GI and Hepatic Lecture

Question 1

What is dysphagia and what happens when it gets worse?

Answer 1

Difficulty Swallowing

If dysphagia gets worse and theres weight loss it could possibly mean oesophageal cancer

Question 2

What is the difference between dysphagia and neurmouscular dysfunction?

Answer 2

Dysphagia =  Liquids are easier to swallow
NMD = Solids are easier to swallow, cough with swallowing

Question 3

What does Sharp, burning pain on swallowing suggest?

Answer 3

mucosal inflammation

Question 4

What causes a globus sensation?

Answer 4

Pharyngeal dysfunction
GERD
Emotion

Question 5

What are some red flags for globus sensation?

Answer 5

Neck or throat pain
Weight loss
Abrupt onset after age 50
Pain, choking, or difficulty with swallowing
Regurgitation of food
Muscle weakness
Palpable or visible mass
Progressive worsening of symptoms

Question 6

What is Dyspepsia and what is it commonly associated with?

Answer 6

A gnawing, burning, ‘indigestion’ type pain in the upper abdomen

Question 7

What causes Dyspepsia?

Answer 7

Achalasia
Cancer (Oesophageal, Gastric)
Coronary Ischemia
Oesophageal Spasm
GERD
Peptic Ulcer Disease

Question 8

What are some red flags of Dyspepsia?

Answer 8

Acute episode with dyspnoea, diaphoresis*, or tachycardia
Anorexia
Nausea or vomiting
Weight loss
Blood in the stool
Dysphagia 
Medication doesnt work

Question 9

Describe Heartburn

Answer 9

Burning pain behind the sternum
Worsens when lying down, straining, or after eating
Suggests the presence of GERD and acid reflux

Question 10

What could cause acute Acute Nausea and Vomiting?

Answer 10

GI infection
Food poisoning
Drugs
Head trauma/migrane
Abdominal visceral pain
Pregnancy

Question 11

What could cause Chronic Acute Nausea and Vomiting?

Answer 11

Motility disturbance
Endocrine/metabolic disorder
Intracranial pathology
Partial obstruction of GI tract

Question 12

Nausea/Vomiting Red Flags

Answer 12

Signs of hypovolemia
HA
Stiff neck 
Change in mental status
Rebound tenderness
Abdominal guarding
Distended, tympanic abdomen

Question 13

What Types of Abdominal Pain are there?

Answer 13

Referred
Somato-parietal
Visceral

Question 14

Describe visceral pain

Answer 14

Dull, poorly localised pain

Often associated with autonomic features

Question 15

Describe Somato-parietal pain

Answer 15

Originates from parietal peritoneum

More localised than visceral pain

Question 16

What is Peritonitis ?

Answer 16

Inflammation of the peritoneal cavity

Question 17

What would be some signs and symptoms of peritonitis?

Answer 17

Guarding, rigidity, rebound tenderness on examination

Question 18

What is Irritable Bowel Syndrome ?

Answer 18

Abdominal discomfort accompanied by at least two of:
Relief by defecation
Change in frequency of stool
Change in consistency of stool
Unknown cause

Question 19

Acute Abdominal Pain Red Flags

Answer 19

Severe pain
Signs of shock (eg, tachycardia, hypotension, diaphoresis, confusion)
Signs of peritonitis
Abdominal distention

Question 20

Chronic Abdominal Pain Red Flags

Answer 20

Fever
Anorexia, weight loss
Pain that awakens patient
Blood in stool or urine
Jaundice
Oedema
Abdominal mass or organomegaly

Question 21

What is Haematemesis ?

Answer 21

Vomiting of blood from the upper part of the GI Tract

Question 22

What is Melaena ?

Answer 22

Blood in the stool from anywhere in the GI Tract

Question 23

Why does diarrhoea occur?

Answer 23

Osmotic load – un-absorbable, water-soluble solutes retain water in the bowel

Increased secretions – infections, unabsorbed fats and certain drugs lead to increased water/electrolyte secretion

Reduced contact time/surface area – rapid intestinal transit and less surface area for absorbing fluid such as in celiac disease

Question 24

What Causes Diarrhoea ?

Answer 24

Travel
Bad food
Disease exposure
Usually associated with acute watery diarrhoea 
 
 Diverticular bleeding and ischemic colitis
Inflammatory bowel disease 
Associated with, acute bloody diarrhoea

Question 25

What signs and symptoms suggest malabsorption.

Answer 25

Oil droplets in stool

Weight loss

Question 26

Diarrhoea Red Flags

Answer 26

Blood or pus
Fever
Signs of dehydration
Chronic diarrhoea
Weight loss

Question 27

What are some Causes of Constipation ?

Answer 27

Sudden decrease in physical activity
Change in diet (reduced fibre)
Use of medication
Functional disorders
Bowel obstruction

Question 28

Constipation Red Flags

Answer 28

Distended, tympanitic abdomen
Vomiting
Blood in stool
Weight loss
Severe constipation of recent onset
Worsening in elderly patients

Question 29

Jaundice Red Flags

Answer 29

Marked abdominal pain and tenderness
Altered mental status
GI bleeding (occult or gross)
Bruising