GI Tract Conditions

Question 1

What is the pathology of achalasia?

Answer 1

Lack of oesophageal peristalsis

Question 2

What are the symptoms of achalasia?

Answer 2

Dysphagia
Nausea/vomiting
Weight loss

Question 3

What investigations would be done if achalasia was suspected?

Answer 3

Barium swallow

Endoscopy

Question 4

How is achalasia treated?

Answer 4

Endoscopic balloon dilatation

Surgery

Question 5

What is the pathology of GORD?

Answer 5

Decreased LOS tone

Question 6

What are the secondary causes of GORD?

Answer 6

Smoking
Pregnancy
Drugs
Alcohol
Obesity

Question 7

What are the symptoms of GORD?

Answer 7

Dyspepsia
Heartburn
Acid regurgitation
Epigastric pain

Question 8

How is GORD investigated?

Answer 8

Endoscopy if dysphagia/ALARM symptoms

24hrs oesophageal pH monitoring

Question 9

How is GORD treated?

Answer 9

Weight loss
Avoid smoking and alcohol
Antacids
PPI - omeprazole
Surgery - nissan's fundoplication

Question 10

What is barrett’s oesophagus?

Answer 10

When the normal lower squamous epithelium of the oesophagus becomes columnar
Pre-malignant

Question 11

What causes barrett’s oesophagus

Answer 11

Chronic GORD

Question 12

How is barrett’s oesophagus investigated?

Answer 12

Endoscopy and biopsy

Question 13

How is barrett’s oesophagus treated?

Answer 13

Endoscopic ablation

Question 14

What are the complications of barrett’s oesophagus?

Answer 14

Oesophageal adenocarcinoma

Question 15

What are the risk factors for oesophageal cancer?

Answer 15

Obesity
Smoking
Barrett's oesophagus
GORD
Excessive alcohol

Question 16

What is the pathology of oesophageal cancer?

Answer 16

Middle 1/3 - squamous

Lower 1/3 - adenocarcinoma

Question 17

What are the symptoms of oesophageal cancer?

Answer 17

Progressive dysphagia

Weight loss

Question 18

How is oesophageal cancer investigated?

Answer 18

Endoscopy and biopsy
Barium swallow
CT

Question 19

How is oesophageal cancer treated?

Answer 19

Oesophagectomy

If non-op - chemo, radiotherapy, palliative

Question 20

What are the causes of peptic ulcers?

Answer 20

Helicobacter pylori - 85%
NSAIDs
Smoking
Alcohol

Question 21

What are the symptoms of peptic ulcers?

Answer 21

Epigastric pain
Heartburn
Nausea/vomiting
If the pain gets better after a meal - duodenal ulcer

Question 22

How are peptic ulcers investigated?

Answer 22

<55 and no alarm symptoms - urea breath test

>55/alarm - endoscopy

Question 23

How are gastric ulcers treated?

Answer 23

H.pylori - triple eradication (PPI, amoxicillin, clarithromycin)
PPI
Avoid worsening factors
Gastric ulcers need repeat endoscopy to ensure healing

Question 24

What are complications of gastric ulcers?

Answer 24

Gi bleed

Perforation

Question 25

What is the pathology of coeliac disease?

Answer 25

Gluten sensitivity T cells respond to gluten Results in villous atrophy and malabsorption

Question 26

What are the symptoms of coeliac disease?

Answer 26

``` Diarrhoea Abdominal pain Bloating Lethargy Anaemia ```

Question 27

What investigations would be done if coeliac disease was suspected?

Answer 27

FBC - anaemia Coeliac serology - anti-tissue transglutaminase, anti-endomysial antibodies, IgA Endoscopy Intestinal biopsy

Question 28

How is coeliac disease treated?

Answer 28

Gluten free diet

Question 29

What are the associations with coeliac disease?

Answer 29

Other autoimmune diseases - type 1 DM, thyroid disease

Question 30

What are the causes of malabsorption?

Answer 30

``` Coeliac Chronic pancreatitis Crohn's disease Bacterial overgrowth Lactose intolerance ```

Question 31

What are the symptoms of malabsorption?

