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What is the role of the diaphragm in digestion?

Prevent backflow of the bolus into the oesophagus.

What medical instrument is used to perform an upper GI endoscopy?

Flexible fibre optic endoscope.

What does the oesophagus appear like when viewed through an endoscope?

White and smooth due to the squamous epithelium lining.

Why may some areas of the oesophagus appear red in certain patients?

The red areas indicate the presence of glandular epithelium, which is abnormal.

Where can adenocarcinoma develop?

Only in areas with glandular tissue.

Which groups of people are more at risk for developing oesophageal cancers?

Males and patients between the ages of 70 and 80.

What are the 5-year survival rates for oesophageal cancers?

Below 10%.

What occurs during Helicobacter gastritis?

H. pylori lives in the mucin layer, attracting inflammatory cells and causing acute inflammation.

Why is there a reducing incidence rate of gastric cancers?

Some cancers previously diagnosed as gastric are now classified as oesophageal cancers.

What environmental factors increase the risk of gastric cancer?

Smoked food and pickled food.

What chain of events leads from normal gastric mucosa to invasive carcinoma?

Gastric mucosa differentiates into intestinal metaplasia, then dysplasia, and finally into invasive carcinoma.

What are the histological changes in the duodenum between a healthy patient and one with coeliac disease?

In health, there are long villi; in coeliac disease, there is villous atrophy and hyperplasia of crypts.

What is an oral relevance of Crohn's disease?

Patients may experience oral aphthous ulceration.

Define an aphthous ulcer.

A recurrent round or oval sore inside the mouth.

What is ulcerative colitis?

Chronic inflammatory disease causing continuous ulceration of the colonic mucosa.

Which layers of the bowel does ulcerative colitis affect?

Only affects the mucosa.

What is diverticular disease?

A condition causing small sacs (diverticula) to form in the large intestine.

What is familial adenomatous polyposis?

An autosomal dominant mutation causing thousands of polyps after puberty.

What is hereditary nonpolyposis colorectal cancer?

An autosomal dominant genetic condition associated with a high risk of colon cancer.

What questions should be asked during history taking for a patient presenting with dysphagia?

Duration, solids/liquids/both, odynophagia, weight loss, previous medical history, medication list, social history.

What is dysarthria?

A motor speech disorder due to damaged or weakened muscles used for speech.

Give examples of oesophageal problems that cause dysphagia.

Benign peptic stricture, oesophageal web, candidal oesophagitis, carcinoma, oesophageal spasm, achalasia.

What is achalasia?

A failure of smooth muscle fibers to relax, causing the lower oesophageal sphincter to remain closed.

What is the management of GORD?

Proton pump inhibitors, H2 antagonists, lifestyle advice, surgery.

How may hiatus hernias cause GORD?

By causing loss of pressure gradient between abdominal and thoracic cavities.

What are the types of hiatus hernia?

Normal, pre-stage, sliding hiatal hernia, paraoesophageal.

What is paraoesophageal hernia?

Upward movement of the gastric fundus alongside normally positioned gastro-oesophageal junction.

What is a sliding hiatal hernia?

Upward movement of the gastro-oesophageal junction through the diaphragmatic hiatus.

What are the causes of indigestion and upper abdominal discomfort?

Peptic ulceration, gastric carcinomas, non-ulcer dyspepsia, pancreatic carcinoma, pancreatitis.

What are common findings in a patient's history with peptic ulceration?

Epigastric pain, pain worsened by foods, weight loss, vomiting, H. pylori infection, NSAID use.

What is a common diagnosis for a patient presenting with epigastric pain that improves by eating?

Duodenal ulcers.

What is the management of peptic ulcers?

Test for H. pylori, suppression therapy, endoscopic treatment for bleeding, rare surgical intervention.

What are the symptoms of gastric carcinoma?

Epigastric pain, weight loss, vomiting.

How are gastric carcinomas diagnosed?

