Gastrointestinal Flashcards
(195 cards)
1
Q
WHAT IS HELIOCBACTER PYLORI?
A
Gram negative, curved motile rod, microaerophilic.
2
Q
What is heliocbacter pylori’s key biochemical feature?
A
Urease positivity-used in testing.
3
Q
How is heliocbacter pylori spread?
A
Oro-fecal or oral-oral.
4
Q
What is the pathogenesis of heliocbacter pylori?
A
Adapted to living in gastric mucus Colonises over gastric but not intestinal epithelium.
Induces inflammation
Stimulates increased gastrin
5
Q
What are some disease associations with heliocbacter pylori?
A
Ulcers.
In the absence of NSAIDS or Zollinger-Ellison syndrome.
Gastric cancer.
Gastric lymphoma.
Oesophageal disease.
Barrett’s oesophagus.
Others.
6
Q
What are the usual symptoms of heliocbacter pylori?
A
Acquisition usually asymptomatic but may cause nausea and epigastric pain.
Chronic diffuse superficial gastritis
Followed by a period of achlorrydria.
7
Q
What investigations can you do for HP?
A
Serology
Stool antigen
Urea breath test
Endoscopy with urease test
Histology ± culture
8
Q
What is the treatment for H.Pylori?
A
Omeprazole
Amoxicillin
Clarithromycin OR metronidazole
IF penicillin allergic then metronidazole for amox
9
Q
WHAT IS PERITONITIS?
A
Inflammation of peritoneum.
10
Q
What are the causes of peritonitis?
A
Perforation of GI tract i.e. trauma
11
Q
What are the symptoms of peritonitis?
A
Pain
Rebound tenderness
Guarding reflex
Fever
Increase in WBC
Shoulder tip pain in sepsis
12
Q
What are the investigations of peritonitis?
A
Erect CXR - air under diaphragm.
USS/CT
13
Q
How can you treat peritonitis?
A
IV fluids
Antibitoics
Metronidazole for anaerobes and cephalexin for aerobes
Electrolytes
Surgery laparotomy
14
Q
WHAT IS THE DEFINITION OF INTESTINAL OBSTRUCTION?
A
Blockage to the lumen of gut Intestinal
15
Q
What are some causes of bowel obstruction?
A
Adhesions
Hernias
Tumour
Crohn’s
Volvulus
Gallstone Ileus
16
Q
How is bowel obstruction classified?
A
According to site - e.g. small vs large intestine
Extent of luminal obstruction
Mechanical / True ( intraluminal / extraluminal)
Paralytic (Pseudo obstruction)
Simple Closed loop Strangulation Intussusception
17
Q
WHAT ARE THE CAUSES OF SMALL BOWEL OBSTRUCTION?
A
tumours
intussusception
gallstone ileus
impacted faeces
meconium
bezoars
18
Q
What are the symptoms of small bowel obstruction?
A
abdominal pain, colicky, i.e. returns to normal periodically. Felt in mid-abdomen. Need to know site, radiation, duration and relieving factors.
no flatus; constipation is present
distention, early in the course of the illness if the obstruction is high
vomiting, again earlier in the course if the obstruction is relatively proximal in the bowel
19
Q
What are the investigations for small bowel obstruction?
A
blood urea and electrolytes
white cell count
- *radiology:**
supine: obstructive picture of dilated small bowel
sitting: multiple air/fluid levels in obstruction
to distguish the site:
20
Q
What is the treatment for small bowel obstruction?
A
Drip and suck
A nasogastric tube is placed in small bowel obstruction or if the patient is vomiting
Nil by mouth and given intravenous fluids
21
Q
WHAT ARE THE CAUSES OF LARGE BOWEL OBSTRUCTION?
A
The principal cause of large bowel obstruction is carcinoma, which together with diverticulitis accounts for 90% of cases.
Colonic volvulus is a rare cause of obstruction
22
Q
What are the symptoms of large bowel obstruction?
A
Present quite late with:
- Faecel vomiting
- Weight loss
- Appetite loss.
- Colicky abdominal pain.
