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Questions and Answers
What triggers coeliac disease?
What triggers coeliac disease?
What is the most common enteropathy in the Western world?
What is the most common enteropathy in the Western world?
Which test is considered the gold standard for diagnosing coeliac disease?
Which test is considered the gold standard for diagnosing coeliac disease?
In patients with IgA deficiency, which antibody measurement is recommended?
In patients with IgA deficiency, which antibody measurement is recommended?
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What may lead to the development of cancer if left untreated?
What may lead to the development of cancer if left untreated?
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What is a common symptom of Peptic Ulcer Disease?
What is a common symptom of Peptic Ulcer Disease?
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Which bacterium is most commonly associated with causing Peptic Ulcer Disease?
Which bacterium is most commonly associated with causing Peptic Ulcer Disease?
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What condition is primarily caused by chronic hypersecretion of gastric acid due to increased gastrin production?
What condition is primarily caused by chronic hypersecretion of gastric acid due to increased gastrin production?
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What factor aids Helicobacter pylori in neutralizing stomach acid?
What factor aids Helicobacter pylori in neutralizing stomach acid?
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Which of the following is NOT a method for diagnosing Peptic Ulcer Disease?
Which of the following is NOT a method for diagnosing Peptic Ulcer Disease?
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Which of the following enzymes is responsible for fat digestion in the pancreas?
Which of the following enzymes is responsible for fat digestion in the pancreas?
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Which substance inhibits the action of pancreatic lipase causing fat malabsorption?
Which substance inhibits the action of pancreatic lipase causing fat malabsorption?
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What is the purpose of the urea breath test in diagnosing Helicobacter pylori infection?
What is the purpose of the urea breath test in diagnosing Helicobacter pylori infection?
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Why are serological tests less effective in confirming the eradication of H.pylori?
Why are serological tests less effective in confirming the eradication of H.pylori?
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What is a key laboratory test for diagnosing acute pancreatitis?
What is a key laboratory test for diagnosing acute pancreatitis?
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What condition is associated with a gastrinoma?
What condition is associated with a gastrinoma?
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What is one of the main causes of acute pancreatitis related to gallstones?
What is one of the main causes of acute pancreatitis related to gallstones?
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Which testing method is considered excellent for pre- and post-treatment detection of H.pylori?
Which testing method is considered excellent for pre- and post-treatment detection of H.pylori?
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Which factor increases oxidative stress inside the pancreas, potentially leading to acute pancreatitis?
Which factor increases oxidative stress inside the pancreas, potentially leading to acute pancreatitis?
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In diagnosing gastrinoma, what condition should patients avoid prior to measuring plasma gastrin levels?
In diagnosing gastrinoma, what condition should patients avoid prior to measuring plasma gastrin levels?
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Which enzyme is not secreted by the pancreas for protein digestion?
Which enzyme is not secreted by the pancreas for protein digestion?
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What type of cells in the gastric glands secrete hydrochloric acid?
What type of cells in the gastric glands secrete hydrochloric acid?
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Which is a symptom of Peptic Ulcer Disease?
Which is a symptom of Peptic Ulcer Disease?
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What is the pH range of stomach contents due to hydrochloric acid?
What is the pH range of stomach contents due to hydrochloric acid?
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Which hormone is primarily released by enteroendocrine G cells?
Which hormone is primarily released by enteroendocrine G cells?
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What is a common symptom of chronic pancreatitis?
What is a common symptom of chronic pancreatitis?
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What condition is characterized by a painful lesion in the stomach lining or duodenum?
What condition is characterized by a painful lesion in the stomach lining or duodenum?
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Which diagnostic test is used to assess pancreatic function?
Which diagnostic test is used to assess pancreatic function?
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What is the role of intrinsic factor produced by parietal cells?
What is the role of intrinsic factor produced by parietal cells?
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Which cells secrete pepsinogen in the stomach?
Which cells secrete pepsinogen in the stomach?
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What complication can arise from chronic pancreatitis?
