Gastrointestinal Disease

Question 1

What are the main defences of the gastrointestinal tract against acid production?

Answer 1

Mucous production
Bicarbonate production in pancreas
Prostaglandin production
Tight junctions
gastric epithelial regeneration

Question 2

Where are peptic ulcers most commonly found?

Answer 2

distal stomach and proximal duodenum

Question 3

How does H. Pylori cause peptic ulcerations?

Answer 3

breaks mucous layer
produces a high pH buffer against acidic environment
adheres to gastric epithelial cells

Question 4

What are the main physical results post H. Pylori infection?

Answer 4

Reduces pH - enhances gastric acid secretion/impairs bicarbonate production
Secretes toxins which damage epithelium and weakens tight junctions
Promotes inflammatory response

Question 5

What are the main complications/outcomes associated with chronic peptic ulcers?

Answer 5

1. Healing
2. Bleeding - small or large bleeds
3. Perforation - ulcer penetrates wall completely
4. Obstruction - intestinal contriction/blockage during healing

Question 6

What are the treatments currently offered for peptic ulcers?

Answer 6

antibiotics - removal of bacterial cause
decrease in NSAIDs
reduce acid secretions
surgery

Question 7

What is GORD?

Answer 7

Gastro-oesophageal reflux disease

Question 8

What are the pathology and symptoms related to GORD?

Answer 8

Damage to mucosa due to lower oesophageal sphincter (LOS) dysfunction
Inflammation, ulceration of luminal surface

Question 9

What other complications can arise due to GORD?

Answer 9

1. Stricture/oesophageal damage

2. Barrett’s oesophagus

Question 10

Which treatments are offered for GORD?

Answer 10

Ant-acids
Proton pump inhibitors
Histamine receptor inhibitors
surgery

Question 11

Describe the pathology related to Coeliac disease

Answer 11

Auto-immune disease - antibodies againt gluten
Immunoglobulins attack the villi within the small intestine
inflammatory response of mucosal surface is activated
atrophy of villi = decreases surface area = decreased absorption

Question 12

What are the symptoms associated with Coeliac disease?

Answer 12

diarrhoea, fatigue, abdominal pain, weight loss, flatulence

Question 13

What percentage of Coeliac disease remain asymptomatic?

Answer 13

38% of cases are asymptomatic

Question 14

What are the natural defences against gastrointestinal infection?

Answer 14

Stomach acidity
epithelial barrier
enterocytes constantly replenished
colonisation resistance
bacteriocins

Question 15

Compare and contrast infection and intoxication

Answer 15

Infection is the invasion of the body by a live pathogen, disease takes a longer time to develop, fever is a common symptom, blood and mucous is present in diarrhoea

Intoxication is ingestion of toxin produced by bacteria/pathogen (NOT BACTERIA ITSELF)
Fast onset of sickness, fever is not typically a symptom, no blood or mucous within diarrhoea.

Question 16

What are the two types of IBD and how do they differ?

Answer 16

1. Ulcerative Colitis - ulcers which are located on the mucosa in ‘sheets’
2. Crohn’s disease - deep lesions which can occur anywhere on the mucosa (eyes, mouth, etc.)

Question 17

What are the treatments offered for IBD?

Answer 17

Immune suppressors
Neutralising antibodies
Microbiota transplant
Surgery

Question 18

Compare and contrast immune suppressors and neutralising antibodies.

Answer 18

immune suppressors have a non-specific effect on the immune system
neutralising antibodies have a targeted approach to specific components of the immune system to decrease the autoimmune response.

Question 19

What is the pharmacology related to colon cancers?

Answer 19

longer transit time and decreased water content of foods transported within the lumen can expose the muscosa to potentially carcinogenic substances. A greater risk of mutations occurring which could cause proliferative complications = cancer

Question 20

What are the treatments available for colon cancer?

Answer 20

Depends on the type, grade and stage of the cancer as well as the general health of the patient at diagnosis