Approach to the patient with luminal disease

Question 1

What is dysphagia

Answer 1

Difficulty in swallowing

Question 2

What is odynophagia

Answer 2

Pain on swallowing

Question 3

What is flobus

Answer 3

a functional syndrome of the sensation of a lump in the throat in the absence of an organic cause

Question 4

What is the first choice investigation for dysphagia

Answer 4

Endoscopy

Question 5

What might be seen in a barium swallow

Answer 5

Irregular stricture - malignant,

smooth stricture - benign

Question 6

If hilar lymphadenopathy is seen on a CXR what might this be

Answer 6

Oesophageal malignancy

Question 7

What is vomiting

Answer 7

Violent expulsion of gastric and intestinal content induced by contraction of the abdominal musculature and diaphragm

Question 8

What is regurgitation

Answer 8

The passive passage of gastric content without abdominal contration

Question 9

What is nausea

Answer 9

The perceptual component of vomiting

Question 10

If dysphagia comes on shortly after meals, what does this suggest

Answer 10

A gastric cause

Question 11

If dysphagia comes on long after meals, what does this suggest

Answer 11

Distal intestinal cause

Question 12

If a patient vomits large volumes, what does this suggest

Answer 12

Obstruction or gastric problem

Question 13

If a patient is vomitting small volumes, what does this suggest

Answer 13

Functional problem

Question 14

If undigested food is present in the vomit, what does this suggest

Answer 14

A gastric cause is very likely

Question 15

If bile is present in the vomit, what does this suggest

Answer 15

The pylorus is patent and gastroparesis is unlikely

Question 16

What are phenothiaxines best for

Answer 16

Neuroological causes and metabolic nausea

Question 17

What are 3 side effects of phenothiazines

Answer 17

Sedation, orthostatic, hypotension

Question 18

What is used for drug induced nausea

Answer 18

5-HT3 antagonist

Question 19

What is an example of a prokinetic agent

Answer 19

Domperidone

Question 20

What are the side effects of prokinetic agents

Answer 20

Gynaecomastia

extrapyramidal effects

Question 21

What is constipation

Answer 21

infrequent stools
passage of hard stools
straining to empty the rectum
sensation of incomplete evacuation

Question 22

What is one of the most common GI complaints

Answer 22

Constipation

Question 23

Constipation is more common in who?

Answer 23

Women and elderly

Question 24

Patients who have a colon of normal diameter with constipation are classified into what 3 groups

Answer 24

Normal transit consitpation
slow transit constipation
disordered defaecation

Question 25

What is the normal transit constipation

Answer 25

the commonest type - characterised by a normal rate of stool movement through thte colon but the patient feels constipated. Usually secondary perceived difficulty with defaecation and hard stools

Question 26

What is slow transit constipation

Answer 26

Most common in young women | characterised by inferequent bowel movements and slow movement of stool through the colon

Question 27

What are some other symptoms of slow transit consitpation

Answer 27

Bloating abdominal pain infrequent urge to defaecate

Question 28

What is disordered defaecation

Answer 28

Usually due to dysfunction of the pelvic floor or anal sphincters

Question 29

What is constipation with a dilated colon secondary to

Answer 29

neuromuscular disorders of the colon hirschsprung's disease idiopathic megacolon chronic intestinal pseudo-obstruction

Question 30

What is constipation with a dilated colon secondary to

Answer 30

neuromuscular disorders of the colon hirschsprung's disease idiopathic megacolon chronic intestinal pseudo-obstruction

Question 31

How often would a patient defaecate with slow transit

Answer 31

Every 2 days or less

Question 32

What is suggestive of idiopathic megacolon

Answer 32

faecal impaction and faecal soiling

Question 33

What are 4 alarm symptoms needing urgent imaging

Answer 33

Rectal bleeding recent onset of symptoms weight loss family history of colon cancer

