oesophag + anus

Question 1

Severe vomiting –> painful mucosal lacerations @GOJ –> Haematemesis

No systemic disturbance or prior symptoms.

Answer 1

Mallory-Weiss Tear

Question 2

Often longstanding history of dyspepsia, patients are often OVERWEIGHT. What should NOT be associated with dysphagia or haematemesis.

Answer 2

Hiatus Hernia Uncomplicated hiatus hernias should not be associated with dysphagia or haematemesis.

Question 3

history of vomiting

severe chest pain

WITHOUT cardiac diagnosis

pneumonia signs without convincing history

Erect CXR shows infiltrate or effusion in 90% of cases

Answer 3

Oesopghageal rupture - Complete disruption of the oesophageal wall in absence of per-existing pathology.

Left postero-lateral oesophageal is commonest site (2-3cm from OG junction).

Question 4

Progressive dysphagia + WL Usually little or NO history of previous GORD type symptoms.

Answer 4

Squamous cell carcinoma of the oesophagus

Question 5

Progressive dysphagia, may have previous symptoms of GORD or Barretts oesophagus treated for COPD #smoker macrocytosis and high GGT #alcoholic .

Answer 5

Adenocarcinoma of the oesophagus

Question 6

Longgggggg history of dysphagia,

Non-progressive.

Usually symptoms of GORD.

Answer 6

Peptic stricture

similar to dysmotility dx…?

Question 7

dysphagia = episodic

non progressive.

Retrosternal pain may accompany the episodes.

Answer 7

Dysmotility disorder

similar to peptic sticture..??

Question 8

Triad of:

dysphagia (secondary to oesophageal webs)

glossitis

iron-deficiency anaemia

Treatment includes iron supplementation and dilation of the webs

Answer 8

Plummer-Vinson syndrome

Question 9

Severe vomiting → painful mucousal lacerations at the gastroesophageal junction resulting in haematemesis. Common in alcoholics

Answer 9

Mallory-Weiss syndrome

Question 10

Severe vomiting → oesophageal rupture

Answer 10

Boerhaave syndrome

Question 11

Painful, bright red rectal bleeding post defecation Poss skin tag at 6/12 o clock midline position Assoc with Crohns/UC Below dentate line

Answer 11

Fissure in ano Stool softeners, topical CCB dili/GTN, botulinum toxin, Sphincterotomy

Question 12

Painless, bright red rectal bleeding ppst defecation and bleeds onto the toilet paper and into the toilet pan Constipation Hx poss!

Answer 12

Haemorroids

Question 13

May initially present with an abscess and thennnnnnnnn persisting discharge onto the perineum, separate from the anus!!!!

Answer 13

Fistula - SETON MRI

Question 14

Peri anal swelling and surrounding erythema Ssevere pain in Ano-rectum + fever

Answer 14

Peri anal/ano-rectal abscess Incision and drainage, leave the cavity open to heal by secondary intention

Question 15

frank haematemesis/altered blood MIXED with vomit.

dyspepsia

nausea and vomiting

anorexia and weight loss

dysphagia

55+ dysphagia OR WL/APain/GORD/Dyspepsia tx fail

55+ Plts+N&V/WAGD // APain/Anemia // N&V+WL/APain/GORD/DyspepsiaTxFail

Answer 15

Gastric cancer

Question 16

Often NO prodromal features prior to haematemesis and malaena, but this AVM may produce quite considerable haemorrhage and may be difficult to detect endoscopically

Answer 16

Dieulafoy Lesion

Question 17

Usually haematemesis and epigastric discomfort. Usually there is an underlying cause such as recent NSAID usage. Large volume haemorrhage may occur with considerable haemodynamic compromise

Answer 17

Diffuse erosive gastritis

Question 18

Small low volume bleeds = more common so would tend to present as iron deficiency anaemia. Erosion into a significant vessel may produce considerable haemorrhage and haematemesis. PAIN @ eating

Answer 18

Gastric ulcer

Question 19

Difficulty swallowing, dysphagia to both LIQUIDS & SOLIDS!!!!!! and sometimes chest pain Usually caused by failure of distal oesphageal inhibitory neurones

