Gastroenterology

Question 1

Define adynophagia?

Answer 1

Difficulty swallowing entirely

Question 2

Define dysphagia?

Answer 2

Problematic swallowing

Question 3

What causes dysphagia?

Answer 3

STRUCTURAL ABNORMALITIES: pharyngeal pouch, oesophagitis, benign/ malignant strictures, extrinsic pressure (goitre)
MOTILITY DISORDERS: achalasia, oesophageal spasm, bulbar palsy, pseudobulbar palsy, systematic sclerosis

Question 4

What is gastro - oesophogeal reflux disease (GORD)?

Answer 4

Dysfunction of lower oesophageal sphincter predisposing to the reflux of acid up into the oesophagus.
Associated with pregnancy, obesity, alcohol, smoking, hiatus hernia, helicobacter pylori

Question 5

What are the symptoms of GORD?

Answer 5

heartburn, odynophagia, increased salivation, acid reflux, belching

Question 6

How can GORD be managed?

Answer 6

LIFESTYLE - weight loss, smoking and alcohol cessation, raise head of bed, avoid eating before bed
MEDICATION - antacids (gaviscon), proton pump inhibitors (omeprazole), H2 antagonists (ranitidine)
GASTROSCOPY - if symptoms persist

Question 7

What complications can occur with GORD?

Answer 7

Benign strictures
Barretts oesophagus
Oesophageal cancer

Question 8

What is Barretts oesophagus?

Answer 8

Metaplastic change of the distal oesophageal epithelium from squamous to columnar type.
Results in an upward migration of squamocolumnar junction.
Increased risk of adenocarcinomas
If dysplastic changes are found, affected tissue is removed by oesophageal resection or mucosal ablation.

Question 9

What is peptic ulcer disease?

Answer 9

A break in the lining of the stomach (most commonly in the lesser curve), first part of the small intestine, or occasionally the lower oesophagus.

Question 10

What are the symptoms of peptic ulcer disease?

Answer 10

Epigastic pain after or before meals, relief with antacids
Heartburn
Belching
Nausea
Recent onset, progressive symptoms:
Anaemia
Weight loss
Anorexia
Difficulty swallowing
Melaena or haematemesis

Question 11

What causes peptic ulcer disease?

Answer 11

Infection by helicobacter pylori (increased gastric acid secretion, gastric metaplasia, immune response, mucosal defence systems)
Drugs - NSAIDs, steroids, bisphosphonates
Hormonal - Zollinger Ellison syndrome
Association with alcohol, smoking, stress, blood group O

Question 12

What are the treatments for peptic ulcer disease?

Answer 12

Adjust lifestyle
Cessation of causative medication
H. pylori eradication
Proton pump inhibitors
H2 receptor antagonists

Question 13

What are the 2 types of upper GI bleeding?

Answer 13

Haematemesis ( vomiting blood)

Melaena (blood in poo)

Question 14

What are the causes of upper GI bleeds?

Answer 14

Oesophagitis
Gastritis
Peptic ulcer disease
GI malignancy
Bleeding disorders
Angio dysplasia
Drugs - NSAIDs, steroids, anticoagulants, thrombocytis

Question 15

What supplies the liver with oxygen and nutrients?

Answer 15

25% from hepatic artery - supplies 02

75% from hepatic vein - supplies nutrients

Question 16

How do you manage an upper GI bleed?

Answer 16

ABC + Urgent OGD

Question 17

What is Coeliacs disease?

Answer 17

An automimmune condition in which there is inflammation of the proximal small bowel mucosa.
Improves when pt maintains gluten - free diet
More common in N. Europeans and mostly in 40’s

Question 18

What are the clinical features of Coeliacs disease?

Answer 18

Diarrhoea steatorrhoea (fat in poo)
Abnormal pain and bloating
Weight loss
Oral ulceration and angular chelitis

Question 19

What is the treament for Coeliac disease?

Answer 19

Maintain gluten free diet

Question 20

What investigations can be done to diagnose Coeliacs disease and what pathology would you find?

Answer 20

INVESTIGATIONS - bloods, jejunal / duodenal biopsy

PATHOLOGY - villous atrophy, crypt hyperplasia, chronic inflammatory lymphocytic infiltration within the epithelium

Question 21

What are the 2 types of Inflammatory bowel disease (IBD)?

