8. Digestive System Pathologies Flashcards
Oral Thrush
- A fungal infection of the mouth which is not contagious and a sign of low immunity.
- Risk of spread (systemic candidiasis).
Oral Thrush: Causes
- Candida albicansis a fungus seen in cases of compromised immunity (cancer patients, diabetics, HIV/AIDs).
- After broad-spectrum antibiotics (destroys healthy microflora and allows for opportunistic fungal growth) or immune suppressant drugs (e.g. steroids).
- Nutritional deficiencies (iron, zinc, vit. B12).
Oral Thrush: Signs and Symptoms
- White patches (plaques) on the oral mucosa.
- “Cottage cheese” consistency that can be wiped/brushed off.
- Red/raw appearance to the underlying tissue (with cracksin corners of mouth).
- Loss of taste or an unpleasant taste.
Oral Thrush: Treatment
Antifungals
Mouth Ulcer
• Areas of ulceration within the oral cavity
that are generally painful (loss of the
mucosal layer).
Mouth Ulcer: Causes
- Physical trauma and hot food/liquids.
- Nutritional deficiencies: Iron, zinc, folate and vitamin B12.
- Stress (“fight or flight” - causes poor mucosal blood flow).
- GIT pathologies such as Crohn’s disease.
Mouth Ulcers: Treatment
• Treat the cause. Correct nutritional status,
improve immunity, probiotics.
Cold Sores
- A viral infection that lays dormant & activates when immunity is low.
- The virus remains dormant in sensory ganglion (nerves) –often the trigeminal nerve.
- When immunity is low, the virus migrates along the nerve to the skin or mucosa around the mouth –causing tingling/burning sensation.
Cold Sores: Causes
- Herpes simplex virus (normally Type I).
* Triggers include stress, steroid use, trauma, local infections, sunlight exposure.
Cold Sores: Signs and Symptoms
- Tingling, itching, burning sensation around the mouth.
* Small fluid-filled sores then appear most commonly on the lower lip.
Cold Sores: Treatment
• Antiviral creams (acyclovir).
Absess
- A localised pocket of pus surrounded by inflammation (can occur anywhere).
- A defensive reaction of the tissue to prevent spread of infection elsewhere.
Absess: Signs and Symptoms
- Pain, redness, local swelling.
* Fever, malaise
Absess: Treatment
Antibiotics
Drainage
Gingivitis and Periodontal Disease
• Gingivitis is a bacterial infection of the gums.
• If left untreated, gingivitis may progress to
periodontal disease (pathology of the bone
around teeth).
Gingivitis and Periodontal Disease: Symptoms
Bleeding and receding gums
Gingivitis and Periodontal Disease: Causes
- Plaque build up, poor dental hygiene, dental amalgams.
- Longterm steroid medication use.
- Diabetes mellitus.
- Smokers.
- Poor nutrition (high in refined sugars, low anti-oxidant).
Anglar Stomatitis
- Fissuring and dry scaling of the surface of the lips and angles of the mouth.
- Commonly seen in elderly where it is predisposed by changes to facial muscles (sagging).
- Also seen in those immuno-compromised.
Angular Stomatitis: Causes
- Vitamin B deficiencies: Riboflavin (B2) & folic acid (B9).
- Iron deficiency.
- Candida albicans (opportunistic) and staphylococcus.
Xerostomia
- Dry mouth due to reduced/absent flow saliva.
* A common complaint in the elderly(20%).
Xerostomia: Signs and Symptoms
- Dry mouth
- burning sensation
- halitosis (bad breath)
- Speech & swallowing interference.
Xerostomia: Causes and Complications
CAUSES:
• Drugs (antidepressants e.g. Amitriptyline).
• Sjögren’s syndrome (AI attack on exocrine glands).
• Stress (sympathetic dominance)&anxiety, dehydration, renal failure, menopause, alcohol, smoking, radiotherapy.
COMPLICATIONS:
• Candidiasis, gingivitis, tonsillitis, pharyngitis.
Cleft Lip
- Malformation of the lip in embryonic development.
- Can be unilateral or bilateral, complete or incomplete.
- Causes: Genetic defects, environmental (maternal disease, dietary factors). Teratogens(chemotherapy, radiation, alcohol, excess vitamin A, anticonvulsant medications, smoking, substance abuse).
