Gastro intestinal disease/medicine

Question 1

functions of GI tract

Answer 1

1) turns food into energy
2) waste removal
3) intake of water – hydration

Question 2

key symptoms associated with GI disfunction

Answer 2

vomiting
haematemesis
weiht loss
jaundice
melaena
diarrhoea
abdominal pain

Question 3

dysphagia

Answer 3

difficulty in swallowing

Question 4

dysphagia problem types

Answer 4

oropharyngeal
oesophageal
gastric

Question 5

history of dysphagia

Answer 5

duration
solids or liquids
pain
weight loss
previous MH
medications
SH

Question 6

oropharyngeal dysphagia

Answer 6

difficulty initiating swallowing
difficulty with choking, nasal regurgitation
drooling, hardness etc

after initiation of swallowing at pharynx and upper oesophageal spincter

Question 7

what can cause oesophageal dysphagia

Answer 7

benign musocsal disease
(reflux may be benign peptic structure)
or maligant
or
motility disorder (oesophageal spasm , achalasia, oesophageal pouch)

Question 8

gastric dysphagia

Answer 8

carcinoma
outlet obstruction
peptic ulceration

Question 9

pharyngeal pouches

Answer 9

defect between constrictor and transverse cricopharyges muscle
- due to incoordiantion of swallowing in pharynx, leads to herniation through cricopharyngeal muscle leading to formation of pouch

Question 10

diagnosis oh pharyngeal poiches

Answer 10

barium swallow

Question 11

management of dysphagia

Answer 11

treat underling cause

if nutritionally deplete may need supplementation

Question 12

what leads to upper abdominal discomfort and cause

Answer 12

gastro oesophageal reflux disease

• excessive relaxation of lower oesophageal sphincter and raised intra abdominal pressure

Question 13

symptoms of gastro oesophageal reflux discomfort

Answer 13

• heartburn
• epigastric pain
• acid reflux
• waterbrash
• nausea
• vomiting
• tooth decay
• asthma

Question 14

management of pts with reflux

Answer 14

lifestyle advice (avoid late meals, sleep upright, weight loss, smoking cessation, reduction in alcohol
surgery
H2 agonist (release symptoms)
PPI

Question 15

PPI examples

Answer 15

proton pump inhibitors
omeprazole
lansoprazole

Question 16

hiatus hernia

Answer 16

pressure lost between the abdonomal and thoracic cavities

leads to reflux

Question 17

types of hiatus hernia

Answer 17

prestage
sliding hiatal hernia
paraoesophageal

Question 18

sliding hiatial hernia

Answer 18

• gastrooesophageal junction and the abdominal part of the oesophagus and cardia of stomach move upwards through diaphragmatic hiatus into the thorax

Question 19

paraoesophageal hiatal hernia

Answer 19

• upward movement of gastric fundus, normal positioned junction (gastric oesophageal)
  i. e. not all of it moves up, pouch forms above where It should be

Question 20

diagnosis of peptic ulcers + treamtnet

Answer 20

1) test for H pylori and then treat
2) treat patients with active suppression therapy
3) endoscopic therapy if bleeding
4) surgical intervention

Question 21

types of ulcers and distinguishing

Answer 21

gastric- associated with weight loss, worsened by food
haemataesis
duodenal - improve with eating, vomiting

Question 22

what can ulcers be due to

Answer 22

helicobacter pylori

non steroidal anti inflammatory drug s

Question 23

what can upper abdominal discomfort be due to

Answer 23

gastric carcinoma
ulcer
non ulcer dyspepsia
pacreatic carcinoma
pancreatitis

Question 24

gastric carcinoma history, management and treatment

Answer 24

• epigastric pain, weight loss, vomiting
• OGD to investigate
• take biopsies from any areas
• imaging to stage and assess
  Treatment
• surgery if possible (gastrectomy)
• chemotherapy
• pallative care

Question 25

pancreatic caricnoma

Answer 25

unremitting pain radiates to back associated with weight loss smoking may cause jaundice

