Week 9-GI Tract Flashcards
Name the 3 parts of the small intestine
Duodenum
Jejunum
Ilium
(From superior to inferior)
List layers of the GIT (from deep to superficial)
- Mucosa (epithelium, MALT, lamina propria, smooth muscle)
- Submucosa (Areolar and connective tissue, blood and lymphatic tissue, neurons)
- Muscular layer (skeletal and smooth muscle, myenteric nerve plexus)
- Serosa layer (areolar and simple squamous epithelium, visceral peritoneum)
What is the peritoneum
Membrane that lines the abdominal and pelvic cavities, covering abdominal organs
Supports organs
Facilitates their vascular and lymphatic supply
What nerve stimulates the main component of the GIT
Vagus nerve (wandering nerve)
Interic nervous system
What is ectopia
Abnormal position/displacement of an organ, tissue or structure.
Can occur from: congenital defects (feral growth), trauma, disease, surgery
This can occur:
Ectopia Cordis - heart is located partially/entirely outside the thoracic cavity. Congenital birth defect. 10% survival as heart failure, infections, respiratory compromise
Ectopic pregnancy: fertilised egg planted outside uterine cavity, mc in fallopians tube
Renal ectopia: kidney. Foetal growth
Diagnosis and treatment: x-rays, ultrasound, CT, MRI
Treatment: management, surgical correction or removal of ectopic tissue
Function of GIT
- Ingestion
2.propulsion (moving food through digestive tract via swallowing and peristalsis(wave-like contractions))
3.mechanical digestion, churning stomach, chewing, segmentation in SI
4.Chemical breakdown
5.absorption (nutrients from digestive tract to blood stream or lymph system SI, LI does water
6.Excretion (faeces rectum and anus)
What is atersia
What is fistulae
congenital absences or closure of a normal body opening
MC occurs at near tracheal
Usually associated with a fistula connecting upper and lower oesophageal segments to a bronchus or trachea
Achelesia- can’t keep food down
Leads to blockages or lack of function
Fistulae is permanent abnormal passageway between2 organs in body or between an organ and exterior of the body
MC in new borns. Males>F
What is diaphragmatic hernia
Incomplete formation of diaphragm allows abdominal viscera to herniate into thoracic cavity
MC left
Can lead to fatal pulmonary hypoplasia
Surgery generally successful
Can be in people too
What is pyloric stenosis
Passage between stomach and duodenum becomes narrower
Congenital/ acquired
M>F
Projectile vomiting, frequent demands for re feeding
1-2cm abdominal mass
Surgery
What is hirschsprung disease
Function obstruction of the colon
S&S failure to pass meconium (black poo)
Obstruction, constipation
Abdominal distension
Vomiting
Affecting ganglion Cells
What is meckel diverticulum
Small bulge on SI, congenital
Can secrete stomach acid, bleeding ulcers of the stomach
When inspecting the mouth, what are we looojing for
-Teeth-gum disease which can effect the heart
-Maligant tumours on the tongue (raised edges, Ulster, hard)
-Pre-malignant lesions
-Oral white patches
-Mercury fillings
What would we be inspecting thr tongue for
Glossitis: red, smooth, sore tongue. B12, iron, folate, acid deficiency
Geographic tongue; Idiopathic
Fissured tongue: bending. Can be associated with psoriasis, Down syndrome
Black hairy tongue: smoking,bad oral hygiene, drugs
Ankyloglossia: tongue tie. Can affect feeding and speech
What is achalasia
Triad
1.incomplete lower oesophageal sphincter relaxation
2.increased lower oesophageal sphincter tone
3.aperistalsis (can’t contract and propel food/liquid to GI) of oesophagus
What is oesophagitis (lacerations)
Longitudinal mucosa tears
MC vomiting and retching
Haematemesis , chest pain, shock
What is oespphagitis cont
Chemical & Infectious Oesophagitis
Stratified squamous cells of the oesophagus may be damaged by:
• Alcohol
• Corrosive acids or alkalis
• Excessively hot fluids
• Heavy smoking
S&S: Self-limited px, Odynophagia, haemorrhage, stricture, perforation
What is reflux oesophagitis (GERD)
Reflux of gastric contents into lower oesophagus
Abrupt coughing, straining, bending, alcohol smoking, obesity, pregnancy, increased gastric volume (overeating)
MC >40
Western problem
S&S heartburn, dysphagia, regurgitation
What is eosinophilia esophagitis
Allergic reaction to food
Presents as GERD
What is oesophagitis cont
Caused by portal HT
Impaired blood flow through portal venous system and liver
MC in patients with cirrhosis due to alcoholic liver disease
Can haemorrhage
List functions of stomach
1.acid secretion to facilitate digestion and prevent foods-borne infections
2.reservoir for food
3.emulsification fo fat and mixing of gastric contents
4.absorption
If stool has dark blood, where is is the issue
Upper GI tract
What is Gastropathy & Acute Gastritis
- Acute Gastritis: Inflammation of the gastric mucosa (neutrophils present)
- Gastropathy: Inflammation of the gastric mucosa (when inflammatory cells are
rare or absent)
Aetiology: Alcohol, NSAID use, bile.
