Case 1 - overview of clinical gastroenterology

Question 1

what percentage of primary care consultations are to do with GI disorders

Answer 1

10%

Question 2

what are GI disorder symptoms

Answer 2

indigestion/heartburn/vomiting
abdominal pain
altered bowel habit (IBS, Crohn’s, diverticualr disease)
rectal bleeding
weight loss etc

Question 3

what is diverticulosis

Answer 3

condition that occurs when small pouches or sacs form and push outward through weak sports in the wall of your colon (diverticulosis)

Question 4

when does diverticulosis change to become diverticular disease

Answer 4

when it causes symptoms, bleeding, inflammation or complications, this is called diverticular disease

Question 5

what are the symptoms of diverticular disease

Answer 5

constipation, diarrhoea, abdominal pain

Question 6

what is altered bowel habit

Answer 6

diarrhoea - frequency increased, loose/liquid

constipation - frequency decreased, straining

Question 7

what is the most important thing about altered bowel habit

Answer 7

it is change from the person’s normal habit

Question 8

diagram showing the bristol stool form scale

Answer 8

Question 9

what are some liver disease symptoms

Answer 9

abnormal bloods
jaundice
fatigue
abdominal swelling

Question 10

what is the most common cause of liver disease

Answer 10

alcohol

Question 11

what usually appears on the liver

Answer 11

cirrhosis

Question 12

what is steatorrhea

Answer 12

is the increase in fat excretion in the stools

Question 13

what are the 2 conflicting roles of the gut

Answer 13

digestion and absorption: get food and water in
vs
barrier function: keep bacteria and toxins out

Question 14

facts about the gut cleanliness etc

Answer 14

10 times more bacteria than human cells
100 times more genes than in our genome
1kg of bugs in your bowel and they are a lot older

Question 15

what are the investigations used in GI disease

Answer 15

bloods
endoscopies
biopsies
imaging
CT
MR
nuclear medicine

Question 16

what are examples of gastrointestinal medical emergencies

Answer 16

GI bleeding
severe inflammatory bowel disease
perforation
obstruction
acute pancreatitis
appendicitis

Question 17

what are severe inflammatory bowel diseases

Answer 17

Crohn’s and colitis

Question 18

what are varices

Answer 18

abnormal blood vessel and is formed when the liver is very scarred

they can perforate and rupture and blleed and can lead to death

Question 19

what is the treatment for a varice

Answer 19

an elastic band type of device is tied around the varice after it is sucked up into a tube by the endoscope

Question 20

what does PEG stand for

Answer 20

percutaneous endoscopic gastrostomy

Question 21

what is a PEG

Answer 21

feeding tube is placed by an endoscope into the abdominal wall

used for people who can no longer eat or swallow

supports nutrition without having to eat

Question 22

what is buried bumper syndrome and how do you prevent it

Answer 22

ring around it has been over grown so no longer able to put anything through the feeding tube

shouldn’t happen as you should rotate a PEG hoop everyday

Question 23

what can be used if a person cannot tolerate a PEG tube

Answer 23

PEG-J tube can be used if person cannot tolerate a normal PEG tube

it is placed distal to the stomach so there is no vomiting or reflux

Question 24

what are polyps removed by

Answer 24

snares - wire loop through which a hot electrical current is placed through it to seal off the area and any blood vessels that have been cut through

Question 25

what are the complications of polypectomy

Answer 25

bleeding (can be fatal)
perforation of the bowel wall (if caught in snare)
can require surgery