Digestive pathologies Flashcards
Abscess
A localized pocket of pus surrounded by inflammation (can occur anywhere)
Causes:
A defensive reaction of the tissue to prevent spread of infection elsewhere
Signs and symptoms:
Pain, redness, local swelling
Fever, malaise
Allopathic treatment;
Antibiotics(adverse effects), drainage
Gastritis (acute)
Acute inflammation of the stomach mucosa causing breakdown of the stomach lining
Causes:
• Helicobacter Pylori
• NSAIDS (lower prostaglandin levels + reduces gastric mucosal barrier)
• Alcohol, food poisoning, stress
Signs and symptoms:
• Epigastric (upper abdomen) pain usually worse with food intake
• Nausea / vomiting, loss of appetite
Complications:
• Bleeding and anaemia
Pathophysiology;
• Insufficient mucus production (due to reduction of prostoglandin synthesis), which protects mucosa from erosion
• Acute inflammation characterised by neutrophil infiltrate
Angular Stomatitis
Fissuring and dry scaling of the surface of the lips and angles of the mouth
Causes:
• Vit B deficiencies; Riboflavin(B2) & folic acid (B9)
• Iron deficiency
• Candida albicans (opportunistic) & staph)
Appendicitis
Inflammation of the appendix
Signs and symptoms:
• Initially umbilical pain- may come/go.
• Right iliac fossa pain - constant & severe
• Rebound tenderness at McBurney’s Point and local muscle guarding
• Pallor, sweating and fever, nausea, vomiting and diarrhea
• May have tachycardia, hypotension and septic shock
Diagnostic:
• Rebound tenderness on palpation CT scan, U/S
• High ESF on blood tests
• Hypotension
Allopathic treatment;
• Surgery (appendectomy) & anti-biotics
• The most common surgical emergency
Complications:
• Rupture; Pain subsiding it usually = rupture
• Peritonitis; Release of faecal matter can result in infection which spreads to peritoneum
Pathophysiology;
• The appendix becomes obstructed, usually by faecal matter
Ascitis
(Peritoneum pathologies)
The accumulation of fluid in the peritoneal cavity.
Gastritis (chronic)
Chronic stomach mucosal inflammation for more than four-six weeks
Causes:
• Autoimmune (e.g. pernicious anaemia)
• Bacterial (H. Pylori)
• Chronic irritation (e.g. Long term NSAIDS)
Signs and symptoms:
• Few symptoms: Epigastric discomfort, feeling full & discomfort with heavy meals
• Nausea and poor appetite
Complications:
• Anaemia: Megablastic, iron, pernicious
• Gastric carcinoma
Pathophysiology:
• Lymphocytes & macrophages in lamina propia
• Prolonged low grade inflammation resulting in fibrosis & hence loss of elasticity and peristalsis
• May be associated with ulcers
Cleft lip / palate
Cleft Lip: Malformation of the lip in the embryonic development
Cleft palate: Malformation of the hard palate in embryonic development
Causes:
• Genetic defect
• Environmental (maternal disease, dietary)
• Teratogens (chemotherapy, radiation, alcohol, excess Vitamin A, anticonvulsant medications, smoking, substance abuse)
Signs and symptoms:
Cleft lip;
•Can be unilateral/bilateral, complete/incomplete
Cleft palate:
•Causes difficulty in speech, feeding and hearing
Coeliac’s disease
An autoimmune condition where the body’s immune system attacks its own mucosa tissue in the small intestine in response to ingestion of gluten
Causes:
• Genetically susceptible: HLA-DQ2 and DQ8.
Signs and symptoms:
Classic GI Signs and Symptoms:
•Chronic diarrhoea / constipation.
•Pale, foul-smelling stools.
•Steatorrhoea (fatty stools).
•Bloating.
•Flatulence.
•Abdominal pain.
•Loss of appetite.
•Weight loss.
•Lactose intolerance (loss of brush border enzymes).
Extra-intestinal symptoms:
•Lethargy, fatigue (iron deficiency anaemia) and irritability.
•Delayed growth in childhood
•Mouth ulcers.
•Neurological problems (anxiety, depression).
•Dermatitis herpetiformis (blistering rash).
•Muscle / joint pain.
•Osteopenia / osteoporosis.
•Infertility.
Diagnostic:
• Blood test - anti-transglutaminase antibodies (IgA, tTG).
• Stool test, endoscopy.
• Biopsy of the small intestinal mucosa
Allopathic treatment;
• Gluten free diet
• Avoid cross contamination
Pathophysiology:
• 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.
