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IHD Part 2 306 > Gastro-intestinal system > Flashcards

Gastro-intestinal system Flashcards

1
Q

Pathogens of the GI tract: What is gastroenteritis?

A

Syndrome characterised by GI-symptoms including nausea, vomiting, diarrhoea and abdominal pain

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2
Q

Pathogens of the GI tract: What is dysentery?

A

Abnormal inflammation of GI-tract: often blood and pus in faeces and pain, fever, abdominal cramps- often disease of large intestine

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3
Q

Pathogens of the GI tract: What is enterocolitis?

A

Inflammation of mucosa of small and large intestine

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4
Q

Pathogens of the GI tract: What are the defences present in the mouth?

A

Flow of liquids, saliva (statherins, defensins), lysozyme, normal bacterial flora

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5
Q

Pathogens of the GI tract: What are the defences in the oesophagus?

A

Flow of liquids, peristalsis

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6
Q

Pathogens of the GI tract: What are the defences in the stomach?

A

Acidic pH

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7
Q

Pathogens of the GI tract:What are the defences in the small intestine?

A 
flow of gut contents
peristalsis
mucus
bile 
secretary IgA 
ymphoid tissue (Peter's patches)
shedding and replacement of epithelium
normal flora
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8
Q

Pathogens of the GI tract: What are the defences in the large intestine?

A

Normal flora
peristalsis
shedding and replication of epithelium
mucus

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9
Q

Pathogens of the GI tract: What two bacterium are common in causing food poisoning?

A

Staphylococcus aureus

Clostridium botulinum

Bacillus cereus - gram positive rod

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10
Q

Pathogens of the GI tract: how does helicobacter pylori resist stomach acid?

A

Produces Urease - produces ammonia cloud (neutralises acid) around organism that allows organism to survive and replicate

Protective cloud during transit to gastric mucin layer

can therefore inhabit gastric mucosa

bleeding/ulcers

Ammonia = basis of breath test

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11
Q

Pathogens of the GI tract: How is helicobacter pylori treated?

A

proton-pump inhibitor PLUS metronidazole/ amoxicillin and Clarithromycin

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12
Q

Pathogens of the GI tract: What is a major cause of diarrhoea?

A

E coli - gram neg rod

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13
Q

Pathogens of the GI tract: How is E coli detected in the lab?

A

macConkey agar

lactose fermentation - used for colour change when E coli grows

PCR and antigen tests used for serotypes

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14
Q

Pathogens of the GI tract: How does EPEC form attachments?

A

Bundle- forming pilli
needle injects toxins into host cell
sits on pedestal

has translocated intimin receptor (intimin mediates attachment to epithelial cells)

leads to watery diarrhoea

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15
Q

Pathogens of the GI tract: How does ETEC form attachments and what toxins does it produces?

A

via adhesive pilli
forms pedestals

Produce Heat Stable (ST) and Labile (LT) enterotoxins (cholera like) that cause diarrhoea

Produce Vero-toxin (Also called Shigella-like toxin)- STx
STx (verotoxin) is a potent diarrhoeal toxin (and has receptor on kidney cells ) acts via damaging cells directly, can damage blood vessels in kidneys

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16
Q

Pathogens of the GI tract: What organism can cause bacillary dysentry?

A

Shigella

low infectious dose - 10-100 cells needed

non lactose fermenters
common in poorer countries

spread faecal- orally

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17
Q

Pathogens of the GI tract: how is salmonella spread?

A

Spread from food- mainly chicken and dairy products, but also person to person

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18
Q

Pathogens of the GI tract: What cells does salmonella spread via?

A

Invade macrophages then to epithelium

doesn’t cause lactose fermentation

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19
Q

Pathogens of the GI tract: What is salmonella associated with?

A

S. Typhi - typhoid fever

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20
Q

Pathogens of the GI tract: Where does S. typhi reside?

A

Gall bladder

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21
Q

Pathogens of the GI tract: how is s.typhi transferred?

