Week 9-GI Tract

Question 1

Name the 3 parts of the small intestine

Answer 1

Duodenum
Jejunum
Ilium

(From superior to inferior)

Question 2

List layers of the GIT (from deep to superficial)

Answer 2

1. Mucosa (epithelium, MALT, lamina propria, smooth muscle)
2. Submucosa (Areolar and connective tissue, blood and lymphatic tissue, neurons)
3. Muscular layer (skeletal and smooth muscle, myenteric nerve plexus)
4. Serosa layer (areolar and simple squamous epithelium, visceral peritoneum)

Question 3

What is the peritoneum

Answer 3

Membrane that lines the abdominal and pelvic cavities, covering abdominal organs

Supports organs
Facilitates their vascular and lymphatic supply

Question 4

What nerve stimulates the main component of the GIT

Answer 4

Vagus nerve (wandering nerve)

Interic nervous system

Question 5

What is ectopia

Answer 5

Abnormal position/displacement of an organ, tissue or structure.
Can occur from: congenital defects (feral growth), trauma, disease, surgery

This can occur:
Ectopia Cordis - heart is located partially/entirely outside the thoracic cavity. Congenital birth defect. 10% survival as heart failure, infections, respiratory compromise

Ectopic pregnancy: fertilised egg planted outside uterine cavity, mc in fallopians tube

Renal ectopia: kidney. Foetal growth

Diagnosis and treatment: x-rays, ultrasound, CT, MRI

Treatment: management, surgical correction or removal of ectopic tissue

Question 6

Function of GIT

Answer 6

1. Ingestion
   2.propulsion (moving food through digestive tract via swallowing and peristalsis(wave-like contractions))
   3.mechanical digestion, churning stomach, chewing, segmentation in SI
   4.Chemical breakdown
   5.absorption (nutrients from digestive tract to blood stream or lymph system SI, LI does water
   6.Excretion (faeces rectum and anus)

Question 7

What is atersia
What is fistulae

Answer 7

congenital absences or closure of a normal body opening
MC occurs at near tracheal
Usually associated with a fistula connecting upper and lower oesophageal segments to a bronchus or trachea

Achelesia- can’t keep food down
Leads to blockages or lack of function

Fistulae is permanent abnormal passageway between2 organs in body or between an organ and exterior of the body
MC in new borns. Males>F

Question 8

What is diaphragmatic hernia

Answer 8

Incomplete formation of diaphragm allows abdominal viscera to herniate into thoracic cavity
MC left
Can lead to fatal pulmonary hypoplasia
Surgery generally successful

Can be in people too

Question 9

What is pyloric stenosis

Answer 9

Passage between stomach and duodenum becomes narrower
Congenital/ acquired
M>F
Projectile vomiting, frequent demands for re feeding
1-2cm abdominal mass
Surgery

Question 10

What is hirschsprung disease

Answer 10

Function obstruction of the colon
S&S failure to pass meconium (black poo)
Obstruction, constipation
Abdominal distension
Vomiting

Affecting ganglion Cells

Question 11

What is meckel diverticulum

Answer 11

Small bulge on SI, congenital
Can secrete stomach acid, bleeding ulcers of the stomach

Question 12

When inspecting the mouth, what are we looojing for

Answer 12

-Teeth-gum disease which can effect the heart
-Maligant tumours on the tongue (raised edges, Ulster, hard)
-Pre-malignant lesions
-Oral white patches
-Mercury fillings

Question 13

What would we be inspecting thr tongue for

Answer 13

Glossitis: red, smooth, sore tongue. B12, iron, folate, acid deficiency

Geographic tongue; Idiopathic

Fissured tongue: bending. Can be associated with psoriasis, Down syndrome

Black hairy tongue: smoking,bad oral hygiene, drugs

Ankyloglossia: tongue tie. Can affect feeding and speech

Question 14

What is achalasia

Answer 14

Triad
1.incomplete lower oesophageal sphincter relaxation
2.increased lower oesophageal sphincter tone
3.aperistalsis (can’t contract and propel food/liquid to GI) of oesophagus

Question 15

What is oesophagitis (lacerations)

Answer 15

Longitudinal mucosa tears
MC vomiting and retching
Haematemesis , chest pain, shock

Question 16

What is oespphagitis cont

Answer 16

Chemical & Infectious Oesophagitis
Stratified squamous cells of the oesophagus may be damaged by:
• Alcohol
• Corrosive acids or alkalis
• Excessively hot fluids
• Heavy smoking
S&S: Self-limited px, Odynophagia, haemorrhage, stricture, perforation

Question 17

What is reflux oesophagitis (GERD)

Answer 17

Reflux of gastric contents into lower oesophagus

Abrupt coughing, straining, bending, alcohol smoking, obesity, pregnancy, increased gastric volume (overeating)

