GI 2

Question 1

What occurs in diffuse gastric adenocarcinoma?

Answer 1

Gastric linitis- leather bottle (submucosa becomes thicker and more rigid)
Signet ring cells in connective tissue

Question 2

What are the characteristics if carcinoid tumours in the stomach?

Answer 2

Neuroendocrine cells
Well differentiated
From mucosa as poly
In intestine and pancreas

Question 3

What are the complications of gastric adenocarcinoma?

Answer 3

Metastasis- peritoneum, lymph nodes (umbilicus, virchows), liver, ovaries (krukenberg)
Paraneoplastic syndromes: leser trelat sign (keratosis), polyarteritis nodosa (kidney failure, MI), trousseau syndrome (migratory thrombosis)
Pseudoachalasia Syndrome (stricture gastroeosophageal junction)

Question 4

What are the anorexia rectal disease differentials?

Answer 4

Haemorrhoids Location: 3, 7, 11 o’clock position
Internal or external
Treatment: Conservative, Rubber band ligation, Haemorrhoidectomy
Fissure in ano Location: midline 6 (posterior midline 90%) & 12 o’clock position. Distal to the dentate line
Chronic fissure > 6/52: triad: Ulcer, sentinel pile, enlarged anal papillae
Proctitis Causes: Crohn’s, ulcerative colitis, Clostridium difficile
Ano rectal abscess E.coli, staph aureus
Positions: Perianal, Ischiorectal, Pelvirectal, Intersphincteric
Anal fistula Usually due to previous ano-rectal abscess
Intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric. Goodsalls rule determines location
Rectal prolapse Associated with childbirth and rectal intussceception. May be internal or external
Pruritus ani Systemic and local causes
Anal neoplasm Squamous cell carcinoma commonest unlike adenocarcinoma in rectum
Solitary rectal ulcer Associated with chronic straining and constipation. Histology shows mucosal thickening, lamina propria replaced with collagen and smooth muscle (fibromuscular obliteration)

Question 5

What are the features of proctitis?

Answer 5

Bright red rectal bleeding and diarrhoea

Nocturnal incontinence

Question 6

What type of cancer is anal cancer typically?

Answer 6

Squamous cell

Sensitive to chemoradiotherapy

Question 7

How does solitary rectal ulcer syndrome present?

Answer 7

Bright red rectal bleeding
IBS
flexible sigmoidoscopy a lesion is biopsied and reported as showing ‘fibromuscular obliteration’.

Question 8

What are rockall scores used for?

Answer 8

Score of 3+ indicates significant upper GI rebelled and mortality of 11%

Question 9

What are pre-endoscopy Rockall scores?

Answer 9

Age 
60-79 = 1 point
≥80 = 2 points
Shock
Tachycardia ≥ 100 = 1 point
SBP < 100 = 2
Co-morbidity
Major = 2 points
CKD/liver failure/ metastatic cancer = 3 points

Question 10

What are post endoscopy rockall scores?

Answer 10

Diagnosis
0 points for M-W Tear
1 for everything else 
2 for malignancy 
Stigmata of bleeding
Score 2 points if blood, a clot of spurting vessel seen

Question 11

What is the Glasgow-blatchford score?

Answer 11

Calculated pre-endoscopy Identify patients for whom outpatient care is suitable
>0 consider admission for endoscopy
6+indicates 50% change fo intervention being required