GIT 1

Question 1

which organs are in the GIT? and their functions?

Answer 1

liver - metabolise nutrients, convert ammonia into urea, produce bile salts

gallbladder - store and release bile for digestion

pancreas
- exocrine role - release digestive proteases into the duodenum where they become active - amylase, lipase, protease
- endocrine role - release hormone to regular blood sugar - insulin, glucagon

Question 2

give the full structure of the GIT from start to finish

Answer 2

oral cavity
oesophagus
stomach
small intestine - duodenum, jejunum, ileum
large intestine - appendix colon - ascending, transverse, descending, rectum, anus

Question 3

how does the lining of the GIT change from the oral cavity, to the stomach, to the bowels

Answer 3

stratified epithelium

stomach - mucous and acid producing glands

small and large bowl - epithelium lined with villi for absorption

Question 4

why does the gut have layers of muscle?

Answer 4

to produce peristaltic waves
- push food down the gut
- and allow motility

Question 5

talk to me about the appendix.

Answer 5

a blind ended tube at the start of the colon
- evolutionary unecessary
- can become obstructed and infected, = appendicitis then needing to be removed

Question 6

describe the blood flow in the GIT

Answer 6

• from the aorta to the mesenteric arteries
• through the mesenteries
• out the portal venous system and goes to the liver for filtration of toxins and bacteria

Question 7

describe the nerve supply to the GIT

Answer 7

parasympathetic
- > gut motility and secretion

sympathetic
- < gut motility and secretion
- decrease the blood flow to the gut and slow down functions so energy and blood flow can be re-directed to muscles

Question 8

what signs and symptoms can the GIT present with during an infection?

Answer 8

• vomiting
• nausea
• abdominal pain
• heartburn/epigastric pain
• loss of appetite and unintentional weight loss
• malabsoption
• vitamin deficiency
• anaemia

Question 9

what about bowel habits? what are abnormalities

Answer 9

normal can be between a shit once every 3 days - 3 times a day

• if theres any weird changes, that is important
• any painful motions
• blood or mucus in the stool
• constipation or diarrhoea
• Tenesmus - the feeling of not being emptied

Question 10

what is GORD? the physiology, why it causes damage and the signs and symptoms.

Answer 10

gastroesophageal reflux disease

• the lower oesophageal sphincter has been damaged and stomach acid refluxes into oseophagus

the oesophagus has no mucus secretion so the acids from the stomach damage the oesophagus

signs and symptoms:
- heartburn
- acid reflux
- belching
- tooth erosion
- inflamed pharynx and larynx

Question 11

what are the risk factors for GORD?

Answer 11

• reduced tone of the lower oesophageal sphincter (=weakened)
• increased intra-abdominal pressure - pregnant or obese
• decreased stomach pH
• increased stomach content
• lifestyle - stress, diet, smoking, alcohol, obese, caffeine
• mechanical
• drugs - non-steroidal

Question 12

how is GORD managed?

Answer 12

• address the risk factors
• neutralise stomach content - gaviscon uses bicarbonate and alginate to create a physical barrier at the top of the stomach
• surgery to tighten the oesophageal sphincter

Question 13

what is Peptic Ulcer Disease?
- risk factors
- symptoms
- management

Answer 13

an ulceration causing a pathological break in the epithelial lining in the stomach or duodenum

produced by acids and enzymes overcoming the mucous defences

risk factors:
- stress, steroids, NSAIDs, SSRI
- H.Pylori bacteria infection

symptom:
- upper abdominal pain
- bloating
- nausea and vomiting
- dark stools if ulcers bleed
- heartburn

management:
- confirm diagnosis using upper GI endoscopy
- correct risk factors
- > stomach pH w/ protein pump inhibitor
- eradicate H.Pylori w/ penicillin - if allergy, clindamycin and metronidazole

Question 14

give 2 inflammatory bowel diseases. describe the common symptoms

Answer 14

ulcerative colitis
crohn’s disease

affect small intestine, large intestine, rectum and anus

• ulceration
• inflammation
• abdominal pain
• blood loss
• anaemia
• oral - recurrent apthous stomatitis
• fever
• arthritis
• skin and eye lesions

Question 15

describe Ulcerative Colitis - symptoms and risk factor

Answer 15

more common than Crohn’s

• begins at the anus/rectum
• never affects the ileum

symptoms:
- rectal inflam
- bleeding
- tenesmus

risk factor fact
- smoking is less likely to cause UC than non-smoker

Question 16

describe Crohn’s Disease aka Regional Ileitis - symptoms and risk factors

Answer 16

less common than UC
can affect any part of the small and large bowel

• abdominal pain
• diarrhoea/constipation
• can lead to fistula formation

risk factor - smoking

Question 17

how would you diagnose IBD?

Answer 17

• endoscopy
• ct scan
• biopsies

Question 18

how would you treat IBD? PAASMMI

Answer 18

• steroids - prednisolone

other drugs:
- Azathioprine

• Aminosalicylates - Sulphasalazine and Mesalazine
• Methotrexate
• biological response modifier - Infliximab

Question 19

describe Coeliac Disease, symptoms and epidemiology

Answer 19

an autoimmune reaction to gluten leading to inflammation to the small bowel

symptoms:
- abdominal pain
- bloating
- villi have reduced height - loss of SA - malabsorption

epidemiology - peaks in infants, have to think about the “failure to thrive” if a child is undernourished and not having enough calories

Question 20

how do you diagnose and manage Coeliac Disease?

Answer 20

blood tests and biopsies

manage: gluten free diet

Question 21

is irritable bowel syndrome an irritable bowel disease?

Answer 21

NO IBS IS NOT AN IBD

Question 22

describe IBS and what you should ask ur patients to verify its not UC, Crohn’s or bowel cancer

Answer 22

very common
- abdominal pain, urgency or strain
- bloating
- worse after eating
- relieved by bowel movement

1. any blood/mucus in poo?
2. lost any sudden weight
3. are u anaemic