Gastrointestinal

Question 1

Mallory-Weiss Tear and causes

Answer 1

• Tear in the tissue of the lower oesophagus that occurs when the mucosa (soft tissue that lines the body canals and organs) at the gastroesphageal junction is lacerated.
• Common cause of acute upper GI bleeding.
  Causes
• Violent coughing, retching, vomiting and or straining.
• Hiatal hernia (rare)
• Childbirth (rare)

Question 2

Mallory-Weiss Tear symptoms

Answer 2

• Haematemesis vomiting of bright red or coffee grounds blood
• Melaena (stool with blood)
• Dysphagia
• Anaemia
• Fatigue, dizziness, faintness
• SOB
• Abdo or chest pain

Question 3

Gastrin hormone

Answer 3

• Peptide hormone
• Component of gastric juice
• G cells found in the lower half of the pyloric glands (found in pyloric region, near the duodenum(small intestine)) secrete gastrin hormone.
• Helps with digestion by stimulating the stomach to release gastric acid and increase gastric motility (coordinated contractions and relaxations of the stomach muscles that move food and drink through the digestive system).

Question 4

Hydrochloric acid

Answer 4

• Antibacterial and converts pepsinogen to pepsin (enzyme that helps to digest proteins).
• Key component of gastric juice, produced by the stomach to aid digestion.
• Creates an acidic environment that breaks down food, especially proteins and activates digestive enzymes.
• Kills bacteria and other harmful microbes that may enter the body through food.
• Helps the body absorb minerals like calcium, iron and phosphate.

Question 5

Appendicitis and causes

Answer 5

• Painful swelling and infection of the appendix, a small pouch in the RLQ connected to the large intestine.
• Becomes inflamed, swollen and infected.
• Appendix gets blocked with - lymphoid hyperplasia, infections, fecaliths, tumours.
• If left the appendix can burst spreading bacteria into the abdominal cavity, this can lead to a life threatening infection called peritonitis.

Cause
- Appendix swells and no one really knows why

Question 6

Symptoms of appendicitis

Answer 6

• First symptoms - usually vague epigastric pain.
• Cramping sensation
• Pain moves to right lower quadrant
• Nausea and vomiting, diarrhoea
• Low grade fever
• Rebound tenderness on palpation (more pain when pressure is released)
• McBurney’s point - specific location where tenderness is most pronounced in acute appendicitis (RLQ)
• Rovsing’s sign - in palpation of the LLQ increases pain in RLQ - sign of appendicitis.
• Psoas sign - pain on extension of right thigh
• Obturator sign - pain on rotation of the hip when right knee is flexed.
• Blood tests, imaging tests

Atypical presentation:
- In pregnancy the appendix can be shifted, and pts present with RUQ pain.
- In some males appendicitis can irritate the ureter and cause testicular pain or urinary symptoms.

Question 7

Grumbling appendix - Chronic appendicitis

Answer 7

• If left untreated chronic appendicitis will turn to acute.
• Usually treated with powerful antibiotics
• Does not always require removal of appendix
• Pain occurs gradually over weeks and is mild to moderate
• No rebound tenderness

Question 8

Ulcerative colitis and causes

Answer 8

• Chronic inflammatory disease of the colon and rectum that causes ulcers and inflammation in the large intestine.
  Cause
• Unknown but it may be due to an immune system problem that causes the intestine ti overreact.
• Could be genes, ethnicity, family history.

Question 9

Symptoms of ulcerative colitis

Answer 9

• Bloody diarrhoea
• Abdo pain
• Cramping
• Rectal bleeding
• Weight loss
• Fatigue
• Fever
• Urgency to have a bowel movement

Question 10

Peritonitis and causes

Answer 10

• Inflammation of the peritoneum (membrane that lines the abdominal cavity and covers most of the organs in the abdomen and pelvis, liver, kidney and bowel).
• The tissues can become inflamed if they’re exposed to irritating or infected body fluids.
  Causes
• Usually happens when something inside leaks or breaks (pancreatitis, liver disease, holes in digestive tract, surgery, trauma).
• Infection is the most common cause.

