GI Flashcards
(211 cards)
1
Q
what is malabsorption
A
failure to fully absorb nutrients due to epithelium destruction or a prblem in the lumen so food is not digested
weight loss despite adequate food intake
2
Q
3 CFs of malabsorbtion
A
weight loss
steatorrhoea
anaemia
3
Q
causes of malabsoption
A
poor intake defective epithelial tranpsort decreased surface area lymphatic obstruction surgery lack of digestive enzymes poor intraluminal digestion
4
Q
causes of a decrease in SA causing malbsorption
A
coeliac = villous atrophy
extensive parasites - giardia
bowel resection
crohns
5
Q
causes of lymphatic obstruction = malabsorption
A
TB
lymphomas
6
Q
causes of surgery causing malabsoption
A
small intestine resection of bypass
7
Q
e.g of lack of digestive enzymes causing malabsorption
A
lactose intolerance
8
Q
e.g of poor intraluminal digestion causing malabsorption
A
pancreatic insuffic (pancreatitis, CF) defective bile secretion (gall stones) bacterial overgrowth = brush border damage
9
Q
what is peritonitis
A
inflam of the peritoneum assos with the rupture of an internal organ
10
Q
what is the peritoneum
A
a serous membrane lining the cavity of the abdomen and covering abdominal organs
11
Q
what is the peritoneal cavity
A
a closed sac lined by mesothelial cells that secrete surfactant
12
Q
causes of peritonitis
A
perforation of GI tract (trauma, peptic ulcer)
autoimmune - SLE
primary = spontatneous bacterial infections
secondary = localised = acute inflam - acute appendicitis, acute cholecystitis
generalized = irritation due to infection (E. coli)/chem irritants due to intest contents leakage (peptic ulcer)
13
Q
RF of peritonitis
A
peritoneal dialysis, ascites
14
Q
what is spontaneous bacterial peritonitis
A
neutrophils in ascitic fluid when ascites is secondary to a chronic liver disease assos with E. coli and S. pneumonia
15
Q
CFs of peritonitis
A
borderline rigitidiy guarding fever abdo pain exab by movement and coughing (hence lay still) n+v tender hard abdo perforation = sudden onset = shock SEPSIS if low bp
16
Q
what is characteristic of the abdo pain in peritonitis
A
exab by movements and coughing, relieved staying still
17
Q
signs of peritonitis
A
fever
tender hard abdo
tachycardia
guarding
18
Q
symptoms of peritonitis
A
nausea and vomiting
severe abdo pain - exab by movement and coughing (LAY STILL)
19
Q
Dx of peritonitis
A
erect CXR = gas under diaphragm
ascitic tap = culture
bloods - rule out pancreatitis
20
Q
Mx of peritonitis
A
broad spec antibiotics
percutaneous catheter drainage
21
Q
what is IBS
A
group of abdominal symptoms for which no organic cause can be found - diagnosis by exclusion
22
Q
3 types of IBS
A
IBS-D
IBS - M
IBS - C
23
Q
epdiemiology of IBS
A
female
stress
western world
less than 40
24
Q
Triggers of IBS
A
depression, anxiety, psychological stress/trauma
gastrointestinal infection
eating disorder
pelvic surgery
25
cancer red flag symptoms when patient for IBS
```
over 50 yo with change in bowels
unexplained WL
PR bleed
rectal/abdo mass
anaemia
fam histroy of ovarina/bowel cancer
increased inflam markers
```
26
CFs of IBS main one
abdo pain releived on passing stool
27
CFS of IBS
```
abdo pain relieved on passing stool
+2 of;
altered stool passage
bloating
mucus in stool
poor sleeping
painful periods (dysmenorrhoea)
symptoms worse on eating
lethargy, back ache, nausea
bladder symptoms (urgency, nocturia)
```
28
what exabberates IBS
stress
menstruation
gastroenteritis
29
Dx of IBS
exclude other causes
FBC - anaemia
colonoscopy - crohns UC colorectal cancer
serology - coeliac - tTG and EMA antibodies
ESR and CRP - inflam
stool sample - faecal calprotectin (IBD)
30
DDx of IBS
lactose intol
caeliac
IBD - crohns UC
colorectal cancer
31
Mx of IBS
lifestyle modifications
