Gastroenterology

Question 1

Causes of bowel obstruction

Answer 1

V.A.N.I.S.H.I.N.G. P.O.O.

Volvulus
Adhesions
Neoplasia
Inflammation (Crohns, ischaemia, diverticulitis)
Strangulation Hernia
Intussusception (meckels diverticulum, polyp)
Neonatal (imperforate anus)
Gallstone ileus

Pseudo-Obstruction (reflex atony)

Question 2

Causes diarrhoea

Answer 2

SOILINGS

Secretory
Osmotic
Inflammation
Laxative and other drugs
Irritable bowel syndrome
Neuropathy
Gastrectomy and other surgery (short bowel, fistulae)
Structural (rectal adenoma, neoplasia, diverticula disease)
Special (alcohol, overflow, dietary indiscretion)

Question 3

Causes constipation

Answer 3

OPEN IT WIDE

Obstruction
Pain
Endocrine/electrolytes
Neurological

Inflammation or ischaemia
Toxins

Wall disease
Irritable bowel syndrome
Diet or dehydration
Elderly, pregnancy

Question 4

Types of laxative

Answer 4

BOSSES

Bulking eg bran, ispaghula
Osmotic eg lactulose, MgSO4
Stimulant eg senna, bisacodyl
Softeners eg liquid paraffin
Enemas eg PO4, Na citrate
Suppositories eg glycerol

Question 5

Causes of nausea and vomiting

Answer 5

GIN & TONICS

Gastrointestinal
Infection
Neoplasia

Toxins
Obstetric
Ophthalmic
Neurology
Infarction
Calcium high/ endocrine elevation 
Systemic

Question 6

Sore throat - causes

Answer 6

INTERNALS

Infection
Neoplasia
Toxins (smoking, alcohol, drugs - lamotrigine; carbimazole and propylthiiuracil due to neutropenia)
Exogenous
Reflux
Nutritional (B12, folate, iron deficiency)
Autoimmune (sjogrens)
Long styloid process (chronic sore throats in children)
Sinusitis (chronic post nasal drip)

Question 7

Haematemesis - Causes

Answer 7

VINTAGE

Varices
Inflammation
Neoplasia
Trauma
Angiodysplasia and vascular
Generalised bleeding disorder
Epistaxis
Exogenous eg factitious

Question 8

Rectal bleeding - causes

Answer 8

DRIPPING TAPS

Diverticulae
Rectal (piles, ulcer)
Infection
Polyps - benign
Polyps - neoplastic
Inflammation
Neoplasia
Gastric upper bowel bleeding
Trauma
Arterial
Systemic

Question 9

Causes of splenomegaly

Answer 9

BIG SPAN

Blood disorders (CML, CLL, haemolytic anaemia)
Infection (hepatitis, CMV, HIV, endocarditis)
Granulomatous (sarcoidosis, PBC)

Storage disease eg Gauchers
Portal hypertension
Autoimmune (RA, SLE, Graves)
Neoplasia

Question 10

Causes of gastric neoplasia

Answer 10

JAPANS SHAME

Japanese
A blood group A
Pernicious...
Anaemia
Nitrates
Smoked, salted, pickled food

Surgery –> bile reflux
Helicobacter pylori
Adenomatous polyp
MEnetries disease: glandular hyperplasia

Question 11

Abdo complications of UC

Answer 11

A.B.C.

Acute colitis

Bleeding - massive

Carcinoma

Question 12

Abdo complications of Crohns

Answer 12

F.O.A.M

Fistula
Obstruction
Abscess
Malabsorption

Question 13

Treatment IBD

Answer 13

S.N.A.C.K.S

Supportive - anti-diarrhoeal and anti mortality
Nutrition
Aminosalicylates - mesalazine, sulphasalazine
Corticosteroids/ other immunosuppressants
Kill bacteria - antibiotics
Surgery

Question 14

Coeliac disease - PC

Answer 14

Anti - G.L.I.A.D.I.N.S.

