Intro to Alimentary

Question 1

Describe the common plan of the gut.

Answer 1

1. Gut lumen
2. Mucosa (contains loose connective tissue called lamina propria - vascular support for epithelium. May also contain mucosal glands).
3. Submucosa - loose connective tissue layer with larger blood vessels, lymphatics and may contain mucus secreting glands. (Also contains submucosal plexus which regulates perfusion, secretion and absorption).
4. SM layers. 2 layers - circular and longitudinal layers. Peristalsis.
5. Serosa - outermost layer of loose connective tissue - covered by visceral peritoneum. Contains vessels, lymph and nerves

Question 2

What are the signs and symptoms of general GI Tract disease?

Answer 2

1. Malaise
2. Rapid weight loss
3. Anorexia
4. Anaemia

Question 3

What are signs and symptoms of upper GI tract disease?

Answer 3

1. Haemoptysis
2. Melaena (black tarry stool) - upper GI bleeding
3. Nausea
4. Vomiting/Vomiting blood (haematemesis)
5. Dysphagia, odynophagia (difficulty swallowing/pain swallowing
6. Heartburn
7. Acid regurgitation
8. Belching
9. Chest pain
10. Epigastric pain

Question 4

Describe hepatobiliary disorders

Answer 4

Right Upper Quadrant pain

Biliary colic pain - gall bladder contracting against a downstream obstruction (e.g. gall stones)
Jaundice - yellowing skin, sclera and mucous membranes (more bilirubin). Dark urine (elevated conjugated bilirubin in urine). Pale stool (lower stercobilin concentration). Ascites (fluid accumulation) - general fluid accumulation in abdominal cavity (>30ml).

Question 5

Describe mid-GI tract disorders.

Answer 5

Abdominal pain. Steatorrhoea. Diarrhoea. Abdominal distension.

Question 6

Describe lower GI tract disorders.

Answer 6

Abdominal pain. Rectal bleeding. Constipation. Diarrhoea. Incontinence. Flatulence.

Question 7

General whole body GI tract disease. Describe.

Answer 7

1. Cachexia - muscle wastage.
2. Obesity - sign of nutritional imbalance
3. Lymphadenopathy
4. Jaundice

Question 8

Signs of GI infection on the hands.

Answer 8

1. Koilonychia (spooning of nails). Indicates iron anaemia
2. Leuconychia - partial/complete whitening of nails
3. Clubbing (enlarged concave experience)
4. Dupytrens contracture (1/more fingers can be pulled into bent position). Persistent uncontrolled diabetes/alcohol
5. Tachycardia
6. Tremor

Question 9

Abdominal signs of GI disease

Answer 9

1. Palpable organ enlargement
2. Abdominal tenderness/swelling
3. Distension

Question 10

Signs of GI disease in anus and rectum

Answer 10

1. Haemorrhoids - swollen superficial blood vessels
2. Fistula - reaching external environment not through anal canal
3. Fissure (tear/ulceration in mucosal lining)
4. Proctitis - inflammation of inside of rectum

Question 11

SOCRATES

Answer 11

Site
Onset
Character
Radiation
Associated Symptoms
Timing
Exacerbating factors
Severity

Question 12

How should abdominal pain be approached.

Answer 12

History
Examination
Investigations