Colloquium Vomiting

Question 1

What histological types of polyps are there?

Answer 1

Villous

Hamatoma

Hyperplasic

Question 2

Why do people who vomit a lot become hypokalaemic?

Answer 2

Metabolic alkalosis causes K loss in the kidney

Question 3

What questions do you want to ask in a Hx of vomiting?

Answer 3

Quality of the vomit

Volume

Haematemesis

Relationship to food

Associated constipation

Sick contacts/Travel Hx

Question 4

What does pain in the setting of a bowel obstruction indicate?

Answer 4

Ischaemic bowel

Question 5

What are the bands in the small bowel?

Answer 5

Plicae circulares

Question 5

What are some complications of stoma’s?

Answer 5

Hernia

Infection

Question 7

What fluids do you use to replace gastric fluid?

Answer 7

Hartman’s or saline

Question 8

What is the sensitivity and specificity of faecal occult blood for colorectal cancer?

Answer 8

Sensitivity: 30-40%

Question 9

If the vomitus is thick, brown, and faecal in nature, what do you think?

Answer 9

Large bowel obstruction

Question 10

What are the DDx for large bowel obstruction?

Answer 10

Left sided colon Ca

Diverticulitis

Volvulus

Question 11

Do you investigate a bowel obstruction?

Answer 11

Erect and supine Xray

CT

FBE, UEC, Blood gas

Question 12

How much fluid is produced in the GIT tract per day?

Answer 12

~3L

Question 12

What are the DDx for small bowel obstruction?

Answer 12

Hernia

Strictures

Internal Ca - lymphoma

Crohn’s

External Ca

Question 13

When is colonic stenting indicated?

Answer 13

Late stage malignancy that is incurable

Question 15

What is the most common cause of low albumin?

Answer 15

Inflammation - it’s an acute phase reaction

Question 16

What is Hartmann’s precedure?

Answer 16

Removal of bowel and replace temporarily

Anastomose later

Question 17

Who get volvulus?

Answer 17

Old people in nursing home with co-morbidities

Young Africans

Question 18

Outline the colorectal cancer screening for at risk individuals

Answer 18

Category 1 - First degree relative (FDR) or SDR >55 age at diagnosis

• FOBT every 1-2 years, flexible sigmoid every 5 years

Category 2 - FDR <55 or 2 FDR or 1 FDR and 1 SDR on same side at any age

• 5 yearly colonscopy from aged 50 or 10 years younger than first diagnosis

Category 3 - Known or suspected familial syndrome (FAP or Lynch)

• Referal to specialist

Question 19

Outline the follow up screening for patients found to have polyps

Answer 19

LOW RISK: 1-2 low risk polyps - 5 yearly colonscopy

HIGH RISK: - 3-4 polyps or >10mm polyp - 3 yearly colonscopy

MULTIPLE: >5, 5-10 = 1 yearly colonscopy, >10 = <1 yearly colonscopy

Possible incomplete excision of large or sessile polyp: colonscopy at 3-6 months