GI Disease

Question 1

Dysphagia

Answer 1

difficulty swallowing
caused by compression, GORD, parkinsons, lumps

Question 2

GORD stands for

Answer 2

gastro-oesophageal reflux disorder

Question 3

GORD symptoms

Answer 3

epigastric burning, worse lying down, dysphagia, GI bleexing, severe pain mimicking MI

Question 4

GORD management

Answer 4

smoking cessation, stop excess coffee drinking, lose weight, avoid triggers, take antacids/H2

Question 5

Hiatus hernia

Answer 5

part of stomach squeezes up into chest through opening in diaphragm
symptoms similar to GORD

Question 6

medications to eliminate GI acid

Answer 6

antacid [rennies]

Question 7

medications to reduce GI acid secretion

Answer 7

H2 receptor blockers, proton pump inhibitors

Question 8

H2 receptor agonists

Answer 8

reduce acid production by preventing histammine activation of acid production
cimetidine

Question 9

proton pump inhibitors

Answer 9

prevents action of acid secretion
omeprazole

Question 10

peptic ulcer disease

Answer 10

discontinuationinner lining of GI tract due to gastric acid secretion or pepsin

Question 11

aetiology of peptic ulcer disease

Answer 11

high acid secretion not neutralised, normal acid secretion without defence, drugs [NSAIDs]
helicobacter pylori

Question 12

H.pylori + peptic ulcer disease

Answer 12

bacteria causing PUD. loss of mucus barrier, allowing acid to cause ulceration in gastric wall

Question 13

signs/symptoms of PUD

Answer 13

asymptomatic, epigastric burning pain worse at meals/night
found with complications like bleeding

Question 14

effects of PUD

Answer 14

inflammation of gastric mucosa, gastric ulcers, irritation, lymphoma

Question 15

investigations for PUD

Answer 15

endoscopy, radiology barium meal, anaemia test, h.pylori test

Question 16

complications of PUD

Answer 16

perforation in peritoneum, haemorrhage, stricture, malignancy
anaemia

Question 17

treatment of PUD

Answer 17

lifestyle changes, stom smoking, small regular meals, surgical repair, vagotomy
medication to reduce acid secretion [H2 receptor blockers, proton pump inhibitors]
eliminate h.pylori

Question 18

triple therapy

Answer 18

elimination of H.pylori
two week course of 2 antibiotics and a proton pump inhibitor [amoxycillin/mentronidazole + omeprazole]

Question 19

surgery for PUD

Answer 19

bilroth - exision of stomach with ulcer, anastomosis of duodenum
vagotomy - dividing small branches in vagal trunk to stomach wall, acid secretion reduced

Question 20

coeliac disease

Answer 20

immune system attacks your own tissue when eaten gluten
sensitivity to a-gliaden component of gluten

Question 21

aetiolgoy of coeliac

Answer 21

a-gluten passed throug bowel and developing immune response, producing antibodies involving T cell and destruction of tissue
genetic susceptibility, environmental trigger
inflammatory changes causes reduction in surface area for absorption

Question 22

symptoms of coeliac

Answer 22

weight loss, lack of energy, weakness, abdominal pain, diarrhoea, dysphagia
malabsoprtion issues - iron, folate, vitb12, fat

Question 23

investigations for coeliac

Answer 23

antibody test, jejunal biopsy, faecal fat [increased if malabsoprtion], haematinics [b12, folate, ferrin]

Question 24

management of coeliac

Answer 24

gluten free diet = reversal of jejunal atrophy, improved well being, reduced risk of lymphoma

Question 25

coeliac skin disease

Answer 25

dermatitis herpetiformis oral disease - ulceration/blisters

Question 26

pernicious anaemia

Answer 26

decrease in red blood cells when intestines cannot absorb VitB12 properly

Question 27

aetiology of pernicious anaemia

Answer 27

lack of vitb12 in diet, disease of gastric parietal cells, IBS, bowel cancer

Question 28

diagnosis of pernicious anaemia

Answer 28

blood tests, histological confirmation, Schilling test [instrinsic factor/parietal cell antibodies]

Question 29

treatment of pernicious anaemia

Answer 29

px responsibility in diet, arrange IM injections of VitB12

Question 30

effects of pernicious anaemia

Answer 30

problems with nerve function and bone marrow production of RBC taken seriously or nerve damage will occur

Question 31

inflammatory bowel disease

Answer 31

chronic inflammation of GI tract Crohn's + ulcerative colitis

Question 32

aetiology of IBS

Answer 32

cause unclear, food intolerance, persistent viral infections, smoking, genetics

Question 33

Ulcerative colitis

Answer 33

continuous disease, superficial layers of gut wall, restricted to colon, rectum always involved

Question 34

Crohn's

Answer 34

discontinuous disease, full thickness of bowel, anywhere in GI tract, rectum involved 50%, oedema of bowel wall

Question 35

UC symptoms

Answer 35

diarrhoea, abominal pain, PR bleeding

Question 36

crohn's symptoms

Answer 36

colonic disease, small bowel disease, orofacial granulomatosis

Question 37

differences in UC and Crohn's

Answer 37

UC -> continuous, colon only, rectum always Crohn's ->discontinuous, anywhere in GI, 50% rectum

Question 38

IBS investigations

Answer 38

blood tests, faecal calprotectin, endoscopy, leukocyte scan, barium study

Question 39

IBS complications

Answer 39

carcinoma, risk increases with time [more likely in UC]

Question 40

IBS treatment

Answer 40

medical - steroids, anti-inflammatory, immunosuppressants anti TNFs therapy

Question 41

IBS surgery

Answer 41

colectomy - cures UC, palliates Crohns symptoms [remove obstructed bowel segments, drain abscesses, clost fitula] results in stoma

Question 42

orofacial granulomatosis

Answer 42

histologically identical to crohn's cobblestone appearance, inflammation lip and oral swelling

Question 43

bowel cancer

Answer 43

colonic adenocarcinoma second msot common in western world bowel cancer screening from age 50

Question 44

bowel cancer symptoms

Answer 44

usually none until tumour blocks bowel and px presents with blockage, reason for poor outcome anaemia, rectal blood loss, unexplained weight loss, extreme tiredness

Question 45

bowel cancer aetiology

Answer 45

polyps, arise from lumen, small growth on inner lining of large intestine/rectum most carcinomas come fromhere will bleed due to irritation/trauma, takes 5 years to progress to malignancy, if removed before cancerous it will not develop into cancer

Question 46

bowel cancer risk factors

Answer 46

diet [high fibre/red meat/fat low veg], smoking, genetics, lack of exercise

Question 47

syndromes associated with polypsis

Answer 47

small intestine = Peutz-Jehgers syndrome large intestine = Gardiner's + Cowden' syndrome

Question 48

what classification is used for colonic cancer staging

Answer 48

Dukes Classification based on level of invasion on bowel wall

Question 49

bowel cancer treatment

Answer 49

surgery, hepatic metastases, raiotherpay, chemotherapy, surgery [stoma]

Question 50

bowel cancer screening

Answer 50

all adults over 50, faecal immunochemical test 2 year repeat, endoscopy if positive results