S&S:
• Epigastric px
• Nausea & vomiting
• mucosal erosion
• Ulceration
• Haemorrhage
• Melena (black tarry stools –
pathognomonic of upper
What is chronic gastritis
MC h.pylori infection
S&S persistent
Nausuea, abdominal pain
What is peptic ulcer disease
Mucosal ulceration affecting duodenum or stomach
S&S epigastic burning, aching
Anemia
Haemorrhage
Nausea
Vomiting
Blaotng
Significant weight loss
Relived by food.
Worse between 11-2am
What is gastric polyps
Pre-cancerous inflammatory lumps
MC 50-60
Develop in associated with chronic gastritis which initiates an injury leading to polyp growth
Can lead to malignant cancer - Gastric cancer
Only 17% survival rate
M>F
What is NSAIDS
Non-steroid anti inflammatory drugs
Ibroprophen which can lead to stomach bleeds, ulcers and holes in the esophagus
Describe How we would perform a GI practical exam
OBSERVATION
Observe hands for pallor (red palms, itchy everywhere is liver issues)
Nails:
Finger clubbing
Palpation:
temp, radial pulse
Arms:
Brushing
Needle marks
Hair loss
Eyes, chest, mouth
Observe THE ABDOMEN for hernias, Cullen’s sign (bruising around belly button) grey turners sign (side bruising), scars, masses, distention, stretch marks
AUSCULTATE
-Normal bowl sounds: gurgling
-Tinkling:obstruction
-Abscent: lieu’s (disruption of normal propulsive ability. Malfunction or peristalsis)
-Aortic bruits (AAA)
Percussion of:
Liver (upwards from right iliac fossa, resonant to dull)
Spleen: (right iliac fossa to left costal Margin, resonance to dull)
Bladder (down from umbilicus from resonance to dullness)
Palpation
Light palp, tenderness, guarding, masses, rebound tenderness
Deep palp, masses, size, ,ovation, shape, mobility
Liver
Start at the right iliac fossa using your finger pads
Ask patient to take a deep breath
Work upward to right costal margin
Assess for size, consistency, tenderness, pulsatility, degree of extension below
costal margin
Gall bladder Not normally palpable in a healthy person (biliary obstruction i.e. gall
stones, pancreatic malignancy. Infection)
Location: R costal margin, mid-clavicular line (large, well defined mass that moves
with respiration)
Murphy’s sign: Pain mid-breath on palpation indicates cholecystitis
Spleen: Only palpable if x3 its size (splenomegaly). Begin palpating at right iliac
fossa and progress to left costal margin.
Causes of splenomegaly; liver cirrhosis, haemolytic anaemia, CHF, splenic
metastasis, glandular fever.
Ballot the kidneys:
R Kidney:
- R hand at anterior abdominal wall just below the right costal margin
- L hand behind the patients ribs, below the flank
Palpable indicates polycystic kidney disease, amyloidosis, cancer
Aorta:
Bilateral hands, superior to umbilicus in the midline
Hands should move superiorly
If hands move outwards: AAA
List 9 abdominal regions
- Right hypochondriac
Liver, gallbladder, R kidney, SI
(Gallstones, stomach ulcer, pancreatitis)
2.Epigastric region
Stomach, liver, pancreas, duodenum, spleen, adrenal glands
(Stomach ulcer, pancreatis, gall stones, indigestion)
3.left hypochondriac
Spleen, colon, left kid, pancreas
(Stomach ulcer, duodenum ulcer, pancreatis)
4.r lumber
Gall;aider, liver, r colon
(Kidneys stones, urine infection, constipation, lumbar hernia)
5.umbilical region
Umbilical, SI, duodenum
(Pancreatis, appendicitis, stomach ulcer, IBS)
6,L lumbar
Descending colon, left kid
(IBD, kidney stones, constipation)
7.R iliac
Appendix, cecum
(Appendicitis, pelvic pain, constipation, groin pain)
8.Hypogastric region
Urinary bladder, sigmoid colon, femal reproductive organs
(Urine infection, appendicitis, pelvic pain, IB)
- L iliac
Descending colon, sigmoid colon
(Pelvic pain, groin pain, inguinal hernia)