• In Coeliac’s, the immune system mistakenly identifies parts of gliadin as foreign.
• The immune system produces antibodies and an inflammatory / immune reaction which strips the microvilli and villi, causing atrophy.
Complications:
• Osteoporosis, anaemia (iron / B9/ B12).
• Bowel cancer.
Cold sores
(Herpes)
A viral infection that lies dormant and activates when immunity is low
Causes:
Herpes simplex virus (normally Type 1)
Stress, steroid use, trauma, local infections, sunlight exposure
Signs and symptoms:
Tingling, itching, burning sensation around mouth
Small fluid-filled sores - on the lower lip
Allopathic treatment;
Antiviral creams (acyclovir)
Pathophysiology:
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
Colonic Polyps
Benign epithelial growths of colonic mucosa.
Signs and symptoms:
• Usually asymptomatic
• Occult (hidden) blood in the stool.
Diagnostic:
• Colonoscopy.
Allopathic:
• Surgery
Complications:
• May become malignant (<1% become malignant).
Colorectal Cancer
Malignant tumour that is locally invasive.
Causes:
• Diet high in meat, low fibre
• Lack of vitamin D
• Polyps,
• Family history.
Signs and symptoms:
• Initially few symptoms.
• Fluctuating bowels (constipation/diarrhoea)
• Blood (and mucus) in stools. Abdominal pain.
Diagnostic:
• Colonoscopy and biopsy.
• Stool analysis (occult blood and M2PK).
• •Blood test (CEA, inflammatory markers & low Hb).
Complications:
• May spread (metastasise) before growth produces symptoms (liver, lungs, brain, bone).
Diverticulosis / Diverticulitis
Diverticulosis:
The presence of pea-sized pouches (diverticula), caused by herniations 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.
Causes:
• Low fibre diet (slow GI transit) = straining = high intra-abdominal pressure.
• Weak connective tissue.
Signs and symptoms:
• Bloating
• Abdominal pain
• Diarrhoea
• Fever, chills.
Allopathic treatment;
Antibiotics and surgery may be recommended.
Complications:
• Diverticulosis can develop into diverticulitis.
• Rupture —leaking into the peritoneum.
Dumping Syndrome
Loss of control of gastric emptying
Causes:
• Bariatric surgery (vagus nerve damage), Cholecystectomy, gastric bypass, gastrectomy, etc.
Signs and symptoms:
Early dumping’ (straight after meal): nausea, vomiting, bloating, cramping, diarrhoea, dizziness and fatigue
• ‘Late dumping’ (one-three hours after meal): weakness, sweating and dizziness (due to hypoglycaemia)
Pathophysiology:
• 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 hypoglycaemia (two-three hours later)
Dysentery
An infection of the intestines that causes diarrhoea containing blood or mucus
Causes:
• Bacterial (shigella) or Amoebic via faeco-oral contamination
Signs and symptoms:
• Bacterial (shigella) or Amoebic via faeco-oral contamination
• Diarrhoea (watery stools) with mucus and blood
. Cramping and possible nausea / vomiting
Diagnostic:
• Stool microscopy
Allopathic treatment;
• Anti-parasitic / anti-bacterial
• Rehydration / fluid and mineral replacement
Complications:
• Dehydration – dangerous in small children, infants, pregnancy and elderly
Other;
• It is a notifiable disease (required by law to be reported to government authorities)
• More prevalent in developing countries / poor sanitation - travelers
Enterobiasis
(Pinworm)
A parasitic ‘Helminth’ infection with a lifespan of approximately two months.
Signs and symptoms:
• Can be asymptomatic; intense itching around anus/vagina particularly at night (when female worms are laying eggs); insomnia.
• Loss of appetite, weight loss, bruxism, enuresis.
• Skin infection around the anus.
Allopathic treatment;
• Anti-parasitic —two doses apart to kill eggs, too
• Whole family may be treated.
Pathophysiology;
• 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.
Gallstones
One or more stones in the gallbladder.
Causes:
• 5Fs (fat, female, forty, fair, fertile).
• Increasing age, pregnancy, obesity, diabetes, hereditary link, women, taking oestrogen or OCP, liver cirrhosis, age, rapid weight loss.
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.
Allopathic treatment;
• Surgery.
Complications:
• Acute cholecystitis
• Jaundice
• Acute cholangitis
• Acute pancreatitis
• Gallbladder cancer.
Gastric Cancer
Cancer in the lining of the stomach.