Signs include:
- Succussion splash
- Dehydration
- Mass due to the tumour, either in the epigastrium or in the lymph nodes
- Hepatomegaly
23
Q
What is the treatment for large bowel obstruction?
A
Drip and suck
A nasogastric tube is placed in small bowel obstruction or if the patient is vomiting
Nil by mouth and given intravenous fluids
24
Q
What are the indications for immediate surgery of a bowel obstruction?
A
- Crescendo pain
- Localised peritonism, implying perforation or ischaemia
- Complete colonic obstruction with competent ileocaecal valve and caecum dilated to greater than 8cm
- “Closed loop” seen radiologically
- Obstruction occurring as a result of hernial incarceration
25
WHAT IS A VOLVULUS?
A twist / rotation of segment of bowel
26
What are the types of volvulus?
Sigmoid (most common)
Cecal
Midgut
27
What is the cause of a sigmoid volvulus?
1. Pregnancy
2. Middle aged and eldery constipation
3. Adhesions
28
What can cause a cecal volvulus and what can cause a midgut volvulus?
Same as sigmoid, mesenteric join loose
Abnormal fetal development for midgut
29
What can happen to a volvulus?
Can twist and stop blood flow to that part
Can release bacteria into body
30
What are the symptoms of a volvulus?
Colicky abdominal pain
Vomiting (earlier with small bowel)
Constipation (earlier with large bowel).
Distension and tinkling bowel sounds.
31
What are the tests for a volvulus?
Abdo X-ray
**_Barium enema_**
Bird's beak
32
What is the treatment for a volvulus?
Sigmoidoscopy
Endoscopy
Surgery
33
What is a Hartmann's procedure?
Hartmann's procedure is performed when a carcinoma of the rectum is found to be unresectable either due to local invasion or because the patient is unfit for a major resection
34
What is Paul-Mikulicz procedure?
A Paul-Mikulicz procedure is used to treat obstructed colonic carcinoma, volvulus or localized diverticular disease
35
WHAT IS A HERNIA?
Protrusion of organ or tissue out of the body cavity in which it normally lies
36
What are some causes of hernias?
1. Age
2. Chronic cough
3. Trauma damage
4. Failure of abdo wall to close properly in womb
5. Constipation
6. Heavy weight lifting
7. Pregnancy
37
What are the different meanings for these?
Irreducible
Reduction
Incarceration
Obstructed
Strangulated
Irreducible= hernia cannot be pushed back into the right place
Reduction = pushing tissue/organ back into place
Incarceration = contents of hernialsac are stuck inside by adhesions
Obstructed = bowel contents cannot pass through them
Strangulated = if ischaemic occurs
38
What are the different types of hernia?
Hiatal
Inguinal
Femoral
Incisional (after surgery)
Umbilical (\<6m, normally corrects itself)
39
What is the most common hernia and why?
Inguinal hernia
70%
More common in MEN because after testicles descend through canal after birth the canal doesn't always close properly so is weakened
40
What is a direct inguinal hernia?
Protrudes DIRECTLY into inguinal canal
Medial to inferior epigastric vessels
41
What is an indirect inguinal hernia?
Protrudes through internal inguinal ring
Lateral to inferior epigastric vessels
42
What is a hiatus hernia?
Part of stomach herniates through oesophageal hiatus of diaphragm
43
How does a hiatal hernia occur?
**_Sliding_**
GO junction slides through hiatus and lies above diaphragm
**_Para-oesophageal hernia_**
Gastric fundus rolls up through hiatus alongside oesophagus, GO junction remains below diaphragm
44
What are the symptoms of a sliding hernia?
None unless gastric oesophageal reflux occurs
45
What are the symptoms of a para-oesophageal hernia?
Serious risk of complications (gastric volvulus, bleeding)
46
What are the investigations for a hernia?
Made clinically with history and examination
47
What are the treatments for hernias?
May require surgical repair
Reducing the hernia can prevent strangulation from occurring
48
WHAT IS DIVERTICULOSIS?
https://www.youtube.com/watch?v=TL9\_WKuNfu0
Little pouches at the side of the gut
49
What is diverticular caused by?
