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PBLs > Week 12 - Abdomen > Flashcards

Week 12 - Abdomen Flashcards

1
Q

What are the symptoms of coeliac disease?

A
  • diarrhoea, which may smell particularly unpleasant
    • stomach aches
    • bloating and farting (flatulence)
    • indigestion
    • constipation

Coeliac disease can also cause more general symptoms, including:
○ tiredness (fatigue) as a result of not getting enough nutrients from food (malnutrition)
○ unintentional weight loss
○ an itchy rash (dermatitis herpetiformis)
○ problems getting pregnant (infertility)
○ nerve damage (peripheral neuropathy)
○ disorders that affect co-ordination, balance and speech (ataxia)
Children with coeliac disease may not grow at the expected rate and may have delayed puberty.

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2
Q

what are some complications of untreated coeliac disease?

A
  • Vitamin deficiency
    • Anaemia
    • Osteoporosis
    • Ulcerative jejunitis
    • Enteropathy-associated T-cell lymphoma (EATL) of the intestine
    • Non-Hodgkin lymphoma (NHL)
      Small bowel adenocarcinoma (rare)
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3
Q

what is the management of coeliac disease?

A

lifelong gluten free diet
immunisation - individuals can often have functional hyposplenism (defective immune response) .: require pneumococcal evert 5 years, influenza every year

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4
Q

what is malabsorption?

A

where your body does not fully absorb nutrients
can lead to a deficiency of vitamins and minerals.

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5
Q

what conditions can be caused by malabsorption?

A

iron deficiency anaemia
vit b12/folate deficiency anaemia
osteoperosis

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6
Q

what test can be carried out to check for compliance with gluten free diet in coeliac disease?

A

IgA tTG measurements

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7
Q

what are the components of a healthy diet?

A
  • Eat at least 5 portions of a variety of fruit and vegetables every day
  • Base meals on higher fibre starchy foods like potatoes, bread, rice or pasta
  • Have some dairy or dairy alternatives (such as soy drinks)
  • Eat some beans, pulses, fish eggs, meat and other protein
  • Choose unsaturated oils and spreads, and eat them in small amounts
    Drink plenty of fluids (at least 6-8 glasses a day
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8
Q

what are some vegan sources of calcium?

A
  • Green, leafy vegetables such as broccoli, cabbage and okra
  • Fortified unsweetened soya, pea and oat drinks
  • Calcium-set tofu
  • Sesame seeds and tahini
  • Pulses
  • Brown and white bread
  • Dried fruit, such as raisins, prunes, figs and dried apricots.
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9
Q

what are some vegan sources of iron?

A
  • Pulses
  • Wholemeal bread and flour
  • Breakfast cereals fortified with iron
  • Dark green, leafy vegetables such as watercress, broccoli and spring greens
  • Nuts
    Dried fruits such as apricots, prunes and figs.
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10
Q

what are some vegan sources of b12?

A
  • Breakfast cereals fortified with B12
  • Unsweetened soya drinks fortified with vitamin B12
    Yeast extract, such as marmite and nutritional yeast flakes which are fortified with vitamin B12
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11
Q

what are some vegan sources of omega3 fatty acids?

A
  • Ground linsees (flaxseed oil)
  • Vegetable (rapeseed) oil
  • Chia seeds
  • Shelled hemp seeds
    walnuts
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12
Q

what causes scurvy?

A

vit c deficiency

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13
Q

what causes rickets?

A

vit d deficiency

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14
Q

what can calcium deficiency cause?

A

brittle bones
excessive bleeding

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15
Q

what can phosphorus deficiency cause?

A

bad teeth and bones

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16
Q

what can iron deficiency cause?

A

anaemia

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17
Q

what can iodine deficiency cause?

A

goitre
enlarged thyroid gland

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18
Q

what can copper deficiency cause?

A

low appetitie
retarded growth

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19
Q

what deficiency can cause night blindness?

A

vit a

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20
Q

how is scurvy presented?

A

bleeding gums
skin spots
swelling in joints

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21
Q

what can deficiency in vit K cause?