Causes:
• Male, smoking, age (55 years+)
• H. Pylori infection
• Diet - salted, pickled smoked (N-nitroso compounds)
• Low fruit & vegetable diet
Signs and symptoms:
• Early stages: Persistent indigestion, frequent burping, heartburn, feeling full quickly, bloated, abdominal discomfort
• Advanced stages: Black blood in the stools, loss of appetite, weight loss, tiredness, anaemia, jaundice
Diagnostic:
• Blood in stool, endoscopy, biopsy
Allopathic treatment;
• Gastrectomy, chemo / radiotherapy
Pathophysiology;
• 50 % affects the pylorus and 25% affects the lesser curvature
Other:
Second highest cause of cancer related death in the world (highest prevalence in Korea and Japan – diet)
Gastro-Oesophageal Reflux Disease (GORD)
The lower oesophageal sphincter relaxes and acid regurgitates from the stomach into the oesophagus
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
Signs and symptoms:
• Retrosternal pain ‘heartburn’ (can mimic a cardiac pathology) – aggravated by lying down
• Belching
Allopathic treatment;
• Antacids (some contain aluminium)
Complications;
• Damage to oesophageal mucosa increasing risk of ulcers, Barratt’s oesophagus (pre-cancerous oesophageal cell changes) and cancer
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).
Causes:
Plaque build-up, poor dental hygiene, dental amalgams
Long-term steroid medication use
Diabetes melitus
Smokers
Poor nutrition
Signs and symptoms:
• Bleeding gums
• Receding gums
Hernia
An internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. 3 Types = Inguinal hernia, Hiatus hernia & Incisional hernia
Causes:
• Often appears after straining —lifting, constipation, heavy coughing (raised intra-abdominal pressure).
Signs and symptoms:
• Swelling / lump in the groin (abdominal region).
• Pain with strain & disappears lying down.
• If strangulation occurs (loss of blood supply or bowel obstruction) there may be necrosis.
Allopathic treatment;
• If no strangulation occurs, it often resolves within a few years.
• Surgery
Pathophysiology;
Inguinal hernia:
• A common type mostly affecting men. Appears as a swelling or lump in the groin (inguinal canal).
• Often appears after straining —lifting, constipation, heavy coughing (raised 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.
Hiatus Hernia
Part of the stomach protrudes (herniates) into the thoracic cavity through an opening in the diaphragm
Causes:
• Increased abdominal pressure: heavy lifting, hard coughing / sneezing, pregnancy, childbirth, violent vomiting, straining with constipation, obesity, hereditary, smoking, drug abuse, stress
Signs and symptoms:
• Often asymptomatic or GORD
Complications:
• Can cause (GORD)
Inflammatory Bowel Disease (IBD)
IBD describes two chronic inflammatory bowel diseases;
1) Ulcerative colitis
2) Crohn’s disease
Causes:
• Suspected AI, dietary links & genetic predisposition
• Environmental triggers (e.g. anti-biotics, infection) with defective immune system
Signs and symptoms:
Symptoms or UC & Crohn’s are similar. Most occurring between 15-35 years. Symptoms include:
• Rectal bleeding
• Abdominal pain / cramps
• Diarrhoea (with blood, mucus)
• Fever and fatigue
• Nausea / vomiting
• Delayed puberty or growth failure
• Weight loss/inability to maintain weight
• Indigestion, feel ‘blocked’
• Anaemia (fatigue etc.)
Diagnostic:
• Blood tests (inflammatory markers) & stool sample (calprotectin)
• Colonoscopy (and biopsy), sigmoidoscopy
Allopathic treatment;
• Anti-inflammatories (steroids)
• Surgery (i.e. bowel resection)
Complications:
• Malnutrition (failure to thrive, growth, osteoporosis etc.)
• Strictures (obstruction)
• Fistulas / fissures
• Abscesses (pus)’
• Toxic megacolon (non-obstructive colon dilation with systemic toxicity)
• Malignancy (higher risk colorectal cancer)
Pathophysiology;
Ulcerative colitis
. Restricted to the colon
• Small ulcers develop on the colon lining which can become inflamed & infected producing blood & pus
. Proximal my continuous
. Thin wall
Crohn’s disease
• Affects the entire GIT, from mouth to anus
• Most common in the terminal ileum
• Transmural inflammation
. Skip lesions.
