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  <head>
    <title>047-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Oesophageal, gastric, intestinal, and anorectal disease">
      <outline text="Orientation">
        <outline text="Localise, then mechanism and tempo"/>
        <outline text="Recognise bleeding, perforation, ischaemia, cancer early"/>
      </outline>
      <outline text="Oesophageal disease">
        <outline text="Oropharyngeal: trouble initiating, cough, aspiration"/>
        <outline text="Oesophageal: food sticks after initiation">
          <outline text="Solids first suggests mechanical narrowing"/>
          <outline text="Solids and liquids from outset suggests dysmotility"/>
        </outline>
        <outline text="Reflux crosses an incompetent antireflux barrier">
          <outline text="Sphincter relaxation, hiatus hernia, obesity"/>
          <outline text="Acid exposure: oesophagitis, stricture, Barrett"/>
          <outline text="Barrett oesophagus raises adenocarcinoma risk"/>
        </outline>
        <outline text="Weight loss, positional measures, proton-pump inhibition">
          <outline text="Long-term therapy needs a clear indication"/>
          <outline text="Warning features require endoscopy"/>
        </outline>
        <outline text="Achalasia: loss of inhibitory myenteric neurons">
          <outline text="Sphincter fails to relax, peristalsis absent"/>
          <outline text="Manometry for motor pattern, endoscopy for cancer"/>
          <outline text="Dilation or myotomy lowers outflow resistance"/>
        </outline>
      </outline>
      <outline text="Gastritis and peptic ulcer disease">
        <outline text="Defences: mucus, bicarbonate, blood flow, prostaglandins"/>
        <outline text="Injury when acid, drugs, or infection exceed defences"/>
        <outline text="Gastritis is histological, dyspepsia is symptomatic"/>
        <outline text="Helicobacter pylori colonises gastric mucus">
          <outline text="Ulcer, atrophy, adenocarcinoma, lymphoma"/>
          <outline text="Acid suppression, antibiotics, sometimes bismuth"/>
          <outline text="Stop suppressing agents before eradication test"/>
        </outline>
        <outline text="Non-steroidal drugs reduce protective prostaglandins">
          <outline text="Ulceration without warning pain"/>
        </outline>
        <outline text="Complications: bleeding, perforation, outlet block">
          <outline text="Peritonism: resuscitate, image, urgent surgery"/>
        </outline>
      </outline>
      <outline text="Gastrointestinal bleeding">
        <outline text="Haematemesis or melaena usually upper"/>
        <outline text="Haematochezia often lower, or brisk upper"/>
        <outline text="Airway, perfusion, access, crossmatch, coagulopathy"/>
        <outline text="Serial measures beat one normal observation"/>
        <outline text="Endoscopy localises and treats upper lesions">
          <outline text="Proton-pump inhibition supports ulcer haemostasis"/>
          <outline text="Varices: vasoactive drugs, antibiotics, endoscopy"/>
        </outline>
        <outline text="Lower: colonoscopy, angiography, or surgery"/>
      </outline>
      <outline text="Coeliac disease and malabsorption">
        <outline text="Gluten triggers enteropathy in susceptible people">
          <outline text="Villous injury reduces absorptive surface"/>
        </outline>
        <outline text="Test tissue-transglutaminase IgA while eating gluten">
          <outline text="Total IgA, alternative serology if deficient"/>
          <outline text="Biopsy confirms, lifelong gluten exclusion"/>
        </outline>
        <outline text="Malabsorption: enzyme, bile, mucosa, overgrowth"/>
        <outline text="Albumin also reflects inflammation and dilution"/>
      </outline>
      <outline text="Diarrhoea and infectious enteritis">
        <outline text="Osmotic, secretory, inflammatory, fatty, motility"/>
        <outline text="Blood, fever, travel, antibiotics change testing"/>
        <outline text="Oral rehydration uses sodium-glucose cotransport"/>
        <outline text="Antibiotics selective: toxin disease, resistance"/>
        <outline text="Clostridioides difficile after microbiome disruption">
          <outline text="Test only compatible symptomatic patients"/>
          <outline text="Stop precipitating drugs, isolate, treat enterally"/>
        </outline>
        <outline text="Chronic: review medicines, diet, endocrine causes">
          <outline text="Nocturnal symptoms, blood, weight loss warn"/>
          <outline text="Faecal markers detect inflammation, not cause"/>
        </outline>
      </outline>
      <outline text="Inflammatory bowel disease">
        <outline text="Ulcerative colitis: continuous mucosal, from rectum"/>
        <outline text="Crohn disease: patchy transmural, mouth to anus">
          <outline text="Strictures, fistulas, abscesses, perianal disease"/>
        </outline>
        <outline text="Treatment matches location and severity">
          <outline text="Corticosteroids induce, do not maintain"/>
          <outline text="Check infection and vaccination first"/>
        </outline>
        <outline text="Acute severe colitis: admit, steroid, plan rescue"/>
        <outline text="Megacolon, perforation, dysplasia need surgery"/>
      </outline>
      <outline text="Diverticular and functional bowel disease">
        <outline text="Diverticula: mucosal outpouchings at weak points"/>
        <outline text="Diverticulitis: left-lower pain, fever, bowel change">
          <outline text="Computed tomography defines complicated disease"/>
          <outline text="Stable cases may avoid antibiotics"/>
        </outline>
        <outline text="Irritable bowel: gut-brain interaction disorder">
          <outline text="Positive diagnosis after warning features"/>
          <outline text="Avoid low-yield tests that reinforce fear"/>
        </outline>
        <outline text="Constipation: diet, drugs, pelvic floor, transit">
          <outline text="Fibre worsens pain with obstruction or loading"/>
        </outline>
      </outline>
      <outline text="Obstruction, ischaemia, and anorectal disease">
        <outline text="Colicky pain, vomiting, distension, no flatus">
          <outline text="Small bowel: adhesions and hernias"/>
          <outline text="Colon: cancer, volvulus, diverticular stricture"/>
        </outline>
        <outline text="Strangulation compromises blood flow">
          <outline text="Continuous pain, fever, acidosis, peritonism"/>
        </outline>
        <outline text="Mesenteric ischaemia: pain exceeds examination">
          <outline text="Rapid progression to necrosis"/>
          <outline text="Lactate may be normal early"/>
        </outline>
        <outline text="Perianal abscess needs drainage, fistula may follow"/>
        <outline text="New rectal bleeding is not assumed benign"/>
      </outline>
    </outline>
  </body>
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