Week9- GIT Pt2 Flashcards
How would volvulus (mechanical obstruction in SI) present upon oscultation
No abdominal sounds
What is the mc intestinal obstruction
Obstruction of small intestine
List signs and symptoms of small intestine obstruction
Abdominal pain
Distention
Vomiting
Constipation
List SI obstructions
Due to narrow lumen
Hernia
Adhesions. 80% mechanical obstructions
Intussuscpetion
Volvulus(kink)
Tumours
Infarction
Crohn’s disease
Function or SI
Extends from duodenum to ileocecal valve
3-6m
Mucosal folds with microvilli mass SA
Enteric nervous system controls functioning via MESENTRIC and SUBMUCOSAL PLEXUS which controls:
Absorption
Secretion
Blood flow
Motility
How is enteric nervous system controlled SI
It controls the functioning via the
Mesentic
And
SUBMUCOSAL plexus
What is ischameic bowel disease
Ischameic damage to bowel wall (infarction)
1.mucosal infarction (after chronic hypoperfusion)
2.transumral infacrtion (involves all 3 layers of wall due to vascular obstruction)
Aetiology: severe atherosclerosis, Hypercoagubility states, oral contraceptive use, embolism, intentional hypopfusion, dehydration, shock, cardiac failure and vasoconstrictive drugs
MC- >70
F>M
S%S Cramping, left lower abdominal px, desire to defecate, bloody stool
What is malabsorption
Defective absorption of fats, fat and water sol vitamins m proteins, carbohydrates, electrolytes, minerals, water
Hallmark= steatorrhea (excessive faecal fat, bulky, frothy, greasy, yellow or clay coloured stool)
Aetiology: pancreatic insufficiency, chronic disease, celiac disease , cystic fibrosis, IBD, coeliac
What is angiodysplasia
Abnormality with blood vessels in GIT
Torturous veins, venules and capillaries
What is Diarrhoea
Diarrhoea:
An increased stool mass, frequency or fluidity.
• Acute <14 days.
- management focuses on volume repletion
- oral rehydration
- Can be viral or bacterial
• Persistent 14-30 days
• Chronic >30 days
- Thorough Hx and investigation required
to form a Dx
What is coeliac disease
Coeliac Disease (Gluten sensitive enteropathy)
• An immune mediated disorder triggered by the ingestion of gluten-containing foods such as:
wheat, rye or barley in genetically predisposed individuals
• Improves when gluten is removed from diet
• Aetiology: F>M (5th decade)
Genetic cause accounts for 50% of cases
Not breastfeeding and introducing solids before 6 months
S&S: Tiredness & malaise Mouth ulcers Osteoporosis
Anaemia , Infertility , Neurological symptoms
Asymptomatic , Anxiety , Muscle weakness
Diarrhoea , or steatorrhea Depression
Abdominal px Gross malnutriti
What does celiac disease affect
Cell mucosa
Shrinking villi
Vilious atrophy
Compare inflammatory bowl disease vs IBS
IBD= disease, IBS isn’t
IBD= inflammatory. IBS Not
IBD= hospitilasation and surgery. IBS= rare
IBD= permanent damage to intestines. IBS=X
IBD=diagnosed with exam and imaging by doctors IBS=exam and imaging don’t show
IBD=risk colon cancer. IBS=Not
IBD=treated anti-infallantory drugs/ surgery IBS= diet is primary treatment
What is irritable bowel sydrome
Chronic, relapsing, abdominal pain, bloating, change in bowel habits
MC GIT
1 in 5
F>M 3:1
20-40
1. Diarrhoea predominant
2.constipation predominant
Normal endoscopic evaluations
Coexist with chronic fatigue, fibromyalgia, TMJ dysfunction
Abdominalpx, discomfits at least 3 days per month over 3 months with improvement after defecaton and change in stool frequency/form
Stres, life experiences, antibiotics, GI infections, diet affect
What is inflammatory bowel disease
Chronic condition resulting from complex interactions between instestinal host immunity in genetically predisposed invididuals, leading to inappropriate mucosal immune activation
1.crohns disease
Ulcerative colitis
Chronic
Infallamtiry
Epidemiological and clinical characterises
Aetiology unknown but points to genetics infections (measles) environment (diet, smoking) phsycologial stress, emotional or physical
What is Crohn’s disease
• Is a chronic, relapsing and remitting inflammatory disease affecting any site from the mouth to the anus.
