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Gastrointestinal (LECTURE NOTES) > Approach to the patient with luminal disease > Flashcards

Approach to the patient with luminal disease Flashcards

1
Q

What is dysphagia

A

Difficulty in swallowing

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2
Q

What is odynophagia

A

Pain on swallowing

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3
Q

What is flobus

A

a functional syndrome of the sensation of a lump in the throat in the absence of an organic cause

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4
Q

What is the first choice investigation for dysphagia

A

Endoscopy

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5
Q

What might be seen in a barium swallow

A

Irregular stricture - malignant,

smooth stricture - benign

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6
Q

If hilar lymphadenopathy is seen on a CXR what might this be

A

Oesophageal malignancy

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7
Q

What is vomiting

A

Violent expulsion of gastric and intestinal content induced by contraction of the abdominal musculature and diaphragm

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8
Q

What is regurgitation

A

The passive passage of gastric content without abdominal contration

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9
Q

What is nausea

A

The perceptual component of vomiting

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10
Q

If dysphagia comes on shortly after meals, what does this suggest

A

A gastric cause

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11
Q

If dysphagia comes on long after meals, what does this suggest

A

Distal intestinal cause

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12
Q

If a patient vomits large volumes, what does this suggest

A

Obstruction or gastric problem

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13
Q

If a patient is vomitting small volumes, what does this suggest

A

Functional problem

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14
Q

If undigested food is present in the vomit, what does this suggest

A

A gastric cause is very likely

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15
Q

If bile is present in the vomit, what does this suggest

A

The pylorus is patent and gastroparesis is unlikely

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16
Q

What are phenothiaxines best for

A

Neuroological causes and metabolic nausea

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17
Q

What are 3 side effects of phenothiazines

A

Sedation, orthostatic, hypotension

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18
Q

What is used for drug induced nausea

A

5-HT3 antagonist

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19
Q

What is an example of a prokinetic agent

A

Domperidone

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20
Q

What are the side effects of prokinetic agents

A

Gynaecomastia

extrapyramidal effects

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21
Q

What is constipation

A

infrequent stools
passage of hard stools
straining to empty the rectum
sensation of incomplete evacuation

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22
Q

What is one of the most common GI complaints

A

Constipation

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23
Q

Constipation is more common in who?

A

Women and elderly

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24
Q

Patients who have a colon of normal diameter with constipation are classified into what 3 groups

A

Normal transit consitpation
slow transit constipation
disordered defaecation

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25
Q

What is the normal transit constipation

A

the commonest type - characterised by a normal rate of stool movement through thte colon but the patient feels constipated.
Usually secondary perceived difficulty with defaecation and hard stools

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26
Q

What is slow transit constipation

A

Most common in young women

characterised by inferequent bowel movements and slow movement of stool through the colon

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27
Q

What are some other symptoms of slow transit consitpation

A

Bloating
abdominal pain
infrequent urge to defaecate

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28
Q

What is disordered defaecation

A

Usually due to dysfunction of the pelvic floor or anal sphincters

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29
Q

What is constipation with a dilated colon secondary to

A

neuromuscular disorders of the colon
hirschsprung’s disease
idiopathic megacolon
chronic intestinal pseudo-obstruction

30
Q

What is constipation with a dilated colon secondary to

A

neuromuscular disorders of the colon
hirschsprung’s disease
idiopathic megacolon
chronic intestinal pseudo-obstruction

31
Q

How often would a patient defaecate with slow transit

A

Every 2 days or less

32
Q

What is suggestive of idiopathic megacolon

A

faecal impaction and faecal soiling

33
Q

What are 4 alarm symptoms needing urgent imaging

A

Rectal bleeding
recent onset of symptoms
weight loss
family history of colon cancer

