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Questions and Answers
What is a common symptom of gastro-oesophageal reflux disease (GORD)?
Which factor is NOT associated with the pathogenesis of GORD?
What indicates life-threatening bleeding from oesophageal varices?
Which of the following is a possible management option for bleeding oesophageal varices?
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Which lifestyle modification is recommended for patients with oesophageal varices?
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What is a primary complication associated with oesophageal varices?
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Which condition is characterized by the inflammation of the oesophagus due to stomach acid?
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What is Barrett’s oesophagus primarily a risk factor for?
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Which symptom is most commonly associated with peptic ulcer disease?
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What is the primary underlying cause of coeliac disease?
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What part of the gastrointestinal tract does the oesophagus connect?
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Which of these factors is associated with an increased prevalence of oesophageal varices?
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What is the main function of the lower oesophageal sphincter?
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What is a primary result of gliadin peptide absorption in individuals with coeliac disease?
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Which manifestation is associated with untreated coeliac disease?
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What is a critical intervention upon diagnosis of coeliac disease?
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What is observed during an endoscopy of an individual with coeliac disease?
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Which condition poses an increased risk for T cell lymphoma when unmanaged?
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How does coeliac disease primarily affect nutrient absorption?
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What unusual items are known to unexpectedly contain gluten?
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During the inflammatory reaction in coeliac disease, which immune cells are primarily involved?
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Study Notes
Coeliac Disease
- People with coeliac disease are reactive to the gliadin in gluten.
- The large gliadin peptides are normally absorbed by enterocytes and do not cause any problems.
- In coeliac disease, the gliadin peptides enter the lamina propria of the small intestine and initiate an immune response.
- A T cell mediated autoimmune inflammatory reaction results in marked atrophy or total loss of villi.
- There is a granular appearance of duodenal folds and a loss of villi in coeliac disease.
- Severe symptoms can cause anemia due to severe malabsorption.
- Malabsorption can also result in major vitamin deficiencies, causing neurological conditions, osteopenia, and severe metabolic disturbances.
- Untreated coeliac disease increases the risk for T cell lymphoma.
- Gluten needs to be totally removed from the diet.
- Even trace amounts can cause changes to the gastrointestinal mucosa.
- Increased risk of T cell lymphoma with non-compliance.
- Foods that most people don’t realize contain gluten: beer, stock cubes, chewing gum, some lollies, icecream, processed meats, tomato sauce and other condiments, hot chips etc.
Oesophageal Varices
- Enlarged veins in the oesophagus.
- These can be diagnosed via endoscopy.
- Life-threatening complication of portal hypertension.
- Seen in up to 50% of patients with liver disease such as liver cirrhosis.
- 25-40% of sufferers will experience bleeding. 15% of these will die from blood loss.
- There are no symptoms until they rupture.
- Signs of bleeding can include vomiting of blood, dark or tarry stools.
- Signs of blood loss: lightheadedness, confusion, loss of consciousness.
- Caused by obstructed blood flow through the portal vein.
- Cirrhosis of the liver can result in portal hypertension, where blood flow is backed up.
- Increased pressure causes veins of the esophagus to become dilated and swollen.
- Lifestyle modifications: weight loss, stopping all alcohol.
- Medication to lower blood pressure: beta blockers.
- Surgery: variceal band ligation.
Gastro-oesophageal Reflux Disease (GORD)
- Gastroesophageal reflux disease (GORD/GERD) is when stomach acid or bile is not contained within the stomach and repeatedly flows back into the oesophagus.
- Prevalence: 10-20% of the population in Western countries.
- Common in people aged 40+.
- Symptoms: Heartburn, pain often worse after eating, when lying down, and with emotional stress.
- Regurgitation of sour-tasting gastric content.
- Nausea, burping.
- Dry cough and sore throat.
- Poor oesophageal clearance: efficient peristalsis and saliva production limits the exposure of the oesophagus to the acid and bile in the stomach.
- Dysfunctional lower oesophageal sphincter (LOS): The LOS relaxes to allow the passage of food into the stomach and closes to protect the oesophagus from the acid in the stomach.
- Alcohol and smoking, obesity, pregnancy, smoking.
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Description
This quiz explores the pathophysiology of coeliac disease, including the immune response to gliadin, effects of malabsorption, and the importance of a strict gluten-free diet. Understand the potential complications of untreated coeliac disease, such as anemia and increased lymphoma risk. Test your knowledge on the key concepts related to this autoimmune condition.
