GI

Question 1

Hirschsprungs disease

Answer 1

No ganglion cells in myenteric plexus.
Obstruction in babies.
RET proto-oncogene Cr10+, assoc with Down’s.
Hypertrophied nerve fibres, no ganglia.
Tx: resect affected (constricted) segment.

Question 2

Mechanical lower GI diseases

Answer 2

All obstruction:
- Constipation
- Diverticular disease
(Meckel’s = “true”, all layers, before 2yo. rule of 2s)
- Adhersions, external masses, herniation
- Intussusception, volvulus (small bowel in small children, sigmoid in ederly)

Question 3

Diverticular disease

Answer 3

V common due to low fibre diet, high pressure.
90% in left colon.
Often ASx, ?PR bleed.
Complications: diverticulitis, perf, fistula, obstruction.

Question 4

Inflammatory Bowel Disease

Answer 4

20s, White, Unknown aetiology. 
Extra-GI: 
- Malabsorption: Fe def, stomatitis; 
- Eyes: Uveitis, conjunctivitis; 
- Skin: pyoderma gangrenosum, erythema nodosum (tender); 
- Joints 
- Liver: pericholangitis, PSC.

Question 5

Crohn’s disease

Answer 5

Smoking makes it worse.
Whole GI tract, whole thickness (transmural), skip lesions, Cobblestone. Aphthous ulcer, rosethorn ulcers. Non-caseating granulomata.
Intermittent diarrhoea (no blood), fever, pain.
Strictures, fitulae, abscesses, perforation.
Ix: CRP, ESR, Barium contrast, Endoscopy.
Mx: Pred / IV hydrocortisone / metronidazole. ?immunosupressors.

Question 6

Ulverative Colitis

Answer 6

Starts in rectum, spreads continuously, doesn’t reach small bowel (unless backwash ileitis). Superficial, no structural problems other than pseudopolyps.
Bloody diarrhoea. mucus, pain relieved by defaecation.
Sever haemorrhage, toxic megacolon, ?adenoCa.
Ix: rectal biopsy, AXR, stool culture.
Tx: Pred + mesalazine.

Question 7

Carcinoid syndrome

Answer 7

Diverse group of tumours of enterochromaffin cell origin. Usually bowel.
Produce Serotonin, so get carcinoid syndrome.
Bronchoconstriction, flushing, diarrhoea.
Ix: 24hr urine 5-HIAA.
Tx: Octreotide.

Question 8

Adenoma of colon / rectum

Answer 8

Benign dysplasia, may become adenoCa.
50% >50yo have them, mainly asymptomatic.
Malingnancy RF: large, dysplastic, villous.

Question 9

Peutz-Jeghers syndrome

Answer 9

Dominant, LKB1.
Multiple GI polyps, freckles around mouth, palms and soles.
More intussusception and malignancy, so watch GI tract.

Question 10

Colon cancer

Answer 10

98% adenoCa. 60-79yo. (Familial if

Question 11

Duke’s staging

Answer 11

Colon cancer. 
 A  : mucosa     (>95% % year survival)
 B1 : muscularis propria 
 B2: transmural 
 C1 : muscularis propria + LN 
 C2: transmural + LN 
 D  : distant metastases  (

Question 12

GORD

Answer 12

Commonest cause of oesophagitis.
Ulceration, haemorrhage, Barrett’s, stricture, perforation.
Los Angeles classification.
Tx: weight, stop smoking, PPIs.

Question 13

Barrett’s oesophagus

Answer 13

After chronic GORD, columnar epithelium moves up.
10% symptomatic GORD become this.
30x risk of adenoCa.
Tx: endoscopic resection.

Question 14

Oesophageal adenoCa

Answer 14

Common.
RF: smoking, obesity, radiotherapy, male.
Usually distal 1/3 because assoc with Barrett’s.

Question 15

Squamous cell oesophageal Ca

Answer 15

Much rarer.
RF: Alcohol, smoking, Afrocab, achalasia of cardia, Plummer-Vinson syndrome, nutritional def, HPV.
Middle 1/3.
Progressive dysphagia, odynophagia, anorexia, weight loss.
Rapid growth, early spread, palliate.

Question 16

Gastritis

Answer 16

Acute (neut): insult - aspirin, NSAIDs, bleach, burns.
Chronic (lymphocytes): H pyori, autoimm, alcohol, smoking.
Can give ulcers, or intestinal metaplasia then dysplasia then cancer.

Question 17

Gastric ulcer

Answer 17

After antral gastritis (H pylori).
Epigastric pain worse with food.
RF: H pylori, smoking, NSAIDs, stress, elderly.
Punched out lesion with rolled margins.
Iron deficiency anaemia, perf, malignancy.

Question 18

Gatric lymphoma

Answer 18

H pylori again!
#Haem
PPI, clarithromycin, amoxicillin.

Question 19

Duodenal ulcer

Answer 19

4x more common than gastric.
Pain, worse at night, better with food and milk.
Younger adults.
Same RF: H pylori, smoking, NSAIDs, steroids.
Same complications: IDA and perf.

Question 20

Coeliac disease

Answer 20

Autoimmune.
Gluten intolerance, villous atrophy, malabsorption.
Irish women.
Sx: steatorrhea, pain, bloating, N+V, weight loss/FTT, fatigue, IDA, rash (dermatitis hepatitis).
Tests: anti-endomysial, anti-TTG.
Best Ix: duodenal biopsy - villous atrophy.
Tx: gluten free diet.
10% progress to duodenal T-cell lymphoma if not treated.