8. DIGESTIVE SYSTEM II - PATHOLOGIES Flashcards
The signs, symptoms, investigation procedures and key orthodox treatments of digestive system pathologies.
What is the difference between a disease and a syndrome?
In a disease, there is a clearly defined disease process, with the cause and the pathophysiology well established. Whereas a syndrome is when a patient presents with a collection of symptoms and signs, but the underlying cause might be different for each person.
What is oral thrush?
A fungal infection of the mouth which is a sign of low immunity in the body.
Explain how broad-spectrum antibiotics contribute to the development of oral thrush?
broad-spectrum antibiotics destroys healthy microflora like lactobacillus and allows for opportunistic fungal overgrowth of candida albicans.
Name TWO possible causes, other than antibiotics, for oral thrush?
- compromised immunity (cancer, HIV / AIDS)
- nutritional deficiencies (iron, zinc, vit B12)
- oral steroid inhaler use
List two characteristic signs / symptoms of oral thrush
- White patches (cottage cheese consistency) on the oral mucosa that can be wiped off
- Red raw appearance to the underlying tissue
- Loss of taste or unpleasant taste in the mouth
Define mouth ulcers
Ulceration of areas of the oral mucosa that are generally painful due to loss of the mucosal layer.
Name two gastrointestinal pathologies that may cause mouth ulcers
Crohn’s Disease and Coeliac’s Disease
What causes cold sores?
Cold sores are caused by Herpes Simplex Virus type I that lies dormant in the trigeminal nerve and gets triggered when immunity is low. Other triggers are UV light (sunlight exposure), stress, steroid use, trauma and local infections.
Name five foods that can trigger GORD
Chocolate, citrus, tomatoes, onions, spicy foods, dairy, fatty foods, coffee, alcohol, carbonated drinks
Using definitions, compare an abscess with gingivitis
An abscess is a localised pocket of pus caused by bacterial infection, surrounded by inflammation which commonly affects the oral cavity and intestines. Gingivitis is a bacterial infection of the gums which get inflamed and bleed.
Explain why poor nutrition contributes to gingivitis
A low level of nutrients and anti-oxidants resulting from a poor diet will hamper the body’s ability to maintain an innate state of wellbeing in the oral environment (and systemically).
List two causes, other than nutritional, for gingivitis.
Long term steroid use, smoking, poor dental hygiene, amalgams, diabetes mellitus
How does periodontal disease differ from gingivitis?
Whilst gingivitis is a bacterial infection of the gums, periodontal disease is a serious bacterial infection of the gums and bone surrounding the teeth and usually develops when gingivitis is left untreated.
Name three nutritional deficiencies associated with angular stomatitis
Vitamin B2 (Riboflavin), B9 (Folic Acid) and Iron
Name one infection that can contribute to angular stomatitis
Staphylococcus Aureus
Candida Albicans
Define xerostomia
Dry mouth caused by reduced or absent flow of saliva
Name one autoimmune cause of xerostomia
Sjögren’s syndrome (Autoimmune attack on exocrine glands)
List two signs/symptoms of xerostomia
Dry mouth
Halitosis
Burning sensation
Speech and swallowing interference
List three causes of xerostomia other than autoimmune disease
Stress
Radiotherapy
Menopause
Describe two key differences between cleft palate and cleft lip
Cleft palate is malformation of the palate in embryonic development, while cleft lip is in the lip. Cleft palate causes difficulty in speech, feeding and hearing. Cleft lip can be complete or partial, unilateral or bilateral.
Name one cause for both cleft lip and palate under the following titles:
a. environmental
b. teratogens
a. Maternal disease
b. Radiation, Vitamin A (excess of)
Name two causes of oral cancer
smoking
HPV infection
alcohol
Define salivary calculi
stones forming in the salivary glands due to a metabolic imbalance affecting mineral concentration
Why is salivary calculi often referred to as the ‘mealtime syndrome’?
Pain usually presents at mealtimes since the saliva that is attemting to be released comes up against the blockage in the salivary ducts.