Cleft Palate
- Malformation of the hard palate in embryonic development
- Caused difficulty in speech, feeding and hearing
- Causes: Genetic defects, environmental (maternal disease, dietary factors). Teratogens(chemotherapy, radiation, alcohol, excess vitamin A, anticonvulsant medications, smoking, substance abuse).
Oral Cancer
- Carcinoma of the oral mucosa, lip or tongue.
* Accounts for 1 in 50 of all cancer cases.
Oral Cancer: Causes
- Smoking (including pipes, chewing tobacco).
* Alcohol, HPV infection.
Oral Cancer: Signs and Symptoms
- Red or white patches on oral mucosa or tongue.
* Difficulty eating and breathing.
Oral Cancer: Treatment
• Allopathic: Surgery, chemotherapy, radiotherapy
Salivary Calculi
- Metabolic imbalance affecting mineral concentration resulting in stone formation in one of the salivary glands.
- Calculi can abrade the gland wall causing inflammation, fibrosis and blockage.
Salivary Calculi: Causes
- Dehydration. Abnormal calcium metabolism.
* Sjögren’s syndrome, chronic salivary duct infections.
Salivary Calculi: Signs and Symptoms
• Intermittent pain and swelling of the affected gland, particular when eating –“mealtime syndrome”. May be a palpable mass.
Tonsillitis
- Inflammation of the tonsils.
* Common in children, although can affect adults.
Tonsillitis: Signs, Symptoms and Complications
SIGNS & SYMPTOMS:
• Red, sore & painful tonsils, pus, fever over 38oC, coughing, headache.
COMPLICATIONS:
• Middle ear infections & abscess.
Tonsillitis: Treatment
Rest & hydrate, antibiotics
Tonsillectomy if repeated infections.
Sjogren’s Syndrome
Immune system attacking salivary system
Gastro-Oesophageal Reflux Disease: GORD
• The lower oesophageal sphincter relaxes and acid regurgitates from the stomach into the oesophagus.
GORD: Signs and Symptoms
- Retrosternal pain “heartburn”(can mimic a cardiac pathology) –aggravated by lying down.
- Belching.
GORD: Causes
- Obesity.
- Hiatus hernia (stomach pushed into thorax).
- Pregnancy (high intra abdominal pressure).
- Trigger foods -spicy, fatty foods, alcohol, caffeine, carbonated beverages, onions, chocolate.
- Stress.
GORD: Complications
•Damage to oesophageal mucosa increasing the risk of ulcers, Barrett’s oesophagus (pre-cancerous oesophageal cell changes) & cancer.
GORD: Treatment
• Antacids (some contain aluminium).
Hiatus Hernia
- Part of the stomach protrudes (herniates) into the thoracic cavity through an opening in the diaphragm.
- Estimated to affect 1/3 of people over 50.
Hiatus Hernia: Signs and Symptoms
• Often asymptomatic or GORD.
Hiatus Hernia: Causes
• Increased abdominal pressure: Heavy lifting, hard coughing/sneezing, pregnancy, childbirth, violent vomiting, straining with constipation, obesity, heredity, smoking, drug abuse, stress.
Hiatus Hernia: Complications
• Can cause gastro-oesophageal reflux disease (GORD).
Hiatus Hernia: Treatment
- Treat the cause.
- Manual therapy –visceral manipulation.
- Eating smaller, more frequent meals, avoiding foods & drinks that exacerbate symptoms.
- Avoiding lying down for three hours after eating.
Oesophageal Cancer
• A common aggressive tumour with a poor prognosis.
Oesophageal Cancer: Signs and Symptoms
- Few early symptoms, later obstruction may occur.
- Dysphagia(red flag!). - Difficulty swallowing
- Anorexia & melaena (due to bleeding in oesophagus) - black tarry stool .
Oesophageal Cancer: Causes and Risk Factors
- Chronic irritation, alcohol, smoking.
- GORD & Barrett’s oesophagus.
- Obesity, low fruit & veg diet, age
Acute Gastritis
- Acute inflammation of the stomach mucosa causing breakdown of the stomach lining.
- Insufficient mucous production (due to reduction of prostaglandin synthesis), which protects mucosa from erosion.