OGD gastroscopy followed by further testing for staging and grading.

What are the symptoms of pancreatic cancer?

Unremitting pain, jaundice, associated with risk factors such as age, smoking, diabetes.

What is the treatment of pancreatic carcinoma?

Surgical resection with poor prognosis; adjunct chemotherapy may be needed.

What are the symptoms of non-ulcer dyspepsia?

Upper abdominal discomfort, nausea, eructation, bloating, motility disturbance.

What is the management of chronic pancreatitis?

Long term opioids and counselling on alcohol.

Define chronic abdominal pain.

Abdominal pain lasting more than 6 weeks.

List three pancreatic diseases that can cause chronic diarrhea.

Pancreatic insufficiency, pancreatic carcinoma, cystic fibrosis.

What will wireless capsule endoscopy show in a patient with coeliac disease?

Scalloping.

What is dermatitis herpetiformis?

Intensely itchy blisters commonly found on the back, knees, elbows, suggestive of coeliac disease.

What features of diarrhea suggest small bowel and pancreatic problems?

Pale, floating, difficult to flush, occurs throughout the day.

What is the treatment of ulcerative colitis?

Aminosalicylates, steroids for short term, long term treatments include thiopurines.

In which age groups should methotrexate be avoided?

Anyone of childbearing age.

List commonly associated ophthalmology diseases with inflammatory bowel diseases.

Episcleritis and uveitis.

List commonly associated liver diseases with inflammatory bowel diseases.

Cirrhosis, CAH, pericholangitis.

What are the causes of post hepatic jaundice?

Gallstones, malignancy, benign biliary stricture.

What are the causes of hepatic jaundice?

Infections, alcoholic hepatitis, drugs, decompensated chronic liver disease.

What are the causes of pre hepatic jaundice?

Haemolytic anaemia with isolated raised bilirubin.

Define gastroenteritis.

Syndrome characterized by GI symptoms such as nausea, vomiting, diarrhea, abdominal pain.

Define dysentery.

Abnormal inflammation of the GI tract resulting in blood and pus in feces.

Dysentery is a result of?

Diseases of the large intestine.

Define enterocolitis.

Inflammation of the mucosa of small and large intestine.

How does Bacillus cereus cause fried rice syndrome?

Spores survive cooking; if left at room temperature, they can germinate and release heat-stable toxins.

What is the relevance of H. pylori producing urease?

Urease neutralizes stomach acid, creating a shield around H. pylori.

What strain of H. pylori is linked to gastric ulcers?

CagA strain is thought to be involved in cancer development.

What is ID50?

Infectious dose for 50% of the test population.

What does lysogenic phage mean?

Viruses that infect bacteria and integrate into their chromosome.

How is E. coli microbiologically detected?

Using MacConkey agar plates or Hektoen enteric agar.

How does enteropathogenic E. coli (EPEC) infect cells?

Through bundle-forming pili and a Type III secretion system.

How does EIEC cause disease?

By invading and destroying epithelial cells, leading to blood in diarrhea.

How does EHEC cause diarrhea?

Attaches to cells via pedestals and produces a potent toxin.

What is haemorrhagic colitis?

Gastroenteritis caused by EHEC leading to bloody diarrhea and potential kidney involvement.

What infections can Shigella dysenteriae cause?

Bacillary dysentery with blood in stool.

What is the appearance of Shigella on MacConkey agar?

Dark green colonies as it is a non-lactose fermenting organism.

How does Salmonella cause disease?

By invading macrophages and spreading to surrounding epithelium.

What can you do to prevent typhoid fever?

Vi antigen vaccine is recommended for travel.

What is Campylobacter spp.?

Gram negative micro-aerophile.

What is the most important serotype of Vibrio cholerae?

O1 serotype.

What is rotavirus?

Pathogen causing serious fever, diarrhea, and vomiting; very contagious.

What is winter vomiting virus?

Norovirus causing chills, headaches, fever, nausea.