some random GI stuff

Question 1

risk factors for Coeliac disease

Answer 1

Irish
female
HLA DQ2 gene

Question 2

pathology of Coeliac disease

Answer 2

reaction to gliadin - T cell mediated

villous atrophy and malabsorption of bile acids and crypt hyperplasia

Question 3

signs of Coeliac disease

Answer 3

diarrhoea that smells offensive
bloating
abdominal pain 
nausea and vomiting
aphthous ulcers
weight loss
angular stomatitis
fatigue

Question 4

complications of Coeliac disease

Answer 4

osteoporosis
malignancies (if pt does not adhere to diet)

Question 5

diagnosis of coeliac disease

Answer 5

jejunal and duodenal biopsies
serology - tissue transglutaminase and anti-endomysial antibodies
gastroscopy

Question 6

treatment of coeliac disease

Answer 6

gluten free diet

Question 7

risk factors for oesophageal reflux

Answer 7

hiatus hernia
gastric surgery
increased abdominal pressure

Question 8

symptoms of oesophageal reflux

Answer 8

heartburn (acid reflux)

Question 9

complications of oesophageal reflux

Answer 9

Barrett’s oesophagus
carcinomas
hyperplasia
metaplasia

Question 10

diagnosis of oesophageal reflux

Answer 10

endoscopy
GI bleeding
pH monitoring

Question 11

treatment of oesophageal reflux

Answer 11

antacids (magnesium trisilicate mixture)
PPIs (omeprazole)
H2RA (ranitidine)
weight loss
meal planning
dietary restraint

Question 12

risk factors for peptic ulcers

Answer 12

inappropriate NSAID use

peptic ulcers

Question 13

pathology of peptic ulcers

Answer 13

ulceration in gastric mucosa, usually due to a pH decrease

Question 14

signs of peptic ulcers

Answer 14

haematemesis
melaena (dark, sticky faeces)
weight loss
epigastric pain

Question 15

complications of peptic ulcers

Answer 15

peritonitis if perforation
pancreatitis
haemorrhage

Question 16

diagnosis of peptic ulcers

Answer 16

endoscopy

H.pylori test

Question 17

treatment for peptic ulcers

Answer 17

triple therapy: PPI, clarithromycin, amoxiclav
stop NSAIDs
stop smoking

Question 18

what normally protects gastric cells from acid?

Answer 18

mucin

Question 19

mesenteric ischaemia risk factors

Answer 19

chronic renal failure
past MI 
AF
heart failure
thrombophilia

Question 20

pathology of mesenteric ischaemia

Answer 20

restriction of blood flow to mesentery (acute or chronic)

Question 21

what are the phases of mesenteric ischaemia?

Answer 21

hyper-active phase
paralytic phase
shock phase

Question 22

what happens in the hyper-active stage of mesenteric ischaemia?

Answer 22

severe abdominal pain
bloody stools

many patients get better after this stage

Question 23

what happens in the paralytic phase of mesenteric ischaemia?

Answer 23

abdominal pain more widespread
more tenderness
bowel motility decreases
abdominal bloating
absent bowel sounds

Question 24

what happens in the shock phase of mesenteric ischaemia?

Answer 24

fluids start to leak through damaged colon lining –> shock and metabolic acidosis with dehydration
low bp
fast heart rate
confusion

patients are critically ill and require intensive care

Question 25

diagnosis for mesenteric ischaemia

Answer 25

``` FBC test for lactic acid in blood CT XR colonoscopy angiography ```

Question 26

treatment of mesenteric ischaemia

Answer 26

resection of bowel if necrotic | medicines for blood pressure

Question 27

risk factors for Mallory Weiss tear

Answer 27

``` alcohol excess chronic cough hyperemesis gravidarum bulimia gastroenteritis ```

Question 28

pathology of Mallory Weiss tear

Answer 28

haematemesis due to oesophageal tear or prolonged vomiting

Question 29

signs of Mallory Weiss tear

Answer 29

melaena haematemesis hypovolaemia/shock

Question 30

complications of Mallory Weiss tear

Answer 30

shock

Question 31

diagnosis of Mallory Weiss tear

Answer 31

endoscopy

Question 32

risk factors for haemorrhoids

Answer 32

hard stool straining pregnancy

Question 33

pathology of haemorrhoids

Answer 33

congested vascular cushions | dilated venous component

Question 34

signs of haemorrhoids

Answer 34

painless bleeding blood coated stool pain when pooing

Question 35

diagnosis of haemorrhoids

Answer 35

proctoscopy endoscopy FBC

Question 36

treatment of haemorrhoids

Answer 36

sclerotherapy

Question 37

risk factors for fistulae

Answer 37

perianal sepsis rectal carcinoma TB Crohn's

Question 38

pathology of fistulae

Answer 38

a track communicates between skin and anal canal | blockage of deep intramuscular gland ducts - formation of abscesses

Question 39

symptoms of fistulae

Answer 39

inflammation pain pus secretion pruritus ani - itching

Question 40

complications of fistulae

Answer 40

active infection

Question 41

diagnosis of fistulae

Answer 41

MRI endoanal USS anoscopy

Question 42

treatment of fistulae

Answer 42

fistulostomy and excision low ones are laid open to healing high ones are sutured tight

Question 43

risk factors for fissure

Answer 43

hard faeces anal cancer rectal artery spasm causing ischaemia anal sex

Question 44

pathology of fissure

Answer 44

tear in squamous lining (usually on posterior wall of lower anal canal)

Question 45

symptoms of fissure

Answer 45

pain after defecation

Question 46

treatment of fissure

Answer 46

``` 5% lidocaine ointment stool softener dietary fibre topical GTN surgery if needed ```

Question 47

risk factors for pilonidal sinus/abscess

Answer 47

obesity family history prolonged sitting greater amounts of hair

Question 48

risk factors for perianal abscess

Answer 48

Crohn's malignancy fistulae

Question 49

pathology of perianal abscess

Answer 49

abscess usually caused by gut organisms, usually E.coli

Question 50

symptoms of perianal abscess

Answer 50

palpable mass near the anus pain constipation fever

Question 51

treatment of perianal abscess

Answer 51

incise and drain under GA

Question 52

pathology of pilonoidal sinus/abscess

Answer 52

ingrown hair in central superior portion of bum crack, sweat can fill space --> anaerobic bacteria grow