G.I Disease

Question 1

When someone presents with Persistent Diarrhea and weight loss, out with the cancer questions, what other major thing should you ask that may guide diagnosis:

Answer 1

Have they been traveling anywhere

Question 2

Name some drugs that may cause Diarrhea:

Answer 2

Metformin

PPIs

Question 3

If someone has rashes developing in the presence of ongoing diarrhea - especially around the elbows - what may this be?

Answer 3

Dermatitis Herpetiformis

• underlying coeliac disease

Question 4

What other disease is Coeliacs disease associated with?

Answer 4

DM1

Hyperactive thyroid

Autoimmune Hepatitis

Question 5

What marker may be found that indicates ongoing inflammation within the bowel?

Answer 5

Faecal Calprotectin

sensitive but non specific

Question 6

If a patient presents with weight loss, long standing diarrhea and lethargy what investigations are you going to carry out?

Answer 6

it is important not to be only thinking about G.I disorders but also systemic disease such as:

• cancer
• TB
• Lymphadenopathies

Key investigations would be:

Systemic Examination

• lymph nodes
• skin examination

*FBC

• Biochemistry
• including HB1AC
• stool Microbiology
• Faecal Calprotectin
• Immunology - tTG - IgA

Faecal Elastase
- see how well pancreas is doing

Question 7

What investigations would you do in after treating Pancreatitis?

Answer 7

Ultrasound of gallbladder

MRCP
- MRI

ERCP

CT

Amylase
- in pancreatitis will be into the 1000’s

**if the amylase is only in 100’s its likely to be perforation of the duodenum

Question 8

What is a neuroendocrine tumour?

Answer 8

Carcinoid tumour

usually benign ones found at appendix

Question 9

What cell arises from the Cajal cells? and what drug targets it?

Answer 9

Gastrointestinal Stromal Tumour

Imatinib

Question 10

What T cell lymphoma is found in the bowel and what is it associated with?

Answer 10

Enteropathy Associated T cell lymphoma

• celiac disease

Question 11

Give some differentials for Crohn’s disease:

Answer 11

Diverticular disease

Sarcoidosis

Infective colitis

Question 12

If a person has lymphocytic Colitis, what kind of diarrhoea will they have?

Answer 12

Chronic non - bloody watery diarrhoea

Question 13

What disease may Precede Crohn’s?

Answer 13

Collagenous Colitis

Question 14

List some histological findings of Coeliacs disease:

Answer 14

Villi Atrophy

Crypt hyperplasia

Intraepithelial lymphocytes

Question 15

What kind of granulomas does Crohn’s form?

Answer 15

Non necrotising

Question 16

List some common complications of Crohn’s:

Answer 16

Fibrosing Strictures

Fistula

Malabsorption

Toxic megacolon

Question 17

What is a major cause of colon cancer?

Answer 17

Miss match repair defects

Question 18

What system is used assess polyps becoming malignant?

Answer 18

Size
Histology type
Number
Epithelial dysplasia

Question 19

What is it called when the bottom of the esophagus tears?

Answer 19

Mallory Weiss Tears

Question 20

What is the management of peptic ulcer bleed?

Answer 20

Resuscitate

• IV access
• fluids
• Check bloods
• *urea is essential - will tell you situation before Hb

Risk assess

• Rockall - decides who needs endoscopy asap
• Glasgow Blatchford score

Drug therapy

Transfusion

Question 21

In the initial tests of an upper G.I bleed, what things in particularly should one remember?

Answer 21

Urea rises disportionately to creatinine when bleeding

Send blood group off, in preparation for transfusion

*remember place a large cannula during blood taking

Question 22

If a patient is on Aspirin, following an upper G.I bleed should they be stopped?

Answer 22

No - risk of cardiovascular issues is greater

Question 23

If a patient is on NSAIDs, following an upper G.I bleed should they be stopped?

Answer 23

Yes

Question 24

At what stage do you transfuse blood?

Answer 24

Hb <7-8g/L

paradoxically anything above this can cause further side effects.

Question 25

List your management of acute variceal bleeding:

Answer 25

Resuscitation - bloods - transfuse <7g/dL - airway protection Diagnosis - endoscopy Therapy - antibiotics - prophylactic - Terlipressin - Endoscopic ligation / TIPS

Question 26

What cells are present in Oesphageal candida, and where are they located?

Answer 26

Neutrophils - especially near the luminal surface of the epithelium

Question 27

What stain confirms Candida albicans?

Answer 27

PAS stain

Question 28

What are the two types of cancer in the oesophagus and which one is related to what?

Answer 28

Squamous carcinoma - smoking - drinking Adenocarcinoma - GORD

Question 29

What is autoimmune gastritis?

Answer 29

Autoimmune destruction of the parietal cells to autoantibodies. leads to complete loss of parietal cells - achlorhydria

Question 30

There are two patterns of H. Pylori infection seen, what are they and what is thought to lead to these differences?

Answer 30

Antral - predominant gastritis - hypergasatrinaemia Pangastritis - hypochlorhydydria Is thought to be due to IL-8 *higher levels are thought to be associated with Pangastritis

Question 31

Gastric cancer:

Answer 31

Strongly associated with: - H. Pylori - Autoimmune background of Atrophic, mucosa, chronic inflammation and dysplasia. Morphologically classified as: - intestinal - Diffuse

Question 32

Diffuse Gastric:

Answer 32

Individual Malignant cells - signet rings which invade create [Linitis plastica] which makes the stomach leather like. **no association with H. Pylori (unlike intestinal gastric cancer)

Question 33

Where do gastric cancers often metastasis too?

Answer 33

Supraclavicular node - virchow's node Ovaries - Krukenberg Umbilical - sister Joseph's nodule **also associated with acanthosis Nigricans

Question 34

Outline your management of Acute Pancreatitis:

Answer 34

ABC management * fluids * oxygen * analgesics * organ support * potential for antibiotics - usually withheld. Depending on severity - those without organ failure, usually oral feeding is restarted shortly afterwards.

Question 35

Name some complications of pancreatitis:

Answer 35

Pancreatic pseudocysts - which contains the digestive enzymes and nectrotic tissue. - high risk of haemorrhage * pancreatic amylase will remain high. Pancreatic abscess - contains pseudomonas

Question 36

What is the further management for Pancreatitis?

Answer 36

ESRP Cholecystectomy No alcohol - 3 months Medications - certain that need to be discussed with Rheumatology

Question 37

What is the pancreatic enzymes that can be given in replace of endogenous pancreatic enzymes?

Answer 37

Creon