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Gastrointestinal System > GI Conditions > Flashcards

GI Conditions Flashcards

1
Q

Name 2 conditions that may cause gastric pain 30 minutes after eating and why?

A

AAA; Acute mesenteric ischaemia due to perfusion to GI tract increasing after ingestion

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2
Q

Name causes of small bowel obstruction.

A 
HAIT
Hernia (inguinal, incision, femoral)
Adhesions
Inflammation 
Tumour
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3
Q

Name symptoms of small bowel obstruction.

A
  • Colicky pain (3-4 minutes)
  • Emesis (early)
  • Absolute obstruction (late)
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4
Q

Name causes of large bowel obstruction. (5)

A
  • Sigmoid volvulus
  • Pseudo-obstruction (intestine can’t move bolus but there is no obstruction in the lumen)
  • Colorectal carcinoma
  • Diverticula
  • Hernia
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5
Q

Name symptoms of large bowel obstruction.

A
  • Colicky pain (10-15 minutes)
  • Absolute obstruction: early
  • Emesis: late
  • Severe abdominal distension
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6
Q

What could happen to an untreated sigmoid volvulus?

A

It can perforate and become ischaemic

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7
Q

What can ulcerative colitis (chronic inflammation) form?

A
  • Toxic megacolon
  • Lead pipe colon (loss of haustra due to constant attack from inflammation)
  • Thumb printing (due to thickening of hausta - oedema in the wall)
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8
Q

Name 2 bacteria, 2 parasites and 2 viruses that cause watery diarrhoea

A

Virus: Norovirus, Rotovirus

Bacteria: Clostridium difficile, Enterotoxigenic Escherichia coli

Parasites: Cryptosporidium, Giardia

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9
Q

What bacteria can cause diarrhoea?

And name their corresponding treatment.

Name mechanism of treatment.

A

Salmonella typhi/paratyphi/non thyphoidal -> Ceftriaxone -> B lactam (cell wall inhibition)
Campylobacter jejuni -> Azithromycin (protein synthesis inhibitor)
Shigella -> Ceftriaxone
Enterotoxigenic Escherichia coli -> NONE
Clostridium difficile-> Metronidazole (inhibit nucleic acid synthesis)

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10
Q

What parasites can cause diarrhoea?

What is its treatment?

A

Entamoeba -> Metronidazole the Paramomycin
Giardia -> Nitazoxanide
Cryptosporidium -> Nitazoxanide

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11
Q

Name causes of peritonitis.

3 secondary causes
1 primary cause

A

Secondary causes:
Perforated peptic ulcer
Perforated appendicitis
Perforated diverticulitis

Primary causes:
Cirrhosis leading to ascites

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12
Q

Name the causes of upper GI bleeding.

A

> Perforated peptic ulcer (gastric>duodenal)

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13
Q

Name the causes of acute mesenteric ischaemia.

A 
HEAA
Hypotension
Emboli (SMA)
Atherosclerosis 
Aortic aneurysm
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14
Q

Describe how a patient with peritonitis will present.

A

Sudden pain

Very still

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15
Q

Name 3 causes of bowel obstruction in children.

A

Atresia

Meconium ileus (they have a thicker and stickier than normal meconium that is stuck in the ileum. MI typical in CF children)

Intussusception (typically occurs at the ileocecal junction

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16
Q

What is the treatment for upper GI bleeding caused by perforated peptic ulcers?

A

PPIs then endoscopy with coagulation/thrombin

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17
Q

How should upper GI bleeding caused by oesophageal bleeding be treated?

A

ADH agonist (Terlipressin) -> reduced portal vein pressure and the pressure in varices

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18
Q

What defect in the arterial wall causes an abdominal aortic aneurysm and what does this cause?

Who do AAAs typically effect

A

Breakdown of the elastin and collagen in the media (SM is still intact) causing the infrarenal aorta to dilate to >3cm.

> 65 men that smoke

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19
Q

Describe how a patient with an AAA (that is about to rupture) will present?

Describe how a patient with a ruptured AAA will present?

