Illness script - week 6

Question 1

GIT disorders

31% _____ and 29% _____ are the most common causes to a GP for acute _____ pain

Answer 1

GIT disorders

31% appendicitis and 29% colics are the most common causes to a GP for acute abdomen pain

Question 2

GIT disorders

hospital presentations most commonly for abdomen pain are _____ (34%), _____ (34%), and _____ (10%)

Answer 2

GIT disorders

Hospital presentations most commonly for abdomen pain are non-specific (34%), appendicitis (34%), and cholecystitis (10%)

Question 3

Probability diagnosis of GIT

1) acute _____ and _____
2) _____
3) _____ _____ _____
4) _____ and _____ colic

Answer 3

Probability diagnosis of GIT

1) Acute gastroenteritis and appendicitis
2) Dysmenorrhoea
3) Irritable bowel syndrome
4) Biliary and renal colic

Question 4

Pitfalls of abdominal pain

1) acute _____
2) _____ _____
3) _____ causes
4) _____
5) _____ _____
6) _____ _____

Answer 4

pitfalls of abdominal pain

1) acute appendicitis
2) myofascial tear
3) pulmonary causes
4) pneumonia
5) pulmonary embolism
6) faecal impaction

Question 5

abdominal diagnostic testing

1) Blood: _____, _____ _____ _____ (ERS), _____ _____ (CRP)
2) Stools: _____ blood, _____ _____ and _____
3) ______
4) Radiology: _____ scan, _____, _____
5) Endoscopy: _____, _____ with _____

Answer 5

abdominal diagnostic testing

1) Blood: haemoglobin, Erythrocyte sedimentation rate (ERS), C-reactive protein (CRP)
2) Stools: occult blood, microscopic analysis and culture
3) Urine
4) Radiology: CT scan, MRI, Ultrasound
5) Endoscopy: colonoscopy, gastroscopy with biopsy

Question 6

endoscopy diagnostic

Sigmodoidoscopy: helps exlude local _____, searching for abnormalities in _____, _____ and _____; __% usually occurs in the first __cm of the bowel

Answer 6

endoscopy diagnostic

Sigmoidoscopy: helps exclude local disease, searching for abnormalities in blood mucus and neoplasia; 60% usually occurs in the first 60 cm of the bowel

Question 7

Appendicitis

The rodimentary part of the colon, it’s role in immunity becomes inflamed and is in risk of perforating leading to peritonitis

Answer 7

appendicitis

The _____ part of the colon, it’s role in immunity becomes inflamed and is in risk of perforating leading to _____

Question 8

Appendicitis

life-time risk is 1 in __ for people in america, 1/__ of appendicitis presents to hospital with a _____ _____

Answer 8

appendicitis

life-time risk is 1 in 15 for people in america, 1/3 of appendicitis presents to hospital with a perforated appendix

Question 9

Signs and symptoms of appendicitis

1) general _____ pain that is localised to the _____ _____ _____
2) _____
3) _____ and _____

Answer 9

signs and symptoms of appendicitis

1) general abdominal pain that is localised to the right iliac fossa
2) anorexia
3) Diarrhea and constipation

Question 10

Diagnosing appendicitis

1) _____ _____ _____
2) _____ (last resort)
3) _____ or _____ scan

Answer 10

diagnosing appendicitis

1) Full blood count
2) Laporoscopy (last resort)
3) Ultrasound or CT scan

Question 11

Treatment of appendicitis

1) Antibiotics: if it is _____ _____
2) _____ and antibiotics: if _____

Answer 11

treatment of appendicitis

1) Antibiotics: if it is low grade
2) Surgery and antibiotics: if perforated

Question 12

Colic

Presents as rhythmical patterns of _____ ______

Biliary colic has smaller variations in ______

Ureteric colic and intestinal colic are more during _____ of _____

Answer 12

colic

Presents as rhythmical patterns of painful contractions

Biliary colic has smaller variations in wavelength

Ureteric colic and intestinal colic are more during periods of rest

Question 13

Colic

Intensely painful: can be faked for _____ seeking behaviour

_____ on palpations

_____ or _____ scans used to find any obstructions

Answer 13

colic

Intensely painful: can be faked for opioid seeking behaviour

Tender on palpations

Ultrasound or CT scans used to find any obstructions

Question 14

Cholelithiasis

_____ are hard, _____-like structures that obstructs the _____ _____

_____ are formed by presence of _____ _____ which is a mix of _____, ______ deposits and _____ crystals in the galbladder or biliary ducts

