Gastric System Flashcards
Aoife
Describe ingestion
food is taken in through the mouth
Describe the process of mechanical digestion
large pieces of food broken into smaller pieces by chewing. also in stomach when food churned and mixed
Describe process of chemical digestion
the breakdown/hydrolysis of food molecules by water and digestive enzymes
Describe movements
Peristalsis propels food through digestive tract
Describe absorption
Food molecules pass through lining of small intestine into blood/lymph capillaries
Describe elimination
Food molecules that cant be digested/absorbed are eliminated from the body in the form of faeces
What are proteins broken into
Amino acids
What are fats broken into
Fatty acids and glycerol
What are carbohydrates broken into
Glucose
Function of Mouth
Saliva moistens food and begins to breakdown starch
Function of Oesophagus
Peristalsis moves food to stomach
Function of Stomach
Produces acid and enzymes
Function of Pancreas
Produces enzymes that metabolise food (small intestine)
Function of Liver
Produces bile that digests fats and vitamins
Function of Gallbladder
Stores bile
Function of Small Intestine
Produces digestive juices which mix with bile and pancreatic enzymes to breakdown proteins, carbs and fats. Absorption of water
Function of Large Intestine
Water absorption, Vitamin K production and where excess waste becomes stool
MUMPS
description
an acute viral disease
MUMPS
characterised by?
Swelling of the parotid salivary glands
MUMPS
age group most common in?
childhood/adolescence
(5-15 years)
MUMPS
when is mumps more severe?
In adults if onset is delayed
MUMPS
what has made mumps less common?
MMR vaccine
MUMPS
signs & symptoms (5)
- painful swelling in side of face, under ears
- headaches
- joint pain
- fever
- dysphagia (difficulty swallowing)
MUMPS
diagnosis
- visual in GP
- clinical examination of saliva for IgM
How is mumps spread?
Spread via droplets
When are mumps contagious?
Contagious before and after symptoms
MUMPS
complications
- may affect other tissues (joints, pancreas, myocardium, kidneys)
- meningitis
- orchitis infertility in males
MUMPS
treatment
Symptom relief
How long until mumps infection passes?
1-2 weeks
MUMPS
prognosis- immunity?
Immunity usually lifelong
When does GORD develop?
When backflow of stomach contents causes troublesome symptoms
What is the development of GORD due to?
Dysfunction of the lower oesophageal sphincter
GORD
symptoms (2)
- heartburn
- acid regurgitation
GORD
causes & risk factors (4)
- obesity
- preganancy
- gastroparesis (delayed emptying of stomach contents)
- diseases of connective tissue (RA, scleroderma, lupus)
What is GORD exacerbated by? (4)
- Smoking
- High fat foods, chocolate, coffee, alcohol
- eating shortly before bed
- medications (aspirin)
GORD
treatments (5)
- Antacids: neutralise acid in stomach and oesophagus
- H2 Blockers: reduces acid in stomch by blocking acid secretion in stomach
- Proton Pump Inhibitors: reduce stomach acid by blocking protein that makes stomach acid
- Surgery: severe cases
- Lifestyle Changes: stop smoking, change diet, no aspirin etc
GORD
complications (4)
- Oesophageal Ulcer: caused by acid
- Oesophageal Stricture
- Barrett’s Oesophagus
- Lung Problems: due to inadvertent aspiration of stomach contents
Barrett’s Oesophagus
What is Barrett’s Oesophagus sometimes a complication of?
GORD/GERD
Barrett’s Oesophagus
Risk factors (7)
overlap with GORD:
1. obesity
2. pregnancy
3. gastroparesis
4. diseases of connective tissue
different:
5. family history
6. being male
7. being Caucasian
Barrett’s Oesophagus
What is the tissue change in the lining of the oesophagus?
Squamous cells to columnar cells
Barrett’s Oesophagus
Metaplasia definition
The conversion of one cell type to another
Barrett’s Oesophagus
Dysplasia defintion
The transformation of a cell into an abnormal version of itself
Barrett’s Oesophagus
What does dysplasia increase the risk of?
Adenocarcinoma (type of cancer that starts in mucous producing/glandular cells)
Barrett’s Oesophagus
What do 3-13% of patients develop?
Oesophageal cancer
Barrett’s Oesophagus
Symptoms? (4)
- heartburn
- regurgitation of stomach contents
- dysphagia
- chest pain (less common)
Barrett’s Oesophagus
Treatment (2)
- daily Proton Pump Inhibitors
- therapy to destroy dysplasia
Barrett’s Oesophagus
Diagnosis (2)
- OGD: OesophoGealDuodenoscopy
- Biopsy
Achalasia
Description?
People with achalasia have dysfunction of the oesophageal muscles and their lower oesophageal sphincter fails to open
Achalasia
Symptoms (5)
- Progressive dysphagia
- Regurgitation
- Heartburn
- Chest pain
- Weight loss (due to difficulty consuming foods)
Achalasia
Causes (5)
- Nerve damage
- Viral infection
- Toxin exposure
- Autoimmune disease
- Genetic
Achalasia
Diagnosis (4)
- Manometry: tube inserted into oesophagus to measure pressure applied along oesophagus
- Barium swallow and x-ray
- Endoscopy eg: OGD
- Biopsy
Achalasia
Treatment (4)
No cure, only supportive treatments:
1. Medicines: relaxants (eg: nitrates) for oesophageal muscles, short lived symptom relief
2. Stretching muscle through dilation with a balloon, multiple treatments needed for long lived symptom relief
3. Surgery: Heller’s Myotomy: muscle fibres of lower oesophageal sphincter cut, disadvantage: acid reflux
4. Botox injection into muscle
Stomach Disorder Terminology
Gastritis
Inflammation of the stomach
Stomach Disorder Terminology
Anorexia
Chronic loss of appetite
Stomach Disorder Terminology
Nausea
Unpleasant feeling that may lead to vomiting
Stomach Disorder Terminology
Emesis
Vomiting
Gastritis
Gastritis is the general term to describe what?
