Digestive Tutorials

                 DIGESTIVE SYSTEM TUTORIALS – November 2011

Date: Monday, November 7, 2011  2:00-4:00p.m.
Tutors	Learning Communities	Topic	Venues
Professor B. Hanchard	13-15	Digestive Pathology	Pathology Teaching Lab
Dr. T. Gibson	16-18	Digestive Pathology	Physiology Lab
Dr. N. Williams	19-21	Digestive Pathology	PreClinical Lecture Theatre
Professor K. Coard	22-24	Digestive Pathology	Physiology Lecture Theatre
Dr. L. Young-Martin	1 – 12 & WJC	Digestive Physiology	MMLT
Date: Monday, November 14, 2011  2:00-4:00p.m.
Dr. J. Jaggon	1-3 & WJC	Digestive Pathology	MMLT
Dr. K. Bishop	4-6	Digestive Pathology	Physiology Lab
Professor B. Hanchard	7-9	Digestive Pathology	Pathology Teaching Lab
Dr. S. Shirley	10-12	Digestive Pathology	PreClinical Lecture Theatre
Dr. L. Young- Martin	13-24	Digestive Physiology	Physiology Lecture Theatre

Digestive Pathology

LEARNING OBJECTIVES

This tutorial is supplementary to the lectures on diseases of the gastrointestinal tract and is designed to consolidate factual knowledge about common gastrointestinal disorders through case discussions.

By the end of the tutorial students should be able to:

Ø  Classify gastrointestinal haemorrhage

Ø  Discuss common causes of upper gastrointestinal tract haemorrhage

Ø  Outline the pathology of various causes and mechanisms of haemorrhage

Ø  Discuss the pathogenesis of Portal Hypertension

Ø  Discuss the causes and consequences of cirrhosis of the liver

Ø  Discuss gastrointestinal neoplastic disorders

Ø  Appreciate the natural history and prognosis of each disorder

The following cases will be discussed

CASE 1

A 65-year-old man was brought to the Accident and Emergency Unit at the UHWI by friends having been found in a collapsed state in the bathroom of a popular night club where he had spent most of the evening drinking.  When he was examined he was somewhat disoriented in time and space, had slurred speech and had no recollection of the events of the evening although he was fully conscious.  Alcohol was smelt on his breath and there was blood and vomitus on his clothes.

He stated that he had been relatively well in the past except that he had noticed that his abdomen was becoming distended and that his palms now looked redder than usual.  He had no known chronic illness.

The significant examination findings were a rapid thready pulse of 92/min, blood pressure 90/60 mm Hg and cold and clammy skin.  No organs were palpated in his abdomen but this was distended and there was evidence of a fluid thrill. His chest was clear and no central nervous system deficits were noted.

He was diagnosed as having had an upper gastrointestinal haemorrhage with shock and referred to the gastrointestinal service for further management.

QUESTIONS

1.         What are the possible causes of upper gastrointestinal haemorrhage (haematemesis) in this patient?

2.                  For each of these disorders, give an account of the:       

a.       Mechanism of haemorrhage

b.      What is the most likely cause in this patient?

c.       What other supporting findings may be present on examination?

3.                  What is the most likely underlying disease in this patient?

4.                  What is the most likely cause of the underlying disease?

a.       Discuss other possible causes and consequences of the underlying disease.

CASE 2

A 37-year-old man presented to his private doctor with a history of weight loss and exertional dyspnea.  On systematic enquiry he admitted to episodic diarrhoea and a family history of gastrointestinal disease.  A fecal occult blood test done was positive.  Colonoscopy was performed and multiple lesions were identified, the largest of which was biopsied.

1.         What is the most likely diagnosis?

2.         What is the likely result of the biopsy?

3.         Are there any other associated aetiologic factors?

4.         If a CT scan of the abdomen revealed pelvic lymphadenopathy, what would be the stage and prognosis?