Digestive Pathologies Flashcards
What is a peptic ulcer?
4 Marks
An ulcer is the result of progressive tissue damage due to constant irritation or something stopping the healing process.
Cells die, a crater forms and erodes into deeper tissue layers, forming an open sore that is liable to infection.
Ulcers in the oesophagus, stomach or small intestine are called peptic ulcers as the enzyme pepsin helps form them.
What are the symptoms of peptic ulcers?
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General burning or gnawing abdominal pain between meals that is relieved by antacids or food. Bloating, burping, gas & vomiting after meals.
How might stress contribute to peptic ulcers?
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The stomach produces hydrochloric acid to help digest food. Usually mucous helps protect the stomach from the acid. The acid is neutralised in the small intestine by bicarbonate from the pancreas.
When a person is in a stressed (sympathetic) state blood flow to the GI tract is slowed and stomach activity stops. Reduced blood flow means mucous production slows but so does that of acid & pepsin - they are all in balance. When the stress is lifted (return to parasympathetic) the production of acid and pepsin returns more quickly than the secretion of mucous and the acid & pepsin can then attack the stomach wall.
Describe possible complications of peptic ulcers.
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Can be serious. If they erode into capillaries slow, cumulative bleeding can cause anaemia. If it’s a larger arteriole or artery - haemorrhaging can quickly lead to shock & death.
They can perforate the organ wall releasing bacteria and half digested food into the peritoneum, leading to peritonitis.
They may create a combination of scar tissue and inflammation that causes the pyloric valve to spasm.
Peptic ulcers significantly increase the risk of developing stomach cancer.
Explain why a person who had been recently taking antibiotics complains of patchy, painless white lesions in the mouth
4 marks
Patchy painless white lesions in the mouth are characteristic of oral thrush. This is caused by a yeast like fungus, Candida albicans, that naturally inhabits the GI tract, usually living in balance with other flora and fauna there.
Antibiotics suppress & kill beneficial as well as harmful bacteria in the GI tract, leaving more opportunity for fungi to reproduce & spread.
What is gingivitis and what are its main signs and symptoms?
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Gingivitis is gum disease, where bacteria attacks the plaque build up on teeth and causes inflammation to the gums that can then bleed when brushed or touched.
Gingivitis can lead to periodontitis where the tissues that support teeth are affected, causing bad taste in the mouth, loose teeth and gum abscesses.
What is indigestion and what are its main signs and symptoms?
Under what circumstances might you consider referring a pt with indigestion to their GP?
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Indigestion, also known as Dyspepsia, is pain or discomfort in the chest or stomach. It usually comes on soon after eating or drinking. Other symptoms include: - Feeling full or bloated. - Heartburn - Nausea - Belching
Indigestion is a common problem, in most cases it is mild and occasional. It's important to see a GP if indigestion is recurring and: - Client is over 55 - There is unexplained weight loss - Difficulty swallowing - Persistent vomiting - Iron deficiency anaemia - Lump in the stomach - Blood in the vomit or stools
These may be symptoms of an underlying condition and need investigating.
Nausea & vomiting are common symptoms in adults & usually clear in a few days. Under what circumstances would you advise a pt with nausea and vomiting to see their GP?
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Vomiting is the body’s way of getting rid of harmful substances from the stomach, or it may be a reaction to something that has irritated the gut.
Gastroenteritis is a common cause in adults and is an infection of the gut by bacteria or a virus. The immune system will usually fight off the infection after a few days.
A GP should be contacted if:
- Vomiting is uncontrollable for > 24 hrs
- Inability to keep fluids down for > 12 hrs - risk of dehydration
- Vomit is green = bile, this could indicate a blockage in the bowel.
- There is blood in the vomit, or what looks like coffee grounds - sign of a peptic ulcer.
- It’s accompanied by severe stomach pain
Diarrhoea is a common condition and is usually nothing to worry about. What factors associated with diarrhoea might give more cause for concern?
