Gastroenterology

Question 1

Where does pain present in Appendicitis

Answer 1

Originates in the umbilical area and migrates to RIF

Question 2

Investigations for suspected Appendicitis

Answer 2

US
Bloods - FBC, U&E, CRP
Pregnancy test - Rule out ectopic

Question 3

Rx for Appendicitis

Answer 3

Surgical Excision - Appendectomy

Question 4

Complication of Appendicitis

Answer 4

Peritonitis

Question 5

GORD Signs and Symptoms

Answer 5

Oesophageal/ Extra-Oesophageal

Oesophageal 
􀁸 Heartburn
􀂃 Related to meals
􀂃 Dysphagia 
􀂃 Relieved by antacids
􀁸 Belching
􀁸 Acid brash, water brash
􀁸 Odonophagia

Extra-oesophageal
􀁸 Nocturnal asthma
􀁸 Chronic cough
􀁸 Laryngitis, sinusitis

Question 6

Causes of GORD

Answer 6

Hiatus hernia - Rolling and sliding
Oesophagitis
Lower oesophageal sphincter angle - Inherited

Question 7

Treatment of GORD

Answer 7

Medical
Surgical
Conservative

Question 8

Medical GORD Tx

Answer 8

Anatacids - Aluminium hydroxide,
H2 Receptor antagonists - Ranitidine
PPI-Omeprazole/Lansoprazole

Question 9

Surgical GORD Tx

Answer 9

Nissen’s fundoplication

Question 10

Conservative management for GORD?

Answer 10

Education
Weight loss
Sleeping adjustments - Raising head of bed
Avoiding triggers - Large meals, smoking, hot drinks, spicy foods, reduce alcohol.
Drug cessation
Small regular meals

Question 11

Complications of GORD

Answer 11

Barrets Oesophagus
Oesophageal Ca
Benign Stricture -> Dysphagia
Ulceration 
Oesophagitis

Question 12

GORD Risk factors?

Answer 12

Smoking 
Excessive alcohol
Excessive coffee
Obesity 
Pregnancy
Drugs - CCB, TCA, Antimuscarinic, Nitrates
Iatrogenic - Heller's Myotomy

Question 13

ALARM SYMPTOMS

Answer 13

Unintentional weight loss
Dysphagia 
Haematemesis
Melena
Anorexia

Question 14

GORD Pathophysiology

Answer 14

Abnormal reflux of stomach acid into the oesophagus damaging the squamous lining causing discomfort.

LOS dysfunction -> Gastric reflux contents -> oesophagitis

Question 15

GORD Investigations (Ix)

Answer 15

􀁸 Isolated symptoms don’t need Ix

􀁸 Bloods: FBC

􀁸 CXR: hiatus hernia may be seen

􀁸 OGD if:
􀂃 >55yrs
􀂃 Symptoms >4wks
􀂃 Dysphagia
􀂃 Persistent symptoms despite Rx

or <55 with ALARM symptoms

􀁸 Ba swallow: hiatus hernia, dysmotility
􀁸 24h pH testing ± manometry
􀂃 pH <4 for >4hrs

Question 16

GORD Differentials

Answer 16

􀁸 Oesophagitis
􀂃 Infection: CMV, candida
􀂃 IBD
􀂃 Caustic substances / burns
􀁸 PUD
􀁸 Oesophageal Ca

Question 17

Differentials for R Hypochondriac Pain

Answer 17

• Pancreatitis.
• Ulcer (gastric).
• Gallstones.
• Biliary colic.

Question 18

Differentials for L Hypochondriac Pain

Answer 18

• Pancreatitis.

* Ulcer (gastric or duodenal).

Question 19

Differentials for Epigastric Pain

Answer 19

• Heartburn.
• Pancreatitis.
• Epigastric hernia.
• Gallstones.
• Ulcer (gastric).

Question 20

Differentials for Hyogastric Pain

Answer 20

• Urinary tract infection.
• Appendicitis.
• IBD.
• Diverticular disease.

Question 21

Differentials for R Illac Pain

Answer 21

• Appendicitis.
• Ectopic pregnancy.
• Ovarian torsion.
• Inguinal or femoral hernias.

Question 22

Differentials for L Illac Pain

Answer 22

• Diverticular disease. 
• IBD.
• Ectopic pregnancy. 
• Ovarian torsion.
• Diverticular disease.
Umbilical region
• Inguinal or femoral hernias.

Question 23

Differentials for R Lumbar Pain

Answer 23

• Kidney stones.
• Urinary tract infection.
• Constipation.

Question 24

Differentials for L Lumbar Pain

Answer 24

• Kidney stones.
• Urinary tract infection.
• Constipation.
• Inflammatory bowel disease
• Diverticular disease.

Question 25

Differentials for Umbilical Pain

Answer 25

* Gastric ulcer. * Early stages of appendicitis. * Aortic aneurysm. * Ruptured aortic aneurysm. * Pancreatitis. * IBD.

Question 26

Causes for Upper GI Bleeds

Answer 26

``` Gastritis Oesophageal varices Peptic ulcers Mallory Weiss tears Maliganancy ```

Question 27

Causes for Lower GI Bleeds

Answer 27

``` Haemorrhoids Polyps Malignancy Angiodysplasia IBD - CR/UC Diverticulitis Infectious diarrhoea ```

Question 28

Causes of GI Malabsorption

Answer 28

DT CAP ``` Disaccharidase deficiency Tropical sprue Coeliac & Crohns A-beta-lipoproteinaemia Pancreatic insufficiency ```

Question 29

Define Coeliac Disease

Answer 29

• An autoimmune disorder caused by an abnormal immune response to dietary gluten.

Question 30

Coeliac Disease Ix?

Answer 30

Bloods - Antibodies - Anti-TTG, Anti- EMA, Anti-Gliadin, IgA, IgG(in IgA deficient) Stool Culture - To exclude Giardia OGD -

Question 31

Coeliac Disease Complications

Answer 31

GLIAD G - GI Malabsorption L - Lymphoma and Carcinoma (T Cell, small bowel adenocarcinoma, breast/bladder ca) I - Immune Associations (IgA deficiency, T1D, PBC) A - Anaemia D - Dermatological

Question 32

Coeliac Disease Signs and Symptoms [ Name 10 ]

Answer 32

``` Fatigue, Weakness Weight loss, Abdominal pain, Diarrhoea Flatus Abdo distension + colic N/V Anaemia Steatorrhea Hyperoxaluria - Renal Stones ```

Question 33

Coeliac Disease Tx

Answer 33

Strict lifelong GF diet. Avoid: barley, rye, oats, wheat OK: Maize, soya, ric

Question 34

What molecules are malabsorbed due to coeliac's

Answer 34

``` Carbohydrates Fats Proteins Vitamins - D,K,Ca, B2, B1, B6 Haematinics - Folate, Fe ```

Question 35

Pathophysiology of Coeliac

Answer 35

Autoimmune response to gliadin in gluten | CD8+ Mediated

Question 36

What Genes are common with people suffering from Coeliac Disease

Answer 36

HLA-DQ2 & DQ8

Question 37

What organism causes giardiasis?

Answer 37

Giardia lamblia

Question 38

What are some features of Giardiasis | 7 Things

Answer 38

``` Asymptotic Bloating Abdominal pain Flatulence Non-bloody diarrhoea Chronic diarrhoea Malabsorption / Lactose intolerance ```

Question 39

What is the most common cause of travellers diarrhoea

Answer 39

E. coli

Question 40

Tx for Giardisis?

Answer 40

Metronidazole