Flashcards in GI Deck (87)
What is peptic ulcer disease?
A break/ulceration in the mucosa of the stomach (gastric ulcer) or duodenum (duodenal ulcer) which are most common
What are the most common causes of peptic ulcer?
H. pylori infection - damages mucosal cells
Long term use of NSAIDS - makes gastric mucosa more susceptible to damage
What is the presentation of peptic ulcers?
-Haematemesis "coffee ground"
-Pain worsens when eating (Gastric ulcer)
-Pain before eating/relieved by eating (duodenal ulcer)
What can cause increased stomach acid secretion?
Alcohol, smoking, caffeine, spicy foods
How to diagnose peptic ulcers?
-Endoscopy and biopsy for visualisation of ulcer and exclude malignancy
-Urea breath test or stool antigen test for H. pylori
What is the Mx for peptic ulcers?
-Avoid trigger foods, limit caffeine and alcohol
-PPI to decrease stomach acid secretion e.g. lansoprazole
-Abx e.g. Clarithromycin (if allergic to penicillin offer metronidazole)
-Stop medications e.g. NSAID
What is bowel ischaemia?
Occurs when blood supply (mesenteric arteries) to the bowel is interrupted due to emboli
RF for bowel ischaemia?
Heart disease, AF, Valvular disease. elderly
Symptoms of bowel ischaemia?
Acute onset severe abdominal pain (generalised)
What are the common causes of small bowel obstruction?
Adhesions (Scar tissue from previous surgery causing kinks in bowel), second most common are hernias
What is the most common cause of large bowel obstruction?
What are volvulus and different types?
Twisting of bowel around itself and mesentery.
Sigmoid volvulus (coffee bean shaped)
Caecal volvulus (fetal lie)
What are the symptoms of bowel obstruction?
Increasing abdominal distention. diffuse pain, worsening abdominal pain
What is the Mx of bowel obstruction?
-Surgical resection (cutting out part of tissue)
What is constipation and faecal impaction?
Constipation is a variety of symptoms e.g. difficulty passing stools, incomplete emptying
Faecal impaction is retaining of faeces in body
What are the symptoms of constipation?
-sensation of incomplete defecation
-<3 bowel movements weekly
- difficult passing stools
-Faecal impaction: Hx of hard stools
What are the red flags symptoms?
-Mealena (digested blood on defecation)
refer urgently 2ww suspicious of colorectal malignancy
What is the Mx of constipation and faecal impaction?
-Increase dietary fibre intake
-Stop medications e.g. NSAIDS
-Bulk forming laxative e.g. isphagula husk for constipation
-Osmotic laxative e.g. bisacodyl for faecal impaction
What is ulcerative colitis?
Long lasting inflammation and ulcers in inner lining of colon and rectum
UC (CLOSE U-ulcerative)
-Limited to colon and rectum
-Only superficial mucosa
-Smoking is protective factor
-Excrete blood and mucus
-Use of amino salicylates
-Primary sclerosing cholangitis
-Entire GI tract affected
-Skip lesions on endoscopy
-Terminal ileum most effected of small bowel
-Smoking is RF
RF for IBD?
<30 years, FHx
Smokers RF for Crohns but protective factor for UC
Symptoms specific to UC and CD?
Non specific - diarrhoea, abdo pain, weight loss,
UC- blood and mucus in stools
CD-acute exacerbations (feeling better then worse), erythema nodosum
Investigations for IBD?
-Faecal calprotectin - screening test specific to IBD
-Endoscopy and biopsy for diagnosis
-Abdo xray: lead piping, and toxic megacolon suggest chronic UC, thumbprinting suggest IBD
-CRP for inflammation
-Imagin will show cobblestone appearance and complications of Crohns
Mx of Crohns?
-Steroids e.g, oral prednisolone
Complications of Crohns?
-Fistulas (abnormal passageway between organs)
Mx of UC?
-Use of aminosalicylates e.g. mesalazine
What is achalasia?
Achalasia is a motility disorder of oesaphagus
Px of achalasia?
1. The oesophageal sphincter will not relax properly, and so food cannot pass into the stomach
2. The peristaltic contractions of the oesophagus do not propagate properly, and so the oesophagus will gradually become more and more dilated.