Flashcards in Coeliac disease, IBS, dyspepsia and peptic ulcer disease Deck (28):
Describe what coeliac disease is?
1. An autoimmune disorder
2. Affects the small intestine when gluten is eaten
3. Also know as celiac disease, gluten sensitivity enteropathy
What is gluten and what happens when a coeliac patient eats gluten?
1. Gluten: a protein thats found in wheat, barley and rye
2. The body launches an autoimmune response in the small intestine
3. Results in the destruction or damage of villi in the small intestine which are responsible for food absorption
4. Leads to a very malnourished patient
What is the difference between normal villi and one that's been affected by gluten in coeliac disease?
1. Blunting with crypt hyperplasia
2. Increased intraepithelial lymphocytes
What are the possible symptoms of coeliac disease?
1. Severe or occasional diarrhoea, excess wind produced
2. Stomach cramping or pain
4. Headache, nausea and vomiting
5. Sudden or unexpected weight loss
6. Mouth ulcers and skin rash
7. Tooth enamel problems and depression
How do you diagnose coeliac disease?
1. Once you experience symptoms, attend to the GP who will do a "antibody test" on you
2. This is the IgA - Tissue Transglutaminase test
3. A gastroenterologist will then review these results if they're positive
4. Do not remove gluten from diet until biopsy is finished
How do you treat coeliac disease and what should you watch for diet wise?
1. ONLY: Strict adherence to a gluten free diet
2. Avoid food such as bread and beer which contain gluten
3. Even ingesting a small amount can lead to small intestine damage
4. Need to watch out for excipients containing gluten
Define what syndrome is?
A group of symptoms which characterise a disease, psychological disorders or abnormal condition
What does IBS stand for?
Irritable Bowel Syndrome
What are the specific causes of IBS?
1. Use of drugs (anti-biotics), gastrointestinal infections, intolerances to food
2. Food with excessive fat, encourages release of cholecystokinin that stimulates colon
3. Caffeinated drinks stimulate bowel action
4. Emotional tension and stress
How does a doctor diagnose IBS when there's no test?
Typical symptoms of:
1. Abdominal pain or discomfort
2. Constipation and bloating
3. Urgency to get to the toilet
4. Alternative constipation or diarrhoea
- Must rule out that the person doesn't have stomach ulcers
- Note: blood in stools is not a symptom of IBS
What are the normal symptoms of IBS?
1. Abdominal pain or discomfort relieved by going toilet
2. Constipation and bloating and swelling of abdomen
3. Urgency to get to toilet
4. Alternative constipation or diarrhoea
5. Rumbling noise and excessive passing of wind
6. Sharp pain felt below the rectum
7. Sensation of incomplete bowel movement
What are the other symptoms of IBS that do not occur in the GI?
1. Headache, dizziness and back ache
2. Passing urine frequently
3. Tiredness, muscle and joint pain
4. Shortness of breath, anxiety and depression
When can post infectious IBS happen?
1. Normally happens after gastroenteritis
2. Can develop this when there's not even any infection: due to stress and emotional trauma
What is the bacteria that can cause IBS?
1. Candida albicans
2. Controlled by Nystatin
What are the traditional methods of alleviating pain by IBS?
1. Addition of more fibre to diet
2. Reduction of stress
3. Anti-sposmotic drugs and tranquillisers
4. Exclusion diets: monitor what you eat, whatever is causing you pain excluded it
5. Herbal remedies: prebiotics and probiotics
What are the therapeutic options for constipation in IBS?
Diet of fibre and fluids (2 litres per day)
What are the therapeutic options for diarrhoea in IBS?
Anti-diahorreal- loperamide (opioid receptor agonist which reduces activity of nerves in smooth muscle)
What are the therapeutic options for pain in IBS?
Anti-spasmodic drugs such as dicycloamine (anti-cholinergics)
Define what dyspepsia is?
1. Indigestion and pain that originates from the upper GI tract
2. Example: oesophagus and stomach
What is GORD?
1. Gastro oesophageal reflux disease
2. Symptoms of mucosal injury that occur due to abnormal reflux of gastric contents in oesophagus
What are the typical symptoms of GORD?
1. Heart burn- regurgitation
2. Water brash: oral cavity fills with excessive odourless liquid that is acidic
3. Dysphagia: blockage to food to substernal area (swallowing problems)
What are the different medicinal treatment options for GORD?
- Sodium alginate can form on a raft on the surface which prevents acid regurgitation
- Magnesium and Aluminimum- neutralise the pH of the acid and make it more alkaline
- Poorly absorbed so doesn't cause alkalosis
3. Magnesium- laxative and diarrhoea
4. Aluminium- constipation
Define what gastritis?
Inflammation of the gastric mucosa that can be determined by endoscopy
Describe how acute and chronic gastritis can occur?
1. Taking of medications such as aspirin and NSAIDs which reduce amount of prostaglandins (this reduces protection on stomach lining)
2. Gram negative bacterium Helicobacter pylori infection
How do you control the acid production in the parental cells in the stomach and give examples of each products?
1. H2 antagonists: block the H2(histamine) receptor which receives the histamine to produce acid in the stomach: Cimetidine and ranitidine
2. Proton Pump Inhibitors: Reduces activity of H+/ K+ ATPase receptor: Omeprazole, Esoprezole, Lansoprazole
What are the indications of ranitidine and mechanism of action?
1. Indications: Benign gastric, duodenal ulceration, GORD and long term treatment of GORD
Selective H2 receptor antagonist, main action on histamine H2 receptor on parental cells, prevents acid production
What are the indications of omeprazole and its mechanism of action?
1. Indications: benign gastric ulceration, prevention of relapse in gastric ulceration, NSAID related gastric ulceration
Proton pump inhibitor that inhibits the H+/K+ ATPase transporter of the stomach acid