GastroEnterology Flashcards
a) How do the different types of peptic ulcer differ clinically and in pathophysiology ?
Peptic ulcer disease (PUD) is a break in the lining of the stomach, first part of the small intestine or occasionally the lower esophagus.[1][7] An ulcer in the stomach is known as a gastric ulcer while that in the first part of the intestines is known as a duodenal ulcer.[1] The most common symptoms of a duodenal ulcer are waking at night with upper abdominal pain or upper abdominal pain that improves with eating
ther symptoms include belching, vomiting, weight loss, or poor appetite.[1] About a third of older people have no symptoms.[1] Complications may include bleeding, perforation and blockage of the stomach.[2] Bleeding occurs in as many as 15% of people.[2]
Treatment includes stopping smoking, stopping NSAIDs, stopping alcohol and giving medications to decrease stomach acid.
The medication used to decrease acid is usually either a proton pump inhibitor (PPI) or an H2 blocker with four weeks of treatment initially recommended.
d) What are the causes of difficulty in swallowing (dysphagia ?) In this case can it be related to his GOR and heavy drinking ? Discuss the pathophysiology of the causes of dysphagia.
Can be linked to Esophogeal cancer and GOR.
a condition that affects the nervous system, such as a stroke, head injury, multiple sclerosis or dementia
Because even one drinking episode weakens the lower esophageal sphincter, according to Montana State University, gastrointestinal reflux disease, often called GERD, often affects alcoholics. Incompetence of the sphincter allows stomach acid to back up into the esophagus, burning and irritating the tissues. Untreated reflux eventually causes the cells of the esophagus to look more like stomach or intestinal cells than esophageal cells, a condition called Barrett’s esophagus, the University of Pennsylvania explains. These cells can secrete acid directly into the esophagus. Barrett’s esophagus increases the risk of developing cancer of the esophagus, even if medical or surgical treatments are done. Frequent medical checkups and testing to detect abnormal cells early may help prevent cancer.
e) What is the differential diagnosis of ‘vomiting’ blood (haematemesis) ? In this case what might be causes ? Could it be related to the alcoholic liver injury ?
Oesophageal varices
Oesophageal varices are enlarged veins in the walls of the lower part of the oesophagus. They bleed, but don’t usually cause any pain.
They’re often caused by alcoholic liver disease
Severe gastro-oesophageal reflux disease
Gastro-oesophageal reflux disease (GORD) is where acid leaks out of the stomach and up into the oesophagus.
Tear in the oesophagus
Prolonged retching can tear the lining of your oesophagus, which can also result in bleeding
f) What is the relevance of H. pylori in the biopsy ?
H. pylori’s helical shape (from which the genus name derives) is thought to have evolved to penetrate the mucoid lining of the stomach.[8][9]
H. pylori harms the stomach and duodenal linings by several mechanisms. The ammonia produced to regulate pH is toxic to epithelial cells, as are biochemicals produced by H. pylori such as proteases, vacuolating cytotoxin A (VacA) (this damages epithelial cells, disrupts tight junctions and causes apoptosis), and certain phospholipases.[43] Cytotoxin associated gene CagA can also cause inflammation and is potentially a carcinogen.[4
To avoid the acidic environment of the interior of the stomach (lumen), H. pylori uses its flagella to burrow into the mucus lining of the stomach to reach the epithelial cells underneath, where it is less acidic.[35] H. pylori is able to sense the pH gradient in the mucus and move towards the less acidic region (chemotaxis). This also keeps the bacteria from being swept away into the lumen with the bacteria’s mucus environment, which is constantly moving from its site of creation at the epithelium to its dissolution at the lumen interface.
1 What are the causes of gastroenteritis?
Bacterial gastroenteritis happens when bacteria causes an infection in your gut. This causes inflammation in your stomach and intestines. You may also experience symptoms like vomiting, severe abdominal cramps, and diarrhea. While viruses cause many gastrointestinal infections, bacterial infections are also common
- What groups or organisms are involved? What are the routes of infection?
