GI

Question 1

When do polyps develop in people with FAP?

Answer 1

Begin in puberty, by 30 can have 100s to 1000s
Mostly in descending colon and rectum
By 40 most will develop colorectal cancer
By 50 all of them will have

Question 2

What are extra GI manifestations found in FAP?

Answer 2

Osteomas (benign bone tumours)
Jaw cysts
Sebaceous cysts
Collectively known as Garderner’s syndrome

Question 3

What symptoms do polyps in FAP cause?

Answer 3

If large cause obstruction to intestine, abide pain and constipation
Can ulcerate, GI bleeding, iron deficiency anaemia

Question 4

What are the layers of the mucosa?

Answer 4

Epithelial (absorbs and secretes mucus and enzymes)
Lamina propria (blood and lymph vessels)
Muscularis mucosa (smooth muscle contracts/breaks down food?

Question 5

What are nonocclusive causes of bowel ischaemia? (mucosal infarcts)

Answer 5

Hypovolemia (haemorrhage or dehydration)

Low cardiac output (post MI)

Question 6

What is seen on an abdo CT in bowel ischaemia?

Answer 6

Bowel dilation
Bowel wall thickening
Intestinal pneumatosis

Question 7

What is intussusception?

Answer 7

When a part of the intestine folds in on itself causing obstruction
Most common cause of obstruction in infants
Ileocecal region (ileum fold into cecum)
Caused by: polyps/tumors (adults)
Lymphoid hyperplasia (babies)
Meckel’s diverticulim
Idiopathic

Question 8

What are the risk factors for intussusception?

Answer 8

Having had one previously
Having a sibling with intussusception
Having intestinal malrotation

Question 9

What are the signs of intussusception?

Answer 9

Intermittent abdominal pain 
Guarding 
Vomiting 
Hard, sausage like mass in abdomen 
Iscahemia- infarction 
Red currant jelly stool 
Sepsis, fever 
Obstruction  - large mass 
Volvulus

Question 10

What does intussusception look like on imaging?

Answer 10

A Bulls-eye telescoped intestine on end

Question 11

What is a volvulus?

Answer 11

An obstruction caused by a loop in the intestines that twists around itself and surrounding mesentery
Sigmoid, cecal and midgut are the most common

Question 12

When do sigmoid volvulus’ occur?

Answer 12

Pregnancy
Middle-aged and elderly- constipation (Hirschsprung)
Abdominal adhesions

Question 13

When do cecal volvulus’ occur?

Answer 13

Abdominal mesentery didn’t develop normally
Colon can flop around freely
Fetus/stool

Question 14

When do midgut volvulus’ occur?

Answer 14

Babies and small children

Abnormal intestinal development

Question 15

What are the complications of a volvulus?

Answer 15

Bowel obstruction
Infarction
Sepsis (cardiovascular collapse)

Question 16

What does a volvulus look like on imaging?

Answer 16

Abdo x-ray- Looks like a bent inner tube/coffee bean

Barium enema- birds beak

Question 17

What causes colonic diverticular?

Answer 17

Low fibre diet
Fatty foods and red meat
Marfan syndrome and Ehlers danlos

Question 18

What causes diverticulitis?

Answer 18

Ledged fecalith
Erosion (from high pressures)
Not associated with rectal bleeding (diverticulosis)
Fistula (cosovesicular (bladder))

Question 19

What causes appendicitis?

Answer 19

Obstruction: fecalith, seeds, pinworm infections, lymphoid hyperplasia

Question 20

What occurs if the appendix ruptures?

Answer 20

Peritonitis- rebound tenderness abdominal guarding

Abscess (periappendical)

Question 21

What can trigger symptoms of IBS?

Answer 21

Fructose and lactose
Visceral hypersensitivity
Diarrhoea/flatus

Question 22

What is a risk factor for IBS?

Answer 22

Gastroenteritis (norovirus, rotavirus)

Stress