Week 12: Gastrointestinal System Flashcards
Abdominal pain: quality Types Visceral pain Parietal pain Referred pain
Visceral pain: when hollow organs like stomach, colon forcefullu contract or become distended.
Solid organs can generate this pain when it swells against their capsules. Visceral pain is usually a dull gnawing, cramping or aching and often difficult to localise
Parietal pain: inflammation from hollow of solid organs which affects parietal peritoneum.
-pain more severs and easily localised eg appendicitis late stage
Referred pain: originate at different sites but shares innervation from same spinal level (gall bladder pain in right shoulder
-usually a dull aching pain
Main symptoms of GI problems
Abdominal pain
- changes in bowel or bladder habits?
- abdominal pain (both important ones)
- visceral➡ constant dull, cramping, aching
- parietal pain- pain is more severe and easily localised-caused by inflammation of organs that affect the parietal peritoneum
- refers pain- dull, aching pain. Pain also at a site other than the location of the painful stimulus- shares embryolgical innervation from same spinal level
- weight loss
- loss of appetite
- jaundice
- difficulty swallowing
- heartburn
- ease nausea/vomiting
Common gastrointestinal conditions
GORD
What is it?
What’s it associated with?
Dysfunction of the lower oesophageal sphincter predisposes to GOR ➡ heartburn
Regurgitation of stomach contexts back into the oesophagus due to dysfunction of the lower oesophageal sphincter, causing heart burn.
-at least 2 episodes a weeks to be considered GORD
Patients with it also experience:
-excessive burping
-regurgitating (food or fluid comes back into mouth)
-difficulty swallowing
-sore throat
Dysfunction of the lower oesophageal sphincter predisposes to GOR ➡ heartburn
GORD Commonly associated with:
-hiatus hernia
-smoking
-alcohol
-obesity
-pregnancy
Slide 23
Prolonged GORD➡ excessive reflux of stomach acid can irritate the inside lining of the oesophagus➡ causes inflammation of the lining causing narrowing of the oesophagus.
Reflux creates changes in the cell lining; squamous lining is replaced by columnar ‘tall’ cells
Common conditions Dyspepsia and Peptic Ulceration What are they. Common types Signs Symptoms
Dyspepsia: Not a disease. It's a group of symptoms which define an upset stomach Symptoms: -pain in epigastric region -bloating -nausea -burping
Causes:
-GORD
-oesophagitis
-peptic ulcer: ulceration of the upper GI tract
Types of peptic ulceration:
1. Gastric ulcer: in the stomach, worse when Hungary but can be relived by eating but only for a few minutes.
2. Duodenal ulcer:
In the duodenum. Back pain. Worse 1-2 hours after a meal and when Hungary.
Signs of peptic ulceration:
- Tenderness on palpating epigastric region
- Haematemesis- vomiting of blood
- Melena- passing of black and foul-smallish stools
- Pain radiation to back
Common conditions
GI Bleeding
Upper and lower causes, symptoms
Upper: Haematemesis (fresh blood of coffee ground blood)
-Melena (black, tarry and foul- smallish stools)
-Peptic Ulcer
Other causes: erosive gastritis, erosive oesophagitis, gastric carcinoma
Lower:
-haematochezia (fresh blood-mixed into stool (maroon) or on surface; on toilet paper/ underwear)
Symptoms depend on the chronicity and volume of blood lost
Symptoms of anaemia due to large/ongoing blood loss
- mucosal and skin pallor
- fatigue
- light-headedness
- palpitations
- BP may be low on examination if severe
Liver disease: Cirrhosis
Hepatitis
Cirrhosis
Gallbladder: Cholelithiasis and cholecystitis
Hepatitis: inflammation of the liver. Caused by node film, viruses, chemicals, alcohol, drug use and other factors,
Cirrhosis= irreversible liver damage (degeneration) and loss of normal hepatic architecture with fibrosis and nodular degeneration
Causes:
-alcoholism
-chronic liver infection
Complications:
Inflammation of the liver causes swelling and pain in that area. It is reversible, but if not treated leads to cirrhosis
-reduced liver function
-hepatic failure
-portal hypertension
-risk of hepatocellular carcinoma
Signs of chronic liver disease?
