GI pathology Flashcards
Oesophageal reflux description and pathology
Reflux of gastric acid into oesophagus
Gastric acid refluxes into oesophagus causing thickening of squamous epithelium cells and eventually ulceration.
Can be caused by part of srtomach herniating through oesophageal sphincter
Oesophageal reflux risk factors
poorly functioning oesophageal sphincter, drugs such as medicine for asthma, high blood pressure, obesity, smoking
Oesophageal reflux symptoms
bloating, nausea, heart burn, dysphagia, chronic sore throat
Oesophageal reflux treatment and complications
Antacids
“Barrett’s oesophagus,
Healing by fibrosis”
Oesophageal cancer description/pathology
Squamous cell or adenocarcinoma cancer in oesophagus.
Abnormal cell proliferation in oesophagus
Oesophageal cancer risk factors
“Squamous: smoking and alcohol
Adenocarcinoma: obesity and Barrett’s oesophagus”
Oesophageal cancer symptoms
dysphagia, coughing, hoarseness, chest pain, worsening heartburn
Oesophageal cancer investigations/ local effects
endoscopy, bloogs (FBC, glucose, CRP)
local effects include: obstruction, ulceration, perforation
Oesophageal cancer treatment
surgery, chemotherapy, radiotherapy
Gastritis description/ pathology
Inflammation of the stomach
3 different causes: Autoimmue, Bacterial (helicobacter pylori) and Chemical
Gastritis symptoms/ treatment
Nausea, abdominal bloating, heartburn, burning or gnawing feeling in stomach between meals and at night, loss of appetite, bloating
T:antacids
Peptic ulceration description/ pathology
ulcers that develop in lining of stomach
imbalance between acid secretion and mucosal barrier
Peptic ulceration symptoms/investigations
S:heartburn, acid reflux, abdominal pain, burping, nausea or vomiting
I:endoscopy, bloods
Stomach cancer description/ pathology/risk factors
D:Cancer that develops in the lining of the stomach
P:Develops through phases of intestinal metaplasia and dysplasia.
Is an adencarcinoma
RF:Can be a consequnce of h.pylori infection
Stomach cancer symptons
dysphagia, abdominal pain, heartburn, blood in stools, weightloss, tiredness, nausea/vomiting, bloadted
Stomach investigations
Endoscopy, endoscopic ultrasound,barium meal Xray
Stomach cancer treatment
gastrectomy, oesophagogastrectomy, chemotherapy, radiotherapy
Peritonitis description
Inflammation of peritoneum
Peritonitis pathology
"Bacterial infection spread by: Perforation of GI/ biliary tract, Female genital tract, Penetration of abdominal wall, Haematogenous spread"
Peritonitis risk factors
Peritoneal dialysis, appendicitis, history of peritonitis
Peritonitis symptoms
Abdominal pain, bloatinf, fever, nause/vomiting, loss of appetite, diarrhoea,low urine output, inability to pass stool or gas, fatigue
Peritonitis investigations and treatment
I:Peritoneal fluid analysis, blood tests
T:Antibiotics, though may need surgery to remove the infected tissue
Intestinal obstruction description/pathology
D;Obstruction within, on or surrounding the intestinal tubes
P:Tumour, hernia, clot
Intestinal obstruction symptoms
Pain, vomiting, distension, constipation, borborgmi (strange bowel sounds), early sanity, weight loss, gastric splash, dehydration, metabolic alkalosis
Intestinal obstruction investigations
Urine test, FBC, U+E, LFT, ultrasound, CT, laproscopy, laparotomy
Intestinal obstruction treatment
Restore circulatinf fluid volume, oxygenation, antibiotics, pain relief
Dyspepsia description and pathology
D:”dys=bad
pepsia=digestion”
P:Upper Gi problems (peptic ulcer, gastritis, gastric cancer), hepatic problesm, gallstobes,pancreatic disease, Lower GI (IBS, colonic cancer), coeliac disease, drugs, psychological, metabolic problmes (diabtetes, high Ca), cardiac problems
Dyspepsia risk factors
"Drug history (NSAIDs, steroids, bisphosphonates, Ca antagonits, nitrates, theophyllines) Lifestyle choices (alcohol, diet, smoking, exercise)"
Dyspepsia symptoms