High pressure within the lumen pushes part of the intestine out
Classically, diverticular disease is believed to occur as a result of deficiency of dietary fibre.
50
Where do most diverticulums occur?
Sigmoid colon
51
What causes incresed risk of diverticulosis?
Low fiber foods leads to constipation
Fatty foods and red meat
Marfan's syndrome
Ehlers-danlos syndrome
52
WHAT IS DIVERTICULAR DISEAESE?
Diverticula + complications e.g. infection, hemorrhage, infection
53
What is the symptoms of diverticular disease
Usually no symptoms
Sometimes stomach pain and bleeding
54
What can happen if a outpouching ruptures?
Can form a fistula
Connection between it and another organ
Most commonly the bladder
55
What is the tests for diverticular disease?
**Diagnosis of exclusion**
Contrast CT Abdo Pelvis
56
What are the treatment options for diverticular disease?
1. **Diet**
More fibre
2. Smooth muscle relaxants
57
WHAT IS DIVERTICULITIS?
Inflammation of diverticula
58
How can a diverticulosis become a diverticulitis?
Inflammation
Through high pressures erroding the wall
OR
Lodged fecalith
59
What are the symptoms of acute diverticulitis?
LIF pain
Fever
Abdoguarding
Tachycardia (similar to appendicitis but on the left)
60
What are the symptoms of chronic diverticulitis?
Chronic diverticulitis exactly mimics the local clinical features of carcinoma of the colon:
1. Mucus/bloody diarrhoea alternating with constipation
2. Which progresses to large bowel obstruction with
3. Vomiting
4. Distension
5. Colicky abdominal pain
6. Constipation
61
What are the tests for diverticulitis?
1. **Diagnostic - Contast CT Abdo Pelvis**
2. Bloods (ESR, CRP)
3. USS
4. Sigmoidoscopy
62
What is the treatment of diverticulitis?
Increasing dietary fibre and physical exercise may improve symptoms
Generally treated with bed rest
IV fluids, analgesics
IV antibiotics - for example cefuroxime and metronidazole - and antispasmodics
Surgical removal - not usually done
63
WHAT ARE THE RISK FACTORS FOR OESOPHAGUS CANCER?
Two main risk factors
gastro-oesophageal reflux
obesity
64
What is the most common cancer found in oesophageal cancer?
Squamous cell carcinoma (SCC) upper 2/3rds
Adenocarcinoma lower 1/3rd
65
What is the staging for oesophageal cancer?
TNM
T = primary tumour
N = lymph nodes
M = metastisis
66
What are the symptoms of oesophageal cancer?
Dysphagia
Weight loss
Anorexia
GI Bleeding
67
What are the investigations for oesophageal cancer?
**Endoscopy**
in patients with ALARM symptoms
Aged 55 or older with unexplained dyspepsia
**Barium oesphagography**
**CT**
Staging
68
What is the treatment for oesophageal cancer?
1. Surgery
2. Chemotherapy
3. Radiotherapy
69
WHAT ARE THE RISK FACTORS FOR STOMACH CANCER?
H.pylori
Age
Sex
Ethnic origin - Black African or Caribbean
70
What is the most common cancer type for stomach cancer?
Adenocarcinomas
71
What are the clinical features of stomach cancer?
Dyspepsia
**Later features include:**
Anorexia and weight loss
Palpable mass
**Troisier's sign** - palpable left supraclavicular lymph node; this is called Virchow's node.
72
What are the investigations for stomach cancer?
Endoscopy and biopsy
Chest X-ray, liver enzymes and liver ultrasound
Anaemia
73
What is the staging of stomach cancer?
TNM
T = primary tumour
N = lymph nodes
M = metastisis
74
What are the differentials for stomach cancer?
carcinoma of the caecum
carcinoma of the pancreas
pernicious anaemia
uraemia
75
What is the treatment for stomach cancer?
Surgery ONLY
76
WHAT IS THE MOST COMMON CANCER OF THE SMALL INTESTINE?
Adenocarcinoma
77
What are the clinical features of small intestine cancer?