A

Typically asymptomatic but when AAA is about to rupture, can have:

  • Back pain
  • Abdominal pain

Post rupture:

  • CVS collapse signs
  • Pulsatile mass in abdomen
  • Syncope
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20
Q

What is ascites?

A

An abnormal collection of fluid in the peritoneal cavity

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21
Q

What do you typically get with intussusception?

A

Abdominal pain
Emesis
Haematochezia
Oedema (as lymph and vein drainage is impaired)

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22
Q

If the
A) gastric
B) duodenal
peptic ulcers perforate, what vessels will they erode?

A

A) splenic artery

B) gastroduodenal artery

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23
Q

Describe the oesophagus drainage.

A

Portal drainage:
Oesophagus vein -> left gastric vein -> portal vein

Systemic drainage:
Oesophagus vein -> azygous vein -> SVC

PORTO-SYSTEMIC HYPERTENSION LEADS TO OESOPHAGEAL VARICES

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24
Q

Causes of portal hypertension

A

Pre hepatic: portal vein thrombosis
Hepatic: cirrhosis, schistosomiasis
Post hepatic: hepatic vein thrombosis

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25
Q

Where is the most common site for gastrointestinal lymphoma?

A

Stomach

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26
Q

What are the signs and symptoms of pancreatic cancer?

A

Jaundice (interfers biliary tree flow to the duodenum)
Persistent and progressively worsening pain
Weight loss
Anorexia
Fatigue

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27
Q

Describe how metastasis to the liver occurs

A

Haematogenous - portal vein
Lymph nodes - sentinel lymph nodes
Other systems - ovary (transcoelomic spread)

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28
Q

Describe the biliary tree and where it empties.

A

R+L hepatic duct (liver)-> common hepatic duct -> bile duct (gall bladder) -> pancreatic duct (pancreas) common bile duct -> duodenum via Ampulla of Vater

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29
Q

Describe right sided large bowel cancer

A

Mass in RIF
Takes longer to see changes in bowel movement so poorer prognosis when this presentation develops
Less likely to have bowel obstruction as water reabsorption is still occuring
Iron deficient anaemia -> due to occult bleeding

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30
Q

Describe left sided bowel cancer

A 
Mass in LIF
Stenosing
Bowel constipation seen early
Tenesmus
PR bleeding
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31
Q

What staging tool do you use for colorectal carcinomas?

Describe this staging tool.

A

Duke’s staging

A- tumour confined to bowel wall
B- tumour pushed through to the adventita
C- tumour travelled to lymph node/s
D- metastasis to distant organs

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32
Q

What staging method is most commonly used for GI cancers in general?

Describe its staging.

A

TNM staging

Tumour (size) (0-3)
Node (0-2)
Metastases (0,1,X)

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33
Q

Describe the characteristics of Chron’s disease.

A

15-30 yo
RLQ pain
multiple non bloody stools/dy
skip lesions - lesions not just confined to colon

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34
Q

Describe the characteristics of Ulcerative colitis.

A

20-30 yo
mild abd. pain
multiple bloody mucus stools/dy
lesions confined to rectum and colon

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35
Q

What skin issues can Ulcerative colitis cause?

A

Erythema nodosum

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36
Q

What MSK conditions can Chron’s disease cause?

A

Arthritis

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37
Q

Ulcerative colitis causes perianal disease

true/false

What is perianal disease?

A

False - Chron’s disease does

Inflammation at the anus with the presence of skin tags, haemorrhoids, openings of fistulas, anal fissures and perianal abcesses

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38
Q

What is inflammed in UC and CD?

A

UC - epithelia (colonic/anal) + lamina propria

CD - transmural so the whole GI wall and beyond

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39
Q

Drug treatment for IBD (stepwise)

A

Flares + remissions: Sulfasalazine
Flares only: Prednisolone
Fistulae + remission: Azathioprine

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40
Q

List 7 conditions that haematochezia is associated with.

A 
HAAAC UI
Intussusception
Upper GI bleeding
AMI
Anal fissures (CD)
Haemorrhoids
Colorectal carcinoma
Acute diverticulitis
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41
Q

What are the common causes of melaena? (4)

A

Oesophageal carcinomas
Oesophageal varices
Peptic ulcers (gastric, duodenal)
Gastric adenocarcinomas

all upper GI bleeding

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42
Q

What is secretory diarrhoea and what causes it?

