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RAD415 PT2 > gastrointestinal pathology > Flashcards

gastrointestinal pathology Flashcards

1
Q

what is peptic ulcer disease

A
  • upper abdominal (epigastric) pain
  • characterized by discontinuation in the inner lining of the gastrointestinal (GI) tract because of gastric acid secretion or pepsin
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2
Q

what are 3 signs that one could have peptic ulcer disease

A
  • haematemesis
  • melaena
  • iron deficiency anemia
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3
Q

what is haematemesis

A

vomiting blood

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4
Q

what is malaena

A

black stools from digested blood

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5
Q

what is gastritis

A

inflammation of the lining of the stomach

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6
Q

what are some symptoms of gastritis

A
  • heaviness
  • pain
  • heartburn
  • nausea and vomiting
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7
Q

what are bacteria causes peptic ulcer disease

A
  • Helicobacter pylori
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8
Q

what are non pathological causes of peptic ulcer disease

A
  • stress
  • alcohol
  • meds such as NSAIDS, corticosteroids
  • bad eating habits
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9
Q

because peptic ulcer disease can be caused by H.pylori, what does this mean about its treatment

A
  • you can use antibiotics to treat it as it is a bacteria residing in the stomach
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10
Q

despite strong acidity in stomach, how is H pylori able to survive in the stomach

A
  • colonisation in gastric mucus
  • creating alkaline ammonia from urea
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11
Q

what scan can be used to identify peptic ulcer disease when red flags are raised

A

oesophagogastroduodenoscopy

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12
Q

when might you start to suspect cancer from suspected peptic ulcer disease

A
  • unexplained IDA
  • weight loss
  • epigastric mass
  • blood loss
  • dysphagia
  • persistent vomiting
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13
Q

what are the conservative and medical treatments for peptic ulcer disease

A

conservative = lifestyle changes, removing contributing meds

medical = proton pump inhibitor, antibiotics if h.pylori is the cuase

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14
Q

how would proton pump inhibitors help treat peptic ulcer disease

A

by reducing the amount of acid your stomach produces, preventing further damage to the ulcer as it heals naturally.

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15
Q

peptic ulcer disease can cause barretts oesophagus, what is this

A

turning columnar to squamous epithelia in oesophagus (increases risk of cancer)

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16
Q

why are squamous cells more prone to developing cancer than others e.g columnar

A
  • mutations occur in squamous cells and likely lead to overdevelopment of them = tumour
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17
Q

how would peptic ulcer disease lead to IDA

A
  • causes upper GI bleed
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18
Q

peptic ulcer could cause a perforated oesophagus if theres continuous vomiting, what is this known as

A

boerhaaves syndrome

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19
Q

as a result of boerhaaves syndrome, what can this lead to

A

pneumomediastium

  • air in the mediastinum
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20
Q

what is appendicitis/what causes it

A
  • inflammation of appendix
  • caused obstruction of appendix lumen by faecolith ( a mass of an accumulation of hardened fecal matter)
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21
Q

how might appendicitis become deathly

A
  • obstruction causes increased intraluminal pressure
  • liminal diameter rises and appendices wall stretches
  • perforation/burst can occur leaking faecal contents into peritoneal space and causes spesis
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22
Q

what area is appendicitis pain usually felt after progression

A

right iliac fossa

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23
Q

where is appendicitis pain felt in the beginning before progression and why

A
  • in central abdomen as visceral peritoneum is inflamed and the brain interporates visceral stimuli from midgut coming from here
  • known as ‘ referred pain ‘
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24
Q

what are the 5 different positions the appendix can be found

A
  • retrocecal (most common)
  • postileal
  • preileal
  • subsecal
  • pelvis
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25
Q

what might appendicitis look like on imaging

A
  • widened appendix lumen (over 6mm)
  • increased thickness of appendices wall (thin if prerupture)
  • appendices fat stranding
  • faecolith visible
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26
Q

as the appendix is harder to be seen on pregnant women using ultrasoun, what is the preferred imaging modality

A

MRI

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27
Q

what is diagnostic laparoscopy

A

Diagnostic laparoscopy (keyhole surgery) is a procedure that allows a doctor to look directly at the contents of the abdomen or pelvis.

