GI Patho 1

Question 1

4 common symptoms of GIS disorders?

Answer 1

Pain - location
Vomiting
Diarrhoea/Constipation
Maldigestion/Malabsorption

Question 2

Stomach Cramps can be indicative of?

1) Epigastric region?
2) Periumbilical?
3) Upper left?
4) Upper right?
5) Lower right?

Answer 2

1) Gastroesophageal Reflux / Stomach
2) bowel / intestines
3) PANCREAS
4) LIVER / GALL BLADDER (Cholecystitis)
5) Appedicitis

Question 3

In excessive vomiting, stomach contents are Repeatedly lost.

1) Resulting in?
2) Blood accumulation of ____ which does what?

Answer 3

1) Dehydration
ALKALOSIS (pH>7.45)
HYPOchloremia
2) Bicarbonate (HCO3-) –> INCREASE Alkalosis

Question 4

Vomiting:
Dehydration & Hypovolemia:
1) What is first affected & how?
2) What does it lead to?
3) All cells affected?

Answer 4

VOMITING

1) Nerve cells first affected due to:
- Lack of O2
- Build up of wastes
2) Decreased enzyme function leads to:
- Inattention
- Drowsiness
- Coma
3) Eventually, all cells affected –> Death

Question 5

Vomiting:
Dehydration & Hypovolemia:
1) What is first affected & how?
2) What does it lead to?
3) All cells affected?

Answer 5

VOMITING:
1) Nerve cells first affected due to:
Lack of O2 / Build up of wastes
2) Decreased enzyme function leads to:
inattention / drowsiness / coma
3) Eventually, all cells affected --> Death

Question 6

Vomiting:

Hypovolemia causes what? (4)

Answer 6

˅ BP
˅ Perfusion of tissues (blood)
˅ O2 & other nutrient delivery to cells
˅ Removal of CO2 & wastes from cells

Question 7

Secretions of Stomach:

1) (3) & their purpose?
2) What does bicarbonate in pancreatic juice do?

Answer 7

1) *Mucus (Protect the mucosa)
* Pepsinogen (Inactive form of pepsin)
* Hydrochloric acid (HCl): Antimicrobial & Activation/conversion of pepsinogen
2) Neutralizes acidic chyme

Question 8

Gastroesophageal reflux:

2 main causes?

Answer 8

1) INCREASED ABDOMINAL PRESSURE:
2) DELAYED GASTRIC EMPTYING:
- Peptic ulcers
- Narrowing of pyloric sphincter

Question 9

Gastroesophageal reflux:

1) Symptoms?
2) Why is heartburn an important symptom?
3) Diagnosis?
4) Treatment?

Answer 9

1) - Pain within 1 hour of eating: Upper abdominal
- Heartburn
2) Need to differentiate from other causes of chest pain (e.g. MI)
3) Endoscopy / Barium meal
4) Antacids / Smooth muscle stimulants / Surgery

(neutralise gastric contents / ^ gastric emptying / narrow gastroesophageal sphincter)

Question 10

Secretions of Stomach:

(3) & their purpose?

Answer 10

1) Mucus (Protect the mucosa)
2) Pepsinogen (Inactive form of pepsin)
3) Hydrochloric acid (HCl): Antimicrobial & Activation/conversion of pepsinogen

Question 11

Peptic ulcer disease:

1) What is it caused by?
2) What part of GI Tract is exposed? (3)
3) 2 common types

Answer 11

1) Exposure to Acid-Pepsin secretions causing ULCER in the Protective mucosal lining
2) Upper GI Tract:
lower oesophagus / stomach / duodenum
3) Duodenal (most common) / Gastric

Question 12

Peptic ulcer disease:

1) Superficial ulcers are also called what? & why?
2) What are true ulcers?
3) What can true ulcers do?

Answer 12

1) Erosions; only erode mucosa
2) Deeper (wubmucosa or muscularis)
3) - Damage blood vessels –>haemorrhage
- Perforate GI wall (make holes)

Question 13

Peptic ulcer disease:

Risk factors?

Answer 13

• Long term NSAIDs (aspirin, ibuprofen)
• H. Pylori infection
  (helicobacter) (exposure to vomit/close contact)

Gastric/Duodenal mucosa:
irregular meal pattern / traumatic event (burns, stroke) / Alcohol / Smoking

Question 14

Duodenal ulcers: Most common type of peptic ulcer
1) More common in? (sex, age, blood type)

2) What is the primary defect in duodenal ulcers?
3) Major causes of duodenal ulcers? (2)

Answer 14

1) Men, age 20-50, Blood type O

2) HYPERSECRETION of Acid & Pepsin from stomach
3) H. Pylori / long term NSAIDs

Question 15

Duodenal ulcers: 
Symptoms:
1) When is there pain?
2) Acute/chronic pain? How often? Area? 
3) What pattern of relief?

Answer 15

1) Empty stomach / 2-3hrs after eating / middle of night
2) Chronic + Intermittent pain
Epigastric area
3) “Pain-Food-Relief” pattern:
- Food/Antacids relieves pain

Question 16

Duodenal ulcers:
Symptoms:
1) First sign of duodenal ulcer if asymptomatic?
2) What does bleeding from duodenal ulcers cause? (2)
3) Recurrence?
4) Diagnosis? (3)
5) Treatment: Triple Therapy (3)

Answer 16

1) Haemorrhage OR Perforation
2) - HematEmesis (Brown VOMIT)
Melena (Black): (bloody stool)
3) Periods of Remission followed by Exacerbation
4) Barium meal / Endoscopy / UREA BREATH TEST for H. Pylori
5) Antibiotics / Acid suppressors / Stomach protectors

Question 17

Gastric ulcers (Stomach ulcers):

1) What is the primary defect in gastric ulcers?
2) Major causes of Gastric ulcers? (2)
3) When is there pain? Area?
4) Acute/Chronic pain? Recurrence?

