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5006 - GI System Cheat Sheet by

Disorders of motility, secretion, digestion & absorption, & GI manifestations of systemic disease

Reflux esopha­gitis

MOTILITY disorder
Defini­tion:
- Compli­cation of gastro­eso­phageal disease (GERD = malfun­ction of LES)
- Oesophagus inflam­mation due to stomach acid reflux
Mechanism:
- Abnormal lower esophageal sphincter (LES) relaxation → allowing the ascent of stomach acid into the esophagus damaging the lining → inflam­mation
Pathop­hys­iology:
Causes of excessive / prolonged LES relaxation
- 1°: Hiatal hernia (✴), foods (coffee, alcohol, chocolate, mint, citrus), drugs (Ca channel blockers, β-agonist, anti-cholinergics)
- 2°: sclero­derma (autoi­mmune disorder), delayed gastric emptying
Sx & Ssx:
- Barret's esophagus: pre-ca­ncerous lesion
- Bright red hemate­mesis: blood in vomit
- Mechanical dysphagia while eating solid foods (swallowing)
- HEARTBURN: epigastric / retros­ternal burning sensation
- Acid regurg­itation (water brash), can lead to → chronic cough (espec­ially @ night), asthma, hoarse voice
Hiatal hernia
- Type 1: sliding h.h. stomach interm­itt­ently slides up through the diaphragm (hiatus)
- Type 2: paraoe­sop­hagheal h.h. (< common) stomach bulges through hiatus but lies along the esophagus
- Mechanism: muscle weakness or ↑ abdominal pressure

Acid peptic disease

SECRETION disorder
Defini­tion:
- Formation of open ulcers in the lining of the stomach, duodenum (upper small intest­ine), or esophagus
- 1° caused by imbalance between factors that protect the mucosal lining & those that promote its erosion
Pathop­hys­iology:
- Helico­bacter pylori infection: bacterium that colonises in the stomach & weakens the protective mechanisms of the gastric mucosa → > vulnerable to acid & other harmful substances
- Acid produc­tion: excessive production (1° hydroc­hloric acid), contri­butes to develo­pment of peptic ulcers
- Impaired mucosal defence mechan­isms: such as reduced mucus produc­tion, diminished blood flow to mucosa, or inadequate bicarb­onate secretion, can compromise mucosal defense
- NSAIDs: such as aspirin or ibuprofen, can directly irritate gastric mucosa & inhibit the production of protective substances like prosta­gla­ndins
Mechanism: imbalance between aggressive factors (acid & pepsin) & protective mechanisms leads to erosion & damage to the mucosal lining, eventually → formation of ulcers
- Acid: excessive production / secretion of stomach acid ↑ acidity of gastric contents, can damage mucosal lining
- Pepsin: (enzyme that helps breakdown proteins in stomach), when excessive presence, can contribute to mucosal injury
- Mucus secretion: reduced mucus production can make the mucosa more suscep­tible to injury
- Bicarb­onate secretion: (neutr­alises stomach acid), insuff­icient secretion can disrupt mucosal defence mechanisms
Sx & Ssx:
- Epigastric pain: in upper abdomen between meals or during the night
- Heartburn
- Nausea & vomiting: especially if ulcers present in stomach
- Loss of appetite or weight loss
- GI bleeding: in severe cases
Duodenal cancer is a compli­cation of acid peptic disease

Acute & chronic gastritis

Compli­cation of acid peptic disease
Defini­tion:
- Sudden onset inflam­mation in the stomach lining
- Tends affect a wider area of mucosa
 
Acute gastritis
Chronic gastritis
Pathop­hys­iology & mechan­isms:
- Irritants & toxins: consum­ption can directly damage the gastric mucosa, leading to acute inflammation
- Helico­bacter pylori: infection
- Immune response: immune system triggers an inflam­matory response in gastric mucosa, leading to release of inflam­matory mediators (lymph­ocytes & plasma cells), this inflam­mation can cause damage to mucosal lining
- Heliob­acter pylori: leads to chronic inflam­mation of the gastric mucosa
- Autoimmune response: mistakenly attacks the stomach lining cells, causing chronic inflammation
- Other factors: prolonged use of NSAIDs, alcohol, bile reflux & certain medical conditions such as Crohn's disease or HIV infection
Sx & Ssx:
- Epigastric pain: typically burning or gnawing
- Nausea & vomiting
- Loss of appetite
- Bloating or feeling of fullness
- Hemate­mesis: in severe cases
- Dyspepsia: abdominal discomfort after eating (often w/ early satiety & bloating)
- Loss of appetite or weight loss
- Nausea or vomiting
- Bloating or fullness
- Anemia: vitamin B12 deficiency
Chronic gastritis aka 'atrophic gastritis' is a pre-ca­ncerous condition
 

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