List one cause of salivary calculi
Sjögren’s syndrome
Dehydration
Using definitions, compare GORD with hiatus hernia
GORD is the regurgitation of stomach acid into the oesophagus due to a relaxed lower oesophageal sphincter which presents as heartburn. Hiatus hernia is the physical protrusion of the top part of the stomach through the opening in the diaphragm, which could present as GORD
Name two causes of GORD that is not food related
Hiatus hernia
Pregnancy
Stress
Obesity
Explain why GORD might be mistaken for a cardiac pathology
It presents with the same intense retrosternal pain
What are he signs and symptoms of oral cancer
Red or white patches on oral mucosa/tongue
Difficulty eating and breathing
Name one way in which the symptoms of GORD are aggravated
Lying down
Name one complication of GORD
Barrett’s Oesophagus (pre-cancerous cell changes)
Cancer
List two causes of hiatus hernia
Increased abdominal pressure due to:
Heavy lifting; hard coughing/sneezing; pregnancy; childbirth; violent vomiting; straining with constipation; obesity; smoking; drug abuse; stress; hereditary
List two dietary/lifestyle causes of oesophageal cancer
Smoking
Low fruit and veg diet
Alcohol
GORD -> Barrett’s Oesophagus
Using definitions, compare acute gastritis with chronic gastritis
Acute gastritis is the sudden onset of inflammation of the stomach mucosa causing breakdown of the stomach lining.
Chronic gastritis is the inflammation of the stomach mucosa for more than 4-6 weeks.
Outline the pathophysiology of:
a) Acute gastritis
b) Chronic gastritis
a) Acute gastritis develops due to insufficient mucus production in the stomach (due to reduction of prostaglandin synthesis) leaving the stomach mucosa vulnerable to erosion. The acute inflammation is also characterised by neutrophil infiltrate.
b) Acute gastritis develops when there is prolonged low-grade inflammation resulting in fibrosis and hence loss of elasticity and peristalsis. Lymphocytes and macrophages are characteristically found in the lamina propria.
Name one bacterial cause of acute gastritis
Helicobacter Pylori
How do NSAIDS contribute to acute gastritis?
NSAIDS inhibit prostaglandin production which reduces the gastric mucosal barrier, leaving it vulnerable to infection, damage and inflammation.
How do the signs and symptoms differ between acute and chronic gastritis?
The symptoms of acute gastritis is much more noticeable, with epigastric pain that is worse with food intake, nausea, vomiting and loss of appetite. Chronic gastritis presents with few symptoms, but there is discomfort with heavy meals.
List two causes of chronic gastritis
Autoimmune
Bacterial (H. Pylori)
Chronic irritation (e.g. long-term NSAIDs)
Name two types of anaemia that are often a complication of chronic gastritis
Iron-deficiency anaemia
Megaloblastic anaemia
Pernicious anaemia
What is the major red flag symptom indicative of oesophageal cancer?
Dysphagia (difficulty swallowing)
Describe two differences between gastric and duodenal ulceration in regards to pain
With gastric ulcers, the onset of pain is usually 30-60 minutes after a meal and not often at night. With peptic ulcers, the pain usually starts 2-3 hours after a meal and often at night and mostly when the stomach is empty.
Which parts of the digestive tract is commonly affected by peptic ulcers?
The lesser curvature of the stomach and the proximal duodenum.
Describe the pathophysiology of dumping syndrome
The loss of control of gastric emptying with sudden, resulting in the duodenum being filled with undigested food, leading to urgent diarrhoea
List two advanced stage symptoms of gastric cancer
Jaundice, black stools, tiredness, anaemia, loss of appetite
Identify two dietary causes of gastric cancer
Diet low in fruit and vegetables
Diet rich in salted, pickled and smoked foods (N-nitroso)
Name one location where rebound tenderness is experienced in appendicitis
McBurney’s point
Name two complications of appendicitis
Rupture of the appendix (pain subsiding is a sign thereof)
Peretonitis: release of fecal matter can result in infection spreading to the peritoneum.
Which blood test can be used to diagnosed appendicitis?
ESR (High Erythrocyte Sedimentation Rate can indicate inflammation)
Why is dysentery a notifiable disease?