Occult bleeding
Obstruction
Epigastric pain
Vomiting
Jaundice
78
What are the investigations for small intestine caner?
Endoscopy + biopsy
Barium studies
79
What is the treatment for small intestine cancer?
Surgical resection
80
WHAT ARE THE RISK FACTORS FOR COLORECTAL CANCER?
Age
Male
Environmental factors - red meat and processed meat
Obesity
81
What is the most common type of cancer for colorectal cancer?
Adenocarcinoma
82
When would you offer screening for colorectal cancer?
age \> 40
family history of colorectal cancer
personal history of colorectal cancer
familial adenomatous polyposis coli
ulcerative colitis
83
What are the symptoms of colorectal cancer?
Pain common to both types
**Right colonic carcinoma**
Weakness and anaemia
**Left colonic carcinoma**
Change in bowel habit
**Rectal carcinoma**
Rectal bleeding
Change in bowel habit
Tenesmus
84
What are the investigations for colorectal cancer?
Colonoscopy
Barium enema, flexible sigmoidoscopy
85
What is the treatment for colorectal cancer?
Surgical resection
+ chemotherapy
86
What is Duke classificaiton?
Staging colorectal carcinoma
87
What are the Dukes classifications?
COLORECTAL CANCER
1. Duke A in gut.
2. Duke B just outside gut.
3. Duke C lymph node.
4. Duke D high tie lymph node.
88
WHAT IS A PEPTIC ULCER?
https://www.youtube.com/watch?v=26Rdx2EiBaA
Having one or more sores in the stomach, gastric ulcers or duodenum, duodenal ulcers
89
What increases the risk of a peptic ulcer?
Stress
Use of NSAIDs
Smoking
Helicobacter pylori
90
What are the symptoms of peptic ulcers?
Epigastric pain - aching in abdomen
Bloating
Belching
Vomiting
91
When do symptoms improve for gastric and duodenal ulcers?
Gastric when not eating
Duodenal when eating
92
What is the diagnosis of peptic ulcers?
Endoscopy + biopsy
**_C13 Urea breath test_**
H pylori
**_Biopsy_**
Check for malignancy
H.pylori
**Gastrin Levels**
If Zollinger-Ellinson syndrome - gastric tumour
93
How could you treat peptic ulcers?
**_H.pylori_**
Antibiotics (Omeprazole, Metronidazole, Clarithromycin)
**_Acid lower medications_**
1. Proton pump inhibitors - Lansoprazole
2. H2 blocker - Rantidine
**_Surgery_**
94
What makes gastric ulcers worse?
NSAIDs
Smoking
Caffiene
Alcohol
95
WHAT IS GASTRITIS?
Irritation of stomach lining without an ulcer
96
What are the causes of gastritis?
Excessive alcohol
NSAIDs
Spicy foods
Stress
97
What are the symptoms of gastritis?
Epigastric pain
Loose stools
Vomiting
Haematemesis.
98
How can you diagnose gastritis
Endoscopy + biopsy
99
What is the differential diagnosis of gastritis?
Ulcerative collits
Chron's
IBS
100
What is the treatment for gastritis?
Ranitidine or PPI; eradicate H. pylori as needed.
Troxipide PO improves gastric mucus.
Endoscopic cautery may be needed.
101
What is the treatment for H.pylori?
Lansoprazole, amoxicillin, and clarithromycin (LAC)
102
WHAT IS THE STRUCTURE OF THE SMALL INTESTINE?
Villi and crypts.
Crypts provide new cells for the villi.
103
What are the different types of malabsorption?
Insufficient intake.
Defective intraluminal digestion.
Insufficient absorptive area.
Lack of digestive enzyme.
Defective epithelial transport.
Lymphatic obstruction.
104
What is Giardia lamblia?
Giardia lamblia, also known as Giardia intestinalis, is a flagellated parasite that colonizes and reproduces in the small intestine, causing giardiasis.
The parasite attaches to the epithelium by a ventral adhesive disc, and reproduces via binary fission.
105
WHAT IS CROHN'S DISEASE?
Massive inflammation and associated ulcers.
Transmural granulomatous inflammation
106
What is the cause of crohn's?
