Common GI Cases

Question 1

What are the common GI disorders?

Answer 1

Diarrhoea
Vomiting 
Upper GI Bleed
Irritable bowel syndrome 
Inflammatory bowel disease (ulcerative colitis and crohns disease) 
Coeliac disease 
Lactose intolerance

Question 2

What are the common liver disorders?

Answer 2

Alcohol 
Drugs
Hepatitis
Cholestasis
Cholangitis
Cholecystitis
Gallstones
Cirrhosis
Fatty liver
Liver cancer

Question 3

What are common pancreas disorders?

Answer 3

Pancreatitis
Pancreatic carcinoma
Pancreatic insufficiency
Type 1 diabetes

Question 4

What are the types of diarrhoea?

Answer 4

Osmotic
Secretory
Inflammatory

Question 5

Biochemically what happens in diarrhoea?

Answer 5

Loss of bicarbonate
Dehydration
Electrolyte disturbance
loss of K+ and bicarbonate

Question 6

What occurs due to upper GI losses?

Answer 6

Loss of acid = increased bicarbonate
Loss of chloride = metabolic alkalosis
Dehydration can result in low K

Question 7

What occurs due upper GI bleed?

Answer 7

Red blood cells released and reabsorbed

Increased K, urea and urea:Cre

Question 8

Differences between IBS and IBD

Answer 8

IBS: No detectable organic cause. Diagnosis of exclusion. Calprotectin negative

IBD: calprotectin positive
Crohns; any part of tract and commonly starts in terminal ileum. S.cerevisiae Ab +ve and pANCA Ab -ve
Ulcerative colitis; restricted to colon and rectum. S.cerevisiae Ab -ve and pANCA Ab +ve

Question 9

What is coeliac disease?

Answer 9

Gluten sensitivity enteropathy

Immune response against TTG and endomysial

Question 10

What is lactose intolerance?

What tests can be used?

Answer 10

Lactase deficiency; genetic or environmental
Bacteria ferment lactate in the colon and produce gas and diarrhoea

Facial reducing substances
Stool pH
Lactose tolerance test

Question 11

What causes cholestasis?

Answer 11

Obstruction of bile flow; pregnancy, gallstones or pancreatic carcinoma

Non-obstructive cases: drug-induced, inherited, TPN

Question 12

What are gallstones?

Answer 12

Blockages in the ball bladder
80% are cholesterol formed
20% are pigment stones of calcium bilirubinate/polymers containing calcium and copper

Question 13

What is cholangitis?

What is the common presentation?

Answer 13

Inflammation of the common bile duct, usually due to infection.

Charcot’s triad:

1) fever/chills/rigor
2) upper right quadrant pain
3) jaundice

Question 14

What is cholecystitis?

Answer 14

Inflammation of the gall bladder

90% cases due to gall stones, other cases include infection and in rare cases a tumour

Question 15

What causes haemochromatosis?

Answer 15

Acquired: repeated blood transfusion and excess iron therapy
Hereditary: autosomal recessive. 1 in 2000 Caucasians. HFE gene on chromosome 6. Increased intestinal iron absorption, and deposition into tissues

Question 16

What is Wilson’s disease?

Answer 16

Autosomal recessive disorder. ATP7B gene on chromosome 13: ATPase that facilitates copper extraction in bile. Copper accumulation in liver, brain, kidneys and eyes.

Question 17

What is A1AT?

Answer 17

Alpha-1 antitrypsin

A protease inhibitor - particularly of neurotrophic elastin which would degrade lung elastin

Question 18

What occurs in A1AT deficiency?

Answer 18

A1AT trapped in proteasome and polymerises
Accumulation leads to liver damage and cirrhosis
(And loss of lung elastin)

Question 19

What are the three types of pancreatitis?

Answer 19

Acute: Abdo pain, nausea and vomiting. U&E, LFT, calcium and bloods gases

Chronic: follows acute, commonly due to alcohol. Faecel elastase

Hereditary

Question 20

How can the likelihood and severity of pancreatitis be predicted?

Answer 20

Ranson’s criteria

Question 21

What happens in type 1 diabetes?

Answer 21

Auto antibodies against islet cells

Deficiency in insulin