Question 11

Peritonitis symptoms

Answer 11

• severe abdo pain
• Fever
• Nausea and vomiting
• Bloating
• Loss of appetite
• Diarrhoea
• Reduced urine
• Thirst

Question 12

Pancreatic juice

Answer 12

• Fluid produced by the pancreas that contains digestive enzymes and alkaline fluid.
• Produces about 1-4 litres of pancreatic juice per day depending on how much food you eat.
• The juice travels through ducts in the pancreas and empties into the duodenum (small intestine). The pancreatic juice and bile from the gallbladder break down food in the duodenum.
• Enzymes break down food
• Lipase breaks down fat with the help of bile produced by the liver
• Protease breaks down proteins and protects against intestinal germs
• Amylase breaks down starches into sugar for energy.

Question 13

Acute pancreatitis and causes

Answer 13

• Inflammation of the pancreas (Organ that produces digestive enzymes and hormones.
• Mild to severe life-threatening

Causes
- Biliary obstruction
- Gallstones
- Heavy alcohol use
- Trauma
- Elevated calcium levels
- Hereditary causes

Question 14

Symptoms of Acute pancreatitis

Answer 14

• Pain in epigastrium and left upper quadrant of abdomen which radiates or penetrates through to the back.
• Tenderness on palpation (examination by hand)
• Reduction in bowel sound
• Low grade fever
• Can lead to shock and acute respiratory distress syndrome (ARDS)
• Nausea and vomiting
• Tachycardia

Question 15

Chronic pancreatitis

Answer 15

• Permanent damage to the pancreas and inflammation over many years.
• Can cause biliary obstruction.

Question 16

Symptoms of chronic pancreatitis

Answer 16

• Nausea and vomiting
• Sob
• Weight loss
• Excessive thirst and fatigue

Question 17

Cirrhosis and causes

Answer 17

• Also known as chronic liver failure
• Progressive disease that occurs when healthy liver tissue is replaced by scar tissue.
• Damage caused is irreversible but it can be slowed or stopped with treatment.

Causes
- Alcohol related liver disease
- Hepatitis B and C
- Non-alcoholic fatty liver disease

Question 18

Symptoms of cirrhosis

Answer 18

• Fatigue
• Loss of appetite
• Nausea and vomiting
• Pain or tenderness
• Skin changes - spider naevi (spider-like blood vessels on the skin, yellowing of the skin and eyes (jaundice)
• Edema in peripheral limbs

Question 19

Bile

Answer 19

• Yellow-green fluid produced by the liver that helps with digestion.
• Stored in the gallbladder
• Made u of water, bile salts, cholesterol, bilirubin and electrolytes.
• The liver produces bile continuously and it travels through ducts to the gallbladder where’s it’s stored and concentrated.
• If you don’t have a gallbladder your liver will still produce enough bile for digestion.
• Neutralises stomach acids
• Breaks down large fat globules into smaller droplets so they can be digested.

Question 20

Gallstones / Cholelithiasis

Answer 20

• Crystallised cholesterol secretions.
• Hypomotility of gallbladder - decrease in movement
• Cholecystitis - chronic inflammation of the gallbladder can increase the risk of gallstones.
  Types of stone - 75% due to cholesterol, 25% due to bilirubin precipitation.

Question 21

Gallstones symptoms

Answer 21

• Usually do not cause any symptoms unless it blocks one of the bile ducts. This would cause sudden, severe abdominal pain, known as biliary colic.
• Abdo pain felt in right upper quadrant radiating to right shoulder blade which worsens with fatty meal.
• Fever and chills
• Tachycardia
• Tachypnoea
• Jaundice
• Itchy skin
• Loss of appetite

Question 22

Crohn’s disease and causes

Answer 22

• Chronic inflammatory bowel disease (IBD) that causes inflammation in the digestive tract.
• Usually affects the small intestine and the beginning of the large intestine.

Causes
- An autoimmune disorder where the body’s immune system attacks healthy tissue.
- May be triggered by bacteria, viruses or other environmental factors.

Question 23

Crohn’s disease symptoms

Answer 23

• Diarrhoea
• Abdo pain
• Mouth sores
• Malnutrition
• Fatigue
• Weight loss
• Bloody stool
• Fever
• Abscesses around the anal canal

Question 24

Gastritis and symptoms

Answer 24

When the lining of your stomach becomes inflamed.

Symptoms:
Tummy pain
Indigestion
Feeling full and bloated
Nausea and vomiting
Not feeling as hungry as usual

Question 25

Portal hypertension & upper Gi bleeding

Answer 25

Portal vein is the main vein that collects all the blood from the digestive system and takes it to the liver to enter the systemic circulation. Due to cirrhosis bp increases, leads to back flow of blood from portal vein to veins around the oesophagus (upper gi tract) Leads to oesophageal varicies of the collateral veins in the oesophagus