A

excessive bleeding due to injury

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22
Q

what is coeliac disease?

A
  • Autoimmune condition where exposure to gluten causes an immune reaction that creates inflammation in the small intestine.
  • It is characterised by gluten sensitivity.

Starts in infancy but can be diagnosed at any age.

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23
Q

what is the pathophysiology of coeliac disease?

A
  1. In coeliac disease autoantibodies (anti TTG and anti EMA) are created in response to exposure to gluten.
  2. These autoantibodies target the epithelial cells of the intestine and lead to inflammation.
  3. This inflammation affects the small bowel, particularly the jejunum and causes atrophy of the intestinal villi.

Atrophy of the intestinal villi then causes malabsorption of nutrients and disease related symptoms.

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24
Q

what are some risk factors of coeliac disease?

A
  1. Genetics
  2. Autoimmune thyroid disease
  3. Type 1 diabetes
  4. igA deficiency
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25
Q

what autoantibodies are present in coeliac disease?

A

anti TTG
anti EMA

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26
Q

what is diarrhoea classed as?

A

3 or more stools a day

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27
Q

what symptoms should you look for if someone presents with dirrhoea?

A
  1. Character
    1. Stool consistency
    2. Blood? - mixed with stool or just around the sides of toilet or on toilet paper
    3. Dysentery? - watery and bloody - infections
    4. Steatorrhoea? - loose, greasy, pale, foul smelling stools - malabsorption
    5. Offensive smell?
    6. Easy to flush? - steatorrhoea

Melena? - dark, tarry, sticky, offensive smelling - upper GI bleed

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28
Q

what are some complications of diarrhoea?

A

dehydration -> hypovolaemic shock

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29
Q

how are carbohydrates digested + absorbed?

A
  1. mouth = salivary amylase
  2. stomach = food is refered to as chyme
  3. SI, pancreas and liver = pancreatic amylase, chyme -> dextrin and maltose
    monosaccharides are absorbed in small intestine
    once absorbed it is processed by liver and stored as glycogen
  4. colon = fibre cannot be digested to eliminated with stool
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30
Q

how are fats digested and absorbed?

A
  1. mouth = lingual lipase initiates digestion
  2. oesophagus = peristalsis moves food down
  3. stomach = gastric lipase breaks triglycerides to diglycerides and fatty acids
  4. SI = bile acts as an emulsifier, pancreatic lipase breaks down fatty acids to monoglycerides, bile envelops monoglycerides to form micelles so they can be absorbed
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31
Q

how are proteins digested and absorbed?

A
  1. mouth to stomach = hyrdrochloric acid and pepsin initiate breakdown of protein
  2. SI = chymotripsin and trypsin break protein into dipeptides and amino acids
  3. absorbtion = occurs in duodenum or proximal jejunum
32
Q

where can crohns disease affect?

A

anywhere on GI tract

33
Q

what is the main identifier of crohns?

A

skip lesions

34
Q

what are the main clinical features of crohns?

A

C - cobblestone appearence
R - rosethorn ulcers
O - obstruction
H- hyperplasia of lymphnodes (granulomas + increased goblet cells)
N - narrowing of lumen
S - skip lesions

N - no bllod or mucus
E- entire GI tract
S- skip lesions
T- transmural (mucosa to serosa) inflmmation
S- smoking is a risk factor

35
Q

what bedside test can be easily done to test for IBD?

A

faecal calprotectin

36
Q

why are barium enemas used in crohns?

A
  • High sensitivity and specificity for examination of the terminal ileum
    • Can visualise cobblestoning, fistulae, bowel dilation, rosethorn ulcers +/-colon strictures
37
Q

how is crohns diagnosed?

A

endoscopy
OGD
colonoscopy = diffuse erythema and deep ulcers in patchy distribution

38
Q

what macroscopic features (endoscopy) are seen in crohns?

A
  • Cobblestone appearance - caused by superficial ulcers which become deep and sepiginous (wavy margin)
    • Bowel wall thickening
    • Lumen narrowing
    • Deep ulcers
    • Fistulae
      Fissures
39
Q

what microscopic changes (histology) can be seen in crohns?

