Gastro Intestinal Disease

Question 1

What is the function of the GIT?

Answer 1

Turns food into energy
Waste removal
Intake of water - hydration

Question 2

Symptoms that arise from the GIT?

Answer 2

Vomiting
Weight loss
Jaundice
Melaena (blood in stools)
Hematemesis (vomiting blood)
Abdominal pain
Diarrhoea

Question 3

What is dysphagia?

Answer 3

Difficulty swallowing

Question 4

When taking a GI history, what questions should you ask?

Answer 4

Duration
Solids or liquids
Pain
Weight loss
Previous med history
Medications
Cigarettes and alcohol

Question 5

What may dysphagia due to?

Answer 5

Oropharyngeal problem
Oesophageal problemG
Gastric problem

Question 6

Oropharyngeal problems?

Answer 6

Salivary gland
-Sjogrens syndrome

Tongue
- amyloid, hypothyroidism, motor neurone disease

Palatal/epiglottal/upper oesophageal disorder:
- Cerebrovascular disease, MND, Parkinson’s disease

Question 7

Oesophageal problems?

Answer 7

Benign mucosal disease
- Benign peptic stricture, oesophageal web, candidal oesophagitis

Malignant mucosal disease
- Carcinoma

Motility disorders
- Oesophageal spasm, achalasia, oesophageal pouch

Question 8

What is a pharyngeal pouch?

Answer 8

Defect between the constrictor and the transverse cricopharyngeus muscle

Question 9

Gastric problems?

Answer 9

Carcinoma

Outlet obstruction - peptic ulceration

Question 10

How to manage dysphagia?

Answer 10

Treat underlying cause

If nutritionally deplete - supplementation - oral supplements, NG, PEG feeding

Question 11

How does gastro-oesophageal reflux disease (GORD) cause upper abdominal discomfort?

Answer 11

Gastro-oesophageal reflux disease (GORD)

• Heartburn, acid reflux, nausea, vomiting, caries, asthma
• Excessive relaxation of lower oesophageal sphincter and raised intra-abdominal pressure

Question 12

How to manage gastro-oesophageal reflux disease?

Answer 12

PPI (omeprazole)
H2 antagonists
Lifestyle - weight loss, smoking, reduce alcohol
Surgery - fundoplication

Question 13

Peptic ulceration symptoms?

Answer 13

Epigastric pain - sometimes radiating into back - worsened by food = weight loss (gastric ulcer) or improved by eating (duodenal ulcer)
Vomiting/hamatemesis
May be complicated by bleeding or perforation

Question 14

What causes peptic ulceration?

Answer 14

Helicobacter pylori or non-steroidal anti-inflammatory drugs

Question 15

Symptoms of gastric carcinoma? (upper abdominal pain)

Answer 15

Epigastric pain, weight loss, vomiting

Must be suspected in anyone over 50yrs with new onset symptoms

Question 16

How to manage a gastric carcinoma? Treatment?

Answer 16

OGD to investigate

Treatment - surgery - gastrectomy

Question 17

What else could cause upper abdominal pain/discomfort?

Answer 17

Non-ulcer dyspepsia

• Upper abdominal discomfort, nausea, bloating
• Motility disturbance

Pancreatic carcinoma
- unremitting pain, often radiating to back, weight loss, jaundice

Pancreatitis

• Acute inflam of pancrease = severe pain, vomiting
• Chronic relapsing pain
• Commonest cause alcohol, the gallstones, then pancreatic trauma, drugs, lipidaemia

Question 18

Acute abdominal pain causes?

Answer 18

Upper left - Acute cholecystitis
Upper middle: myocardial infarction, acute cholecystitis
Upper right = ruptured spleen, gastric ulcer

Lower left: appendicitis, ruptured ectopic pregnancy

Lower right: Sigmoid diverticulitis , Acute pancreatitis, Intestinal obstruction

Question 19

How to manage acute abdominal pain?

Answer 19

Surgical referral
Usually kept NBM
IV antibiotics
Imaging - CT scan /USS (universal spine system)

Question 20

When does acute abdominal pain become chronic? Features and management of chronic abdominal pain?

Answer 20

If more than 6 weeks
Organic vs inorganic
Investigate
Management - analgesics, surgery

Question 21

What causes vomiting?

Answer 21

Systemic illness (bac, viral, diabetic ketoacidosis)
Drugs, alcohol
Centrally mediated
- Middle ear disease, cerebellar disease, brain stem disease
- Raised intracranial pressure (tumour, haemorrhage)
Psychiatric disorders (bulimia)
Oesophageal disease
Gastric disease
Small bowel disease
Colonic disease

Question 22

How to manage vomiting?

Answer 22

Identify underlying cause
Antiemetics
PPI
Cognitive behavioural therapy

Question 23

What causes acute diarrhoea?

Answer 23

Infection (gastroenteritis: bacterial or viral)
Drugs - antibiotics, alcohol
Food allergy/intolerance

Question 24

What causes chronic diarrhoea?

