Endoscopic Tour of the GI Tract

Question 1

Describe the diff endoscopic and laparoscopic tools available to investigate the GI tract

Answer 1

endoscopy = visualise GI tract

Caliber nasendoscopes = pharynx and larynx

Endoscopic retrograde cholangiography and pancreatography (ERCP) = biliary or pancreatic ductal systems

Capsular endoscopy = small bowel

Colonoscopy = colon

Question 2

What is barrett’s oesophagus?

Answer 2

Long term gastroesophageal reflux disease (GERD)

Metaplasia = stratified squamous ep to simple columnar ep with goblet cells

Question 3

What is hiatus hernia?

Answer 3

Weakness in the oesophageal hiatus (opening in the diaphragm, oesophagus and vagus nerve pass through) allows the cardia and the fundus of the stomach to herniate into the thorax

Question 4

What are oesophageal varicies?

Answer 4

Extremely dilated sub-mucosal veins in the lower third of the oesophagus

Mixed venous drainage into the portal system

Most commonly due to portal hypertension caused by cirrhosis

Question 5

Outline dysphagia

Answer 5

Difficulty/discomfort swallowing

Achalasia = failure of smooth muscle fibres to relax, sphincter to remain closed

Malignancy

Benign stricture = narrowing of oesophagus

Question 6

Discuss gastric ulceration

Answer 6

Commonly benign, on lesser curve at the angulus

Malignancy suspected if irregular margins

Question 7

What is coeliac disease?

Answer 7

SI is hypersensitive to gluten = inflam = diff digesting food

Vili and crypts atrophy

Question 8

Why would the oesophagus be dilated?

Answer 8

Procedure to correct narrowing, due to scaring from reflux

Anaesthetic throat spray, endoscope, dilation with a balloon or plastic dilators

Question 9

How does oesophageal perforation occur?

Answer 9

Vomit against a closed epiglottis

Iatrogenic

Question 10

What is boerhaave syndrome?

Answer 10

Rupture of oesophageal wall due to vomiting = sudden increase in intraesophageal press combined with relatively -ve intrathoracic pressure

Question 11

What are gallstones and why do they form?

Answer 11

Either in the gallbladder or common bile duct

Made up of mainly cholesterol

Cause = high cholesterol, bilirubin. Incomplete/infrequent emptying of the gallbladder may cause the bile to become over-concentrated and contribute to gall formation

Question 12

What is a choledocoduodenal fistula?

Answer 12

Fistulous connection between the gallbladder and the duodenum

Question 13

What is gallstone ileus?

Answer 13

Rare form of small bowel obstruction caused by an impaction of a gallstone within the lumen of the SI

Question 14

What are duodenal ulcers and the cause?

Answer 14

crater in the lining of the beginning of SI

caused by infection with Helicobacter pylori

Other factors predisposing a person to ulcers include anti-inflam meds and smoking

Question 15

Describe peritonitis

Answer 15

inflam of the peritoneum, typically caused by bacterial infection either via the blood or after rupture of an abdominal organ.

Question 16

What is zollinger-ellison syndrome?

Answer 16

gastrin-secreting tumour or hyperplasia of the islet cells in the pancreas causes overproduction of gastric acid, resulting in recurrent peptic ulcers

Question 17

What is aorta-duodenal fistula and its cause?

Answer 17

Connection between the aorta and duodenum

Usually secondary to abdominal aortic aneurysm

Question 18

Outline SMA syndrome

Answer 18

Superior mesenteric artery

gastro-vascular disorder in which the third and final portion of the duodenum is compressed between the abdominal aorta (AA) and the overlying superior mesenteric artery

Question 19

What is the cause of obstructive jaundice?

Answer 19

Blockage of the bile ducts or abnormal retention of bile in the liver

Gallstones, tumours

Bile remains in bloodstream

Question 20

When is the pringle manoeuvre used?

Answer 20

Surgical manoeuvre in some abdo ops

Clamping the petatoduodenal ligament = interrupting blood flow through hepatic artery and portal vein = control bleeding from liver

Question 21

Obstruction of the caecum can cause what?

Answer 21

May dilate to the point of necrosis or perforation

if the ileocaecal valve is competent it prevents back flow of excess air and colonic contents which may not pass distally

Question 22

Discuss colonic tumours

Answer 22

20% occur in the caecum and right side of the colon

often present with a mass

change in bowel habit, iron def anaemia, pain

Question 23

What is an appendicitis?

Answer 23

inflam of appendix

Caused by blockage of the hollow portion

Question 24

What is diverticulosis?

Answer 24

Condition of having multiple pouches (diverticula) in the colon (not inflamed)

These are out-pockets of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall

Question 25

Outline diverticulitis

Answer 25

Pouches within the large bowel wall become inflamed

Can have bloody stool

Question 26

What are the characteristics of ulcerative colitis?

Answer 26

Tends to occur in the rectum and spread proximally throughout the colon

Area of inflam are continuous and the mucosa is highly friable

Question 27

What are the characteristics of crohns?

Answer 27

Patch or focal areas of inflam = skip lesions

Ulcers are deep and fissuring = cobble stone

Question 28

What are haemorrhoids and how does the position impact pain?

Answer 28

Dilation of the superior rectal veins

If confined above the dentate line = painless

If they extend below the dentate line where the nervous innervation is somatic = extremely painful

Question 29

What are tumours in upper rectum?

Answer 29

Above the dentate line will be adenocarcinoma

Question 30

What are tumours in lower rectum?

Answer 30

Below the dentate line are generally squamous cell carcinoma