6. Gastroenterology: a symptoms based approach

Question 1

What should be asked about abdominal pain when taking a history?

Answer 1

Quality
Location
Radiation
Timing
Connection with eating
What aggravates and relieves
Associated symptoms

Question 2

Define diarrhoea

Answer 2

Increased frequency (>3) and liquidity of faeces
>250g of stool a day

Question 3

What is the difference between acute, persistent and chronic diarrhoea?

Answer 3

Acute <7 days
Persistent 14-21
Chronic >1 month

Question 4

What are the characteristics of small bowel diarrhoea?

Answer 4

Watery
Large volume
Cramping, bloating
Gas
Weight loss

Question 5

What are the characteristics of large bowel diarrhoea?

Answer 5

Frequent
Small volume
Blood and mucous
Fever

Question 6

What are the parameters for severe diarrhoea?

Answer 6

>6 in 24 hours
Blood
Fever
Dehydration
Severe abdominal pain

Question 7

What is tenesmus?

Answer 7

feeling that the bowel is full even after a bowel movement

Question 8

What effects can chemo and radiotherapy have on the GIT?

Answer 8

Colitis and enteritis

Question 9

What is fever associated with?

Answer 9

infection

inflammatory

Question 10

What is weight loss associated with?

Answer 10

Malignancy
Coeliac disease
Crohn’s disease
Pancreatic insufficiency

Question 11

What symptoms are associated with IBD?

Answer 11

Uveitis
Joint pains
Mouth ulcers
Erythema nodosum

Question 12

What effects does smoking have on the GIT?

Answer 12

Worsens Crohn’s, malignancy

Protective to ulcerative colitis

Question 13

What effect does alcohol have on the GIT?

Answer 13

Chronic pancreatitis

Pancreatic insufficiency

Question 14

What are NSAIDs associated with?

Answer 14

Colitis

Question 15

What are proton pumps associated with?

Answer 15

c. diff

Question 16

What should be looked for on examination if a patient presents with diarrhoea?

Answer 16

Dehydration and malnourishment
Mouth ulcers
Rashes
Hepatomegaly, arthritis, anorectal disease

Question 17

Define constipation

Answer 17

<3 bowel movements per week

Question 18

What are the causes of constipation?

Answer 18

Lack of fibre, dehydration or exercise
Medications
Life or routine changes
Psychological
Neurological and metabolic
Diverticulosis, coeliac disease, GI tumours, IBS
Hypothyroidism, hypercalcaemia

Question 19

What complications are associated with constipation?

Answer 19

Haemorrhoids
Anal fissures
Rectal prolapse
Fecal impaction

Question 20

What treatments can be used for constipation?

Answer 20

Bulk forming agents
Osmotic laxatives
Stimulant/irritant laxatives
Stool softeners
Cholinergic agonists

Question 21

What is odynophagia?

Answer 21

Painful swallowing

Question 22

What is globus sensation?

Answer 22

Throat tightness

Question 23

What are the mechanical causes of dysphagaia?

Answer 23

Oesophageal cancer
Peptic stricture
Achalasia
Oesophagitis

Question 24

What are the neuromuscular causes of dysphagia?

Answer 24

Diffuse oesophageal spasm

CNS causes

Question 25

Causes of clubbing

Answer 25

IBD Cirrhosis Coeliac disease

Question 26

What causes leuconychia?

Answer 26

Hypoalbuminaemia

Question 27

What causes koilonychia?

Answer 27

Iron deficiency anaemia

Question 28

What causes palmar erythema?

Answer 28

Cirrhosis

Question 29

What causes palmar crease pallor and conjunctival pallor?

Answer 29

Anaemia

Question 30

What causes Dupytren's contracture?

Answer 30

Excess alcohol

Question 31

What causes hepatic flap?

Answer 31

Hepatic encephalopathy | Uraemia

Question 32

What causes scleral icterus?

Answer 32

Liver disease

Question 33

What causes xanthelasma?

Answer 33

Hyperlipidaemia

Question 34

What causes angular stomatitis and tongue glossitis?

Answer 34

Iron/B12 deficiency | Glossitis also folate deficiency

Question 35

What diseases are associated with mouth ulcers?

Answer 35

Crohn's | Coeliac disease

Question 36

What is candidiasis a sign of?

Answer 36

Immunodeficiency

Question 37

What are spider naevi and gynaecomastia a sign of?

Answer 37

Chronic liver disease

Question 38

What are the infective causes of hepatomegaly?

Answer 38

Hepatitis EBV Malaria Hepatic abscess

Question 39

What are the infiltrative causes of hepatomegaly?

Answer 39

``` Haemochromatosis Wilson's Sarcoid Amyloid Fatty liver ```

Question 40

What are the blood related causes of hepatomegaly?

Answer 40

Lymphoma Leukaemia Myeloproliferative disorders Haemolytic anaemia

Question 41

What are the congestive causes of hepatomegaly?

Answer 41

Right heart failure Tricuspid regurgitation Budd Chiari syndrome

Question 42

What are the causes of splenomegaly?

Answer 42

Malaria CML Myelofibrosis Feltys syndrome

Question 43

What is Feltys syndrome?

Answer 43

RA Neutropaenia Splenomegaly