Gastroenterology

Question 1

Gastric Cancer

Answer 1

Predisposing factors:
✓ Male, smoking, alcohol, lower socio-economic class, more common in individuals with blood group A.
✓ Diet high in salt and nitrates.
✓ Pernicious anaemia, partial gastrectomy, chronic gastritis, Helicobacter pylori.
✓ Gastric polyps.

Question 2

Plummer-Vinson Syndrome

Answer 2

Presents as: dysphagia, iron-deficiency anaemia and oesophageal webs.

Associated with increased risk of squamous cell carcinoma of the pharynx and oesophagus.

Question 3

IBS - Irritable Bowel Syndrome

Answer 3

diagnosis - abdominal pain that is
✓ Related to defecation, and/or
✓ altered stool frequency, and/or
✓ altered stool form/appearance PLUS at least 2 of following (along with exclusion of alternative conditions):
✓ Altered stool passage e.g. straining
✓ Abdominal bloating, distension, or hardness
✓ Symptoms worsened by eating
✓ Passage of rectal mucus

Red flags: unintentional weight loss, rectal bleeding, family history of bowel or ovarian cancer, or a change in bowel habit in a patient over the age of 60 years.
✓ Carry out CA125 in any woman over 50 years who presents with IBS symptoms in the past 1 year.
✓ In people who meet the IBS diagnostic criteria, the following tests should be done to exclude other diagnoses: FBC, ESR, CRP and coeliac screen.