Common GIT Diagnoses

Question 1

Name the pathology: rapid onset of abdo pain, worsened by sudden movements (e.g. coughing), guarding & rigidity w/ possible rebound tenderness

Answer 1

Peritoneal inflammation

Question 2

Name the pathology: rapid onset of abdo pain & tenderness, worst at 1/3 way from right ASIS to umbilicus, guarding & rigidity w/ possible rebound tenderness, release of pressure at LLQ = pain at RLQ

Answer 2

Appendicitis

• McBurney’s Line & Point
  
  • Line spans from ASIS - umbilicus
  • Point of maximal tenderness is ~1/3 along this line (closer to ASIS)
• Rovsing’s Sign: releasing pressure at LLQ will produce pain in RLQ

Question 3

Name the pathology: burning pain in epigastrium, worsened after eating, when bending forward & lying flat. May cause belching & regurgitation.

Answer 3

GORD

Question 4

What are the features of Barrett’s Oesophagus?

Answer 4

Replacement of oesophageal squamous epithelium with columnar mucosa.
Pre-cancerous
Often develops after long-term GORD

Question 5

Name the pathology: weight loss, regurgitation of food

Answer 5

Achalasia

• Failure of LOS to relax before oncoming bolus of food
• Often due to intramural nerve plexus denervation of smooth muscle

Question 6

Name the pathology: Dysphasia to solids, progressing to dysphasia of liquid. Odynophagia, weight loss & malnutrition

Answer 6

Oesophageal cancer

- Classic history

Question 7

Name the pathology: epigastric pain & dyspepsia, often longstanding.

Answer 7

Peptic ulcer (stomach or duodenum)

• Commonly due to NSAID use and/or H. Pylori infection.
• Smoking increases risk

Question 8

Name the pathology: epigastric pain & dyspepsia, with bleeding/anaemia, weight loss and difficulty swallowing.

Answer 8

Gastric cancer
ALARM SYMPTOMS: weight loss, bleeding/anaemia, difficulty swallowing, any masses.
- Even more suspicious in Pt’s >50 y.o.

Question 9

Name the pathology: Diarrhoea/steatorrhoea, absent at night, possible iron deficiency anaemia.

Answer 9

Coeliac disease - associated with eating gluten.

• Serologic studies
• Endoscopic biopsy - blunted/absent villi

Question 10

Name the pathology: Chronic abdominal pain with diarrhoea, possible ileocaecal pain & tender right iliac fossa.

Answer 10

Crohn’s Disease

Question 11

What are the key features of Crohn’s disease?

Answer 11

Can affect any part of the intestine but mainly affects distal small bowel & proximal large bowel (ileocaecal area)

• Thickening & fibrosis of bowel can = strictures
• Penetrating ulcers can = fistulae
• Skip lesions often noted on histology

Question 12

Name the pathology: Chronic abdominal pain with diarrhoea, rectal bleeding & passage of mucous.

Answer 12

Ulcerative Colitis

Question 13

What are the key features of Ulcerative Colitis?

Answer 13

Inflammation is limited to the mucosa of the large bowel.

- Slow & insidious onset

Question 14

Name the pathology: Abdominal pain, bleeding per rectum, change in bowel habit, anaemia; can present with obstruction, anal pain, tenesmus.

Answer 14

Colon Cancer

• Increased suspicion in older person, fevers, weight loss.
• Symptoms dependent on location of tumour.

Question 15

Name the pathology: Flu-like symptoms, fever, anorexia, nausea, vomiting & jaundice.

Answer 15

Acute Hepatitis - clinical course varies widely.

Question 16

Possible causes of acute hepatitis

Answer 16

Viruses
- Hep A, B, E
- CMV
- EBV
Non-viral infections:
- Q fever
Drug-induced hepatotoxicity
- Paracetamol overdose
Ischaemic hepatitis following circulatory shock

Question 17

Name the pathology: Jaundice, ascites, hard liver (if palpable)

Answer 17

Cirrhosis

Question 18

Name the pathology: Sudden onset of colicky pain in epigastric & umbilical regions

Answer 18

Acute pancreatitis