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Biomedicine I > 8. Digestive System Pathologies > Flashcards

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).
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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).
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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.
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4
Q

Oral Thrush: Treatment

A

Antifungals

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5
Q

Mouth Ulcer

A

• Areas of ulceration within the oral cavity
that are generally painful (loss of the
mucosal layer).

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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.
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7
Q

Mouth Ulcers: Treatment

A

• Treat the cause. Correct nutritional status,

improve immunity, probiotics.

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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.
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9
Q

Cold Sores: Causes

A
  • Herpes simplex virus (normally Type I).

* Triggers include stress, steroid use, trauma, local infections, sunlight exposure.

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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.

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11
Q

Cold Sores: Treatment

A

• Antiviral creams (acyclovir).

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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.
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13
Q

Absess: Signs and Symptoms

A
  • Pain, redness, local swelling.

* Fever, malaise

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14
Q

Absess: Treatment

A

Antibiotics

Drainage

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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).

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16
Q

Gingivitis and Periodontal Disease: Symptoms

A

Bleeding and receding gums

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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).
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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.
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19
Q

Angular Stomatitis: Causes

A
  • Vitamin B deficiencies: Riboflavin (B2) & folic acid (B9).
  • Iron deficiency.
  • Candida albicans (opportunistic) and staphylococcus.
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20
Q

Xerostomia

A
  • Dry mouth due to reduced/absent flow saliva.

* A common complaint in the elderly(20%).

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21
Q

Xerostomia: Signs and Symptoms

A
  • Dry mouth
  • burning sensation
  • halitosis (bad breath)
  • Speech & swallowing interference.
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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.

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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).
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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).
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25
Q

Oral Cancer

A
  • Carcinoma of the oral mucosa, lip or tongue.

* Accounts for 1 in 50 of all cancer cases.

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26
Q

Oral Cancer: Causes

A
  • Smoking (including pipes, chewing tobacco).

* Alcohol, HPV infection.

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27
Q

Oral Cancer: Signs and Symptoms

A
  • Red or white patches on oral mucosa or tongue.

* Difficulty eating and breathing.

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28
Q

Oral Cancer: Treatment

A

• Allopathic: Surgery, chemotherapy, radiotherapy

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29
Q

Salivary Calculi

A
  • 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.
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30
Q

Salivary Calculi: Causes

A
  • Dehydration. Abnormal calcium metabolism.

* Sjögren’s syndrome, chronic salivary duct infections.

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31
Q

Salivary Calculi: Signs and Symptoms

A

• Intermittent pain and swelling of the affected gland, particular when eating –“mealtime syndrome”. May be a palpable mass.

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32
Q

Tonsillitis

A
  • Inflammation of the tonsils.

* Common in children, although can affect adults.

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33
Q

Tonsillitis: Signs, Symptoms and Complications

A

SIGNS & SYMPTOMS:
• Red, sore & painful tonsils, pus, fever over 38oC, coughing, headache.
COMPLICATIONS:
• Middle ear infections & abscess.

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34
Q

Tonsillitis: Treatment

A

Rest & hydrate, antibiotics

Tonsillectomy if repeated infections.

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35
Q

Sjogren’s Syndrome

A

Immune system attacking salivary system

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36
Q

Gastro-Oesophageal Reflux Disease: GORD

A

• The lower oesophageal sphincter relaxes and acid regurgitates from the stomach into the oesophagus.

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37
Q

GORD: Signs and Symptoms

A
  • Retrosternal pain “heartburn”(can mimic a cardiac pathology) –aggravated by lying down.
  • Belching.
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38
Q

GORD: Causes

A
  • Obesity.
  • Hiatus hernia (stomach pushed into thorax).
  • Pregnancy (high intra abdominal pressure).
  • Trigger foods -spicy, fatty foods, alcohol, caffeine, carbonated beverages, onions, chocolate.
  • Stress.
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39
Q

GORD: Complications

A

•Damage to oesophageal mucosa increasing the risk of ulcers, Barrett’s oesophagus (pre-cancerous oesophageal cell changes) & cancer.

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40
Q

GORD: Treatment

A

• Antacids (some contain aluminium).

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41
Q

Hiatus Hernia

A
  • 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.
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42
Q

Hiatus Hernia: Signs and Symptoms

A

• Often asymptomatic or GORD.

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43
Q

Hiatus Hernia: Causes

A

• Increased abdominal pressure: Heavy lifting, hard coughing/sneezing, pregnancy, childbirth, violent vomiting, straining with constipation, obesity, heredity, smoking, drug abuse, stress.