pain/bloat - antispasmodic - buscopan / mebeverine
constip = laxitive - senna
diarrhoea - loperamide (antimobility)
pain - low dose tricyclic antidepressant = amitriptyline
32
antispasmodic for treating IBS
buscopan, mebeverine
33
antimotility for IBS Mx
Loperamide (for diarrhoea)
34
drug for constipation in IBS
laxative = Senna
35
pain relief in IBS
amitriptyline
36
life style modifications for IBS
```
FODMAP diet
small regular meals
avoid alcohol and caffiene
avoid fizzy drinks
increase fibre - soluble fibre softens stool insol increases gut motility
```
37
what does FODMAP stand for
fermentable, oligosaccharides, disacharides, monosacharides, polyols
38
what is crohns disease
transmural granulomatous inflammation in any part of the GI tract - chronic XS immune response to an unknwon trigger
39
where is Crohns most likely to affect in the GI tract
terminal ileum to proximal colon
40
RFs for crohns
smoking, appendectomy,
fam history
genetic
41
microscopic features of Crohns
no crypts absesses,
goblet cells present
transmural.
granulomas w langerhans giant cells
42
what is a granuloma
Aggregate of epitheliod Histyocytes - noncaesating
43
macroscopic features of crohns
skip lesions
cobblestone appearance due to deep ulcers and fissures
thickened and narrowed bowel
anywhere from oesophagus to anus
44
MNEUMONIC for crohns
```
driving CROHN for CHRISTMAS
Cobble stone
High temp
Reduced lumen (obstruction)
Intestinal fistuale (complic)
Skip lesions
Transmural
Malabsorption
Abdo pain /anal (peri) lesions
Submucosal fibrosis
```
45
how to Dx crohns
colonoscopy and biopsy - transmural inflam, goblet cells, granulomas
bloods - anaemia - Fe and folate defic, increase CRP,
barium swallow - strictures and bowel shortening
stool sample - faecal calprotectin, infection
46
Mx of crohns
```
smoking cessation
induce remission (glucocorticoid) PREDNISOLONE
add on - athioprine
if severe = infliximab
surgery
```
47
the corticosteroid with crohns
prednisolone
48
Ulcerative colitis what is it
autoimmune inflam disease triggered by colonic bacteria causing inflam in the colonic mucosa only
Relapsing and remitting inflammatory disorder of the COLONIC MUCOSA .
49
what causes Crohns disease pathophysiology
trigger = Th cells relase inflam cytokines = INFLAM - further mediators (free radicals, proteases), unregulated = increase in inflam and tissue destroyed and invade intestineal mucosa - ULCER and GRANULOMA - TRANSMURAL - fistulae/narrowing
50
complications of crohns
obstruction, enteric fistulae, perforation = major bleed
51
symptoms of Crohns
abdo pain (RLQ if ileum)
fatigue
weight loss
N and V
52
signs of crohns
```
fever
pyrexia
dehydration
aphthous mouth ulceration
abdo tenderness/mass (if inflamed loops)
arthritis
uveitis
perianal (skin tags)
```
53
causes of UC
CD8+ cell activation destroying cells in the mucosal submucosa colonic layers
assos w p.ANCA
54
where does UC affect
never spreads proximal to the ileocaecal valve
55
what is UC called if only affects rectum
proctitis (50%)
56
what si UC called if affects rectum and extends to sigmoid and desc colon
L sided colitis (30%)
57
what is UC called if affects whole COLON
extensive colitis (20%)
58
RFs for UC
```
stress
infection
NSAIDS
genetic
NOT SMOKING NOT APPENDICECTOMY
```
59
peak incidence for UC
| for crohns
UC - 15-25 then 55-65
| Crohns - 20-40
60
Ethnic group at risk in IBD
Jewish
61
Macroscopic features of UC
mucasa red and inflamed = friable
continuous
circumferential inflam
severe - ulcers and pseudopolyps
62
mircoscopic features of UC
superficial mucosal inflam - mucosal layer only
no granulomas
goblet cell depletion
crypt abssesses
63
what characteristic of UC on a colonoscopy
drainpipe mucosa (lack of haustrations)
64
stools test in UC - why?
