8. Digestive System Pathologies Flashcards
1
Q
Oral Thrush
A
- A fungal infection of the mouth which is not contagious and a sign of low immunity.
- Risk of spread (systemic candidiasis).
2
Q
Oral Thrush: Causes
A
- 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).
3
Q
Oral Thrush: Signs and Symptoms
A
- 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.
4
Q
Oral Thrush: Treatment
A
Antifungals
5
Q
Mouth Ulcer
A
• Areas of ulceration within the oral cavity
that are generally painful (loss of the
mucosal layer).
6
Q
Mouth Ulcer: Causes
A
- 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.
7
Q
Mouth Ulcers: Treatment
A
• Treat the cause. Correct nutritional status,
improve immunity, probiotics.
8
Q
Cold Sores
A
- 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.
9
Q
Cold Sores: Causes
A
- Herpes simplex virus (normally Type I).
* Triggers include stress, steroid use, trauma, local infections, sunlight exposure.
10
Q
Cold Sores: Signs and Symptoms
A
- Tingling, itching, burning sensation around the mouth.
* Small fluid-filled sores then appear most commonly on the lower lip.
11
Q
Cold Sores: Treatment
A
• Antiviral creams (acyclovir).
12
Q
Absess
A
- A localised pocket of pus surrounded by inflammation (can occur anywhere).
- A defensive reaction of the tissue to prevent spread of infection elsewhere.
13
Q
Absess: Signs and Symptoms
A
- Pain, redness, local swelling.
* Fever, malaise
14
Q
Absess: Treatment
A
Antibiotics
Drainage
15
Q
Gingivitis and Periodontal Disease
A
• Gingivitis is a bacterial infection of the gums.
• If left untreated, gingivitis may progress to
periodontal disease (pathology of the bone
around teeth).
16
Q
Gingivitis and Periodontal Disease: Symptoms
A
Bleeding and receding gums
17
Q
Gingivitis and Periodontal Disease: Causes
A
- Plaque build up, poor dental hygiene, dental amalgams.
- Longterm steroid medication use.
- Diabetes mellitus.
- Smokers.
- Poor nutrition (high in refined sugars, low anti-oxidant).
18
Q
Anglar Stomatitis
A
- 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.
19
Q
Angular Stomatitis: Causes
A
- Vitamin B deficiencies: Riboflavin (B2) & folic acid (B9).
- Iron deficiency.
- Candida albicans (opportunistic) and staphylococcus.
20
Q
Xerostomia
A
- Dry mouth due to reduced/absent flow saliva.
* A common complaint in the elderly(20%).
21
Q
Xerostomia: Signs and Symptoms
A
- Dry mouth
- burning sensation
- halitosis (bad breath)
- Speech & swallowing interference.
22
Q
Xerostomia: Causes and Complications
A
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.
23
Q
Cleft Lip
A
- 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).
24
Q
Cleft Palate
A
- 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).
25
Oral Cancer
* Carcinoma of the oral mucosa, lip or tongue.
| * Accounts for 1 in 50 of all cancer cases.
26
Oral Cancer: Causes
* Smoking (including pipes, chewing tobacco).
| * Alcohol, HPV infection.
27
Oral Cancer: Signs and Symptoms
* Red or white patches on oral mucosa or tongue.
| * Difficulty eating and breathing.
28
Oral Cancer: Treatment
• Allopathic: Surgery, chemotherapy, radiotherapy
29
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.
30
Salivary Calculi: Causes
* Dehydration. Abnormal calcium metabolism.
| * Sjögren's syndrome, chronic salivary duct infections.
31
Salivary Calculi: Signs and Symptoms
• Intermittent pain and swelling of the affected gland, particular when eating –“mealtime syndrome”. May be a palpable mass.
32
Tonsillitis
* Inflammation of the tonsils.
| * Common in children, although can affect adults.
33
Tonsillitis: Signs, Symptoms and Complications
SIGNS & SYMPTOMS:
• Red, sore & painful tonsils, pus, fever over 38oC, coughing, headache.
COMPLICATIONS:
• Middle ear infections & abscess.
34
Tonsillitis: Treatment
Rest & hydrate, antibiotics
| Tonsillectomy if repeated infections.
35
Sjogren's Syndrome
Immune system attacking salivary system
36
Gastro-Oesophageal Reflux Disease: GORD
• The lower oesophageal sphincter relaxes and acid regurgitates from the stomach into the oesophagus.
37
GORD: Signs and Symptoms
* Retrosternal pain “heartburn”(can mimic a cardiac pathology) –aggravated by lying down.
* Belching.
38
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.
39
GORD: Complications
•Damage to oesophageal mucosa increasing the risk of ulcers, Barrett’s oesophagus (pre-cancerous oesophageal cell changes) & cancer.