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44
Q

Hiatus Hernia: Complications

A

• Can cause gastro-oesophageal reflux disease (GORD).

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45
Q

Hiatus Hernia: Treatment

A
  • 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.
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46
Q

Oesophageal Cancer

A

• A common aggressive tumour with a poor prognosis.

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47
Q

Oesophageal Cancer: Signs and Symptoms

A
  • Few early symptoms, later obstruction may occur.
  • Dysphagia(red flag!). - Difficulty swallowing
  • Anorexia & melaena (due to bleeding in oesophagus) - black tarry stool .
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48
Q

Oesophageal Cancer: Causes and Risk Factors

A
  • Chronic irritation, alcohol, smoking.
  • GORD & Barrett’s oesophagus.
  • Obesity, low fruit & veg diet, age
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49
Q

Acute Gastritis

A
  • 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
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50
Q

Acute Gastritis: Causes

A
  • Helicobacter pylori.
  • NSAIDs(lower prostaglandin levels = reduces gastric mucosal barrier).
  • Alcohol, food poisoning, stress.
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51
Q

Acute Gastritis: Signs and Symptoms

A
  • Epigastric pain usually worse with food intake.

* Nausea/vomiting, loss of appetite

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52
Q

Acute Gastritis: Complications

A

• Bleeding and anaemia

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53
Q

Chronic Gastritis

A
  • 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.
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54
Q

Chronic Gastritis: Causes

A
  1. Autoimmune.
  2. Bacterial (H pylori).
  3. Chronic irritation (e.g. Long term NSAIDs).
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55
Q

Chronic Gastritis: Signs and Symptoms

A
  • Few symptoms: Epigastric discomfort, feeling full and discomfort with heavy meals.
  • Nausea and poor appetite.
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56
Q

Chronic Gastritis: Complications

A
  • Anaemia: Megaloblastic, iron, pernicious.

* Gastric carcinoma.

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57
Q

Peptic Ulcer

A
  • 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.
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58
Q

Peptic Ulcer: Signs and Symptoms

A
  • 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.)
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59
Q

Peptic Ulcer: Causes

A
  • 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.
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60
Q

Dumping Syndrome

A
  • 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).
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61
Q

Dumping Syndrome: Causes

A

• Bariatric surgery (vagusnerve damage). Cholecystectomy, gastric bypass, gastrectomy etc.

62
Q

Dumping Syndrome: Signs and Symptoms

A
  • “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
Q

Dumping Syndrome: Treatment

A
  • Avoid refined carbs/sugar, separate fluids from meals, smaller more frequent meals.
  • Supplement dietary fibre (blood glucose control).
64
Q

Gastric Cancer

A
  • 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
Q

Gastric Cancer: Causes/Risk Factors

A
  • Male, smoking, age (55yrs+).
  • H. pylori infection.
  • Diet rich in salted, pickled and smoked foods (N-nitroso compounds).
  • Low fruit and vegetable diet.
66
Q

Gastric Cancer: Diagnosis

A

• Blood in stool, endoscopy, biopsy.

67
Q

Gastric Cancer: Signs and Symptoms

A

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
Q

Gastic Cancer: Treatment

A

Gastrectomy, chemo/radiotherapy.

69
Q

Appendicitis

A
  • Inflammation of the appendix.

* The appendix becomes obstructed, usually by faecal matter.

70
Q

Appendicitis: Signs and Symptoms

A
  • 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
Q

Appendicitis: Diagnosis

A
  • Rebound tenderness on palpation.
  • CT scan.high ESR on blood tests.
  • Hypotension.
72
Q

Appendicitis: Treatment

A
  • Surgery(appendectomy) & antibiotics are usually required.
  • The most common surgical emergency.
73
Q

Appendicitis: Complications

A
  • Rupture: if pain subsides it usually indicates a rupture.

* Peritonitis: release of faecal matter can result in infection which spreads to peritoneum.

74
Q

Dysentery

A
  • 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
Q

Dysentery: Causes

A

• Bacterial(‘Shigella’)or amoebicvia faeco-oral contamination.

76
Q

Dysentery: Signs and Symptoms

A
  • Diarrhoea (watery stools) with mucus and blood.

* Cramping and possible nausea/vomiting.

77
Q

Dysentery: Diagnosis

A

Stool microspopy

78
Q

Dysentery: Treatment

A
  • Anti-parasitic/anti-bacterial.
  • Rehydration: fluid & mineral replacement.
  • Herbs: antimicrobial & immune, probiotics.
  • Colonic irrigation (to help rid of amoebic cysts).
79
Q

Dysentery: Complications

A

• Dehydration-dangerous in small children, infants, pregnancy & elderly.