- Acute inflammation characterised by neutrophil infiltrate -> acute infection or inflamm. condition
Acute Gastritis: Causes
- Helicobacter pylori.
- NSAIDs(lower prostaglandin levels = reduces gastric mucosal barrier).
- Alcohol, food poisoning, stress.
Acute Gastritis: Signs and Symptoms
- Epigastric pain usually worse with food intake.
* Nausea/vomiting, loss of appetite
Acute Gastritis: Complications
• Bleeding and anaemia
Chronic Gastritis
- Chronic stomach mucosal inflammation for more than 4-6 weeks.
- Lymphocytes and macrophages in lamina propria.
- Prolonged low grade inflammation resulting in fibrosis and hence loss of elasticity and peristalsis.
- May be associated with ulcers.
Chronic Gastritis: Causes
- Autoimmune.
- Bacterial (H pylori).
- Chronic irritation (e.g. Long term NSAIDs).
Chronic Gastritis: Signs and Symptoms
- Few symptoms: Epigastric discomfort, feeling full and discomfort with heavy meals.
- Nausea and poor appetite.
Chronic Gastritis: Complications
- Anaemia: Megaloblastic, iron, pernicious.
* Gastric carcinoma.
Peptic Ulcer
- Ulcer of the GI mucosa (stomach, duodenum).
- Tissue erosion can be superficial or penetrate down to the submucosa or muscularis.
- Commonly affects the proximal duodenum and lesser curvature of the stomach.
Peptic Ulcer: Signs and Symptoms
- Gastric: epigastric pain, 30-60 mins after eating, less often at night.
- Duodenal: epigastric pain 2-3 hours after eating and at night.
- Pain mostly when stomach is empty.
- Burping, nausea, reaction to irritating food (alcohol, coffee, spicy food, fatty/fried food etc.)
Peptic Ulcer: Causes
- Helicobacter pylori(80%).
- NSAIDs (10%): disrupts mucous barrier, lowers stomach bicarbonate, disrupts blood flow.
- Stress(SNS dominance) can often cause ischaemia (resulting in defective tissue repair).
- Chronic gastritis.
Dumping Syndrome
- Loss of control of gastric emptying.
- Duodenum is filled with undigested food.
- Water drawn out from surrounding vessels causing sudden and urgent diarrhoea.
- Presence of carbohydrates -> elevated serum glucose -> excessive insulin release from the pancreas = reactive hypoglycemia(2-3 hrs later).
Dumping Syndrome: Causes
• Bariatric surgery (vagusnerve damage). Cholecystectomy, gastric bypass, gastrectomy etc.
Dumping Syndrome: Signs and Symptoms
- “Early dumping” (straight after meal): nausea, vomiting, bloating, cramping, diarrhoea, dizziness and fatigue.
- “Late dumping” (1-3 hours after meal): weakness, sweating and dizziness (due to hypoglycaemia).
Dumping Syndrome: Treatment
- Avoid refined carbs/sugar, separate fluids from meals, smaller more frequent meals.
- Supplement dietary fibre (blood glucose control).
Gastric Cancer
- 2nd cause of cancer related death in the world (highest prevalence in Korea and Japan –diet).
- 50% affects the pylorus& 25% the lesser curvature.
Gastric Cancer: Causes/Risk Factors
- Male, smoking, age (55yrs+).
- H. pylori infection.
- Diet rich in salted, pickled and smoked foods (N-nitroso compounds).
- Low fruit and vegetable diet.
Gastric Cancer: Diagnosis
• Blood in stool, endoscopy, biopsy.
Gastric Cancer: Signs and Symptoms
Early stages:
• Persistent indigestion, frequent burping, heartburn, feeling full quickly when eating, bloated, abdominal discomfort.
Advanced stages:
• Black blood in the stools, loss of appetite, weight loss, tiredness, anaemia, jaundice.
Gastic Cancer: Treatment
Gastrectomy, chemo/radiotherapy.
Appendicitis
- Inflammation of the appendix.
* The appendix becomes obstructed, usually by faecal matter.
Appendicitis: Signs and Symptoms
- Initially umbilical pain that may come and go.
- Within hours the pain travels to the right iliac fossa, becoming constant and severe.
- Rebound tenderness at McBurney’s Point and local muscle guarding.