to exclude C difficile
65
what does bloods show in UC
p-ANCA POSITIVE (neg in crohns)
ESR CRP increased
normochromic/cytic anaemia of chronic disease (iron and b12 defic)
66
symptoms of UC
```
diarrhoea as cant absorb water
bloody and mucous
lower abdo discomfort (LL quadrant)
WL
Fatigue
```
67
signs of UC (intestinal)
pyrexia
dehydration
abdo tenderness/distentsion
tachycardia
68
extra intestinal signs of UC
clubbing
oral ulcers
erythema nodosum (red lumps under skins)
69
Complications of UC
```
toxic megacolon
fatty liver changes
erythema nodosum on skin
increased colon cancer risk
arthritis = joints
uveitis = eyes
```
70
what is toxic megacolon
non obstruction, dilatation of think walled colon = gas filled - emergency
fever hypotension and tachycardia
71
which is smoking protective for in IBD
UC
72
Mx of UC
5ASA (aminosalicyclic acid) - induction and maintanence
acute relapses - corticosteroid - prednisolone
suregery (curative)
Mx complications
INFLIXIMAB - biologics - severe
73
what is the drug used in UC for induction and maintenence
5ASA - aminosalicyclic acid
74
what used to manage acute relapses of UC and Crohns
corticosteroid - prednisolone
75
what biologic used for UC and Crohns
infliximab
76
in UC how to differenciate between proctitis or L sided/extensive
proctitis - freq blood and mucus with urgency and tenesmus
| l sided or extensive collitis - bloody diarrhoea. urgency /incontinence at night. 10-0 LIQUID stools/day
77
which IBD has pseudo polyps
UC
78
which IBD has granulamtous inflam
Crohns
79
what is GORDS
prolonged or recurrent reflux of gastric contents into oesophagus
80
pathophysiology of GORDS
LOS loses tone and increased freq of LOS transient relaxations and so gastric contents reflux into oesophagus - prolonged contact with LO mucosa (has greaer sensitivity to gastric acid and decreased clearance
81
causes of GORDS
```
pregnancy (increased abdo pressure)
decrease in pressure of LOS - LOS hypotension
LOS dysfunction
antireflux mechanism impairment - hiatus hernias
slow gastric emptying
drugs - nitrates, tricyclics,
gastric acid hypersecretion
alcohol
smoking
overeating - spicy foods
```
82
what is a cause of antireflux mechanism impairment
hiatus hernia
83
drugs that cause GORDS
nitrates, tricyclics,
84
CFs of GORDS
```
food/acid brash =- regurg
heart burn - worse lying down, hot drinks, alcohol
odynophagia - painful swallowing
chronic cough
laryngitis
```
85
what is characterisitc of heart burn in GORDS
worse on lying down, alcohol and hot drinks
86
Dx of GORDS
oesophago-gastroduodenoscopy if red flags new onset heart burn and over 45yo
treat based on history
87
alarm signs in GORDS - get oesophagogastroduodenoscopy
```
ALARM Help!
