GI disorders Flashcards
common GI symptoms
- abdominal pain,
- diarrhoea,
- constipation,
- bloating,
- fullness,
- nausea and vomiting
- changed bowel habits
- Bleeding
- Swelling(ascites)
braod classes
- Bleeding disorders
- Congenital disorder
- Inflammations
- Infections
- Immune related
- Motility
- Malabsorptive conditions
- Neoplasms
- Obstructions
external/non medical influences of GI health
- GI is influenced by a range of dietary factors, influenced by societal factors shaping “what/where e.g. world regions, urban vs rural/when/why/how much we eat.”
- Supported by large global industries across “wellness/sports agriculture/food industry etc.”
GI global burdne
- in the global rank: has dropped from 4 to 12 - enteric infections DALYs all ages
- from 3 for enteric infections and nutritional deficiencies 7 to…unchanged - DALYs under 5 - less developed immune system
- in 2019 -there were 6·60 billion (95% UI 6·07–7·16) incident cases and 98·8 million (92·0–106) prevalent cases of enteric infections contributing to 1·75 million (1·29–2·42) deaths, and 96·8 million (79·2–120) DALYs
DESCribe enteric infections, types, and RFS
- enteric infections include:
- **Diarrhoeal diseases
- Typhoid and paratyphoid fever
- Invasive non-typhoidal Salmonella (iNTS)
- Other intestinal infectious diseases
- RFs for most enteric infections:
- **unsafe water
- unsafe sanitation
- child wasting
- no access to handwashing
- non-exclusive breastfeeding
Three types of diarrhoea
Three clinical types of diarrhoea:
1. acute watery – lasts several hours or days and includes cholera;
2. acute bloody – also called dysentery;
3. persistent – lasts 14 days or longer
Causes of diarrhoeal disease in children
- Infection: Diarrhoea is a symptom of infections caused by bacterial, viral and parasitic organisms, most of which are spread by faeces- contaminated water.
- Rotavirus and Escherichia coli are the two most common etiological agents of moderate-to-severe diarrhoea in low-income countries. Other pathogens, such as Cryptosporidium and Shigella species, may also be important
- .- Enteropathic E. coli types commonly found in persistent diarrhoea (up to 63%) [abba et al. 2009]
- Location-specific etiologic patterns also need to be considered.
- Malnutrition: Children who die from diarrhoea often suffer from underlying malnutrition, which makes them more vulnerable to diarrhoea.
- Each diarrhoeal episode, in turn, makes their malnutrition even worse.
- Diarrhoea is a leading cause of malnutrition in children under five years old
Globally, Pneumonia and diarrhoea together account
for 29% of all child deaths (WHO combined targeted program)
Epidemiology of acute diarrhoea
- diarrhoea can be associated with considerable mortality especially for young children in developing countries
- AU: diarrhoea can occur as an isolated incidence of gastro or a localised outbreak associated with eating at an event/cafe. Occasionally we have had larger outbreaks or epidemics due to contaminated food products available commercially
- incidence of diarrhoea is higher in some indigenous communities, particularly rural and remote communities with poor infrastructure leading to higher morbidity and mortality
- diarrhoea is also an important issue for older Aus living alone, as they may experience dehydration; and unable to manage self-care or call for help
Causes diarrheal diseases in vulnerable or elderly
Causes of Diarrheal Disease in Elderly/vulnerable adults
- Highest mortality rates due to gastroenteritis in high-income countries occur in the elderly, particularly people aged ≥75 years.
- Talley et al. reported a prevalence of ‘chronic diarrhoea’ of 7% and 14% in an elderly population
- Chronic diarrhoea may place an elderly patient at risk of dehydration and malnutrition.
- Alterations in body composition, as well as hepatic and renal dysfunction, are more common in the elderly and may impact drug pharmacokinetics, with a consequent influence on drug-related chronic diarrhoea and subsequent management.
- Clostridium difficile infection is particularly common among older adults in hospitals and nursing homes, and relapsing disease in these groups may be more frequent than among younger adults
- hospitalisation due to infectious gastroenteritis linked with poor-self rated health
pathophysiology in eldely
Aging decreases the quality and proportion of T cells, reducing the production of secretory IgA, the primary immune response of the gut.
- Acid production in the stomach decreases with age and compromises its vital self-sterilising function, thus increasing the risk of diarrhoea due to viral, bacterial and protozoal pathogens.
