GI track diseases I

Question 1

Disorders of the Oesophagus

Answer 1

obstruction

inflammation

Question 2

What does obstruction of Oesophagus cause?

Answer 2

dysphagia

Question 3

dysphagia

Answer 3

inability to swallow, feeling something is stuck

Question 4

What is dysphagia caused by?

Answer 4

carcinoma - presents late, usually inoperable

benign structure (eg. scar tissue) - associated with reflux oesophagitis

stroke

neurological issues
- motor neurone disease

Question 5

What does lower oesophageal sphincter protect against?

Answer 5

lower oesophageal sphincter (LES) protects against reflux of HCl

Question 6

GORD/GERD - Gastro-oesopheal reflex disease

Answer 6

HCl moves into oesophagus

Question 7

What is GORD/GERD caused by?

Answer 7

Central NS depressant, pregnancy, alcohol

Question 8

Anatomical changes resulting from disorders of oesophagus

Answer 8

1. infiltration of inflammatory cells in the squamous epithelial layer
2. neutrophils are markers of severe injury

Question 9

Treatment of inflammation of the oesophageal mucosa

Answer 9

removal of acid, sleeping upright, smaller meals (reduced stimulus for HCl)

Question 10

What can we use to detect oesopahitis?

Answer 10

gastroscopy

Question 11

Oesophageal Varices

Answer 11

secondary to liver disease

end up with portal hypertension
- blood can’t flow properly through hepatic portal vein

blood diverted to sub-musosal veins - gastric and oesophageal

small vessel abnormally dilated

very prone to bleeding - vomiting blood

Question 12

Disorders of the stomach

Answer 12

gastritis

Question 13

What is gastritis?

Answer 13

inflammation of the gastric mucosa to HCl

Question 14

Acute gastritis

Answer 14

neutrophil infiltration

Question 15

Chronic gastritis

Answer 15

long term changes in cell types, lymphocytes, intestinal metaplasia and atrophy

Question 16

What does chronic gastritis lead to?

Answer 16

ulcer
- breach of 4-layer structure
- stomach contact leaks into peritoneum

Question 17

Range of gastritis

Answer 17

loss of superficial mucosa

rupture of stomach

acute GI bleeding

Question 18

What is gastritis associated with?

Answer 18

alcohol and tobacco

servere stress/chemo

bacterial and viral infections

NSAIDs eg. ibuprofen

Question 19

What do NSAIDs do to the stomach?

Answer 19

impacts mucus and bicarbonate production

Question 20

What does alcohol and tobacco do to stomach?

Answer 20

increases HCl production

damaging blood supply

Question 21

What are the three ways damage is caused to the stomach?

Answer 21

increased HCl

decreased HCO3 - reduced blood flow

disruption to mucus layer
- direct damage to epithelium

Question 22

Is gastritis self-limiting?

Answer 22

yes
- does not require more than simple OCT treatment

Question 23

How to diagnose chronic infection with H.Pylori

Answer 23

biopsy
- presence of bacteria or urease enzyme activity OR urea breath test OR stool sample

Question 24

Complications of disorders if the stomach

Answer 24

bleeding

perforation of stomach/duodemun

severe pain/rigid abdomen - will require surgery

Question 25

Treatment of disorders of the stomach

Answer 25

Al/Mg hydroxide eg. gaviscon Histamine H2 receptor antagonist - reduces HCl production Proton pump inhibitors - switch off HCl production Antibiotics - against H.pylori

Question 26

Malabsorption Syndromes

Answer 26

Defective Intraluminal Digestion Mucosal Reduced SI surface area

Question 27

Defective Intraluminal Digestion

Answer 27

Pancreatic insufficiency - no enzyme or bicarbonate - pancreatitis - CF Biliary Insufficiency - no bile, no emulsification which leads to fat malabsorption Bacterial Overgrowth in Small Intestine (SIBO) - colonic bacteria enter sl

Question 28

Mucosal Malabsorption

Answer 28

Disaccharidase deficiency - lactose intolerance Abetolipoproteinaemia - LCFA malabsorption Primary bile acid malabsorption - causes bile acid diarrhoea

Question 29

Reduced SI surface area

Answer 29

coeliac disease crohn disease

Question 30

Fat malabsorption

Answer 30

greasy stool which do not flush bile insufficiency pancreatic lipase deficiency mucosal defects

Question 31

How to confirm fat malabsorption

Answer 31

faecal fat test

Question 32

Coeliac disease

Answer 32

sensitivity to gluten from wheat and close related grains t-cell mediated inflammatory reaction anti-gliadin antibodies

Question 33

dermatitis herpetiformis

Answer 33

fluid filled blisters skin manifestation of celiac disease in 15-25%

Question 34

SI biopsy to diagnose coeliac disease

Answer 34

- atrophy and loss of villi - intra-epithelial lymphocytes - immune reaction - crypts elongated - overall mucosal thickness in unchanged

Question 35

What happens to coeliac disease in gluten free diet?

Answer 35

musosal histology reverts to near normal following period of gluten exclusion

Question 36

What are the 4 major causes of intestinal obstruction

Answer 36

herniation of segment surgical adhesions intussusceptions volvulus

Question 37

herniation of segment

Answer 37

weakness in a wall of peritoneal cavity causes blockage and loop of bowel loses blood supply - surgery

Question 38

Surgical adhesions

Answer 38

surgery or infection resulting in Peritonitis (forming of scar tissue on outside) as infection heals, fibrous bridges causing strangulations of intestinal segment, bowl blockage

Question 39

intussusceptions

Answer 39

segment of intestine becomes telescoped within a distal segment during peristalsis - defect of peristalsis

Question 40

volvulus

Answer 40

complete twisting of loop of bowel, connective tissue to abnormal wall is lost

Question 41

Is volvulus rare?

Answer 41

rare birth defect malrotation lacks normal attachment to abdominal wall

Question 42

volvulus symptoms

Answer 42

vomiting trapped gas abdominal pain and distension constipation

Question 43

Superior mensenteric artery syndrome

Answer 43

- occurs in very learn people - flattering of duodenum by SMA - anorexia (very low visceral fat) - duodenum crushed between arteries