Gastritis, Ulceration, Malabsorption and Gallstones

Question 1

Why do gastric ulcers get rescoped 6 weeks after being treated?

Answer 1

To ensure that they’ve healed, as indicator of malignancy if they haven’t

Question 2

What is the main criteria for Dyspepsia and what are the main causes?

Answer 2

Criteria: Early satiation, post-prandial fullness, Epigastric burning/pain
Causes: Excess acid, prolonged NSAIDs, large volume meals, obesity, smoking/alcohol, pregnancy

Question 3

What are the main red flag symptoms from someone with dyspepsia?

Answer 3

Anaemia, unexplained weight loss, dysphagia, upper abdominal mass and persistent vomiting

Question 4

What are the investigations and management for someone with dyspepsia?

Answer 4

Inv: Endoscopy, Gastroscopy, Barium swallow and Capsule endoscopy
Man: NSAID use, medication review, endoscopy and referral to a specialist

Question 5

How wold you treat someone for suspected dyspepsia without red flag symptoms?

Answer 5

1) Review medication
2) Lifestyle advice
3) Full PPI dose
4) Test for and treat Heliobacter Pylori infection

Question 6

What lifestyle/public health advice given to someone with dyspepsia?

Answer 6

1) Cut down on alcohol and stop smoking

2) Lose weight and modify diet

Question 7

How is GORD treated?

Answer 7

1) PPI
2) Anti-Reflux surgery
3) Lifestyle modification

Question 8

What are the potential problems of either an anterior or posterior ulcer haemorrhage?

Answer 8

1) Anterior: Acute peritonitis

2) Posterior: Pancreatitis

Question 9

What ways are the stomach mucin-layer broken down and cause gastritis?

Answer 9

1) Mucosal Ischaemia
2) H. Pylori
3) Aspirin/NSAIDs
4) Increased acid or Bile reflux
5) Alcohol

Question 10

How is gastritis treated?

Answer 10

1) Enteric-coated aspirin
2) H2RA
3) PPI
4) Reduction of mucosal ischaemia

Question 11

What are the main causes of malabsorption?

Answer 11

1) Defective I-L digestion
2) Insufficient absorptive area
3) Lack of digestive enzymes
4) Defective endothelial transport
5) Lymphatic absorption

Question 12

How does pancreatitis cause malabsorption?

Answer 12

Pancreatic insufficiency arises so lack of pancreatic digestive enzymes, so defective I-L absorption which leads to malabsorption

Question 13

What can result in defective I-L absorption?

Answer 13

1) P Ins: Lack of digestive enzymes (pancreatic enzymes and CF)
2) Bacterial Overgrowth
3) Defective bile secretion from biliary obstruction and ileal resection

Question 14

What can cause insufficient absorptive areas?

Answer 14

1) Coeliac disease
2) Crohn’s disease
3) Extensive parasitisation
4) Small intestinal resection

Question 15

What is an example of lack of digestive enzyme?

Answer 15

Lactose Intolerance: Disaccharide enzyme deficiency

Question 16

What can cause lymphatic obstruction?

Answer 16

1) Lymphoma

2) TB

Question 17

What are the main components in gallstones and investigations?

Answer 17

Bile pigment, cholesterol and phospholipids

INV: ERCP and Ultrasound

Question 18

What disorders can gallstones cause?

Answer 18

Acute pancreatitis, Duct obstruction

Question 19

What are the main risk factors for gallstone development?

Answer 19

Gender (Female), Weight and Fertility

Question 20

How can gallstones be removed from the gallbladder?

Answer 20

Laparoscopic cholecystectomy

Question 21

What are the main complications of gallstones in the bile duct?

Answer 21

1) Biliary Pain
2) Obstructive Jaundice
3) Pancreatitis
4) Cholangitis (Infection of the biliary tract)

Question 22

What is ascending cholangitis?

Answer 22

Infection of the biliary tract leading to bacterial infection

Question 23

What is Charcot’s triad?

Answer 23

Triad describing the three main common symptoms of AC:

1) RUQ pain
2) Fever
3) Jaundice (Cholestatic)

Question 24

What investigations may be conducted for someone that has ascending cholangitis?

Answer 24

Ultrasound, Blood Test(LFT), ERCP (definitive investigation)

Question 25

What is the treatment for ascending cholangitis?

Answer 25

IV fluid, IV antibiotics, ERCP to remove any stones and stenting

Question 26

What is the difference between ascending cholangitis and acute cholecystitis?

Answer 26

A patient with cholangitis has jaundice

Question 27

What is acute cholecystitis?

Answer 27

Inflammation of the gall bladder caused by blockage of the bile duct -> obstruction to bile emptying.

Question 28

What are the main symptoms of acute cholecystitis?

Answer 28

1) RUQ pain
2) Raised inflammatory markers
3) Fever
[Obesity and Diabetes are RF]

Question 29

What is biliary colic?

Answer 29

“Gallbladder attack” - RUQ pain from gallstone blocking the bile duct
(Triggered by eating a heavy meal with high fat content)

Question 30

What are primary features and the PP of primary sclerosing cholangitis?

Answer 30

PF: Itching, Rigor, Pain and Jaundice (IBD in 75%)
PP: Bile duct gets inflamed, strictures and hardening, progressive obliterating fibrosis of bile duct branches –> Cirrhosis –> Liver failure