GI Symposium

Question 1

What history would you take from someone with GI symptoms?

Answer 1

Duration, solids of liquids, pain (better one eating or not)§, weight loss, dysphagia

Question 2

What categories does dysphagia fall into?

Answer 2

1. Oropharyngeal
2. Oesophageal
3. Gastric

Question 3

What problem would you expect with oropharyngeal dysphagia?

Answer 3

Salivary gland dysfunction - sjogrens
Tongue - amyloid, hypothyroidism
Palatal/ epiglottal and upper oesophageal - MND, parkinsons

Question 4

What problem would cause oesophageal dysphagia?

Answer 4

Benign mucosal disease - peptic stricture
Malignant mucosal disease
Motility disorders

Question 5

What is a pharyngeal pouch?

Answer 5

Defect between constrictor muscles and transverse cricopharyngeus muscles - cause out pouching of mucosa where food can become stuck if becomes large can cause regurgitation
Seen w/ endoscopy or barium swallow

Question 6

How would you manage dysphagia?

Answer 6

Tx underlying cause
Benign: acid reflux suppression and balloon dilation
Malignancy: surgery +- chemo or radio

Question 7

What symptoms may you see in upper abdominal discomfort?

Answer 7

Heartburn, abdominal bloating, chest pain

Question 8

Give 2 examples of causes of upper abdominal discomfort?

Answer 8

1. GORD

2. Hiatus hernia

Question 9

What is GORD - why it happens and symptoms?

Answer 9

1. Gastro-oesophageal reflux disease
   Excessive relaxation of lower oesophageal sprinter and raised intra-abdominal pressure

Symptoms : heartburn, epigastric pain, acid reflux, nausea, tooth decay, asthma

Question 10

Management of GORD

Answer 10

1. Lifestyle - weight loss, smoking cessation, reduce alcohol
2. PPI - irreversibly block H+/K+ ATPase
3. H2 antagonist - reduce acid by inhibiting cells produce acid
4. Fundoplication

Question 11

What is a hiatus hernia?

Answer 11

When stomach moves up towards chest due to problems w/ diaphragm
Manage: surgery

Question 12

What is oesophageal manometry?

Answer 12

Investigation - probe sits at back of gullet and measures pH and pressure (test abnormal amounts of acid)

Question 13

What hx would you expect of someone with peptic ulceration?

Answer 13

Epigastric pain - can radiate to back and worsened by food (improved by eating duodenal)
Weight loss
Vomiting/ haematemesis

Question 14

Cause peptic ulceration?

Answer 14

NSAIDs and helicobacter pylori

Question 15

Appearance would you expect w/ peptic ulcer?

Answer 15

Clean ulcer, visible vessel and adherent clot

Question 16

Tx peptic ulcer

Answer 16

1. Medication to reduce acid - PPI
2. Clips
3. Injection adrenaline
4. Surgery - if perforation

Question 17

Name some diff types of cancer w/ gastric associations?

Answer 17

1. Gastric carcinoma - epigastric pain, weight loss and vomit
2. Pancreatic carcinoma - pain that radiated to back, weight loss and poss jaundice

Question 18

Differentiate visceral and periotoneal pain?

Answer 18

Visceral pain - inflammation inside organ fewer never endings - dull pain

Peritoneal pain - outside organ - lots of nerves - sharp pain

Question 19

Difference between acute and chronic abdominal pain?

Answer 19

Acute: sweating, guarded, increased HR
Chronic: longer than 6 weeks

Question 20

Name some causes of emesis?

Answer 20

Systemic illness - viral/ bacterial
Drugs/ alcohol
Centrally mediated - middle ear disease
Psychiatric disorder - bulimia 
Gastric disease

Question 21

Management of vomiting?

Answer 21

Identify underlying cause
Antiemetic/ PPI
CBT - if central

Question 22

Give some examples of small bowel disease?

Answer 22

Lactase deficient, coeliac disease, crohn’s disease

Question 23

Give some examples of colonic disease?

Answer 23

Ulcerative colitis, Crohn’s disease, carcinoma

Question 24

Difference between small bowel and colonic disease?

Answer 24

S.B - pale, floating and diff to flush/ throughout day/ pain - variable timing/ pain not relieved by defaecation

Colonic - blood and mucus/ often morning/ pain related to but relieved by defeacation

Question 25

What is coeliac disease (inc histology and presentation)?

Answer 25

Small bowel disease - gluten sensitivity - immunological response to gliadin Histology: increased lymphocytes, atrophic villi Presentation: malabsorption symptoms, dermatitis herpetifromis (immunological response to gluten presented in the skin)

Question 26

What is Crohn's disease?

Answer 26

Affect any part GI tract - mouth to rectus Discontinuous ulceration - cobble stone appearance Affect all lining of GI tract Symptoms: pain, fever, diarrhoea, vomiting, weight loss

Question 27

What is ulcerative colitis?

Answer 27

Affect rectum and colon Continuous ulceration Affect just mucosa Symptoms: diarrhoea, rectal bleeding, pain

Question 28

What is associated with UC?

Answer 28

``` Skin - erythema nodosum Mouth - ulceration Joints - arthritis Eyes - uveitis Liver - cirrhosis ```

Question 29

Symptoms, investigation and management of colon cancer?

Answer 29

Symptoms: can be none, rectal bleeding, altered bowel habits Investigation: barium enema, colonoscopy Manage: evaluate extend of disease - if limited - surgical resection

Question 30

What associated features would you see with chronic liver disease?

Answer 30

Clubbing, palmar erythema, spider navei