GI 5

Question 1

What is globus/globus pharyngeus?

Answer 1

The medical term for a sensation of a lump in the throat where no true lump exists, commonly with intense emotional experience

Question 2

What is functional dysphagia?

Answer 2

Functional dysphagia is the sensation of solid and/or liquid foods sticking, lodging, or passing abnormally through the oesophagus

Question 3

What is the link between IBS and psychology?

Answer 3

• IBS can be due to emotional stimuli such as stress or abuse
• 32-44% have history of physical or sexual abuse; most trauma during childhood (abuse, neglect, bereavement or serious childhood illness)
• Stress and anxiety can trigger chemical changes that affect the normal workings of the digestive system

Question 4

What is anorexia nervosa?

Answer 4

Self induced significant weight loss leading to (BMI <17.5 kg/m2 – below 15% of expected)/failure to reach expected weight in children due to dietary restriction

Question 5

What are the effects of anorexia nervosa?

Answer 5

• Widespread endocrine abnormality (not in bulimia)
• Decreased Na, K, Mg, PO4, Insulin, Glucose, Thyroid (Secondary to starvation)
• Cardiovascular / arrhythmias
• Bone health
• Amenorrhoea / Loss of sexual interest/potency (Hypothal/Pituitary/Gonadal)
• Elevated GH / Cortisol / Cholesterol

Question 6

What are the causes of anorexia/bulimia nervosa?

Answer 6

• Socio-cultural pressures
• Family dysfunction
• Personal vulnerability factors
• Conflicts relating to sexual maturity
• Biological vulnerability

Question 7

What are the outcomes of surgery in intestinal bowel disease?

Answer 7

• UC is cured by surgery
• Pouches are good but not like rectums
• Crohn’s is managed through surgery but never cured
• Many will need surgery again and again over the years
• Perianal disease is challenging for patients and for us

Question 8

How are infections transmitted during sex?

Answer 8

• Sexual/genital secretions
• Ingestion e.g. shigella
• Fomites e.g. gonorrhoea
• IVDU e.g. HIV and HCV
• Trauma e.g. HCV
• Direct inoculation e.g. HSV

Question 9

How do rectal gonorrhoea and rectal chlamydia spread?

Answer 9

Direct contact of mucosal surfaces with infected secretions. For proctitis: anal sex, transmucosal spread, fomite

Question 10

What is the clinical presentation for rectal gonorrhoea/chlamydia?

Answer 10

• Anal discharge (mucus)
• Anal itch/discomfort
• Rectal bleeding
• Change in bowel habits
• Low abdominal pain
• Associated genito-urinary symptoms
• Can be asymptomatic; gonorrhoea more severe

Question 11

What is the diagnosis/testing for rectal chlamydia/gonorrhoea?

Answer 11

• Examination
• Gram stain of discharges
• C+G PCR
• G cultures
• Comprehensive STI testing at all relevant sexual sites

Question 12

What is the 6 Manning criteria for diagnosis of IBS?

Answer 12

1) Pain relieved with defection
2) More frequent stools at the onset of pain
3) Looser stools at the onset of pain
4) Visible abdominal distension
5) Passage of mucus
6) Sensation of incomplete evacuation

Question 13

When should you reconsider a diagnosis of IBS?

Answer 13

• > 50
• Anorexia/weight loss
• Short history (<6/12) of progressive pain
• Fever
• Anaemia
• Blood in stools
• Mouth ulcers
• Waking at night with pain/diarrhoea

Question 14

What is antimicrobial stewardship?

Answer 14

An organisational or healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness

Question 15

What are the principles of optimum prescribing?

Answer 15

• Start smart: only prescribe if evidence of infection

- Review (stop, switch, change, continue) at 24 and 48 hours

Question 16

How does upper small bowel obstruction present?

Answer 16

• Acute presentation
• Hours of onset
• Large volumes vomited

Question 17

How does distal small bowel / large bowel obstruction present?

Answer 17

• Colicky abdominal pain and distension

- Vomiting (possibly ‘faeculent’)

Question 18

What are the symptoms of intestinal obstruction?

Answer 18

• Vomiting
• Pain
• Constipation
• Distension
• Complete obstruction
• Incomplete obstruction

Question 19

What information can vomit give in an intestinal obstruction?

Answer 19

• The more proximal the obstruction, the earlier vomiting develops
• Nature of vomitus gives clues to the level of obstruction:
• Semi-digested/no bile -> gastric outlet
• Copious bile stained fluid -> small bowel
• Thicker, brown, foul-smelling -> more distal

Question 20

What are the symptoms of incomplete bowel obstruction?

Answer 20

• Less defined clinical features
• Intermittent vomiting/erratic bowel habit
• Peristaltic activity -> bouts of colicky pain

Question 21

What are the physical signs of intestinal obstruction?

Answer 21

• Dehydration
• Abdominal distension
• Visible peristalsis
• Lack of abdominal tenderness
• Palpable obstructing mass
• Resonant centre of abdomen
• High pitched tinkling bowel sounds

Question 22

What are the investigations for a suspected bowel obstruction?

Answer 22

• Supine abdominal x-ray

- CT scan

Question 23

What are the mechanical causes of a bowel obstruction?

Answer 23

• Adhesions or bands
• Incarcerated abdominal wall hernia
• Internal hernia
• Volvolus
• Tumour
• Inflammatory strictures (Crohn’s/DD)
• Bolus obstruction
• Intussusception

Question 24

What is bowel strangulation?

Answer 24

When a segment of bowel becomes trapped so that its lumen becomes obstructed (incarcerated) and its blood supply compromised (strangulated); leads to infarction and perforation

Question 25

What are dynamic bowel obstructions?

Answer 25

• Paralytic ileus: disruption of the normal propulsive activity of the GI tract, due to failure of peristalsis
• Pseudo-obstruction (Ogilvie’s syndrome): acute dilatation of the colon in the absence of colonic obstruction in acutely unwell patients