A

Typically caused by infection and it is a diarrhoea where there is a defect in the ion channels in the apical surface of the gut leading to:

  • increased excretion of anions (Cl-, HCO3-)
  • reduced reabsorption of Na+
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43
Q

What is osmotic diarrhoea?

A

Diarrhoea caused by an osmotically active material (e.g. glucose) in the lumen of the gut - thus drawing in more water

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44
Q

What are common causes of lower GI tract bleeding?

A

> Diverticulosis
Ulcerative colitis pseudo-polyps
Cancer

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45
Q

What is acute appendicitis?

A

Appendix lumen is blocked by either:

  • faecolith matter
  • lymphoid hyperplasia

Leading to the appendix wall undergoing ischaemia due to luminal kpa ↑ . Thus bacteria can infect the wall and you also get necrosis/perforation

46
Q

What is a diverticula?

A

Where the mucosa and submucosa herniate into the muscularis propria

47
Q

What is diverticulitis?

A

When a diverticula becomes inflamed/infected. This occurs via the same method of appendicitis.

48
Q

When do you start to feel symptoms with internal haemorrhoids (which are found above the dentate line)?

A

When the CT support is lost -> so haemorrhoids prolapse

The Prolapsed Haemorrhoids are more likely to be bleed as a result of TRAUMA

49
Q

What are anal fissures and what are the typical symptoms?

A

Linear tear of the anoderm - caused by HYPOPERFUSION to the anoderm or INCREASED MUSCLE TONE to the internal anal sphincter

  • ↑ pain when passing stools
  • blood

↑ Water, fibre, hygiene

50
Q

How do you categorise constipation?

A

Normal transit constipation - psychological stressor
Slow colonic transit - hypothyroidism, Parkinson’s disease, megacolon
Defecation problems - issue w/ pelvic floor or anorectal muscles

51
Q

How would you categorise appendicitis?

A

Acute (mucosal oedema)
Gangrenous (transmural inflammation and necrosis)
Perforated (leads to peritonitis)

52
Q

Describe where the appendicitis pain will be felt in

A) a pregnant women
B) the retro-caecal or pelvic appendix position

typical presentation is peri-umbilical pain changed to right iliac fossa pain

A

A) RUQ due to the gravid uterus

B) peri-umbilical (T10 dermatome) due to the parietal peritoneum not being in contact with the appendix

53
Q

Where does diverticulosis typically occur?

85%

A

Sigmoid colon

54
Q

How does a malignancy at the head of the pancreas cause jaundice?

What type of jaundice is it?

A

It is post hepatic jaundice because the common bile duct is obstructed therefore the conjugated bilirubin cannot enter the GI tract (2nd part of the duodenum) so you get pale stools and dark urine (as the conjugated bilirubin is water soluble so it enters the kidney and is excreted).

55
Q

What are the common causes of pre hepatic jaundice?

A

Haemolytic anaemia caused by:

  • sickle cell anaemia
  • hereditary spherocytosis

Microcytic anaemia:
-a and b thalassaemia

56
Q

Name 3 causes of hepatic jaundice.

A

Viral/AI hepatitis
Paracetamol overdose
Wilson’s disease

57
Q

Name 3 common causes of post hepatic jaundice.

A
  • ductal adenocarcinoma
  • biliary tree strictures
  • gallstones
58
Q

Why is alanine transaminase more specific to liver pathologies than aspartate aminotransferase?

A

As AST is also found in cardiac muscle, skeletal muscle and RBCs

59
Q

If AST>ALT what liver pathologies could be present?

A 
Alcoholic hepatitis (reversible)
Cirrhosis (irreversible - liver shrinks)
60
Q

If ALT>AST what liver pathology could be present?

A

Acute liver damage

61
Q

Name 4 complications of gallstones.