Upper abdominal discomfort, retrosternal pain, anorexia, nausea, vomitinf, bloating, fullness, early satiety and heartburn
Dyspepsia signs
"Anorexia Loss of weight Anaemia (iron deficiency) Recent onset >55 years or persistent despite treatment Melaena/haematemesis or Mass Swallowing problems
All signs for reference for endoscopy”
Dyspesia investigations
“Bloods (FBC, ferritin, LFTs, UandEs, Calcium, glucose, coeliac serology/serum IgA)
Endoscopy
Test for helicobacter pylori “
Dyspesia treatment
antacids
Helicobacter pylori infection description and pathology
D:Bacterial infection in digestive tract
P:H.pylori invades in antrum- more likely to get ulcers in duodenum and small bowel, if invades higher up more likely to get gastric cancer
H.pylori infection symptoms
Upper abdominal discomfort, retrosternal pain, anorexia, nausea, vomitinf, bloating, fullness, early satiety and heartburn
H.pylori infection investigations
Serology (increase IgG), urea breath test, stool antigen test, endoscopy
H.pylori infection treatment
“antibiotics, PPI,
eradication therapy- triple therapy for 7 days:
Clarithromycin 500mg
Amoxycillin 1g bd (tetracycline if allergic to penicillin)
PPI eg omeprazole 20mg”
Peptic ulceration treatment
If caused by H.pylori- eradication therapy (read h.pylori infection), antacid or H2 receptor antagonist, stopping bad drugs
Causes of acute liver disease
Hepatitis (viruses, alcohol, drugs) or bile duct obstruction
What is pre-hepatic jaundice
When there is increased release of bilirubin from rbc
Hepatic causes of jaundice
Cholestasis and intrahepatic bile duct obstruction
What is cholestasis?
Accumulation of bile within hepatocytes or bile canaliculi
Causes of intra-hepatic duct obstruction?
Primary biliary cholangitis, primary sclerosing cholangitiis, tumours of liver
Post-hepatic causes of jaundice
Cholelithiasis, gallbladder diseases, extra-hepatic duct obstruction
Types of stool analysis?
stool culture, faecal calprotectin (increased inflammatory condition), faecal elastase (pancreatic insufficiency/malabsorption
What is the endoscopic retrograde cholangio-pancreatography used to view?
Used to visulaise ampulla, biliary system and pancreatic ducts
What is enteroscopy used to visulaise
Used to visualise small intestine
What pathways are interrupted by alcohol?
glucose-6-phosphate to glucose, acetyl CoA into citric acid cycle, this causes decreased glucose concentration and increased ketone concentration, there is also an increase build up in fatty acids
Labs performed to assess liver damage from alcohol?
aspartate amino transferase > alanine amino transferase, raised gamma glutamyl transferase, macrocytosis (creates large rbc), thrombocytopenia (low platlets)- alcohol affects bone marrow
2 ways of measuring alcoholic hepatitis levels?
Glasgow hepatitis score, Maddreys discriment function
What are gallstones made up of?
A mix of cholesterol and pigment
Risk factors for cholesterol gallstones
Obesity, iteal disease, cirrhosis, CF, DM, TPN, heart transplant, delayed GB emptying, clofibrate, long-term low-fat diet
Risk factors for pigment gallstones
haemplytic anaemia, bile infection (e.coli, bacteroides)
Causes of congenital biliary tract disease
Biliary atresia, choledochal cysts
Causes of benign billary stricture
latrogenic, gallstone related, inflammatory causes: pyogenic, parasitic, PSC, pancreatitis, HIV
What does odynophagia mean?
pain with swallowing
Name some investigations for oesophageal disease
oesphago-gastro-duodenoscopy, upper Gi endoscopy, contrast radiology, oesophageal pH and manometry
3 readings from glasgow criteria score that would result in pancreatitis to be described as severe
White cell count >15x10(9)/l, blood glucose >10mmol/l, blood urea >16mmol/l, serum albumin <32g/l, serum calcium <2.0mmol/l, arterial PO2 <7.5kPa
What is hyperamylasaemia and what condition can it be a complication of?
