Diseases Of The Stomach And Ileum

Question 1

What are some diseases of the stomach and duodenum

Answer 1

Peptic ulcer disease
Acute gastritis
IBD
Colonic diverticula
Hirschprung’s disease
Malabsorption syndrome (MAS)

Question 2

What causes peptic ulcer disease

Answer 2

H. pylori or chronic NSAID use
(And also in Zollinger-Ellison syndrome - gastrinoma, or Crohn’s disease)

Question 3

What is PUD characterized by

Answer 3

One or more ulcerative lesions in the duodenum (most common) or stomach

Question 4

What are the RFs (risk factors) of PUD

Answer 4

Smoking/Heavy alcohol use (delay healing as well)
Glucocorticoids
Caffeine
Stress

Question 5

What are the presentations of PUD

Answer 5

Usually asymptomatic but presents as:
Epigastric pain (gnawing/burning)
Dyspepsia
N/V
Bloating

Question 6

How does acute gastritis come about

Answer 6

It results from acidic damage due to imbalance between damaging and protective factors of the stomach

Question 7

What are the RFs of acute gastritis

Answer 7

H. pylori
Smoking/heavy alcohol consumption
NSAID overdose
Severe burn (Curling ulcer) or increase ICP (Cushing ulcer)

Question 8

What are the presentations of acute gastritis

Answer 8

Hematemesis
Melena
Iron deficiency anaemia (IDA)
Epigastric pain
Dyspepsia and early satiety
Microscopy (redness and hyperemia indicating a superficial inflammation)

Question 9

What are the types of acute gastritis

Answer 9

Type A atrophic gastritis
Autoimmune gastritis
Type B atrophic gastritis
H. pylori gastritis

Question 10

What is IBD

Answer 10

It is the chronic inflammation of the bowel. It has an unknown etiology

Question 11

What are the two types of IBD

Answer 11

Crohn’s disease and ulcerative colitis

Question 12

What is a colonic diverticula

Answer 12

It is the outpouring of only the mucosa and submucosa through the muscularis propria due to intramural pressure (Eg. Constipation due to low fiber or uncontrollable peristalsis) or areas where the muscle is transversed by vessels. It is mostly a false diverticulum

Question 13

What is the most common location of a colonic diverticulum

Answer 13

Sigmoid colon (narrowest part of the colon)

Question 14

What are some complications of colonic diverticulum

Answer 14

Usually asymptomatic or with abdominal discomfort and painless hematochezia
Diverticulitis presents with LLQ pain, fever, leukocytosis but no bleeding

Question 15

What are some complications of a colonic diverticulum

Answer 15

Hemorrhage (most common cause of lower GI bleeding in adults due to session of the surface which causes painless hematochezia
Fistula (most common is a colovesical fistula). Presents with dysuria, air/feces in urine and recurrent UTIs
-Inflammation (diverticulitis) and abscess (persistent fever and abdominal pain despite antibiotic treatment)
Perforation (presents with acite abdomen due to fecal peritonitis)

Question 16

What are some positional disorders

Answer 16

Volvulus
Intussusception
Ileus
Hurschprung’s disease
Malabsorption syndrome

Question 17

What is volvulus

Answer 17

Twisting of the bowel along its mesentery

Question 18

What is the most common site of a volvulus

Answer 18

Sigmoid colon in adults and caecum in children

Question 19

What is the presentation of positional disorders

Answer 19

Abdominal pain
Distention
Bilous vomiting
Hematochezia or ischaemia

Question 20

What is intussusception

Answer 20

Telescoping of the proximal segment of the bowel into a distal segment

Question 21

How do adults mostly get intussusception

Answer 21

Due to tumor

Question 22

What are some effects of intussusception

Answer 22

Obstruction and ischemia (currant-jelly stool)

Question 23

What is an ileus

Answer 23

Disruption of the normal propulsive ability of the intestine

Question 24

What are some causes of an ileus

Answer 24

Drugs (opiates)
Hypokalemia
IBD
Acute pancreatitis

Question 25

What are some presentations of ileus

Answer 25

Constipation Pain Distention (decreased bowel sounds) Nausea and vomiting

Question 26

What is Hirschprung’s disease

Answer 26

A birth defect from the neural crest fail to migrate resulting in the absence of myenteric and submucosal plexus

Question 27

What are some presentations of Hirschprung’s disease

Answer 27

Defective relaxation and peristalsis of rectum and distal sigmoid colon Affected segment cannot relax and pass stool resulting in localized ileus and megacolon proximally Bilious vomiting and failure to pass meconium

Question 28

What is malabsorption syndrome

Answer 28

An impaired intestinal absorption of all types of nutrients

Question 29

What causes MAS

Answer 29

Insufficient absorption (malfunction of the intestinal wall) or improper digestion of nutrients (insufficient secretion of pancreatic enzymes or bile)

Question 30

What are the presentations of MAS

Answer 30

Chronic diarrhea (mass and frequency) Steatorrhea (hallmark of malabsorption) Anorexia and weight loss Hypoalbuminemia (edema/ascites) Dehydration Vitamin deficiency (B12, folate, K) Bloating and flatulence

Question 31

What are the types of MAS

Answer 31

Primary and secondary MAS

Question 32

What are the examples of the primary MAS

Answer 32

Celiac disease Topical sprue Lactose intolerance

Question 33

What are some examples of secondary MAS

Answer 33

Whipple disease Crohn’s disease Gastroenteritis

Question 34

What are some examples of extra-intestinal MAS

Answer 34

Pancreatic insufficiency Bile deficiency Gastritis