L6: Gastroenterology - A Symptoms Based Approach

Question 1

According to the bristol stool chart, which types are considered to be “normal”?

Answer 1

Type 3 or 4

Question 2

What is the definition of diarrhea?

Answer 2

increased frequency and liquidity of faecal evacuation (frequency > 3 a day)

Question 3

What is considered acute diarrhea?

Answer 3

less than 7 days

Question 4

What is considered persistent diarrhea?

Answer 4

occurs for between 14 to 21 days

Question 5

What is considered chronic diarrhea?

Answer 5

occurs for more than 1 month

Question 6

List some of the characteristics of small bowel diarrhea

Answer 6

• watery
• large volume
• cramping, bloating, gas
• weight loss
• no blood
• rarely fever

Question 7

List some of the characteristics of large bowel diarrhea

Answer 7

• frequent
• small volume
• blood present
• mucus
• fever common
• rarely weight loss

Question 8

How many stools/day would be considered a trait of severe diarrhea?

Answer 8

6 stools/24 hours

Question 9

What is steatorrhea? Why does it occur? How does it appear?

Answer 9

fat in the stool; due to fat malaborption

- appears as pale stools

Question 10

What is tenesmus? What may be some causes of this?

Answer 10

Tenesmus: sensation that rectum is full; need to go to the washroom

may result from proctitis or a rectal issue
- can also be a tumour!

Question 11

Why may tenesmus be concerning? (i.e. why should it be investigated?)

Answer 11

There may be a tumour present near/around the rectum that is causing the feeling of fullness and need to go to the washroom

Question 12

PPIs may increase the risk for what type of diarrhea?

Answer 12

C. difficile - associated diarrhea

Question 13

What are the effects of opioids in the GIT and what can it cause?

Answer 13

• opioids inhibit gastric emptying and inhibit peristalsis in the GIT
• leads to hardening of stool and constipation

opioids a/w with OVERFLOW DIARRHEA

Question 14

Which bacteria cause bloody diarrhea?

Answer 14

campylobacteria, shigella, salmonella

Question 15

Which bacteria cause non-bloody diarrhea?

Answer 15

norovirus, c. difficile, cholera

Question 16

If stool is described as yellow, loose and difficult to wash away - what is this describing?

Answer 16

Steatorrhea (fat in the stool)

Question 17

What is a medication that may cause diarrhea? (hint: PPI and what else?)

Answer 17

Metformin

Question 18

What is malabsorption? (definition)

Answer 18

impaired absorption of digested food caused by alterations of the intestinal mucosa

Question 19

What are the 4 categories of malabsorption?

Answer 19

1. Intestinal
2. Pancreatic
3. Biliary
4. Other

Question 20

Malabsorption is characterized by what 3 things?

Answer 20

1. Diarrhea
2. Steatorrhea
3. Weight Loss

Question 21

What are some examples of intestinal malabsorption (or intestinal causes of malabsorption)?

Answer 21

coeliac disease
crohn’s disease
giardiasis
whipple’s disease

Question 22

What are some examples pancreatic malabsorption (or pancreatic causes of malabsorption)?

Answer 22

Main One = chronic pancreatitis
cystic fibrosis
pancreatic cancer

Question 23

What are some examples of biliary malabsorption (or biliary causes of malabsorption)?

Answer 23

biliary obstruction

primary biliary cirrhosis

Question 24

What can hypercalcaemia cause?

Answer 24

constipation

Question 25

What are haemorrhoids?

Answer 25

they are swollen and inflamed veins in the rectum or anus

Question 26

What are anal fissures?

Answer 26

small tears in the anus

Question 27

List the complications of constipation

Answer 27

- haemorrhoids - anal fissures - rectal prolapse - fecal impaction

Question 28

What is the connection between the brain-gut axis and constipation?

Answer 28

patients become constipated due to ignoring the urge to have a bowel movement/for psychological reasons - treated w/ biofeedback

Question 29

Laxatives are used to treat what condition?

Answer 29

constipation

Question 30

What are some non-medicinal treatments for constipation?

Answer 30

- changes in diet/nutrition - exercise and lifestyle changes - biofeedback

Question 31

What are some medicinal treatments for constipation?

Answer 31

- Bulk Forming Agents - Osmotic Laxatives - Stimulant/Irritant Laxatives - Stool Softeners - Cholinergic Agonists

Question 32

What are the 5 F's of abdominal distension and bloating? (5 possible causes)

Answer 32

``` Fluid Faeces Flatus Foetus Fat ```

Question 33

List some of the symptoms of oesophageal disease

Answer 33

``` heartburn regurgitation chest pain dysphagia odynophagia globus sensation water brash ```

Question 34

What is odynophagia?

Answer 34

painful swallowing

Question 35

What symptoms of oesophageal disease should raise a red flag?

Answer 35

dysphagia | odynophagia

Question 36

What is globus sensation/globus pharyngeus?

Answer 36

tightness in the throat/sensation of a constant lump in throat without any difficulty of swallowing - mainly psychological

Question 37

What are the "mechanical" causes of dysphagia?

Answer 37

oesophageal cancer peptic stricture achalasia inflammatory (oesophagitis)

Question 38

What are the clinical features/symptoms of achalasia?

Answer 38

dysphagia, regurgitation and CHEST PAIN*

Question 39

What is achalasia? What imaging is used and how does it appear?

Answer 39

narrowing of the LES barium swallow used - Bird Beak appearance

Question 40

What is a possible treatment of achalasia?

Answer 40

botox injection

Question 41

What is a possible complication of oesophagitis?

Answer 41

narrowing of eosophagus causing a stricture

Question 42

What is a possible complication of diverticulae in the eosophagus?

Answer 42

food may get stuck in the pouches

Question 43

What is the Schatski ring? How would it present?

Answer 43

thin, web like constriction located @ squamocolumnar mucosal junction or near border of LES dysphagia to solids is the only symptom

Question 44

What is eosinophilic oesophagitis? What is the treatment for it?

Answer 44

huge amount of eosinophils in oesophagus; can get dysphagia a/w asthma and eczema treated w/ PPI

Question 45

What is eosinophilic oesophagitis associated with?

Answer 45

asthma and eczema

Question 46

Clubbing of the fingers is associated with which conditions?

Answer 46

IBD, cirrhosis, coeliac disease

Question 47

Leuconychia is associated with what condition?

Answer 47

hypoalbuminaemia

Question 48

What is koilonychia associated with?

Answer 48

iron deficiency anaemia

Question 49

What is dupytren's contracture associated with?

Answer 49

excess alcohol

Question 50

What is palmar crease pallor associated with?

Answer 50

anaemia

Question 51

What is angular stomatitis? What is it associated with?

Answer 51

causes swelling around sides of mouth; a/w iron or b12 deficiency

Question 52

Aphthous ulcers are associated with what?

Answer 52

Crohn's or Coeliac disease

Question 53

What is Felty's Syndrome? What triad is it a/w?

Answer 53

- a rare subtype of rheumatoid arthritis | - characterized by arthritis, splenomegaly*, and neutropenia

Question 54

What gastrointestinal condition can NSAIDs cause?

Answer 54

colitis

Question 55

A Schatski Ring may only present with 1 symptom which is...

Answer 55

dysphagia to solids

Question 56

What is a hepatic flap a/w?

Answer 56

hepatic encephalopathy or uraemia

Question 57

What is conjunctival pallor a/w?

Answer 57

anaemia

Question 58

What is scleral icetrus a/w?

Answer 58

liver disease/jaundice

Question 59

What is xanthelasma a/w?

Answer 59

hyperlipidaemia + PBC