Gastrointestinal

Question 1

what can cause GORD

Answer 1

poor lower oesophageal sphincter
increased pressure in stomach with reduced clearing
hiatus hernia

Question 2

what might be complication of GORD

Answer 2

barrett’s oesophagus - metaplasia of the epithelial lining of stomach, to withstand acid, pre-neoplastic

Question 3

what medications may patients with GORD be on

Answer 3

proton pump inhibitors - prevent production of acid by pp in parietal cells - omeprazole
antacid - convert acid to salt - rennies
H2 receptor agonist - rinitidine

Question 4

what are the different types of mouth ulcers

Answer 4

minor aphthae, major aphthae or herpetiform aphthae

Question 5

what is orofacial granulomatos

Answer 5

when macrophages engulf cells but cannot break them down, forms giant multi-nucleated cells. these then block the lymphatic ducts and prevent drainage. granuloma production with giant cells and fluid

Question 6

what is a hiatus hernia

Answer 6

when part of the stomach herniates - either into oesophagus (sliding) or as a separate thing (rolling). severe GORD can be seen in sliding as every time the diaphragm contracts, the stomach and acid goes into the oesophagus

Question 7

what is peptic ulcer disease

Answer 7

ulceration of lining caused by perforation by stomach acid

Question 8

what causes peptic ulcer disease

Answer 8

over production of acid - acid into small intestine where the lining cannot withstand
normal production but not normal mucous production, so the stomach lining is not protected
helicobacter pylori - bacteria that causes inflammation of lining at pylorus at stomach. chronic inflammation can result in lymphoma

Question 9

what complications can occur with peptic ulcers

Answer 9

can perforate through lining, right through to muscle and eventually cause a complete perforation into peritoneum, may get haemorrage or peritonitis.

Question 10

what are signs and symptoms of peptic ulcer disease

Answer 10

normally none until it has perforated through

Question 11

what investigations can be done into peptic ulcer disease

Answer 11

endoscopy, blood test for anaemia if bleeding, can check for antibodies to h pylori

Question 12

how can peptic ulcer disease be treated

Answer 12

if reversible - medication such as PPI, antacid but if perforated may need surgery

Question 13

what are possible causes for inflammatory bowel disease

Answer 13

psychological - stress and anxiety
immune system - over reaction to non threatening things
genetic

Question 14

what are the differences between crohns disease and ulcerative colitis

Answer 14

crohns disease - can affect anywhere in tract, discontinuous, transmural (the whole way through), granulo formation cobble stone appearance, non vascular
UC - vascular appearance, mucosal ulcers, serosa not involved, continuous disease

Question 15

what investigations can be done for IBD

Answer 15

faeces - calprotectin suggest inflammation
for a child - measuring their growth, make sure it isnt halted by malnutrition. blood test for anaemia markers, barium studies and endoscopy

Question 16

what treatment is available for IBD

Answer 16

steroids if an immune reaction but not good long term
anti-tnf - directly attack, can get surgery to remove part for bowel but may result in stoma bag which has social implications

Question 17

if a patient is presenting with recurrent oral ulcers what might you suspect

Answer 17

anaemia - may be due to malabsorption and inflammatory bowel disease

Question 18

what can malabsorption result in

Answer 18

weight loss, diarrhoea, sterrohea, pernicious anaemia

Question 19

what is the aetiology of coeliac disease

Answer 19

sensitivity to alpha gliaden which is in gluten. causes immune system to produce cytokines and attack villi, resulting in villous atrophy and an inability for absorption

Question 20

what investigations can be done for coeliac disease

Answer 20

blood test for haemantics, endoscopy with biopsy, can be done before and after period with no gluten to check for improvement, faeces to check for fat in stool

Question 21

describe the screening tool used for colon cancer

Answer 21

every person over the age of 50 sends a faecal sample in the post, its then check for blood, if none detected, nothing for the next 5 years. polyps cause bleeding and can turn neoplastic within 5 years

