GI Diseases and Conditions

Question 1

Types of Hepatitis

Answer 1

Acute: abrupt onset, can have nausea, vomiting, fever, anorexia, fatigue, arthralgia, myalgia, headache, pharyngitis, cough, diarrhea, jaundice after 1-2 weeks (defined as infection for < 6 months)

Chronic: diagnosed based on liver function blood test (high ALT and AST) or end stage by liver dysfunction (defined as infection for > 6 months)

Histologically: acute has lymphocytes and chronic has fibrosis

Question 2

Hepatitis A

Answer 2

Oral-fecal route

Acute only

Can be asymptomatic

Common in developing countries

Question 3

Hepatitis B

Answer 3

Sexual transmission (more common in MSM), vertical transmission, blood exposure

Can be acute or chronic

Question 4

Hepatitis C

Answer 4

Blood exposure (not certain it is passed sexually)

Chronic only (?)

Histologically: goes STRAIGHT to chronic–fibrosis without ever having inflammation

Question 5

What else can causes hepatitis?

Answer 5

Toxins, prescription drugs (tylenol)

Alcoholism (alcoholic hepatitis)

Steatosis (fat deposits, which can be due to alcohol or due to obesity!) can lead to steatohepatitis (not always though)

Question 6

Women’s complications from alcoholism

Answer 6

Women progress to alcoholic liver disease on average 10 years earlier than men

Women are more likely to suffer alcoholic cardiomyopathy than men

Question 7

What hurts when you have liver problems?

Answer 7

Spleen!

Note: if you have a gallbladder problem, spleen doesn’t usually hurt

Question 8

Lab results for viral hepatitis versus alcoholic hepatitis

Answer 8

HepA, B, C: ALT, AST = 400 - 4000 (high); WBC normal-low

Alcoholic hepatitis: ALT, AST = <400 but still high; AST>ALT; WBC increased (You’re toASTed with alcoholic hepatitis)

Question 9

Diabetes mellitus

Answer 9

Group of disorders

Characterized by high blood glucose

Either absolute or relative lack of insulin

80% of diabetics die of cardiovascular disease

(Insulin is required to get glucose out of the bloodstream and into the cells, and diabetics can’t do this!)

Question 10

Type 1 diabetes mellitus

Answer 10

Absolute lack of insulin

Antibodies against (beta) islet cells in the pancreas that make insulin so >90% beta cells destroyed and have unopposed action of alpha cells that secrete glucagon

See autoreactive T cells in islets of Langerhans of the pancreas

Usually presents in childhood or adolescence

Genetic susceptibility (HLA D region genes), but unidentified environmental component

Concordance in identical twins: 30 - 70%; most pts with type 1 diabetes DON’T have first degree relative with disease

Question 11

Type 2 diabetes mellitus

Answer 11

Resistance to action of insulin in target tissues; relative lack of inuslin

May have higher than normal levels of insulin in body

Over time, pancreatic islet cells lose function, and this can lead to absolute lack of insulin (and then ketoacidosis)

Obesity is strongest risk factor; is more common in AAs, Latinos, Asian-Pacific Islanders, Native Americans

Can lose weight to treat type 2 diabetes, so might not even need drugs to lower blood sugar

Concordance in identical twins is 70 - 90%; risk for person with both parents with type 2 diabetes is 40%

Question 12

Drug treatments for diabetes

Answer 12

Insulin: injected, causes weight gain

Sulfonylureas: stimulate beta cells to secrete insulin (glucotrol, glipizide)

Biguanides: inhibit gluconeogenesis and enhance GLUT4 translocation (metformin); mostly for type 2 diabetes

Thiazolidines: enhance insulin receptor activity and GLUT4 translocation in fat cells; not used anymore because didn’t reduce MIs or stroke

Incretin mimetics: signal beta cells to secrete more insulin; associated with weight loss; incretins naturally occuring hormones secreted from intestine in response to food intake (exenatide)

Dipeptidyl peptidase-4 (DPP-4) inhibitors: increase incretin available to respond to elevated glucose levels by limiting degradation of them by DPP-4; don’t cause weight gain (sitagliptin)

Question 13

Why has type 2 diabetes increased so much in children over past 20 years?

Answer 13

Yes, more obese children now, but more because of lack of physical exercise

(Exercise causes insulin sensitivity)

Question 14

Diabetes and cardiovascular disease

Answer 14

Because 80% of diabetics die of cardiovascular disease, must act to prevent microvascular, macrovascular, lipid problems

Maintaining normal blood sugar levels important to prevent microvascular disease (retinopathy, neuropathy, nephropathy)

Maintaining normal blood sugar levels important in Type 1 to prevent macrovascular disease (heart attack, stroke)

Use statins, aspirin to prevent cardiovascular disease

Maintain normal BP to prevent atherosclerotic complications

Question 15

Gestational diabetes

Answer 15

When pregnant, everyone gets insulin resistant because want baby to grow more than mother

If you were already genetically predisposed to Type 2 Diabetes and thus were losing beta cells, when you get pregnant you can pass the threshold and develop diabetes

After delivery, diabetes goes away

However, now we know they’re predisposed to Type 2 Diabetes

Question 16

Pancreatitis

Answer 16

Digestive enzymes the pancreas usually secretes can no longer be secreted and they start destroying the pancreas

Can be caused by gall stone blocking pancreatic duct