- Pallor, sweating & fever, nausea, vomiting & diarrhoea.
- May have tachycardia, hypotension and septic shock.
Appendicitis: Diagnosis
- Rebound tenderness on palpation.
- CT scan.high ESR on blood tests.
- Hypotension.
Appendicitis: Treatment
- Surgery(appendectomy) & antibiotics are usually required.
- The most common surgical emergency.
Appendicitis: Complications
- Rupture: if pain subsides it usually indicates a rupture.
* Peritonitis: release of faecal matter can result in infection which spreads to peritoneum.
Dysentery
- Dysentery is an infection of the intestines that causes diarrhoea containing blood or mucus.
- It is a notifiable disease (required by law to be reported to government authorities).
- More prevalent in developing countries/poor sanitation –travellers.
Dysentery: Causes
• Bacterial(‘Shigella’)or amoebicvia faeco-oral contamination.
Dysentery: Signs and Symptoms
- Diarrhoea (watery stools) with mucus and blood.
* Cramping and possible nausea/vomiting.
Dysentery: Diagnosis
Stool microspopy
Dysentery: Treatment
- Anti-parasitic/anti-bacterial.
- Rehydration: fluid & mineral replacement.
- Herbs: antimicrobial & immune, probiotics.
- Colonic irrigation (to help rid of amoebic cysts).
Dysentery: Complications
• Dehydration-dangerous in small children, infants, pregnancy & elderly.
Small Intestinal Bacterial Overgrowth: SIBO
- Small Intestinal Bacterial Overgrowth (‘SIBO’) describes the overpopulation of microflora in the small intestines.
- The small intestines are not normally densely populated by microflora. In SIBO, bacterial growth is excessive and can lead to the production of hydrogenand methane gases as a result of carbohydrate use.
- As a result of excessive gas, patients often experience bloating, flatulence, belching, a loss of appetite and diarrhoea or constipation.
- SIBO could ultimately result in malabsorption, anaemia, as well as inflammation and increased small intestinal permeability.
Inflammatory Bowel Disease
• IBD describes two chronic inflammatory bowel diseases: ulcerative colitis & Crohn’s disease.
Ulcerative colitis:
• Restricted to the colon.
• Small ulcers develop on the colon lining which can become inflamed & infected producing blood & pus.
Crohn’s disease:
• Affects the entire GIT, from mouth to the anus.
• Most common in the terminal ileum.
• Transmural inflammation.
Inflammatory Bowel Disease: Signs and Symptoms
- Symptoms of Ulcerative Colitis and Crohn’s disease are similar. Most occurring between 15-35 years. Symptoms include:
- Rectal bleeding.
- Abdominal pain / cramps.
- Diarrhoea (with blood, mucous).
- Fever and fatigue.
- Nausea / vomiting.
- Delayed puberty or growth failure.
- Weight loss / inability to maintain weight.
- Indigestion, feel “blocked”.
- Anaemia (fatigue etc.)
Inflammatory Bowel Disease: Causes
- Suspected autoimmune, dietary links & genetic predisposition.
- Environmental triggers (e.g. antibiotics, infection) with defective immune system.
Inflammatory Bowel Disease: Complications
- Malnutrition (failure to thrive, growth, osteoporosis etc).
- Strictures (obstruction).
- Fistulas/ fissures. - overlapping sections of bowel which intersect
- Abcesses (pus).
- Toxic megacolon (non obstructive colon dilation with systemic toxicity).
- Malignancy(risk colorectal cancer).
Inflammatory Bowel Disease: Diagnosis
- Blood tests (inflammatory markers) & stool sample (calprotectin).
- Colonoscopy (& biopsy), sigmoidoscopy
Inflammatory Bowel Disease: Treatment
- Anti-inflammatories (steroids –often for long periods so significant side effects)
- Surgery (i.e. Resection)
Crohn’s Disease
Region affected: Anypart of the GIT but mostly the terminal ileum.
Distribution: Skip lesions.
Layers affected: All layers (transmural).
Key symptoms: Crampy abdominal pain(right). Loose semi solid stools.
Complications: Fistulas,abscess, obstruction, malabsorption.
Bowel wall: Cobblestone appearance.
