common GI pathologies

Question 1

dysphagia to both solid foods and liquids
= achalasia

investigation and management

Answer 1

PPI therapy
endoscopy

regurgitation
weight loss

achalasia is failure of the lower oesophageal sphincter to relax secondary to neuronal degeneration of the myenteric plexus

1st line: oesophageal manometry

barium swallow is helpful to look for obstruction / stricture of oesophagus / malignancy

mx: pneumatic dilation

Question 2

small intestinal bacterial overgrowth (SIBO)

Answer 2

malabsorption post surgery (low vitamin b12, high serum folate)

SIBO can cause malabsorption (fat- de-conjunction of bile acids by intestinal bacteria) (B12- utilised by bacteria) steatorrhoea, megaloblastic anaemia (b12 deficiency), raised folate due to increased folate synthesis by intestinal bacteria

gold standard diagnosis:

• culture of small intestinal fluid aspirate
• duodenal aspirate

pathophysiology:
failure of normal mechanisms that control bcterial growth in the small gut (decreased gastric acids, slow gut motility)- proceudures, inestinal surgery

mx: antibiotics metronidazole, ciprofloxain, co-amoxiclav, rifaximin. 2 week course

Question 3

toxic megacolon

Answer 3

rare but potentially fatal complication of UC

precipitating factors:
electrolyte disturbacnes (Diarrhoea= hypokalaemia)
antimotility (anti diarrhoeals)
opiates

iagnose with a straight xray of the abdomen
shows colonic dilation with a diameter of >6cm and loss of haustrations mainly in transverse colon