Question 34

What 2 things are important to ask about in the dietary history

Answer 34

meal frrequency | fibre intake

Question 35

What 5 blood tests would you want in constipation

Answer 35

``` FBC - anaemia U&E - uraemia Thyroid function est Calcium Glucose ```

Question 36

What 3 imaging investigations could be done for a patient with constipation

Answer 36

Colonoscopy Barium enema CT colonography

Question 37

What does evacuation proctography detect

Answer 37

Functional abnormalities and structural abnormalities

Question 38

Plain abdominal Xray is a sensitive diagnostic test of constipation. True or false

Answer 38

False - it is not

Question 39

What is the first treatment for constipatino

Answer 39

Diet - increase fibre and liquid intake

Question 40

Does fibre help to accelerate transit

Answer 40

No - it tends to exacerbate bloating instead

Question 41

What type of laxative is useful in slow transit

Answer 41

Osmotic agents

Question 42

Is surgery useful in constipation

Answer 42

Not usually unless there is an underlying pathology

Question 43

Is surgery useful in constipation

Answer 43

Not usually unless there is an underlying pathology

Question 44

What is diarrhoea defined as

Answer 44

An increase in stool weight above 200g - mostly occurring as a result of an increase in stool water content

Question 45

What is chronic diarrhoea

Answer 45

>4 weeks of symptoms

Question 46

What are the 3 main types of diarrhoea

Answer 46

Osmotic Secretory Dysmotility

Question 47

What does osmotic diarrhoea look like

Answer 47

porridgey stool

Question 48

how do symptoms resolve

Answer 48

fasting

Question 49

What are 4 causes of osmotic diarrhoea

Answer 49

Laxative misuse Lactose intolerance Bacterial overgrowth Steatorrhoea cauases

Question 50

What does secretory diarrhoea look like

Answer 50

Watery stool in huge volumes

Question 51

Does secretory diarrhoea settle with fasting

Answer 51

No

Question 52

What are the 2 common causes of secretory diarrhoea

Answer 52

Toxins (E. Coli, Clostridium, V choler) | Tumour

Question 53

Describe the stool consistency of dysmotility diarrhoea

Answer 53

It varies day to day

Question 54

What are 3 causes of dysmotility diarrhoea

Answer 54

IBS Post GI resection Drugs

Question 55

What do pale, fatty stools that are hard to flush away suggest

Answer 55

Steatorrhoea

Question 56

What might morning diarrhoea suggest

Answer 56

IBD IBS Alcohol misuse

Question 57

If the patient has night -time diarrhoea what diagnosis can e excluded

Answer 57

IBS

Question 58

What investigations should be done for diarrhoea

Answer 58

Stool microscopy Stool Culture Blood tests

Question 59

What investigation should be done if the patient has diarrhoea associated with fresh rectal bleeding

Answer 59

Flexible sigmoidoscopy

Question 60

What is suggested for patients with normal stool and blood tests

Answer 60

Colonoscopy and ileoscopy with biopsies

Question 61

What is the main treatment required for patients with diarrhoea

Answer 61

Supportive - fluids and treating pyrexia

Question 62

What drug could be given to help treat the symptoms

Answer 62

Codeine

Question 63

What is anal incontinence

Answer 63

The involuntary passage of rectal content and it is a cource of major embarrassment to the sufferrer

Question 64

Incontinence arises when there is disturbance in what 3 things

Answer 64

Anus Rectum Co-ordination between anus and rectum

Question 65

What are the 2 forms of anal incontinence

Answer 65

Urge incontinence | Passive incontinence

Question 66

What is urge incontinence

Answer 66

when there is marked urgency to void the bowel with incontinence occurring before the patient can get tot eh toilet

Question 67

What is passive incontinence

Answer 67

Due to leaking of stool without perception of any urge

Question 68

What is the general treatment for anal incontinence

Answer 68

To optimise the stool consistency - antidiarrhoeals Dietary advice - ration fibre and avoid caffeine and alcohol Review medications Anal sphincter exercises

Question 69

How is BMI calculated

Answer 69

weight in kg / height m^2

Question 70

What is a normal BMI value

Answer 70

20-25

Question 71

What are 4 findings in a general examination for iron-deficiency anaemia

Answer 71

Angular stomatitis glossitis cheilosis koilonychias