UGI&HPB

Question 1

Most common composition of gallstones?

Answer 1

Cholesterol

Question 2

Who gets bile pigment stones?

Answer 2

Patients with increased bilirubin production e.g. haemolysis, most commonly patients with haemolytic anaemia or sickle-cell

Question 3

Optimal treatment for oesophageal varices?

Answer 3

Banding is better than injection sclerotherapy

Question 4

Presentation of acute appendicitis?

Answer 4

Gradual onset dull ache in umbilicus which becomes more intense and shifts to RIF. Patients usually nauseated and soft abdomen with localised peritonism in RIF

Question 5

Indications for OLT in PSC?

Answer 5

Recurrent bacterial cholangitis, intractable pruritus

Question 6

Treating acute ascending cholangitis?

Answer 6

Do emergency decompression of the CBD with ERCP

Question 7

Indications for ERCP?

Answer 7

Obstructive jaundice, biliary/pancreatic duct disease, pancreatic cancer, pancreatitis of unknown origin, pancreatic pseudocysts (drainage), SoO dysfunction (sphincterotomy)

Question 8

What are pancreatic pseudocysts?

Answer 8

Collections of necrotic-haemorrhagic material rich in enzymes, lacking epithelial lining. Most common cyst in pancreas. Usually arise after acute pancreatitis

Question 9

Where do pancreatic cancers arise?

Answer 9

Mostly (60%) in the head, 15% in the body, 5% in the tail, 20% diffusely across whole gland

Question 10

Most specific antibodies for PBC?

Answer 10

Anti-mitochondrial antibodies

Question 11

p-ANCA antibodies occur in which three conditions?

Answer 11

Microscopic polyangitis (MPA), Churg-Strauss (EGPA), primary sclerosing cholangitis

Question 12

Which two antibodies are associated with autoimmune hepatitis?

Answer 12

Anti-smooth muscle antibodies with type 1 AIH, anti-liver kidney microsomal antibodies with type 2 AIH

Question 13

Using terlipressin and octreotide together?

Answer 13

Not done

Question 14

When are terlipressin and octreotide indicated?

Answer 14

Management of variceal bleed, with octreotide sometimes preferred if have CV comorbidities

Question 15

Giving PPI in UGI bleed?

Answer 15

Contentious - some argues that is may mask bleeding at endoscopy. Probably good to hold until OGD then give stat IV dose then IV infusion if peptic ulcer found to be cause

Question 16

Using CT angiogram and percutaneous embolisation in UGI bleed?

Answer 16

Can be indicated if still apparently bleeding and OGD normal; done by IR

Question 17

Differentiating oesophageal carcinoma and achalasia?

Answer 17

Both get dysphagia and weight loss, but dysphagia in carcinoma is progressive, and worse with solids, while achalasia is solids and liquids. Greater weight loss in cancer.

Question 18

Features of pharyngeal pouch?

Answer 18

Palpable lump in the neck, may appear with meals or on examination, more common in older men. Dysphagia may occur when food accumulates in pouch and presses on oesophagus. May get regurgitation, halitosis, gurgling

Question 19

What is bulbar palsy?

Answer 19

Neurological condition with a variety of causes such as MND, presents with palsy of the muscles of mastication, face and tongue

Question 20

Identifying pneumoperitoneum if cannot tolerate erect CXR?

Answer 20

Can do supine abdo radiograph (see Rigler’s sign i.e. double wall), or lateral decubitus AXR

Question 21

What is Hartmann’s pouch?

Answer 21

Region of the biliary tree at junction of GB and cystic duct

Question 22

Features suggesting gastrinomas?

Answer 22

(Male aged 30-50), with multiple ulcers/ulcers in unusual locations, ulceration with diarrhoea, ulcers refractory to therapy, absence of H. pylori, severe complications like bleeding/perf.

Question 23

What are gastrinomas and how are they diagnosed?

Answer 23

Neuroendocrine tumours normally found in duodenum, test serum gastrin. If have gastrinomas causing ulcers = ZES

Question 24

Rapid urease test?

Answer 24

Aka CLO test,