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34 Cards in this Set
- Front
- Back
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Achalasia
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Abnormal dilation of the esophagus resulting in the retention of food in the esophagus
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Achalasia
etiology and pathogenesis |
Lack of peristalsis in part of esophagus, and relaxation of the esophageal sphincter after swallowing
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Achalasia
Clinical features |
* dysphagia
*regurgitation of swallowed food * aspiration may occur |
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Hiatus hernia
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Abnormal protrusion of viscus, through an opening which maybe normal or abnormal
Eg. Diaphragmatic hernia This maybe congenital or acquired If acquired - maybe traumatic or hiatal A hiatus hernia is the herniation of intranet abdominal esophagus and cardia of the stomach through the diaphragmatic hiatus |
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Hiatus hernia
Epidemiology |
Common
Obese Middle age Men Pregnancy |
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Hiatus hernia
Etiology |
Progressive weakening of the muscles of the hiatus
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Hiatus hernia
Clinical features |
Mechanical
*cough - hiccough -dyspnoea -palpitations Reflux -incompetence of the cardiac sphincter - heartburn -burning in retrosternal /epigastric pain Worse on lying down or stooping Lifting or straining increasing intraabdominal pressure Can refer to jaw or arms-stimulating cardiac ischemia Effects of esophagitis -Stricture formation -bleeding -occult or acute -reflux esophagitis - ulceration and bleeding |
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Hiatus hernia
Relieving factors |
Eating smaller meals more frequently
Staying upright after meal Sleep more upright Weight loss Antacids |
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Intestinal obstruction
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Mechanical Bowel obstruction
Paralytic |
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Mechanical bowel obstruction
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An obstruction of a section of intestine by physical cause, may be complete of partial, may be large or small intestine
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MBO
Classification |
1. Speedo of onset
- acute -chronic -acute on chronic 2. Site -high -low 3. Nature - simple Occluded - no blood supply lost -strangulated Loss of bs Strangulated heir Vovulus Intussuption All cause necrosis |
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MBO
Etiology |
1.obstruction in lumen
Tumour 2.obstruction in the wall Stragulated hernia Vovuls Intussuption 3. Compression from outside the wall Fibrous tissue post op |
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MBO
Pathology |
1. Simple occlusion
-distal to obstruction , bowel empties followed by constipation -proximal obstruction dilates with gas and fluid. Increased peristalsis Increased bowel sound Pain cramps To overcome the obstruction Distal No sound No peristalsis Dehydration As bowel distends blood supply is impeded - mucosal ulceration and possible perforation 2. Strangulation -ishaemic bowel can't contain toxins- bacteria and toxins enter peritoneal cavity - secondary peritonitis 2. Unrelieved strangulation - gangrene with perforation |
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MBO
Symptoms |
4 signs
1. Pain - colicky 2. Vomiting - may vomit faeces 3. Distension - 4. Acute constipation |
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MBO
Signs |
- dehydration - vomit
- tachycardia - temp around obstruction if strangulation ^temp - abdominal distention - abdominal scars - palpation - mass - bowel sounds - |
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Paralytic bowel obstruction
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State of atony of the intestine
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PBO
Etiology |
1. Reflex
Interference with autonomic nervous system Eg -spinal fracture 2. Peritonitis Bowel in peritonitis is atonic 3. Metabolic causes Potassium depletion Ureamia 4. Drugs 5. Post operative - most common ( handle the bowel it is turned off ) |
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PBO
Pathology |
- severe loss of fluid and electrolytes
- gross gaseous distention - impaired bf to bowel = absorption of toxins -may turn mechanical after surgery |
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PBO
Clinical features |
Abdominal distention
Absolute constipation Vomiting Absence of peristalsis Pain |
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Large intestine
Diverticulosis |
Diverticulae are outpouchings of the mucous membrane.
Mostly found in the sigmoid and descending colon Most prolific in left |
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LI
diverticulosis Epidemiology |
>40
elderly Western |
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LI
Diverticulosis Etiology |
Hypertrophy in the muscle wall of sigmoid colon - mucosal out poaching - weakness in the wall
- low fiber diet - responsible for muscle thickening due to increased intro colonic pressure |
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LI
Diverticulosis Clinical features |
No symptoms in unaffected
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LI
Acute Diverticulosis |
Infection of one or more of the diverticulum
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LI
Acute Diverticulosis Etiology |
Similar to appendicitis
Lumen obstructed | increased fluid enters lumen from mucosa of diverticulum | increased luminal pressure | Collapse of vessel wall of diverticulum | Diverticulum predisposed to infection | Acute inflammation |
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LI
Acute Diverticulosis Pathology |
Inflamed diverticulum may
- perforate into peritoneal cavity - produce chronic infection with inflammatory fibrosis - hemorrhage - |
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LI
Acute Diverticulosis Clinical features |
- left sided appendicitis
- acute onset of abdominal pain shifting to the left iliac fossa - fever - vomiting - guarding / tenderness - mass in left iliac fossa -perforation - signs and symptoms of peritonitis - pericolic abscess - swinging fever and low white blood cell count |
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LI
Chronic Peri- DIverticulosis |
A form of diverticulosis characterized by the narrowing of the colonic lumen and subsequent changes in bowel habit
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LI
Chronic Peri- DIverticulosis Etiology |
Consequence of fibrosis
Previous acute diverticulosis Obstruction may form |
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LI
Chronic Peri- DIverticulosis Clinical features |
Mimics that of colon carcinoma
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LI
Irritable Bowel Syndrome |
Spastic colon, Idiopathic Diarrhoea
Functional disorder of the bowel with no structural or biochemical changes |
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LI
Irritable Bowel Syndrome Etiology |
Most common single cause of abdominal pain
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LI
Irritable Bowel Syndrome Etiology |
Multifactorial
Exaggerated bowel activity Psychological ? |
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LI
Irritable Bowel Syndrome Clinical features |
Abdominal pain intermittently in iliac fossa or hypogastrium
-constant or colicky pain - diffuse or localized -not severe - relieved by defecation Constipation Diarrhoea Nausea, anorexia, weakness and fatigue Altered patterns of defecation -change in frequency -consistency -passage -mucous Diagnosis -abdominal pain / discomfort -altered frequency -absence of disease |
