Gas Facts Flashcards
Explain what happens when NSAIDs inhibitor the enzyme COX
(1) NSAIDs inhibit the activity of the enzyme cyclooxygenase (COX).
(2) COX is responsible for converting arachidonic acid into prostaglandins, including prostaglandin E (PGE)
(3) By inhibiting COX, NSAIDs prevent the synthesis of prostaglandins, including PGE.
(4) PGE is known to have a protective effect on the gastric mucosa and also inhibits gastric acid secretion
(5) Without the presence of PGE, the inhibition of gastric acid secretion is diminished.
(6) This leads to an increase in gastric acid production by the parietal cells in the stomach
(7) The reduction in PGE formation and subsequent increase in gastric acid secretion can contribute to the development of gastric ulcers and gastrointestinal bleeding, which are known side effects of NSAID use
How do NSAIDs like aspirin or ibuprofen cause upset to your stomach?
Your stomach lining has a special layer of mucus that protects it from stomach acid. NSAIDs mess with this mucus by blocking the production of a helpful substance called prostaglandin. Prostaglandin helps keep the mucus layer thick and healthy. Without it, the lining is weak and may become vulnerable to the acid within your stomach
Cholecystitis meaning
infammation of th gallbladder
Achalasia meaning
a condition in which the muscles of the lower part of the oesophagus fail to relax, preventing food from passing into the stomach.
Norovirus treatment
supportive
Where do you usually get norovirus?
Common on cruise ships
Hepatitis A treatment and where it usually comes from?
- Increased risk in men who have sex with men
- Treatment → supportive
What is a Hookworm?
Enters through the skn and causes GI disease
Explain Schistosoma.
Usually found in lakes abroad
Explain Giardia Lamblia
Flagellated protozoa
Swimming in pools, lakes, rivers or where there is untreated water/sanitation issues
Person to person spread
Causes large volume foul smelling diarrhoea
- Explosive and intermittent
- Also associated with ‘eggy burps’
Most common in south/southeast asia
Explain Entamoeba Histolytica
Amoebiasis
90% of people are asymptomatic
- Linked to travel to warm country
- Can cause colitis and liver issues
- Associated with bloody diarrhoea, weight loss and pain
One to three-week onset
Liver onset can be years after exposure
Yersinia enterocolitica?
Associated with pigs
Vibrio cholerae?
Profuse watery diarrhoea and causes electrolyte issues
Aeromonas?
Water-associated and infects immunosuppressed people
Bacillus cereus?
associated with reheated foods
Explain Enterobacteriaceae
Gram negative coliform
53 genera, 26 of which cause human infection
Facultative anaerobes mostly
Ferment sugars
Explain C. diff
Gram-positive
Heavily associated with previous antibiotic exposure via the 4 deadly C’s
Treatment is with vancomycin
Prevention is with handwashing as it is spore-forming
- Important not to hand gel as it won’t clean well enough
Explain Salmonella
Non-typhoidal salmonella
Typically self-limiting
Commonly foodborne
In immunocompromised people, it can also cause endocarditis and other infections
Can be linked to ownership of reptiles, change in GI flora and eating undercooked meat
Explain Enterobius
Pinworm
Causes an itch in the bum
Worms typically come out at night to lay their eggs
Explain Cryptosporidium
Prolonged diarrhoea in immunosuppressed
Contaminated oocysts ingested in water
Inhalation can cause disease in immunosuppressed
Explain Cytomegalovirus
Colitis in very immunosuppressed
Other invasive illnesses associated
Bloody diarrhoea
Biopsy is the best diagnostic method
Explain Lysteria
Gram-positive rods
Undergoes cold enrichment → grows at the same temperature as a fridge is kept at
Often causes meningitis or bacteraemia
Peritonitis is treated with what?
(1) Gentamicin - for gram negatives (coliforms)
(2) Metronidazole - anaerobic cover
(3) Amoxicillin - enterococcus
INVESTIGATIONS for H. Pylori
- bedside - stool test or carbon-13 urea breath test
- If at OGD, a rapid urease test (CLO) can be done
Patients should not be taking PPI for at least 2 weeks prior as could indicate false negative results
Management for H. Pylori
(1) 1st episode, 1st line - amoxicillin, clarithromycin and a PPI twice daily for seven days - so-called triple therapy.
Treatment should only be initiated in cases of documented H. Pylori infection.
(2) After 4-8 weeks patients can be re-tested for H. pylori to check it has been eradicated with a urea breath test
(3) If still present, NICE recommend another course of triple therapy with metronidazole or clarithromycin (whichever was not used in the initial course) amoxicillin and a PPI
(4) If the patient has taken two courses of eradication therapy, they should be referred to a Gastroenterologist
Differentiate between gastric and duodenal ulcer
pain, milk
Prehepatic jaundice is what
gilberts, haemolytic anaemia, newborn, trauma
Intrahepatic jaundice is what?
viral hepatitis, alcoholic hep, autoimmune hep,
decompensated cirrhosis, PBC, PSC
Post hepatic jaundice is what?
gall stone, head of pancreas cancer, gallbladder cancer
Primary biliary cirrhosis antibodies
Anti-mitochondrial antibody (AMA)
Autoimmune hepatitis antibodies
Anti-smooth muscle antibody (ASMA)
Primary sclerosing cholangitis antibodies
(ANCA) (cANCA)
Pancreatitis antibodies
Raised amylase, lipase, vomiting, pain
Coeliac disease antibodies
Anti-transglutaminase antibody, anti
endomysial antibody
Diffuse stomach cancer antibdoies
Signet ring cells seen on biopsy