Answer 31

``` Diarrhoea Steatorrhoea Weight loss Bloating Anaemia ```

Question 32

What investigations would be done if malabsorption was suspected?

Answer 32

``` FBC, U&Es, LFT, albumin, Ca, folate, B12, vit D Coagulation Coeliac serology Stool microscopy H breath test Endoscopy Small bowel biopsy ```

Question 33

How is malabsorption treated?

Answer 33

Aimed at cause

Question 34

What is the pathology of irritable bowel syndrome?

Answer 34

No pathological cause | Functional disorder

Question 35

What are the causes of IBS?

Answer 35

Stress Post-infective Anxiety Adverse life events

Question 36

What are the symptoms of IBS?

Answer 36

Abdominal discomfort Relief with defaecation Alternating bowel habit Bloating

Question 37

What investigations would be done if IBS was suspected?

Answer 37

Routine bloods Coeliac serology Sometimes sigmoidoscopy if >45 and persistent symptoms

Question 38

How is IBS treated?

Answer 38

Avoid triggers Antispasmodics - mebeverine Diarrhoea - codeine phosphate/loperamide

Question 39

What is the pathology of ulcerative colitis?

Answer 39

Continuous inflammation of the colonic mucosa starting at the rectum and working its way up

Question 40

What causes UC?

Answer 40

Unknown Genetic predisposition Non-smokers

Question 41

What are the symptoms of UC?

Answer 41

``` Diarrhoea Rectal bleeding Mucous Abdominal pain Weight loss Fever Erythema nodosum ```

Question 42

What investigations would be done if UC was suspected?

Answer 42

``` Bloods - FBC, increased CRP, increased ERP, increased platelets, decreased albumin, decreased Hb Stool microscopy and culture Abdominal x-ray Faecal caprotectin Sigmoidoscopy AXR - rule out toxic megacolon ```

Question 43

How is UC treated?

Answer 43

5-ASA - mesalazine Steroids Azathioprine

Question 44

What are the complications of UC?

Answer 44

Toxic megacolon Haemorrhage Colorectal carcinoma

Question 45

What is the pathology of Crohn's disease?

Answer 45

Affects any part of the GI tract Transmural - full thickness Pathy Cobblestone appearance

Question 46

What causes crohn's disease?

Answer 46

Unknown Genetic predisposition Smoking

Question 47

What are the symptoms of crohn's disease?

Answer 47

``` Depends on site affected Diarrhoea Abdominal pain Weight loss Fever Anaemia Anal strictures Erythema nodosum ```

Question 48

What investigations would be done if crohn's disease was suspected?

Answer 48

``` Stool microscopy and culture Increased CRP, ESR Decreased Hb, albumin Colonoscopy with biopsies B12, folate, vit D, Ca Faecal calprotectin Capsule endoscopy ```

Question 49

How is crohn's disease treated?

Answer 49

Steroids Azaithoprine Nutrition

Question 50

What are the complications of crohn's disease?

Answer 50

Sticturing Bowel obstruction Perforation

Question 51

What is the pathology of colorectal cancer?

Answer 51

Adenocarcinoma

Question 52

What are the predisposing factors for colorectal cancer?

Answer 52

``` Neoplastic polyps IBD Genetic predisposition - FAP, HNPCC Alcohol Smoking Previous cancer ```

Question 53

What are the symptoms of colorectal cancer?

Answer 53

Depends on site Left - bleeding, mucus, altered bowel habit, obstruction Right - weight loss, abdominal pain

Question 54

How is colorectal cancer investigated?

Answer 54

Sigmoidoscopy Colonoscopy CT

Question 55

How is colorectal cancer treated?

Answer 55

Laparoscopic surgery Radiotherapy Chemotherapy

Question 56

Where does colorectal cancer metastasise to?

Answer 56

Liver Lung Bone

Question 57

How is colorectal cancer staged?

Answer 57

Dukes staging

Question 58

What are ALARM symptoms?

Answer 58

``` Anaemia Loss of weight Anorexia Recent onset of progressive symptoms Masses and melaena/haematemesis Swallowing difficulty ```

Question 59

What are signs of an upper GI bleed?

Answer 59

``` Haematemesis Melaena Elevated urea Associations - dyspepsia, reflux NSAID use ```

Question 60

What are the signs of a lower GI bleed?

Answer 60

Fresh blood/clots Magenta stools Normal urea Typically painless