A
  • biliary colic
  • acute cholecystitis
  • acute pancreatitis
  • ascending cholangitis
62
Q

How can jaundice, oedema/ascites, bleeding and confusion be linked to liver pathologies?

A

Jaundice- bilirubin metabolism impaired
Confusion- ammonia metabolism impaired
Oedema/ascites - reduced albumin production in liver
Bleeding - reduced clotting factors produced in liver

63
Q

What are the stages of alcoholic liver disease?

A 
Fatty liver (hepatomegaly) R
Alcoholic hepatitis (rapid onset jaundice, tender hepatomegaly) R
Cirrhosis IR
64
Q

What cancer can a chronic viral hepatitis infection/hereditary haemochromatosis cause?

A

Chronic Hepatitis B/C infection and HH can cause

hepatocellular carcinoma

65
Q

What can fat deposition in the hepatocytes cause?

And if INFLAMMATION is present with this disease what will this cause?

A

NAFLD non-alcoholic fatty liver disease

NASH non-alcoholic steatohepatitis

66
Q

What is Wilson’s disease and what is it less likely to cause?

A

It is a less common cause of cirrhosis and it is an autosomal recessive condition where there is reduced secretion of Cu2+ from the biliary tree leading to increased Cu2+ levels in tissues

67
Q

What is Hereditary haemochromatosis?

A

There is high Fe3+ storage in the hepatocytes. Is autosomal recessive.

Treatment: venesection to remove the high iron load in the blood

68
Q

Describe Budd Chiari syndrome.

A

Ultimately get liver cirrhosis due to the hepatic vein blockage that leads to increase in pressure in the liver, portal vein and IVC

Liver: central vein necrosis + fatty deposits outside the liver lobules = nutmeg liver

Portal vein: leads to increase back pressure into the splenic vein (splenomegaly) + SMV (ascites)

IVC: oesophageal varices, caput medusa and haemorrhoids

69
Q

How can portal hypertension caused by cirrhosis lead to the formation of internal haemorrhoids?

A

As the superior rectal vein drains into the IMV which then drains into the portal vein, a blockage in the portal vein/increased pressure in the portal vein, as a result of the fibrotic liver compressing the portal vein, can lead to increased pressure in the anorectal cushions causing them to burst and clot.

70
Q

Describe the formation of caput medusas.

A

A cirrhotic liver is unable to expand leading to the portal vein being compressed so the ligamentum teres (which is connected to the PV and umbilicus) is forced open as a result of the increased back pressure

71
Q

What is hepatorenal syndrome?

How can portal hypertension caused by cirrhosis lead to hepatorenal syndrome?

A

AKI + liver cirrhosis

Portal hypertension -> splanchnic arterial vessel dilation (↑ blood flow to the GI tract, spleen and pancreas) -> RAAS activation (as hypoperfusion to renal artery) -> renal artery vasoconstriction -> GFR ↓

72
Q

What is biliary colic?

A

RUQ pain a few hours after eating as the gallstone moves into and obstructs the cystic duct as a result of CCK release

73
Q

What is steatorrhoea?

What causes it?

A

Fatty poo, foul smell, pale and difficult to flush

↓bile salts and/or ↓pancreatic lipases released

74
Q

What does the oral rehydration therapy consist of and how does it work?

A

Consists of Na+ and monosaccharides (glucose, galactose, fructose)

Works by glucose being taken up into enterocytes so more Na+ is taken up into enterocytes (then into blood capillary) so water follows via osmosis (transcellularly or paracellularly)

75
Q

What is coeliac disease?

A

The gliadin fraction of gluten damages mucosa in the GI tract so you get:

  • crypt hypertrophy
  • malabsorption (-> weight loss, flatulence, bloating, abd. pain, iron def.)
  • lymphocytes entering epithelia and LP of mucosa
  • destroyed villi
76
Q

What causes chronic gastritis?
chronic inflammation of the stomachs mucosal layer

Regarding the minor cause of chronic gastritis, what types of anaemia does it cause and how?

A

Chronic Helicobacter pylori infection>AI: Ig to parietal cells

AI: Parietal cells destroyed -> vitamin B deficiency as less IF made (which leads to PERNICIOUS ANAEMIA) and less HCl made to activate ferri reductase so less iron absorption (so microcytic anaemia - iron deficiency)

77
Q

What triggers acute gastritis?