80
Q

Small Intestinal Bacterial Overgrowth: SIBO

A
  • 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
Q

Inflammatory Bowel Disease

A

• 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
Q

Inflammatory Bowel Disease: Signs and Symptoms

A
  • 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
Q

Inflammatory Bowel Disease: Causes

A
  • Suspected autoimmune, dietary links & genetic predisposition.
  • Environmental triggers (e.g. antibiotics, infection) with defective immune system.
84
Q

Inflammatory Bowel Disease: Complications

A
  • 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
Q

Inflammatory Bowel Disease: Diagnosis

A
  • Blood tests (inflammatory markers) & stool sample (calprotectin).
  • Colonoscopy (& biopsy), sigmoidoscopy
86
Q

Inflammatory Bowel Disease: Treatment

A
  • Anti-inflammatories (steroids –often for long periods so significant side effects)
  • Surgery (i.e. Resection)
87
Q

Crohn’s Disease

A

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
Q

Ulcerative Colitis

A 
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
Q

Irritable Bowel Syndrome (IBS)

A
  • 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
Q

IBS: Signs and Symptoms

A
  • 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
Q

IBS: Causes and Triggers

A
  • 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
Q

IBS: Treatment

A

• Antispasmodics.
Diet: FODMAPs, non-refined
foods, avoid dairy & aggravating foods,
probiotics, fibre, peppermint, manage stress,
slippery elm, 5-HTP.

93
Q

Coeliac Disease

A
  • 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
Q

Coeliac disease: Pathophysiology

A
  • 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
Q

Coeliac Disease: Classic GI Signs and Symptoms

A
  • 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
Q

Coeliac Disease: Atypical extra-intestinal symptoms

A
  • 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
Q

Coeliac Disease: Diagnosis

A
  • Blood test -anti-transglutaminase antibodies (IgA TTG).
  • Stool test, endoscopy.
  • Biopsy of the small intestinal mucosa is required for a definite diagnosis.
98
Q

Coeliac Disease: Treatment

A

• Gluten free diet –avoiding wheat (including spelt & kamut), barley, rye.

99
Q

Coeliac Disease: Complications

A
  • Osteoporosis, anaemia (iron / B9/ B12).

* Bowel cancer.

100
Q

Diverticulosis

A 
• 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
Q

Diverticulitis

A

• 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
Q

Diverticulosis / Diverticulitis: Signs and Symptoms

A

• Bloating, abdominal pain & diarrhoea. Fever, chills.

103
Q

Diverticulosis / Diverticulitis: Causes

A
  • Low fibre diet (slow GI transit) -> straining->high intra-abdominal pressure.
  • Weak connective tissue.
104
Q

Diverticulosis / Diverticulitis: Complications

A
  • Diverticulosis can develop into diverticulitis.

* Rupture –leaking into the peritoneum.

105
Q

Diverticulosis / Diverticulitis: Treatment

A

Antibiotics & surgery may be recommended.

106
Q

Hernia

A

• An internal part of the body pushes through a
weakness in the muscle or surrounding tissue wall.
Inguinal hernia
Hiatus hernia
Incisional hernia

107
Q

Inguinal hernia

A 
• 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
Q

Hiatus hernia

A

• Portion of the stomach protrudes into the
thoracic cavity through an opening in the diaphragm.
• Rarely symptomatic, but can cause GORD.

109
Q

Incisional hernia

A

• Occurs at the site of a previous incision in the abdominal wall

110
Q

Hernia: Signs and Symptoms

A
  • 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
Q

Hernia: Treatment

A
  • If no strangulation occurs, they often resolve within a few years.
  • Surgery.
112
Q

Colonic Polyps

A

• Benign epithelial growths of colonic mucosa.

113
Q

Colonic Polyps: Signs and Symptoms

A

• Usually asymptomatic, occult blood in the stool.

114
Q

Colonic Polyps: Diagnosis

A

Colonoscopy

115
Q

Colonic Polyps: Complications

A

• May become malignant (<1% become malignant).

116
Q

Colonic Polyps: Treatment

117
Q

Colorectal Cancer

A
  • Malignant tumour that is locally invasive.

* May spread (metastasise) before growth produces symptoms (liver, lungs, brain, bone).