It is required by law to be reported to the government because of the risk of severe spreading
List two causes of dysentery disease
- Shigella bacteria
- Amoebic (via faeco-oral contamination)
Name two characteristic signs / symptoms of dysentery disease
- Diarrhoea with mucus and blood
- Cramping and possible nausea/vomiting
Name four characteristic signs / symptoms of SIBO
Bloating, flatulence, belching, loss of appetite, diarrhoea, constipation
Briefly outline the pathophysiology of SIBO
SIBO develops when there is an overgrowth of bacteria in the small intestine that would normally populate the large intestine.
List some probable causes for IBD (Inflammatory Bowel Disease)
- Suspected autoimmune
- Dietary links (Sugar, wheat, diary)
- Genetic predisposition
- Environmental triggers: antibiotics, infection, defective immune system
List four signs / symptoms of IBD
Abdominal pain/cramps Rectal bleeding Diarrhoea (with blood, mucus) Fever and fatigue Nausea / vomiting Indigestion, feel 'blocked' Anaemia Weight loss
Name three complications of IBD
Malnutrition (osteoporosis) Strictures (obstruction) Fistulas Abscesses Toxic megacolon Malignancy (increased risk of cancer)
How is IBD diagnosed?
Blood tests: ESR and CRP
Stool test: Calprotectin (inflammatory biomarker found in leukocytes
Colonoscopy (and biopsy)
What are the two types of Inflammatory Bowel Diseases called?
Crohn’s Disease
Ulcerative Colitis
List three signs / symptoms of IBS (Irritable Bowel Syndrome)
- Abdominal pain and cramping relieved by passing a stool
- Alternating diarrhoea and constipation
- Bloating, painful flatulence
- Post-prandial urgency
- Incomplete bowel emptying
- Mucus in the stools (not blood)
Explain how stress contributes to IBS
The sympathetic nervous system is dominant during stress and inhibits important GIT functions such as secretions, motility and pain sensitivity
Name two causes of IBS other than stress
Food allergies
Excessive antibiotic use
GIT infections
Describe in detail the pathophysiology of Coeliac Disease
Coeliac disease is an autoimmune condition where the body’s immune system attacks its own small intestinal mucosal tissue in response to the ingestion of gluten.
Gluten is a protein that is made up of glutenin and gliadin. This gliadin is modified by tissue transglutaminase (tTG), an enzyme found in the mucosa of the small intestine. This modification allows the protein to be presented to the immune system to which it is being identified as foreign.
The immune system then produces antibodies and an inflammatory reaction which strips the villi and microvilli, causing atrophy.
Name two genes associated with Coeliac disease
HLA-DQ2
HLA-DQ8
List two extra-intestinal signs/symptoms of coeliac’s
- Dermatitis Herpetiformis (blistering rash)
- Mouth Ulcers
- Lethargy, fatigue (Iron-deficiency anaemia)
- Irritability
- Muscle / joint pain
- Osteopenia / osteoporosis
- Neurological problems (anxiety, depression)
- Infertility
What is Coeliac’s Disease?
An autoimmune condition where the body’s immune system attacks its own mucosal tissue in the small intestine in response to ingestion of gluten.
Name one antibody test used to diagnose Coeliac disease
IgA-tTG blood test (Immunoglobulin-A tissue Trans Glutaminase)
Outline the difference between diverticulosis and diverticulitis
Diverticulosis is the presence of pea-sized pouches caused by herniations of the mucosa bulging through the colon wall and are often asymptomatic. Diverticulitis is when these pouches get inflamed and infected.
What complications can result from Coeliac disease?
Osteoporosis
Anaemia (Iron / B9 /B12)
Bowel cancer
What is required for a definite diagnosis of Coeliac disease?