Answer 24

Small bowel disease

• lactose deficiency
• coeliac disease
• crohns disease

Pancreatic disease

• pancreatic insufficiency
• pancreatic carcinoma
• cystic fibrosis

Colonic disease

• ulcerative colitis
• crohns
• carcinoma

Question 25

Define coeliac disease

Answer 25

Abnormal proximal small intestinal mucosa that improves morphologically on a gluten free diet and relapses when gluten is introduced

Question 26

How does the coeliac duodenal mucosa differ from the normal mucosa?

Answer 26

Increased inflam cells (lymphocytes), crypt hyperplasia and villous atrophy

Question 27

Background of coeliac disease?

Answer 27

1 in 100 40-60yrs old Normal weight or overweight 9x more adult presentations than child

Question 28

Symptoms of diarrhoea: small bowel/pancreatic derived and colonic derived?

Answer 28

Small bowel/pancreatic: Pale, floating, difficult to flush Throughout day Pain variable timing Pain not relieved by defaecation Colonic: Blood and mucus Often in morning Pain related to defaecation Pain relieved by defaecation

Question 29

What is Crohn's disease?

Answer 29

Chronic inflam disease affecting any part of the gastrointestinal tract, from mouth to perineum May be discontinuous

Question 30

What is ulcerative colitis?

Answer 30

Chronic inflam disease invariably affecting the rectum and extending more proximally to involve all or part of the colon

Question 31

How does coeliac disease present?

Answer 31

``` GI Iron def anaemia Neuro dysfunction Fatigue Vit B12 def Osteoporosis ```

Question 32

Symptoms of crohn's?

Answer 32

``` Pain Diarrhoea Weight loss Anorexia Fever Vomiting Lassitude Nausea Acute abdomen Nutritional disturbance ```

Question 33

Symptoms of ulcerative colitis?

Answer 33

Diarrhoea Rectal bleeding Pain Weight loss

Question 34

Associated diseases?

Answer 34

Skin - erythema nodosum, pyoderma gangrenosum Mouth - ulcers. Crohn’s: lips, buccal mucosa Joints - arthritis, ankylosing spondylitis Eyes - episcleritis, uveitis Vascular - thromboses Liver - cirrhosis, CAH, pericholangitis. U.C: primary sclerosing cholangitis

Question 35

Colon cancer prevalence?

Answer 35

35,000 a yr diagnosed in UK

Question 36

Symptoms of colon cancer?

Answer 36

None Rectal bleeding Altered bowel habit Lethargy/weight loss

Question 37

How to investigate and manage colon cancer?

Answer 37

Colonoscopy CT Manage: - Evaluate extent of disease - If limited disease to colon - surgical resection possible - If not - chemo/radiotherapy

Question 38

Jaundice - post hepatic causes?

Answer 38

Gallstones (choledocholithiasis): - Biliary colic, fever, fluctuating jaundice Malignancy (pancreatic carcinoma, cholangiocarcinoma) - Constant pain radiating to back - Weight loss Benign biliary stricture (post operative, sclerosing cholangitis) - cholangitis (fever and pain) (summary - gallstones, external compression - pancreatitis, lymphadenopathy, pancreatic tumour)

Question 39

Jaundice - hepatic causes?

Answer 39

Infection (hepatitis A,B,C, EBV) - Malaise, lethargy, anorexia, distaste for cigarettes, jaundice, pale stools, dark urine, right upper quadrant discomfort Alcoholic hepatitis - above, plus history of excess alcohol Drugs - augmentin, flucloxacillin, many others Decompensated chronic liver disease (alcoholic cirrhosis, haemachromatosis, PBC, CAH, Chronic hepatitis B or C, Wilson’s disease) - jaundice, ascites, varices, hepatic encephalopathy (Summary - cirrhosis, infil of liver by tumours, acute hepatitis)

Question 40

Jaundice: pre hepatic causes?

Answer 40

``` Haemolytic anaemia (hereditary spherocytosis, G6PD deficiency, sickle cell disease) - anaemia, jaundice, gallstones, splenomegaly, leg ulcers ``` (summary - haemolysis)

Question 41

Signs of chronic liver disease?

Answer 41

Nail clubbing Spider blood vessels on skin Fluid within abdominal cavity (spider naevi, palmer erythema, enlarged breasts in men, white nails from low albumin, clubbing, jaundice, ascites)

Question 42

What is the function of the liver?

Answer 42

Synthetic - Clotting factors - prothrombin time (INR) - Proteins - albumin - Bile Metabolic (detoxification of blood) - Excretion of nitrogenous compounds - NH3 - Excretion of some drugs/metabolites Immune funcs Energy storage (Fat and glycogen) Fat and CHO metabolism

Question 43

What are the types of hiatus hernias?

Answer 43

Sliding = adjoining section of oesophagus and stomach breach the diaphragm wall Paraoesophageal = fundus of stomach is breached by diaphragm wall. No tx - prevention (e.g. do not lie down immediately after food)