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In adults diarrhoea that lasts more than a few weeks may be a sign of a more serious condition, such as bowel cancer, Crohn’s disease or IBS.
A GP should be seen if:
- Diarrhoea is persistent - a cause should be established.
- If there is blood or pus in the stools
- If the person is really unwell with the diarrhoea
- There is severe pain
If a baby or child has had 6 or more episodes of diarrhoea in 24 hours they should be seen by a GP.
In a patient with constipation, what factors in their case history may be seen as being contributory to the condition? Give 3 common complications that can arise from constipation.
6 marks
A number of things can increase the risk of constipation, including:
- Not eating enough fibre - fruit, vegetables and whole grains.
- Dehydration - not drinking enough water/fluids
- A change in routine, eg eating habits
- Ignoring the urge to pass stools
- Side effects of certain medications
- Anxiety or depression
For children, poor diet, fear of using the toilet and poor toilet training can all be responsible.
For most people constipation rarely causes complications, people with long term constipation can develop:
- Haemorrhoids
- Faecal impaction - dry hard stools collecting in the rectum
- Faecal incontinence
There is an internationally recognised symptom profile for IBS - briefly describe the symptoms.
Precisely why should a patient who appears to exhibit IBS symptoms contact their GP if they develop a fever or have blood in their stools?
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- Recurrent abdominal pain at least 3 days every month
- Pain with defecation
- Changes in stool frequency
- Changes in stool appearance
Also gas, bloating, headaches & general malaise
The changes brought about by IBS are purely functional: no structural anomalies like scar tissue, ulcers, polyps or tumours develop. So if a person with IBS develops a fever or blood in their stools IBS is not the cause and the new symptoms need investigating by a GP.
What signs & symptoms might you expect to be characteristic of a patient who reports a diagnosis of Crohn’s Disease?
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Periods of flare & remission.
May be no symptoms in remission but during flare:
- Abdominal pain, esp. in lower right quadrant
- Cramping diarrhoea (often with blood)
- Bloating
- Weight loss
- Fever
- Joint pain
- Small ulcers in mouth & throat & lesions on skin
- May also have severe pain around anus along with anal fissures & abscesses.
Ulcerative colitis is a disease involving inflammation and shallow ulcers of the colon, but other systems may also be affected. Briefly describe the effects there may be on other systems.
4 marks
Inflammation of the liver or gallbladder ducts, arthritis, osteoporosis, anaemia from blood loss and kidney stones from disruption in electrolyte balance & chronic dehydration that follows from long term diarrhoea.
Uveitis or inflammation of the structures of the eye, may result in permanent loss of vision. Some skin disruptions.
What is diverticular disease, and how might you recognise it when taking a case history? Give a brief account of possible complications of diverticular disease.
5 marks
Diverticular disease is a condition of the small intestine or colon, where layers of the GI tract bulge through the outer muscular sac to form a bulge or diverticulum. If the bulges get infected it is diverticulitis. There may be no signs or symptoms but if infection is present they may include:
Bloating, nausea, fever, cramping & severe pain - usually in lower left side of abdomen.
May be sudden onset & become rapidly worse.
Complications can include: bleeding, abscess, perforation & rupture, blocking & fistula.
Why is there such a wide range of symptoms & complications associated with cirrhosis of the liver? Why would early identification of the damage be particularly important in the liver?
5 marks
Cirrhosis is a result of long term liver damage.
Healthy liver cells (Hepatocytes) are crowded out & replaced with non functioning scar tissue.
This interferes with virtually every function of the liver and they are numerous, including:
Production of bile, hormones, clotting factors, enzymes and toxin neutralisation.
Under normal circumstances the liver has great powers of long term regeneration but chronic long term irritation or infection can suppress the growth of new hepatocytes, so there are none to replace damaged ones. By the time signs & symptoms are apparent damage may be so extensive, it can’t be repaired.