40
GORD: Treatment
• Antacids (some contain aluminium).
41
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.
42
Hiatus Hernia: Signs and Symptoms
• Often asymptomatic or GORD.
43
Hiatus Hernia: Causes
• Increased abdominal pressure: Heavy lifting, hard coughing/sneezing, pregnancy, childbirth, violent vomiting, straining with constipation, obesity, heredity, smoking, drug abuse, stress.
44
Hiatus Hernia: Complications
• Can cause gastro-oesophageal reflux disease (GORD).
45
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.
46
Oesophageal Cancer
• A common aggressive tumour with a poor prognosis.
47
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 .
48
Oesophageal Cancer: Causes and Risk Factors
* Chronic irritation, alcohol, smoking.
* GORD & Barrett’s oesophagus.
* Obesity, low fruit & veg diet, age
49
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
50
Acute Gastritis: Causes
* Helicobacter pylori.
* NSAIDs(lower prostaglandin levels = reduces gastric mucosal barrier).
* Alcohol, food poisoning, stress.
51
Acute Gastritis: Signs and Symptoms
* Epigastric pain usually worse with food intake.
| * Nausea/vomiting, loss of appetite
52
Acute Gastritis: Complications
• Bleeding and anaemia
53
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.
54
Chronic Gastritis: Causes
1. Autoimmune.
2. Bacterial (H pylori).
3. Chronic irritation (e.g. Long term NSAIDs).
55
Chronic Gastritis: Signs and Symptoms
* Few symptoms: Epigastric discomfort, feeling full and discomfort with heavy meals.
* Nausea and poor appetite.
56
Chronic Gastritis: Complications
* Anaemia: Megaloblastic, iron, pernicious.
| * Gastric carcinoma.
57
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.
58
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.)
59
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.
60
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).
61
Dumping Syndrome: Causes
• Bariatric surgery (vagusnerve damage). Cholecystectomy, gastric bypass, gastrectomy etc.
62
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).
63
Dumping Syndrome: Treatment
* Avoid refined carbs/sugar, separate fluids from meals, smaller more frequent meals.
* Supplement dietary fibre (blood glucose control).
64
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.
65
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.
66
Gastric Cancer: Diagnosis
• Blood in stool, endoscopy, biopsy.
67
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.
68
Gastic Cancer: Treatment
Gastrectomy, chemo/radiotherapy.
69
Appendicitis
* Inflammation of the appendix.
| * The appendix becomes obstructed, usually by faecal matter.
70
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.
71
Appendicitis: Diagnosis
* Rebound tenderness on palpation.
* CT scan.high ESR on blood tests.
* Hypotension.
72
Appendicitis: Treatment
* Surgery(appendectomy) & antibiotics are usually required.
* The most common surgical emergency.
73
Appendicitis: Complications
* Rupture: if pain subsides it usually indicates a rupture.
| * Peritonitis: release of faecal matter can result in infection which spreads to peritoneum.
74
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.
75
Dysentery: Causes
• Bacterial(‘Shigella’)or amoebicvia faeco-oral contamination.
76
Dysentery: Signs and Symptoms
* Diarrhoea (watery stools) with mucus and blood.
| * Cramping and possible nausea/vomiting.
77
Dysentery: Diagnosis
Stool microspopy
78
Dysentery: Treatment
* Anti-parasitic/anti-bacterial.
* Rehydration: fluid & mineral replacement.
* Herbs: antimicrobial & immune, probiotics.
* Colonic irrigation (to help rid of amoebic cysts).
79
Dysentery: Complications
• Dehydration-dangerous in small children, infants, pregnancy & elderly.
80
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.
81
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.
82
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.)
83
Inflammatory Bowel Disease: Causes
* Suspected autoimmune, dietary links & genetic predisposition.
* Environmental triggers (e.g. antibiotics, infection) with defective immune system.
84
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).
85
Inflammatory Bowel Disease: Diagnosis
* Blood tests (inflammatory markers) & stool sample (calprotectin).
* Colonoscopy (& biopsy), sigmoidoscopy
86
Inflammatory Bowel Disease: Treatment
* Anti-inflammatories (steroids –often for long periods so significant side effects)
* Surgery (i.e. Resection)
87
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.
88
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.
```
89
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.
90
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.
91
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.
92
IBS: Treatment
• Antispasmodics.
Diet: FODMAPs, non-refined
foods, avoid dairy & aggravating foods,
probiotics, fibre, peppermint, manage stress,
slippery elm, 5-HTP.
93
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.
94
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.
95
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).
96
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
97
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.
98
Coeliac Disease: Treatment
• Gluten free diet –avoiding wheat (including spelt & kamut), barley, rye.