- common reasons: IBS, diet (lactase deficiency, caffeine, excess alcohol), colonic response, IBD, drugs (Mg, antibiotics, NSAIDs, anti-neoplastic drugs), overflow diarrhoea, bile acid diarrhoea
broad GID classificaiton
- FGID or DGBI – disorders of gut-brain interaction
- definition
- Common abdominal symptoms without a structural or biochemical abnormality explaining the problems.
- Occur due to abnormal functioning of the GI tract. GI looks normal on imaging and testing
- example
- Irritable bowel syndrome, functional dyspepsia, or functional constipation
- prevalence
- 40% (people mild)- 25%(severe cases)
- Mild cases- 2/3rds have chronic, fluctuating symptoms.
- Women>Men
- Increased risk of both atopic and autoimmune diseases in DGBI
- pathophysiology
- Complex, but involves bidirectional dysregulation of the gut-brain interaction (via the gut-brain axis)
- Visceral hypersensitivity, the central theme in the pathophysiology of DGBI( abnormal pain signaling to chemical stimuli and/or mechanical distention)
- diagnosis
- Rome IV diagnostic criterion:
- When a patient’s combination of symptoms and other factors meet the Rome criteria for a specific functional disorder
- 33 adult FGIDs categorised by anatomical location
- Rome IV diagnostic criterion:
- definition
- Structural
- definition
- Persistent and recurring GI symptoms with clear underlying organic(structural tumour/masses) or biochemical abnormalities. Physical damage causes symptoms. GI looks abnormal on imaging and testing.
- example
- Inflammatory bowel disease (IBD:Ulcerative Colitis/Crohn’s) / Enteric infections of known aetiology/ Hepatitis/Pancreatitis /CRC/..all others non-DGBI gut conditions
- prevalence
- In 2017, 6·8 million cases of IBD globally
- In 2019 -6·60 billion enteric infection cases globally with 1·75 million deaths,
- pathophysiology
- Varies according to organ E.g. IBD: non-infectious chronic inflammation of the gastrointestinal tract
- diagnosis
- ICD 10/ 11classification
- definition
Deiscuss IBD
*Crohn’s disease and ulcerative colitis, collectively called inflammatory bowel diseases, are chronic diseases requiring
complex long-term care. Another category added to IBD is the intermediate colitis/ Inflammatory bowel disease-unclassified (IBDU)
*The trajectory of IBD usually involves periods of remission, flares and relapses.
*Though it can be diagnosed at any age, it is commonly diagnosed between 15 and 35 years of age and usually has lifelong effects – increasing in young adults and children
* Australian health costs attributed to IBD exceed AU$2.7 billion per annum with national productivity losses of AU$380 million.
- Globally emergence linked with beginning of urbanisation — end up with stable population with it with increasing urbanisation (more diagnosis with unmasking incidence?)
VISION of IBD National plan:
* All Australians living with inflammatory bowel disease have access to high-quality, integrated care to best manage their own health and improve quality of life
Discuss some Crohn’s RFs
Males were independently associated with a lower risk of Crohn’s disease (OR: 0.86; 95% CI: 0.81, 0.90) but a greater risk of ulcerative colitis
(OR: 1.12; 95% CI: 1.06, 1.17) than females.
* Compared to non-smokers, patients who were current smokers were associated with a greater risk of Crohn’s disease (OR: 1.13; 95% CI: 1.04, 1.23) but a lower risk of ulcerative colitis (OR: 0.52; 95% CI: 0.47, 0.57).
* Other factors positively associated with both Crohn’s disease and ulcerative colitis were age (> 25 years), non-Indigenous status and socioeconomic advantage.
* Current smoking is independently associated with a greater CD risk but a lower UC risk.
note: high incidence of IBD in northern Australia
- north south gradient not demonstrated
Discuss GERD
While GORD does not contribute significantly to mortality, it imposes a high societal and financial burden on the community.
* A recent systematic review demonstrated a reduction in health-related quality of life in patients with GORD comparable to other chronic diseases such as diabetes, arthritis and cardiovascular disease.
* The estimated prevalence of diagnosed GORD in general practice patients in Australia is 11.6% (95CI 10.5–12.6) and 7.5% (95% CI, 6.8–8.2) in the Australian population. presumably large pool of undiagnosed GORD in the community. A meta-analysis of GORD’s
epidemiology suggests a community prevalence of 10–20% of the population in the Western world
