Gastroenterology

Question 1

Red flags for admission with lower GI bleeding

Answer 1

Age >60
Active bleeding
Aspirin or NSAID use
Reduced Hb
Haemodynamic compromise
Pt has liver disease/heart disease

Question 2

When to test for H pylori

Answer 2

Dyspepsia sx predominate
Pt from high risk area
-South Auckland/Porirua/East Cape
-India
-Asia
Pt ethnicity is Maori/Pacific/Asian/Indian

Question 3

Red flags for dyspepsia

Answer 3

Malignancy:
FHx gastric cancer <50yo
Unexplained weight loss
Progressive oesophageal dysphasia
Abdominal mass
Iron deficiency anaemia
Protracted vomiting or persistent regurgitation of food
Age >55 with persistent heartburn

Bleeding:
Malena
Prev PUD
Anticoagulant use
NSAID use

Question 4

Constipation medical causes

Answer 4

Depression
Dehydration
Hypercalcaemia/hypokalaemia
Hypothyroidism
Diabetes
Parkinsons/MS
GI obstruction
Coeliacs
IBD/IBS
Damage to pelvic floor muscles

Question 5

Medication causes of constipation

Answer 5

Anticholinergics/Antihistamines/oxybutynin
Antidepressants esp TCAs
Antipsychotics eg clozapine
Ondansetron
Parkinsons meds
Calcium supplements + Ca channel blockers
Opiates
Diuretics
Antispasmodics
Antacids
Iron
PPI

Question 6

Assessment of upper GI bleed severity

Answer 6

Rockall: (mortality risk assess)
age, HR, BP, co-morbidities
Glasgow-Blatchford: (?OP mgmt assess)
Hb, urea, sex, BP, HR, syncope, malena, hepatic failure, cardiac failure

Question 7

Types of laxatives with examples and MOA

Answer 7

Bulk forming:
-any fibres
-konsyl-D/metamucil
Stimulant:
Increases intestinal motility
-laxsol
-fleet
-bisacodyl
-glycerol
Softeners:
-laxsol
Osmotic:
(draws fluid into large bowel contents)
-lactulose
-microlax
-movicol
-fleet
-glycerol