In children, rotavirus is the most common cause of severe disease.[10] In adults, norovirus and Campylobacter are common causes
Eating improperly prepared food, drinking contaminated water, or close contact with a person who is infected can spread the disease.
3.What is the pathophysiology of the symptoms in infectious diarrhea? How could an alteration in the normal processes of secretion, absorption and motility bring these about?
Gastroenteritis is defined as vomiting or diarrhea due to inflammation of the small or large bowel, often due to infection.[17] The changes in the small bowel are typically noninflammatory, while the ones in the large bowel are inflammatory.[17] The number of pathogens required to cause an infection varies from as few as one (for Cryptosporidium) to as many as 108 (for Vibrio cholerae).[1
- What mechanisms might lead to an increase in the diarrhea of:
a) Fat
b) Mucus
c) Blood
d) Water
Fat undigested
Mucus
- What is the difference between diarrhoea and dysentery ? What are the two principal groups of organisms that cause dystentery?
Diarrhea is a disease that affects the small bowel. Dysentery is a disease that affects the colon.
Fever is more common in dysentery.
Diarrheal infection is located and targets only intestinal lumen and upper epithelial cells. Dysentery not only upper epithelial cells are targeted but colon ulceration also results.
no cell death in diarrhea and the infection is only caused because of the release of some toxins by the infecting agent. When a person gets dysentery, the upper epithelial cells are attacked and destroyed by the pathogen or disease causing agent.
Diarrhea is presented as watery stool with no blood and mucus. Dysentery is presented as a mucoid stool that may be accompanied by blood.
bacillary dysentery or shigellosis – caused by shigella bacteria; this is the most common type of dysentery in the UK
amoebic dysentery or amoebiasis – caused by an amoeba (single-celled parasite) called Entamoeba histolytica, which is mainly found in tropical areas; this type of dysentery is usually picked up abroad
- What is Coeliac Disease and what is its aetiology?
lmost all people with coeliac disease carry one of two major histocompatibility complex class-II molecules (HLA-DQ2 or -DQ8) that are required to present gluten peptides in a manner that activates an antigen-specific T cell response. The requirement for DQ2 or DQ8 is a major factor in the genetic predisposition to coeliac disease. However, most DQ2- or DQ8-positive people never develop coeliac disease despite daily exposure to dietary gluten.
Loss of immune tolerance to gliadin peptide antigens derived from wheat, rye, barley, and related grains is the central abnormality of coeliac disease. These peptides are resistant to human proteases, allowing them to persist intact in the small intestinal lumin
Classic coeliac disease: typical symptoms including diarrhoea, weight loss, abdominal pain and discomfort, and fatigue. Classic symptoms are found in <50% of patients.
You refer her back to her GP for blood tests. They reveal low haemoglobin, calcium, B12 and folate. Is this consistent with her symptoms and possibly Coeliac Disease? Why?
Celiac disease can cause damage to the small intestine where iron, folate, and vitamin B12 are absorbed.
Iron and folate anemias are seen more often in people with celiac disease because these nutrients are absorbed in the upper two parts of the intestine where damage can occur in earlier stages of celiac disease. When celiac disease progresses, the lower part of the small intestine can be damaged and cause vitamin B12 deficiency.
Antibody tests are also undertaken that indicate Coeliac Disease. What are these?
In adults, with suspected coeliac disease, the following blood tests are recommended:
Total immunoglobulin A (IgA)
IgA Tissue transglutaminase antibody (shortened to tTG)
If IgA tTG is weakly positive then IgA endomysial antibodies (shortened to EMA) should be used.
In children with suspected coeliac disease, the following blood tests are recommended:
Total IgA
IgA tTG
What is the difference between Coeliac Disease, gluten hypersensitivity and gluten intolerance?
Symptoms of an allergy to wheat can include itching, hives, or anaphylaxis, a life-threatening reaction
Non coeliac gluten sensitivity is when symptoms similar to coeliac disease are experienced, but there are no associated antibodies and no damage to the lining of the gut.
Diagnosis of IgE food allergies, such as a wheat allergy, is generally done through RAST or skin prick testing and a double-blind placebo test using the allergen. This is usually completed by an allergist.