Question 26

pancreatitis and treatment

Answer 26

- acute inflammation of pancreas causing severe pain, vomiting - chronic relapsing pain (chronic pancreatitis) long term opioids

Question 27

management of acute lower abdominal pain

Answer 27

1) surgical referral 2) usually kept NBM - pts may need surgical intervention 3) IV antibiotics 4) Imaging – USS and CT scan - assess cause of acute pain

Question 28

what can acute lower abdominal pain be due to

Answer 28

- inflammation (pain develops gradually, diffuse until becoming localised eg acute appendicitis) - perforation (starts abruptly, severe and can lead to generalised peritonitis) - obstruction (colicy? pain)

Question 29

chronic lower abdominal pain

Answer 29

more than 6 weeks investigate like acute management analgesics/sugery

Question 30

vomiting causes

Answer 30

``` systemic illness drug/alcohol centrala mediated psychiatric disorders gastric disease small bowel disease colonic diease ```

Question 31

definition of diarrhoea

Answer 31

3 or more loose stools per day/change to normal bowel habit

Question 32

acute causes of diarhoea

Answer 32

1) infection - gastroenteritis: bacterial/viral - eg campylobacter, salmonella, E coli - should not last more than 10 days 2) drugs - antibiotics - alcohol 3) food allergy/intolerance

Question 33

chronic causes of diarrhoea

Answer 33

``` • Small bowel disease – lactase deficiency – Coeliac disease – Crohn‘s disease • Pancreatic disease – pancreatic insufficiency – pancreatic carcinoma – cystic fibrosis • Colonic disease – ulcerative colitis – Crohn’s disease – carcinoma ```

Question 34

coeliac disease

Answer 34

hyperplasia increased lymphocytes management blood test serology tests to look for ab (when on normal gluten diet)

Question 35

dermatitis herpetiformis

Answer 35

ulcers on the body | features when being a coeliac

Question 36

types of diarrhoea and symptoms associated

Answer 36

``` Small bowel/pancreatic - pain, floating, difficult to flush - throughout day - pain variable timing - pain not relieved by defecation Colonic - blood and mucus - often in the morning - pain related to defecation and relieved on defecation ```

Question 37

inflammatory bowle diseases

Answer 37

crohns disease | ulcerative colitits

Question 38

crohns disease

Answer 38

chronic inflammatory disease affects any part of GI tract from mouth to perineum discontinuous

Question 39

ulcerative colitis

Answer 39

chronic inflammatory disease invariably affecting the rectum and extending proximal to involve all or part of the colon continuous inflammation

Question 40

ulcerative colitis symptoms

Answer 40

diarrhoea rectal bleeding pain weight loss

Question 41

crohns disease symptoms

Answer 41

``` pain diarrhoea weight loss fever vomiting nausea ```

Question 42

associated diseases of inflammatory diseases

Answer 42

* 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 43

colon cancer symptoms

Answer 43

- none (bowel cancer screening) - rectal bleeding - altered bowel habits - lethargy/weight loss

Question 44

risk factors for cancer seen in the Bowles (colon cancer)

Answer 44

polyps

Question 45

investigation and management of colon cancer

Answer 45

``` Investigations - colonoscopy - barium enema - CT Management - evaluate extent of disease - if limited to colon – surgical resection possible - if not – chemo/radiotherapy - Pala ```

Question 46

haemorrhoids

Answer 46

rectal bleeding bright red history of constipation lasts few days /weeks

Question 47

what is jaundice due to

Answer 47

high bilirubin levels

Question 48

post hepatic causes of jaundice

Answer 48

gall stones malignancy benign biliary structure

Question 49

hepatic causes of jaundice

Answer 49

infection alcohol hepatitis drugs decompensaties chronic liver disease

Question 50

pre hepatic causes of jaundice

Answer 50

isolated higher bilirubin level | haemolytic anaemia,

Question 51

chronic liver disease signs

Answer 51

``` clubbing palmar ertyhema spider naevei asicties tanned appearance ```