-Right hypochondrial pain, jaundice, clubbing
Acute cholecystitis: acute inflammation, follows stone impaction at neck of gall bladder
Signs and symptoms:
-acute abdominal pain esp. RUQ pain
-continuous +’ve murphys sign
-peritoneal signs and palpable mass
Steatorrhea
-result of fat malabsorption
-pale, bulky, floating and malodorous (offensive stools)
Management:
-surgery
Its a very common presenting symptom in practice
Common conditions
Inflammatory Bowel Disease
Two types: Ulcerative Colitis & Crohns Disease
Ulcerative Colitis:
- relapsing-remitting inflammatory disorder of the colonic mucosa
- rectum to ileocaecal valve, usually not above
Pathology:
- inflammation ➡ulceration that may extend deep into the mucosa
- small abscess formation
Acute cholecystitis
Chronic cholecystitis
Acute:
-inflammation of the gall vbladder
-Gall stones at beck of gall bladder, means bile becomes trapped
signs and symotoms:
-RUQ pain
-positive murpheys sign
-Steatorrhea (prescence of fat in feaces) means that they float due to lipis and have oily appearance.
Cause:
- unknown
- genetic predisposition
- age range usually 15-30 years
Signs and symptoms:
- gradual onset of diarrhoea and blood and mucus
- cramping abdominal discomforts (colic)
- urgency/tenesmus during active phase: a feeling of constantly needing to pass stools (urine), even is the bladder is already empty
- colonoscopy is of the most value for diagnosis
Chronic:
-caused be repeated attacks of cholecystitis. Attacks cause walls of gall bladder to thicken, and over time gall bladder will lose its ability to concentrate, store and release bile.
Crohn's disease What is it? Cause? Signs and symptoms? Complications
- chronic inflammatory disease of the GI characterised by transmural granulomatous inflammation- can lead to fibrosis and obstructive symptoms
- may affect any part of the gut but has a predilection for terminal ileum of proximal colon
- unlike UC there are unaffected areas if Bowen during active disease
Signs and symptoms:
- diarrhoea
- abdominal pain
- weight loss, often due to malabsorption
- constitutional symptoms such as low-grade fever and fatigue
Complications:
-obstruction , fistulae….but bowel cancer is of greatest concern
GI bleeding could be seen in both
Irritable Bowel Syndrome (IBS)
- sometimes refers to as “spastic colon”
- is a syndrome comprising abdominal signs and symptoms (pain, diarrhoea, bloating and nausea)
- pain relieved by bowel movements
Most likely an intestinal motility problem (physiological)
Features: 20-40 years old, F>M -central or Lowe abdominal pain/discomfort, relieved by defecation -abdominal bloating -alternating constipation and diarrhoea common -mucus common with faeces (NO bleeding) -no constitutional signs of symptoms -exacerbated by stress, menstruation
BMI
What is it?
How is it calculated?
What does it mean?
Body mass index
its used to give you an idea whether your underweight, overweight etc. Is used to estimate your total amount of fat. It is a approximate measure of the best weight for your health.
How to calc:
Weight over height(m) 2??
Colorectal (bowel) cancer
-cancer from uncontrolled cell growth in the colon, rectum or appendix
-signs and symptoms:
-abdominal pain
-anaemia
-rectal bleeding
-constipation
Predispose factors (make people more susceptible)
-inflammatory bowel disease
-fam history
-diet
Diverticular disease
Out-pitching or hernia ton in the wall of the colon. Occurs mostly in the sigmoid colon
Appendicitis
Inflammation of the appendix
- begins with peri umbilical pain which progresses to right iliac fossa
- RLQ pain for all 3 appendicitis tests
Abdominal aortic aneurysm
Abdominal aorta becomes large and balloons outward
Signs and symptoms:
Noticeable pulsation/ mass
-back pain
-tenderness/ pain in abdomen or epigastric region
AAA can be caused by:
- smoking
- hypertension