Immune response occurs in reponse to pathogen but is wide and damages cell in GI tract
Defect in epithelial wall which lets bacteria in
107
What are the bacteria thought to be responsible for Crohn's?
Mycobacterium paratuberculosis
Pseudomonas
Listeria
108
Where in the GI tract is Crohn's disease most common?
Terminal Ilieum.
109
Where can ulceration/granulomatous inflammation be found in Crohn's?
Whole length of the GI tract
PATCHY
Throughout the mucosa, submucosa, muscular propriety and fat of the gut.
110
Where do crohn's ulcers extend?
All the way through muscle layer
Ulcerative colitis does not
111
What are the symptoms of crohn's?
Pain in assocaited areas
RLQ
Diarrhoea and blood in stool
If affecting large bowel
Malabsorption
If affect small bowel
112
What are the test for crohn's disease?
Acutely can sound like Appendicitis.
```
**_Barium Swallow_**
COBBLESTONE APPEARANCE (may also have stricture formation and bowel shortening)
```
**_CT_**
Shows areas of wall thickening
**_Colonoscopy (and biopsy)_**
DIAGNOSITIC
113
What does the histology look like for crohn's?
Skip Lesions
Transmural inflammation
Increase in Goblet cells
Non-Caseating Granulomas
114
What are the treatment option for crohn's?
**Maintenance:**
1. Azathioprine
2. Mercaptopurine / Methotrexate
3. TNF-alpa inhibitors (all the –imabs)
4. Surgery eg. Strictures, resection
**Flares:**
1. 7 days prednisolone then taper dose for 7 weeks
2. If systemically unwell – admit for IV hydrocortisone and monitoring (incl Xrays). Supportive – fluids, transfusion if \<80Hb).
3. Switch to oral pred once improving or biologics if not improving
115
What are some Crohn's disease complications?
Malabsorption
-disease extent -surgical resections
Obstruction
-acute swelling -chronic fibrosis
Perforation
-acute abdomen
Fistula formation
Osteoporosis
Neoplasia
-colorectal cancer
116
What different surgical resections are there?
Ileocolonic anastomosis
Jejunocolonic anastomosis
End-jejunostomy
117
WHAT IS ULCERATIVE COLITIS?
Inflammation in the large intestine forming ulcers including colon and rectum
118
What is the cause of ulcerative collitis?
Autoimmune
Stress and diet make it worse
119
What trait do a large amount of people with ulcerative collitis have?
p-ANCAs
Thought to be due to bacteria mimicary
Increase in Sulfide gut bacteria
120
What is the epidemology of ulcerative collits?
Family history positive
Women
30s
Caucasions and eastern europeans
121
Where does ulcerative collitis start and what does it look like inside the lumen?
Rectum
Makes way round with no breaks
Circumfrential and continuous
122
What can ulcerative colitis involve?
Inflammatory disorder of the colonic mucosa.
Does not involve the muscle
Forming ulcers
123
How do you distinguish ulcerative colitis from Crohn's disease?
Ulcerative colitis only involves mucosa whilst Crohn's involves many layers of the gut.
124
What are the symptoms of ulcerative colitis?
1. Pain in LLQ
2. Episodic or chronic diarrhoea
3. Cramps abdominal discomfort
4. Bowel frequency relates to severity
5. Urgency/tenesmus.
6. Fever, malaise, anorexia, weight.
125
What are some complications of ulcerative colitis?
**Skin**
Erythema nodosum
Pyoderma gangrenosum
**Colon**
Blood loss toxic dilatation
Colorectal cancer.
**Joints**
Ankylosing Spondylitis
**Eye**
Iritis
Uveitis
126
What would show on histology for UC?
Continuous superficial inflammation
Crypt Abscesses
Goblet cell depletion
Ulcers
Only rectum affected (not proximal to ileocaecalvalve)
127
What investigations can be done for ulcerative colitis?
Bloods
**_BARIUM SWALLOW_**
Loss of haustrations and drain pipe colon
**_XR_**
No faecal shadows; mucosal thickening/islands, colonic dilatation
**_Stools_**
Exclude bacteria
**_Colonoscopy_**
Look for inflammatory infiltrate; goblet cell depletion; glandular distortion; mucosal ulcers; crypt abscesses.
