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Gastrointestinal (LECTURE NOTES) > Approach to the patient with luminal disease > Flashcards

Flashcards in Approach to the patient with luminal disease Deck (71):
1

What is dysphagia

Difficulty in swallowing

2

What is odynophagia

Pain on swallowing

3

What is flobus

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

4

What is the first choice investigation for dysphagia

Endoscopy

5

What might be seen in a barium swallow

Irregular stricture - malignant,
smooth stricture - benign

6

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

Oesophageal malignancy

7

What is vomiting

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

8

What is regurgitation

The passive passage of gastric content without abdominal contration

9

What is nausea

The perceptual component of vomiting

10

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

A gastric cause

11

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

Distal intestinal cause

12

If a patient vomits large volumes, what does this suggest

Obstruction or gastric problem

13

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

Functional problem

14

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

A gastric cause is very likely

15

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

The pylorus is patent and gastroparesis is unlikely

16

What are phenothiaxines best for

Neuroological causes and metabolic nausea

17

What are 3 side effects of phenothiazines

Sedation, orthostatic, hypotension

18

What is used for drug induced nausea

5-HT3 antagonist

19

What is an example of a prokinetic agent

Domperidone

20

What are the side effects of prokinetic agents

Gynaecomastia
extrapyramidal effects

21

What is constipation

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

22

What is one of the most common GI complaints

Constipation

23

Constipation is more common in who?

Women and elderly

24

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

Normal transit consitpation
slow transit constipation
disordered defaecation

25

What is the normal transit constipation

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

26

What is slow transit constipation

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

27

What are some other symptoms of slow transit consitpation

Bloating
abdominal pain
infrequent urge to defaecate

28

What is disordered defaecation

Usually due to dysfunction of the pelvic floor or anal sphincters

29

What is constipation with a dilated colon secondary to

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

30

What is constipation with a dilated colon secondary to

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

31

How often would a patient defaecate with slow transit

Every 2 days or less

32

What is suggestive of idiopathic megacolon

faecal impaction and faecal soiling

33

What are 4 alarm symptoms needing urgent imaging

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

34

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

meal frrequency
fibre intake

35

What 5 blood tests would you want in constipation

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

36

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

Colonoscopy
Barium enema
CT colonography

37

What does evacuation proctography detect

Functional abnormalities and structural abnormalities

38

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

False - it is not

39

What is the first treatment for constipatino

Diet - increase fibre and liquid intake

40

Does fibre help to accelerate transit

No - it tends to exacerbate bloating instead

41

What type of laxative is useful in slow transit

Osmotic agents

42

Is surgery useful in constipation

Not usually unless there is an underlying pathology

43

Is surgery useful in constipation

Not usually unless there is an underlying pathology

44

What is diarrhoea defined as

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

45

What is chronic diarrhoea

>4 weeks of symptoms

46

What are the 3 main types of diarrhoea

Osmotic
Secretory
Dysmotility

47

What does osmotic diarrhoea look like

porridgey stool

48

how do symptoms resolve

fasting

49

What are 4 causes of osmotic diarrhoea

Laxative misuse
Lactose intolerance
Bacterial overgrowth
Steatorrhoea cauases

50

What does secretory diarrhoea look like

Watery stool in huge volumes

51

Does secretory diarrhoea settle with fasting

No

52

What are the 2 common causes of secretory diarrhoea

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

53

Describe the stool consistency of dysmotility diarrhoea

It varies day to day

54

What are 3 causes of dysmotility diarrhoea

IBS
Post GI resection
Drugs

55

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

Steatorrhoea

56

What might morning diarrhoea suggest

IBD
IBS
Alcohol misuse

57

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

IBS

58

What investigations should be done for diarrhoea

Stool microscopy
Stool Culture
Blood tests

59

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

Flexible sigmoidoscopy

60

What is suggested for patients with normal stool and blood tests

Colonoscopy and ileoscopy with biopsies

61

What is the main treatment required for patients with diarrhoea

Supportive - fluids and treating pyrexia

62

What drug could be given to help treat the symptoms

Codeine

63

What is anal incontinence

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

64

Incontinence arises when there is disturbance in what 3 things

Anus
Rectum
Co-ordination between anus and rectum

65

What are the 2 forms of anal incontinence

Urge incontinence
Passive incontinence

66

What is urge incontinence

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

67

What is passive incontinence

Due to leaking of stool without perception of any urge

68

What is the general treatment for anal incontinence

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

69

How is BMI calculated

weight in kg / height m^2

70

What is a normal BMI value

20-25

71

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

Angular stomatitis
glossitis
cheilosis
koilonychias