Diagnosis is by pH and manometry studies together with contrast swallow and endoscopy Treatment is with either botulinum toxin, pneumatic dilatation or cardiomyotomy

Answer 19

Achalasia WL Regurg Dysphasia Manometry contrast swallow = dilated tapered oesophagus Balloon Endo dilation – > cardio myotomy + PPI

Diagnosis is by pH and manometry studies together with contrast swallow and endoscopy Treatment is with either botulinum toxin, pneumatic dilatation or cardiomyotomy

Question 20

Symptoms include dysphagia, retrosternal discomfort and dyspepsia May show ‘nutcracker oesophagus’ on barium swallow

Answer 20

Diffuse oesophageal spasm Spectrum of oesophageal motility disorders Caused by uncoordinated contractions of oesphageal muscles

Question 21

Tearing interscapular pain Discrepancy in arterial blood pressures taken in both arms May show mediastinal widening on chest x-ray

Answer 21

Dissection of thoracic aorta

Question 22

Symptoms of obstructed pooing Assoc with childbirth and rectal intususception Either int/ext

Answer 22

Rectal prolapse

Question 23

Bright red rectal bleed Hx of IBS Assoc w/ chronic straining and constipation. indurated ulcer located anteriorly approximately 4cm from the dentate line Histology = mucosal thickening, lamina propria replaced with collagen and smooth muscle Fibromuscular obliteration @ sigmoidoscopy

Answer 23

Solitary rectal ulcer syndrome

Question 24

Odynophagia painful swallow unpleasant’ retrosternal sensation Poss dyspepsia Hx

Answer 24

Oesophagitis

Question 25

Duke’s colorectal classification

Answer 25

Mucosa, Bowel wall, LNmets, Distant Dukes’ A Tumour confined to the mucosa 95% Dukes’ B Tumour invading bowel wall 80% Dukes’ C Lymph node metastases 65% Dukes’ D Distant metastases

Question 26

look at pic, what scars they are? Their indications?

Answer 26

Kochers = cholecystectomy

Rooftop gable = hepatobiliary surg

Gridiron @ mcburneys= appendicectomy

Lanz = appendicectomy

Rutherford Morrison = renal transplant

Pfannelstein = C-SECTIONS

Question 27

Rectal Bleeding +

altered bowel habit, malaise, history of fissures (especially anterior) and abscesses

Perineal inspection may show fissures or fistulae.

Proctoscopy = indurated mucosa and possibly strictures.

Skip lesions may be noted at colonoscopy.

poss surg @ RIGHT SIDE

Answer 27

Crohns disease

Question 28

Bright red bleeding often mixed with stool

Diarrhoea, WL, Nocturnal incontinence,

passage of mucous PR

Proctitis is the most marked finding.

Peri anal disease is = ABsent.

Colonoscopy will show continuous mucosal lesion.

Answer 28

Ulcerative colitis

Question 29

sudden onset profuse dark red rectal bleeding.

She was previously well.

Answer 29

Diverticular bleed

Question 30

There may be a history of heartburn
Odynophagia but no weight loss and systemically well

Answer 30

Oesophagitis

Question 31

There may be a history of HIV or other risk factors such as steroid inhaler use

Answer 31

Oesophageal candidiasis

Question 32

Extraocular muscle weakness or ptosis
Dysphagia with liquids as well as solids

Answer 32

Myesthenia Gravis

Question 33

older men
Usually not seen but if large then a midline lump in the neck that GURGLES on palpation

dysphagia, regurgitation, aspiration and chronic cough.

Halitosis may occasionally be seen

herniation between thyropharyngeus and cricopharyngeus muscles

Answer 33

Pharyngeal pouch

Question 34

History of anxiety
Symptoms are often intermittent and relieved by swallowing
Usually painless - the presence of pain should warrant further investigation for organic causes

Answer 34

Globus hytsericus

Question 35

Classically LLQ pain, diarrhoea and fever

Answer 35

Diverticulitis

Question 36

abdominal pain, bloating and change in bowel habit - diarrhoea / constipation

may also present with:

Lethargy/nausea, HA

LBP FUNDHS

Answer 36

IBS

Question 37

Young men, DYSPHAGIA

History of food allergy, eczema and asthma - ATOPY

Answer 37

Eosinophilic esophagitis