Sigmoidoscopy and biopsy - \*\*\*DIAGNOSTIC
128
What are the principles of management for ulcerative colitis?
**Maintenance:**
1. Mesalazine (which is an aminosalicylate or 5-ASA)
2. Azathioprine
3. Mercaptopurine / Methotrexate
4. TNF-alpa inhibitors (all the –imabs)
5. Surgery eg. Strictures, resection, stoma
**Flares:**
1. Mesalazine
2. 7 days prednisolone then taper dose for 7 weeks
3. If unwell – admit for IV steroids and monitoring (incl Xrays). Supportive – fluids, transfusion if \<80Hb).
129
What happens in barrett's oesophagus?
Change from squamous epithelium to glandular. Columnar lined lower oesophagus.
130
WHAT IS IBS?
Recurrent abdominal pain and abnormal bowel motility
131
What are the symptoms of IBS?
Constripation and/or diarrhoea
Symptoms improve after voiding
Does not involve inflammation
132
What is the cause of IBS?
Unknown
133
What happens with visceral hypersensitivity in IBS?
Sensory nerve endings
Abnormaly stong response to stimuli
When eating
Recurrent abdo pain
134
How does increased bowel motitlity work with IBS?
Short-chain carbohydrates
Fructose and lactose act as solutes
Draw water into lumen
Stretch lumen causing pain
Smooth muscle spasm and diarrhoea
Gut flora metabolise short chain and produce gas
135
What is the epidemology of IBS?
**_North america_**
Middle aged women
Other parts
Both sexes equally
136
What are some risk factors for IBS?
**_Gastroenteritis_**
Norovirus
Rotovirus
Stress
137
What is the treatment of IBS?
Diet modification
Avoid certain food, apples, beans and caulifflour
**_Constipation_**
Soluble fibre
Stool softeners
Laxatives
**_Spasms_**
Antimuscarinic
**_Manage stress_**
**_LOW FODMAP_**
Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols
138
WHAT IS COELIACS DISEASE?
https://www.youtube.com/watch?v=nXzBApAx5lY
Autoimmune response which attacks the small intestine
139
What is the main culprit of coeliacs?
Gliadin found in gluten
140
What screening tests can be used to detect coeliacs disease?
Anti-tTG and anti-endomyseal useful in severe cases
141
What are the signs seen in the intestinal wall for coeliac's?
Villus atrophy
Crypt hyperplasia
Lymphocyte infiltration
142
How does coeliac's disease present?
**_Classical_**
Diarrhoea
Steatorrhoea
Weight loss
Failure to thrive
**_Non-classical_**
Irritable bowel type symptoms
Iron Deficiency
Anaemia
Osteoporosis
Chronic Fatigue
Dermatitis Herpitiformis
Ataxia
Peripheral neuropathy
Hyposplenism
Ammenorhoea Infertility
143
What is Dermatitis Herpetiformis?
1. Rash common with coeliac disease patients.
2. Bumpy skin rash which pops up from IgA antibodies
3. Transglutaminase in dermal papillae
4. Neutrophils come by and start reaction
144
How do you test for coeliac's disease?
**_Serology_**
Tissue transglutaminase (tTG)
Anti-endomysial antibody (EMA)
Immunoglobulins.
Endoscopy + Duodenal biopsies.
**_Histology_**
Villous atrophy.
145
How do you manage coeliac's disease?
1. Gluten free diet – strict and lifelong
2. Patients with coeliac disease often have a degree of functional hyposplenism
- - Pneumococcal vaccine
3. DEXA scan- osteoporotic risk
4. Prescription entitlement Inform 10% risk in 1st degree relatives.
146
What happens if coeliac's disease is left untreated?
Persistent symptoms
Osteoporosis
Subfertility
Cancer risk
Quality of life.
147
WHAT IS TROPICAL SPRUE?
https://www.youtube.com/watch?v=In1uajyiSxE
GI disease that results in malabsorption of nutrients in water
148
What is the cause of tropical sprue?