Anaemia
Loss of weight
Anorexia
Rapid onset of symptoms
Melaena
```
Help! ( haematemesis)
88
Lifestyle modifications for GORDS
stop smoking
less alcohol
sleep w head raised at night (extra pillow)
89
Mx of GORDS
lifestyle mod
anatacids - alginate containing - gaviscon/rennie (magnesium trisilicate)
PPIs - omeprazole - blocks gastric acid secretion
H2 recp antagonist - rinetidine - blocks histamine recep - no acid release
90
complications of GORDS
BARRETTS OESOPHAGUS
peptic stricture
premalig for adenocarcinoma
91
e.g of a h2 recp anatagonist used in GORDS
rinetidine
92
e.g of PPI used in gords
omeprazole
93
e.g of anatacids used in gords and SE
magnesium trisilicate - Mg and Al
SE- Mg = diarr
Al= constip
(gavison, rennies)
94
how does an antacid work in gords
forms a protective foam layer over the gastric contents
95
what is a peptic ulcer
a break in superficial epithelial cells pentrating down to the muscualris mucosa of the stomach or duodenum
assos with chronic gastritis
>5mm in diameter
96
what do fovela cells secrete and where
mucous in cardia
97
what do parietal cells secrete n where
HCl (H+) in the fundus and body
98
what do chief cells secrete and where
pepsinogen in the body and fundus
99
what do g cells secrete and where
gastrin in duodenum and pancreas
100
what does gastrin do
stimulate parietal cells to secrete HCL
101
what does brunner glands in duodenum do
secrete mucus rich in bicarb to prevent self digestion from acid
102
what do prostaglandins do
stim mucous and bicarb
| vasodilate BV nearby increasing blood flow promoting epithelial cell growth and inhib acid secretion
103
what is the cause of peptic ulcer disease
```
HELIOBACTER PYLORI
NSAIDS
smoking
alcohol
mucosal ischaemia
```
104
how does H. pylori cause peptic ulcers
colonizes the gastric antrum mucosa and increases gastric acid secretion and decreases duodenal bicarb secretion
produces ammonia so able to survive the acidic conditions
lives in crypts next to acid sensors and alters feedback mechanisms = XS acid produced
causes localised inflam
105
why do NSAIDs cause peptic ulcers
inhib COX1 which reduces prostaglandin synthesis
106
why does a decrease in prostaglandin synthesis mean peptic ulcers form
postaglandins inhibit ECL and so decreases histamine production. less HCl from parietal cells.
less prostaglandin therefore = more HCl
107
why does smoking cause PUD
decrease prostaglanding synth which is a mucosal protective
108
why does mucosal ischaemia cause PUD
less mucin so less protection = mucosa damaged causing an ulcer
(due to atherosclerosis)
109
symptoms of PUD
```
epigastric pain - Gastric ulcers = worse on eating hence weight loss
duodenal ulcers = improves on eating
N and V
bloating
haematemesis and melaena
dyspepsia (indigestion)
heart burn
aneamia symptoms - fatigue,m dizziness
```
110
complications of Duodenal ulcers
perforation - peritonitis
haemorrhage
gastric outlet obstruction
111
which type of ulcers is worse on eating
gastic - hence weight loss
| duodenal relieved
112
diagnosis of peptic ulcers
H PYLORI BREATH TEST - urea breath - C13
endoscopy
stool antigen test - H. Pylori
bloods - FBC (anaemia)
113
explain how to test for H. pylori as cause of Peptic ulcers
H. pylori breath test = positive = urea breath
H. pylori converts urea to ammonia and co2. as it secretes urease
use C 13
stool antigen test also
rapid urease test on a stomach biopsy
114
specific clinical features of duodenal ulcers
epigastric pain 2-5hrs after eating - radiate to back in panreas affected
more common
115
specific clin features of gastric ulcers
epigastic pain 1-2 hrs after eating
| haematesis or melaena
116
signs of PUD
melaena
haematesis
epigastic tenderness
117
Mx of PUD
```
lifestyle
eradicate cause (H. pylori - using triple therapy - (PPI + Amoxicillin + Clarithromycin)