Increases serum amylase levels and can be caused by a complication of acute pancreatitis known as pseudocyst
Causes of chronic pancreatitis
“O-A-TIGER:
Obstruction of MPD (tumour, sphincter of Oddi dysfunction, pancreatic divisum, duodenal obstruction, trauma, stricture)
Autoimmune
Toxin (ethanol, smoking, drugs)
Idiopathic
Genetic
ENvironmental (tropical chronic pancreatitis)
Recurrent injuries (biliary, hyperlipidaemia, hypercalcemia) “
Name the 3 different approaches to oesophagectomy
Ivor Lewis, trans-hiatal, left-thoraco-abdominal
What are the ALARM symptoms?
Anaemia Loss of weight Anorexia Recent onset of progressive symptoms Masses or melaena/ haematemesis
4 main functions of the small intestine?
digestion, endocrine and neuronal control, absorption, barrier functions
What is steatorrhoea a result of?
fat malabsorption
what are characteristics of steatorrhoea?
high fat content, less dense, floats, pale, foul smelling, leaves oily marks on toilet
What is dermatitis herpetiformis?
cutaneous manifestation of coeliac disease due to IgA deposit in skin, causes blisgering itch on scalp, shoulder, elbows and knees
Causes for finger clubbing
coeliac disease, crohns
What is the gold standard diagnosis of Coeliac?
distal duodenal biopsy
Wich conditions is coeliac associated with
dermatitis herpetiformins, IDDM, autoimmune thyroid,autoimmune hepatitis, primary biliary cirrhosis, autoimmune gastritis, sjogren syndrome, downs syndrome
What is refractory coeliac disease
ongoing symptoms of coeliac disease despite gluten free diet
2 main causes of malabsorption
inflammation (eg coeliac disease, crohns) and infection (eg tropical sprue, HIV, giardia lamblia)
Small bowel overgrowth can occur in conditions in which what functions are affected?
motility, gut structure, immunity
Difference between structural and functional GI disorders?
structual has detectable pathology (macroscopic (cancer) or microscopic (colitis)) and functional has no detectable pathology but is related to gut function
What is non-ulcer dyspsia?
dyspeptic type pain with no ulcer
How is vomiting stimulated?
via sympathetic and vagal components via vomiting centre or chemoreceptor trigger zone: receptor for opiates, digioxin, chemotherapy, uraemia
What is the likely cause of vomiting if immediately after food?
psychogenic
What is the likely cause of vomiting if 1 hour or more after food?
pyloric obstruction, motility disorder (diabetes, post gastrectomy)
What is the likely cause of vomiting if 12 hours after food?
Obstruction eg tumour
Functional causes of vomiting
drugs, pregnancy, migraine, cyclical vomiting syndrome, alcohol
2 main functional diseases of lower GI tract?
Irritable bowel syndrome and slow transit constipation
Organic causes of constipation
strictures, tumours, diverticular disease, procitis, anal fissure
Functional causes of constipation
megacolon, idiopathic constipation, depression, psychosis, instutionalised patients
Systemic causes of constipation
diabetes mellitus, hypothyroidism, hypercalcaemia
Neurogenic causes of constipation
autonomic neuropathies, parkinson’s disease, strokes, multipe sclerosis, spina bifida
What is the ROME III diagnostic criteria for IBS?
recurrent abdominal pain/ discomfort for >3 days/month in the past 3 months, associated with 2 or more: improvement with defaecation, onset associated with change in stool frequency, onset associated with change in stool form
What is the NICE diagnostic criteria for IBS?
abdominal pain/ discomfort relieved by defaecation or associated with altered sith still frequency/ form, plus 2 or more of: altered stool passage, abdominal bloating/ distension, symptoms worse by eating, passage of mucus
What is calprotectin and what is it a sign of if present in blood?