Unknown
Maybe E. coli
149
What happens to the villi in tropical sprue?
Villi become flattened
150
What is thought to be the pathology of tropical sprue?
Bacteria, virus or protazoa initially damage gut wall
Cause inflammation
Enteroglucagon released by enterocytes
Decreases intentinal motility
151
What are the bacteria in tropical sprue?
Klebsiella
E.Coli
Enterobacter
152
What are the symptoms of tropical sprue?
Has flare ups
Diarrhoea
Abdominal pain
Fatigue
Weight loss
Dehydration
153
What is the diagnosis of tropical sprue?
Lived in tropics and have long standing GI symptoms
**_Fat malabsorption_**
72 hour stools test on prescribed diet
**_Carbohydrate malabsorption_**
D-xylose absorption test
**_Imaging techniques_**
Endoscopy
Villi atropy
Barium swallow
intestinal wall thickening
**_Tissue biopsy of jejenum_**
154
What is the treatment for tropical sprue?
**_Antibiotics_**
Tetracycline 250mg QDS
**_Nutrition_**
Folate
B12
155
What is a complication of tropcial sprue?
Megaloblastic anaemia
Large immature RBCs
156
WHAT IS MALLORY-WEISS TEAR?
https://www.youtube.com/watch?v=YEaP\_P5HrLQ
A longtitudinal tear in the mucosa lining at the gastroesophageal opening
157
What is the cause of mallory-weiss?
Anyhting that causes a suddden rise in intragastric pressure
Normaly prolonged vomiting
Persistant retching
Intentse coughing
Alcholic binge drinking
Beluimic
Gastritis
158
What are the symptoms of Mallory-Weiss?
Upper GI pain
Severe vomiting
Vomiting blood (Hematemisis)
Bloody or black stools (Melena)
159
How can you diagnose Mallory-weiss?
**_Pateint history and presenting complaint_**
Binge drinking?
Bulimic?
**_Upper GI endoscopy_**
See tear in mucosa
**_FBC_**
Low RBC
160
What are the treatment options for Mallory-weiss?
**_Most of the time it heals itself_**
1. IV fluid
2. Oesophagus balloon tamponade
3. Oesophageal clips
4. Proton pump inhibitors
5. Sclerotherapy (medications close off vessel)
6. Coagulation therapy
161
WHAT ARE OESOPHAGO-GASTRIC VARICES?
https://www.youtube.com/watch?v=06nBQxYro8s&t=37s
The dilated veins that are in the distal oesophagus
162
What causes varices?
Increase in portal venous system
163
What diseases cause varices?
Liver cirhosis
Alcoholics
164
How does liver cirrhosis cause varices?
progressive liver fibrosis + regenerative nodules produce contractile elements in the liver’s vascular bed
Portal hypertension
Causes veins in oesophagus to become engorged and serpentine
165
What are the symptoms of varices?
**History**
Alcoholic
**Upper GI bleeding**
More than Mallory Weiss
166
How do you diagnose varices?
Endoscopy
FBC
PT
PTT
LFT
167
What is the treatment for varices?
**_Endoscopic banding_**
Put rubber band around enlarged veins
**_TIPS_**
Transjugular, intrahepatic portosystemic shunting
Bypass between portal and hepatic venous circulations
**_Octreotide IV_**
Decreases blood flow
Inhibits vasodilation
**_Non-selective beta blockade_**
Propanalol
168
WHAT IS ACHALASIA?
https://www.youtube.com/watch?v=Ck5Xhre-UZU&t=1s
Lower esopahgeal sphincter does not relax
Esophagus dilates
169
What is the cause of achalasia?
1. Contraction of lower oesophagael by loss of spinchter nerve innervation
2. BY loss of ganglion cells (Auerbach's plexus)
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What is the pathophysiology of achalasia?
1. Impaired of peristalsis
2. Lack of relaxation of LOS
3. Increased pressure
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What are the symptoms of achalasia?
1. Dysphagia of BOTH liquids and solids
2. Patinet will regurgitate food at night
3. Cough
4. Pulmonary aspiration
5. Weight loss
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What is the diagnosis of achalasia?