• Abdominal px and perianal disease
• Characterised by ‘cobble stoning’ mucosa or aphthous or linear ulceration
• Mucosa discontinuity
• Granulomas inflammation in 1/3rd of patients
• Fistulae (benign fibrous structures)
• Relapsing and remitting
• Average age at dx is 27 years (90% of patients have S&S <40 years old)
• MC urban over rural populations
• Ethnic minorities at lower risk
• 10-15% familial
Crohn’s Disease
S&S: Extraintestinal S&S
• Abdominal cramps (1-2 hours post meals) • Arthritis (migratory)
• Diarrhoea
• Fever
• Delayed growth (in prepubescent patients) • Skin rash
• Weight loss
• Pericholangitis (liver
inflammation and fibrosis)
• Fever
• Kidney stones
• Anaemia
• Right lower quadrant mass
• Perianal fistula
• Gradual decrease in their sense of wellbein
Describe gross pathology of crohn disease
Linear mucosal Ulster’s,
Cobblestone affect in appearance to mucosa
Thickened intestinal wall
Creeping fat
What is ulcerative colitis
Ulcerative Colitis
• A disease that causes mucosal inflammation and sores (ulcers) in the lining of
the large intestine
• Characterised by GI bleeding
• Presents with diffuse continuous involvement of the mucosa
• Colon only
• Limited to mucosa
• Unknown aetiology
• Usually occurs before the age of 30 (but can b up to 60 years)
• MC in Caucasians
• Higher risk if a family member has it
Diarrhoea (often with blood or pus)
• Abdominal px or cramping
• Rectal px/bleeding
• Urgency to defecate
• Inability to defecate despite urgency •
• Weight loss •
• Fatigue
• Fever
• Delayed growth in children
Complications are
Severe bleeding
Perforated colon
Osteoporosis
Inflammation of skin, joints, eyes
Toxic mega colon
Increased risk of blood clots and colon cancer
Describe gross pathology of ulcerative colitis
Inflammatory polyps (can be cancerous growths)
Mucosal bridges can join inflammatory polyps
Red, granular mucosa in cecum
What does ulcerative colitis and crowns disease involve and where do they start
UC= begins in rectum and may extend continuously to involve entire colon
Affects only inner layer of bowel wall
Psuedopolyp
Ulcer within the mucosa
CD= MC. Involves end of SI and begining of colon
May affect any part of GI tract in a patchy pattern
May affect all layers of bowel wall
Transmuarl inflammation
Ulcerations
Fissures
Muscular hypertrophy (swelling)
Crohn’s disease vs ulcerative colitis
MC= cd terminal ilium
UC= rectum
Distribution
CD=mouth to anus
UC- rectum to colon
Spread
CD=discontinues
UC=continues
Gross features
CD=ulcers intervening normal mucosa
Linear fissures
Cobblestone appearance
Thickened bowel wall
Creeping fat
UC-extensive ulceratuon
Pseudopolyps
CD=transmural inflammation
UC=limited to mucosa and SUBMUCOSAL
Complications
CD=obstruction
Abscesses
Fistulas
Sinus tracts
UC=toxic mega colon
UC genetic associated with HLA-B27
Extraintestinalmanifestations
CD= common arthritis, spondylitis is, sclerosis cholangitis, gangrenosum
UC=arthritis, spndultis, sclerosing cholangitis, gangrenosum
Cancer risk
CD=slight
UC= more common
List causes of constipation
Motility (DIET, IBS, pelvic floor disorder)
Mechanical (tumour, prolapse, disease, stricture)
Metabolic (diabetes, increase calcium, decrease k, hypothyroidism, hyperparathyroidism, chronic kidney failure)
Neurogenic (stroke, MS, Parkinson’s)
Drugs (iron, opioids)
Coeliac disease, anal pain, fissure, laxative use, psychological
What is a stricture
An area of narrowing in the intestines
Crohn’s disease can result in this
What is diverticula’s disease
Abnormal sac or ouch protruding wall of hollow organ or herniation of mucosa through colon at sites of penetration of muscular wall by arterioles
50% sigmoid colon
50% patients 50<
Aymptimatic
Water problum(unprocessed cereals, sugar, meat)
S+S= left iliac fossa pain
Erratic bowel habit
Complications: perforation, obstruction, haemorrhage, fistula formation
What is a fistula
Tubes connecting internal tubular structures like arteries, veins, intestines to one another
Fistulae result of trauma or surgery can result from infection or trauma
List a ore tall dissorders
Pruritis ani: ‘itchy bottoms” haemorrhoids, sweat glands overactive, fungal infect, eczema, threadworm
Haemorrhoids. Mc cause of recall bleeding
Anal fissures: tear in sensitive skin-lined lower anal canal. Pain on defecaton
Recall prolapse, ulcer, intisuscpetion
List colonic tumours
Colon polyps:
• An abnormal growth of tissue projecting from the colonic mucosa.
• Range from a few millimetres to several centimetres
• Single or multiple
Adenoma:
• Benign, dysplastic tumour of columnar cells or glandular tissue.
• Can become malignant (adenoma-carcinoma)
• 60-70 years of age
Colorectal Carcinoma
• 3rd mc cancer worldwide
• 2nd mc cause of cancer death in the UK
• Average age at dx is 60-65 years
• Approximately 20% of patients have distant
• metastasis at dx
S&S
• Change in bowel habit (looser, more frequent stools)
• Rectal bleeding
• Tenesmus (the feeling you need to pass stools)
• Anaemia
• Palpable rectal or abdominal m
Peritoneum
• The peritoneal cavity is a closed sac lined
by
mesothelial cells; these produce surfactant
which
acts as a lubricant within the peritoneal cavity
• Largest serous membrane in the body
• Functions:
* Pain perception
* Visceral lubrication
* Fluid and particulate absorption
* Inflammatory and immune res
What is peritonitis
Acute or chronic
• MC 2nd to a GI disease
• Ascites is associated with all diseases of the peritoneum
• MC cause of ascites in a young-middle aged woman is ovarian carcinoma
S&S
• Poorly localised px • Absent bowel sounds
• Malaise, nausea, vomiting, • Fever
4 cardinal signs: • Dehydration
1. Tenderness
2. Guarding
3. Rigidity
4. Rebound tendernes
What is acute appendicitis
The appendix is a normal true diverticulum of the cecum that is prone to acute and
chronic inflammation
Acute:
• mc in adolescents and young adults
• 50-80% of cases caused by overt luminal obstruction (stool, gallstone, tumour)
S&S
• Periumbilical px ultimately localised to lower right quadrant
• Nausea
• Vomiting
• Low grade fever
• McBurney sign (deep tenderness located 2/3rds of the distance from the
umbilicus to the right AS
What is atherosclerosis
The build up of plaque blocking artery walls