A

oral- faecal route during food prep

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22
Q

Pathogens of the GI tract: What is the most common cause of food poisoning?

A

Campylobacter - gram neg micro-aeophiles

Campylobacter jejuni most common
Acquired by ingestion of contaminated food

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23
Q

Pathogens of the GI tract: what type of bacterium is cholera?

A

motile Gram-negative comma-shaped bacterium

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24
Q

Pathogens of the GI tract:What does colonisation of cholera of the SI depend on?

A

Motility (polar flagella)
production of mucinase
attachment to specific receptors

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25
Pathogens of the GI tract: What effect does the cholera toxin have?
disruption of ADP-ribosylation of G-protein signalling pathways causes increased secretion of Chloride ions This prevents influx of Sodium ions into cells Results in rapid loss of water from tissue- massive diarrhoea
26
Pathogens of the GI tract: What is the treatment for cholera?
Rapid fluid and electolyte replacement required or dehydration and death result
27
Pathogens of the GI tract: What are the symptoms of cholera?
``` absent tears very dry mouth and tongue lethargic/ unconscious sunken and dry eyes drinks poorly or not able to drink skin pinch goes back slowly ```
28
Pathogens of the GI tract: how can cholera be prevented?
Vaccines | best - improvement of water system and sanitation
29
Pathogens of the GI tract: What % of gastroenteritis cases are viral?
20
30
Pathogens of the GI tract: What is a rotavirus?
``` Wheel-like viral particle Diarrhoea caused by tissue damage in small intestine Dehydration main risk Very low-infectious dose Very contagious V resistant to celaining products ```
31
Pathogens of the GI tract: What is the most common gI infection causing virus?
Noro virus
32
Pathogens of the GI tract: What type of bacteria generally cause diarrhoea and gastro enteritis?
gram negative
33
GI disease medicine: What are the functions of the GI tract?
Turns the food you eat into energy Waste removal Intake of water - hydration
34
GI disease medicine: What are some symptoms of GI diseases?
Vomiting, weight loss, jaundice, malaena, diarrhoea, abdominal pain, hematemesis
35
GI disease medicine: What questions would you ask for someone who has dysphagia?
``` Duration Solids or liquids Pain (odynophagia) Weight loss Previous medical history Medications Cigarettes and alcohol ```
36
GI disease medicine: What 3 areas could dysphagia be a problem of?
1) Oropharyngeal Problem 2) Oesophageal Problem 3) Gastric problem
37
GI disease medicine: What oropharyngeal problems cause difficulty swallowing?
Salivary gland - Sjogrens syndrome Tongue - amyloid, hypothyroidism, motor neurone disease (not strong enough or doesn't co-ordinate properly - spasticity) Palatal / epiglottal / upper oesophageal disorder - cerebrovascular disease, MND, Parkinson’s disease
38
GI disease medicine: What oesophageal problems cause difficulty swallowing?
Benign mucosal disease benign peptic stricture (gullet narrows due to acid reflux), oesophageal web (Plummer Vinson syndrome), Candidal oesophagitis - thrush infections of the gullet if inhaler swallowed incorrectly Malignant mucosal disease Carcinoma Motility disorders oesophageal spasm, achalasia, oesophageal pouch
39
GI disease medicine: What is a pharyngeal pouch?
Defect between the constrictor and the transverse cricopharyngeus muscle.
40
GI disease medicine: What gastric problems cause difficulty swallowing?
Carcinoma Outlet obstruction - peptic ulceration
41
GI disease medicine: How is dysphagia managed?
Treat underlying cause If nutritionally deplete, may require supplementation – oral supplements, NG, PEG feeding balloon dilation cancer treatment
42