Calprotectin released by inflamed gut mucosa and is a sign of IBD
Severe attack of ulcerative colitis clinical features
stool frequency >6 stools/day with blood, fever, tachycardia, raised ESR, anaemia, albumin <30g/l, leucocytosis/thrombocytosis
Calprotectin levels
<50=normal
50-200=equivocal
>200=elevated
Name the differences between crohn’s and ulcerative colitis in histology
CD= granulomas and less crypt abscesses than UC
UC has depleted goblet cells
Extra-intestinal manifestations from IBD
eyes: uveitis, episcleritis, conjunctivitis
joints: sacrolitis, monoarticular arthritis, ankylosing spondylitis, renal calculi
liver and biliary tress: fatty change, pericholangitis, sclerosing cholangitis, gallstones
skin: pyoderma gangrenosum, erythem nodosum, vasculitis
Name the aminosalicylates
Aminosalicylates (mesalazine: acrylic resin (asacol, ipocol, mesren, salofalk) or ethylcellulose microgranules (pentasa))(pro-drugs (balsalazide,olzalazine, sulfasalazine))
Types of steroids used in IBD
prednisolone, budenoside
Types of thiopurines used for IBD
Azathioprine or 6-Mercaptopurine, these drugs keep inflammation under control
Side effects of thiopurines
Leucopenia, hepatoxicity (blood monitoring required), pancreatitis
Immunosuppressants used for IBD
ciclosporin, mycophenolate, tacrolimus
Anti-TNFalpha antibodies used in IBD
infliximab (8 weekly IV infusion)
adulimumab (2 weekly SC injections)
alpha4b7 integrin blockers
vedolizumab (8 weekly IV infusions)
IL12/IL23 blockers
ustekinumab
What antibiotic is used in IBD for crohn’s peri-anal disease and small bowel bacterial over growth
metronidazole
Define upper and lower GI bleed
Upper GI bleed: bleeding from oesophagus, stomach or duodenum, proximal to liigament of trietz
Lower GI bleed: bleeding distal to duodenum, distal to ligament of trietz
Upper GI bleed signs
haematemesis, melaena, elevated urea, dyspepsia, reflux, epigastric pain, NSAID use
Lower GI bleed signs
fresh blood/clots, magenta stools, normal urea, typically painless, more common in advanced age
Causes of upper GI bleed in the oesophagus
oesophageal ulcer, oesophagitis, oesophageal varices, Mallory Weiss Tear, oesophageal malignancy
Causes of upper GI bleed in the stomach
gastric ulcer, gastritis, gastric varices, portal hypertensive gastropathy, gastric malignancy, angiodysplasia
Causes of upper GI bleed in the duodenum
duodenal ulcer, duodenitis, angiodysplasia
Causes of oesophagitis
reflux oesophagitis, hiatus hernia, alcohol, bisphosphonates, systemic illness
What is diuelafoy?
When a submucosal arteriolar vessel erodes through mucosa, normally in gastric fundus, causing upper GI bleed
What is angiodysplasia?
A vascular malformation that occurs anywhere in the GI tract, causing upper GI bleeding
Colonic causes of lower GI bleed
diverticular disease, haemorrhoids, vascular malformations (angiodysplasia), neoplasia, ischaemic colitis, radiation enteropathy/proctitis, IBD
What is angiodysplasia treated with?
argon phototherapy, transexamic acid, thalidomide
What is colonic neoplasia?
colonic polyps or carcinoma
Investigations for acute lower GI bleed
flexible sigmoidscopy, colonoscopy, CT angiography
Acute lower GI bleeding small bowel cause
meckel’s diverticulum, small bowel angiodysplasia, small bowel tumour/ GIST, small bowel ulceration, anteroentero fistulation
Small bowel investigations
CT angiogram, meckel’s scan, capsule endoscopy, double balloon enteroscopy
Define shock
Circulatory collapse resulting in inadequate tissue oxygen deliverly leading to global hypofusion and tissue hypoxia
Signs of shock
tachypnoea, tachycardia, anxiety or confusion, cool clammy skin, oliguria (low urine output), hypotension
What is the Rockhall score used for
Designed to predict death and re-bleeding, uses inital assessment and endoscopic findings
What is Glasgow Blatchford score used to determine?
