Flashcards in GI Deck (20):
No ganglion cells in myenteric plexus.
Obstruction in babies.
RET proto-oncogene Cr10+, assoc with Down's.
Hypertrophied nerve fibres, no ganglia.
Tx: resect affected (constricted) segment.
Mechanical lower GI diseases
- Diverticular disease
(Meckel's = "true", all layers, before 2yo. rule of 2s)
- Adhersions, external masses, herniation
- Intussusception, volvulus (small bowel in small children, sigmoid in ederly)
V common due to low fibre diet, high pressure.
90% in left colon.
Often ASx, ?PR bleed.
Complications: diverticulitis, perf, fistula, obstruction.
Inflammatory Bowel Disease
20s, White, Unknown aetiology.
- Malabsorption: Fe def, stomatitis;
- Eyes: Uveitis, conjunctivitis;
- Skin: pyoderma gangrenosum, erythema nodosum (tender);
- Liver: pericholangitis, PSC.
Smoking makes it worse.
Whole GI tract, whole thickness (transmural), skip lesions, Cobblestone. Aphthous ulcer, rosethorn ulcers. Non-caseating granulomata.
Intermittent diarrhoea (no blood), fever, pain.
Strictures, fitulae, abscesses, perforation.
Ix: CRP, ESR, Barium contrast, Endoscopy.
Mx: Pred / IV hydrocortisone / metronidazole. ?immunosupressors.
Starts in rectum, spreads continuously, doesn't reach small bowel (unless backwash ileitis). Superficial, no structural problems other than pseudopolyps.
Bloody diarrhoea. mucus, pain relieved by defaecation.
Sever haemorrhage, toxic megacolon, ?adenoCa.
Ix: rectal biopsy, AXR, stool culture.
Tx: Pred + mesalazine.
Diverse group of tumours of enterochromaffin cell origin. Usually bowel.
Produce Serotonin, so get carcinoid syndrome.
Bronchoconstriction, flushing, diarrhoea.
Ix: 24hr urine 5-HIAA.
Adenoma of colon / rectum
Benign dysplasia, may become adenoCa.
50% >50yo have them, mainly asymptomatic.
Malingnancy RF: large, dysplastic, villous.
Multiple GI polyps, freckles around mouth, palms and soles.
More intussusception and malignancy, so watch GI tract.
98% adenoCa. 60-79yo. (Familial if
A : mucosa (>95% % year survival)
B1 : muscularis propria
C1 : muscularis propria + LN
C2: transmural + LN
D : distant metastases (
Commonest cause of oesophagitis.
Ulceration, haemorrhage, Barrett's, stricture, perforation.
Los Angeles classification.
Tx: weight, stop smoking, PPIs.
After chronic GORD, columnar epithelium moves up.
10% symptomatic GORD become this.
30x risk of adenoCa.
Tx: endoscopic resection.
RF: smoking, obesity, radiotherapy, male.
Usually distal 1/3 because assoc with Barrett's.
Squamous cell oesophageal Ca
RF: Alcohol, smoking, Afrocab, achalasia of cardia, Plummer-Vinson syndrome, nutritional def, HPV.
Progressive dysphagia, odynophagia, anorexia, weight loss.
Rapid growth, early spread, palliate.
Acute (neut): insult - aspirin, NSAIDs, bleach, burns.
Chronic (lymphocytes): H pyori, autoimm, alcohol, smoking.
Can give ulcers, or intestinal metaplasia then dysplasia then cancer.
After antral gastritis (H pylori).
Epigastric pain worse with food.
RF: H pylori, smoking, NSAIDs, stress, elderly.
Punched out lesion with rolled margins.
Iron deficiency anaemia, perf, malignancy.
H pylori again!
PPI, clarithromycin, amoxicillin.
4x more common than gastric.
Pain, worse at night, *better* with food and milk.
Same RF: H pylori, smoking, NSAIDs, steroids.
Same complications: IDA and perf.