GI disease medicine: What are the causes of GORD?
Excessive relaxation of lower oesophageal sphincter and raised intra-abdominal pressure (diaphragm damaged so stomach able to extend up- hiatus hernia)
43
GI disease medicine: What are the symptoms of GORD?
Heartburn, epigastric pain, acid reflux, waterbrash, nausea, vomiting, tooth decay, asthma
44
GI disease medicine: What is the management of GORD?
PPI (omeprazole, lansoprazole) Histamine- 2 antagonists ``` Lifestyle advice (weight loss, smoking cessation, reduce alcohol and caffeine) - first raise the head of the bead so gravity can push acid back down ``` Surgery - fundoplication - tie the loose bit of the stomach
45
GI disease medicine: What is a hiatus hernia?
Top bit of the stomach pushes into the thorax
46
GI disease medicine: What are the types of hiatus hernia?
A= normal B= pre- stage C= sliding hiatal hernia D= paraoesophageal type (most painful)
47
GI disease medicine: What is a oesophageal Manometry?
tube down pt's nose, sits in the back of gullet and measures acid going up or down
48
GI disease medicine: What is the history for a peptic ulceration?
malaena, haematemesis and pain - 3 pain symptoms of ulcers Epigastric pain, sometimes radiating into back, perhaps worsened by food and therefore associated with weight loss (gastric ulcer) or improved by eating (duodenal ulcer). Vomiting/ Hematemesis (due to gastric ulcer or pyloric outlet obstruction due to duodenal ulceration). May be complicated by bleeding or perforation Due to Helicobacter pylori or non-steroidal anti-inflammatory drugs e.g. ibuprofen not good as causes further ulceration in the small bowel
49
GI disease medicine: How are peptic ulcers managed?
proton pump inhibitors clips adrenaline injections to cause vasoconstriction surgery if bleeding
50
GI disease medicine: What are the causes of upper abdominal discomfort/pain?
Non-ulcer dyspepsia - upper abdominal discomfort, nausea, eructation, bloating - motility disturbance Pancreatic carcinoma - unremitting pain, often radiating to back and associated with weight loss and may cause jaundice Pancreatitis - acute inflammation of pancreas causing severe pain, vomiting - chronic relapsing pain (chronic pancreatitis) - commonest cause alcohol > gallstones > pancreatic trauma, drugs, hypercalcamia / lipidaemia, familial
51
GI disease medicine: What are the two most common causes of pancreatitis?
Gall stones and alcohol
52
GI disease medicine: How do you manage acute abdominal pain?
Surgical referral Usually kept NBM nil by mouth IV antibiotics?? Imagaing - USS/ CT scan
53
GI disease medicine: When does abdominal pain become chronic?
more than 6 weeks
54
GI disease medicine: What are some causes of vomiting?
``` Systemic illness (viral, bacterial, diabetic ketoacidosis) Drugs, alcohol ``` Centrally mediated - middle ear disease, labyrinthitis (infection), cerebellar disease, brain stem disease (cerebrovascular or tumour) raised intracranial pressure (tumour, haemorrhage, hydrocephalus) ``` Psychiatric disorders (psychogenic vomiting, Bbulimia) Oesophageal disease Gastric disease Small bowel disease Colonic disease - obstruction due to tumours, volvulus ```
55
GI disease medicine: What is the management for vomiting?
Identify underlying cause Antiemetics (eg. cyclizine, metaclopramide) PPI Cognitive Behavioural therapy
56
GI disease medicine: What are some causes of acute diarrhoea?
Infection (gastroenteritis: bacterial or viral) - Campylobacter, Salmonella, Shigella, E. Coli Drugs - antibiotics, alcohol Food allergy / intolerance
57
GI disease medicine: What are some chronic causes of diarrhoea?
Small bowel disease - lactase deficiency - Coeliac disease - Crohn‘s disease Pancreatic disease - pancreatic insufficiency - pancreatic carcinoma - cystic fibrosis Colonic disease - ulcerative colitis - Crohn’s disease - carcinom