28
Q

what must be done to the abdomen before insertion of laparoscope

A
  • ensure the abdomen is gas filled
29
Q

what is the main treatment for appendicitis

A

appendicectomy

30
Q

what are the 2 types of inflammatory bowel disease

A
  • crohns disease
  • ulcerative colitis
31
Q

what is the difference between crohns and ulcerative colitis

A

crohns = transmural inflammation that can occur anywhere in GI tract

ulcerative colitis = superficial inflammation limited to colon

32
Q

what are some symptoms of ibd

A
  • bloody diarrhoea
  • increased still frequency
  • colicky abdominal pain
  • tenesmus
  • joint pains
  • fever
  • weight loss
  • skin lesions
33
Q

what is tenesmus

A
  • feeling of incomplete emptying after defecation
34
Q

what is the most common way of diagnosing IBD

A
  • Biopsy via endoscopy
35
Q

what is the radiographic sign of crohns / ibd

A

fat halo sign
thumbrinting
penematosis intestinalis

36
Q

what is penematosis intestinalis

A

air in bowel wall

37
Q

what are the main treatments for IBD

A
  • corticosteroids
  • immunosuppression
  • biological agents (e.g monoclonal antibodies)
  • colectomy
38
Q

as a result of ibd, it can cause toxic megacolon, what is this

A

extreme inflammation and distention of the colon

  • colonic diameter over 6cm
    or
  • caecal diameter over 9cm
39
Q

IBD can lead to stoma formation, what is this

A
  • removed of some parts of the bowel
    (commonly the colon)
  • requires ileostomy (ileum connected to the skin)
40
Q

what is the increased risk for patients who have stomas

A

parastomal hernias

41
Q

what is a fistula

A

abnormal connection between 2 epithelial lined organs

42
Q

what is a common fistula caused due to IBD

A

perianal fistula

43
Q

what might you spot on double contrast barium enema to identify IBD

A
  • ulcers
  • pseuopolyps
  • thickened haustra or lack of haustra (pouches not he bowel)
44
Q

why would you not give double contrast barium enema to a patient with acute severe disease

A

increased risk of perfortation

45
Q

someone with IBD can have reduced vitamin d, this along with prescription of corticosteroids can affect the bones in what way

A
  • causing increased risk of osteoporosis

(decrease density of bones, more fragile)

46
Q

increased inflammation and turnover of gut lining increases risk of bowel cancer

A
47
Q

what are common causes of small bowel obstruction

A
  • adhesion (small bowel sticking to itself)
  • hernias
  • ibd
  • carcinoid
48
Q

dilated loops of the small bowel can be identified as small bowel obstruction, what is the size range to be classified as such

A
  • over 2.5-3cm
49
Q

what does small bowel obstruction look like on abdominal x ray

A
  • central location of valvulae conniventes (stacked pennies look)
  • dilated loops
50
Q

what is the treatment used for small bowel obstruction

A
  • drip and suck
  • drip = IV fluids to replace losses
  • suck = nasogastric tube to decompress faecal contents in stomach
51
Q

what are the common symptoms of large bowel obstruction

A
  • colicky lower abdominal pain
  • lack of passing flatus (gas)
  • abdominal distension
  • potentially nausea and vomiting
52
Q

what are main causes of large bowel obstruction

A
  • colonic carcinoma
  • volvulus
  • ischaemic stricture
  • faecal impaction
  • hernia (uncommon)
53
Q

what is the main sign of large bowel obstruction on a radiograph

A
  • increased gas proximal to obstruction
  • little to no gas post obstruction
  • enlarged bowel
54
Q

symptoms of colonic carcinoma differ depending on if it is found on the left or right side of the colon, give the differences

A

left sided =
- change in bowel habit
- colicky pain
- PR bleeding
- obstruction

right sided =
- weight loss
- anamia
- mass in abdomen

55
Q

what screening is done to check for large bowel obstruction

A

faecal occult blood test

56
Q

according to NICE 2WW referral criteria, what are the symptoms for age groups that require doctor to check for colonic cancer

A

age 40+ = unexplained weight loss and abdominal pain

age 50+ = unexplained rectal bleeding

age 60+ = iron deficiency or changes in bowel habit

57
Q

what imaging is done to identify suspected colonic carcinoma

A
  • colonoscopy
58
Q

what is the TNM classification of cancer

A
  • tumour (layer of invasion)
  • nodes (involvement of local lymph nodes)
  • mets (distant metastases)
59
Q

what is a bowel resection

A
  • surgery to remove part of bowel

different types =
- right/left hemicolectomy
- ap resection
- high anterior resection
- low anterior resection

60
Q

what is a volvulus

A

occurs when a loop of intestine twists around itself and the mesentery that supports it, causing bowel obstruction.

61
Q

what are symptoms of volvulus

A
  • lack of flatus
  • abdominal pain
  • vomiting in severe disease
62
Q

what can be seen on exam as a result of volvulus

A
  • abdominal distension
  • hyperactive bowel sounds
  • tinkling bowel sounds
63
Q

what is a typical structural sighting of volvulus on a radiograph

A
  • coffee bean
64
Q

what is the difference between treatment of a sigmoid and caecal volvulus

A

sigmoid = flatus tube and maybe surgery if reoccurent

caecal = surgery

65
Q
A

RAD415 PT2 (14 decks)

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