Gastro 1A

Question 1

Define constipation

Answer 1

bowel movements that occur less than three times a week

Question 2

what medications can cause constipation ?

Answer 2

opiates, antiepileptics and antidepressants

Question 3

management of constipations?

Answer 3

Bulk forming laxative: Isphagula husk
Osmotic laxative e.g. lactulose and macrogols
Treating faecal impaction: high dose osmotic laxative, suppository (bisacodyl) or an enema (docusate sodium)

Question 4

'’head to toe’’ screening Qs for overdose?

Answer 4

Neurological symptoms: confusion, drowsiness, visual changes
Respiratory symptoms: Shortness of breath, wheeze
Cardiac symptoms: Chest pain, Palpitations
Gastrointestinal symptoms: diarrhoea, constipation, vomiting

Question 5

what is dyspepsia?

Answer 5

Heartburn and bloating that can happen after eating

upper abdo pain/discomfort, acid reflux, nausea and vomiting

Question 6

common causes of dyspepsia?

Answer 6

peptic ulcer disease
GORD

Question 7

what are the key symptoms YOU NEED TO ASK about in features of dyspepsia?

Answer 7

ALARMS:
ANAEMIA
LOSS OF WEIGHT
ANREXIA
RECENT ONSET PROGRESSIVE SYMPTOMS
MASSESS/MAELENA/ HAEMATEMESIS
SWOLLOWING DIFFICULTIES

(alarms or over 55= upper GI endoscopy)

Question 8

differential diagnosis for dyspepsia?

Answer 8

gastroenteritis
IBS
upper GI malignancy

Question 9

what is gastritis and its most common cause?

Answer 9

inflammation of the inner lining of the stomach
infection with helicobacter pylori is the most common cause

Question 10

pathophysiology of gastritis?

Answer 10

bacteria stimulates toxins which activate inflammatory cells this in turn leads to gastritis and destroys acid producing glands

Question 11

what test for H.pylori?

Answer 11

faecal antigen test and urea breath test (PPIs should be stopped 1-2 weeks beforehand to not interfere with test

Question 12

eradication therapy for H.pylori?

Answer 12

omeprazole and two antibiotics, classically amoxicillin and clarithromycin

In patients who are penicillin-allergic, the regime would consist of a PPI, clarithromycin and metronidazole.

Question 13

what medications can cause GORD?

Answer 13

NSAIDs, bisphosphonates and steroids

Question 14

what can cause gastroenteritis?

Answer 14

viruses: Norovirus and Rotavirus
Bacteria: E.coli, salmonella, shigella and campylobacter

Question 15

norovirus affects on body (gastroenteritis)

Answer 15

mild fever
lethargy
headache
vomiting
stomach pain
symptoms appear after 12-48hrs after initial infection
symptoms last 1-3 days and virus contagious for up to 2 weeks

Question 16

symptoms of gastroenteritis?

Answer 16

abdo pain/cramping
watery diarrhoea
low grade fever
dehydration
inability to keep fluids down
vomiting
frequency to open bowels

Question 17

define haemorrhoids?

Answer 17

enlarged blood vessels (veins) in the anal canal

Question 18

haemorrhoids red flag symptom?

Answer 18

A change in bowel habit with painless rectal bleed or tenesmus is a red flag!

Question 19

what is the special test used for haemorrhoids?

Answer 19

proctoscopy
colonoscopy
flexible sigmoidoscopy

Question 20

what is infectious diarrhea defined as?

Answer 20

acute onset of 3 or more episodes of over 200g of loose/liquid stools within 24 hours,

Question 21

symptoms of infectious diarrhoea?

Answer 21

food and water intake
recent travel history
medication history- antibiotics

Question 22

management of infectious diarrhoea?

Answer 22

oral rehydration therapy
Medical: loperamide (if no fever or blood in stool)
antibiotics only if diarrhoea over 7 days and high grade fever

Question 23

Irritable bowel syndrome symptoms?

Answer 23

abdo pain
constipation/diarrhoea
bloating
fatigue
nausea
incontinence
ask about diet/triggers
RED FLAGS: PR BLEEDING, UNINTENDED WEIGHT LOSS, >50 YEARS, MALAENA

Question 24

what test differentiates between IBS and IBD

Answer 24

faecal calprotectin

Question 25

what is a peptic ulcer?

Answer 25

break in the lining of the stomach

Question 26

types of peptic ulcers?

Answer 26

duodenal ulcers
gastric ulcers
These are diffrentiated by location

Question 27

difference in symptoms between gastric ulcers and duodenal ulcers

Answer 27

gastric: pain increases while eating and weight loss

duodenal ulcers: pain eased by eating and weight gain

Question 28

when should you report assessment for IBS

Answer 28

You shoulder consider an assessment for IBS if a patient reports having any of the following symptoms for 6 months: Abdominal pain or discomfort or bloating or change in bowel habit.