Hx of the GIT

Which graph represents the pain from an obstruction, inflammation or perforation

Name some things that could cause Acute & Severe Abdominal Pain

•Perforated viscus

•Peritonitis

•Acute appendicitis

•Mesenteric ischemia

•Ruptured aortic aneurysm

What is considered Chronic Abdominal Pain

continuous or intermittent abdominal discomfort lasting for at least 3 months

Name some things that could cause Chronic Abdominal Pain

• Gastritis

• Oesophagitis

• Gastro-esophageal reflux disease

• Peptic ulcer disease

• Gallstones

• Pancreatitis

• Inflammatory bowel disease

• Kidney stones

• Constipation /cancer

• Diverticulitis

• Irritable bowel syndrome

For someone with Chronic Abdominal Pain, if their Pain is made worse by eating it may indicate what (5)

• Gastric ulcer

• Chronic pancreatitis

• Gallstone

• Abdominal ischaemia

• Irritable bowel syndrome

For someone with Chronic Abdominal Pain, if their Pain is relieved by eating it may indicate what (1)

Duodenal peptic ulcer disease

For someone with Chronic Abdominal Pain, if their Pain is relieved by defecation it may indicate what (1)

Irritable bowel syndrome

Differentiate between functional & organic Chronic abdominal pain

Functional e.g. Irritable bowel syndrome (no structural defect visible with tests)

Organic: vascular, inflammatory, mechanical (structural defect)

What are 6 Non-GI causes of Abdominal Pain

• Acute coronary syndrome

• Herpes Zoster (shingles)

• Pelvic disorders e.g. ovarian cyst, ectopic pregnancy

• Diabetic ketoacidosis

• Sickle cell crisis

• Pneumonia

What are the 6 Fs that cause Abdominal Distension

• Foetus

• Flatus

• Faeces

• Fluid (Ascites)

• Fat

• Filthy big Tumour

Diarrhoea

Diarrhoea is watery or liquid stools, usually with an increase in stool weight above 200g daily and an increase in daily stool frequency

What to look out for in Diarrhoea

• Duration

• Nocturnal

• Distinguish diarrhoea from faecal urgency or tenesmus (rectal pathology)

• Red-flag symptoms: passing of blood, weight loss

What are some causes of diarrhoea

• Infection: viral, bacterial, parasites

• Inflammatory: IBD: Crohn’s disease, Ulcerative Colitis

• Malabsorption: Coeliac disease

• Pancreatic disease: pancreatitis, tumour

• Large bowel/Colon: Colorectal cancer

• Sigmoid colon: Diverticulitis

• Endocrine: hyperthyroidism, carcinoid syndrome

• Drugs: laxative abuse, antibiotics, NSAIDs, PPIs, alcohol

• Overflow diarrhoea (constipation)

• Irritable bowel syndrome

What can cause constipation

• Diet: low fibre

• Drugs: opiates, CCBs, iron, anticholinergics

• Stricture: (Crohn’s disease)

• Cancer: e.g. carcinoma of colon

• Pelvic mass (foetus, fibroids)

• Hypothyroidism

• Hypercalcaemia

• Idiopathic

Recommended intake of fibre / day

25-30g/day

Jaundice

Yellow pigment of the skin, sclerae and mucosa due to an increase in plasma bilirubin

At what level of bilirubin is jaundice visible

>35μmol/L

Differentiate between Conjugated/Unconjugated bilirubin

Unconjugated bilirubin= water insoluble (fat soluble) does not enter urine

Conjugated bilirubin= water soluble & is excreted in urine (dark colour)

Give 3 causes of Unconjugated hyperbilirubinemia

Issues in prehepatic region

• Increased production e.g. haemolytic anaemia

• Impaired uptake by liver e.g. Drugs (rifampicin), congestive cardiac failure

• Impaired conjugation e.g. Gilbert’s syndrome, Criglar-Naijar syndrome

3 causes of Conjugated hyperbilirubinemia

Issues in hepatic region

• Hepatocellular dysfunction e.g. viral infections, drugs (e.g. statins, sodium valproate, isoniazid, paracetamol overdose), cirrhosis, cancer, haemachromatosis, Wilson’ disease, alpha-1 antitrypsin deficiency

• Impaired excretion: e.g. Dubin Johnson syndrome, right heart failure

Issues in posthepatic region

• Primary biliary cholangitis; drugs (flucloxacillin, nitrofurantoin, choledocholithiasis, compression (cancer head of pancreas, lymph nodes)

What do each of these Oesophagus GI system Symptoms mean:

•Dysphagia

•Odynophagia

•Chest pain

•Heartburn, acid-brash, water brash, belching

•Haematemesis

Dysphagia → Difficulty swallowing.

Odynophagia → Pain when swallowing.

Acid brash → Sour or bitter taste in the mouth from refluxed gastric acid.

Water brash → Sudden filling of mouth with saliva due to oesophageal irritation.

Haematemesis → Vomiting of blood.

What do you call the passage of black, tarry, foul-smelling stool caused by digested blood, typically indicating an upper GI bleed

Melaena

What is Haematochezia & where would the issue be

Haematochezia is the passage of fresh, bright red blood per rectum

Issue in Large bowel/colon

What is tenesmus & where would the issue be

Tenesmus is the persistent, painful feeling of needing to evacuate the bowels even when they are empty, often involving straining and cramping

Issue in Large bowel/colon

If a patient has Pale stools & dark urine, where would the issue be

Hepatobiliary System

Jaundice would be due to an issue where (2)

Hepatobiliary System / Pancreas

3 Signs of infection

Fever, rigors, dehydration

5 causes of anorexia

pancreatitis

IBD

Any tumour

Liver disorders

Inflammation

Name 3 Motor disorders (nerve/ muscle) that could cause GI system Symptoms

Achalasia

Gastro-paresis e.g. ass. with diabetes

Dysphagia e.g. motor-neuron disease

Name 3 causes of Unintentional weight loss

• GI tumour

• IBD (malabsorption)

• Chronic inflammation

3 GI causes of Fatigue

Tumour

Inflammation

Malnutrition/Malabsorption

What could be a GI cause of Raised intra-cranial pressure

Vomiting

Achalasia meaning

Failure of relaxation of the lower gastro- esophageal sphincter

Caused by degeneration of the myenteric plexus

Causes Dysphagia (difficulty swallowing)

Name some risk factors for Duodenal Ulcers

Males

Blood group O

Helicobacter Pylori

NSAIDs

Aspirin

Steroids

Smoking, alcohol, steroids

Zollinger-Ellison syndrome

2 Complications of Duodenal Ulcer

Bleeding

Perforation

What does the Serology (antibodies) of coeliac disease look like (wat antibody is found)

Tissue Transglutaminase IgA antibody