Ulcerative Colitis
Region affected: Colon and rectum. Distribution: Proximally continuous. Layers affected: Mucosa only (‘ulcers’). Key symptoms: Abdominal pain(left), Bloody diarrhoea. Complications: Haemorrhage. Bowel wall: Thin wall.
Irritable Bowel Syndrome (IBS)
- A functional GI disorder characterised by lower abdominal discomfort & altered bowel habits.
- Absence of organic pathology: inflammation or specific tissue damage.
- Diagnosed according to ROME criteria: 3 months history of symptoms.
IBS: Signs and Symptoms
- Abdominal pain & cramping relieved by passing a stool.
- Diarrhoea, constipation or alternative between both.
- Bloating, painful flatulence, post-prandial urgency.
- Incomplete emptying of bowels and mucus in the stools.
IBS: Causes and Triggers
- Stress/emotional factors: central nervous system alterations in GI secretions, motility & pain sensitivity.
- GIT infection.
- Food allergy or intolerance.
- Altered microbiome, excessive antibiotic use.
IBS: Treatment
• Antispasmodics.
Diet: FODMAPs, non-refined
foods, avoid dairy & aggravating foods,
probiotics, fibre, peppermint, manage stress,
slippery elm, 5-HTP.
Coeliac Disease
- A common autoimmune condition where the body’s immune system attacks its own mucosa tissue in the small intestine in response to ingestion of gluten.
- It affects 1 in 100 people affected in the UK, all ethnic groups. However only 10-20% are diagnosed.
- It effects those genetic susceptible: HLA-DQ2 and DQ8.
- Gluten is a protein found in wheat, rye, spelt, barley, oats.
- Gluten is made up of two types of protein molecules: Gliadins & Glutenins.
Coeliac disease: Pathophysiology
- Gliadin is modified by tissue transglutaminase (tTG), an enzyme found in the mucosa of the small intestine.
- This modification is suggested to allow the protein to be more efficiently presented to the immune system.
- In Coeliac’s the immune system mistakenly identifies parts of gliadin & glutenin as foreign.
- Immune system produces antibodies and an inflammatory / immune reaction which strips the microvilli & villi, causing atrophy.
Coeliac Disease: Classic GI Signs and Symptoms
- Chronic diarrhoea (or constipation).
- Pale, foul smelling stools.
- Steatorrhoea (fatty stools).
- Bloating.
- Flatulence.
- Abdominal pain.
- Loss of appetite.
- Weight loss.
- Lactose intolerance (loss of brush border enzymes).
Coeliac Disease: Atypical extra-intestinal symptoms
- Lethargy, fatigue (iron deficiency anaemia) and irritability.
- Children not growing at the expected rate.
- Mouth ulcers.
- Neurological problems (anxiety, depression).
- Dermatitis herpetiformis.
- Muscle/joint pain.
- Osteopenia/osteoporosis.
- Infertility
Coeliac Disease: Diagnosis
- Blood test -anti-transglutaminase antibodies (IgA TTG).
- Stool test, endoscopy.
- Biopsy of the small intestinal mucosa is required for a definite diagnosis.
Coeliac Disease: Treatment
• Gluten free diet –avoiding wheat (including spelt & kamut), barley, rye.
Coeliac Disease: Complications
- Osteoporosis, anaemia (iron / B9/ B12).
* Bowel cancer.
Diverticulosis
• The presence of pea-sized pouches (diverticula), caused by herniation's of mucosa bulging out through the colon wall. • Usually due to constipation. • Most diverticula are asymptomatic.
Diverticulitis
• Faeces and food trapped in the pea-sized colon pouches and they become infected, inflamed (and bleed).
• More common >50 years.
• 15 to 25% of people with diverticulosis develop
diverticulitis.
Diverticulosis / Diverticulitis: Signs and Symptoms
• Bloating, abdominal pain & diarrhoea. Fever, chills.
Diverticulosis / Diverticulitis: Causes
- Low fibre diet (slow GI transit) -> straining->high intra-abdominal pressure.
- Weak connective tissue.
Diverticulosis / Diverticulitis: Complications
- Diverticulosis can develop into diverticulitis.
* Rupture –leaking into the peritoneum.
Diverticulosis / Diverticulitis: Treatment
Antibiotics & surgery may be recommended.
Hernia
• An internal part of the body pushes through a
weakness in the muscle or surrounding tissue wall.