58
GI disease medicine: whAT IS Coeliac disease?
immunological response to gliadin abnormal proximal small intestinal mucosa that improves morphologically on a gluten free diet (GFD) and relapses when gluten is reintroduced” increased IEL's, crypt hyperplasia, villous atrophy
59
GI disease medicine: how is the diarrhoea affected by small bowel/pancreatic or colonic involvement? - SORT OUT
Small bowel / pancreatic Pale, floating, difficult to flush Blood and mucus Throughout day Often in morning Pain variable timing Pain related to defaecation Pain not relieved by defaecation Pain relieved by defaecation
60
GI disease medicine: What is Crohn's disease?
Chronic inflammatory disease affecting any part of the gastrointestinal tract, from mouth to perineum May be discontinuous (i.e. affect several different parts of the GI tract at the same time, with normal gut in between).
61
GI disease medicine: What is ulcerative colitis?
Chronic inflammatory disease invariably affecting the rectum and extending more proximally to involve all or part of the colon
62
GI disease medicine: What are the symptoms of Crohn's disease and ulcerative colitis?
``` Crohn's Pain Diarrhoea Weight loss Anorexia Fever Vomiting Lassitude Nausea Acute abdomen Nutritional disturbance Fistula Miscellaneous ``` ``` ulcerative colitis diarrhoea rectal bleeding pain weight loss ```
63
GI disease medicine: What associated diseases are there with Crohn's and ulcerative colitis?
Skin - erythema nodosum, pyoderma gangrenosum Mouth - ulcers. Crohn’s: lips, buccal mucosa Joints - arthritis, ankylosing spondylitis Eyes - episcleritis, uveitis Vascular - thromboses Liver - cirrhosis, CAH, pericholangitis. U.C: primary sclerosing cholangitis
64
GI disease medicine: What are the symptoms of colon cancer?
``` Symptoms: None!! (Bowel Cancer Screening – FOB) Rectal Bleeding Altered Bowel Habit Lethargy/ Weight Loss ``` polyps - cancer
65
GI disease medicine: How would you investigate colon cancer?
Colonoscopy/ Barium enema | CT
66
GI disease medicine: How would you manage colon cancer?
Evaluate extent of disease If limited disease to colon- surgical resection possible If not- chemo/ radiotherapy
67
GI disease medicine: What are the causes of post hepatic jaundice?
Gallstones (choledocholithiasis) - Biliary colic, fever, fluctuating jaundice Malignancy (pancreatic carcinoma, cholangiocarcinoma) - Constant pain radiating to back - Weight loss Benign biliary stricture (post operative, sclerosing cholangitis) - cholangitis (fever and pain) - inflammation of the biliary tree
68
GI disease medicine: What are the hepatic causes of liver failure?
Infection (hepatitis A,B,C, EBV) - Malaise, lethargy, anorexia, distaste for cigarettes, jaundice, pale stools, dark urine, right upper quadrant discomfort Alcoholic hepatitis - above, plus history of excess alcohol Drugs - augmentin, flucloxacillin, many others Decompensated chronic liver disease (alcoholic cirrhosis, haemachromatosis, PBC, CAH, Chronic hepatitis B or C, Wilson’s disease) - jaundice, ascites, varices, hepatic encephalopathy
69
GI disease medicine: What are the pre-haptic causes of jaundice?
``` Haemolytic anaemia (hereditary spherocytosis, G6PD deficiency, sickle cell disease) - anaemia, jaundice, gallstones, splenomegaly, leg ulcers ```
70
GI disease medicine: What is the most common cause of chronic liver disease in the UK and worldwide?
alcohol hepatitis (infection) = B moving more towards non alcoholic fatty liver disease - metabolic syndrome
71
GI disease medicine: What is the most common cause of chronic liver disease in the UK and worldwide?
alcohol hepatitis (infection) = B moving more towards non alcoholic fatty liver disease - metabolic syndrome (when it causes irreversible damage - cirrhosis)

IHD Part 2 306 (23 decks)

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