Used to decide who did not require endoscopy
What to do when bleeding is uncontrolled at endoscopy
sengstaken-blakemore tube transjugular intrahepatic porto-systemic shunt
Define haematemesis
vomiting of blood due to active haemorrhage from the oesophagus, stomach or duodenum
Define coffee ground vomit
brown vomit, poor correlation with significant GI bleeding in isolation often reflection of systemic illness
Define melaena
black tar-like loose stools per rectum
Define magenta stools
red-purple stools, normally from right colon or distal small bowel
define haematochezia
Passage of fresh or altered blood per rectum, may be from upper GI (fast transit) or lower GI
Define dyspepsia
Epigastric discomfort, that can be exacerbating by eating
What is the myenteric plexus made of?
Meissener’s plexus is at the base of the submucosa,
Auerbach plexus is between the inner circular and outer longitudinal layers of the muscularis propria
Describe idiopathic inflammatory bowel disease
Chronic inflammatory conditions resulting from inappropriate and persistent activation of the mucosal immune system driven by the presence of normal intraluminal flora
what does pANCA stand for
perinuclear antineutrophillic cytoplasmic antibody, found +ve in 75% of UC patients and in 11% of CD patients
What is backwash ileitis
When the ileus is involved in ulcerative colitis
What happens to the mesentery surrounding the colon in crohn’s disease
thickened, oedematous and fibrotic
What does acute occlusion of one of the 3 major abdominal supply vessels leads to (coeliac, inferioir and superior mesenteric arteries)
infarction
What does gradual occlusion of one of the 3 major abdominal supply vessels leads to (coeliac, inferioir and superior mesenteric arteries)
anastomotic circulation
Causes for arterial thrombosis, which predispositions for ischaemia
severe atherosclerosis, systemic vasculitis, dissecting aneurysm, hypercoagulate state, oral contraceptive
Causes for arterial embolism, which predispositions for ischaemia
cardiac vegetations, acute atheroembolism, cholesterol embolism
Causes for non-occlusive ischaemia
cardiac failure, shock/dehydration, vasoconstrictive drugs
histology findings for acute ischaemia
oedema, interstitial haemorrhages, sloughing necrosis of mucosa-ghost outlines, bacteria gangrene and perforation
main histological types of colorectal polyps
tubular, villous, indeterminate tubulovillous
Carcinoma sequence: molecular aspects
there is activation of oncogene (k-ras, c-myc), loss of tumour suppressor gene (APC, p53, DCC) and defective DNA repair pathway genes (microsatellite instability)
What is used to stage colorectal cancer?
Dukes staging system
What is the aim of population screening for colorectal cancer?
detect pre-malignant adenomas/ early cancers in the general population
Investigations carried out to screen population for colorectal cancer
faecal occult blood test, faecal immunochemical test, flexible sigmoidoscopy, colonoscopy, CT colonography
What classes people as high risk for colorectal cancer?
if they have heritable conditions (Familial adenomatous polyposis or hereditary non-polyposis colorectal cancer), IBD, familial risk, previous adenomas/ colorectal cancer
WHat does FAP stand for?
familial adenomatous polyposis
What is FAP?
FAP is an autosomal dominant condition, which results in multiple adenomas throughout the colon, caused by mutations of the APC gene on chromosome 5
How is FAP treated?
screening- annual colonoscopy
prophylatic proctocolectomy between 16-25 years
What does HNPCC stand for?
hereditary non-polyposis colorectal cancer
WHat is HNPCC?
