Types of blood in the vomit?
Haematemesis = Birght red blood in the vomit, usually indicates acute, severe bleeding more proximal than the stomach
Coffee Ground Vomitus = Bloody vomit looks like ground coffee. Indicates a slow or less severe bleed where the blood has sat in the gastric juice for some time prior to vomiting.
Define colic pain?
Coming and going dull pain due to muscular contraction often against an obstruction
Related to any hollow viscera such as bile duct, appendix, colon etc.
Describe the pain of appendicitis?
Colic pain in the centre of the abdomen developin to sharp pain in the right iliac fossa as the irritation reaches the parietal peritoneum
Pressure, coughing and walking can make it worse
What is the theory behind the cause of appendicitis?
Dense (possibly calcified) and stagnant faeces in the appendix causes irritation leading to the appendix twisting on its mesentery and becoming infected
What are enterogastrones?
Enteric hormones e.g. CCK, secretin & GIP
When is CCK released and hwat does it do?
A response to fat/amino acids and hypertonicity in the duodenum:
- Decreased Gastric motility
- Contracts the pyloric sphincter
- Contracts the gall bladder
- Relaxes the sphincter of Oddi
- Increases pancreatic enzyme secretion
What is the trigger and action of secretin?
Released from duodenal S cells in response to acid in the duodenum via vagal and entero nervous reflexes:
- Stimulates Bicarbonate secretion from brunners glands and pancreatic duct cells
- Inhibited by acid neutralisation (-ve feedback)
What is the trigger and action of Gastric Inhibitory Polypeptide (GIP):
A response to fat & Hypertonicity in the duodenum:
- Inhibits gastric motiltiy & Emptying
- Inhibits G cell gastrin secretion
- Inhibits parietal cell HCl secretion
Why would drinking milk make you get drunk slower?
The fat increases GIP & CCK release which inhibits gastric motiltiy, emptying and HCl release –> Thus slowing the absorption of alcohol
What are the problems after having a total gastrectomy?
Anastomotic leaks, bleeding, reflux.
Define pernicieous anaemia and how it occurs post gastrectomy?
A lack of B12 absortption leading to a lack of RBCs.
B12 can only be absorbed as a complex with intrinsic factor which is released in the stomach.
What is dumping syndrome?
Food from a meal hits the duodenum in one go and is quickly digested by pancreatic enzymes resulting in a highly hypertonic solution in the lumen, normally this would trigger reduced gastric emptying and even itself out. However in this case theres no stomach so the hypertonic solution forces loads of water from the blood into the intestine causing low blood volume and shock + abdominal pain and vomiting. The solution = eat smaller more often.
If a gallstone gets stuck just before the duodenum what will it cause?
- Biliary Cholic
- Osmotic Diarrhoea (excess fat in colon broken down to FAs which induces fluid shifts into colon)
- Malnutrition/vitamin deficiencies due to lack of pancreatic enzymes
Eventually post hepatic jaundice, cholangitis, pancreatitis etc