A
  • Inflammatory infiltration:
    ○ Hyperplasia of lymph nodes
    ○ Granulomas
    • Skip lesions
    • Transmural ulceration (from mucosa to serosa)
      Increased goblet cells
40
Q

what complications can occur in crohns?

A
  • Bowel obstruction (stricture)
    ○ Thickened wall of intestines causes narrowing of the bowel
    ○ This is more common in Crohn’s than UC
    • Fistula
      ○ Inflammation goes through the wall and creates tunnels
      ○ Abnormal passage between 2 organs or an organ and the outside of your body
      ○ Can become infected
    • Abscesses
      ○ Swollen, pus-filled pockets of infection in intestinal walls
    • Anal fissures
      ○ Small tears in the anus that may cause itching, pain or bleeding
    • Ulcers
    • Malnutrition
    • Inflammation in other areas of the body
      Colorectal cancer
41
Q

what is the presentation of crohns?

A

Symptoms
Nausea & vomiting
Fatigue
Low-grade fever
Weight loss
Abdominal pain
Diarrhoea (+/- blood)
Rectal bleeding
Perianal disease

Signs
Pyrexia
Dehydration
Angular stomatitis
Aphthous ulcers
Pallor
Tachycardia
Hypotension
Abdominal pain, mass and distension

42
Q

what is the first line management of crohns?

A

steroids e.g. oral pred or IV hydrocortisone

43
Q

what is the second line management of crohns?

A

if steroids dont work then move onto immunosuppressant medication

	○ Azathioprine
	○ Mercaptopurine
	○ Methotrexate
	○ Infliximab Adalimumab
44
Q

what therapies are used to maintain remission in crohns?

A

thiopurines
* immunosuppressive properties E.g.Mercaptopurine + Azathioprine

45
Q

thiopurines can be used to maintain remission in crohns. give some examples and what are the side effects?

A

○ E.g.Mercaptopurine + Azathioprine
SE: pancreatitis + hepatotoxicty

46
Q

how is methotrexate used in crohns?

A

helps maintain remission

47
Q

what are the side effects of methotrexate?

A

bone marrow suppression
hepatotoxicity
pulmonary toxicity

48
Q

what monoclonal antibodies can be used to maintain remission in crohns? what are the side effects?

A

E.g. Infliximab + Adalimumab

SE: numbness/tingling, vision problems, leg weakness, chest pain, SOB, new joint pain, hives/itching

49
Q

what surgery management options are available in crohns?

A
  • Ileocaecal resection = when the disease only affects the distal ileum it is possible to surgically resect this area and prevent further flares of the disease.
    ○ Often recurs within 10 years
    • Stoma
      ○ May be needed after an operation to remove part of the bowel
      ○ Colostomy = created with loop of large intestine, solid waste
      ○ Ileostomy = created with end of small intestine, liquid waste + undigested food
    • Surgery can also be used to treat strictures and fistulas secondary to Crohns disease.
50
Q

what is ulcerative colitis?

A

disease of colonic mucosa
relapsing-remitting course

51
Q

how is ulcerative colitis characterised?

A

inflammation of mucosa
affecting rectum and may progress proximally through the colon
the terminal ileum can be affected in extensive colitis

52
Q

what is the presentation of ulcerative colitis?

A

Symptoms
* Weight loss
* Fatigue
* Abdominal pain
* Loose stools
* Rectal bleeding
* Tenesmus (incomplete emptying)
* Urgency

Signs
* Febrile
* Pale
* Dehydrated
* Abdominal tenderness
* Abdominal distension/mass
* Tachycardic, hypotensive

53
Q

how do you induce remission in ulcerative colitis?

A

aminosalicylates and or steroids

54
Q

how do you assess the severity of ulcerative colitis?

A

truelove and witts score

55
Q

what management options are used to maintain remission in ulcerative colitis?

A

thiopurines (side effects pancreatitis and hepatotoxicity)

monoclonal antibodies e.g. infliximab or adalimumab

56
Q

what are some common causes of diarrhoea?

