Issues with GIT Flashcards
learn about main issues
Helicobacter pylori infection
Pathophysiology:
Oral-oral or faecal-oral transmission
Chronic gastritis H. pylori becomes anchored - if Inflammation becomes persistent, peptic ulcer disease may result
Peptic ulcer disease
Pathophysiology:
Disruption of the balance between the secretion of gastric acid and the defence mechanisms located in the gastroduodenal
Gastritis
Pathophysiology
May be acute or chronic,
Erosive (gut reaction) non-erosive (infective or fungal). Range of causes
Reduction in prostaglandin synthesis from use of painkillers is a key mechanism whereby protective mechanisms are reduced and so the stomach lining is more exposed to acid
GORD – Gastro-oesophageal Reflux Disease
Poor mobility in the oesophagus, dysfunctional opening of oesophageal sphincter and delayed emptying causing intragastric pressure
Hiatus Hernia
Pathophysiology
Reduced lower oesophageal sphincter pressure & relaxation times. Reduced oesophageal acid clearance, longer transient time
Muscle weakening and loss of elasticity
Oesophagitis
Pathophysiology
Persistent acid exposure in reflux
Different types:
Reflux: infectious e.g. candida, herpes simplex; systemic-associated: e.g. inflammatory bowel disease, sarcoidosis; pharmacologic associated: e.g. antibiotics, NSAIDs, radiation. Risk factors differ by type
GORD risk factors apply for reflux
Signs and Symptoms
Dysphagia and/or odynophagia
Food impaction in the oesophagus
Heartburn and acid reflux
Chest pain on eating
Barrett’s Oesophagus
Pathophysiology
Secretion of bicarbonate
Hiatus hernia, reduced lower oesophageal sphincter pressure, delayed oesophageal clearance and gastro-oesophageal reflux
Often asymptomatic in itself, the usual symptoms associated are those of GORD heartburn, difficulty swallowing, regurgitation
Constipation
Considerations are obstruction within the colon, impairment of motility and outlet obstruction (for example severe haemorrhoids). Can also be linked to liver function
Comfortable to pass – no pain, straining, uncomfortable looseness etc.
dietary, systemic disease (e.g. hypothyroidism, Parkinsons, MS), neurological, certain medications, obstruction
Abdominal bloating, low back pain
Straining on defecation
Pain on defecation
Dry hard stool
Rectal bleeding
Overflow diarrhoea
Diverticulitis
Single muscle layer in large intestine presents more vulnerability to herniation than the double muscle layer of the small intestine.
Diverticula - small pouches in the large bowel wall
Pouches formed when inner layers of large bowel push through weak areas in the more superficial muscle layers
Most common in descending/sigmoid colon
Ageing leads to decreased elasticity of the colonic wall, more prone to damage
Dietary impacts (Low-fibre, high-animal fat diet combined is shown) slow transit time and increase weight and retention of stool
Increased pressure in bowel lumen, erosion, inflammation
Medications –steroids, NSAIDS, Opioids
Signs and symptoms
Pain, usually lower left quadrant but right-sided in people of Asian descent
Fever
Abdominal tenderness
Nausea and vomiting
Constipation or, less commonly, diarrhoea
IBD Overview
Altered GI motility Hypersensitivity to pain and bowel movement, Microscopic inflammation Psychological disorder SIBO
Intestinal permeability, dietary intolerance, alterations in gut microbiome (and previous severe GIT infection), dysfunctional contractility and innervation, stress
Signs and symptoms
Abdominal pain –diffuse, can localise to left lower quadrant
Abdominal bloating
Altered bowel habit which may be constipation, diarrhoea or a combination of both
Mucorrhoea (passing mucus per rectum)
Symptoms triggered by eating
Nausea, dyspepsia and urinary frequency may accompany the condition
Red Flags - dark tarry stool, weight loss, palpable mass in abdominal region.
SIBO –Small intestinal bowel overgrowth
A slowing of flow and stagnation in the small intestine allowing bacteria to flourish (normally an area with lower bacterial populations)
Risk factors include certain medical conditions e.g. Crohn’s disease, diabetes and coeliac disease (conditions slowing transit through the bowel), structural abnormalities of the bowel and abdominal surgery
Signs and Symptoms
Loss of appetite
Abdominal pain and bloating
Nausea
Diarrhoea –distinct from IBS as SIBO doesn’t tend to present with constipation
Malnutrition
Unintentional weight loss
Consider Red Flags
Coeliac
Pathophysiology
Exposure to gluten derived peptide GLIADIN: found in wheat, barley and rye; Human leukocyte antigen (HLA) presents gliadin to helper T cells; Helper T cells initiate inflammatory response; Autoantibodies develop within the immune response ; Lymphocyte infiltration and destruction of the intestinal lining.
Signs and symptoms in the GIT:
Diarrhoea
Fatigue
Weight loss
Abdominal pain
Nausea and vomiting
Constipation
Systemic symptoms
Anaemia, joint pain and headache, paraesthesia, mouth ulcers, itchy rash
