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Flashcards in Gastroenterology Deck (37):
1

Define adynophagia?

Difficulty swallowing entirely

2

Define dysphagia?

Problematic swallowing

3

What causes dysphagia?

STRUCTURAL ABNORMALITIES: pharyngeal pouch, oesophagitis, benign/ malignant strictures, extrinsic pressure (goitre)
MOTILITY DISORDERS: achalasia, oesophageal spasm, bulbar palsy, pseudobulbar palsy, systematic sclerosis

4

What is gastro - oesophogeal reflux disease (GORD)?

Dysfunction of lower oesophageal sphincter predisposing to the reflux of acid up into the oesophagus.
Associated with pregnancy, obesity, alcohol, smoking, hiatus hernia, helicobacter pylori

5

What are the symptoms of GORD?

heartburn, odynophagia, increased salivation, acid reflux, belching

6

How can GORD be managed?

LIFESTYLE - weight loss, smoking and alcohol cessation, raise head of bed, avoid eating before bed
MEDICATION - antacids (gaviscon), proton pump inhibitors (omeprazole), H2 antagonists (ranitidine)
GASTROSCOPY - if symptoms persist

7

What complications can occur with GORD?

Benign strictures
Barretts oesophagus
Oesophageal cancer

8

What is Barretts oesophagus?

Metaplastic change of the distal oesophageal epithelium from squamous to columnar type.
Results in an upward migration of squamocolumnar junction.
Increased risk of adenocarcinomas
If dysplastic changes are found, affected tissue is removed by oesophageal resection or mucosal ablation.

9

What is peptic ulcer disease?

A break in the lining of the stomach (most commonly in the lesser curve), first part of the small intestine, or occasionally the lower oesophagus.

10

What are the symptoms of peptic ulcer disease?

Epigastic pain after or before meals, relief with antacids
Heartburn
Belching
Nausea
Recent onset, progressive symptoms:
Anaemia
Weight loss
Anorexia
Difficulty swallowing
Melaena or haematemesis

11

What causes peptic ulcer disease?

Infection by helicobacter pylori (increased gastric acid secretion, gastric metaplasia, immune response, mucosal defence systems)
Drugs - NSAIDs, steroids, bisphosphonates
Hormonal - Zollinger Ellison syndrome
Association with alcohol, smoking, stress, blood group O

12

What are the treatments for peptic ulcer disease?

Adjust lifestyle
Cessation of causative medication
H. pylori eradication
Proton pump inhibitors
H2 receptor antagonists

13

What are the 2 types of upper GI bleeding?

Haematemesis ( vomiting blood)
Melaena (blood in poo)

14

What are the causes of upper GI bleeds?

Oesophagitis
Gastritis
Peptic ulcer disease
GI malignancy
Bleeding disorders
Angio dysplasia
Drugs - NSAIDs, steroids, anticoagulants, thrombocytis

15

What supplies the liver with oxygen and nutrients?

25% from hepatic artery - supplies 02
75% from hepatic vein - supplies nutrients

16

How do you manage an upper GI bleed?

ABC + Urgent OGD

17

What is Coeliacs disease?

An automimmune condition in which there is inflammation of the proximal small bowel mucosa.
Improves when pt maintains gluten - free diet
More common in N. Europeans and mostly in 40's

18

What are the clinical features of Coeliacs disease?

Diarrhoea steatorrhoea (fat in poo)
Abnormal pain and bloating
Weight loss
Oral ulceration and angular chelitis

19

What is the treament for Coeliac disease?

Maintain gluten free diet

20

What investigations can be done to diagnose Coeliacs disease and what pathology would you find?

INVESTIGATIONS - bloods, jejunal / duodenal biopsy
PATHOLOGY - villous atrophy, crypt hyperplasia, chronic inflammatory lymphocytic infiltration within the epithelium

21

What are the 2 types of Inflammatory bowel disease (IBD)?

Crohns disease
Ulcerative Colitis

22

What are the causes of IBD?

Thought to be 3 interactive factors:
genetic susceptibility
environmental factors
host immune response

23

What is Ulcerative Colitis?

One type of IBD that causes inflammation and ulcers in your digestive tract.
Inflamation can be in rectum alone (proctitis) or can extend to involve descending colon or whole colon.
More common in caucasions, males and onset 30 yrs old

24

What are the clinical symptoms of Ulcerative Colitis

Diarrhoea with blood and mucus
Tenesmus (need for the toilet)
Lower abdominal discomfort
Malaise, anorexia, fever, lethargy
Oral ulceration

25

How is IBD investigated (Ulcerative colitis and Crohns)?

Blood tests - iron deficiency, increase CRP/WBC
Barium enema
Colonoscopy
MRI
Biopsy

26

How do you manage Ulcerative colitis?

Aminosalicylates (eg. 5 ASA or axathiopine if resistant)
Rectal corticosteroid preparations as foam / enema
Oral cortcosteroids
Surgery - subtotal colorectomy with end ileostomy and preservation of rectum

27

What is Crohns Disease?

One type of IBD, a chronic inflammatory disease of the intestines, especially the ascending colon and terminal ileum, associated with ulcers and fistulae.
More commons in Caucasions and in females, 30 yrs onset

28

What is a skip lesion?

Occurs in Crohns Disease when multiple areas are affected and there are skip lesions with normal mucosa in between affected areas.

29

What are the clinical symptoms of Crohns Disease?

Abdominal pain
Diarrhoea
Weight loss
Oral lesions (labial swelling and ulcerations)
Perianal lesions ( fissures, skin tags, abscesses)

30

How do you manage Crohns Disease?

Smoking cessations
Treat diarrhoea / anaemia
Oral cortcaosteroids
Azathioprine
Biological agents - infliximab
Surgery - stricturoplasty, resection with end to end anastomosis but recurrence rates high.

31

What are the similarities between Ulcerative colitis and Crohns Disease?

Both associated with arthropathy, uveitis (swelling in the eye), primary sclerosing, erythema, pyoderma gangrenosum (bacterial infection), increased risk of carcinoma

32

What are the differences between Ulcerative colitis and Crohns disease?

UC - limited to colon CD - any part of tract mouth to anus
UC - continuous inflammation CD - patchy inflammation
UC - mucosa and submucosa inflammations
CD - transmural inflammation
UC - superficial inflamation CD - deep ulcers, fistulae, abscesses and stricturing
UC - no granulomas CD - granulomas present
UC - polyps common CD - polyps rare
UC - smoking decreases risk CD - smoking increases risk
UC - blood diarrhoea most prominant
CD - abdominal pain most prominent

33

What is Irritable bowel syndrome (IBS)?

A functional bowel disorder in which no organic cause is known but likely to be a disorder of the intestinal mobility / enhanced visceral perception
Affects females more and roughly 20-40 yrs

34

What are the symptoms of IBS?

Abdominal bloating
Central and lower abdominal pain
Pain relieved by defecation
Altered bowel habits

35

What is the treatment for IBS?

Antispasmodics eg. mebeverine
Treat constipation and diarrhoea
Tricyclic antidepressants

36

What is constipation and what causes it?

Infrequent passage of hard stool with straining or discomfort during defecation
CAUSES - poor diet, dehydration, immobility, IBS, elderly

37

What is diarrhoea and what causes it?

Increased watery stools, increased frequency and looseness
Acute 14 days
Chronic > 3 months
CAUSES - gastroenteritis, IBS, IBD, coeliac disease, colorectal cancer, drugs (antibiotics, laxatives, proton pump inhibitors, NSAIDs)