PPIs - omeprazole
h2 recep antagonists - rantidine
STOP NSAIDS
```
118
how treat PUD if H pylori the cause
triple therapy =
| PPI + amoxicillin + clarithromycin
119
what PPI use in PUD
omeprazole
120
what is coeliac disease
gluten sensitive enteropathy
| = t cell mediated condition in response to prolamin == malabsoption
121
what does coeliac disease result in histologically
villous atrophy
crypt hyperplasia
intraepithelial lymphocytosis (increased lymphocytes in lamina propria)
122
causes of coeliac disease
genetic - HLA DQ2 or DQ8
123
HLAs assoc with coeliac disease
HLA DQ2 or DQ8
124
what is it that triggers the immune response in coeliac disease
gliaden = toxic component in gluten resistent to digestion by pepsin and chymotypsin so remains in intestinal lumen
125
what happens to gliaden in the gut
gliaden peptides pass through epithelium via TFR receptor and get DEAMINATED by TISSUE TRANSGLUTAMINASE (increases immunicity)
they bind to antigen presenting cells and interact w CD4+ cells via HLA class 2 molecules
produces pro inflam cytokines (INF-gamma, TNF)
B cells secrete anti EMAs anti gliadin and anti itTG
activates T nat killer cells causing villous atrophy
gaps in epithelial cells widen = more gliadin IN
126
what antibodies on serology for coeliac
```
IgA tTG (tissue transglutaminase)
IgA EMA (anti-endomysial antibodies)
```
127
what found on bloods of coeliac disease
anaemia (folate and iron defic)
128
how to Dx coeliac
serology - IgA tTG, anti-endomysial antibodies
intestinal biopsy
HLA typing - HLA DQ2 or DQ8
129
symptoms of Coeliac
diarrhoea/ constip and steatorrhoea
WL
X to thrive in children
fatigue
130
signs of coeliac
mouthulcers, angular stomatitis, abdo distenstion
131
complication of coelica
```
dermatitis herpeti formis = skin rash due to antibodies
Iron deficiency anaemia
osteoporosis
vit deficiency (vit D, ADEK, iron)
MALIGNANCY (small bowel lymphoma..)
```
132
what is dermatitis herpeti formis
skin rash die to antibodies found in coeliac disease
133
how to treat coeliac
strict gluten free diet
monitor complications
i.e DEXA scan for osteoporeosis
vit supplements
134
what causes acute appendicitis
obstruction by a faecalith
135
Cfs of appendicitis
central periumbilical pain radiating to R iliac fossa
ANOREXIA
N&V
rebound tenderness and muscle guarding in RIF
diarrhoea
tender mass if appendix abbsess
R shoulder pain if diaphragm irritation
136
where is the pain in appendicitis
central periumbilical radiating to RIF
| R shoulder pain if diaphragm irritation
137
what is the point of abdo pain called in appendicitis
Mcburneys point (REBOUND = pain)
138
why do you get abdo pain in appendicitis
increased pressure in appendix due to faecalith plug but mucus production still continues.
enlarges and presses on visceral nerve fibres
139
why do u get a fever in appendicitis
appendix obstructed by faecalith
stasis causes bacterial overgrowth (e.coli)
increaseing WBC and pus accumulates causing a fever
140
patho of ischaemia in appendicitus
faecalith blockage
stasis
bacterial overgrowth- WBC and pus increases pressure further
compromises blood supply and therfeore no oxygen = ischaemia
141
how can appendicitis lead to peritonitis
iscahemia of appendix wall = weakens = prone to rupture
releasing bacteria into peritoneum
=rebound tenderness and abdo guarding
142
Dx of appendicitis
clin exam
bloods - increased WBC, increase C reactive protein, ESR
CT and US
143
Mx of appendicitus
appendectomy
| ABX (IV Metronidazole + cefuroxime)
144
CI of appendicectomy
IBD involving the caecum
145
what causes gastroenteritis (general)
```
viral
bacterial
parasitic
fungal
antibiotic assos
```
146
viral causes of infective diarr
rotavirus (children)
norovirus (winter vomiting, carehomes)
adenovirus
147
bacterial causes of infective diarr