Inguinal hernia
Hiatus hernia
Incisional hernia
Inguinal hernia
• A common type mostly affecting men. Appears as a swelling or lump in the groin (inguinal canal). • Often appear after straining – lifting, constipation, heavy coughing (high Intra abdominal pressure).
Hiatus hernia
• Portion of the stomach protrudes into the
thoracic cavity through an opening in the diaphragm.
• Rarely symptomatic, but can cause GORD.
Incisional hernia
• Occurs at the site of a previous incision in the abdominal wall
Hernia: Signs and Symptoms
- Swelling or lump in the groin (abdominal region).
- Pain may be noticeable with strain and disappears when lying down.
- If strangulation occurs (loss of blood supply or bowel obstruction) there may be necrosis.
Hernia: Treatment
- If no strangulation occurs, they often resolve within a few years.
- Surgery.
Colonic Polyps
• Benign epithelial growths of colonic mucosa.
Colonic Polyps: Signs and Symptoms
• Usually asymptomatic, occult blood in the stool.
Colonic Polyps: Diagnosis
Colonoscopy
Colonic Polyps: Complications
• May become malignant (<1% become malignant).
Colonic Polyps: Treatment
Surgery
Colorectal Cancer
- Malignant tumour that is locally invasive.
* May spread (metastasise) before growth produces symptoms (liver, lungs, brain, bone).
Colerectal Cancer: Signs and Symptoms
- Fluctuating bowel habits (constipation/diarrhoea)
* Blood (& mucous) in stools. Abdominal pain.
Colerectal Cancer: Causes
Strong link with a diet high in meat, low fibre, lack of Vitamin D. Polyps, family history.
Colerectal Cancer: Investigations
- Colonoscopy & biopsy. Stool analysis (occult blood (trace) & M2PK (turmor marker)).
- Blood test (CEA (tumor marker), inflammatory markers and low Hb).
Acute Pancreatitis
- Acute inflammation of the pancreas –a medical emergency.
* Enzymes (proteases) areactivated whilst still inside the pancreas leading to self digestion of pancreatic tissue.
Acute Pancreatitis
- Sudden extreme periumbilical pain, nausea, vomiting, diarrhoea, fever.
- Mild cases improve within a week.
Acute Pancreatitis: Causes
• Alcohol abuse, gall stones, cancer
Acute Pancreatitis: Diagnosis
• Serum amylase 3 x normal level; raised blood glucose.
Chronic Pancreatitis
- Chronic inflammationof the pancreas.
- Leading to permanent tissue changes (fibrosis& cysts) and obstruction of the common bile duct with calcified secretions.
Chronic Pancreatitis: Signs and Symptoms
- Repeated episodes ofabdominal pain.
* Fatty foul-smelling stools.
Chronic Pancreatitis: Causes
• 60% Long-term alcohol abuse, autoimmune pancreatitis, pancreatic duct obstruction, complication of cystic fibrosis, idiopathic.
Chronic Pancreatitis: Complications
Diabetes mellitus, pancreatic cancer, weight loss, malnutrition.
Pancreatic Cancer
- Common in older people, uncommon in people under 40 years with a poor prognosis.
- Most arise from the exocrine cells.
- Less commonly from endocrine Islet cells (‘pancreatic neuroendocrine tumour’).
- Approx. 60% metastatic at diagnosis.
Pancreatic Cancer: Causes
- Cause is unknown, but risks include: age, smoking, family history (germ line defects in 5-10%).
- Other health conditions (diabetes, chronic pancreatitis, H. pylori).
Pancreatic Cancer: Signs and Symptoms
- Asymptomatic early.
- Epigastric pain radiating to the back.
- Unexplainedweight loss, anorexia and fatigue.
- Jaundice.
- Post-prandial nausea.
- Glucose intolerance (neuroendocrine tumours).
Pancreatic Cancer: Treatment
• Surgery, chemotherapy, radiotherapy
Liver Cirrhosis
- Irreversible scarring of liver tissue due to long-term damage.
- Conversion of normal hepatocytes with fibrotic non-functional tissue.
- Scar tissue disrupts hepatic blood and bile flow. Can lead to ‘portal hypertension’.
- “Liver failure” = 80-90% destruction of functional liver tissue.
