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Flashcards in Gastrointestinal Deck (45)
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what can cause GORD

poor lower oesophageal sphincter
increased pressure in stomach with reduced clearing
hiatus hernia


what might be complication of GORD

barrett's oesophagus - metaplasia of the epithelial lining of stomach, to withstand acid, pre-neoplastic


what medications may patients with GORD be on

proton pump inhibitors - prevent production of acid by pp in parietal cells - omeprazole
antacid - convert acid to salt - rennies
H2 receptor agonist - rinitidine


what are the different types of mouth ulcers

minor aphthae, major aphthae or herpetiform aphthae


what is orofacial granulomatos

when macrophages engulf cells but cannot break them down, forms giant multi-nucleated cells. these then block the lymphatic ducts and prevent drainage. granuloma production with giant cells and fluid


what is a hiatus hernia

when part of the stomach herniates - either into oesophagus (sliding) or as a separate thing (rolling). severe GORD can be seen in sliding as every time the diaphragm contracts, the stomach and acid goes into the oesophagus


what is peptic ulcer disease

ulceration of lining caused by perforation by stomach acid


what causes peptic ulcer disease

over production of acid - acid into small intestine where the lining cannot withstand
normal production but not normal mucous production, so the stomach lining is not protected
helicobacter pylori - bacteria that causes inflammation of lining at pylorus at stomach. chronic inflammation can result in lymphoma


what complications can occur with peptic ulcers

can perforate through lining, right through to muscle and eventually cause a complete perforation into peritoneum, may get haemorrage or peritonitis.


what are signs and symptoms of peptic ulcer disease

normally none until it has perforated through


what investigations can be done into peptic ulcer disease

endoscopy, blood test for anaemia if bleeding, can check for antibodies to h pylori


how can peptic ulcer disease be treated

if reversible - medication such as PPI, antacid but if perforated may need surgery


what are possible causes for inflammatory bowel disease

psychological - stress and anxiety
immune system - over reaction to non threatening things


what are the differences between crohns disease and ulcerative colitis

crohns disease - can affect anywhere in tract, discontinuous, transmural (the whole way through), granulo formation cobble stone appearance, non vascular
UC - vascular appearance, mucosal ulcers, serosa not involved, continuous disease


what investigations can be done for IBD

faeces - calprotectin suggest inflammation
for a child - measuring their growth, make sure it isnt halted by malnutrition. blood test for anaemia markers, barium studies and endoscopy


what treatment is available for IBD

steroids if an immune reaction but not good long term
anti-tnf - directly attack, can get surgery to remove part for bowel but may result in stoma bag which has social implications


if a patient is presenting with recurrent oral ulcers what might you suspect

anaemia - may be due to malabsorption and inflammatory bowel disease


what can malabsorption result in

weight loss, diarrhoea, sterrohea, pernicious anaemia


what is the aetiology of coeliac disease

sensitivity to alpha gliaden which is in gluten. causes immune system to produce cytokines and attack villi, resulting in villous atrophy and an inability for absorption


what investigations can be done for coeliac disease

blood test for haemantics, endoscopy with biopsy, can be done before and after period with no gluten to check for improvement, faeces to check for fat in stool


describe the screening tool used for colon cancer

every person over the age of 50 sends a faecal sample in the post, its then check for blood, if none detected, nothing for the next 5 years. polyps cause bleeding and can turn neoplastic within 5 years


what is a polyp

a growth on the mucosal lining, as food passes through, it is irritated and can cause the mucosa to bleed, if left, likely to turn into malignant cancer, but can be removed easily


what can increase the likelihood of polyps

ulcerative colitis, smoking, low fibre high fat diet,


what is jaundice

excess unconjugated billirubin deposited on skin


what is billirubin

product of breakdown of RBC, especially haem group


how are RBC broken down

broken down by bone marrow to produce unconjugated billirubin. this then goes to liver where it can be conjugated for excretion from kidneys or git


what are the 3 ways jaundice can occur and give examples of when this would happen

pre-hepatic - build up of rbc breakdown, too many RBC, mismatch blood transfusion or maternal blood in fetus
hepatic - problem with hepatocytes conjugating bilirubin, cirrhosis
post-hepatic - blockage in bile duct, preventing bilirubin being cleared, backs up into vein - gall stones


how can the colour of urine or faeces tell what type of jaundice it is

if urine is normal colour - conjugated bilirubin into blood to get to kidney - pre or post but not hepatic
if faeces is normal colour - conjugated bilirubin into GIT, cannot be hepatic or post, must be pre


how can jaundice be treated

light therapy in neonate, but not much can do other than let it pass. ursodeoxycholic acid can be used to prevent build up of bile acid in post


what is acute cholecysitis

inflammation of bile ducts due to blockage from a gall stone