campylobacter jejuni,
E. coli,
Salmonella (animals),
shigella (blood)
148
parasitic cause of infective diarr
Giardia lamblia (travel history)
149
fungal cause of infective diarr
histoplasmosis
150
antibiotic assoc infective diarr causes
(= C DIFFICILE)
ciprofloxacin
clindamycin
151
RF for gastroenteritis
forgein travel
poor hygiene
over crowding
new/diff foods
152
who is at risk for gasteroentertisi
```
immunosuppresed
young
old
decreased gastric acid secretion
travellers
```
153
clinical features of infective diarrhoea
```
blood in stool (=suggests bacterial)
vomiting
fever
fatigue
headache
muscle pains
```
154
Diagnosis of infective diarrhoea
history (eating habits, occupation, travel)
stool culture
C. diff assay
chronic = sigmoidoscopy
155
Mx of gastroenteritis
rehydration
antibiotics (empirical) for infective
antimobility (loperamide)
life style = wash hands,exclude from work etc
156
what is C difficile
gram positive spore forming anaerobic bacteria ingested faeco orally
157
what causes C. diff assos diarhoea
broad spec antibiotics
158
RFs for C diff assos diarrhoea
```
age and co morbidities,
ABX
PPIs
long HOSPITAL admission
NG tube fed
immunocomp
```
159
pathology of C. diff assos diarrhoea
colonises stool then to patient (asympt)
when normal colonic microbiota is altered by ABX
environ then favours proliferation
inflamed and ulcerated and a pseudo membrane on endoscopy (inflam exudate)
160
what see on endoscopy of C diff ass diarrhoea
pseudo membrane
161
abx assos with C diff diarrhoea
```
rule of "C"
Clindamycin
ciprofloxacin
cephalosporins
ciprofloxacin
co-amoxiclav
```
162
how to diagnose C diff diarrhoea
stool sample - toxin A or B
163
clin features of C diff diarrhoea
abdo pain and watery stools
| collitis
164
what conditions make up ischaemia of the colon
acute mesenteric
chronic mesenteria
ischaemic colitis
165
what is the pathophysic behind acute mesenteric ischaemia
low flow in the superior mesentery artery
166
causes of acute mesenteric ischaemia
SMA thrombosis or embolism (AF)
mesenteric vein thrombosis
non occlusive diesease ( i.e low flow and poor cardiac output)
167
CFs of acute mesenteric ischaemia
acute severe abdo out of proportion with signs
| rapid hypovolaemia -- shock
168
Dx of acute mesenteric ischaemia
ABG - metabolic acidosis and high lactate (due to intestinal hypoxia - increased lactic acid)
Bloods - Leukocytosis
laparotomy- cut into abdo wall = diagnosis
169
Mx of acute mesenteric ischaemia
surgery - remove dead bowel
fluid resus
antibiotics - IV gentamicin, IV metronidazole
IV heparin to reduce clotting
170
Complications of acute mesenteric ischaemia
septic peritonitis
| systemic inflamm response syndrome (SIRS)
171
what is systemic inflam response syndrome
multiple organ dysfunction syndrome mediated by bacteria translocation across dying gut wall
172
pathophysiology of acute mesenteric ishaemia
```
sudden interuption of SMA
intestinal hypoxia (metabolic acidosis due to increase lactic acid)
haemorrhagic infarction and necrosis
disrupts mucosal barrier +perforation
bacteria and toxins, ROS released
sepsis
Systemic inflam response sydrome
```
173
what is ischaemic colitis
low flow in inferior mesenteric artery resulting in ischaemia of the colon
174
Cx of ischaemic colitis
low flow in IMA underlying atherosclerosis and vessel obstruction
175
Rf of ischaemic colitis
cotraceptive pill
thrombophillia
vasculitis
nicorandil drug
176
Cfs of ischaemic colitis
BLOODY diarrhoea
| LLQ pain
177
complications of ischaemic colitis
perforation
sepsis
peritonitis
178
Dx of ischaemic colitis
colonoscopy (when recovered to exlcu strictures)
urgent CT to excl perforation
barium enema - thumb printing of submucosal swelling at splenic flexure
179
Mx of ischaemic colitis
conservative
