GI Session 11

Question 1

Why is gallstone colicky pain a misnomer?

Answer 1

There is a fairly constant level of pain which gets worse

Question 2

Is large bowel colic true colic?

Answer 2

No, has baseline level of pain which then fluctuates

Question 3

How does colic pain in the small and large bowel compare?

Answer 3

Small = 2-3 mins
Large = 10-15 mins

Question 4

What is anorexia?

Answer 4

Loss of appetite

Question 5

What can cause anorexia?

Answer 5

Subjectively unpleasant food or surroundings
Anxiety
Anger/fear
Physical disorder
Psychological disorder

Question 6

What should be considered if a pt presents with weight loss?

Answer 6

Intentional?

Unintentional –> sufficient intake? –> yes-fast metabolism or malabsorption?

Question 7

What is nausea?

Answer 7

Subjective sensation of the need to vomit

Question 8

What stimulates vomiting?

Answer 8

Labyrinths in ears —> ACh on vomiting centre in medulla
Emetic drugs/dopamine/5-HT on chemoceptor trigger zone
Distension/irritation in chemo- and baroreceptors
Peripheral pain receptors –> histamine on vomiting centre in medulla

Question 9

Where is the CTZ which is activated in vomiting located?

Answer 9

Base of fourth ventricle outside BBB so it can detect blood contents

Question 10

What can cause constipation?

Answer 10

Diet
Medication (opioids, tricyclics in chronic back pain)
Neurological disease
Colorectal stricture
Dehydration
Immobility (decreased transit time so more water reabsorption)
Diabetes
Functional esp in children

Question 11

What can diarrhoea be classified as?

Answer 11

Change in frequency or consistency of both

Question 12

What are the different types of diarrhoea?

Answer 12

Secretory e.g. Cholera
Osmotic e.g. Lactose intolerance
Abnormal intestinal motility e.g. IBS
Exudative e.g. Colitis
Malabsorption e.g. Pancreatic enzyme deficiency

Question 13

What is Odynophagia?

Answer 13

Painful swallow

Question 14

What are the two broad categories of dysphasia and what do they indicate?

Answer 14

Difficulty with liquids –> difficulty initiating swallow due to neurological causes
Food sticking –> anatomical problem with oesophagus or cardia of stomach

Question 15

What can cause bleeding from the top of the GI tract?

Answer 15

Acute/chronic peptic ulcer
Malory Weiss tear
Oesophageal/gastric Varices
Erosive oesophagitis
Erosive gastric/oesophageal cancer

Question 16

What causes malaena?

Answer 16

Chronic upper GI bleed –> bacteria break down haem –> black tarry stool

Question 17

How is malaena differentiated from black tarry stool due to food consumption?

Answer 17

Malaena is foul smelling

Question 18

Does the R or L colon bleed more commonly?

Answer 18

R

Question 19

What can cause bleeding at the bottom of the GI tract?

Answer 19

Angiodysplasia
Diverticular disease
Colonic carcinoma
Haemorrhoids/anal fissure
IBD esp UC as superficial
Massive upper GI bleed

Question 20

How does bleeding from the bottom of the GI tract present?

Answer 20

Haematochezia - bright red blood from anus

Question 21

What is Mallory-Weiss tear?

Answer 21

Repeated vomiting –> tear in mucosa where oesophagus and stomach meet. Bleeding usually self limits

Question 22

What is angiodysplasia?

Answer 22

Multiple lesions of small vascular malformations in the gut

Question 23

What are the 5 Fs in abdominal distension?

Answer 23

Fat
Fluid
Faeces
Flatus
Foetus

Question 24

What causes flatus?

Answer 24

Aerophagia (swallowing air)

Gas production in gut, especially if digestion is incomplete

Question 25

What is ascites?

Answer 25

Abnormal amounts of fluid in the peritoneal cavity due to changes in both hydrostatic and oncotic pressure

Question 26

What should be considered O/E of abdominal disorders?

Answer 26

Palmar erythema
Nail clubbing (IBD)
Bruising
Asterixis
Jaundice (sclera first)
Pruritis
Spider naevi
Oragnomegaly

Question 27

What is ‘real’ colicky pain?

Answer 27

No pain between exacerbations