Diseases Of The Gastrointestinal System Long Essays

Diseases Of The Gastrointestinal System Long Essays

Question 1. Describe the pathophysiology, clinical features, diagnosis & management of reflux oesophagitis.

Answer:

Reflux oesophagitis

Gastro-oesophageal reflux disease (GERD)

Definition:

• It is defined as reflux of gastric contents into the esophagus resulting in inflammation of esophagus caused by H+ ions, pepsin & bile salts.

Pathophysiology

Clinical Features:

1. Heartburn
2. Acid eructation.
3. Painful swallowing.
4. Transient dysphagia, n Strictures.
5. Iron deficiency anaemia. b Hoarseness of voice.
6. Acid erosion of incisors.
7. Pneumonia.

Diagnosis:

1. General Measures
   • Weight reduction
   • Avoid alcohol & smoking.
   • Avoid sleeping immediately after large meals.
   • Avoid use of analgesics & anti-inflammatory drugs.
   • Use of small volumes & frequent meals.
2. Medical Measures:
   • In mild cases.
     • Liquid antacid – 10 – 15 ml 1 – 3 hours after meals.
   • In moderate cases – H2 antagonists are used.
     • Cimetidine – 400 mg.
     • Ranitidine – 150 mg BD or QID with meals. & before bed for 6 weeks.
   • In severe cases – proton pump inhibitors are used.
     • Omeprazole – 20 – 40 mg/ day.
     • Lansoprazole – 15 – 30 mg/ day.
     • Pantaprazole – 40 mg/ day.
     • Rabiprazole – 10 – 20 mg/day.
   • Other
     • Metoclopramide 10 mg TID increases lower oesophageal sphincter.
3. Surgical treatment:
   • Repair of the sphincter.
   • Construction of additional valve mechanism.

Read And Learn More: General Medicine Question and Answers

Question 2. Describe etiology. Clinical features, diagnosis & management of peptic ulcer.

Answer:

Peptic Ulcer:

1. It is defined as the presence of an ulcer in the lower esophagus, stomach or duodenum, in the jejunum after surgery to the stomach.
2. It is a breach in the mucosa.

Etiology:

1. Hereditary.
2. Helicobacter pylori infection.
3. Smoking.
4. Corticosteroids
5. Acid-pepsin versus mucosal resistance.
6. Alcohol consumption.

Pathogenesis:

Peptic Ulcer Clinical Features:

1. It is chronic condition
2. Epigastric pain.
3. Hunger pain – occurring in an empty stomach.
4. Night pain – wakes the patient from sleep.
5. Episodic pain.
6. Excessive salivation.
7. Heart bum.
8. Loss of appetite.
9. Nausea, vomiting anorexia.
10. Haematemesis.
11. Weight loss.

Peptic Ulcer Investigations:

Peptic Ulcer Treatment:

1. General measures:
   • Avoid smoking
   • Avoid alcohol consumption
   • Avoid NSAIDs
2. Medical treatment:
   • Antacids
     • 15 – 30 ml liquid, 1 – 3 hours after food and before bedtime for 4-6 weeks.
   • H2 receptor antagonists.
     • Cimetidine – 400 mg BD
     • Ranitidine – 150 mg BD
   • Proton pump inhibitor.
     • Omeprazole – 20 mg daily for 4 – 8 weeks.
     • Lansoprazole – 15 – 30 mg daily for 4-8 weeks.
     • Pantaprazole – 40 mg daily for 4-8 weeks.
   • Prostaglandin analogs.
     • Misoprostol – 200 mg 4 times daily.
3. Surgical treatment:
   • Truncal vagotomy + pyloroplasty.
   • Partial gastrectomy.
   • Elective surgery.

Question 3. Discuss the etiology, clinical features and management of malabsorption syndrome.

Answer:

Malabsorption syndrome:

• It refers to the defective absorption of one or more essential nutrients through the intestine.

Etiology:

1. Pancreatic disorders.
   • Chronic pancreatitis
   • Cystic fibrosis
   • Malignancy pancreas.
2. Disorders causing deficiency of bile acids.
   • Interruption of enterohepatic circulation.
   • Abnormal bacterial proliferation in small intestine.
   • Drugs like neomycin.
   • Inadequate absorptive surface.
   • Mucosal defects.
     • Mucosal defects.
     • Tropical sprue.
     • Lymphoma.
     • Amyloidosis.
3. Biochemical or genetic abnormalities.
   • Disaccharidase deficiency.
   • Hypogammaglobulinaemia.
4. Metabolic defects.
   • Diabetes mellitus
   • Addison’s disease
5. Specific malabsorption.
   • Lactose deficiency.
   • Vitmai B₁₂ malabsorption.

Malabsorption syndrome Clinical Features:

1. General Features:
   • 3 health
   • Loss of weight
   • Lazziness, lassitude
   • Fatigue, weakness.
2. GIT symptoms
   • Diarrhea
   • Abdominal pain, distension.
   • Stomatitis, glossitis, cheilosis.
3. Genitourinary.
   • Nocturia.
   • Loss of libido.
4. Hematopoietic.
   • Anaemia.
5. Skeletal
   • Bone pain
   • Tetany
   • Muscle wasting
6. Nervous system
   • Night blindness
   • Xerophthalmia.
   • Peripheral neuropathy.
7. Skin
   • Purpura.
   • Hyperkeratosis
   • Edema of legs

Malabsorption syndrome Management:

1. Use of gluten-free diet.
2. Use of a low-fat diet and cholestyramine.
3. Replacement therapy for anemia, bone disease, and coagulation defects.
4. Vitamins and minerals supplementation.
5. Oral administration of folic acid & iron.
6. Intravenous fluid administration for dehydration.
7. Use of corticosteroids to suppress immunological responses.

Question 4. How will you investigate a case of dysphagia? Enumerate conditions causing dysphagia.

Answer:

Dysphagia:

• It is defined as difficulty in swallowing.

Dysphagia Causes:

1. Mechanical narrowing of the esophagus.
   • Intrinsic causes.
     • Congenital atresia.
     • Stomatitis, glossitis, tonsillitis, pharyngitis.
     • Benign or malignant tumors.
     • Oesophageal stricture or ulceration.
   • Extrinsic causes.
     • Retropharyngeal abscess.
     • Enlarged thyroid gland.
     • Aortic aneurysm.
2. Motor dysphagia.
   • Lower motor neuron paralysis.
   • Neuromuscular paralysis.
   • Oesophageal muscle weakness.
   • Paralysis of the oesophageal sphincter.

Dysphagia Investigations: