HA Medicine I And Gynecology Unit 4 Gastrointestinal Disorders Notes | HA Medicine I And Gynecology Unit 4 Gastrointestinal Disorders Second Year In Health Science (PCL)

HA Medicine I & Gynecology

UNIT 4: Gastrointestinal Disorders

Second Year Health Science (PCL) | CTEVT Syllabus (2024)

Introduction to Gastrointestinal Disorders

The gastrointestinal (GI) system is essential for digestion, absorption, and elimination. Disorders of this system are among the most common clinical presentations in general practice. This unit covers key GI conditions including peptic ulcer disease, functional bowel disorders like diarrhea and constipation, and important infectious causes such as abdominal tuberculosis. Understanding these disorders is crucial for diagnosis, management, and prevention of complications. – HA Medicine I And Gynecology Unit 4 Gastrointestinal Disorders Notes

Clinical Relevance: GI disorders account for a significant proportion of outpatient visits and hospital admissions. Proper assessment, including a detailed history of pain, bowel habits, and associated symptoms, is the cornerstone of diagnosis.

4.1 Peptic Ulcer Diseases (PUD)

Definitions & Classification

Gastritis: Inflammation of the gastric mucosa.
Peptic Ulcer: A break in the mucosal lining of the stomach or duodenum, extending into the submucosa.
Gastric Ulcer: Ulcer located in the stomach.
Duodenal Ulcer: Ulcer located in the first part of the duodenum.
Esophageal Ulcer: Ulcer occurring in the lower esophagus.

Key Etiology

Helicobacter pylori infection (Most common cause)
Chronic use of NSAIDs (e.g., Aspirin, Ibuprofen)
Stress (Critical illness, burns)
Smoking and excessive alcohol intake
Hypersecretory states (Zollinger-Ellison syndrome)

Pathophysiology Snapshot

An imbalance between aggressive factors (HCl acid, pepsin, H. pylori) and defensive factors (mucous layer, bicarbonate, prostaglandins). NSAIDs inhibit cyclooxygenase-1 (COX-1), reducing protective prostaglandins.

Clinical Features & Diagnosis

Feature	Gastric Ulcer	Duodenal Ulcer
Pain Relation to Food	Pain worsens with or soon after eating	Pain occurs 2-3 hours after meals; relieved by food
Common Symptoms	Nausea, vomiting, weight loss, bloating	Epigastric burning, night pain, heartburn

Investigations: Upper GI Endoscopy (Gold Standard), Urea Breath Test/Stool Antigen for H. pylori, CBC (for anemia), Stool for Occult Blood.

Management & Prevention

Medical Therapy:

Eradication Therapy (for H. pylori): PPI + Clarithromycin + Amoxicillin/Metronidazole (Triple therapy for 14 days).
Acid Suppression: Proton Pump Inhibitors (PPIs like Omeprazole) or H2 Receptor Blockers (Ranitidine).
Lifestyle: Avoid NSAIDs, smoking, alcohol. Encourage small, frequent meals.
Surgical: Required for complications like perforation, obstruction, or uncontrolled bleeding.

Mnemonic for PUD Complications: “BOP” – Bleeding, Obstruction, Perforation.

4.2 Diarrhea, Constipation, and Vomiting

Definitions and Causes

Diarrhea

>3 loose stools/day.
Causes: Viral (Rotavirus), Bacterial (E. coli, V. cholerae), Protozoal (Giardia), Drugs, Malabsorption.

Constipation

Infrequent, difficult passage of hard stools.
Causes: Low fiber, dehydration, inactivity, drugs (opioids), hypothyroidism.

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Vomiting

Forceful expulsion of gastric contents.
Causes: Gastroenteritis, CNS disorders, pregnancy, intestinal obstruction.

Assessment of Dehydration (WHO Classification)

Sign/Symptom	No Dehydration	Some Dehydration	Severe Dehydration
Mental Status	Normal	Restless/Irritable	Lethargic/Unconscious
Skin Turgor	Instant recoil	Slow recoil	Very slow (>2 sec)
Thirst	Normal	Thirsty	Drinks poorly/unable

Management Protocol

A. Oral Rehydration Therapy (ORT): First-line for mild-moderate dehydration. Use WHO-ORS.

B. Intravenous Therapy (for Severe Dehydration): Immediate rapid infusion of Ringer’s Lactate or Normal Saline (20-30 ml/kg within 30-60 mins), then reassess.

C. Zinc Supplementation: For children with diarrhea, reduces duration and severity.

D. Treat Cause: Antimicrobials only for specific bacterial causes (e.g., Cholera, Shigella).

Prevention: Safe water, hand hygiene, proper sanitation, rotavirus vaccination.

4.3 Abdominal Tuberculosis

Medical illustration of gastrointestinal system with focus on intestines

Illustrative representation of the GI tract, common site for abdominal TB.

Definition: Infection of the gastrointestinal tract, peritoneum, lymph nodes, or solid organs by Mycobacterium tuberculosis.

Clinical Features

Chronic or intermittent abdominal pain
Fever, night sweats, weight loss (Constitutional symptoms)
Altered bowel habits (Diarrhea or Constipation)
Abdominal distension (due to ascites or obstruction)
Palpable abdominal mass (matted loops, lymph nodes)
Features of malabsorption or intestinal obstruction

Pathogenesis & Forms

Spread: Hematogenous, lymphatic, or ingestion of sputum from pulmonary TB.

Ulcerative: Multiple superficial ulcers in ileum.
Hypertrophic: Fibrotic reaction mimicking carcinoma.
Stricturing: Fibrotic strictures causing obstruction.
Peritoneal: “Dry” with adhesions or “Wet” with ascites.

Investigations and Management

Diagnostic Tests

Imaging: CXR, USG/CT Abdomen (showing ascites, lymph nodes, thickening).
Microbiology: Ascitic fluid ADA (>36 U/L suggestive), Culture/PCR.
Histology: Laparoscopic/Colonoscopic biopsy showing caseating granuloma.
Others: Mantoux test, IGRA.

Treatment (DOTS Strategy)

First-line ATT: 2HRZE / 4HR (6 months standard).
Supportive: Nutritional support (high-calorie, high-protein).
Surgical: For complications like obstruction, perforation, fistula.

Complications: Intestinal obstruction, perforation, malabsorption, fistulae.