What complication can arise from chronic pancreatitis?
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What may cause dark or black stool in Peptic Ulcer Disease?
What may cause dark or black stool in Peptic Ulcer Disease?
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What does the glucose hydrogen breath test help diagnose?
What does the glucose hydrogen breath test help diagnose?
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Which of the following conditions leads to fat malabsorption due to bacterial colonization?
Which of the following conditions leads to fat malabsorption due to bacterial colonization?
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What effect does chronic pancreatitis typically have on blood glucose levels?
What effect does chronic pancreatitis typically have on blood glucose levels?
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What can lead to false-positive results in fecal elastase testing?
What can lead to false-positive results in fecal elastase testing?
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What is a potential consequence of small intestinal bacterial overgrowth (SIBO)?
What is a potential consequence of small intestinal bacterial overgrowth (SIBO)?
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Study Notes
Biochemistry Department - Clinical Biochemistry
- Course name: Clinical Biochemistry
- Course code: PB416/PBC416
- Instructor: Nora Aborehab, PhD, FHEA, PGCHE
- Associate Professor of Biochemistry & Molecular Biology
- Head of Biochemistry Department
- Faculty of Pharmacy, Ahram Canadian University
Lecture 8 - Gastrointestinal Disorders
- Topic: Gastrointestinal Disorders
Learning Outcomes
- Discuss causes and symptoms of peptic ulcer and Zollinger-Ellison syndrome
- Differentiate between acute and chronic pancreatitis
- Explain bacterial colonization of the small intestine
- Demonstrate Coeliac disease
References
- Clinical chemistry: principles, techniques, and correlations by Michael L. Bishop, Edward P. Fod, Larry E. Schoeff
- 7th ed.
- Lecture notes: Clinical biochemistry by Simon Walker, Geoffrey Beckett, Peter Rae, Peter Ashby-9th ed
Interactive Teaching Methods
- E-learning (asynchronous)
- Case-based learning
Stomach: Peptic Ulcer Disease (PUD)
- Definition: A painful lesion in the stomach lining (gastric ulcer) or duodenum (duodenal ulcer)
- Symptoms: Burning pain, bloating, heartburn, nausea/vomiting, dark/black stool (due to bleeding), vomiting blood (coffee-grounds), weight loss, severe pain in the mid to upper abdomen
- Causes: Helicobacter pylori infection, excessive use of NSAIDs, alcoholism, radiation treatment, Zollinger-Ellison syndrome
Stomach: H. pylori
- Virulence factors: flagella (motility), urease (breaks down urea into ammonia and carbon dioxide, neutralizing stomach acid), multiple adhesins (attachment/penetration)
Stomach: PUD Diagnosis
- Endoscopy-based (invasive)
- Laboratory testing (non-invasive): urea breath test, serological tests, faecal antigen testing
PUD: Urea Breath Test
- Principle: Relies on urease activity of H. pylori to detect active infection
- Procedure: Patient ingests 13C- or 14C-labeled urea. Urease hydrolyzes urea into ammonia and isotopically labeled carbon dioxide. Carbon dioxide is absorbed from the gut and subsequently expired in the breath.
- Use: Identification of patients with active infection, effectiveness of treatment
- Feature: Highly sensitive and specific
PUD: Serological Test
- Feature: Detects antibodies to H. pylori in patients who have been infected.