Answer 14

cholelithiasis

Gallstones are hard, pebble-like structures that obstructs the cystic duct

Gallstones are formed by presence of biliary sludge which is a mix of glycoproteins, calcium deposits and cholesterol crystals in the gallbladder or biliary ducts

Question 15

Cholelithiasis

More common in adults __-__% between __-__ years old

Ages <40 Males to females __:__
Over >40 Males to females __:__

Relationship between _____ and high diet of _____ _____

Answer 15

cholelithiasis

More common in adults 10-15% between 18-65 years old

Ages <40 Male to females 1:3
Over >40 Males to females 1:1

Relationship between disease and high diet of refined sugar

Question 16

cholecystitis

almost always associated with obstruction of gallbladder or cystic duct by a gall stone, the obstruction may be from mucus, parasitic worm or bile tumour

the initial inflammation is _____ induced and leads to _____ damage which releases _____ and _____

Answer 16

cholecystitis

almost always associated with obstruction of gallballder or cystic duct by a gallstone, the obstruction may be from mucus, parasitic worm or bile tumour

the initial inflammation is chemically induced and leads to mucosal damage which releases phosphollipase and lysolecithia

Question 17

Dsypepsia

_____ _____ _____ most common cause

__% of population experienced at some point, but not all are caused by _____ _____

__% develops into _____ _____ _____, __ - __% of chronic _____ users have peptic ulceration

Answer 17

Dsypepsia

Gastoesophagal reflux disease most common cause

80% of population experienced at some point, but not all are caused by hiatal hernia

10% Develops into peptic ulcer disease, 10-20% of chronic NSAIDs users have peptic ulceration

Question 18

Gastroesophageal reflux disease

when _____ _____ is exposed to gastric contents for prolonged periods

factors such as delayed _____, increased _____-_____ pressure or abnormal lower _____ _____ function can lead to GORD

Answer 18

gastroesophagel reflux disease

when oesophageal mucus is exposed to gastric contents for prolonged periods

factors such as delayed emptying, increased intra-abdominal pressure or abnormal lower esophageal sphincter function can lead to GORD

Question 19

GORD

Can develop into _____ oesophagus a pre-malignant lesion that can lead to _____ _____

Answer 19

GORD

Can develop Barret oesophagus a pre-malignant lesion that can lead to oesophageal adenocarcinoma

Question 20

Treating GORD

1) _____: for rapid relief but is ineffective for long term treatment
2) _____-_____ _____ (PPI): 4 weeks
3) _____-_____ _____: 8 weeks

Answer 20

Treating GORD

1) Antacids: for rapid relief but is ineffective for long term treatment
2) Proton-pump inhibitior (PPI): 4 weeks
3) H2-receptor antagonists: 8 weeks

Question 21

Peptic ulcer

Strong associated with _____; _____ like to borrow in _____ which stimulates the chronic _____ by stimulating local inflammatory repsonse

Answer 21

peptic ulcer

Strongly associated with H.pylori; H.pylori like to borrow in mucosa which stimulates the chronic gastritis by stimulating local inflammatory response

Question 22

Peptic ulcer

_____ can impair muscosal defence which inhibits the _____ and __ (_____, _____); they are _____ that protect the function of gut _____

__% of the population is affected

Answer 22

peptic ulcer

NSAIDs can impair mucosal defence which inhibitis the COX1 and 2 (voltaren, ibuprofen); they are enzymes that protect the function of gut mucosa

2% of the population is affected

Question 23

Treating peptic ulcer

1) _____ _____ with heater probe and low _____ injection
2) IV _____/_____ or _____
3) _____ is also an option

Answer 23

treating peptic ulcer

1) endoscopic haemostasis with heater probe and low adrenaline injection
2) IV omeprazole/esomeprazole or pantroprazole
3) Surgery is also an option

Question 24

Histamine H2 receptor antagonists

_____, _____ and _____: these medications are less likely to affect _____ of other medications; they can be administered without food and patients are advised to avoid _____ _____ and _____

Answer 24

Histamine H2 receptor antagonists

Ranitidine, nizatidine and feimotidine: these medications are less likely to affect metabolism of other medications; they can be administered without food and patients are advised to avoid spicy foods and caffeine

Question 25

Proton-pump inhibitor (PPI) Inhibits _____ _____ _____, it is more potent than _____ _____ _____ and managing conditions associated with _____ _____ is the most common medication

