Pathological basis of gastrointestinal signs and symptoms

Question 1

Impaired neuromuscular function

Intrinsic or extrinsic obstruction

Answer 1

Dysphagia

Question 2

Blood loss associated with upper GI bleed leading to partially digested blood in the faeces

Answer 2

Melaena

Question 3

Ulceration or inflammation of colorectal mucosa, or oozing from surface of a tumour, or ruptured blood vessel(haemorrhoid)

Answer 3

Rectal bleeding

Question 4

Impaired food intake
Malabsorption of food
Catabolic state associated with malignant neoplasm

Answer 4

Weight loss

Question 5

Irritation or inflammation of parietal layer of peritoneum. Pain signals carried on somatic nerves so pain is more localized

Answer 5

Abdominal pain(parietal)

Question 6

Spasm(colic) of muscular layer in gut wall

Answer 6

Abdominal pain(visceral)

Question 7

Blood loss(tumour or ulcer) or impaired absorption of iron, foliate or vitamin B12

Answer 7

Anaemia

Question 8

Excessive secretion or impaired absorption of fluid within lumen of gastrointestinal tract

Answer 8

Diarrhoea

Question 9

Blood loss via vomit, caused by ruptured blood vessel in oesophagus(varices) or stomach(erosion by ulcer)

Answer 9

Haematemesis

Question 10

Oesophageal/gastric mucosal irritation, often with inflammation and ulceration

Answer 10

Heartburn

Question 11

Impaired absorption of fat due to reduced lipase secretion or reduced mucosal surface area for absorption

Answer 11

Steatorhoea

Question 12

Haemolysis(increased bilirubin formation), liver disease(impaired conjugation and/or excretion) or biliary obstruction

Answer 12

Jaundice

Question 13

Conjugated hyperbilirubinaemia due to failure of bile excretion

Answer 13

Dark urine

Question 14

Bile duct obstruction causing lack of bile pigments in faeces

Answer 14

Pale faeces

Question 15

Secondary to hyperoestrogenism, failure of hormone metabolism

Answer 15

Spider naevi, Gynaecomastia

Question 16

Reduced plasma oncotic pressure due to hypoalbuminaemia

Answer 16

Oedema

Question 17

Cutaneous lipid deposits due to hypercholesterolaemia in cronic biliary obstruction

Answer 17

Xanthelasma

Question 18

Malabsorption of fat due to lack of bile or reduced absorption at mucosal surface

Answer 18

Steatorrhoae

Question 19

Biliary obstruction leading to bile salt accumulation

Answer 19

Pruritus

Question 20

Combination of hypoalbuminaemia, portal hypertension and secondary hyperaldosteronism

Answer 20

Ascites

Question 21

Impaired hepatic synthesis of clotting factors

Answer 21

Bruising or bleeding

Question 22

Increased liver size due to inflammation(e.g. hepatitis), infiltration (e.g. amyloid, fat) or tumour (secondary metastasis more common than primary tumour)

Answer 22

Hepatomegaly

Question 23

Enlargement of spleen due to congestion in portal hypertension

Answer 23

Splenomegaly

Question 24

Ruptured oesophageal varices due to portal hypertension

Answer 24

Haematemesis

Question 25

Failure of liver to remove substances which mimic of alter the balance of neurotransmitters

Answer 25

Encephalopathy