Gastrointestinal and malabsorption
Lymphoma and carcinoma
Immune abnormalities (DM, infertility, IBD)
Anaemia
Dermatological
IgA mesangial nephropathy
Neurological eg peripheral neuropathy, cerebral calcification 
Systemic

Question 15

Causes ascites

Answer 15

PAT PINTS

(transudate)
Portal hypertension
Albumin low
Thyroxin low

(exudate)
Pancreatitis
Infection
Neoplasia 
Thrombosis, hepatic vein - Budd Chiari
Severe pain - ectopic pregnancy, aortic aneurysm

Question 16

Primary Biliary Cirrhosis - PC

Answer 16

P.B.C.

Pruritis: excoriations, pale stool, dark urine
Pigmentation: Melanesia of face
Bones: osteomalacia, osteoporosis
Big organs: hepatosplenomegaly, lymphadenopathy
Cirrhosis: clubbing, varices, ascites
Cholesterol increased, xanthomata

Question 17

Chronic autoimmune hepatitis - PC

Answer 17

C.A.H.

Early - 
Constitutional
Cushingoid: striae, hirsute, acne
Amenorrhoea
Arthralgia
Hepatitis (recurrent jaundice)
Hepatosplenomegaly

Complications-
Cirrhosis
Autoimmune
Haematological

Question 18

Haemochromatosis - PC

Answer 18

Iron M.E.A.L.S

Myocardial: arrhythmias, heart block, dilated and restrictive cardiomyopathy

Endocrine: pancreas- diabetes; pituitary - amenorrhoea; parathyroid - hypocalcaemia, hypothyroidism

Arthritis

Liver: chronic hepatitis, cirrhosis, hepatocellular carcinoma

Skin: slatey grey

Systemic: fatigue &a scurvy

Question 19

OGD if?

Answer 19

>55 years
persistent symptoms
ALARMS
Anaemia
Loss of weight
Anorexia
Recent onset progressive symptoms
Melaena
Swallowing difficulty

Question 20

Risk factors pancreatic carcinoma

Answer 20

SINED

Smoking
Inflammation: chronic pancreatitis
Nutrition: high fat diet
EtOH
DM

Question 21

Causes chronic pancreatitis

Answer 21

AGITS

Alcohol (70%)
Genetic
Immunes
Triglycerides high
Structural eg tumour, pancreas divisum

Question 22

Carcinoid syndrome presentation

Answer 22

FIVE HT

Flushing
Intestinal: diarrhoea
Valve fibrosis
wheeze: bronchoconstriction
Hepatic involvement: bypassed 1st pass metabolism
Tryptophan deficiency: pellagra

Question 23

Portal hypertension - PC

Answer 23

SAVE

Splenomegaly
Ascites
Varices
Encephalopathy

Question 24

Precipitants to encephalopathy

Answer 24

HEPATICS

Haemorrhage e.g. varices
Electrolytes (low K, low Na)
Poisons: diuretics, sedatives
Alcohol
Tumour: HCC
Infection: SBP, pneumonia, UTI
Constipation (commonest cause)
Sugar (glucose) low e.g. low calorie diet

Question 25

Clinical features of Wilson’s disease

Answer 25

CLANKAH

Cornea - Kayser-Fleischer rings

Liver disease: acute hepatitis in children, fulmninant necrosis –> cirrhosis

Arthritis: Chondrocalcinosis, osteoporosis

Neurology: Parkinsonism, depression, ataxia

Kidney: Fanconi’s syndrome

Abortions

Haemolytic anaemia: coombs negative

Question 26

Presentation of PBC

Answer 26

PPBBCCS

Pruritus and fatigue
Pigmentation of face
Bones - osteoporosis, osteomalacia (dec.vit D)
Big organs - hepatosplenomegaly
Cirrhosis and coagulopathy (dec. vit K)
Cholesterol high: xanthelasma, xanthomata
Steatorrhoea