an autosomal dominant condition, caused by a mutation in the DNA mismatch repair genes (MLH1 and MSH2),tumours have a molecular characteristic called microsatellite instability, in which there are frequenct mutations in short repeated DNA sequences
Liver failure description and pathology
P:Acute: hepatitis (viruses, alcohol, drugs) causes inflammation of liver and cell damage and death to hepatocytes, bile duct obstruction
D:Complication of acute or chronic liver injury
Liver failure risk factors
Hept A, B, C, jaundice, Cirrhosis, liver disease, alcoholic liver disease, any disease of liver (see below)
Liver failure description
Loss of appetite, loss of sex drive, jaundice, fatugue and feeling weak, nausea, vomiting, itchy skin
Jaundice description
Increasing circulating bilirubin, causing yellowing of skin and eyes
Jaundice pathology
Pre-hepatic:Increased release of haemoglobin from redcells (haemolysis)
Hepatic: Cholestasis, intra-hepatic bile duct obstruction
Post-hepatic: Cholelithiasis, disease of gallbladder, extra-hepatic duct obstruction
Jaundice risk factors
Gallstones, alcoholic liver disease, pancreatitis, hepatitis, sickle cell disease
Jaundice signs
Yellowing os skin and whites of eyes
Intrahepaatic bile duct obstruction description
Obstruction of intra-hepatic bile duct
Intrahepaatic bile duct obstruction pathology
Primary biliary cholagitis- organ specific auto-immune disease, causes granulomatous inflammation of bile ducts, there is loss of intra-hepatic bile ducts
Primary sclerosing cholangitis- chronic inflammation and fibrous obliteration of bile ducts, there is loss of intra-hepatic bile ducts
tumours of liver: hepatocellular carcinoma, intra-hepatic bile ducts, metastatic
Intraheptaic bile duct risj factors
Gallstones, inflammation of bile ducts, trauma, cysts, enlarged lymph nide, pancreatitis, injury to gallbladder, obesity, chronic pancreatitis, sickle cell anaemia
Intrahepatic bile duct symptoms, signs
Sy:Nausea, vomiting, weight loss, fever, itching, pain in upper right side of the abdomen
Si:light-coloured stools, dark urine, jaundice
Intrahepatic bile duct obstruction investigations
Anti-mitochondrial auto-antibodies in serum , raised serum alkaline phosphatase
CBC, LFT, Ultrasound, biliary radionuclide scan, cholangiography, MRI, endoscopicretrograde cholangiopacreatography, magentic resonance cholangiopancreatography
Intrahepatic bile duct obstruction treatment
Treating underlying cause, cholecystectomy, endoscopic retrograde cholangiopancreatography
Cirrhosis description
End stage chronic liver disease, liver looks very nodular and scarred
Cirrhosis pathology?
Normal liver structure is replaced by nodules of hepatocytes and fibrous tissue
Cirrhosis risk factors
Alcohol, hepatitis B,C, immune mediated liver disease (auto-immune hepatitis, primary biliary cholangitis), primary haemochromatosis,Wilson’s disease, obestiy, cryptogenic
Cirrhosis symptoms + signs
Fatigue, loss of appetite, weight loss, muscle wasting, nausea/vomiting, tenderness or pain around liver area, itchy skin
Jaundice, vomiting blood, dark tarry stools, oedema, abdominal ascites
Cirrhosis investigations
Magnetic resonace elastography
Cirrhosis treatment
Changing lifestyle, diet and easing symptoms: diuretics, high blood pressure tablets, creams for itching
Cirrhosis complications
Altered liver function, abnormal blood flow, increased risk of hepatocellular carcinoma
Hepatocellular carcinoma description and risk factors
D:Malignant tumour of heaptocytes
RF:Chronic alcohol consumption, hept B, C, Wilson’s disease, primary biliary cirrhosis, non-alcoholic fatty liver disease
Hepatocellular carcinoma symptoms and signs
Abdominal pain or tenderness, easy bruising or bleeding, ascites
Distened abdomen, yellow skin and eyes, weight loss, pale, chalky bowel movements and dark urine
Liver cancer investigations
Bloods: AFP, ultrasound, CT, MRI, liver biopsy, endoscopy, laproscopry
Liver cancer treatment
Chemotherapy, radiotherapy, transplant, hepatectomy
Cholangiocarcinoma description and risk factors
D: Malignant tumour of bile duct epithelium
RF:Primary sclerosing cholangitis, congenital liver malformations
Cholangiocarcinoma symptoms and signs
Abdominal pain, loss of appetite, weight loss, itching, nausea/vomiting
Jaundice, greasy stools, dark urine
Metastatic cancer in liver syptoms and signs
Abdominal pain, vomiting/nausea, weight loss, decreased appetite
Distened abdomen, yellow skin and eyes, weight loss, pale, chalky bowel movements and dark urine
Acute cholecystitis description and risk factors
acute inflammation of gallbladder
RF:Gallstones, tumour
Acute cholecystitis symptoms and signs
Pain (typically after a meal), nausea, chills, abdominal bloating, vomiting
Jaundice, clay-coloured stools
Acute/ chronic cholecystitis investigations
ultrasound, hepatobiliary scintigraphy, cholangiography, CT scans, bloods:LFT, CBC
Acute/ chronic cholecystitis treatment
Cholecystectomy
Chronic cholecystitis description
Chronic inflammation and fibrosis of gall bladder
Chronic cholecystitis risk factors
genetic predisposition, obestity, diabetes, tumours in liver, pancreas or gallbladder, pregnancy
Chronic cholecystitis symptoms and signs
severe sharp or dull abdominal pains, abdominal cramping and bloating, pain that spreads to back or below right shoulder pain, fever, chills, nausea, vomiting, itching
loose, light coloured stools, jaundice
Describe marasmus malnutrition
Undernourished causing a child’s weight to be significantly low for their age
Describe Kwashiorkor malnutrition
Oedema malnutrition, caused by lack of protein in the diet.