inflammation of the lining of the stomch
Gastritis
Causes (4)
- Infection
- Use of pain relievers aspirin, ibuprofen
- Alcohol abuse: irrates and erodes stomach lining
- Autoimmune gastritis: seen in Hashimoto’s Disease, T1DM
Gastritis
The onset can be both??
Acute or chronic
eg. acute: food poisoning
Gastritis
Symptoms (4)
- Indigestion
- Nausea
- Emisis: vomiting
- Feeling of fullness in upper abdomen after eating
Gastroparesis
What is gastroporesis?
Delayed gastric emptying
Gastroparesis
Most common cause?
Diabetes
Gastroparesis
What does the delayed gastric emptying do to the flow of food?
Slows/stops flow of food to small intestine through pyloric sphincter
Gastroparesis
Symptoms (4) (same as gastritis)
- Indigestion
- Nausea
- Emesis
- Feeling of fullness in upper abdomen after eating
Gastric Ulcers
What are gastric ulcers?
Open sores that develop on lining of stomach
Gastric Ulcers
Symptoms (4)
- Indigestion
- Heartburn
- Nausea
- Asymptomatic - open sore = blood in stool
Gastric Ulcers
Causes (2)
- Helicobacter pylori
- NSAID use: aspirin, ibuprofen
Gastric Ulcers
Risk factors for H. pylori infections (5)
- low socio economic background
- geography: high rates in developing world
- hygiene
- non filtered water
- high meat/fish content diet
- smoking
Gastric Ulcers
Risk factors for development of H.pylori ulcers (5)
- Diet: too much sugar/fat/acidic foods/spicy foods
- Alcohol
- Smoking
- Family history
- Age
Gastric Ulcers
Diagnosis- to visually detect
OGD
Gastric Ulcers
Diagnosis- Micro Methods (5)
- Antigen tests: presence/absence of antigens specific to bacterium in stool sample
- Urea breath test: breathe into 2 tubes, H.pylori breaks up substance (urea C13) if present
- Culture/ sensitivity: biopsy placed in special culture medium & grown in special conditions
- PCR: stool sample, detection of genes specific to bacterium, ability to detect resistance to antibiotics
- Serology: detection of IgM antibodies specific to bacterium
Gastric Ulcers
Diagnosis- Histo Method
Staining of biopsy
Gastric Ulcers
Treatment (2)
- Antibiotics -> Clarithromycin and Amoxicillan
- PPIs
Gastric Ulcers
Why is antibiotic resistance a concern in the diagnosis??
Treatment failures after receiving Clarithromycin, limited choices then, have to do susceptibility testing = biopsy
Gastric Ulcers
Complications (5)
- Bleeding: most common
- Perforation: hole forms through stomach
- Penetration: ulcer/perforation continues to adjacent organs/ tissues
- Obstruction: cycles of inflammation= scarring = pyloric stenosis
- Cancer: most commonly adenocarcinoma
Coeliac Disease
Description
A digestive problem where the SI can’t absorb nutrients due to it becoming inflamed
Coeliac Disease
Symptoms (8)
- Diarrhoea
- Abdominal pain & cramps
- Bloating
- Indigestion & Constipation
Systemic symptoms: - Tiredness -> malnutrition
- Weight loss
- Rash
- Nerve damage
Coeliac Disease
Causes (2)
- Autoimmune: immune system mistakes substances found in gluten as threat & attacks them
- Damage to intestines: affects ability to absorb nutrients from food
Coeliac Disease
What is the genetic component of the autoimmunity demostrated by??
The dependence of certain halotypes
Coeliac Disease
What are halotypes?
A set of DNA variations that tend to be inherited together
Coeliac Disease
What do the halotypes affect?
Genes of white blood cells that distinguish between self and non self cells
Coeliac Disease
Diagnosis- Histo
Biopsy examined using different stains forpresence/absence of villi destruction commonly seen in Coeliacs Disease
Coeliac Disease
Diagnosis- Biochem/Immunology
Blood serum analysed for antibodies specific to Coeliac Disease
eg. anti-TGA
Coeliac Disease
What do worldwide rates mirror?
Spread of wheat consumption
Coeliac Disease
Complications (6)
- Malnutrition: insufficient absorption of nutrients
- Bone weakening: insufficient absorption of calcium & Vit.D
- Infertility & miscarraige
- Lactose intolerance: damage to SI
- Cancer: intestinal lymphoma and cancer of SI
- Spleen disorders: reduced immunity
Coeliac Disease
Treatment
Exclude foods w/ gluten
Coeliac Disease
What may be the problem if a gluten free diet does not work?
Patient has Refractory Coeliac Disease
Coeliac Disease
Treatment of refractory coeliac disease
Medicines to reduce inflammatory response -> steriods
Coeliac Disease
Cause of Refractory coeliac disease (5)
- Inadvertant gluten contaminations
- Microscopic colitis
- Bacterial overgrowth of small bowel
- Lactose intolerance
- Bowel disorders