34
Q

What 2 things are important to ask about in the dietary history

A

meal frrequency

fibre intake

35
Q

What 5 blood tests would you want in constipation

A 
FBC - anaemia 
U&E - uraemia 
Thyroid function est 
Calcium
Glucose
36
Q

What 3 imaging investigations could be done for a patient with constipation

A

Colonoscopy
Barium enema
CT colonography

37
Q

What does evacuation proctography detect

A

Functional abnormalities and structural abnormalities

38
Q

Plain abdominal Xray is a sensitive diagnostic test of constipation. True or false

A

False - it is not

39
Q

What is the first treatment for constipatino

A

Diet - increase fibre and liquid intake

40
Q

Does fibre help to accelerate transit

A

No - it tends to exacerbate bloating instead

41
Q

What type of laxative is useful in slow transit

A

Osmotic agents

42
Q

Is surgery useful in constipation

A

Not usually unless there is an underlying pathology

43
Q

Is surgery useful in constipation

A

Not usually unless there is an underlying pathology

44
Q

What is diarrhoea defined as

A

An increase in stool weight above 200g - mostly occurring as a result of an increase in stool water content

45
Q

What is chronic diarrhoea

A

> 4 weeks of symptoms

46
Q

What are the 3 main types of diarrhoea

A

Osmotic
Secretory
Dysmotility

47
Q

What does osmotic diarrhoea look like

A

porridgey stool

48
Q

how do symptoms resolve

A

fasting

49
Q

What are 4 causes of osmotic diarrhoea

A

Laxative misuse
Lactose intolerance
Bacterial overgrowth
Steatorrhoea cauases

50
Q

What does secretory diarrhoea look like

A

Watery stool in huge volumes

51
Q

Does secretory diarrhoea settle with fasting

A

No

52
Q

What are the 2 common causes of secretory diarrhoea

A

Toxins (E. Coli, Clostridium, V choler)

Tumour

53
Q

Describe the stool consistency of dysmotility diarrhoea

A

It varies day to day

54
Q

What are 3 causes of dysmotility diarrhoea

A

IBS
Post GI resection
Drugs

55
Q

What do pale, fatty stools that are hard to flush away suggest

A

Steatorrhoea

56
Q

What might morning diarrhoea suggest

A

IBD
IBS
Alcohol misuse

57
Q

If the patient has night -time diarrhoea what diagnosis can e excluded

A

IBS

58
Q

What investigations should be done for diarrhoea

A

Stool microscopy
Stool Culture
Blood tests

59
Q

What investigation should be done if the patient has diarrhoea associated with fresh rectal bleeding

A

Flexible sigmoidoscopy

60
Q

What is suggested for patients with normal stool and blood tests

A

Colonoscopy and ileoscopy with biopsies

61
Q

What is the main treatment required for patients with diarrhoea

A

Supportive - fluids and treating pyrexia

62
Q

What drug could be given to help treat the symptoms

A

Codeine

63
Q

What is anal incontinence

A

The involuntary passage of rectal content and it is a cource of major embarrassment to the sufferrer

64
Q

Incontinence arises when there is disturbance in what 3 things

A

Anus
Rectum
Co-ordination between anus and rectum

65
Q

What are the 2 forms of anal incontinence

A

Urge incontinence

Passive incontinence

66
Q

What is urge incontinence

A

when there is marked urgency to void the bowel with incontinence occurring before the patient can get tot eh toilet

67
Q

What is passive incontinence

A

Due to leaking of stool without perception of any urge

68
Q

What is the general treatment for anal incontinence

A

To optimise the stool consistency - antidiarrhoeals
Dietary advice - ration fibre and avoid caffeine and alcohol
Review medications
Anal sphincter exercises

69
Q

How is BMI calculated

A

weight in kg / height m^2

70
Q

What is a normal BMI value

A

20-25

71
Q

What are 4 findings in a general examination for iron-deficiency anaemia

A

Angular stomatitis
glossitis
cheilosis
koilonychias

Gastrointestinal (LECTURE NOTES) (29 decks)

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