GI Clinical Seminars

Question 1

SOCRATES of GORD

Answer 1

S - epigastirc
O - anytime
C - burning
R - none, or to back of mouth
A - heartburn, waterbrash, burping, chest pain, coughing, asthma
T - episodic
E/R - lying down bad, antacids good
S - mild/moderate

Question 2

SOCRATES of peptic ulcer and gastritis

Answer 2

S - epigastric
O - Variable, worse overnight
C - dull, burning
R - through to back
A - bloating, fullness, early satiety
T - episodic, for a few hours
E/R - lying down, food bad, antacids good
S - mild/severe if perforation

Question 3

SOCRATES of GI cancers

Answer 3

S - Episodic
O - insidiously
C - Deep, gnawing
R - depends on anatomy
A - red flags
T - constant/progressive
E - large meals, vomiting
S - mild/severe

Question 4

SOCRATES of pancreatic diseases

Answer 4

S - epigastric/umbilical
O - variable. worse after meals
C - constant, deep gnawing
R - back
A - weight loss, nausea, vomiting, exo/endo failure
T - acute to progressive
R - sitting up and leaning forward
S - moderate/severe

Question 5

SOCRATES of Biliary Colic

Answer 5

S - epigastric/RUQ
O - fatty meals, unpredictable
C - colicky, constant
R - none, back
A - fever, cholangitis, nausea
T - episodic, hours
E - none
S - moderate/severe

Question 6

6 serious upper GI conditions?

Answer 6

pancreatitis, PUD, GI foreign body, cancer, perforation, motility disease

Question 7

Reflux vs GORD?

Answer 7

Reflux is physiological and becoms GORD when symptomatic

Question 8

What does H. pylori cause?

Answer 8

gram -ve bacilli with chronic infection causing
1. functional dyspepsia
2. Gastritis
3. Peptic Ulcers
4. Gastric cancer
5. MALT

Question 9

6 causes of distension?

Answer 9

fat, flatulence, faeces, fluid, foetus, filthy tumour

Question 10

3 Complications of ovarian cysts?

Answer 10

1. Torsion
2. Haemorrhage
3. Rupture

Question 11

Inflammatory diarrhoea associated features and cause?

Answer 11

mucus and bloody stool, tenesmus, fever and pain. Small volumes with frequent movements but doesnt cause volume depletion in adults. Caused by bacteria eg. camplobacter, salmonella, shigella

Question 12

Secretory vs Osmotic diarrhoea?

Answer 12

1. Secretory - altered ion transport leading to increased secretions and decreased water absorption. Caused by enterotoxins, medication, coeliac, tumours
2. Osmotic - presence of poorly absorbed or unabsorbed solute in digestive tract causing increased secretions of liquid into gut lumen. Stool volume small and solves with fasting. Further differentiate into maldigestion and malabsorption

Question 13

Storage symptoms?

Answer 13

Cant keep urine in
- frequency, nocturia, urgency, incontinence

Question 14

What is the micturition reflex and pathway?

Answer 14

1. Bladder fills, walls distend and constant intravesicular pressure is maintained
2. Afferent signals through spinal cord to pontine micturition center and cerebellum.
3. Decision to urinate leads to neurons of pontine micturition center fire
4. Excitation of sacral preganglionic neurons
5. Parasympathetic S2-4 stimulation
6. Release of Ach
7. Muscarinic Ach receptor M3 on detrusor muscle contracts
8. Increase of intravesicular pressure causing voiding

Question 15

What is Onufs nucleus?

Answer 15

Sacral motor neurons that inhibit striated voluntary muscles of pelvic floor to keep sphincter constricted. Pontine micturition center inhibits onufs nucleus reducing sympathetic stimulation to external sphincter causing relaxation

Question 16

What are voiding symptoms and causes?

Answer 16

Cant get it out
- hesitancy, intermittency, slow stream, straining, terminal dribble. Can be bladder related (obstruction or muscle underactivity) or neurological (pudendal nerve injury)

Question 17

DDx of macroscopic haematuria?

Answer 17

1. Cancer
2. Calculi
3. Glomerulonephritis or pyelonephritis
4. UTI

Question 18

3 major prognostic factors of haematuria/proteinuria?

Answer 18

Albumin:creatnine ratio, blood pressure, creatinine

Question 19

4 major signs of nephrotic syndrome?

Answer 19

1.Proteinuria
2. Increased cholesterol
3. Hypoalbuminuria
4. Oedema

Question 20

Management of actue renal stones?

Answer 20

If less than 5mm, analgesia, NSAIDS, PO fluid, IVH, follow up xray
Dietary advice - reduce animal protein and oxalate containing foods and drinks (coffee, tea, rhubarb, chocolate, spinach) and increase fluid intake

Question 21

Common and rare side effects of vasectomy?

Answer 21

Common - irreversible, scrotal bruising, chronic scrotal pain
Rare - inflammation or infection, late failure

Question 22

Treatment of benign prostate hyperplasia? (3)

Answer 22

1. Alpha blockers to relax smooth muscle - prazosin, tamulosin, silodosin
2. 5-alpha reductase inhibitors which removes DHT so physically shrinks as DHT is a driver - dutasteride, finasteride
3. Bladder outlet surgery - prostatectomy, green light laser, urolift