positives and duodenal biopsy required to fully diagnose
What examination is required to recieve a definitive diagnosis of Coeliac disease?
Duodenal biopsy
What can the complications of coeliac disease be?
- Malignancy, especially lymphoma
- Osteoperosis
What foods contain gluten?
- Wheat
- Barley
- Rye
- Many common foods: breads, cakes, biscuits, pizzas, cereals, beer, soups, sauces, ready meals
What may people with celiac disease also be susceptible to?
Oats - avenin intolerance which is similar to gluten
What is dermatitis Herpetiformis?
- Skin condition linked to coeliac disease
- Skin bilstering, red, raised patches, often with blisters, severe itching, often stinging
- Affects fewer ppl
- Can appear at any age but is most commonly diagnosed in those aged
- between 50 nd 69
What is the most common drug prescribed for Dermatitis Herpetiformis?
Dapsone
How is dermatitis herpetiformis diagnosed?
Confirmed by a simple skin biopsy
What are the potential causes of a newborn vomiting blood?
- Cracked nipples during breastfeeding
- Swallowed blood during delivery
- Forceful spit up
- Clotting disorder
- Milk protein allergy
- Nose, throat or oesophagus irritation
What does bile-stained vomitting mean?
- Red flag
- Intestinal obstruction beyond duodenum
What does vomitting + a history of polyhydramnios suggest?
Upper GI (oesophageal, duodenal, ileal) atresia
What must be considered when vomitting occurs shortly after birth and is persistent?
Intestinal obstruction and increased intracranial pressure
What does an upright abdominal film showing characteristic “double bubble” suggest?
Duodenal atresia (dilated stomach + dilated proximal duodenum)
What will malrotation with obstruction from midgut Volvulus cause?
SI tissue to die as blood supply will be cut off
What is hypertrophic pyloric stenosis associated with?
Projectile Vomitting
What is hypertrophic pyloric stenosis caused by?
Muscle around pylorus is thickened and causes mechanical obstruction
What infants are more likely to have HPS?
- 1 out of every 1000 babies born
- More likely to affect full-term, first born male infants
- More likely in white infants
- Sometimes FH
What is pyloromyotomy?
an incision is made in the longitudinal and circular muscles of the pylorus. It is used to treat hypertrophic pyloric stenosis. Hypertrophied muscle is cut along the whole length until the mucosa bulges out
What can cause vomitting in infants that is not associated with an obstruction in GI tract?
- Lactose intolerance
- Congenital adrenal hyperplasia of the salt-losing variety
- Galactosaemia
- Hyperammonaemias
- Organic acidaemias
- Increased intracranial pressure
- Septicaemia
- Meningitis
- UTIs
What percentage of mechanical intestinal obstruction is large and small obstructions?
- Large: 20%
- Small: 80%
How can small bowel obstruction causes be divided?
Into congenital and aquired
What is usually more periferal on an X-ray small or large bowel?
Large
What percentage of obstructions are due to incarcerated hernias in the developed world?
80%
What are the most common causes of colon obstruction in adulthood?
Colon cancer (50-60%) - usually involves sigmoid colon - Acute diverticulitis i =s the second most common (involiving sigmoid colon)
What is the most common cause of neonatal colonic obstruction?
Hirschsprung disease
What is Hirschsprung disease commonly characterised by?
A short segment of colonic aganglionosis affecting term neonates, especially boys
How common is Hirschsprung disease?
1:5000-8000
What does hirschsprung disease typically present with?
Failure to pass meconium in the first1-2 days after birth
What is meconium?
The earliest stool of an infant
What is parlytic ileus?
- Functional intestinal obstruction without an actual physical obstruction
- Caused by a multifactorial malfunction in the nerves in the intestine and subsequent impairment in intestinal peristalsis
WHat are bowel sounds like in mechanical obstruction in comparison with paralytic ileus?
- Increased in mechanical
- Decreased in paralytic ileus
What does paralytic ileus look like on a radiograph?
Generalised, uniform, gaseous distention of the large and small bowel
What are the common causes of paralytic ileus?
5 Ps
- Postoperative
- Peritonitis
- Low Potasium
- Pelvic and spinal fractures
- Parturition
What is pancreatitis caused by?
Release of activated exocrine enzymes into the substance of the pancrease causing inflammation
What percentage of acute surgical admissions are in relation to acute pancreatitis?
1%
What are the causes of pancreatitis?
BAD HITS
- Biliary (most common)
- Alcohol (most common)
- Drugs (corticosteroids, HIV drugs, diuretics, valproic acid)
- Hypertriglyceridemia/hypercalcemia
- Idiopathic
- Trauma
- Scorpion sting
What is Cullen’s sign?
Tracking of blood from retroperitoneum to the umbilicus along the gastrohepatic and falciform ligament and then subsequently to subcutaneous umbilical tissues throughthe connective tissue covering of the round ligament
What is Grey Turner’s sign?
- Produced by haemorrhagic fluid spreading from the posterior pararenal space to the lateral edge of the quadrants lumborum muscle and thereafter to the subcutaneous tissues by means of a defect in the fascia of the flank
- Severe acute pancreatitis and high mortality associated
What is the mortality rate for severe acute pancrwatitis?
15-20%
What percentage of acute pancreatitis is mild and what is severe acute?
- Mild: 80%
- Severe: 20%
