Category Archives: Gastroenterology

Inflammatory bowel disease

Two major forms of non-specific inflammatory bowel disease are recognized: Crohn’s disease, which can affect any part of the gastrointestinal tract, and ulcerative colitis, which affects only the large bowel. There is overlap between these two conditions in their clinical features, and histological and radiological abnormalities; in 10% of cases of colitis a definitive diagnosis of either ulcerative col

INVESTIGATION

There may be a palpable mass and a small bowel followthrough will detect most lesions. Ultrasound and CT will show bowel wall thickening and the involvement of lymph nodes which is common with lymphoma. Biopsies, to determine histological type, are helpful to decide treatment. TREATMENT Treatment is often with resection, radiotherapy and chemotherapy. The 5-year survival rate for T-cell lymphomas is 25%, but

Whipple’s disease

This is a rare disease usually affecting males. It presents with steatorrhoea and abdominal pain along with systemic symptoms of fever and weight loss. Peripheral lymph adenopathy, arthritis and involvement of the heart, lung and brain may occur. Histologically, the villi are stunted and contain diagnostic periodic acid-Schiff (p AS )-positive macro phages. On electron microscopy, bacilli can be seen ‘

Dermatitis herpetiformis

This is an uncommon blistering subepidermal eruption of the skin associated with a gluten-sensitive enteropathy. Rarely there may be gross malabsorption, but usually the jejunal morphological abnormalities are not as severe as in coeliac disease. The inheritance and immunological abnormalities are the same as for coeliac disease. The skin condition responds to dapsone but both the gut and the skin will impro

COELIAC DISEASE (GLUTENSENSITIVE ENTEROPATHY)

Coeliac disease is a condition in which there is an abnormal jejunal mucosa that improves morphologically when the patient is treated with a gluten-free diet and relapses when gluten is reintroduced. Gluten is contained in the cereals wheat, rye, barley and possibly oats. Dermatitis herpetiformis is a skin disorder that is associated with a gluten-sensitive enteropathy. INCIDENCE Coeliac disease is common in

Other tests

[14C)GLYCOCHOLIC ACID BREATH TEST  This is performed to look for bacterial overgrowth. The patient is given 14C-labelled bile salts by mouth. Bacteria deconjugate the bile salts, releasing [14C)glycine, which is metabolized and appears in the breath as l4C02. This radioactivity in the breath can easily be measured. An early rise indicates either bacterial overgrowth in the upper small intestine or rapid trans

Peptide production

The hormone-producing cells of the gut are scattered diffusely throughout its length and also occur in the pancreas. The cells that synthesize these hormones are derived from neural ectoderm and are known as APUD (amine recursor uptake and decarboxylation) cells. Many of these hormones have very similar structures. Although they can be detected by radioimmunoassay in the circulation, their action is often lo

The small intestine

STRUCTURE The small intestine extends from the duodenum to the ileum. Its surface area is enormously increased by mucosal folds. In addition, the mucosa has numerous finger-like projections called villi and the surface area is further increased by microvilli . Each villus consists of a core containing blood vessels, lacteals (lymphatics) and cells, e.g. plasma cells and lymphocytes, and is covered by epithel

Specific conditions

CHRONIC PEPTIC ULCER. Since the advent of H2- receptor antagonists, omeprazole and the role of H. pylori in aetiology, every effort should be made to avoid surgery. If necessary to control haemorrhage the bleeding vessel is ligated, but no other surgical procedure is undertaken. Eradication of H. pylori is mandatory following a bleed. GASTRIC CARCINOMA. Most patients do not have large bleeds with this conditi

Acute and chronic gastrointestinal bleeding

This section should be read in conjunction with the descriptions of the specific conditions mentioned. Acute upper gastrointestinal bleeding Haematemesis is the vomiting of blood. Melaena is the passage of black tarry stools; the black colour is due to altered blood by acid-50 ml or more is required to produce this. Melaena can occur with bleeding from any lesion from areas proximal to and including the cae