Describe the term malnutrition
A state of nutrition in which a deficiency or excess of energy, protein and other nutrients, causes measurable adverse effects on tissue/ body form, body function and clinical outcome
Name the different BMI classes
25 overweight
>30 obese
3 different causes for undernutrition
appetite failure
access failure
intestinal failure
4 types of drugs used for IBD
aminosalicylates, corticosteroids, immunosuppressants, biologics
How do antacids and alginates work?
antacids: neutralise gastric acid,
alginates: form a viscous gel that floats on stomach contents and reduces reflux
What conditions are acid suppression drugs used for?
indigestion, peptic ulcer disease, gastrointestinal refux disease
How do H2 receptor antagonists work?
BLock histamine receptor and thereby reduce acid secretion
Hpw do proton pump inhibitors work?
They block proton pump and therby reduce acid secretion, they can cause GI upset and predisposition to c.difficile infection, hypomagnesaemia, B12 deficiency
What do prokinetic agents do and how?
Prokinetic agents increase gut motility and gastric emptying using the parasympathetic nervous system control of smooth muscle and sphincter tone
Name 2 prokinetic agents?
Metoclopramide, domperidone
What are the 3 mechanisms of anti-spasmodics?
anti-cholinergic muscarinic antagonists (inhibits smooth muscle constriction in the gut wall, producing muscle relaxation and reduction of spasm), direct smooth muscle relaxants and Ca-channel blockers reduce calcium which is required for smooth muscle contraction
What are the 4 types of laxatives?
bulk (isphagula), osmotic (lactulose), stimulant (senna) and softeners (arachis oil)
What drug is used to treat gallstones and primary biliary cirrhosis
ursodeoxycholic acid
How does low albumin levels affect distribution of drugs
causes decreased binding and increased free drug concentration
How is drug metabolism affecting by liver disease?
Liver enzymes are inhibited or induced, there is increased gut bacteria which metabolise drugs
How does liver disease affect excretion of drugs?
there is increased toxicity if there is hepatobiliary disease
Name the 2 types of hepatotoxicity
intrinsic hepatotoxicity (type A adr) and idiosyncratic hepatotoxicity (type B ADR)
What is the Child-Pugh classification for?
classification used to assess the prognosis of chronic liver disease and cirrhosis
What is tested for in LFTs?
bilirubin, aminotransferases, alkaline phosphatase, gamma GT, albumin, prothrombin time and creatinine
Why would alkaline phosphatase be elevated?
alkaline phosphatase is an enzyme present in the bile duct that is elevated when there is obstruction of liver infiltration
What does prothrombin tome tell us?
tells degree of liver dysfunction and is used to calculate scores to decide stage of liver disease, and who gets a liver transplant
when is jaundice detectable?
When total plasma bilirubin levels exceed 34umol/L
What is refeeding syndrome?
when you starve your body it is called adapted starvation, causing your body to shut down, if you then eat there is an increase in insulin release which causes extracellular ions to rush into cells causing electrolyte disturbance and death
The criteria for people at high risk of refeeding problems?
