GI & Surgery 2

oelomar's version from 2016-01-02 23:45


Question Answer
What is the most common cause of GORD?Transient LOS relaxation.
The heartburn associated with GORD is aggravated when the individual is in what position?Bending, stooping, lying down (promotes acid exposure).
What is a hiatal hernia?Separation of the diaphragmatic crura and protrusion of the stomach into the thorax through the resulting gap.
What are the symptoms of a hiatal hernia?Fewer than 10% of adults with a hiatal hernia have symptoms. Symptoms include reflux and heartburn.
How can GORD be treated/managedAntacids, loss of weight, and raising the head of the bed at night. Precipitating factors should be avoided, with dietary measures, reduction in alcohol consumption and cessation of smoking.


Question Answer
What is Barrett's oesophagus?Replacement of the normal stratified squamous epithelium lining of the oesophagus by simple columnar epithelium with goblet cells (which are usually found lower in the gastrointestinal tract) - i.e. it is metaplasia of the lower part of the oesophagus.
Upper intestinal obstruction or gastric outlet obstruction (GOO) results in what type of vomit?Projectile vomit.
Lower intestinal obstruction or a gastrocolic fistula results in what type of vomit?Faeculent vomit (vomiting of faeces).
What is Ménétrier's disease?Ménétrier's disease is a rare condition with characteristic giant gastric folds. Histologically, there is hyperplasia of the gastric pits, parietal cell atrophy, and an increase in mucous cells (and resultant protein loss leading to peripheral oedema). This is a precancerous disease. The rugae of the stomach become so hypertrophied that they look like brain gyri.
What is early gastric cancer (EGC) and what 5-year survival rate is it associated with?Carcinoma confined to the mucosa or submucosa regardless of the presence of lymph node metastasis. It is associated with a 5-year survival rate of around 90%.


Question Answer
What is Virchow's node?A lymph node in the left supraclavicular fossa. It takes supply from the lymph vessels in the abdominal cavity.
What is Troisier's sign and what is it indicative of?It is an enlarged, hard Virchow's node. It is indicative of the presence of cancer in the abdomen, specifically gastric cancer, that has spread through the lymph vessels.
What regards to stomach cancer, transabdominal ultrasound can demonstrate what?Masses; gastric wall thickening; lymphadenopathy.
With regards to stomach cancer, endoscopic ultrasound can demonstrate what?The depth of penetration of the cancer.
What are the risk factors for gastric adenocarcinoma?Age, h.pylori, salt, smoked food, tobacco.


Question Answer
What is a primary gastric lymphoma?Lymphoma that originates in the stomach itself (it is an uncommon condition, accounting for less than 15% of gastric malignancies and about 2% of all lymphomas). However, the stomach is a very common extranodal site for lymphomas (lymphomas originating somewhere else with metastasis to stomach).
What do patients with primary gastric lymphoma present with?Stomach pain, ulcers, or other localised symptoms. They rarely have systemic complaints such as fever or fatigue.
What are the causes of primary gastric lymphoma?About 90% of cases are due to H. pylori infection.
What is the most common cause for acute upper GI bleeding?Peptic ulceration.


Question Answer
Which formal risk assessment scores are used as screening tools to assess the likelihood that a patient with acute upper GI bleeding (UGIB) will need to have medical intervention?The Blatchford score at first assessment and the full Rockall score after endoscopy.
What variables contributes to the Blatchford score (ie how is the Blatchford score measured)?Blood urea, haemoglobin (different levels if man/woman), systolic blood pressure, and "other markers" (e.g. pulse>100, presentation with melaena, hepatic disease).
With regards to the Blatchford score, a score of _ or greater is associated with a greater than 50% risk of needing an intervention6.
What variables contributes to the Rockall score (ie how is the Rockall score measured)?Age, shock, co-morbidity, diagnosis, evidence of bleeding.
How is the Rockall score interpreted? A score less than 3 carries good prognosis but total score more than 8 carries high risk of mortality.


Question Answer
List some causes of acute lower GI bleedingDiverticular disease, ischaemic colitis, haemorrhoids, anal fissures.
How is acute lower GI bleeding managed?Most acute lower GI bleeds start and stop spontaneously. Appropriate investigations include proctoscopy, flexible sigmoidoscopy or colonoscopy, and agiography.
Patients with chronic GI bleeding normally present with what?Iron deficiency anaemia.
What conditions would one want to exclude when testing a patient with chronic GI bleeding?Cancer and coeliac disease (coeliac disease is a recognised cause of iron deficiency).
What is the most common world-wide cause of chronic GI blood loss?Hookworm.


Question Answer
If a patient presents with diarrhoea/, weight loss, anaemia, and gets worse when gluten is part of the diet, what disease is suspected?Coeliac disease (note: the symptoms of coeliac disease can often be non specific).
Infertility and neuropsychiatric symptoms of anxiety and depression can occur in coeliac disease. True or false?True.
What tests can be done to diagnose coeliac disease?Test for IgA tissue transglutaminase (tTGA) as a first-choice test. Use IgA endomysial antibodies (EMA) testing if the result of the tTGA test is uncertain. If both tests are negative but suspicion is high test for IgA deficiency. If antibody tests are positive refer for small bowel biopsy for diagnosis.
What is the commonest cause of villous atrophy?Coeliac disease.
Mild/moderate anaemia is present in _________% of coeliac disease?50%.


Question Answer
What is the long term effect of being in a gluten-free diet for life?Osteoporosis.
If one has a problem with their spleen such as splenic atrophy, what infection are they particularly susceptible to?Pneumococcal infection.
Sometimes patients with coeliac disease who are on a strict diet do not improve. This is referred to as unresponsive coeliac disease. What could be the initial cause for this?Enteropathy-associated T cell lymphoma (EATCL), ulcerative jejunitis or carcinoma. Sometimes no cause is found.
What is dermatitis herpetiformis?A chronic blistering skin condition characterised by blisters filled with watery fluid. It is a specific manifestation of coeliac disease. The severity of it can vary in response to the amount of gluten ingested.
What is tropical sprue?This is a condition presenting with chronic diarrhoea and malabsorption that occurs in residents or visitors to affected tropical areas. The term tropical sprue is reserved for severe malabsorption (of two or more substances - particularly fat and vitamin B12) accompanied by diarrhoea and malnutrition. There is also villous atrophy throughout the small bowel.


Question Answer
What is giardiasis?A parasitic disease caused by the flagellate Giardia lamblia. Symptoms are caused by Giardia organisms infecting the cells of the duodenum and jejunum of the small intestine and blocking nutrient absorption. Most people are asymptomatic; only about a third of infected people exhibit symptoms. Symptoms include weakness in the body, loss of appetite, diarrhoea, and loose or watery stools.
How can tropical sprue be treated?Leaving the sprue area, taking folic acid, and antibiotics.
Anti-endomysial antibodies is a specific test for what disease(s)?Coeliac disease and dermatitis herpetiformis.