| if gangrenous - resus and bowel resection (peritonitis and hypovolaeimic shock)
180
what is gastritis
inflamm assos with mucosal injury
181
what protective mechanism to gastric cells have in the stomach
secrete mucin to protect from low pH in stomach
182
Cx of gastritis main one
Heliobacter pylori infection
183
causes of gastritis (detailed)
H. pylori
autoimmune gastritis (vs parietal cells and IF = pernicious aneamia)
duodenogastric reflux - bile salts enter and damage mucin production)
granulomas (crohns, sarcoidosis)
viruses - herpes simplex
mucosal ischaemia ( low blood supply less mucins = more acid)
chemical - NSAIDs aspirin alcohol ( inhib prostaglandins which stim mucous production)
184
causes of gastritis menumonic form
```
DRAG HIV
Drugs (NSAIDs, aspirin, alcohol)
Reflux (duodenogastric)
Autoimmune
Granuloma (crohns)
```
H pylor
Ischaemia of mucosa
Virus (herpes simplex)
185
Cfs of gastritis
N+V
abdo bloat
haematemesis
186
Prevention of gastritis
PPIs alongside NSAIDs ( to prevent bleeding from actue stress ulcers and gastritis
187
Tx of gastritis
etradicate h pylori if positive - triple therapy (PPI and 2 of metronidazole, bismuth, amoxicillin, tetracycline)
decrease stress
remove Cx agents
PPI or H2 receptor antagonists
188
complications of H pylor gastitis infection
GASTRIC CANCER
peptic ulcers
inflam and metaplasia
189
Dx of gastritis
endoscopy
| biopsy
190
DDx of gastritis
GORDs
peptic ulcer disease
gastric carcinoma
191
how to confirm cause of gastritis is H. pylor
urea breath test
| foeacal antigen test
192
how does H pylori cause gastritis
colonises mucous layer in gastric antrum
adhers to epithelial cells in gastric pits under MUCOUS LAYER SO PROTECTED
damages by enzyme release -
urease converts urea to ammonium = toxic to gastric mucosa so less mucous produced
chem mediators produced = induce inflam = ulcers and more acid
193
why can H pylori survive in stomach
adherres to epithelium UNDER mucus layer so is protected
194
what is a hernia
protrusion of organ or tissue out of the body cavity it normally lies
195
Causes of hernias
```
muscle weakness (age trauma)
body strain - pregnancy contsipation heavy lifting, chronic cough
```
196
what is an inguinal herna
protusion through the inguinal canal
197
2 types of inguinal hernia and the difference
indirect and direct
direct = MEDIAL to inferior epigastric vessels
indirect = LATERAL to inferior epigastric vessels and protrudes through the INTERNAL INGUINAL RING (follows spermatic cords path)
198
which hernia can go to the scrotum
indirect inguinal hernia
199
which hernia lies LATERAL to inferior epigastric vessels
indirect
200
which hernia lies medical to inferior epigastric vessels
direct
201
CFs of an inguinal hernia
visible lump
| pain/ache on exertion
202
Mx of inguinal hernia
surgery
203
Rfs of inguinal hernais
male smoker,
| history of hernias (weak abdo wall)
204
2 types of hernias
hiatus and inguinal
205
what is a hiatus hernia
part of the stomach herniates through the oesohphageal hiatus of the diaphragm
206
2 types of hiatus hernai
rolling and sliding
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what is a sliding hiatus hernia
gastro oesophageal junction slides up into the chest
| get gastric acid reflux as LOS less competent
208
what is a rolling hernia
gastro oesopheal junction remains in the abdo but bulge of stomach herniates into chest alongside oesophagus = still intact hence no gross acid reflux
209
which hernia causes acid reflux and why
sliding hiatus hernia - gastro - oesp junction slides up into chest so LOS less competent
rolling, it remains in the abdo below diaphragm
210
in which hiatus hernia does the gastro oespho junction remain below the diaphragm
rolling
211
CFs of hiatus hernias
rolling - none as no reflux, pain if severe due to strangulation
sliding - acid reflux
