GI disease

Question 1

GORD classification

Answer 1

Los Angeles Classification

Question 2

GORD -other name

Answer 2

Reflux Oesophagitis

Question 3

Barrett’s Oesophagus - cells invovled

Answer 3

Squamous mucosa to Columnar epithelium

Question 4

Oesophageal Adenocarcinoma - who gets it?

Answer 4

Caucasians, M more then F

Question 5

Oesophageal Adenocarcinoma - Where is it usually?

Answer 5

Distal 1/3 of oesophagus

Question 6

Squamous cell oesophageal carcinoma - Associated with?
who gets it?
where on oesophagus is it most commonly found?

Answer 6

Alcohol and smoking
Afro-carribeans, M more then F
Usually found in middle 1/3

Question 7

Squamous cell oesophageal carcinoma presentation

Answer 7

Progressive dysphagia (solids then fluids)
Odynophagia (pain)
Severe weight loss

Question 8

What is Gastritis?

Answer 8

Inflammation of the lining of the stomach

Question 9

Gastric Ulcer - better or worse with food?

Answer 9

Worse

Question 10

What is the main cause of Gastric Lymphoma

Answer 10

H. Pylori

Question 11

What relieves the pain of a duodenal ucler?

Answer 11

Food and Milk

Question 12

Coeliac Disease - buzz words

Answer 12

T cell mediated
Irish women
serological tests - Anti-endomysial Ab
Gold standard = upper Gi endoscopy and duodenal biopsy

Question 13

Diverticular disease - overview

Answer 13

In the west due to low fibre diet
High intraluminal pressure = outpouching in wall (seen on barium enema CT)
90% in left colon
Often asymp, can have PR bleed

Question 14

Complications of Diverticular disease?

Answer 14

Diverticulitis - fever and peritonisms, gross perforation, fistula, obstruction

Question 15

Crohns - Facts

Answer 15

20s, more women then men
Smoking WORSENS symptoms
Affects whole GIT
Skip lesions = cobblestone appearance
Can have deep Rosethorn ulcers

Question 16

Ulcerative Colitis - facts

Answer 16

20-25yrs
Extends proximally from rectum, continuously
Small bowel rarely affected
Superficial broad ulcers and pseudopolyps
Bloody Diarrhoea and mucus

Question 17

Extra-GI manifestations of Crohns and UC

Answer 17

Eyes - Uveitis
Skin - Erythema nodosum
Joints - asymmetrical polyarthropahty of large joints
Liver - Primary sclerosing cholangitis

Question 18

Carcinoid syndrome - what is it?

Answer 18

Diverse group of tumours of enterochromaffin cell origin. Produce 5-HT (serotonin). Slow growing, often in bowel

Question 19

Symptoms of Carcinoid syndrome?

Answer 19

Bronchoconstriction
Flushing
Diarrhoea

Question 20

Symptoms of Carcinoid crisis?

Answer 20

Live threatening vasodilation
Hypotension
Tachycardia
Bronchoconstrction
Hyperglycaemia

Question 21

Adenoma - What are they? random facts

Answer 21

Benign dysplastic lesions
Found in 50per cent of over 50s in the western world
Mostly asymptomatic so need regular surveillance
Villous adenomas are rare - they leak protein and K
Large size is most important risk factor for malignancy

Question 22

Adenoma - ‘First Hit’ hypothesis

Answer 22

can have 2 hits on APC, progress with mutations of p53

Question 23

Clinical features of Hamartomatous polyp

Answer 23

Found sporadically

Also seen in Peutz-jaghers syndrome = Multiple polyps, freckles around the mouth, palms and soles

Question 24

Colorectal cancer - epidemiology

Answer 24

60-79yrs, if found under 50 think familial syndrome

98% are denocarcinoma, 45% in rectum

Question 25

Clinical features of colorectal cancer

Answer 25

Right sided tumours - iron def anaemia, weight loss

Left sided tumours - change in bowel habit, crampy LLQ pain

Question 26

Familial adenomatous polyposis (FAP) inheritance?

Answer 26

70per cent autosomal dominant mutation in APC gene

present 10-15years

Question 27

hereditary non-polyposis colorectal cancer (HNPCC) - inheritance?

Answer 27

Autosomal dom mutations in DNA mismatch repair genes