DIGESTIVE SYSTEM TUTORIALS November 2015

Date: Tuesday, November 3, 2015 - 2:00-4:00p.m.

Tutors
Dr. L. Young-Martin
Dr. K. Bishop
Dr. T. Gibson
Dr. S. Shirley
Dr. N. Williams

Tutorial
Topic
Groups
1 -12 & WJC
Digestive
Physiology Case
13-15
Digestive Pathology
Cases
16-18
Digestive Pathology
Cases
19-21
Digestive Pathology
Cases
22-24
Digestive Pathology
Cases

Date: Monday, November 9, 2015 - 2:00-4:00p.m.

Dr. L. Young-Martin
13-24
Digestive
Physiology Case
Dr. M. Bromfield
1-3
Digestive Pathology
Cases
Dr. R. Thompson
4-6
Digestive Pathology
Cases
Prof. G. Char
7-9
Digestive Pathology
Cases
Prof. B. Hanchard
10-12 + WJC Digestive Pathology
Cases

Digestive Pathology:

Venues
MMLT
Physiology Lab.
Level 4 FMSTRC
Pathology Teaching Lab.
Level 0 Conference Room
FMSTRC
Level 1 Conference Room
FMSTRC
MMLT
Level 0 Conference Room
FMSTRC
Level 1 Conference Room
FMSTRC
Pathology Teaching Lab.
Lecture Theatre 3
Level 0 FMRSTRC

LEARNING OBJECTIVES

This tutorial is supplementary to the lectures on diseases of the gastrointestinal tract and
is designed to consolidate factual knowledge about common gastrointestinal disorders
through case discussions.
By the end of the tutorial students should be able to:

Classify gastrointestinal haemorrhage

Discuss common causes of upper gastrointestinal tract haemorrhage
Outline the pathology of various causes and mechanisms of haemorrhage
Discuss the pathogenesis of Portal Hypertension
Discuss the causes and consequences of cirrhosis of the liver
Discuss gastrointestinal neoplastic disorders
Appreciate the natural history and prognosis of each disorder

The following cases will be discussed

CASE 1
A 65-year-old man was brought to the Accident and Emergency Unit at the UHWI by
friends having been found in a collapsed state in the bathroom of a popular night club
where he had spent most of the evening drinking. When he was examined he was
somewhat disoriented in time and space, had slurred speech and had no recollection of
the events of the evening although he was fully conscious. Alcohol was smelt on his
breath and there was blood and vomitus on his clothes.
He stated that he had been relatively well in the past except that he had noticed that his
abdomen was becoming distended and that his palms now looked redder than usual. He
had no known chronic illness.
The significant examination findings were a rapid thready pulse of 92/min, blood
pressure 90/60 mm Hg and cold and clammy skin. No organs were palpated in his
abdomen but this was distended and there was evidence of a fluid thrill. His chest was
clear and no central nervous system deficits were noted.
He was diagnosed as having had an upper gastrointestinal haemorrhage with shock and
referred to the gastrointestinal service for further management.
QUESTIONS
1.

What are the possible causes of upper gastrointestinal haemorrhage

(haematemesis) in this patient?
2.
For each of these disorders, give an account of the:
a. Mechanism of haemorrhage
b. What is the most likely cause in this patient?
c. What other supporting findings may be present on examination?
3.
What is the most likely underlying disease in this patient?
4.
What is the most likely cause of the underlying disease?
a. Discuss other possible causes and consequences of the underlying disease.

CASE 2
A 37-year-old man presented to his private doctor with a history of weight loss and
exertional dyspnea. On systematic enquiry he admitted to episodic diarrhoea and a
family history of gastrointestinal disease. A fecal occult blood test done was positive.
Colonoscopy was performed and multiple lesions were identified, the largest of which
was biopsied.
1.
2.
3.
4.

What is the most likely diagnosis?

What is the likely result of the biopsy?
Are there any other associated aetiologic factors?
If a CT scan of the abdomen revealed pelvic lymphadenopathy, what would be the
stage and prognosis?

Digestive Physiology:
The following case will be discussed
A 35-year-old woman presents with severe abdominal pains, bloody stools and
chronic diarrhoea. She has been taking antacids for the last month with little pain
relief. She indicates that she has had symptoms of heartburn in the past.
Radiological studies reveal multiple ulcers involving the duodenum and jejunum.
Analysis of the basal gastric acid secretory rate is high and radioimmunoassay of
serum gastrin is elevated.
a)
Describe the functional organization of the stomach.
b)
Describe the mechanism of gastric acid secretion?
c)
Describe the regulation of gastric acid secretion?
d)
State the different types of gastrin.
e)
What are the functions of gastrin?
f)
How is gastrin secretion regulated?
g)
Is the gastrin level high or normal?
h)
Is the basal gastric secretory rate high or normal?
i)
How do antacids work?
j)
Describe the pathophysiology associated with heartburn?
k)
Describe the physiology of the duodenum.
l) Name the hormones released and the functions of each.
m)
What is the most likely cause of the presenting symptoms?
n)
How can provocative tests using calcium, secretin or a test meal be used to
differentiate antral G-cell hyperplasia from the Zollinger-Ellison syndrome?
o)
Suggest another drug treatment for this patient.
p)
Would you recommend surgery?