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Year 2 Conditions > GI > Flashcards

GI Flashcards

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1
Q

What is a hernia?

A

A protrusion of abdominal contents beyond the confines of the abdominal wall

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2
Q

What are the symptoms of a hernia that isn’t stuck?

A

Fullness/swelling
Swelling that gets larger w/ increased intra-abdominal pressure eg coughing
Aches

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3
Q

What are the symptoms of an incarcerated hernia?

A

Pain
A swelling that won’t move
Nausea and vomiting
Systemic problems with ischaemia

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4
Q

What are the causes of a hernia?

A

Weakness in the cavity;
Congenital - patent processus vaginalis
Post surgery

Increased intra-abdominal pressure;
Obesity, weight lifting, chronic cough, chronic constipation

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5
Q

What are the borders of the inguinal canal?

A

Anterior: aponeurosis of external oblique

Roof: internal oblique, transversus abdominis

Posterior: transversalis fascia

Floor: inguinal ligament, lacunae ligament

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6
Q

What is Hesselbach’s triangle?

A

A point of weakness in the abdominal wall

Borders
Medial; lateral border of rectus abdominis
Lateral; inferior epigastric vessels
Inferior; inguinal ligament

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7
Q

What is the pathway of an indirect inguinal hernia?

A

Deep inguinal ring => inguinal canal => superficial inguinal ring

Can descend into scrotum with patent processus vaginalis

Lateral to epigastric vessels

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8
Q

What is the pathway of a direct inguinal hernia?

A

Hesselbach’s triangle => superficial inguinal ring

Medial to epigastric vessels

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9
Q

What is a femoral hernia?

A

A hernia through the empty space in the femoral canal

More common in females due to wider pelvises

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10
Q

What is an omphalocele?

A

A type of congenital hernia
Viscera are covered in peritoneum
Abdominal cavity may not have grown to correct size to accommodate viscera
High mortality as often associated w/ other genetic problems

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11
Q

What is gastroschisis?

A

A congenital hernia caused by a defect in the ventral body wall
Viscera don’t have a covering of peritoneum
Can often be closed at birth

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12
Q

What is an umbilical hernia?

A

Found in infants
Mostly leave alone as they close spontaneously by about 3 yrs
Presents as bulge at umbilicus

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13
Q

What is a para-umbilical hernia?

A

Acquired in adults
Hernia through linea alba in region of the umbilicus
More common in females
Happens as a result of increased intra-abdominal pressure
Risk of strangulation due to disrupted blood supply

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14
Q

What is GORD?

A

Persistent acid reflux

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15
Q

What are some symptoms and consequences of GORD?

A

Symptoms:
Chest pain, acid taste in mouth, cough

Consequences:
Oesophagitis, benign strictures, Barrett’s oesophagus => adenocarcinoma

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16
Q

How is GORD treated?

A

Lifestyle modifications; lose weight, change diet
Antacids
H2 antagonists
PPIs

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17
Q

What is acute gastritis?

A

Exposure of stomach mucosa to chemical injury => damaged epithelial cells and reduction in mucus production

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18
Q

What causes acute gastritis?

A

NSAIDs decreases prostaglandin synthesis, reduction in blood supply so epithelium can’t repair itself
Lots of alcohol dissolves mucus layer in stomach
Chemotherapy targets rapidly dividing cells
Bile reflux

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19
Q

What are symptoms and treatment of acute gastritis?

A

Symptoms:
Sometimes none
Abdo pain, nausea and vomiting
Sometimes bleeding

Treated by removing irritant

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20
Q

What causes chronic gastritis?

A

Same things as acute

H-pylori
Can lead to peptic ulcers, adenocarcinoma

Autoimmune
Antibodies to gastric parietal cells

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21
Q

How does helicobacter pylori cause gastritis?

A

Release of cytotoxins => direct epithelial injury
Release of enzymes
Urease => production of ammonia => toxic to epithelium

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22
Q

How does the location of H pylori determine the symptoms?

A

Antrum:
Increased gastrin secretion, increased parietal cell acid secretion, duodenal metaplasia => ulceration

Body:
Atrophy
Results in gastric ulcer

If present in antrum and body then there are no symptoms

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23
Q

What is peptic ulcer disease?

A

A defect in gastric or duodenal mucosa which extends through muscularis mucosa
Most commonly affects the duodenum, can also affect the lesser curve/antrum of stomach

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24
Q

What are the causes of mucosal injury leading to peptic ulcer disease?

