gi*
What is the Role of the Diaphragm in Digestion
Although it is not a Valve, it prevents the backflow of the Bolus into the Oesophagus.
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What Medical Instrument is used to do an Upper GI Endoscopy
Flexible Fibre Optic Endoscope.
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In Health, What is the Appearance of the Oesophagus when looking down an Endoscope
White and Smooth. This is because the Squamous Epithelium lining the Oesophagus reflects lots of light.
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In Some Patients, the Appearance of the Oesophagus may be Red in some areas.
Why may this be.
The Red areas are where Glandular Epithelium is present. This is abnormal and should not be in the Oesophagus.
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Where can you get an Adenocarcinoma
You can only get Adenocarcinoma where there is Glandular Tissue.
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Which Groups of People are more at risk to develop Oesophageal Cancers
- Males, the incidence of Oesophageal Cancers in Males have doubled in the last 20/30 years.
- Patients between the ages of 70 and 80, disease manifest itself at advanced stages
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What are the Survival Rates for Oesophageal Cancers
5 Year Survival Rates below 10%
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Describe the Pathology that occurs during Helicobacter Gastritis
In Health, the Stomach is lined with Mucin Layer above Glandular Epithelium and Capillaries.
H.Pylori Live in the Mucin Layer in the Stomach. This is a very Niche Environment due to the low pH
H.Pylori produces chemicals that attract acute inflammatory cells into the stomach causing Acute Inflammation.
The Acute Inflammatory Cells can cause Ulceration
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Explain why Gastric Cancers have a reducing Incidence Rate
Some Cancers previously known to be Gastric Cancers are now classified as Oesophageal Cancers.
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What Environmental Factors increase the risk of Gastric Cancer (2)
1) Smoked Food
2) Pickled Food
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List the Chain of Events from Normal Gastric Mucosa to Invasive Carcinoma
Smoked/Pickled Foods, Pernicious Anaemia and H.Pylori Infection can cause Gastric Mucosa to differentiate into Intestinal Metaplasia.
Genetic Changes occur causing the Intestinal Metaplasia to differentiate into Dysplasia and further into Intramucosal Carcinomas.
Further genetic changes cause Invasive Carcinomas.
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Describe Histological Changes in the Duodenum between a Healthy Patient and a Patient with Coeliac Disease
In Health, the Duodenum has full length finger like Villi Projections designed to increase the surface area for absorption of food.
In Coeliac Disease, the Villi are much shorter. There is Villous Atrophy and the Crypt have got Hyperplasia
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What is the Oral Relevance of Crohn's Disease
Patient with Crohn's Disease may get Oral Aphthous Ulceration
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What is an Aphthous Ulcer
An aphthous ulcer is typically a recurrent round or oval sore inside the mouth on an area where the skin is not tightly bound to the underlying bone, such as on the inside of the lips and cheeks or underneath the tongue
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What is Ulcerative Colitis
Chronic inflammatory disease that causes continuous ulceration of the colonic mucosa. Only in the Large Intestine
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Which Layers of the Bowel does Ulcerative Colitis affect
Only affects the Mucosa
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What is Diverticular Disease
Diverticular disease is the general name for a common condition that causes small bulges (diverticula) or sacs to form in the wall of the large intestine (colon).
Although these sacs can form anywhere in the colon, they are most common in the sigmoid colon
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What is Familial Adenomatous Polyposis
An Autosomal Dominant mutation of the APC tumour suppressor gene on chromosome 5q that results in thousands of polyps (adenomas) after puberty.
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What is Hereditary Nonpolyposis Colorectal Cancer
an autosomal dominant genetic condition that is associated with a high risk of colon cancer
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A patients presents in your clinic with Dysphagia.
What questions need to be asked regarding this matter in form of History Taking (7)
1) Duration - Was this of Gradual or Progressive Onset. Is it Intermittent
2) Does the Patient have Dysphagia to Solids or Liquids or Both.
3) Is there any pain on swallowing (Odynophagia)
4) Weight Loss (Weight Loss is a concern regarding Malignancy)
5) Previous Medical History (Any Previous GI Surgery, any Neuromuscular Disorders)
6) Medication List
7) Social History including Smoking, Alcohol Intake and Occupation
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What is Dysarthria
A motor speech disorder in which the muscles that are used to produce speech are damaged, paralyzed, or weakened
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Give Examples of Oesophageal Problems that cause Dysphagia
Benign Mucosal Disease
- Benign Peptic Stricture, Oesophageal Web, Candidal Oesophagitis
Malignant Mucosal Disease
- Carcinoma
Motility Disorders
- Oesophageal Spasm, Achalasia, Oesophageal Pouch
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What is Achalasia
a failure of smooth muscle fibres to relax, which can cause the lower Oesophageal sphincter to remain closed.