Irritable Bowel Syndrome (IBS)
A functional GI disorder characterized by lower abdominal discomfort and altered bowel habits
Causes:
• Stress: CNS alterations in GI secretions, motility & pain sensitivity
• GIT infection
• Food allergy or intolerance
• Altered microbiome, excessive ABX use
Signs and symptoms:
• Abdominal pain & cramping relieved by passing a stool
• Diarrhoea, constipation or alternating between both
• Bloating, painful flatulence, post-prandial urgency
• Incomplete emptying of bowels & mucus in stools
Diagnostic:
• Diagnosed according to ROME criteria: Three months history of symptoms
Allopathic treatment;
• Antispasmodics
Pathophysiology:
• Absence of organic pathology: inflammation or specific tissue damage
Liver Cancer
Cancer of the liver
Primary or secondary (spread from another tissue).
Causes:
• Associated with liver cirrhosis: Alcohol, toxins - necrosis > chronic inflammation & cell proliferation
• Hepatitis B/C - viral integration into host genome affecting DNA.
Signs and symptoms:
• Advanced: Jaundice, ascites, hepatomegaly.
• Pruritus (itchy skin), bleeding oesophageal varices (secondary to portal hypertension), weight loss.
• Vomiting, loss of appetite, feeling very full after eating, feeling sick, pain or swelling in the abdomen, fatigue and weakness.
Allopathic treatment;
• Surgery —transplant.
Liver Cirrhosis
Irreversible scarring of liver tissue due to long-term damage.
Causes: • Alcoholic liver disease.
• Hepatitis B / C.
• Bile obstruction, autoimmune liver disease, long-term exposure to toxins.
Signs and symptoms:
• Jaundice
• Fatigue
• Increased appetite
• Itchy skin
• Anaemia
• Oesophogeal varices
• Splenomegaly
• Gynecomastia
• Ascites
• Peripheral Oedema
• Vomiting blood
• Dark tarry stools
Diagnostic:
• Blood tests (raised liver enzymes; ie ALT & AST).
• •Ultrasound, biopsy.
Allopathic treatment;
• Liver transplant.
Pathophysiology;
• Conversion of normal hepatocytes to 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
Complications:
Impaired liver function results in:
• 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.
Mouth ulcer
Areas of ulceration within the oral cavity that are generally painful (loss of the mucosal layer)
Causes:
Physical trauma
Nutritional deficiencies; iron, zinc, folate and vit B12
Stress
GIT pathologies - Crohn’s disease
Oesophageal cancer
A common aggressive tumour with a poor prognosis
Causes:
• Chronic irritation, alcohol, smoking
• GORD and Barratt’s oesophagus
• Obesity
• Low fruit and veg diet
• Age
Signs and symptoms:
• Few early symptoms, later obstruction may occur
• Dysphagia (difficulty swallowing)
• Anorexia & melaena (due to oesophagus bleed)
Oral Cancer
Carcinoma of the oral mucosa, lip or tongue
Causes:
• Smoking (including pipes, chewing tobacco)
• Alcohol
• HPV infection
Signs and symptoms;
• Red or white patches on oral mucosa or tongue
• Difficulty eating and breathing
Allopathic treatment;
• Surgery
• Chemotherapy
• Radiotherapy (adverse effects)
Oral thrush
(Candida / Candidiasis)
A fungal infection of the mouth which is a sign of low immunity and not contagious
Causes:
Candida albicans (fungus)
Broad-spectrum antibiotics
Immune-suppressant drugs (e.g. steroids).
Nutritional deficiencies (iron, zinc, B12)
Signs and symptoms; •
White patches on oral mucosa
Red / raw appearance
Loss of taste or an unpleasant taste
Allopathic treatments:
Anti-fungals
Pancreatic Cancer
Cancer of the pancreas.
Common in older people, uncommon in people under 40 years with a poor prognosis
Causes:
• Cause unknown, risks include: Age, smoking, family history (germline defects in 5–10%).
• Other health conditions (diabetes, chronic pancreatitis, H. pylori).
Signs and symptoms:
• Asymptomatic early.
• Epigastric pain radiating to the back.
• Unexplained weight loss
• Anorexia
• Fatigue.
• Jaundice.
• Post-prandial nausea.
• Glucose intolerance (neuroendocrine tumours).
Allopathic treatment;
• Surgery, chemotherapy, radiotherapy (adverse effects).
Pathophysiology;
• Most arise from the exocrine cells.
• Less commonly from endocrine islet cells (‘pancreatic neuroendocrine tumour’).
Pancreatitis (Chronic)
- Chronic inflammation of the pancreas.