Answer 25

Proton-pump inhibitor (PPI) Inhibits gastric acid secretion, it is more potent than H2 receptor antagonist and managing conditions associated with hyperacidity Omeprazole is the most common medication

Question 26

Recurrent abdominal pain 3 distinct _____ over __ months, occurs in __% of school children __-__% are diagnosed by organic causes, the other are psychological and emotional

Answer 26

recurrent abdominal pain 3 distinct episodes over 3 months, occurs in 10% of school children 5-10% are diagnosed by organic causes, the other are psychological and emotional

Question 27

Inflammatory bowel disease (IBD) abnormal host response to an _____ trigger, causes the gut _____ and release of inflammatory mediators that cause _____ _____

Answer 27

Inflammatory bowel disease (IBD) abnormal host response to an environment trigger, causes the gut inflammation and release of inflammatory mediators that cause tissue damage

Question 28

IBD Ulcerative colitis: __/100,000 Chrohn's disease: __/100,000

Answer 28

IBD Ulcerative colitis: 9.8/100,000 Chrohn's disease: 6.3/100,000

Question 29

Chrohn's disease More common in terminal _____ and right side of _____; the entire walls thicken and deep _____ create linear _____ This may ulcerate and form fistulas with _____, _____ and bowel

Answer 29

Chrohn's disease More common in terminal ileum and right side of colon; the entire walls thicken and deep ulcers create linear fissures This may ulcerate and form fistulas with bladder, uterus and bowel

Question 30

Ulcerative colitis (UC) involves _____ and _____ colon or even _____ colon; inflammation is confluent and affects the _____

Answer 30

ulcerative colitis (UC) involves rectum and signoid colon or even whole colon; inflammation is confluent and affects the mucosa

Question 31

Treating IBD 1) _____, _____, _____ for treating UC 2) _____: for acute flares 3) _____ drugs for severe attacks: _____, _____ 4) _____ agents: _____

Answer 31

treating IBD 1) Sulfasalazine, olsalazine, mesalazine for treating UC 2) Corticosteroid: for acute flares 3) Immunomodifying drugs for severe attacks: azathiopine, cyclosponn 4) Biological agents: infliximab

Question 32

Irritable bowel syndrome (IBS) __-__% worldwide: most common functional GI disorder caused by _____ and _____ (__% triggered by food) _____-_____ breath test

Answer 32

Irritable bowel syndrome (IBS) 7-21% worldwide: most common functional GI disorder caused by malabsorption and FODMAPs (90% triggered by food) Hydro-methane breath test

Question 33

Treating IBS 1) Regular _____ pattern 2) No _____, _____, _____ and _____ 3) High _____, low _____ and a lot of _____ 4) Avoid _____

Answer 33

treating IBS 1) Regular eating pattern 2) No smoking, alcohol, laxatives and codeine 3) High fibre, low carbs and a lot of water 4) Avoid FODMAPs

Question 34

Diverticulitis long-life and _____ deficient diet; small stools require higher _____-_____ pressure resulting in herniation of the _____

Answer 34

diverticulitis long-life and fibre deficient diet; small stools require higher intra-colic pressure resulting in herniation of the mucosa

Question 35

diverticulitis <40 years old: __% >80 years old: __% ~__% of patients have at least 1 _____

Answer 35

diverticulitis <40 years old: 10% >80 years old: 70% ~20% of patients have at least 1 recurrence

Question 36

Colon cancer Common GIT _____, second most common cause of _____ in western society; Males >50 years old (__%) Mortability rate is __%, _____ prognosis if diagnosed early

Answer 36

colon cancer Common GIT malignancy, second most common cause of death in western society; Males >50 years old (90%) Mortality rate is 60%, good prognosis if diagnosed early

Question 37

Duke stages ~__ year survival A-cancer: limited to _____ and _____ __% B-cancer: extends into _____ or _____ __% C-cancer: involves regional _____ _____ __% D-distant _____ 7%

Answer 37

Duke stages ~5 year survival A-cancer: limited to mucosa and submucosa 88% B-cancer: extends into muscularis or terosa 70% C-cancer: involves regional lymph nodes 43% D-distant mestastses 7%

Question 38

diagnosing colon cancer 1) _____ _____ _____ _____ (FOBT): if results are positive, _____ or _____ 2) _____ scan 3) _____ every __ years after 50 years old

Answer 38

diagnosing colon cancer 1) Full occult blood test (FOBT): if results are positive, colonscopy or sigmoidoscopy 2) PET scan 3) FOBT every 2 years after 50 years old