Gastrointestinal COPY

Question 1

What is Barrett’s oesophagus?

Answer 1

• metaplasia of lower oesophagus mucosa
• stratified squamous to columnar epithelium with goblet cells

Question 2

Risk factors for Barrett’s oesophagus

Answer 2

• GORD
• male
• caucasian
• family history
• hiatus hernia
• obesity
• smoking
• alcohol

Question 3

Presentation of Barrett’s oesophagus

Answer 3

classic history = middle aged caucasian male with long history GORD and dysphagia

Question 4

Investigations for Barrett’s oesophagus

Answer 4

• oesophago-gastro-duodenoscopy
• biopsy

Question 5

Management of Barrett’s oesophagus

Answer 5

• lifestyle changes
• endoscopic surveillance with biopsies
• high dose PPIs
• dysplasia → endoscopic mucosal resection, radiofrequency ablation
• severe = oesophagectomy

Question 6

What lifestyle changes are needed in Barrett’s oesophagus?

Answer 6

• weight loss
• smoking cessation
• reduce alcohol
• small regular meals
• avoid hot drinks/alcohol/eating <3hrs before bed
• avoid nitrates, anticholinergics, TCAs, NSAIDs, K+ salts, alendronate

Question 7

What are psuedo-bowel obstructions?

Answer 7

• identical presentation to SBO or LBO → depends on location
• entire bowel can be obstructed → both presentations

Question 8

Causes of psuedo-bowel obstructions

Answer 8

• intra-abdominal trauma-
• post-op states eg paralytic ileus
• intra-abdominal sepsis
• drugs eg opiates, antidepressants
• electrolyte imbalances

Question 9

Treatment of pseudo-bowel obstructions

Answer 9

treat underlying cause

Question 10

What are the 3 main types of ischaemic bowel disease?

Answer 10

• acute mesenteric ischaemia → SB
• chronic mesenteric ischaemia → SB
• ischaemic colitis → LB

Question 11

What areas are most susceptible to ischaemia?

Answer 11

watershed areas

• splenic flexure
• caecum

Question 12

Causes of AMI

Answer 12

• SMA thrombosis
• SMA embolism due to AF
• mesenteric vein thrombosis
• non-occlusive disease → poor blood flow/CO

Question 13

Presentation of AMI

Answer 13

classic triad

• acute, severe abdominal pain → constant, central
• no abdominal signs on exam
• rapid hypovolaemia → shock

AF and sever abdominal pain = AMI

Question 14

Diagnosis of AMI

Answer 14

blood

• high Hb
• metabolic acidosis

abdominal xray → rule out obstruction

laparoscopy → visualise necrosis

CT/MRI angiography → visualise blockages in arteries

Question 15

Management of AMI

Answer 15

• fluid resuscitation
• Abs → metronidazole, gentamicin
• IV heparin
• surgery → remove necrotic bowel

Question 16

Complications of AMI

Answer 16

• sepsis
• peritonitis

Question 17

Chronic mesenteric ischaemia

Answer 17

• very similar to AMI
• symptoms on a lower level, persist for much longer
• abdominal angina

Question 18

Causes of IC

Answer 18

• thrombosis, emboli
• low flow states → low CO, arrhythmias
• surgery
• vasculitis
• coagulation disorders
• the pill
• idiopathic

Question 19

Presentation of IC

Answer 19

• sudden onset LIF pain
• passage of bright red blood
• signs of hypovolaemic shock

Question 20

Diagnosis of IC

Answer 20

• urgent CT → rule out perforation
• flexible sigmoidoscopy with biopsy
• barium enema

GOLD STANDARD = colonoscopy with biopsy

• after recovery
• exclude strictures at site, confirm mucosal healing

Question 21

Management of IC

Answer 21

• most patients fine with symptomatic treatment
• fluid replacement
• Abs

Question 22

Gangrenous IC

Answer 22

• peritonitis and hypovolaemic shock
• surgery