Answer 17

1) ^ Permeability to H+ of Gastric Mucosa
2) H. Pylori & NSAIDs
3) IMMEDIATELY after eating - Epigastric area
4) Chronic; WITHOUT periods of remission & exacerbation

Question 18

Acute pancreatitis:

1) What is it?
2) How dangerous?
3) What happens in acute pancreatitis?
4) Most common cause? (2)

Answer 18

1) Sudden and Severe Inflammatory Reaction of pancreas
2) Life Threatening
3) Escape of activated pancreatic enzymes: autodigestion of the pancreas
4) - Alcohol & Fatty food
- Gallstone

Question 19

Gastric ulcers (Stomach ulcers):
Diagnosis & Treatment?

Answer 19

Same as Duodenal ulcers.

i. e. Diagnosis:
- Barium meal
- Endoscopy
- Urea breath test for H. Pylori

Treatment:

• Antibiotics (To kill H. Pylori)
• Acid suppressors
• Stomach protectors

Question 20

Pancreas:
Endocrine pancreas releases hormones into blood.
1) What does EXOcrine pancreas do?
2) What are acini and what do they produce?
3) What is activated in the duodenum?

Answer 20

1) Releases digestive juices through a duct –> To the DUODENUM
2) Smallest secreting part of gland & produce:
- Inactive digestive enzymes
- Bicarbonate (anti-acid)
3) Digestive enzymes

Question 21

Acute pancreatitis:
Patho:
1) Where is severe pain located?
2) Inflammation leads to what? (2)
3) What happens to the dead pancreatic cells?
4) Bleeding.
5) Damage to other organs? (3)

Answer 21

1) Upper left abdominal pain & Radiates to back
2) - Fever, Nausea, Vomiting
- Large volumes of exudate into abdominal cavity –> Hypovolemia –> ˅ BP
3) They undergo Fat Necrosis:
- Calcium from blood is deposited into dead cells
- Hypocalcaemia (˅ 25%)
5) - Acute Respiratory distress
- Acute renal failure
* ** Myocardial insufficiency –> Multi-organ Failure –> Death

Question 22

Acute pancreatitis:
1) Diagnosis: Lab test:
Which 2 serums are elevated?
2) Treatment: ICU: (4)

Answer 22

1) Elevated:
- Serum Amylase (within 24h)
- Serum Lipase (24-48h)
2) - Pain relief
- Antibiotics
- Fasting (INCLUDING FLUIDS) to rest pancreas
- IV fluids, Electrolytes, Colloid solutions (volume expander)

Question 23

Chronic pancreatitis:
*** similar Signs & Symptoms to acute pancreatitis

3 problems often associated with chronic pancreatitis?

Answer 23

1) Digestive problems
2) Glucose control problems
3) signs of Biliary (bile duct) Obstruction:

1) can’t deliver enzymes to duodenum
2) damage to islets of β-cells
3) - underlying bile tract disorders
- duct compression by tumors

Question 24

Malabsorption syndromes:

1) What is it?
2) Which is more common cause: maldigestion or malabsorption?

Answer 24

1) Failure of intestinal mucosa to absorb digested
nutrients
2) Maldigestion

Question 25

Malabsorption syndromes: | 2 main digestive failures that cause malabsorption syndromes?

Answer 25

- Pancreatic insufficiency | - Bile salt deficiency

Question 26

Digestive failure (Pancreatic insufficiency) as cause of Malabsorption syndromes: 1) What is pancreatic insufficiency? 2) Which maldigestion presents as the greatest problem? 3) What is pancreatic insufficiency due to? (3)

Answer 26

1) Deficiency of Pancreatic Enzymes required for digestion of proteins, carbohydrates & fats 2) Fat maldigestion 3) - Chronic Pancreatitis - Pancreatic Cancer - Pancreatic Cystic Fibrosis

Question 27

Digestive failure (Bile Salt Deficiency) as cause of Malabsorption syndromes: 1) Why are bile salts necessary? 2) Conditions that decrease production & secretion of bile result in what? & 2 examples 3) What prevents reabsorption of bile? (2)

Answer 27

``` 1) Necessary for emulsification of fats (breakdown of larger fat into smaller) 2) Fat malabsorption E.g. - Advanced Liver Disease - Obstruction of the Common Bile Duct 3) - Intestinal stasis & - Diseases of the ileum ``` intestinal stasis: impairment of the normal passage of intestinal contents, due to mechanical obstruction or to impaired intestinal motility.

Question 28

Malabsorption syndromes: ˅ Fat absorption --> ˅ absorption of fat soluble vitamins & cholsterol Which vitamins will be in deficit if no fats digested? & what does it cause?

Answer 28

``` - Vit A (Night blindness) - Vit D (˅ Ca+ absorption: osteoporosis, bone pain) - Vit E (slow healing, nerve damage) - Vit K (easy bruising, decreased clotting) - Cholesterol (˅ steroid hormone synthesis) ```

Question 29

Malabsorption syndromes: 1) Steatorrhoea? 2) Diarrhoea?

Answer 29

1) Increased fat in stool (Bulky, very foul smell due to digestion of extra food) 2) Fluids, electrolytes & proteins are dragged into the stool by Excess Fat