Gas Facts

Question 1

Explain what happens when NSAIDs inhibitor the enzyme COX

Answer 1

(1) NSAIDs inhibit the activity of the enzyme cyclooxygenase (COX).
(2) COX is responsible for converting arachidonic acid into prostaglandins, including prostaglandin E (PGE)
(3) By inhibiting COX, NSAIDs prevent the synthesis of prostaglandins, including PGE.
(4) PGE is known to have a protective effect on the gastric mucosa and also inhibits gastric acid secretion
(5) Without the presence of PGE, the inhibition of gastric acid secretion is diminished.
(6) This leads to an increase in gastric acid production by the parietal cells in the stomach
(7) The reduction in PGE formation and subsequent increase in gastric acid secretion can contribute to the development of gastric ulcers and gastrointestinal bleeding, which are known side effects of NSAID use

Question 2

How do NSAIDs like aspirin or ibuprofen cause upset to your stomach?

Answer 2

Your stomach lining has a special layer of mucus that protects it from stomach acid. NSAIDs mess with this mucus by blocking the production of a helpful substance called prostaglandin. Prostaglandin helps keep the mucus layer thick and healthy. Without it, the lining is weak and may become vulnerable to the acid within your stomach

Question 3

Cholecystitis meaning

Answer 3

infammation of th gallbladder

Question 4

Achalasia meaning

Answer 4

a condition in which the muscles of the lower part of the oesophagus fail to relax, preventing food from passing into the stomach.

Question 5

Norovirus treatment

Answer 5

supportive

Question 6

Where do you usually get norovirus?

Answer 6

Common on cruise ships

Question 7

Hepatitis A treatment and where it usually comes from?

Answer 7

• Increased risk in men who have sex with men
• Treatment → supportive

Question 8

What is a Hookworm?

Answer 8

Enters through the skn and causes GI disease

Question 9

Explain Schistosoma.

Answer 9

Usually found in lakes abroad

Question 10

Explain Giardia Lamblia

Answer 10

Flagellated protozoa

Swimming in pools, lakes, rivers or where there is untreated water/sanitation issues

Person to person spread
Causes large volume foul smelling diarrhoea
- Explosive and intermittent
- Also associated with ‘eggy burps’

Most common in south/southeast asia

Question 11

Explain Entamoeba Histolytica

Answer 11

Amoebiasis

90% of people are asymptomatic
- Linked to travel to warm country
- Can cause colitis and liver issues
- Associated with bloody diarrhoea, weight loss and pain

One to three-week onset

Liver onset can be years after exposure

Question 12

Yersinia enterocolitica?

Answer 12

Associated with pigs

Question 13

Vibrio cholerae?

Answer 13

Profuse watery diarrhoea and causes electrolyte issues

Question 14

Aeromonas?

Answer 14

Water-associated and infects immunosuppressed people

Question 15

Bacillus cereus?

Answer 15

associated with reheated foods

Question 16

Explain Enterobacteriaceae

Answer 16

Gram negative coliform

53 genera, 26 of which cause human infection

Facultative anaerobes mostly

Ferment sugars

Question 17

Explain C. diff

Answer 17

Gram-positive

Heavily associated with previous antibiotic exposure via the 4 deadly C’s

Treatment is with vancomycin

Prevention is with handwashing as it is spore-forming
- Important not to hand gel as it won’t clean well enough

Question 18

Explain Salmonella

Answer 18

Non-typhoidal salmonella

Typically self-limiting

Commonly foodborne

In immunocompromised people, it can also cause endocarditis and other infections

Can be linked to ownership of reptiles, change in GI flora and eating undercooked meat

Question 19

Explain Enterobius

Answer 19

Pinworm

Causes an itch in the bum

Worms typically come out at night to lay their eggs

Question 20

Explain Cryptosporidium

Answer 20

Prolonged diarrhoea in immunosuppressed

Contaminated oocysts ingested in water

Inhalation can cause disease in immunosuppressed

Question 21

Explain Cytomegalovirus

Answer 21

Colitis in very immunosuppressed

Other invasive illnesses associated

Bloody diarrhoea

Biopsy is the best diagnostic method

Question 22

Explain Lysteria

Answer 22

Gram-positive rods

Undergoes cold enrichment → grows at the same temperature as a fridge is kept at

Often causes meningitis or bacteraemia

Question 23

Peritonitis is treated with what?

Answer 23

(1) Gentamicin - for gram negatives (coliforms)
(2) Metronidazole - anaerobic cover
(3) Amoxicillin - enterococcus

Question 24

INVESTIGATIONS for H. Pylori

Answer 24

1. bedside - stool test or carbon-13 urea breath test
2. If at OGD, a rapid urease test (CLO) can be done

Patients should not be taking PPI for at least 2 weeks prior as could indicate false negative results

Question 25

Management for H. Pylori

Answer 25

(1) 1st episode, 1st line - amoxicillin, clarithromycin and a PPI twice daily for seven days - so-called triple therapy.

Treatment should only be initiated in cases of documented H. Pylori infection.

(2) After 4-8 weeks patients can be re-tested for H. pylori to check it has been eradicated with a urea breath test

(3) If still present, NICE recommend another course of triple therapy with metronidazole or clarithromycin (whichever was not used in the initial course) amoxicillin and a PPI

(4) If the patient has taken two courses of eradication therapy, they should be referred to a Gastroenterologist

Question 26

Differentiate between gastric and duodenal ulcer

Answer 26

pain, milk

Question 27

Prehepatic jaundice is what

Answer 27

gilberts, haemolytic anaemia, newborn, trauma

Question 28

Intrahepatic jaundice is what?

Answer 28

viral hepatitis, alcoholic hep, autoimmune hep,
decompensated cirrhosis, PBC, PSC

Question 29

Post hepatic jaundice is what?

Answer 29

gall stone, head of pancreas cancer, gallbladder cancer

Question 30

Primary biliary cirrhosis antibodies

Answer 30

Anti-mitochondrial antibody (AMA)

Question 31

Autoimmune hepatitis antibodies

Answer 31

Anti-smooth muscle antibody (ASMA)

Question 32

Primary sclerosing cholangitis antibodies

Answer 32

(ANCA) (cANCA)

Question 33

Pancreatitis antibodies

Answer 33

Raised amylase, lipase, vomiting, pain

Question 34

Coeliac disease antibodies

Answer 34

Anti-transglutaminase antibody, anti
endomysial antibody

Question 35

Diffuse stomach cancer antibdoies

Answer 35

Signet ring cells seen on biopsy