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IMF-047-01-0001-en	What should reasoning about a gastrointestinal presentation establish beyond naming the symptom?	It should localise the process, identify mechanism and tempo, estimate consequence, and recognise haemorrhage, perforation, ischaemia, obstruction, or cancer early.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0002-en	What distinguishes oropharyngeal from oesophageal dysphagia clinically?	Oropharyngeal dysphagia impairs initiating a swallow, with coughing, nasal regurgitation, wet voice, or aspiration, whereas oesophageal dysphagia is food sticking after the swallow has been initiated.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0003-en	What does the order in which solids and liquids become difficult suggest about the mechanism of dysphagia?	Difficulty first with solids suggests mechanical narrowing, while difficulty with solids and liquids from the outset suggests disordered motility, although the patterns overlap.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0004-en	Why does gastro-oesophageal reflux occur, and which factors contribute?	Gastric contents repeatedly cross an incompetent antireflux barrier, helped by transient lower sphincter relaxation, hiatus hernia, obesity, pregnancy, delayed emptying, and impaired clearance.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0005-en	Why does persistent acid exposure in reflux matter beyond symptom control?	It can cause erosive oesophagitis, peptic stricture, and metaplastic Barrett oesophagus, which increases adenocarcinoma risk.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0006-en	What neural loss underlies achalasia, and how does it disturb oesophageal function?	Loss of inhibitory myenteric neurons impairs lower sphincter relaxation and abolishes organised peristalsis, so regurgitation, weight loss, and aspiration may follow.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0007-en	In achalasia, why are both manometry and endoscopy needed, and what do the treatments have in common?	Manometry establishes the motor pattern while endoscopy excludes obstructing cancer; pneumatic dilation and surgical or endoscopic myotomy all reduce outflow resistance.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0008-en	Why does dyspepsia not establish that a patient has gastritis?	Gastritis is histological inflammation arising when mucosal defences are overwhelmed by factors such as acid, pepsin, or Helicobacter, whereas dyspepsia is a symptom syndrome that does not prove mucosal injury.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0009-en	Why must some drugs be stopped for a period before confirming Helicobacter pylori eradication?	Agents that suppress the organism can produce false-negative results, so adequate time off them is allowed before eradication is confirmed.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0010-en	How do non-steroidal anti-inflammatory drugs cause ulceration, and why is the absence of pain not reassuring?	They reduce protective prostaglandins, and the resulting ulcers can develop without warning pain.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0011-en	In ulcer disease, what does sudden severe pain with peritonism suggest, and what does it require?	It suggests perforation and requires resuscitation, antibiotics, imaging, and urgent surgical review.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0012-en	Why does haematochezia not exclude an upper gastrointestinal source of bleeding?	Although haematochezia often indicates lower bleeding, it can also accompany brisk upper haemorrhage.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0013-en	In gastrointestinal bleeding, what should be weighed more heavily than one apparently normal observation?	Pulse, postural change, skin perfusion, cognition, urine output, lactate, and serial haemoglobin, taken together over time.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0014-en	How does the management of suspected variceal bleeding differ from that of ulcer bleeding?	Proton-pump inhibition supports ulcer haemostasis, whereas suspected variceal bleeding requires vasoactive therapy, antibiotics, and urgent endoscopic control.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0015-en	Why is coeliac serology performed while gluten is still being eaten, and why is total immunoglobulin A measured with it?	The enteropathy is triggered by gluten, so testing needs ongoing intake; total immunoglobulin A detects deficiency, in which alternative serology is needed.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0016-en	Why is a low albumin a poor specific marker of malabsorption?	Albumin also reflects inflammation, liver disease, renal loss, and dilution.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0017-en	Why does oral rehydration work in many secretory diarrhoeas, and why are antibiotics used selectively?	Sodium-glucose cotransport remains effective in many secretory illnesses; antibiotics are selective because some infections are self-limited and treatment can worsen toxin-mediated disease or resistance.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0018-en	What distinguishes the inflammation of ulcerative colitis from that of Crohn disease?	Ulcerative colitis is continuous mucosal inflammation from the rectum proximally; Crohn disease is patchy and transmural anywhere from mouth to anus, with strictures, fistulas, abscesses, and perianal disease.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0019-en	What determines whether diverticulitis needs antibiotics, drainage, or surgery?	Computed tomography defines complicated disease; stable uncomplicated cases may be managed selectively without antibiotics, while systemic illness or complications require antibiotics, drainage, or surgery.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0020-en	Why is irritable bowel syndrome diagnosed positively rather than by repeated exclusion testing?	It is a disorder of gut-brain interaction without structural explanation, so once warning features are assessed, repetitive low-yield investigations mainly reinforce fear.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0021-en	Why is fibre not a universal treatment for constipation?	Appropriate fibre is part of treatment, but it can worsen pain with obstruction or severe loading, so the patient is examined for impaction and warning features.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0022-en	How does strangulation change the clinical picture of mechanical obstruction?	Strangulation compromises blood flow and may produce continuous rather than colicky pain, with fever, tachycardia, acidosis, local tenderness, or peritonism.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0023-en	Why can mesenteric ischaemia be missed early despite its danger?	Pain may initially exceed examination findings and lactate may be normal early, yet embolism, thrombosis, low flow, or venous thrombosis can progress rapidly to necrosis.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending
IMF-047-01-0024-en	Why should new rectal bleeding not automatically be attributed to benign disease?	Benign attribution is unsafe, especially when bowel change, anaemia, weight loss, or cancer risk point towards more serious disease.	Integrated Medical Foundations; chapter 47, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: c3727ac8ccd8adeeb8a66508a25bed3dd95cc0852b4f3d4c71f44ef4e0de2ffa; editorial review pending	imf lang::en chapter::047 module::047-01 review::pending