A biopsy
Explain how a low fibre diet can contribute to diverticulitis
A low fibre diet can lead to constipation which creates high intra-abdominal pressure and puts strain on the colon and can cause small herniations in the colon wall
Using definitions, compare colonic polyps to colorectal cancer
Colonic polyps are benign epithelial growths of colonic mucosa whereas colorectal cancer is malignant tumours that are locally invasive
List three signs / symptoms of colorectal cancer
Abdominal pain
Blood and mucus in stool
Bowel habits fluctuating between constipation and diarrhoea
Name one nutritional deficiency associated with colorectal cancer
Vitamin D
List two dietary factors associated with colorectal cancer
A diet high in meat and low in fibre
Name one stool test and one blood test used to diagnose colorectal cancer
Stool analysis: M2-PK and occult blood
Blood test: CEA (Carcinoebryonic Antigen) and inflammatory markers (CRP and ESR)
Describe what a hernia is and name three common types of hernia
A hernia is an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall.
Hiatus hernia happens when a portion of the stomach protrudes into the thoracic cavity.
Inguinal hernia appears as a swelling or lump in the groin (inguinal canal) and most commonly affects men.
Incisional hernia occurs at the site of a previous incision in the abdominal wall.
Explain why acute pancreatitis is a medical emergency
The inflammation of the pancreas leads to pancreatic enzymes (proteases) backing up in the pancreas, becoming activated which leads to self digestion of the pancreas. This can lead to the life-threatening failure of multiple organs.
Describe the pain associated with acute pancreatitis
Sudden, extreme peri-umbilical pain
List two possible causes of acute pancreatitis
Alcohol abuse
Gallstones
Cancer
Name one diagnostic criterium for acute pancreatitis
Serum amylase raised to three times the normal level
Raised blood glucose
Describe the stool nature associated with chronic pancreatitis
Fatty, foul smelling stools
Name two causes of chronic pancreatitis
Long term alcohol abuse
Cystic fibrosis complication
Autoimmune pancreatitis
Pancreatic duct obstruction
Name one complication of chronic pancreatitits
Diabetes Mellitis
Pancreatic cancer
Weight loss
Malnutrition
Name two risk factors for pancreatic cancer
Age
Smoking
Family history
Describe the nature of pain associated with pancreatic cancer
Epigastric pain, radiating to the back
Outline the pathophysiology of Liver Cirrhosis
Liver Cirrhosis develops when normal hepatocytes are converted to fibrotic, non-functional scar tissue which disrupts the normal blood and bile flow
Explain why the following signs and symptoms are associated with liver cirrhosis:
a) Jaundice
b) Itchy skin
c) Anaemia
d) Dark tarry stools
a) Jaundice - Decreased bile flow and impaired conjugation of bilirubin
b) Itchy skin - Build up of bile salts in the blood and tissues
c) Anaemia - Lack of iron storage
d) Dark tarry stools - Oesophageal varices due to portal hypertension
Name the main component of gallstones
Cholesterol
Describe the pain associated with biliary colic
Biliary colic is a sign of gallstones and presents as pain radiating under the right shoulder, mostly occuring at 1-2 am in the morning. This is linked to the fact that the nerve at T3 ennervates both the diaphragm and the skin on the shoulder.
Describe the difference in pathophysiology between liver cancer due to:
a) Liver cirrhosis
b) Hepatitis B/C
a) Alcohol and toxins create necrosis of liver tissue which leads to chronic inflammation and cell proliferation
b) Viral integration into the host genome affects the DNA, causing cancer
What is meant by the ‘5F risk factors’ in gallstones?
Individuals that fall in the following categories are most at risk: Fat, Female, Forty, Fair, Fertile
List two possible causes of gallstones, outside of the 5F risk factors.
Diabetes
Rapid weight loss
Oral contraceptive pill use
Liver cirrhosis
Describe the lifespan of a pinworm.
This parasitic ‘Helminth’ infection has a lifespan of approximately two months. The eggs are ingested (faeco-oral route) and hatch in the duodenum within six hours. Worms mature in two weeks and commonly inhabit the terminal ileum and large intestine. Female worms migrate to the rectum, and if not expelled, migrate to the anus at night and deposit eggs.
Which two groups of people are most affected by pinworms?
Children under 10 and institutionalised adults
List two causes of toxoplasmosis
Cat faeces
Undercooked meat
List one complication of toxoplasmosis
Miscarriage
Encephalitis