Question 22

what is a polyp

Answer 22

a growth on the mucosal lining, as food passes through, it is irritated and can cause the mucosa to bleed, if left, likely to turn into malignant cancer, but can be removed easily

Question 23

what can increase the likelihood of polyps

Answer 23

ulcerative colitis, smoking, low fibre high fat diet,

Question 24

what is jaundice

Answer 24

excess unconjugated billirubin deposited on skin

Question 25

what is billirubin

Answer 25

product of breakdown of RBC, especially haem group

Question 26

how are RBC broken down

Answer 26

broken down by bone marrow to produce unconjugated billirubin. this then goes to liver where it can be conjugated for excretion from kidneys or git

Question 27

what are the 3 ways jaundice can occur and give examples of when this would happen

Answer 27

pre-hepatic - build up of rbc breakdown, too many RBC, mismatch blood transfusion or maternal blood in fetus hepatic - problem with hepatocytes conjugating bilirubin, cirrhosis post-hepatic - blockage in bile duct, preventing bilirubin being cleared, backs up into vein - gall stones

Question 28

how can the colour of urine or faeces tell what type of jaundice it is

Answer 28

if urine is normal colour - conjugated bilirubin into blood to get to kidney - pre or post but not hepatic if faeces is normal colour - conjugated bilirubin into GIT, cannot be hepatic or post, must be pre

Question 29

how can jaundice be treated

Answer 29

light therapy in neonate, but not much can do other than let it pass. ursodeoxycholic acid can be used to prevent build up of bile acid in post

Question 30

what is acute cholecysitis

Answer 30

inflammation of bile ducts due to blockage from a gall stone

Question 31

how can bile ducts be investigated

Answer 31

ultrasound to check dilation endoscopy retrograde cholangiopancreatography, done through to small intestine then up through bile duct to check for blockage - can put in stent while there to open up but if cancer - need more treatment

Question 32

how can gall stones be treated

Answer 32

lithotripsy - breaking up with sound waves then vaccuming up or removal of gall bladder

Question 33

what are the types of liver failure

Answer 33

acute - sudden damage to liver with alcohol or drugs chronic - constant damage to liver, as it tries to repair, lays down fibrotic tissue, any hepatocytes produced, dont link to bile ducts

Question 34

what causes cirrhosis

Answer 34

alcohol, drugs, primary biliary sclerosis, infection

Question 35

what are the functions of liver

Answer 35

metabolic - metabolise drugs, toxins, RBC | synthetic - synthesis clotting factors and plasma proteins

Question 36

what are some signs and symptoms of liver failure

Answer 36

ascites - build up of pulmonary pressure in abdomen due to reduced drainage in liver, also not producing plasma proteins so lower oncotic pressure, results in oedema in abdomen oesophageal varices - pressure through to oesophagus, cause dilation can rupture

Question 37

what tests can be done to check liver function

Answer 37

should be doing what it is - INR check production of clotting factors

Question 38

who are more at risk of C diff infections

Answer 38

those on antibiotics - clears good bacteria, these normally protect and prevent others from colonising those immunosuppressed

Question 39

how is norovirus transmitted

Answer 39

oro-faecal route

Question 40

what are symptoms of norovirus

Answer 40

fever, abdominal pain, diarrhoea, vomitting

Question 41

how is norovirus treated

Answer 41

electrolyte and water rebalance, can be done at home

Question 42

describe c diff bacteria

Answer 42

anaerobic gram positive bacilli producing spores that are resillient in the environment - can last up to 5 months

Question 43

how does c diff spread

Answer 43

healthcare workers - faecal to oral, contaminating surfaces

Question 44

what are symptoms of c diff

Answer 44

fever, nausea, loose stool

Question 45

what are treatments of c diff

Answer 45

antibiotics, probiotics, faecal transplant, rehydration