A

· Coeliac Disease
· Inflammatory bowel disease
· Crohn’s and Ulcerative Colitis
· Irritable bowel syndrome
· Colorectal Cancer
· Infective gastroenteritis
· Drugs

57
Q

what are the bristol stool chart types?

A

1 = separate hard lumps - very constipated

2 = lumpy and sausage like - slightly constipated

3 = sausage shape with cracks in surface - normal

4 = smooth sausage - normal

5 = soft blobs - lacking fibre

6 = mushy consistnacy with ragged edges - inflammation

7 = liquid - inflammation

58
Q

what type of bateria is salmonella?

A

gram negative rod

59
Q

how is salmonella transmitted?

A

contaminated food

60
Q

what type of bacteria is campylobacter jejuni?

A

gram negatice helical

61
Q

what can cause viral gastroenteritis?

A

norovirus
rotavirus

62
Q

what can cause bacterial gastroenteritis?

A

salmonella
campylobacter jejuni
shigella
e.coli
cholera
yersiniosis
staph. aureas
bacillus cereus
clostridium difficile

63
Q

what type of bacteria is staph aureus?

A

gram positive coccus

64
Q

what is the function of the duodenum?

A
  • Provide a site for neutralising the acidic gastric juices by secretion of alkaline substances.
    • Mechanically processing and digesting chyme through muscle contraction.
    • Mixing bile and pancreatic enzymes into the chyme
    • Absorbing water, electrolytes and nutrients, especially water soluble substances like monosaccharides.
65
Q

what is the arterial supply of the duodenum?

A

supplied by anterior and posterior superior duodenal arteries (Branches of gastroduodenal artery), and the inferior pancreaticoduodenal artery (branch of superior mesenteric)

66
Q

what is the sympathetic and parasympathetic innervation of the duodenum?

A

sympathetic = coeliac plexus
parasympathetic = vagus nerve

67
Q

what is the fucntion of the jejunum?

A
  • Breakdown of nutrients by amalayses and proteinases
    • The primary function of the jejunum is to absorb sugars, amino acids, and fatty acids. Both the jejunum and ileum are peritoneal.
    • Absorbs fat soluble nutrients like fat, proteins, cholesterol and vitamins A,D,E, and K.
      Absorbs
68
Q

what is the function of the ileum?

A

The ileum absorbs any remaining nutrients that did not get absorbed by the duodenum or jejunum, in particular vitamin B12, as well as bile acids that will go on to be recycled. Additionally absorbs some water.

69
Q

what is the blood supply to the jejunum and ileum?

A

rich network of arteries that travel through the mesentery and originate from the Superior Mesenteric Artery. The multitude of arterial branches that split from the SMA is known as the arterial arcades, and they give rise to the vasa recta that deliver the blood to the jejunum and ileum

70
Q

what is the sympathetic and parasympathetic innervation of the jejunum and ileum?

A

sympathetic = splanchnic nerve ganflion
parasympathetic = vagus nerve

71
Q

what is the function of the exocrine pancreas?

A

Secretes digestive enzymes, water and bicarbonate to assist in digestion.
Digestive enzymes secreted by the pancreas reach their optimum function at a basic pH. This is achieved by the bicarbonate secretions of the pancreas.
Stimulated to produce these enzymes in response to raised level of CCK, because lipid has entered the duodenum.

The functional unit of the exocrine pancreas is the acinus, and its duct system.

Acinar cells produce digestive enzymes on their RER. These enzymes are concentrated and stored in granules ready for secretion. These granules are then deposited into the pancreatic duct which merges with the bile duct at the head of the pancreas and forms the ampulla of vater.

72
Q

what stimulates the production of enzymes by the pancreas?

A

cck

73
Q

what is the blood supply to the pancreas?

A

coeliac and superior mesenteric arteries

74
Q

what is the venous drainage of the pancreas?

A

splenic vein
superior mesenteric veins
drain to portal vein

75
Q

what is the parasympathetic and sympethetic innervation of pancreas?

A

parasympathetic = vagus nerve

76
Q
A

PBLs (19 decks)

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