MC >40
Western problem

S&S heartburn, dysphagia, regurgitation

Question 18

What is eosinophilia esophagitis

Answer 18

Allergic reaction to food
Presents as GERD

Question 19

What is oesophagitis cont

Answer 19

Caused by portal HT
Impaired blood flow through portal venous system and liver

MC in patients with cirrhosis due to alcoholic liver disease

Can haemorrhage

Question 20

List functions of stomach

Answer 20

1.acid secretion to facilitate digestion and prevent foods-borne infections

2.reservoir for food

3.emulsification fo fat and mixing of gastric contents

4.absorption

Question 21

If stool has dark blood, where is is the issue

Answer 21

Upper GI tract

Question 22

What is Gastropathy & Acute Gastritis

Answer 22

1. Acute Gastritis: Inflammation of the gastric mucosa (neutrophils present)
2. Gastropathy: Inflammation of the gastric mucosa (when inflammatory cells are
   rare or absent)
   Aetiology: Alcohol, NSAID use, bile.
   S&S:
   • Epigastric px
   • Nausea & vomiting
   • mucosal erosion
   • Ulceration
   • Haemorrhage
   • Melena (black tarry stools –
   pathognomonic of upper

Question 23

What is chronic gastritis

Answer 23

MC h.pylori infection
S&S persistent
Nausuea, abdominal pain

Question 24

What is peptic ulcer disease

Answer 24

Mucosal ulceration affecting duodenum or stomach

S&S epigastic burning, aching
Anemia
Haemorrhage
Nausea
Vomiting
Blaotng
Significant weight loss
Relived by food.
Worse between 11-2am

Question 25

What is gastric polyps

Answer 25

Pre-cancerous inflammatory lumps MC 50-60 Develop in associated with chronic gastritis which initiates an injury leading to polyp growth Can lead to malignant cancer - Gastric cancer Only 17% survival rate M>F

Question 26

What is NSAIDS

Answer 26

Non-steroid anti inflammatory drugs Ibroprophen which can lead to stomach bleeds, ulcers and holes in the esophagus

Question 27

Describe How we would perform a GI practical exam

Answer 27

OBSERVATION Observe hands for pallor (red palms, itchy everywhere is liver issues) Nails: Finger clubbing Palpation: temp, radial pulse Arms: Brushing Needle marks Hair loss Eyes, chest, mouth Observe THE ABDOMEN for hernias, Cullen’s sign (bruising around belly button) grey turners sign (side bruising), scars, masses, distention, stretch marks AUSCULTATE -Normal bowl sounds: gurgling -Tinkling:obstruction -Abscent: lieu’s (disruption of normal propulsive ability. Malfunction or peristalsis) -Aortic bruits (AAA) Percussion of: Liver (upwards from right iliac fossa, resonant to dull) Spleen: (right iliac fossa to left costal Margin, resonance to dull) Bladder (down from umbilicus from resonance to dullness) Palpation Light palp, tenderness, guarding, masses, rebound tenderness Deep palp, masses, size, ,ovation, shape, mobility Liver  Start at the right iliac fossa using your finger pads  Ask patient to take a deep breath  Work upward to right costal margin  Assess for size, consistency, tenderness, pulsatility, degree of extension below costal margin Gall bladder Not normally palpable in a healthy person (biliary obstruction i.e. gall stones, pancreatic malignancy. Infection) Location: R costal margin, mid-clavicular line (large, well defined mass that moves with respiration) Murphy’s sign: Pain mid-breath on palpation indicates cholecystitis Spleen: Only palpable if x3 its size (splenomegaly). Begin palpating at right iliac fossa and progress to left costal margin. Causes of splenomegaly; liver cirrhosis, haemolytic anaemia, CHF, splenic metastasis, glandular fever. Ballot the kidneys: R Kidney: - R hand at anterior abdominal wall just below the right costal margin - L hand behind the patients ribs, below the flank Palpable indicates polycystic kidney disease, amyloidosis, cancer Aorta: Bilateral hands, superior to umbilicus in the midline Hands should move superiorly If hands move outwards: AAA

Question 28

List 9 abdominal regions

Answer 28

1. Right hypochondriac Liver, gallbladder, R kidney, SI (Gallstones, stomach ulcer, pancreatitis) 2.Epigastric region Stomach, liver, pancreas, duodenum, spleen, adrenal glands (Stomach ulcer, pancreatis, gall stones, indigestion) 3.left hypochondriac Spleen, colon, left kid, pancreas (Stomach ulcer, duodenum ulcer, pancreatis) 4.r lumber Gall;aider, liver, r colon (Kidneys stones, urine infection, constipation, lumbar hernia) 5.umbilical region Umbilical, SI, duodenum (Pancreatis, appendicitis, stomach ulcer, IBS) 6,L lumbar Descending colon, left kid (IBD, kidney stones, constipation) 7.R iliac Appendix, cecum (Appendicitis, pelvic pain, constipation, groin pain) 8.Hypogastric region Urinary bladder, sigmoid colon, femal reproductive organs (Urine infection, appendicitis, pelvic pain, IB) 9. L iliac Descending colon, sigmoid colon (Pelvic pain, groin pain, inguinal hernia)