A

Alcohol, LT NSAID use

78
Q

What is peptic ulcer disease?

What is the pathogenesis?

A

When there is a breach in the GASTRIC or duodenal muscularis mucosa

Acts like an NSAID (↓prostaglandins so ↓mucus secreted from mucous cells, vasoconstriction so reduced clearance of acid that has go down to the MM and reduced HCO3- secretion) + epithelial renewal every 3-6 days is damaged

79
Q

If Helicobacter pylori is predominantly found in the antrum, what does it cause?

A

Gastrin and parietal cell secretions are high

Duodenal ulcers and epithelial metaplasia

80
Q

What are the clinical consequences of PUD?

A

Haemorrhage from bottom of ulcer
Perforation leading to peritonitis
Cancer
Pyloric stenosis as a result of scarring

81
Q

What is Zollinger-Ellison Syndrome?

What is the common pair of symptoms

A

Gastrinomas (typically in the pancreas) secrete too much gastrin -> gets to the duodenum via the CBD leading to duodenal peptic ulcers as there is too much acid stimulated to be made (gastrin acts on CCK on the parietal cell)

Upper gastric pain + diarrhoea

82
Q

What are the borders of the Hesselbach’s triangle and what hernia do you typically get here?

Why does this hernia occur here?

A

Direct inguinal hernias
Inguinal ligament, inferior epigastric vessels and lateral border of the rectus abdominis muscles

This is a weak point in the anterior abdominal wall

83
Q

Describe the route of the indirect inguinal hernia

A

Enter: deep inguinal ring
iii-indirect inguinal enters inguinal canal
Exit: superficial inguinal ring

DIS

84
Q

Describe the route of the femoral hernia

A

Enter: femoral ring
Through: Femoral canal
Exit: saphenous opening

85
Q

Describe the route of direct inguinal hernias

A

Enter/Through: Hesselbach’s triangle

Exit: Superficial inguinal ring

86
Q

Describe the route of a para-umbilical hernia

A

Weakness of the umbilical area of the linea alba, herniates through the umbilical ring

87
Q

What herniates in an umbilical hernia

A

Midgut

88
Q

If the sigmoid volvulus’ visceral peritoneum is irritated, why would you feel the pain down the midline of T9 and T10 dermatomes in the peri-umbilical area?

A

Activated visceral afferents from the sigmoid volvulus viscera are activated and travel back to the inferior mesenteric ganglia. Continues back to the sympathetic trunk along the least splanchnic nerve to the dorsal horn in the spine.

Here, it CONVERGES with SOMATIC AFFERENTS at T9 and T10 spinal levels.

Brain interprets visceral afferents to be coming from T9 and T10 dermatomes so get pain in the peri-umbilical area

Pain will be felt down the MIDLINE as that is where is preganglionic neurones are found

89
Q

If the processus vaginalis is patent (so it has not obliterated to form the tunica vaginalis below) what type of hernia do you have?

A

An indirect inguinal hernia as the processus vaginalis is obliterated in direct hernias

If the IIH grows further down into the scrotum, it can become a SCROTAL HERNIA

90
Q

What hernias are found lateral to and medial to the arcuate line/inferior epigastric vessels?

A

Lateral: IIH
Medial: DIH

91
Q

What is an omphalocele?

A

When a bit if the midgut and its viscera get stuck outside of the abdominal cavity but remain within the umbilical ring

92
Q

What is gastroschisis?

A

When the ventral abdominal wall does not develop properly so some of the intestines grow outside of the body. The intestines lack visceral peritoneum so is irritated by amniotic fluid

93
Q

Name 2 malrotations of the primitive gut tube and describe them

A

Incomplete rotation: get only one 90^ anticlockwise rotation so ascending colon on the left and small intestine on the right

Reversed rotation: get only on 90^ clockwise so transverse colon grows behind the duodenum

Should get 3x 90^ anticlockwise normally

94
Q

What congenital condition has the Rules of 2?

