Disorders aorta, oesophagus, stomach, small intestine and liver, gall bladder and pancreas Flashcards
Abdominal Aortic Aneurysm aeitiology? clinical features? complications? management?
Aetiology-any factor that disrupts the collagen and elastin fibres in arterial wall predisposes it to dilation e.g. HTN, atherosclerosis
Features: pressure on surrounding structures e.g. dysphagia, dyspnoea
rupture-acute abdominal pain, features of hypovolaemic shock
Complications: dilation and rupture, stagnant blood flow can undergo thrombosis, thromboembolism can obstruct peripheral flow
Management: surgery/prosthtic graft for rupture, anti-hypertensive drugs and smoking cessation for early diagnosis
Define Barrett’s Mucosa
what condition can lead to Barrett’s Mucosa?
what implication does Barrett’s Mucosa have for oesophageal pathology?
A change in the lining of the lower Oesophagus from stratified squamous to simple columnar epithelium.
Hiatal Hernia may cause BM
BM can cause metaplasia, which is a pre-malignant process
state the clinical triad for oesophageal cancer
dysphagia, odynophagia, weight loss
list 2 types of hiatal hernia
sliding
rolling
how can the risk factors for GORD be classified?
- decreased tone of Lower Oesophageal Sphincter
- impaired mucosal defences
- increased IAP
3 common presentations of GORD
3 medications for GORD and mechanism of action
heartburn, dyspepsia, dysphagia, odynophagia
histamine H2 receptor antagonists-inhibit action of Histamine at H2-receptors on gastric parietal cell
- Proton Pump Inhibitor- inhibits H+ K+ ATPase pump
- Antacids-neutralises HCL in oesophageal lumen
common sites for peptic ulcers
Duodenal ulcers are more common than gastric ulcers.
duodenal ulcers-D1
gastric ulcers- lesser curvature
Define Coeliac Disease
Which region of the bowel is most affected by Coeliac Disease?
Summarise pathological changes that occur in Coeliac Disease
Genetically determined, abnormal hypersensitivity reaction to gluten or it’s peptide derivative gliadin
proximal bowel, especially the duodenal jejunal flexure
type 4 (cell mediated) hypersensitivity reaction
immune cells infiltrate lamina propria
T Lymphocytes release inflammatory cytokines
plasma cells produce IgA antibodies
damage to mucosa and atrophy of villi
impaired intracellular metabolism
Describe the role H. Pylori plays in peptic ulceration by listing its 4 pathogenic properties
- produce urease (allows survival in low pH)
- helical structure and flagella (burrowing capacity)
- release bacterial toxins and Reactive Oxidative Species (damages mucosa)
- recruitment of inflammatory cytokines e.g. neutrophils, mast cells and macrophages (further damage)
list the 4 mechanisms by which antibiotics work
- inhibit cell wall synthesis
- disrupts cell wall membrane
- inhibits protein synthesis
- interference of metabolic processes
what are the preferred antibiotics for H. Pylori eradication?
Clarithromycin (inhibits protein synthesis)
Amoxycilin (inhibits cell wall synthesis)
Metronidazole (prevents DNA replication)
explain how prolonged use of NSAIDS may predispose a patient to peptic ulceration
reduces prostaglandin content of mucosal cells, therefore reduces mucous secretion
aspirin can directly damage cell membranes
Define jaundice and identify 3 types of Jaundice
Jaundice is the yellow discolouration of the skin, sclerae and mucous membranes due to excess biliruben; a sign of liver disease.
- Haemolytic jaundice- excessive RBC destruction
- Hepatic Jaundice- imparied hepatocyte function (e.g. neonatal)
- Cholestatic Jaundice- obstruction of intrahepatic or extrahepatic bile ducts
how does chronic alcohol abuse cause liver damage?
list the stages of alcoholic liver disease
in the liver, alcohol causes the induction of oxidases, which damage hepatocytes with chronic exposure
stage 1 fatty liver
stage 2 alcoholic hepatitis
stage 3 cirrhosis
other than alcohol, what can cause cirrhosis?
non-alcoholic liver disease (risk factors are obesity, hyperlipidaemia, insulin resistance)
viral & autoimmune hepatitis
cholestasis
metabolic disorders e.g. haemochromatosis
