6.6 Stomach & Small Bowel Dysfuntion

Question 1

Acute gastritis
How to characterise
2 Types - aetiology + RF

Answer 1

ACUTE GASTRITS
Characterise - dense infiltration of stomach with neutrophils ±chronic inflam cells (lymphocytes; plasma cells)

1. Suppurative phlegmonous
- Gram -
- Anaerobes
- Gram + = group A strep
- Fungi
- spread to stomach and liver
- RF - recent excessive alcohol intake, URTI, immune-suppressed

2. Emphysematous
- Gas producing org ( C. Perfringens, E. coli, S. aureus
- lead to gas gangrene in stomach
- RF - gasroduodenal surgery, ingestion of corrosive sub, gastroenteritis, GI infarction

Question 2

Chronic gastritis
What is causes
Types (3x)

Answer 2

Causes:
- PUD
-Gastric hyperplasia polyps
- Gastric cancers

Types
1. Diffuse antral gastritis (H. Pylori) 80%
2. Enviromental metaplastic atrophic
3. Autoimmune metaplastic atrophic (Thyroid, diabetes, Pernicious Anaemia)

Question 3

Infective Gastritis
4 Types of Aetiology
Most common under each

Answer 3

Viral - HHV5, HSV, EBV, measles
Bacterial - Myobac, syphilis
Fungal - Candidiasis, Aspergillosis, Cryptococ
Parasitic - Cryptosporidiosis

Question 4

Granulomatous gastritis
Most common causes in children and Adults
Other causes

Answer 4

Children - Crohn’s disease
Adults - Crohn’s disease & Sarcoids

Other causes - Spirochetes, FB, Langerhans cell histiocytes, eosinophilic granulomatosis withy polygiitis, idiopathic

Question 5

Eosinophilic gastritis
Pathogenesis
Classified
Clinical presentation

Answer 5

-Eosinophilic infiltration of GIT
- Peripheral eosinophils
- GI symptoms (absence of other causes)

Classified by mucosal layer involved - mucosa, muscularis, serosa

Clinical - abdominal pain, N&A, LOW, anaemia, PLE, Gastric outlet obstruction

Question 6

IBD Associated gastritis
Pathogenesis
Histological findings

Answer 6

• Nodular cobblestoned pattern
• Ulcers - serpiginous; longitudinal

Histology - granulomatous gastritis, transmural chronic inflam, ulcers, submucosal fibrosis

Question 7

Which medications are associated with gastritis?

Answer 7

• Aspirin
• NSAID

Question 8

Helicobacter pylori
Virulence factors
CagA effects on cell
VacA effects on cell

Answer 8

• Gram -
• Contain urease (enzyme that neurtrilizes acid)

Virulence factors - colonizing mucosa, disrupts cell function, local inflam + systemic immune response, alter acid secretory physiology

CagA - Morphological changes, Cell proliferation, Proinflam response

VacA - Proinfalm signalling route, apoptosis, vascuolization, membrane channel interfere

Question 9

What is the risk factors for NSAID’s related ulcers?

Answer 9

• History of ulcers (complicated & uncomplicated)
• Increased dose of NSAID’s
• Anticoagulant
• Age (>70)
• Hp infec
• Use Glucocorticoid

Question 10

Functional dyspepsia
Definition
Criteria to diagnose

Answer 10

Def - pain/discomfort in central upper abdom; originate from upper GI

Criteria: Both
1. _>1 symptoms (bothersome)
- postprandial fullness
- early satiation
- epigastric pain/burning
2. No evidence of structural disease (Normal EGD)

Question 11

Celiacs disease
Definition
Pathogenesis
What it causes

Answer 11

Def - chronic immune mediated enteropathy (dietary gluten susceptible)

• Villus atropy / IEL / Crypt hyperplasia

Malabsorption - Vit B12, Folate, Iron, CMP, Electrolytes

Question 12

Small intestinal bac overgrowth
Definition
Pathogenesis

Answer 12

• Norm balance disrupted (SB>Colon)
• Excess bac in small intestine (quantitive; qualitative)
• Classic SIBO: Malabsorp, Maldigest, Steatorrhoea