Week 1 - Prerequisite knowledge

Question 1

What is the primary function of the gastrointestinal tract (GIT)?

Answer 1

Absorption of nutrients and water

The GIT lining composition varies from the stomach to the anus, but the primary function remains the same.

Question 2

Name two upper gastrointestinal disorders discussed.

Answer 2

• Peptic Ulcer Disease
• Gastro-oesophageal Reflux Disease (GORD)

These conditions are often seen as co-morbidities in patients.

Question 3

Why is it important to understand GORD in surgical patients?

Answer 3

It can influence the patient’s current health status and potential complications during surgery

Knowing a patient’s history of GORD is pertinent when administering general anaesthesia.

Question 4

What characterizes Peptic Ulcer Disease (PUD)?

Answer 4

Erosion of the GI mucosa from the digestive action of hydrochloric acid (HCl) and pepsin

PUD can occur in various areas of the GIT.

Question 5

Where can peptic ulcers occur within the gastrointestinal system?

Answer 5

• Oesophagus
• Mucosal wall of the stomach
• Pylorus
• Duodenum

These areas are affected by the erosive action of gastric secretions.

Question 6

What are the characteristics of Gastric Ulcers?

Answer 6

• Superficial, smooth margins
• Round, oval, or cone-shaped lesions
• Predominantly in the antrum of the stomach
• Normal to decreased gastric secretion
• Greater incidence in women

Gastric ulcers are associated with an increased risk of cancer and H. pylori infection in 80% of cases.

Question 7

What are the characteristics of Duodenal Ulcers?

Answer 7

• Penetrating lesions
• Located in the first 1–2 cm of the duodenum
• Increased gastric secretion
• Greater incidence in men, rising in postmenopausal women

Duodenal ulcers do not increase cancer risk and are associated with H. pylori infection in 90% of cases.

Question 8

List the common signs and symptoms of Gastric Ulcers.

Answer 8

• Burning or gaseous pressure in high left epigastrium
• Pain 1–2 hours after meals
• Discomfort worsens with food

Symptoms can vary based on ulcer location and severity.

Question 9

List the common signs and symptoms of Duodenal Ulcers.

Answer 9

• Burning, cramping, pressure-like pain across mid-epigastrium
• Back pain with posterior ulcers
• Pain 2–4 hours after meals
• Pain relief with antacids and food

Symptoms are often periodic and episodic.

Question 10

What are the potential complications of Peptic Ulcer Disease?

Answer 10

• Haemorrhage
• Perforation
• Gastric outlet obstruction
• Intractability

Monitoring for these complications is crucial in managing PUD.

Question 11

What are the two most common causes of upper GI tract bleeding?

Answer 11

• Perforation from a peptic ulcer
• Haemorrhage from a peptic ulcer

Upper GI bleeding can be serious and life-threatening.

Question 12

What is a common presentation of a patient experiencing upper GI bleeding?

Answer 12

Hypovolaemic shock

Prompt resuscitation efforts are necessary to avoid further decline.

Question 13

Fill in the blank: Patients with a known history of PUD may be placed on medications to reduce _______.

Answer 13

gastric secretions

This preventive measure is essential when managing patients with PUD.

Question 14

What is the function of the lower oesophageal sphincter (LOS)?

Answer 14

Tonically closed valve; prevents reflux

Failure or frequent relaxations can lead to gastroesophageal reflux disease (GERD).

Question 15

What is the final common pathway for acid secretion in the stomach?

Answer 15

H⁺/K⁺-ATPase (proton pump) secretes H⁺ into the lumen

PPIs irreversibly block this pump, providing strong acid suppression.

Question 16

What characterizes mucosal inflammation in ulcerative colitis (UC)?

Answer 16

Inflammation confined to mucosa/submucosa

Symptoms include bleeding, urgency, and risk of toxic megacolon.

Question 17

What characterizes transmural inflammation in Crohn’s disease?

Answer 17

Inflammation through the entire wall

Leads to fissures, fistulae, abscesses, and strictures.

Question 18

Define continuous lesions in ulcerative colitis.

Answer 18

Starts at rectum and extends proximally without gaps

This is in contrast to the skip lesions seen in Crohn’s disease.

Question 19

What is a stricture in the context of Crohn’s disease?

Answer 19

Fixed narrowing from fibrosis ± ongoing inflammation

Can cause colicky pain, distension, and vomiting.

Question 20

What is a fistula?

Answer 20

Abnormal tract between organs (e.g., entero-enteric, entero-vesical)

Can present with recurrent UTIs or non-healing perianal disease.

Question 21

What is toxic megacolon?

Answer 21

Acute colonic dilation with systemic toxicity

Surgical emergency; requires urgent GI/surgical review.

Question 22

What triggers reflux related to the lower oesophageal sphincter (LOS)?

Answer 22

• Transient relaxations or low tone
• ↑ Intra-abdominal pressure (bending, late meals, obesity, pregnancy)

These factors can lead to gastro-oesophageal reflux disease (GORD).

Question 23

What is the final common pathway for parietal cells?

Answer 23

H⁺/K⁺-ATPase (proton pump) secretes H⁺ into the lumen; irreversibly inhibited by PPIs → strongest acid suppression.

This mechanism is crucial for gastric acid secretion.

Question 24

Differentiate between mucosal vs transmural inflammation with examples and symptoms.

Answer 24

• Mucosal/submucosal only (UC) → bleeding/urgency
• Transmural (Crohn’s) → fissures, fistulae, abscess, strictures, creeping fat

Understanding these differences is essential for diagnosis and treatment.

Question 25

What are the differences between **UC vs Crohn’s** in an exam context?

Answer 25

* UC: bloody diarrhoea + urgency/tenesmus (mucosal, continuous) * Crohn’s: weight loss + perianal disease + obstructive symptoms (transmural, skip) ## Footnote Recognizing these differences is key for diagnosis.