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What is the Management of GORD
1) Proton Pump Inhibitors (Omeprazole, Lansoprazole)
2) H2 Antagonists (Relieve Symptoms but do not treat the disease)
3) Lifestyle Advice
5) Surgery (Fundoplication)
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How may Hiatus Hernias cause GORD
Due to loss of pressure gradient between abdominal and thoracic cavities.
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What are the 4 types of Hiatus Hernia. Which of the 4 types are most common.
1) Normal
2) Pre-Stage
3) Sliding Hiatal Hernia
4) Paraoesophageal
Sliding Hiatal Hernia and Paraoesophageal Hernias are the main type.
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What is Paraoesophageal Hernia
Upward movement of the gastric fundus alongside normally positioned gastro-oesophageal junction
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What is a Sliding Hiatal Hernia
This is where the Gastro oesophageal junction and abdominal part of the oesophagus and cardia of the stomach move upwards through the diaphragmatic hiatus into the thorax.
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What are the causes of Indigestion and Upper Abdominal Discomfort
1) Peptic Ulceration
2) Gastric Carcinomas
3) Non-Ulcer Dyspepsia
4) Pancreatic Carcinoma
5) Pancreatitis
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What are common findings in a Patient's History who has Peptic ulceration
1) Epigastric Pain sometimes radiating into the back
2) Pain worsened by Foods and therefore associated with Weight Loss
3) Pain can sometimes be improved by eating
4) Vomiting/Haematemesis
5) Can be Bacterial in Origin (H.Pylori)
6) Can be due to NSAIDs.
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A Patient Presents with Epigastric Pain which improves by eating
What is a common Diagnosis
Duodenal Ulcers
Peptic Ulcers that improve during eating are likely to be Duodenal Ulcers.
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What is the Management of Peptic Ulcers (4)
1) Test for H.Pylori and then treat if present
2) Suppression Therapy
3) If the Peptic Ulcer is bleeding then do Endoscopic Treatment
4) Surgical Intervention but is Rare.
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What are the Symptoms of Gastric Carcinoma (3)
1) Epigastric Pain
2) Weight Loss
3) Vomiting
Must be suspected in anyone over 50 years with new onset symptoms
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How are Gastric Carcinomas Diagnosed?
OGD Gastroscopy to investigate
if confirmed then do further testing to see the Staging and Grading of the Cancer via CT Scan or Endoscopy Ultrasound
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What are the symptoms of Pancreatic Cancer
1) Unremitting Pain often radiating to back and associated with weight loss
2) Jaundice
Increasing Risk with Age, Smoking, Diabetes and History of Chronic Pancreatitis
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What is the Treatment of Pancreatic Carcinoma
Surgical Resection but prognosis is poor.
Patient may need Adjunct Chemotherapy
Majority Patients are treated with Palliative Approach
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What are the Symptoms of Non-Ulcer Dyspepsia
Upper Abdominal Discomfort
Nausea
Eructation
Bloating
Motility Disturbance
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What is the management of Chronic Pancreatitis
Long Term Opioids
Counselling on Alcohol
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Acute Lower Abdominal Pain
1) Inflammation where pain tends to develop gradually over a few hours
2) pain is quite localised
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How is Acute Abdominal Pain assessed
Imaging using Ultrasonic Scans and CT scans
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Define Chronic Abdominal Pain
Abdominal Pain lasting more than 6 weeks
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List 3 Pancreatic Diseases that can cause Chronic Diarrhoea
1) Pancreatic Insufficiency
2) Pancreatic Carcinoma
3) Cystic Fibrosis
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A patient with Coeliac Disease may have Wireless Capsule Endoscopy as part of their Diagnosis. What will this show
Scalloping
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What is Dermatitis Herpetiformis
Crops of Intense Itchy Blister commonly found on the Back, Knees, Elbows and Buttocks.
Suggestive of Coeliac Disease.
