GI history

Question 1

What to ask about the mouth in a GI history?

Answer 1

Ulcer
Chewing/swallowing
Diet
Saliva/dry mouth
appetite
Taste

Question 2

What does metallic taste signal

Answer 2

GORD - bile

Question 3

What to ask about indigestion

Answer 3

come back up - what sick looks like
SOCRATES
Heart burn, after eat

Question 4

Red flags GI

Answer 4

Weight loss unexplained
Change in bowel habit - erratically, especially over 50s
Blood in stool
Unknown cause of Iron deficiency anaemia in older poeple

Question 5

Questions around stomach

Answer 5

Comitting - what looks like, frequency, volume
Pain - SOCRATES
Appetite
Bloating

Question 6

Intestinal questions

Answer 6

Flatulaence
Bloating
Continence
Change bowel habit

Question 7

What is normal bowel habit

Answer 7

Relative but normally 3 x a day to once every 3 days

Question 8

Rectal questions

Answer 8

Blood, mucus, when and where see and volume

Question 9

GI meds to ask about

Answer 9

Laxatives, loperamide, buscapan, mebavarine, peppermint oil

Question 10

Questions to ask about diarrhoea

Answer 10

What do you mean by diarrhoea?Any blood in the stool? Is it mixed in the stool or just on the toilet paper?Any history of foreign travel?Any unexplained weight loss?
Any associated abdominal pain?
Any nocturnal symptoms?
Any fevers?

Question 11

What is a red flag with chronic diarrhoea, but less so in menstruating women?

Answer 11

Iron deficiency anaemia

Question 12

What is an apthlous ulcer? What are they ;linked to?

Answer 12

Mouth ulcer

Question 13

What is an apthlous ulcer? What are they ;linked to?

Answer 13

Mouth ulcer, crohns

Question 14

What is dermatitis herpateformis and what disease is it linked to?

Answer 14

Blisters flled with watery fluid intensely itchy. Made use by eating gluten

Question 15

What is erythema nodosum? What are they linked to?

Answer 15

Painful red marks on shins. IBD

Question 16

What does faecal calprotectin investigate?

Answer 16

If negative rules out IBD, if + doesnt diagnose but could be -> colonoscopy

Question 17

What marker is not raised in coeliac disease?

Answer 17

Faecal calprotectin

Question 18

What to check for in recent antibiotic use and acute diarrhoea

Answer 18

C.difficile

Question 19

Why does recent antibiotic use increase the risk of C.difficile?

Answer 19

Act on GI tract on healthy bacteria, which no longer keep C.difficile in check form multiplying

Question 20

Risk factors for C.difficile

Answer 20

• Antibiotic exposure - any
• > 65
• Hospital or institiutional care
• Prev C.difficle illness
• Multiple existing illnesses
• Institutional exposure to another patinet with C difficile
• Immunocompromised status incl chemotherapy
• Lack of antitoxin antibodies, poor antitoxin response
• Procedures or treatment that modify normal flora of the bowel, esp the colon
• PPIs

Question 21

What antibiotics are at greater risk of causing C.difficile?

Answer 21

Moderate
- Macrolides
- Amoxicillin/claculanic acid/ampicillin
- Tetracycclines
- First generation cephalosporins
- Cotrimaxazole

High
- Clindamycin
- Advanced cephalosporin like
- Carbapenems
- Fluroquinolones

Question 22

C diff positive culture but negative toxin n

Answer 22

C DIFF COLONISATION CONFIRMEDBUT POSSIBLY NOT CAUSINGSYMPTOMS (see previous)