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Common gastrointestinal problems

In this short presentation, I'm just going to outline some clinical features of the gastrointestinal tract
and its accessory organs of digestion. I'm going to look at gastric and also duodenal ulcers, gall
stones, and also resection of a portion of the large intestine.
So if we start off with gastric and duodenal ulcers, then what are they? Well, ulcers on the lining of
the stomach or the proximal duodenum are a damaged proportion of that mucosal membrane.
Duodenal ulcers are more common, with about 15% of the population suffering from a duodenal
ulcer. And they're also more common in men.
So what's the cause? Well, an ulcer is going to be the breakdown of the mucosal membrane lining
the duodenum or the stomach. And this can be caused by the gastric acid.
The release of gastric acid into the stomach is important to lower the pH, to enable certain enzymes
to work correctly and begin the chemical breakdown of the ingested food. Overproduction of this
gastric acid can wear away at the wall of the stomach or the duodenum, leading to an ulcer.
It can also be linked to a bacterial infection, specifically helicobacter pylori. And it can also be linked
to non-steriodal anti-inflammatory drugs. So if you take lots of these types of medication, then it can
also lead to gastric or duodenal ulcers. And there's also genetic factors.
So on the screen, we can see both a gastric ulcer of the stomach and a duodenal ulcer. Gastric ulcers
are typically located along the lesser curvature of the stomach. And they lead to sharp, burning pain
about one to two hours after the person has eaten some food.
Duodenal ulcers are located in the proximal part of the duodenum. And this proximal part of the
duodenum, its first part, is also going to receive some of this gastric acid as the food passes from the
pylorus into the duodenum. And this can lead to ulceration of the duodenum.
For this, pain is also located. And this usually happens about two to four hours after the person has
eaten. And because the person may have gone to bed, this pain is actually sufficient to wake them
from their sleep.
So the complications of these gastric or duodenal ulcers are a perforation. Although this is
uncommon, if the ulcer was actually to perforate the wall of the duodenum or the stomach, then the
contents of the stomach or duodenum can spill into the peritoneal cavity, leading to peritonitis.
Haemorrhage, if the ulcer penetrates the blood vessels. For example, along the lesser curvature of
the stomach we have the gastric arteries. Then these blood vessels can bleed out into the stomach.
And they can also then pass into the stools. And this gives black, tarry stools, the presence of blood
within the faeces.
Blood within the stomach wall, it can irritate the stomach and cause vomiting to occur. And there
will be obviously blood within the vomit.
There's also the problem of obstruction. If the ulcer is swelling and scarred, then obstruction can be
found, preventing food passing into the duodenum. And this can also lead a back-up of food within
the stomach. And we can have copious projectile vomiting.
So there we've got some gastric and some duodenal ulcers, usually treated by some antacids or
some medication, some antibiotics if it's a bacterial infection.
So now, let's move on to gall stones. What is it? Well, gall stones are small stones located within the
gall bladder.
Why do they happen? Why do we have them? Well, we can see some gall stones on the screen at
the moment.
And they're small, little stone-like structures, like pebbles from the beach. And they're due to high
levels of cholesterol and also byproducts of red blood cell breakdown within the gall bladder. This
chemical imbalance leads to crystal development within the bile. And here we have these large
crystals forming these pebbles.
Symptoms of gall stones can be constant abdominal pain, a high temperature, fever, jaundice, which
is a yellow coloration of the skin, diarrhoea. We can have pale stools, as sometimes the bile which
colours the faeces into that dark brown colour, is prevented from entering the gastrointestinal tract.
So the stools are pale.
But because of this bile now being secreted into the blood system, it's absorbed into the arterial
system. It actually is then filtered by the kidneys and you can have dark urine. So a number of
symptoms which could indicate you have gall stones.
So what happens? What's the treatment for gall stones?
Well, you can have a cholecystectomy. This is when a portion of the gallbladder or all of the gall
bladder and cystic duct is removed.
So we can see the liver, the duodenum, and the biliary tree here. We've got the cystic duct, the gall
bladder, and the common bile duct. Remember, the liver produces the bile, that's then stored within
the gall bladder. This passes by the common bile duct to the duodenum.

A cholecystectomy is to remove the gall bladder. And here we can see where the incision is made
along the cystic duct to cut away the gall bladder. We can see in this image that a gall stone is
actually blocking the cystic duct.
Once that happened, then we do not have a gall bladder any more. And the cholecystectomy has
been a success. The liver still produces bile. And the bile then runs down the biliary tree, excluding
the cystic duct, to the duodenum.
So I just briefly want to go over resection of the large intestine. And that leads into the discussion we
have today.
So colorectal cancer is the leading cause for a resection of a portion of the large intestine. And that's
a cancer of the large intestine, as we can see on the screen, at any point from caecum to rectum. It's
the third most common cancer in England. And the University of Leeds is actually a specialist centre
in researching colorectal cancer.
Symptoms? There can be blood found in the stools; unusual bowel movements, either diarrhoea or
constipation; abdominal pain. There can be weight loss.
The diagnosis is done by a number of ways. There could be digital rectal examination, where fingers
are passed into the rectum through the anal opening to feel for a tumour.
There could be a sigmoidoscopy, where a tube is inserted into the sigmoid colon so we can have a
look at the walls. Or it can be a colonoscopy, where this tube is extended throughout the entire
colon to have a look at the surface of the large intestine.
The treatment can be a number of treatment, surgery, chemotherapy, radiotherapy. And we'll hear
more about these in the clinical discussion that follows.
[end of transcript]