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What features of Diarrhoea suggest that is caused by Small Bowel and Pancreatic Problems
It is Pale, Floating and Difficult to Flush
Occurs throughout the Day
Pain is Variably Timed and not relieved by Defaecation
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What is the Treatment of Ulcerative Colitis
Aminosalicylates such as Mesalamine
Short Term Treatment with Steroids such as Prednisolone and Hydrocortisone (IV)
Long Term Management with Thiopurines,
Inflixamab and Aderlonamab
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Which age groups such Methotrexate be avoided in
Anyone with Child Bearing Age
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List Commonly Associated Ophthalmology Diseases with Inflammatory Bowel Diseases like Crohn's and Ulcerative Colitis
Episcleritis and Uveitis
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List Commonly Associated Liver Diseases with Inflammatory Bowel Diseases like Crohn's and Ulcerative Colitis
Cirrhosis
CAH
Pericholangitis
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What are the causes of Post Hepatic Jaundice
1) Gallstones
2) Malignancy
3) Benign Biliary Stricture
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What are the causes of Hepatic Jaundice (4)
Infection (Hep A, B, C and EBV)
Alcoholic Hepatitis
Drugs (Flucloaxicllin, Augmentin)
Decompensated Chronic Liver Disease
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What are the causes of Pre Hepatic Jaundice
Haemolytic Anaemia characterised by an isolated raised Billirubin Level
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Define Gastroenteritis
Syndrome characterised by GI symptoms including Nausea, Vomiting, Diarrhoea and Abdominal Pain
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Define Dysentery
Abnormal Inflammation of the GI Tract resulting in Blood and Pus in Faeces. Other symptoms include Pain, Fever, Abdominal Cramps
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Dysentery is a result of
Disease of Large Intestine
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Define Enterocolitis
Inflammation of the Mucosa of Small and Large Intestine.
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How does Bacillus Cereus cause Fried Rice Syndrome
B.Cereus is a spore forming organism. It is present in most pulses at low level.
The spores formed can survive the rice cooking process. If the rice is left on the counter at room temperature, these spores can germinate and release toxins which are heat stable.
When you re-fry or heat up the rice again to eat, you ingest the toxin.
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H.Pylori produces Urease. What is the relevance of this.
H.Pylori produces Urease which breaks down Urea in Stomach Acid and turns it into Ammonia.
Ammonia is an Anti-Ion and Neutralised Stomach Acid.
A shield forms around H.Pylori so that the H+ ions in stomach acid do not attack the bacteria.
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What Strain of H.Pylori has a confirmed link to Gastric Ulcers
CagA is thought to be involved in Cancer Development.
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What is ID50?
infectious dose for 50% of the test population
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What does Lysogenic Phage mean
Virus infect bacterias and then go into their chromosome.
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How is E.Coli Microbiologically detected
MacConkey Agar Plates or Hektoen Enteric Agar
E.Coli is a Lactose Fermenting Orgnaism, therefore on MacConkey Agar plates if E.Coli is present we find a Deep Red/Pink Colour.
Hektoen Enteric Agar plates detect the pH changes when Lactose Ferments as acid is produce, the pH indicator in the agar plate changes colour representing E.Coli
To see which type of E.Coli is present we can do PCR tests or Antigen Tests to detect the serotypes
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How does Enteropathogenic E.Coli (EPEC) infect cells.
Bundle Forming Pili important in Attachment
Has a Type III Secretion System that injects proteins into host to manipulate cytoskeleton.
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How does EIEC cause disease
Invades and Destroys Epithelial Cells leading to Blood in the Diarrhoea.
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How does EHEC cause diarrhea?
EHEC attaches to cells via Pedestals. It produces Vero-Toxin which is a potent diarrhoeal toxin and acts via damaging cells directly.
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EHEC Infections can causes Haemorrhagic Colitis
What is Haemorrhagic Colitis
a type of gastroenteritis in which certain strains of the bacterium Escherichia coli infect the large intestine and produce a toxin (Shiga toxin) that causes bloody diarrhea.
The toxin can spread to the kidneys
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What infections can Shigella Dysenteriae cause
1) Bacillary Dysentry
Classical Diarrhoea with blood in stool similar to EHEC
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What is the appearance of Shigella on MacConkey Agar and why
Form Dark Green Colonies as it is a non lactose fermenting organsim.
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How does Salmonella cause disease
Invades Macrophage Cells and then spread to surrounding Epithelium into underlying tissues causing Diarrhoea and Enterocolitis.
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What can you do to prevent Typhoid Fever
Vi Antigen vaccine recommended for travel
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What is Campylobacter Spp.
Gram Negative Micro-aerophile
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What is the most important Serotype of Vibrio Cholerae
O1 Serotype most important
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What is Rotavirus
A pathogen that causes serious fever, diarrhea, and vomiting
Wheel-Like Viral Particle
Very Contagious
Very Resistant to Cleaning Products
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What is Winter Vomiting Virus
Norovirus
causes Chills, Headaches, Fever, Nausea