Study These Flashcards
A

Stomach acid
H-pylori
NSAIDs
Smoking

25
What are some symptoms of peptic ulcer disease?
Epigastric pain/back pain following meal times, often at night Bleeding and anaemia; Malaena, haematemesis Early satiety Weight loss
26
What are some clinical consequences of peptic ulcer disease?
Contraction of scar tissue => pyloric stenosis Perforation => peritonitis Erosion into adjacent structure Haemorrhage into adjacent blood vessels (left gastric artery, splenic artery) => haematemesis
27
How is peptic ulcer disease managed?
``` Lifestyle modification Stop NSAIDs Test for H pylori and get rid of it PPIs Endoscopy => clips ```
28
What is Zollinger-Ellison syndrome?
Non-beta islet cell gastrin secreting tumour of pancreas Causes proliferation of parietal cells => lots of acid production => ulceration of stomach and bowel Presents with abdo pain and diarrhoea
29
Who is gastric pathology diagnosed?
``` Upper GI endoscopy Urease breath test (from H pylori) Erect CXR (pneumoperitoneum) Blood test (anaemia) ```
30
What are inflammatory bowel disease?
A group of idiopathic conditions causing inflammation of the GI tract Affecting function of the gut
31
What is Crohn’s disease?
Inflammation of the GI tract, can occur anywhere from mouth to anus Most commonly affects the ileum Transmural - extends throughout the whole bowel wall
32
How does Crohn’s disease present?
``` Generally affects younger people Hx of loose non-bloody stools multiple times a day Weight loss Right lower quadrant pain Peri-anal inflammation eg fistulas Anaemia due to lack of IF ```
33
What gross pathology is seen in Crohn’s?
``` Skip lesions Hyperaemia Mucosal oedema Discrete superficial and deeper ulcers Cobblestone appearance ```
34
What is seen microscopically in Crohn’s?
Epithelioid granuloma
35
What investigations are done for Crohn’s?
Bloods - anaemia, CRP CT/MRI - bowel wall thickening, obstruction Barium swallow - shows structures and fistulas Colonoscopy- shows gross morphological changes
36
How is Crohn’s managed?
Target immune system with immunosuppression | Surgery isn’t curative as can occur anywhere along the GI tract
37
What is ulcerative colitis?
Inflammation beginning in the rectum and moving proximally Can extend to involve the whole colon Typically confined to large bowel, but could involve terminal ileum
38
Who does ulcerative colitis present?
``` Affects younger people Hx of bloody stools multiple times a day, can also have mucus Weight loss Lower abdo pain and cramping No perianal disease ```
39
What is the gross pathology of ulcerative colitis?
Pseudopolyps which develop as a result of repeated inflammation Loss of haustra
40
What is the microscopic pathology of ulcerative colitis?
Chronic inflammatory infiltrate of lamina propria Crypt abscesses Crypt distortion - irregular shape w/ dysplasia, risk of colon ca Reduced number of goblet cells
41
What investigations are done for ulcerative colitis?
Bloods - anaemia and serum markers Stool cultures Colonoscopy Barium enema CT/MRI
42
How is ulcerative colitis managed?
Immunosuppression | Surgery can be curative - colectomy done when inflammation doesn’t settle or there are pre-cancerous changes
43
What are haemorrhoids?
Symptomatic anal cushions
44
What causes internal haemorrhoids?
Loss of connective tissue support Occurs above the dentate line so relatively painless Can enlarge and prolapse PR bleeding
45
What are external haemorrhoids?
Occurs when anal cushions enlarge then thrombosis | Occur below dentate line so v painful
46
What are anal fissures?
Linear tear in the anoderm, usually in posterior midline Occurs after passing hard stool V painful when passing stool => haematochezia
47
What causes anal fissures?
High anal sphincter tone and reduced blood flow to anal mucosa
48
What bacteria cause gastroenteritis?
``` Salmonella Campylobacter Shigella Enterotoxigenic E. coli C. diff ```
49
What type of bacteria is salmonella, and how does it cause infection?
Gram negative rod 1) Gain access to enterocytes via endocytosis 2) Move to submucosa via macrophages 3) Transfer to RES => multiple in cells 4) Causes lymphoid hyperplasia 5) Re-enter gut via liver
50
What are the symptoms of salmonella?
Nausea, vomiting, non-bloody diarrhoea, fever, abdo cramps Self limiting in 2-3 days
51
What are the symptom of a campylobacter infection?
Fever, abdo cramps, diarrhoea - can be bloody Can last days to weeks, generally self limiting Abx required if diarrhoea is bloody
52
What type of bacteria is shigella and how does it cause infection?
Gram negative rod Invades large intestine colonocytes then multiplies in cells Invades neighbouring cells Kills colonocytes Forms abscesses
53
What are the symptoms of a shigella infection?
Bloody diarrhoea | Abdo cramps
54
What type of bacteria is E. coli and how does it cause infection?
Gram negative rod Invades enterocytes and produces enterotoxins Causes hypersecretion of Cl- => Na+ follows => water follows => diarrhoea
55
What type of bacteria is C. diff and how does it cause infection?
Gram positive Spreads via spores Releases toxins Toxin A - enterotoxin => excess secretion of Cl- and inflammation Toxin B - cytotoxin
56
What does a C diff infection cause?
Varying degrees of diarrhoea, can be bloody Abdo cramping Rarely results in pseudomembranous colitis or toxic megacolon
57
What viruses can cause gastroenteritis?
Rotavirus | Norovirus
58
Who does rotavirus commonly affect?
Children < 5yrs | Adults are rarely affected as immunity lasts throughout adulthood
59
How does rotavirus cause diarrhoea?
Increased Cl- secretion => Na+ follows => water follows SGLT1 disruption => Na+ and glucose remain in lumen Reduced brush border enzyme function => general malabsorption

Year 2 Conditions (3 decks)

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