University Of Wales College Of Medicine Cardiff (UWCM)
Medicine- gastrointestinal tract
Summary
Summary Gastrointestinal tract Most common disorders
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Course
Medicine- gastrointestinal tract
Institution
University Of Wales College Of Medicine Cardiff (UWCM)
In this document you will find a revision including all the common disorders of the GI tract, diagnosis, signs and symptoms, lab findings, treatment options
University of Wales College of Medicine Cardiff (UWCM)
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Medicine- gastrointestinal tract
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Available practice questions
Gastrointestinal tract
Flashcards36 Flashcards
$15.470 sales
Flashcards36 Flashcards
$15.470 sales
Some examples from this set of practice questions
1.
What is the most common extrahepatic manifestation of celiac disease involving the skin?
Answer: Dermatitis herpetiformis
2.
What part is most commonly affected in SMALL intestine obstruction?
Answer: Ileus
3.
what is the most common part affected in LARGE bowel obstruction?
Answer: sigmoid colon
4.
Why do you avoid enemas when diagnosing a patient with suspected intestinal obstruction?
Answer: distortion of XRAY image
5.
What is the most common cause of intestinal ischemia?
1)non-occlusive disease
2)arterial thrombotic disease
3)arterial embolism
4)venous thrombotic disease
Answer: 3-arterial embolism
6.
What is the most common cause of intestinal ischemia in a YOUNG patient?
1)venous thrombotic disease
2)arterial embolism
3)non-occlusive disease
3)arterial thrombotic disease
Answer: 1-venous thrombotic disease
7.
What symptom is expected in a patient with pancreatic cancer in the HEAD of the pancreas?
Answer: jaundice
8.
what sign is expected in a patient with pancreatic cancer in the BODY or TAIL of the pancreas?
Answer: pain and weight loss
9.
What marker can be used to diagnose pancreatic cancer?
Answer: CA 19-9
10.
What marker can be used to diagnose colorectal carcinoma?
Celiac disease reaction with GLUTEN (rye, barley, wheat)
DERMATITIS HERPETIFORMIS:
itchy blistering rash around elbows, knees, scalp and buttocks.
Teenege years more in Males
Clears with gluten free
SCREENING:
1. Immediate family member
2. Exposure to gluten <3m
3. Major life event eg:surgery, pregnancy in people genetically predisposed
4. Type 1 Diabetes, thyroid disease other autoimmune diseases
5. Genetic disorders Down syndrome, turner syndrome
The average of person with symptoms to be diagnosed is 4 YEARS
SEROLOGIC TESTING:
1. IgA anti tissue transgluminase tTG
2. IgA endomysial antibody
3. IgG or IgA deamidated gliadin peptides
4. IgA 5% defic
,GENETIC TEST:
DQ2
DQ8 gene
High negative predictive value
More common in DQ2
DIAGNOSIS:
Biopsy of small intestine to confirm blood test
Endoscopically
Damage of the small villi
60% children and 40% adults will have no symptoms.
->damaged intestinal lining-> MALABSORPTION, OSTEOPOROSIS, INFERTILITE AND
NEUROLOGIC SYMPTOMS
If DIABETES 1 > risk for celiac
Untreated will cause lower blood glucose
Can occur alongside with other autoimmune diseases
If osteoporosis-> Vit D+ Calcium
Supplaments: Fe, Ca, vit D,zinc,folic acid
If resistant to gluten free diet-> STEROIDS (oral or IV)
,INTESTINAL OBSTRUCTION
Small intenstine most commontly affected ILEUS
Large bowel only 15% in SIGMOID COLON
Location of obstruction
Presence of ischemia ->discriminate for treatmnet
Degree of obstruction
1)MECHANICAL OBSTUCTION
Jejunum or ileum obstruction 4x more than large colon
EXTRINCIC: surgery,hernia,wound,masses,70% adhesion
INTRINSIC:hematoma,tumor,intussusception,stricute,stenosis
INTRALUMINAR:foreign body, fecal or bareim impaction,stones,meconium in infant
POSTOPERATIVE PTS: 90% due to adhesions, nonsurgical due to hernia
2)PARALYTIC ILEUS:
Diminished motor activity
Toxin or trauma
No physical obstruction or interruption of blood supply
Disappears after 2-3 d
Spinal cord injury, GIT surgery, peritonitis,pneumonia,would dehiscence
2)STANGULATION OBSTRUCTION:
Commpromised blood supply leading to gangrene
Caused by prolonged mechanical obstruction
RISK FACTOR: Abdominal surgery which causes adhesions, CD, cancer of abdomen
SYMPTOMS:
Abdominal distention
Abdominal fullness
Gas
Pain and cramping
Breth odor
Constipation
Diarrhea
Vomiting
Fever, peritoneal irritation
Increased WBC
Toxicity and shock in ALL typer
DIAGNOSIS:
, 1. Physical exam
2. Fecal aspiration with NGtube
3. XRAY: presence of gas or fluid, BIRD BEAK LESION in colonic volvulus, Foreign
material
4. Barium enema in ILEUS
LABORATORY TESTS:
Decresead Na,K,CL
Increase WBC
Increased SERUM AMYLASE-> irritation of the pancreas
SIGMOIDOSCOPY OR COLONOSCOPY -> to identify the source of obstruction
TREATMENT:
1. Correction of fluid , Ringers solution
2. NG tube to decompress
3. TPN to correct protein def
4. Anaglestic and sedatives
5. Antibiotics to prevent peritonitis
6. AMBULATION IN PARALYTIC ILEUS
SURGERY:
Closed bowel procedure:lysis of adhesions,intussusetion of hernias
Enterotomy for foreign bodies
Resection of bowel for obstructing regions
Intestinal bypass around obstruction
Temporary ostomy
MAINTAIN electrolyte and fluid balance->measure intake and output+vital signs
MAINTATIN normal bowel elimination-> stool samples, fluid, record stool,NG tube
MAINTAIN VENTILATION:FOWLERS POSITION->40-60 degrees to relieve abdominal dist
MONITORA abgs
Avoid ENEMAS -> may distort xray image
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