99
Coeliac Disease: Complications
* Osteoporosis, anaemia (iron / B9/ B12).
| * Bowel cancer.
100
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.
```
101
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.
102
Diverticulosis / Diverticulitis: Signs and Symptoms
• Bloating, abdominal pain & diarrhoea. Fever, chills.
103
Diverticulosis / Diverticulitis: Causes
* Low fibre diet (slow GI transit) -> straining->high intra-abdominal pressure.
* Weak connective tissue.
104
Diverticulosis / Diverticulitis: Complications
* Diverticulosis can develop into diverticulitis.
| * Rupture –leaking into the peritoneum.
105
Diverticulosis / Diverticulitis: Treatment
Antibiotics & surgery may be recommended.
106
Hernia
• An internal part of the body pushes through a
weakness in the muscle or surrounding tissue wall.
Inguinal hernia
Hiatus hernia
Incisional hernia
107
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).
```
108
Hiatus hernia
• Portion of the stomach protrudes into the
thoracic cavity through an opening in the diaphragm.
• Rarely symptomatic, but can cause GORD.
109
Incisional hernia
• Occurs at the site of a previous incision in the abdominal wall
110
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.
111
Hernia: Treatment
* If no strangulation occurs, they often resolve within a few years.
* Surgery.
112
Colonic Polyps
• Benign epithelial growths of colonic mucosa.
113
Colonic Polyps: Signs and Symptoms
• Usually asymptomatic, occult blood in the stool.
114
Colonic Polyps: Diagnosis
Colonoscopy
115
Colonic Polyps: Complications
• May become malignant (<1% become malignant).
116
Colonic Polyps: Treatment
Surgery
117
Colorectal Cancer
* Malignant tumour that is locally invasive.
| * May spread (metastasise) before growth produces symptoms (liver, lungs, brain, bone).
118
Colerectal Cancer: Signs and Symptoms
* Fluctuating bowel habits (constipation/diarrhoea)
| * Blood (& mucous) in stools. Abdominal pain.
119
Colerectal Cancer: Causes
Strong link with a diet high in meat, low fibre, lack of Vitamin D. Polyps, family history.
120
Colerectal Cancer: Investigations
* Colonoscopy & biopsy. Stool analysis (occult blood (trace) & M2PK (turmor marker)).
* Blood test (CEA (tumor marker), inflammatory markers and low Hb).
121
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.
122
Acute Pancreatitis
* Sudden extreme periumbilical pain, nausea, vomiting, diarrhoea, fever.
* Mild cases improve within a week.
123
Acute Pancreatitis: Causes
• Alcohol abuse, gall stones, cancer
124
Acute Pancreatitis: Diagnosis
• Serum amylase 3 x normal level; raised blood glucose.
125
Chronic Pancreatitis
* Chronic inflammationof the pancreas.
* Leading to permanent tissue changes (fibrosis& cysts) and obstruction of the common bile duct with calcified secretions.
126
Chronic Pancreatitis: Signs and Symptoms
* Repeated episodes ofabdominal pain.
| * Fatty foul-smelling stools.
127
Chronic Pancreatitis: Causes
• 60% Long-term alcohol abuse, autoimmune pancreatitis, pancreatic duct obstruction, complication of cystic fibrosis, idiopathic.
128
Chronic Pancreatitis: Complications
Diabetes mellitus, pancreatic cancer, weight loss, malnutrition.
129
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.
130
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).
131
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).
132
Pancreatic Cancer: Treatment
• Surgery, chemotherapy, radiotherapy
133
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.
134
Liver Cirrhosis: Causes
* Alcoholic liver disease.
* Hepatitis B/C.
* Bile obstruction, autoimmune liver disease, long-term exposure to toxins.
135
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.
136
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
137
Liver Cirrhosis: Investgation/Treatment
```
INVESTIGATIONS:
• Blood tests (raised liver enzymes i.e. ALT & AST).
• Ultrasound, biopsy.
ALLOPATHIC TREATMENT:
• Liver transplant.
```
138
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)
139
Liver Cancer: Treatment
Surgery
| Transplant
140
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.
141
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.
142
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.
143
Gallstones: Treatment
Surgery
144
Gallstones: Complications
• Acute cholecystitis, jaundice, acute cholangitis, acute pancreatitis, gallbladder cancer
145
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.
146
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
147
Enterobiasis: Causes
Faeco-oral contamination
148
Enterobiasis: Treatment
Anti-parasitic: 2 doses apart to kill eggs too. Whole family may be treated
149
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.
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Toxoplasmosis: Causes/Risks
* Eating under cooked meats, poor food hygiene.
* Handling cat litter trays.
* (Rarely) blood transfusion, organ transplant.
* Immunocompromised.
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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
