What would a SI biopsy show in midgut dysmotility?
alpha actin staining deficiency in the inner circular layer of smooth muscle
Symptoms of an inguinal hernia?
mass in groin, pain, more painful on coughing
Which two main arteries become occluded in ischaemic colitis?
The superior and inferior mesenteric arteries
What is type A chronic gastritis?
Autoimmune cause, where autoantibodies attack parietal cells in the fundus/body of the stomach leading to atrophic gastritis and loss of parietal cells with achorhydria and intrinsic factor deficiency causing pernicious anaemia
DD for epigastic pain?
heartburn, pancreatitis, epigastric hernia, gall stones, gastric ulcer
Complications of Crohns?
stenosis, abscess formation, fistula, colon cancer, perforation (more severe than UC), pyoedma gangrenous, anaemia, osteoporosis
Symptoms and signs of biliary colic?
RUQ pain spreading to right shoulder and right scapula, can cause nausea and vomiting. Pain subsides after a few hours. U/S shows gallstones, there is an increased serum alkaline phosphatase and bilirubin during an attack.
What is cirrhosis?
Necrosis and apoptosis of liver cells followed by fibrosis and nodule formation, causing liver architecture to become abnormal, interfering with blood flow causing portal hypertension.
What are the causes of ascites?
cirrhosis (75%), malignancy (10%), heart failure, TB, pancreatitis, increased sodium, abdominal surgery, selective protein deficiency e.g. albumin (as reduces plasma oncotic pressure), obesity
What is GORD?
Gastro oesophageal reflux disease - abdnorma reflux from the stomach to oesophagus
What 5 mechanisms prevent GORD?
- Folds of gastric mucosa forming mucosa roulette
- crural diaphram contraction
- secondary peristalsis
What risk factors causes failure of LOS relaxtion causing GORD?
obesity, fatty foods, caffeine, carbonated bevarages, alcohol, smoking, pregancy, CCB, antimuscarinic drugs, tricyclic antidepressants, oesophagitis, sliding or rolling hiatus hernia, genetic inheritance of angle of LOS
How does acid reflux cause damage and what two complications can this lead to?
Acid has prolonged contact with the squamous oesophageal lining, causing it discomfort which can lead to a peptic stricure of Barrett's oesopahgus
What clinical features does GORD present with?
heartburn (worse with bending over, lying down, heavy meal, alcohol), regurgitated acid in mouth, water brash (excess salivation), dysphagia, nocturnal asthma, chronic cough, iron deficient anaemia
In GORD, what is the correlation like between heartburn and severity of disease?
What are the investigations for GORD?
If younger than 55 and no alarm symptoms (weight loss, haematemesis, anorexia) - precede straight to treatment
If older than 55, do an EGD and a 24 hour pH monitor
What is the treatment of GORD?
- lifetsyle management e.g. stop drinking, smoking, no fatty foods, raise bed head
- anatacids e.g. aluminium hydroxide - reduces reflux
- PPI e.g. omeprazole - inhibit gastric hydorgen/potassium ATPase and reduce 90% of gastric secretion
- H2 blockers e.g. ranitidine - for acid suppression if anatacids fail
- dopamine anatagnoist prokinetic agents e.g. metoclopramide - enhance peristalsis and increase gastric emptying
- endolumincal gastroplication making multiple plications and pleats in the GO juntion to reduce symptoms
- Niseens fundoplicaton if all else fails
Side effects of Mg and Al antacids in GORD?
Mg - cause diarrhoea
Al - cause constipation
What is Barretts oesophagus?
metaplasaia of oesophagus squamous epithelieum to columnar epithelieum
What will investigations show on Barretts oesophagus?
- endoscopy shoes proximal displacement of squamous coloumnar junction
- biopsy shows columnar lining above proximal gastric folds in all four quadrants
- continual circumferential sheet or finge like projections extending upwards from squamocolumnar junction
What is the treatment of Barretts esophagus?
PPIs, endoscopic surveillance every 2 years, multiple oesophageal biopsies to look for carnicoma, oesophagectomy in young, endoscopic muscosal resection, screening if longterm heart burn, endoscopic ablative therapies to ablate dysplasstic tissue, radiofrequency ablation
What does a peptic stricture present with?
intermittent dysphagia for solids, getting worse over time
What is treatment of a peptic stricture?
PPI, surgery if that fails
If what age group do peptic strictures normally occur?
What is coeliac disease also known as?
Gluten sensitive enteropathy with a heightened immunological response or coeliac spure
What is coeliac disease?
An immune repsonse to gliadin.
Gliadin has a high glutamine and proline content and can be resistant to digestion from pepsin and chymotrypsin so remains in a high content in the intestine causing an immune T cell response, causing injury to villus
What is gliadin?
A component of gluten which is a protein found in wheat, rye and barley
What is the epidemiology of coeliac disease?
occurs in 1% of the population, more common in females and adults, mainly occurs in 40-60years and 10-15% genetics in 1st degree relatives
What does the histology of the intestine show in coeliac disease?
- abnormal villus architecture
- hyperplastic crypts
- chronic inflammatory cells in lamina propria
- villus atrophy
- cuboidal enterocytes
- increased lymphocytes
- increased EILS
What symptoms would present in coeliac disease?
anaemia, folate/B12 deficiency, diarrhoea, steatorrhoea, weight loss, failure o thrive, IBS, chronic fatigue, osteomalacia, osteoporosis, dermatitis herpetiformis