Answer 21

Crohns disease

Ulcerative Colitis

Question 22

What are the causes of IBD?

Answer 22

Thought to be 3 interactive factors:
genetic susceptibility
environmental factors
host immune response

Question 23

What is Ulcerative Colitis?

Answer 23

One type of IBD that causes inflammation and ulcers in your digestive tract.
Inflamation can be in rectum alone (proctitis) or can extend to involve descending colon or whole colon.
More common in caucasions, males and onset 30 yrs old

Question 24

What are the clinical symptoms of Ulcerative Colitis

Answer 24

Diarrhoea with blood and mucus
Tenesmus (need for the toilet)
Lower abdominal discomfort
Malaise, anorexia, fever, lethargy
Oral ulceration

Question 25

How is IBD investigated (Ulcerative colitis and Crohns)?

Answer 25

``` Blood tests - iron deficiency, increase CRP/WBC Barium enema Colonoscopy MRI Biopsy ```

Question 26

How do you manage Ulcerative colitis?

Answer 26

Aminosalicylates (eg. 5 ASA or axathiopine if resistant) Rectal corticosteroid preparations as foam / enema Oral cortcosteroids Surgery - subtotal colorectomy with end ileostomy and preservation of rectum

Question 27

What is Crohns Disease?

Answer 27

One type of IBD, a chronic inflammatory disease of the intestines, especially the ascending colon and terminal ileum, associated with ulcers and fistulae. More commons in Caucasions and in females, 30 yrs onset

Question 28

What is a skip lesion?

Answer 28

Occurs in Crohns Disease when multiple areas are affected and there are skip lesions with normal mucosa in between affected areas.

Question 29

What are the clinical symptoms of Crohns Disease?

Answer 29

Abdominal pain Diarrhoea Weight loss Oral lesions (labial swelling and ulcerations) Perianal lesions ( fissures, skin tags, abscesses)

Question 30

How do you manage Crohns Disease?

Answer 30

``` Smoking cessations Treat diarrhoea / anaemia Oral cortcaosteroids Azathioprine Biological agents - infliximab Surgery - stricturoplasty, resection with end to end anastomosis but recurrence rates high. ```

Question 31

What are the similarities between Ulcerative colitis and Crohns Disease?

Answer 31

Both associated with arthropathy, uveitis (swelling in the eye), primary sclerosing, erythema, pyoderma gangrenosum (bacterial infection), increased risk of carcinoma

Question 32

What are the differences between Ulcerative colitis and Crohns disease?

Answer 32

UC - limited to colon CD - any part of tract mouth to anus UC - continuous inflammation CD - patchy inflammation UC - mucosa and submucosa inflammations CD - transmural inflammation UC - superficial inflamation CD - deep ulcers, fistulae, abscesses and stricturing UC - no granulomas CD - granulomas present UC - polyps common CD - polyps rare UC - smoking decreases risk CD - smoking increases risk UC - blood diarrhoea most prominant CD - abdominal pain most prominent

Question 33

What is Irritable bowel syndrome (IBS)?

Answer 33

A functional bowel disorder in which no organic cause is known but likely to be a disorder of the intestinal mobility / enhanced visceral perception Affects females more and roughly 20-40 yrs

Question 34

What are the symptoms of IBS?

Answer 34

Abdominal bloating Central and lower abdominal pain Pain relieved by defecation Altered bowel habits

Question 35

What is the treatment for IBS?

Answer 35

Antispasmodics eg. mebeverine Treat constipation and diarrhoea Tricyclic antidepressants

Question 36

What is constipation and what causes it?

Answer 36

Infrequent passage of hard stool with straining or discomfort during defecation CAUSES - poor diet, dehydration, immobility, IBS, elderly

Question 37

What is diarrhoea and what causes it?

Answer 37

Increased watery stools, increased frequency and looseness Acute 14 days Chronic > 3 months CAUSES - gastroenteritis, IBS, IBD, coeliac disease, colorectal cancer, drugs (antibiotics, laxatives, proton pump inhibitors, NSAIDs)