**_Oesophageal monometry_** - catheter down esophagus
Assess peristalsis
100% failed peristalsis
Function of LOS
Incomplete relaxation
Increased pressure
**_Barium swallow_**
Fluid stuck in esophagus
Bird's beak
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What is the treatment for achalasia?
Try to open LOS
Decrease pressure at LOS
**_Surgical myotomy_**
Cut muscles of LOS
**_Balloon dilation_**
Then proton pump inhibitors
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WHAT IS SCLERODERMA?
Collagen deposition in skin and other organs
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What is the epidemology of scleroderma?
30-50 years
Women more than men
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What is the cause of scleroderma?
Unknown agent causes disease in suseptable host
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What antibody is involved with scleroderma?
Limited: Anticentromere
Diffuse: Antitopoisomerase-1
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What are the symptoms of scleroderma?
**_CREST_**
**C**alcinosis
**R**aynaud's phenomenom
Esophageal dysfunction - acid reflux and decrease in motility
**S**clerodactyly - thickening and tightening of the skin on the fingers and hands
**T**elangiectasis - dilation of capillaries causing red marks on surface of skin
Skin develops hard texture
Cannot be wrinkled
Face is expressionless
Claw like fingers
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What is the diagnosis of sclermoderma?
**_Radiography_**
Diffuse widening of peridontal ligament space
**_Microscopy_**
Excess collagen in stroma of organ involved
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What is the cure of scleroderma?
No cure
**_Immunosuppresants_**
Cyclophosphamide
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WHAT IS GASTROINTESTINAL REFLUX?
Symptoms or mucosal damage produced by abnormal reflux of gastric content into the oesophagus
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What are some causes of GI reflux?
Obesity
Eating large meals
Tight clothing
Pregnancy
Drugs
Tricylic depressants
Anticholinergics
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What are the symptoms of GI reflux?
Heartburn
Acid regurgitation
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What is the mechanism in GI reflux?
In the normal individual the pressure in the intra-abdominal pressure exceeds the intra-thoracic pressure. This differential is exacerbated in the obese person. Obesity has two effects:
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What are the investigations for GI reflux?
Endoscopy
Barium radiology
24 hour oesophageal pH monitoring
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What is the management for GI reflux?
**PPI**
Omeprazole
**H2RA**
Ranitidine
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WHAT IS ISCHAEMIC COLITIS?
Ischaemic colitis is typically, a chronic segmental process in elderly patients affecting the watershed areas of the splenic flexure or rectosigmoid area. It is caused by transient critical ischaemia.
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What is the cause of ischaemic colitis?
The most common cause is arterial occlusion, usually of the superior mesenteric artery.
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What are the clinical features of ischaemic colitis?
Cramp-like, left sided abdominal pain which lasts for a few hours, and is followed by rectal bleeding.
The bleeding is dark red, often without faeces, and may occur 2-3 times over a period of 12 hours.
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What are the investigations for ischaemic colitis?
Plain abdominal x-ray - may reveal mucosal oedema at the splenic flexure, so called "thumb printing"; a single segment is affected with symmetrical stricture
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What is the treatment for ischaemic colitis?
May resolve
Strictures may develop which require surgical resection
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WHAT IS A PILONIDAL SINUS?
'Pilonidal' means a nest of hairs.
A pilonidal sinus is a sinus that contains a tuft of hairs.
These sinuses are commonly found in the skin covering the sacrum and coccyx but can occur between the fingers, particularly in barbers, and at the umbilicus.
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What are the clinical features of a pilonidal sinus?
Recurrent episodes of pain or sepsis.
There are often periods of several months between episodes.
As the size of the sinus increases the frequency of painful episodes also increases
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What is the management of a pilinidal abscess?
If a pilonidal sinus is small, then it may only require antibiotic treatment. If the sinus develops into an acutely inflamed abscess, then it will require drainage.
**There are three alternative procedures that may be undertaken:**
the lesion can be incised and laid open
the lesion can be completely excised
the lesion can be curetted and injected with phenol
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