The Physiology of GI Disorders

Question 1

How can sialorrhea (drooling) be managed in patients with complex neurodisability?

Answer 1

Anticholinergic medication which can be delivered via transdermal scopalmine patches. You can also deliver a botulinum toxin type A injection into parotid and submandibular salivary glands (not great though)

Question 2

What are the side effects of anticholinergic medications?

Answer 2

• Drowsiness,
• Blurred Vision,
• Dizziness,
• Urinary retention,
• Confusion or delirium,
• Hallucinations,
• Dry mouth,
• Constipation
• Reduced sweating and elevated body temp.

Question 3

What does the follow surgical terms mean?

• tomy,
• ectomy,
• ostomy,
• plasty,
• pexy,
• rraphy,
• Desis

Answer 3

• tomy = Surgeon cuts something,
• ectomy = Surgeon removes something,
• ostomy = Surgeon made an opening,
• plasty - Changed the shape of something,
• pexy = Surgeon moved the organ to the right place,
• rraphy = Surgeon sutured something up,
• Desis = Surgeon made two things stick together

Question 4

What is coeliac disease and some of the symptoms?

Answer 4

• Auto-immune condition where the individual’s small intestine becomes inflamed if they eat gluten. Symptoms include; indigestion, constipation, diarrhoea, bloating or stomach pain, unexplained weight loss, numbness and tingling in legs, tooth enamel loss, anaemia joint pain, weak bones and infertility

Question 5

What is the testing for coeliac disease?

Answer 5

Serology - Total immunologlobin A and IgA tissue transglutaminase

Duodenal biopsy should be used for definitive diagnosis

Question 6

What are some complications of coeliac disease?

Answer 6

Malignancy (especially lymphoma) and osteoporosis

Question 7

Describe the management of coeliac disease

Answer 7

• Consider the need for assessment of diet and adherence to the gluten free diet.
• Yearly review of symptoms, weight and height and consider the need for specialist dietetic review.

Question 8

What is dermatitis herpetiformis?

Answer 8

A skin condition linked to coeliac disease. The typical symptoms are; red, raised patches often with blisters that burst with scratching, there is severe itching and stinging.

Question 9

What is the diagnostic testing and treatment for dermatitis herpetifomis?

Answer 9

Confirmed via skin biopsy. The treatment is a lifelong gluten free diet.

Question 10

When is vomiting in newborns a red flag?

Answer 10

Bile stained emesis as this suggests intestinal obstruction beyond the duodenum and requires investigation.

Question 11

With malrotation of the intestines, what can occur?

Answer 11

1) Obstruction of the duodenum,
2) A midgut volvulus,
3) Internal hernia in the mesentery

Question 12

What is hypertrophic pyloric stenosis?

Answer 12

It causes babies to projectile vomit and is more common in Caucasian infants.

Question 13

What are some other causes of infant vomiting?

Answer 13

• Cow milk protein allergy,
• Congenital adrenal hyperplasia of the salt losing variety,
• Galactosaemic,
• Hyperammonaemia’s,
• organic acidaemia’s,
• increased intracranial pressure,
• septicaemia,
• meningitis,
• UTIs

Question 14

What are the most common causes of small bowel obstruction in developed and developing countries?

Answer 14

Developed - adhesions,

Developing - Incarcerated hernias

Question 15

What are some common causes of large bowel obstruction

Answer 15

Most common - colonic cancer,

2nd most common cause - cute diverticulitis

Question 16

What is Hirschsprung disease?

Answer 16

It is the most common cause neonatal colonic obstruction. It is characterised by colonic aganlionosis resulting in loss of peristalsis.

Question 17

What is paralytic ileus

Answer 17

It is functional intestinal obstruction without an actual physical obstruction . Symptoms include nausea/vomiting, distension and reduced/absent bowel movements

Question 18

What are the common causes of paralytic ileus?

Answer 18

5 P’s;

• Postoperative,
• Peritonitis,
• Potassium (low),
• Pelvic and spinal fractures,
• Parturition

Question 19

Describe features of acute pancreatitis?

Answer 19

It is inflammation of the pancreas triggered by release of activated exocrine enzymes into the organ resulting in autodigestion. The most common causes are alcohol abuse and gallstone migration

Question 20

What are the causes of pancreatitis

Answer 20

BAD HITS;
Biliary,
Alcohol,
Drugs,
Hypertriglyceridemia/Hypercalcemia,
Idiopathic,
Trauma,
Scorpion sting