- Limitation: Less helpful in confirming eradication due to slow reduction in antibody titres
PUD: Faecal Antigen Testing
- Method: Enzyme immunoassays detect H. pylori in stool specimens
- Application: Pre- and post-treatment
Stomach: Zollinger-Ellison Syndrome
- Cause: Gastrinoma – neoplasia of gastrin-producing cells
- Effect: Increased gastrin production leads to chronic hypersecretion of gastric acid, resulting in peptic ulceration, diarrhoea, and fat malabsorption (steatorrhoea)
- Diagnosis: Elevated fasting plasma gastrin levels in presence of gastric acid hypersecretion
- Important note: Patients should not be receiving proton pump inhibitors or H2 receptor blockers during measurement
Pancreas
- Function: Complex gland with endocrine (insulin and glucagon secretion to regulate glucose metabolism) and exocrine (pancreatic juice production) functions
- Pancreatic juice composition: Alkaline solution containing enzymes (amylase, lipase, and colipase, trypsinogen, chymotrypsinogen) for digestion
- Regulation of pancreatic juice secretion: Presence of acid in the duodenum causes secretin release to stimulate bicarbonate secretion; presence of fats in duodenum triggers cholecystokinin release to stimulate enzyme secretion; vagal stimulation releases pancreatic enzymes
Pancreas: Acute Pancreatitis
- Cause: Gallstones (obstruction of major papilla, causing bile reflux into pancreatic duct); alcoholism (metabolite increases oxidative stress); hypertriglyceridemia
- Diagnosis: Endoscopic retrograde cholangiopancreatography (ERCP), laboratory testing (amylase, lipase)
Pancreas: Acute Pancreatitis Diagnosis
- Amylase: Serum amylase levels increase, peaks within 24-72 hours. Highly sensitive but not specific.
- Lipase: Serum lipase levels increase, peaks with some delay after amylase. Highly sensitive and specific marker for acute pancreatitis.
- Note: Transient rises may occur in various other abdominal conditions (e.g., perforated peptic ulcer, ruptured ectopic pregnancy), or after morphine or other drug injection.
Pancreas: Chronic Pancreatitis
- Occurrence: Commonly follows acute pancreatitis
- Symptoms: Constant dull abdominal pain, epigastric tenderness, weight loss
- Complications: Malabsorption (steatorrhoea), diabetes (elevated random plasma glucose)
Pancreas: Chronic Pancreatitis Diagnosis
- Imaging techniques (e.g., plain abdominal X-ray)
- Laboratory testing (e.g., fecal elastase - 5-6 times higher than duodenal fluid concentrations. Low levels indicate pancreatic insufficiency)
Small Intestine & Colon: Bacterial Colonization of the Small Intestine (SIBO)
- Another name: Small intestinal bacterial overgrowth syndrome
- Impaired immune mechanisms lead to anaerobic bacteria colonization.
- Results: Fat malabsorption, due to excessive deconjugation of bile acid in the presence of bacteria and premature reabsorption of unconjugated bile acids. This leads to relative deficiency of bile salts, and decreased micelle formation. This can also lead to Vitamin B12 deficiency due to the bacteria consuming it.
- Diagnosis: culture of small bowel aspirate, glucose hydrogen breath test (GHBT).
Small Intestine & Colon: Glucose Hydrogen Breath Test (GHBT)
- Principle: Based on the ability of some bacteria to ferment carbohydrates, producing hydrogen as an end-product.
- Process: Patient ingests a glucose load; hydrogen produced in gut is absorbed and measured in exhaled breath.
- Application: Indicator of malabsorption and proximal bacterial overgrowth.
Small Intestine & Colon: Coeliac Disease (Celiac Sprue)
- Definition: Chronic inflammatory autoimmune disorder triggered by sensitivity to gliadin (gluten).
- Causes: Gluten sensitivity, malabsorption in the small intestine. If left untreated can cause cancer
- Diagnosis: Presence of antibodies to tissue transglutaminase (anti-tTG IgA). Small intestinal biopsy remains the gold standard.
- Risk factors: Type 1 diabetes, thyroid disease, positive family history of Celiac disease
- IgA Deficiency: Occurs in 1 in 500 of the general population, and in approximately 2-3% of patients with celiac disease
Case Study
- The case study has components of knowledge, subject, research, method, criteria analysis, conclusion, and evidence.
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Description
This quiz covers key concepts from Lecture 8 of the Clinical Biochemistry course, focusing on gastrointestinal disorders. Students will explore topics such as peptic ulcers, pancreatitis, and Coeliac disease through interactive learning and case studies.
