Flashcards in WEEK 6 Deck (52)
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1
INFECTIOUS DIARRHOEA
- Disruption of the epithelium of the intestine due to pathogens is a common cause of diarrhoea
- Blood in the lumen→ blood stool
- Loss of the epithelial absorptive properties→ water retained in the lumen
Examples of pathogens frequently associated with infectious diarrhoea include:
- Bacteria Salmonella, E. coli, Campylobacter
- Viruses
- Protozoa, including Cryptosporidium, Giardia
2
SECRETORY DIARRHOEA
- Occurs when secretion of water into the intestinal lumen exceeds absorption
- Does NOT stop after fasting
- Often associated with cholera (Vibrio cholerae)
3
INFLAMMATORY BOWEL DISEASE: ULCERATIVE COLITIS
- Chronic non-specific inflammatory condition
- Ulceration of the colonic mucosa, usually in the sigmoid colon or the rectum
- Pinpoint mucosal haemorrhages and pus → Stool contains blood and mucus
- Inflammation makes the colon empty frequently causing diarrhoea
4
INFLAMMATORY BOWEL DISEASE: CROHN’S DISEASE
- Chronic inflammatory condition involving entire intestinal wall
- Most commonly affects the last part of the small intestine (ileum) and/or the large intestine (colon and rectum) but can occur in any part of the GIT
- “Cobblestone” appearance
- Nutritional deficiencies
5
INFLAMMATORY BOWEL DISEASE: SYMPTOMS (SIMILAR FOR BOTH)
- Abdominal pain
- Diarrhoea
- Blood and mucus in stools
- Dehydration
- Fever
- Weight loss
- Periods of remission and exacerbation
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IRRITABLE BOWEL SYNDROME (IBS) DESCRIPTION
- Functional gastrointestinal disorders: dysregulation of intestinal motor and sensory functions moderated by the CNS due to stress
- Women > men
- Persistent of recurrent lower abdominal pain
- Altered bowel function
- Flatulent, bloating
- Nausea, anorexia
- Abdominal pain relieved by defecation and change in consistency/ frequency of stools
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IRRITABLE BOWEL SYNDROME (IBS) DIAGNOSIS
- Continuous or recurrent symptoms of at least 12 weeks duration of abdominal discomfort
- Or pain in the preceding 12 months
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IRRITABLE BOWEL SYNDROME (IBS) TREATMENT
- Manage psychological and physiologic stress
- Adequate fibre intake; avoid fat, gas-producing food, alcohol and caffeine
- Antispasmodic and anticholinergic drugs
9
LIVER FUNCTION
- Detoxification: bilirubin, ammonia, toxins
- Metabolism: Glucose, lipid, protein
- Synthesis: Bile, albumin, haemoglobin, precursors (steroid hormone, clotting factors)
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JAUNDICE
- Yellowing of the skin and sclera of the hyperbilirubinemia
Major causes
- Prehepatic factors: Disorders causing excess haemolysis of red blood cells
- Intrahepatic factors: Any condition which impairs hepatocyte function of
- Conjugation of bilirubin
- Bilirubin uptake. E.g. hepatitis, cirrhosis, liver cancer
- Posthepatic factors: Primarily involve blockage of bile flow- e.g. from gallstones or tumours
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LIVER DISORDERS
- Hepatitis: Inflammation of the liver- acute or chronic
- Cirrhosis: Dead liver cells replaced irreversibly with non-functioning scar tissue
12
HEPATITIS
- Non-infectious causes
- Alcohol, Autoimmune disease, Drugs and toxins, Tumours
- Infectious hepatitis caused by viruses
Hep A, Hep B, Hep C, Hep D, Hep E
13
ALCOHOL LIVER DISEASE
- Reduced fatty acid oxidation→ lipid accumulation
- Usually occurs in binge drinkers; Reversible after quitting alcohol
- Fatty liver disease: independent of dietary habit
- Alcoholic Hepatitis→ Liver inflammation and necrosis
14
VIRAL HEPATITIS
- Cell injury is due to
- Direct cell damage by the virus
- Indirect damage by the body’s immune responses against the viral antigens, which kill the virus but also damages cells
- The clinical course of infections may be:
- Asymptomatic (serologic evidence only) - a carrier state without clinical features (e.g. HBV)
- Acute
- Chronic with or without progression to cirrhosis
- Fulminating disease with rapid onset of liver failure
15
ACUTE HEPATITIS (3 IDENTIFIABLE STAGES) PRODROMAL (ABRUPT OR INSIDIOUS)
- Abdominal pain, usually mild on the right side
- Fatigue
- Severe anorexia
- Nausea and vomiting, diarrhoea or constipation
- Possibly a distaste for smoking in smokers
- Muscle and Joint pain
- Chills and fever may occur with abrupt onset
- Increased AST, ALT
16
ACUTE HEPATITIS (3 IDENTIFIABLE STAGES) ICTERUS (5-10 DAYS)
- Severe pruritus and liver tenderness common
- Increased bilirubin and jaundice
- Jaundice less likely in HCV infection
- Dark urine- black tea colour
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ACUTE HEPATITIS (3 IDENTIFIABLE STAGES) CONVALESCENT (2-3 WEEKS)
- Increased sense of well-being
- Decreased jaundice
- Course: HAV- 9 weeks, uncomplicated HBV- 16 weeks
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HEPATITIS A: Summary
Viral infection with hepatitis A virus (HAV) causing inflammation of the liver
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HEPATITIS A: Transmission
- Via the fecal- oral route and is highly infectious
- More common in countries with poor sanitation
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HEPATITIS A: Clinical Features
- Clinical features are acute or can be asymptomatic
- Fever
- Malaise
- Anorexia
- Abdominal discomfort
- Dark urine
- Jaundice
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HEPATITIS A: Treatment
- Benign (uncomplicated)
- Self-limited- recover after 2 weeks usually
- Symptomatic support
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HEPATITIS A: Carrier State
No
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HEPATITIS A: Vaccine
Yes, develop immunity through IgG antibodies
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HEPATITIS A: Incubation period
2-6 weeks
25
HEPATITIS A: Chronic Disease Development
Does not develop to a chronic state
26
HEPATITIS B: Summary
Viral infection with Hepatitis B Virus (HBV) causing inflammation of the liver
27
HEPATITIS B: Transmission
Transmitted by body fluids, vertical
Can also be transmitted by breast milk
28
HEPATITIS B: Clinical Features
Fever
Malaise
Anorexia
Abdominal discomfort
Dark urine
Jaundice
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HEPATITIS B: Treatment
- Some recover without meds in 16 weeks
- Antiviral medication
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