118
Q

Colerectal Cancer: Signs and Symptoms

A
  • Fluctuating bowel habits (constipation/diarrhoea)

* Blood (& mucous) in stools. Abdominal pain.

119
Q

Colerectal Cancer: Causes

A

Strong link with a diet high in meat, low fibre, lack of Vitamin D. Polyps, family history.

120
Q

Colerectal Cancer: Investigations

A
  • Colonoscopy & biopsy. Stool analysis (occult blood (trace) & M2PK (turmor marker)).
  • Blood test (CEA (tumor marker), inflammatory markers and low Hb).
121
Q

Acute Pancreatitis

A
  • Acute inflammation of the pancreas –a medical emergency.

* Enzymes (proteases) areactivated whilst still inside the pancreas leading to self digestion of pancreatic tissue.

122
Q

Acute Pancreatitis

A
  • Sudden extreme periumbilical pain, nausea, vomiting, diarrhoea, fever.
  • Mild cases improve within a week.
123
Q

Acute Pancreatitis: Causes

A

• Alcohol abuse, gall stones, cancer

124
Q

Acute Pancreatitis: Diagnosis

A

• Serum amylase 3 x normal level; raised blood glucose.

125
Q

Chronic Pancreatitis

A
  • Chronic inflammationof the pancreas.
  • Leading to permanent tissue changes (fibrosis& cysts) and obstruction of the common bile duct with calcified secretions.
126
Q

Chronic Pancreatitis: Signs and Symptoms

A
  • Repeated episodes ofabdominal pain.

* Fatty foul-smelling stools.

127
Q

Chronic Pancreatitis: Causes

A

• 60% Long-term alcohol abuse, autoimmune pancreatitis, pancreatic duct obstruction, complication of cystic fibrosis, idiopathic.

128
Q

Chronic Pancreatitis: Complications

A

Diabetes mellitus, pancreatic cancer, weight loss, malnutrition.

129
Q

Pancreatic Cancer

A
  • 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
Q

Pancreatic Cancer: Causes

A
  • 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
Q

Pancreatic Cancer: Signs and Symptoms

A
  • Asymptomatic early.
  • Epigastric pain radiating to the back.
  • Unexplainedweight loss, anorexia and fatigue.
  • Jaundice.
  • Post-prandial nausea.
  • Glucose intolerance (neuroendocrine tumours).
132
Q

Pancreatic Cancer: Treatment

A

• Surgery, chemotherapy, radiotherapy

133
Q

Liver Cirrhosis

A
  • 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
Q

Liver Cirrhosis: Causes

A
  • Alcoholic liver disease.
  • Hepatitis B/C.
  • Bile obstruction, autoimmune liver disease, long-term exposure to toxins.
135
Q

Liver Cirrhosis: Effects

A
  • 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
Q

Liver Cirrhosis: Signs and Symptoms

A

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
Q

Liver Cirrhosis: Investgation/Treatment

A 
INVESTIGATIONS:
• Blood tests (raised liver enzymes i.e. ALT &amp; AST).
• Ultrasound, biopsy.
ALLOPATHIC TREATMENT:
• Liver transplant.
138
Q

Liver Cancer: Causes

A
  • 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
Q

Liver Cancer: Treatment

A

Surgery

Transplant

140
Q

Gallstones

A

• 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
Q

Gallstones: Signs and Symptoms

A

• 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
Q

Gallstones: Causes/Risk Factors

A
  • 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
Q

Gallstones: Treatment

144
Q

Gallstones: Complications

A

• Acute cholecystitis, jaundice, acute cholangitis, acute pancreatitis, gallbladder cancer

145
Q

Enterobiasis (pin/thread worm)

A
  • 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
Q

Enterobiasis (pin/thread worm): Signs and Symptoms

A
  • 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
Q

Enterobiasis: Causes

A

Faeco-oral contamination

148
Q

Enterobiasis: Treatment

A

Anti-parasitic: 2 doses apart to kill eggs too. Whole family may be treated

149
Q

Toxoplasmosis

A
  • 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.
150
Q

Toxoplasmosis: Causes/Risks

A
  • Eating under cooked meats, poor food hygiene.
  • Handling cat litter trays.
  • (Rarely) blood transfusion, organ transplant.
  • Immunocompromised.
151
Q

Toxoplasmosis: Signs and Symptoms

A

(often asymptomatic)
• Mild flu-like symptoms, tender lymph nodes, fever, muscle aches, lethargy.
• Miscarriage, stillborn child.
• Can cause encephalitis and schizophrenia

Biomedicine I (18 decks)

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