gastro

Question 1

lethargy, pruritus, minor inc in AST, GGT and inc in ALP

Answer 1

primary biliary colangitis

Question 2

post mortem liver cirrhosis pathology

Answer 2

many nodules of liver tissues trhoughout liver with intervening bands (septa) of fibrous tissue

Question 3

hgih anti smooth muscle antibodies

Answer 3

autoimmune hepatitis

Question 4

high antimicrobial antibodies

Answer 4

primary biliary cholangitis

Question 5

high serum transferrin saturation

Answer 5

haemochromatosis

Question 6

steaotosis and mallory hyaline on liver biopsy

Answer 6

alcoholic hepatitis

Question 7

ERCP

Answer 7

Endoscopic retrograde cholgangiopancratography. Useful if stunting is needed and can obtain tissue diagnosis for biopsy

Question 8

MRCP

Answer 8

Diagnostic tool and best suited for suspected choledocholithiasis

Question 9

Metastatic Gastric cancer treatment

Answer 9

Chemo may improve survival and QOL, palliative radiotherapy for treatment of GI bleed. Surgery only for non metastatic cancer

Question 10

Stomach cancer RF

Answer 10

Adenocarcinoma most common. Inc age, male, poor SES, h. Pylori, smoking, poor diet, pernicious anaemia, blood group A, FH.
Can also present with ovarian masses

Question 11

Large bowel in between diaphragm and liver

Answer 11

Normal!

Question 12

8mm calculus in CBD Mx

Answer 12

Urgent ERCP and sphincterotomy stones retrieval. Stone can lead to sepsis and unlikely to pass unaided

Question 13

Gastric cancer T2

Answer 13

tumour has grown into (but not through ) muscularis propria

Question 14

Gastric cancer T4

Answer 14

Tumour has penetrated through Sherpas and peritoneal surface. N2= 4 or more lymph node involvement. N1 3 or less lymph nodes involved

Question 15

Pseudo obstruction

Answer 15

Rectal air makes left sided obstruction less likely (in low left obstruction air is normally absent in rectum. A febrile and normal WCC suggests sepsis so making megacolon and abscess unlikely

Question 16

generalised peritonitis

Answer 16

abdo pain, ridgidity, quiet bowel sounds, guarding= peritonitis
but usually localised (eg RIF- appendicitis, RUQ- cholecystitis.
generalised peritonitis in unwell pt: perforation of abdominal viscus

Question 17

CXR for perforated vsicus

Answer 17

pneumoperitoneum. need metronidazole(anti anaerobic) and cefuroxime=for both gram + and - but pen is for gram + bacteria whilst gentamycin is good for gram -

Question 18

incarcerated inguinal hernai exam

Answer 18

mass in scrotum: you can’t palpate above lump so not confined to scrotum and originate form abdomen- wither hydrocele of spermatic cord or inguinal hernia

Question 19

loop ileostomy

Answer 19

defunctioning ileostomy.
The colon has been reconnected and so the ileostomy is temporary. This enables the point at which the bowel is joined (anastomosis) to heal prior to receiving faecal load. Then the surgeon will decide (~6months) to close the ileostomy (join the two ends), and replace the ileum into the abdominal cavity and close the abdominal wound. The loop ileostomy will have two orifices to it, compared to an end ileostomy which will have one.

Question 20

end ileostomy

Answer 20

this means that everything distal to the ileum has been removed. i.e. colectomy. This is required in severe ulcerative colitis and some colon cancers.

Question 21

when would you not do liver biopsy

Answer 21

extensive ascites, INR 2.5, HB 60, acute confusional state