Biology of Disease

X]VeiZg&&/ DISORDERS OF THE GASTROINTESTINAL TRACT, PANCREAS, LIVER AND GALL BLADDER

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Mark, a 52-year-old plumber, was admitted to hospital

because of severe abdominal pain. The pain had started

suddenly about 15 h previously. On questioning, Mark

admitted to being a heavy alcohol drinker over many

years. Clinical examination showed that Mark had a

tender abdomen and was in mild shock. Radiographic

examination did not show any evidence of intestinal

obstruction. Biochemical tests gave the following results

(reference ranges are shown in parentheses):

Serum Na+ 140 mmol dm–3 (135–145 mmol dm–3)

K+ 4.2 mmol dm–3 (3.6–5.0 mmol dm–3)

Urea 11 mmol dm–3(3.3–6.7 mmol dm–3)

Glucose 13 mmol dm–3 (2.8–6.0 mmol dm-3)

Amylase 5000 IU dm–3 (<300 IU dm–3)

Questions

(a) What is the most likely diagnosis?

(b) Why does Mark have a high serum urea

concentration?

CASE STUDY 11.3

11.9 Summary

The GIT and its associated organs are necessary for the digestion of food and

the absorption of nutrients derived from food. Digestion takes place in the

mouth, esophagus, stomach and small intestine, with the bulk of ingested

water being absorbed in the latter. The pancreas provides enzymes for diges-

tion in the small intestine while the liver secretes bile, containing detergents

that aid in the digestion of fats. Most nutrients from digestion are carried to

the liver in the hepatic portal vein.

The GIT also contributes to nutrient homeostasis, through metabolic reac-

tions that take place in GIT enterocytes, delivering metabolic products such

as lactate to the liver. The GIT also produces a number of hormones that help

in coordinating its activities.

Disorders of the pancreas, such as acute and chronic pancreatitis, are serious

conditions that may be fatal. Disorders of the liver may be caused by drugs,

poisons, viruses, and alcohol or by blockage of the bile duct, as in cholestasis.

Liver disorders may be diagnosed by assaying several enzymes, together with

an X-ray examination and palpation to detect a swollen liver. Jaundice is a fre-

quent complication of liver disease. Disorders of the GIT include gastritis and

ulcers that are associated with infection of Helicobacter pylori, intolerance to

certain nutrients, such as lactose, celiac disease and malabsorption.

Questions

1. Which of the following is associated with the development of peptic
   ulcers?

a) smoking;

b) Helicobacter pylori;

c) weight loss;

d) celiac disease;

e) lactose intolerance.

2. Which one of the following tests is best used to assess pancreatic
   function?

a) fecal fat test;

b) serum bilirubin;