One of the following: BMI<16 kg/m2, weight loss >15% within 3-6 months, little or no nutritional intake for more than 10 days, low levels of K, P or Mg prior to feeding
Or
Two of the following:
BMI<18.5kg/m2, unintentional weight loss >10% in last 3-6 months, little/no nutritional intake for more than 5 days, history of alcohol abuse or drugs (insulin, chemotherapy, antacids, diuretics)
Diagnosis of ascites
Diagnostic paracentesis
Ascities fluid analysis
routine: cell count, protein, albumin
optional: culture, glucose, LDH, amylase, gram stain
Serum-ascites albumin gradient
> 1.1g/dl = portal hypertension, CHF, constrictive pericarditis, BUdd Chiarri, myxedema, massive liver metastases
<1.1g/dl = malignancy, TB, chylous ascites, pancreatic, biliary ascites, nephrotic syndrome, serositis
Treatment options for ascites?
diuretics, large volume paracentesis, TIPs, aquaretics, liver transplant
What environmental factors affect the types of microbes found?
transit time, oxygen, pH
What does bacterial fermentation of fibre produce?
releases additional phytochemicals, maintains slightly acidic pH, increased commensal bacterial population and pH improves resistance to pathogen, essential supply of short chain FAs.
3 main short chain fatty acids produced from non-digested charbohydrate
Butyrate, propionate, acetate
Function of butyrate
epithelial cell growth and regeneration
Function of propionate
guconeogenesis in the liver, satiety signalling
Function of acetate
transported in blood to peripheral tissues, lipogenesis
How does indigenous microbiota defend against pathogens?
barrier effect, active competitive exclusion, pH inhibition, mucus layer
What do the IgM anti-HBC, igG anti-HBc and anti-HBe antobodies indicate
igM anti-HBc= acute infection
IgG anti HBc= chronic infection/exposure
Anti-HBe= inactive virus
Treatment for HBV
pegylated interferon and oral antiviral drugs
5 antiviral drugs
lamivudine, adeforvir, entecavir, telbivudine, tenofovir
Treatment of Hepatitis C
peglFNalpha and ribavirin
What is NAFLD score used for and what are teh components?
NAFLD score used to stage and for best treatment of NAFLD.
High risk if >45year old, has diabetes, BMI>30, AST:ALT>1, platlet count <150, albumin <34
Treatment for Non-alcoholic fatty liver disease
diet, exercise, weight loss, insulin sensitizers (metoformin, piofglitazone), glucagon-like peptide-1 analogues eg Liraglutide, farnesoid X nuclear receptor ligand eg Obeticholic acid, vitamin E and weight reduction surgeries
Autoimmune liver disease
autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis
How do you treat autoimmune hepatitis?
steroids and azathioprine
How would you treat primary biliary cholangitis
ursodeoxycholic acid
Primary sclerosing cholangitis antibody positive and treatment
lpANCA positive and treat with liver transplant and biliary stents
WHat supplies the ascending colon?
ileocal and right colic arteries from superioir mesenteric artery
What supplies the transverse colon
middle colic artery from the SMA
What supplies the descending colon and sigmoid
left colic and sigmoid arteries from IMA.
they anastamose with marginal artery
What supplies the rectum with blood
Superior rectal from IMA to proximal rectal supply
middle rectal from the internal iliac artery and the inferior rectal arterysupply the midpart and distal part of the rectum
What are the names of the lymph node groups that drain the large colon?
epicolic, paracolic, intermediate, central lymph nodes
Early, general complications of colonic resection
infection, haemorrhage, DVT, chest infection
Early, specific complications of colonic resection
anastomotic leakage, intra-abdominal abscess, damage to surrounding structures
Late complications of colnic resection
tumour recurrence, hernia formation and adhesion formation causing obstruction
Dysbiosis meaning
Microbial imbalance
can result in disease
What is a probiotic?
Live microorganism which when in adequate amounts confer a health benefit on host (added live bacteria)
What is a prebiotic?
Substrate that is selectively utilized by host microorganism conferring a healht benefit (food for resident bacteria
Health benefits of prebiotics?
improved gut function, managemtne t of IBD, reduce risk of colon cancer, increase Ca absorption and bone health
