Medical abdo pain & diarrhoea

Question 1

Important dyspepsia conditions to rule out?

Answer 1

Severe oeophagitis due to stricture
Peptic ulcer
Oesophageal / gastric cancer

Question 2

1st Ix for someone with dyspepsis with NO FLAWS?

Answer 2

Helicobacter testing & eraditcation

Question 3

Definitive Ix for dyspepsia?

Answer 3

OGD

Question 4

Epigastric pain worse after eating, radiating to back. Relieved by antacid. Dx?

Answer 4

Peptic ulcer disease

Question 5

Can people with peptic ulcers be asymptomatic?

Answer 5

YES - often. Sometimes no Sx until massive bleed

Question 6

Diagnosis of peptic ulcer disease?

Answer 6

OGD

Question 7

Causes of peptic ulcers ?

Answer 7

H.Pylori
NSAIDs
gastric cancer
Zollinger-Ellison Syndrome

Question 8

What is Z-E syndrome?

Answer 8

Tumour of endocrine tissues in pancreas resulting in XS acid secretion

Question 9

Rare causes of peptic ulcers?

Answer 9

CD, sarcoidosis, TB

Question 10

What are the 2 patterns of H.Pylori infection in stomach?

Answer 10

Antrum predominant

Pan-gastritis

Question 11

What type of ulcer is Antrum predominant gastritis associated with?

Answer 11

Duodenal

Question 12

What type of ulcer is pan gastritis infection associated with?

Answer 12

Gastric ulcer & CANCER

Question 13

Which type of infection pattern is associated with low/high acid production?

Answer 13

Low = pan gastritis 
High = antrum predominant

Question 14

H.Pylori + is associated with which type of ulcer?

Answer 14

Duodenal

Question 15

Diagnosis of H.Pylori?

Answer 15

Rapid urease test (yellow –> red)
C-urea breath test
PCR in faeces

Question 16

WHat are 3 key Qs to ask in diarrhoea Hx?

Answer 16

Opening bowel at night?
Can you flush the stool?
Is there an urgency to poo?

Question 17

What is dysentery?

Answer 17

Diarrhoea + frank blood passage

Question 18

Causes of dysentery?

Answer 18

CHESS 
Campylobacter 
Haemorrhagic E.Coli 
Entamoeba histolytica 
Salmonella 
Shigella

Question 19

Key features of gut infection causing diarrhoea ?

Answer 19

Short Hx
Obvious precipitating event eg travel/contacts/bad meal
Other Sx eg cramping/fever/abdo pain
+/- dysentery

Question 20

Mx of diarrhoea?

Answer 20

Rehydration

Appropriate ABx

Question 21

Where is c.difficle most common?

Answer 21

Hospital

Question 22

What is complication of c.diff?

Answer 22

Pseudomembranous colitis

Question 23

Why is c.diff most common in hospital?

Answer 23

ABx wipe out normla gut flora so c.diff can grow uncompeted

Question 24

Tx for c.diff?

Answer 24

Rehydration

Oral metronidazole / vancomycin

Question 25

How specific is anti TTG for coeliac?

Answer 25

> 90%

Question 26

Colitis Sx?

Answer 26

Bleeding, mucus, urgency, diarrhoea

Question 27

Perianal Sx?

Answer 27

Anal pain
Leakage
Difficulty passing stool

Question 28

Small bowel disease Sx?

Answer 28

Abdo pain 
Weight loss 
Tiredness, lethargy 
Diarrhoea 
Abdo mass

Question 29

Extra intestinal manifestations of IBD?

Answer 29

Ank spon
Skin: erythema nodosum & pyoderma gangrenosum
Eyes: anterior uveitis & episcleritis
Liver: PSC & AI hepatitis