Liver Cirrhosis: Causes
- Alcoholic liver disease.
- Hepatitis B/C.
- Bile obstruction, autoimmune liver disease, long-term exposure to toxins.
Liver Cirrhosis: Effects
- Reduced ability to synthesise substances (i.e. clotting factors).
- Decreased removal & conjugation of bilirubin.
- Impaired nutrient absorption.
- Impaired glucose metabolism.
- Decreased inactivation of hormones.
- Decreased removal of toxic substances.
Liver Cirrhosis: Signs and Symptoms
Jaundice: Impaired conjugation of bilirubin & decreased bile flow
Fatigue, loss of appetite: Decreased gluconeogenesis,
decreased bile(digestion)
Itchy skin: Bile salts back up into blood/tissues
Anaemia: decreased Iron storage
Oesophagealvarices& splenomegaly: Portal vein hypertension
Gynaecomastia: Impaired inactivation of sex hormones
Ascites & peripheral oedema: Portal hypertension causing shift of fluid, lymph obstruction
Vomiting blood / dark tarry stools: Oesophageal varices, occult blood
Liver Cirrhosis: Investgation/Treatment
INVESTIGATIONS: • Blood tests (raised liver enzymes i.e. ALT & AST). • Ultrasound, biopsy. ALLOPATHIC TREATMENT: • Liver transplant.
Liver Cancer: Causes
- Associated with liver cirrhosis: alcohol, toxins -> necrosis -> chronic inflammation and cell proliferation (turnover).
- Hepatitis B/C -> viral integration into host genome (host DNA deletions; oncogenes activated)
Liver Cancer: Treatment
Surgery
Transplant
Gallstones
• One or more stones in the gallbladder.
• Usually made of cholesterol (80%).
• In developed countries at least 10–20% of adults
and over 20% of people over 65 years old have
gallstones.
Gallstones: Signs and Symptoms
• 70% asymptomatic at diagnosis.
• Biliary colic (pain radiating under right shoulder,
mostly at 1-2 am.
• Abdominal pain/shoulder pain, jaundice, fever,
bloating, nausea.
Gallstones: Causes/Risk Factors
- 5F’s (fat, female, forty, fair, fertile).
- Increasing age, pregnancy, obesity, diabetes, hereditary link, women, taking oestrogen or OCP, liver cirrhosis, age, rapid weight loss.
Gallstones: Treatment
Surgery
Gallstones: Complications
• Acute cholecystitis, jaundice, acute cholangitis, acute pancreatitis, gallbladder cancer
Enterobiasis (pin/thread worm)
- A parasitic ‘Helminth’ infection with a lifespan of approximately 2 months.
- Eggs are ingested (faeco-oral) and hatch in the duodenum within 6 hours.
- Worms mature in 2 weeks and commonly inhabit the terminal ileum andlarge intestine.
- Female worms migrates to the rectum and if not expelled, migrate to the anus at night and deposits eggs.
- Very common amongst children under age 10 & institutionalised adults, but can affect all people.
Enterobiasis (pin/thread worm): Signs and Symptoms
- Can be asymptomatic, intense itching around the anus or vagina particularly at night (when female worms are laying eggs).
- Loss of appetite, weight loss, insomnia.
- Skin infection around the anus
Enterobiasis: Causes
Faeco-oral contamination
Enterobiasis: Treatment
Anti-parasitic: 2 doses apart to kill eggs too. Whole family may be treated
Toxoplasmosis
- Intracellular protozoan parasite
- Main host = cats (can only reproduce in the intestines of a cat).
- 10-20% of UK population estimated to carry the parasite as cysts.
- Many carriers are asymptomatic (immune system contains the illness).
- Significant healthrisks during pregnancy; infection of the foetus.
- A self-limiting disease that only requires treatment if pregnant or immunocompromised.
Toxoplasmosis: Causes/Risks
- Eating under cooked meats, poor food hygiene.
- Handling cat litter trays.
- (Rarely) blood transfusion, organ transplant.
- Immunocompromised.
Toxoplasmosis: Signs and Symptoms
(often asymptomatic)
• Mild flu-like symptoms, tender lymph nodes, fever, muscle aches, lethargy.
• Miscarriage, stillborn child.
• Can cause encephalitis and schizophrenia