Causes:
• 60% long-term alcohol abuse
• Autoimmune pancreatitis
• Pancreatic duct obstruction
• Complication of cystic fibrosis
• Idiopathic.
Signs and symptoms:
• Repeated episodes of abdominal pain.
• Fatty, foul-smelling stools.
Pathophysiology;
• Leading to permanent tissue changes (fibrosis and cysts) and obstruction of the common bile duct with calcified secretions.
Complications:
• Diabetes mellitus, pancreatic cancer, weight loss, malnutrition.
Pancreatitis (acute)
Acute inflammation of the pancreas —a medical emergency.
Causes:
• Alcohol abuse
• gall stones
• Cancer.
Signs and symptoms:
• Sudden extreme periumbilical pain
• Nausea
• Vomiting
• Diarrhoea
• Fever.
• Mild cases improve within a week.
Diagnostic:
• Serum amylase (3 x normal level)
• Lipase; raised blood glucose.
Pathophysiology;
• Enzymes (proteases) are activated whilst still inside the pancreas leading to self-digestion of pancreatic tissue.
Peptic Ulcer
Ulcer of the GI mucosa (stomach, duodenum)
Causes:
• Helicobacter Pylori
• NSAIDs (10%): Disrupt mucous barrier, lower stomach bicarbonate, disrupt blood flow
. Sress (SNS dominance) can often cause isachaemia (resulting in defective tissue repair)
• Chronic gastritis
Signs and symptoms:
• Gastric: epigastric pain, 30-60 mins after eating, less often at night
• Duodenal: epigastric pain two-three 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.)
Pathophysiology:
• Tissue erosion can be superficial or penetrate down to the submucosa or muscularis
Peritonitis
(Peritoneum pathologies)
An acute inflammation of peritoneum.
Periton = peritoneum, -it is = inflammation
Salivary Calculi
Metabolic imbalance affecting mineral concentration resulting in stone formation on one of the salivary glands
Causes:
• Dehydration
• Abnormal calcium metabolism
• Sjogren’s syndrome
• Chronic salivary duct infections
Signs and symptoms:
• Intermittent pain & swelling of the gland, esp when eating – ‘mealtime syndrome’. May be a palpable mass
Pathophysiology;
• Calculi can abrade the gland wall causing inflammation, fibrosis and blockage
Small Intestinal Bacterial Overgrowth (SIBO)
Small intestinal bacterial overgrowth (SIBO) describes the overpopulation of microflora in the small intestines
Signs and symptoms:
• Excessive gas = bloating, flatulence, belching, a loss of appetite & diarrhoea or constipation
Complications:
• SIBO could ultimately result in malabsorption, anaemia, as well as inflammation & increased small intestinal permeability
Pathophysiology;
• The small intestines are not normally densely populated by microflora. In SIBO, bacterial growth is excessive and can lead to the production of hydrogen & methane gases as a result of carbohydrate use
Tonsillitis
Tonsillitis describes inflammation of the tonsils
Causes:
• Viral (common cold or flu virus)
• Bacterial (streptococci)
• Common type of infection in children 5-10 years and 15-25 years
• Short incubation period
Signs and symptoms:
• Sore throat that becomes worse when swallowing
• Fever over 38’C
• Coughing
• Headache
• Red / inflamed tonsils
• Pus
Allopathic treatment;
• Painkillers
• Antibiotics
• Surgery (tonsillectomy)
Complications:
• Middle ear infection (otitis media)
• Quinsy (abscess)
Toxoplasmosis
Intracellular protozoan parasite
Causes:
• Eating under-cooked meats, poor food hygiene.
• Handling cat litter trays.
• (Rarely) blood transfusion, organ transplant.
• Immunocompromised.
Signs and symptoms:
• Often asymptomatic
• Mild flu-like symptoms, tender lymph nodes, fever, muscle aches, lethargy.
• Miscarriage, stillborn child.
• Can cause encephalitis and schizophrenia
Complications:
Health risks in pregnancy; miscarriage, stillbirth, (rarely) birth defects.
Xerostomia
Dry mouth due to reduced / absent flow saliva
Causes:
• Drugs (antidepressants)
• Sjogrens syndrome
• Stress and anxiety, Dehydration
• Renal failure
• Menopause
• Alcohol
• Smoking
• Radiotherapy
Signs and symptoms:
• Dry mouth
• Burning sensation
• Halitosis (bad breath)
• Speech and swallowing interference
Complications:
• Candidiasis
• Gingivitis
• Tonsilitis
• Pharyngitus
