oesophagus, small bowel and large bowel

Question 1

What are the signs and symptoms of oesophageal disease?

Answer 1

Heartburn
Dysphasia
-Solids and liquids indicate dysmotility

Question 2

What does CREST stand for?

Answer 2

This is the features of systemic sclerosis

• Calcinosis
• Raynaud phenomenom
• Eosophageal dysmotility
• Sclerodactyly
• Telangiectasia

Question 3

What are the clinical findings in hiatus hernia?

Answer 3

Heartburn
Noctural epigastric distress from reflux
Haematemesis
Ulceration and stricture
Bowel sounds heard over left lung base

Question 4

What is the treatment for hiatus hernia?

Answer 4

Non-pharmacological
-Avoid foods that reduce lower oesophageal sphincter tone e.g. cofee, chocolate
-Sleep with head of bed elevated
-Avoid eating large quantities of food
Pharmacological
-H2 antagonists
-PPI
Surgery if indicated

Question 5

What are the signs and symptoms of GORD?

Answer 5

Heartburn
Nocturnal cough/asthma
Acid damage to enamel
Abdominal fullness
bloating/belching
Barrett oesophagus

Question 6

What is the treatment for GORD?

Answer 6

See hiatal hernia

Surgery if indicated - fundoplication - gastric wrap around oesophageal junction

Question 7

What can cause infectious oesophagitis?

Answer 7

Presents with pain swallowing
Usually in AIDS
can be caused by HSV
Cytomegalovirus 
Oral candida

Question 8

What is the management for oesophageal varices?

Answer 8

Endoscopy to diagnose/ can treat - ligation, scerotherapy
Insert NG tube to gastric lavage and can assess rate of bleeding
Beta blockers decerase rate of recurrence
TIPS - transjugular intrahepatic portasystemic shunt can be used

Question 9

What is the difference between mallory-weiss syndrome and boerhaave syndrome?

Answer 9

Mallory weiss is a mucosal tear that is vertical not full perforation
Boerhaave is a complete perforation - can cause pneumomediastinum

Question 10

What is the pathogenesis and findings of achalasia?

Answer 10

This is when there is loss of the myenteric nerve fibres which causes dilation of the oesophagus with absent peristalsis
Clinical findings:
-nocturnal regurgitation of undigested food
-dysphasia for solids and liquids
-chest pain and heartburn
-frequent hiccups
-nocturnal cough from aspiration

Question 11

What is the diagnosis and treatment of achalasia?

Answer 11

Abnormal barium swallow - bird beak appearance
Non pharmacological
-Pneumatic dilation - opens LOS
-Oesophagomyotomy
Pharacological
-Long acting nitrates
-Calcium channel blockers
-Botulinum toxin injection

Question 12

What are the common types of oesophageal carcinomas and where do they occur?

Answer 12

Small cell carcinoma - upper and middle thirds of oesophagus

Adenocarcinoma - glandular cells - lower third of oesophagus

Question 13

What are the clinical findings for oesophageal carcinoma?

Answer 13

Dysphagia for solids initially
rapid weight loss
Painless enlarged supraclvicular lymph nodes
Dry cough and haemoptysis - tracheal invasion
Hoarseness - laryngeal nerve invasion
Hypercalcaemia - parathyroid hormone released by cancer

Question 14

What are the T 1 to T 4 types of oesophgeal carcinoma?

Answer 14

T1 - confined to submucosa
T2 - Invasion into the muscularis propria
T3 - invasion into the peri-oesophageal adventitia
T4 - invasion into the pleua, pericardium and other organs

Question 15

What are some signs and symptoms of stomach disease?

Answer 15

haematemesis - ost commonly due to peptic ulcer disease

Melena

Question 16

What are some causes of acute gastritis?

Answer 16

NSAIDs
Alcohol
helicobacter pylori
CMV
Burns

Question 17

What are the common causes of chronic gastritis?

Answer 17

H. Pylori infection - gram negative

Secretes urease and proteases that cause gastritis

Question 18

How is H pylori infection diagnosed?

Answer 18

With a urea breath test and stool antigen test

Question 19

What is the staging of stomach cancers?

Answer 19

T1 - confined to submucosa
T2 - Invasion into the muscularis propria
T3 - invasion into the subserosa
T4a - invasion onto the peritoneum
T4b - invasion into other organs

Question 20

What is the most common stomach cancer?

Answer 20

Gastric adenocarcinoma

Question 21

What are the signs and symptoms of small bowel disease?

Answer 21

Colicky pain - symptom of bowel obstruction
Diarrhea - may how infaction or malabsorption
Anaemia - due to iron, folic acid, B12 malabsorption

Question 22

What are the signs and symptoms of large bowel disease?

Answer 22

Diahrrhea - infection, IBD
Dysentery - bloody diahorrea with mucus
Pain
Tenesmus
Iron deficiency

Question 23

What are some common causes of malabsorption?

Answer 23

Pancreatic insufficiency - chronic pancreatitis
Bile salt/acid deficiency
Small bowel disease e.g. coeliac

Question 24

What is the pathogenesis in coeliac disease?

Answer 24

T cell and IgA response against gluten causes loss of villus, elongation of crypts and increase in the number of intra-epithelial lymphocytes

Question 25

What is whipples disease?

Answer 25

Accumulation of foamy macrophages in the lamina propria that contains bacteria

Question 26

What are the characteristics of crohns vs UC?

Answer 26

Crohns is characterised by transmural granulomatous inflammation whereas UC is not transmural and are pseudopolyps. Crohns is skip lesions whereas UC is continous.

Question 27

What is Meckel's diverticulum? How do you remember it?

Answer 27

``` This is a remenant of an embryonic duct causing an outpouching of the gut 2222 2 inches long 2 feet proximal to the iliocoecal valce 2% of population 2% symptomatic ```

Question 28

What is the commonest type of tumour in the small bowel?

Answer 28

lymphomas

Question 29

What is angiodsyplasia?

Answer 29

Vascular malformation that causes - Thin walled blood vessels in the mucosa and submucosa are prone to rupturing

Question 30

What are the commonest polyps of the colon?

Answer 30

Hyperplastic polyps they show increased cellularity of crypts with heaped up epithelium

Question 31

What are the commonest tumours of the colon?

Answer 31

Adenocarcinomas

Question 32

What are the stages of colon cancer?

Answer 32

pT1 Confined to the submucosa pT2 Invasion into, but not through, the muscularis propria pT3 Invasion into the subserosa pT4 Invasion onto the peritoneal surface or adjacent organs