List them.

A

Meckel’s diverticulum (a diverticulum of the ileum 2ft from the the ileo-coecal valve

Detected in Under 2’s
2% of population
male:female 2:1

95
Q

What areas of the primitive gut tube are most likely to have their gut lumen to become atresic or stenotic?

Name reasons for this

A

Duodenum>ileum

Proximal duodenum (enlarged pylorus because recanalisation did not occur or hypertrophy of the circular muscles around the pyloric sphincter)

Distal duodenum (vascular defect as a result of volvulus or malrotation)

96
Q

What is xerostomia?

A

Epithelial atrophy of the buccal mucosa leads to pale and dry buccal mucosa (excessive dry mouth)

Causes: Head radiotherapy, blocked nose so breath through mouth

97
Q

Nutcracker oesophagus is a motility oesophageal disease.

What is nutcracker oesophagus?

And further discuss the components that make up NO.

A

Diffuse oesophageal spasms + achalasia

Achalasia: LES doesn’t open on time, leading to regurgitation

DES: Oesophageal muscles have uncoordinated contractions

98
Q

What is hypersensitive oesophagus?

A

Get acid reflux and regurgitation as a result of the LES being too relaxed

99
Q

What is dyspepsia?

Name 4 causes of dyspepsia.

A

Dyspepsia is a group of upper GI symptoms: pain, nausea, vomiting, bloating, belching

GORD, regular antacid use, peptic ulcers, upper GI cancers

100
Q

In Alagille Syndrome there is a reduced number of bile ducts in the liver, what liver disease does this cause?

Give 6 signs/symptoms of this liver disease

What serum marker will be raised in this liver disease?

A

Leads to Cholestasis as less bile enters the gall bladder from the liver, thus leading to:

  • Jaundice (yellowing of skin and eyes)
  • Itchy skin
  • Pale stools and dark urine
  • Splenomegaly
  • Hepatomegaly

Raised ALP (Alkaline phosphate)

101
Q

The presence of splenomegaly and spider navei suggests what?

A

Liver cirrhosis

Portal hypertension

Autoimmune hepatitis (high in young women)

102
Q

What type of anaemia do patients with Wilson’s disease get?

A

Haemolytic anaemia

103
Q

If a pt has just been on antibiotics and they now complain of abdominal pain and profuse diarrhoea, what condition may they have?

A

Pseudomembranous colitis

104
Q

What would you see on a AXR in pseudomembranous colitis?

A

Oedematous thickened colon wall thus showing the thumb-printing sign.

105
Q

What is the most common causative organism of Pseudomembranous colitis?

Name 2 antibiotic options that can be used to treat Pseudomembranous colitis.

A

Clostridium difficile

Vancomycin or Metronidazole

106
Q

Haemolytic uraemic syndrome (HUS) is typically caused by what toxin?

Name 2 bacteria that release this toxin

A

Escherichia coli O157 and Shigella both release Shiga toxin

107
Q

What os the classic triad of HUS?

A

Haemolytic anaemia (where the haemolytic comes from)
AKI (where the uraemia comes from)
Thrombocytopenia (low platelets)

108
Q

Why wouldn’t you give antibiotics and antimotility (e.g. Loperamide) drugs to treat Gastroenteritis (bloody diarrhoea, vomiting, abdominal pain)?

A

Both of these drugs will increase the Shiga toxin levels in the body so increase the chance of developing Haemolytic uraemic syndrome

109
Q

Discuss the full presentation of HUS

A

1st pt will have Gastroenteritis (all its associated symptoms are present)

5 days later - the pt will start to show HUS symptoms:

  • AKI - Hypertension and reduced UO
  • Haemolytic anaemia - Haematuria
  • Abdominal pain
  • Irritability and lethargy
  • Bruising
110
Q

Give 5 risk factors for Splenic artery aneurysm

A
  • Female
  • Pancreatitis
  • Multiple pregnancies
  • Pancreatic pseudocyts
  • Portal hypertension
111
Q

Name 3 visceral aneurysm

A

Hepatic
Splenic
Renal

Gastrointestinal System (4 decks)

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