GI: Pathology

Question 1

What is paralytic ileus?

Answer 1

Loss of GI contractility

-Can occur following GI surgery

Question 2

What is achalasia?

Answer 2

Failure of LOS to relax

Question 3

What is Hirschsprung’s disease?

Answer 3

• Lack of myenteric and submucosal plexus

- Results in function obstruction

Question 4

What are the effects of inflammatory bowel disease on crypts?

Answer 4

• Crypt alteration
• Cryptitis (inflammation of wall)
• Crypt abscess (neutrophils in lumen)

Question 5

What is coeliac disease?

Answer 5

• Inability to tolerate gliadin found in gluten.
• Gluten is found in wheat, rye and barley
• Results in immune response which damages the mucosa leading to poor digestion and malabsorption
• Causs absence of intestinal villi and causes lengthening of intestinal crypts.
• Lymphocytes infiltrate epithelium

Question 6

What is xerostomia?

Answer 6

-Dry mouth

Can lead to dental cavities, mouth ulcers, bad breath and oral thrush

Question 7

What are causes of dysphagia?

Answer 7

Dysphagia is difficulty swallowing

Causes are

• Stroke that affect nerves controlling swallowing
• Oesophageal tumour (solid are a problem)
• Hardening of muscular layers

Question 8

Which drugs could have an effect of the parasympathetic innervation of the salivary glands?

Answer 8

• Anti muscurinic

- Can cause xerostomia

Question 9

What are the narrowings found in the oesophagus?

Answer 9

• Tightest narrowing is the junction between the pharynx and oesophagus
• Second narrowing is when the arch of aorta crosses the oesophagus
• Third narrowing is when the left main bronchus crosses the oesophagus
• Final narrowing is when oesophagus passes through diaphragm (T10)

Question 10

Outline some of the clinical consequences of free gastro-oesophageal reflux.

Answer 10

-Barrett’s oesaphagus

Question 11

What is the treatment for gastro-oesophageal reflux disease?

Answer 11

-Lifestyle modifications

Pharmacological

• Antacids
• H2 antagonists (block histamine)
• Proton Pump Inhibitors

Surgery(rare)

Question 12

What is acute gastritis?

Answer 12

Acute mucosal inflammatory process. Caused by:

• Heavy use of NSAIDS
• Lots of alcohol
• Chemotherapy
• Bile reflux

Question 13

What are the symptoms of acute gastritis?

Answer 13

Asymptomatic most of the time but can present with

• Pain
• Nausua
• Vomiting
• Occasionally bleeding

Question 14

What are the common causes of chronic gastritis?

Answer 14

Bacterial
-H pylori infection

Autoimmune

• Antibodies to gastric parietal cells
• Can lead to pernicious anemia

Chemical/reactive (minimal inflammation)

• Chronic alcohol abuse
• NSAIDS
• Reflux of bile

Question 15

What are symptoms of chronic gastritis caused by H.pylori?

Answer 15

Asymptomatic or similar to acute gastritis

-Symptoms may develop due to complications (peptic ulcers, adenocarcinoma, MALT lymphoma)

Question 16

What are symptoms of chronic gastritis caused by an autoimmune disorder?

Answer 16

• Symptoms of anaemia
• Glossitis
• Anorexia
• Neurological symptoms

Question 17

What is peptic ulcer disease?

Answer 17

Defects in gastric/duodenal mucosa that extend through the muscular mucosa
-Commonly in first part of duodenum and lesser curve of the stomach

Question 18

What are the causes of peptic ulcer disease?

Answer 18

• Stomach acid
• H pylori
• NSAIDS
• Smoking
• Massive physiological stress

Question 19

What are the symptoms of peptic ulcer disease?

Answer 19

Epigastric pain

• Burning/Gnawing
• Follows meal times
• Often at night

Serious symptoms

• Bleeding/anaemia
• Satiety (early)
• Weight loss

Question 20

What is functional dyspepsia?

Answer 20

• Symptoms of ulcer disease
• No physical evidence
• Diagnosis of exclusion

Question 21

What are the methods used to diagnose gastric pathology?

Answer 21

• Upper GI endoscopy (biopsies)
• Urease breath test
• Erect chest X-ray (perforation)
• Blood test (anaemia)

Question 22

How do H2 blockers work?

Answer 22

-Stop histamine components which stimulate parietal cells

Question 23

Describe the pathogenesis of helicobacter-pylori?

Answer 23

• Spread via faecal-oral route
• Helix shaped gram negative
• Produces urease which covers urea to ammonium to increase local pH
• Has flagellum for good motility. It lives in mucus layer/adheres to gastric epithelia

Question 24

How does helicobacter pylori cause problems?

Answer 24

• Relase cytotoxins to cause direct epithelial injury
• Expresses urease which can form ammonia which is toxic to epithelium
• Possibly degrades mucus layer
• Promotes inflammatory response which can cause self injury

Question 25

What is the pathological result of the location of H-pylori colonisation?

Answer 25

In antrum
-Duodenal ulceration

In antrum and body
-Asymptomatic

Predominantly in body
-Can lead to cancer

Question 26

What are causes of stress ulceration?

Answer 26

• Severe burns
• Raised intracranial pressure
• Sepsis
• Severe trauma
• Multiple organ failure

Question 27

What are the symptoms of coeliac disease?

Answer 27

• Diarhoea

- Flatulence

Question 28

What investigations done for coeliac disease?

Answer 28

• Upper GI endoscopy and biopsies. Checks for mucosal pathology and whether villli are reduced or absent
• Bloods (Serology, Electrolyte imbalances and Anaemia)
• Treatment (diet)