FFCP Gastro

Question 1

What effect does smoking have on Crohn’s and UC?

Answer 1

Crohn’s tends to target smokers and smoking cessation is effective treatment
UC - tends to be non smokers, and onset often occurs after smoking cessation

Question 2

what drugs can cause relapse in IBD?

Answer 2

NSAIDs, oral contraceptives, opioids (loperamide, codeine)

Question 3

What might you find in bloods of someone with UC?

Answer 3

microcytic anaemia, low ferritin, low albumin. Raised inflammatory markers, abnormal faecal calprotectin

Question 4

What is the first line treatment for ulcerative colitis?

Answer 4

Mesalazine oral and topical (It is a 5-amino salicylic acid)

Question 5

If the firstline for UC isnt working what do you then add in?

Answer 5

Immunomodulators - azathioprine and 6-mercaptopurine

Question 6

Mutation in what intracellular pathogen recognition receptor gene causes Crohn’s disease?

Answer 6

NOD2

Question 7

When is Bile Salt malabsorption usually seen?

Answer 7

In people who have diseases of small intestine such as Crohn’s or in people who have had an operation to remove their small intestine

Question 8

What does faecal elastase tell us?

Answer 8

How well the pancreas is functioning

Question 9

What are the key components of pancreatic enzyme replacement therapy?

Answer 9

Amylase - hyrdolyses starch to sugar
Lipase - hydrolyses fats
Trypsin - hydrolyses proteins
Chymotrypsin - hydrolyses proteins

Question 10

What kind of obstruction could a gallstone or a bezoar cause?

Answer 10

Intra luminal

Question 11

Obstruction in which part of the bowel is more likely to cause vomiting > distension?

Answer 11

Small bowel

Question 12

What is gastrograffin abdominal xray?

Answer 12

water soluble contrast given via nastrogastric tube. If contrast is in colon in less than 24 hours then suggests that obstruction has been reversed

Question 13

Differences in whereabouts squamous cell carcinoma and adenocarcinomas tend to be found in esophagus?

Answer 13

Squamous - upper and middle sections
Adenocarcinoma - lower. Often caused by Barrett’s

Question 14

Two biggest red flag symptoms for oesophageal cancer?

Answer 14

Dysphagia and weight loss

Question 15

What blood group puts you at increased risk of gastric cancer?

Answer 15

Group A

Question 16

What is Mirizzi syndrome?

Answer 16

a rare condition characterised by compression of common bile duct or common hepatic duct by a gallstone becoming impacted

Question 17

What duct do gallstones typically block?

Answer 17

Cystic duct

Question 18

What is Charcot’s triad of cholangitis

Answer 18

RUQ pain, jaundice, fever

Question 19

Obstructive jaundice symptoms?

Answer 19

Dark urine, pale stools, epigastric pain, fever, vomiting

Question 20

What is eosinophillic oesophagitis?

Answer 20

An allergic like inflammatory condition of esophagus, causes difficulty swallowing. More common in children

Question 21

Management of dyspesia if no red flag symptoms?

Answer 21

Test for H.pylori (faecal antigen or 13c urea breath test)
If neg, 2 week treatment with PPI
If pos eradication therapy

Question 22

What will you see in non-ulcer dyspepsia?

Answer 22

Normal endoscopy

Question 23

What scoring system is used for classification of esophagitis?

Answer 23

Los Angeles

Question 24

In what type of ulcers is the pain relieved by food?

Answer 24

Duodenal ulcers (99% H.Pylori related)

Question 25

If Hpylori causes more acid secretion, what type of ulcer? Vs less acid secretion?

Answer 25

More - duodenal ulcer Less - you get gastric atrophy and gastric ulcer

Question 26

H, pylori eradication therapy?

Answer 26

PPI plus 7 days amoxicillin and either metronidozole/ clarithyomycin

Question 27

Best imaging modality for acute abdominal pain warranting hospital admission?

Answer 27

Ultrasound or CT. Ultrasound preferred in children and young people for biliary, renal, gynae and appendix cause. CT for adults with suspected bowel ischaemia

Question 28

When might MRI be used in acute surgical abdomen?

Answer 28

Only for pregnant women and children who had findings on ultrasound

Question 29

What's the best modality for identifying renal calculi?

Answer 29

CT without contrast (low radiation dose should be used for kids of people with multiple presentation)

Question 30

What does unconjugated vs conjugated bilirubin test for?

Answer 30

Unconjugated - pre hepatic and hepatocellular causes Conjugated - post hepatic and hepatocytes

Question 31

What does elevated ALP and GGT suggest?

Answer 31

Inflammation of biliary epithelium

Question 32

What does positive Murphy's sign mean?

Answer 32

Cholecystitis - inflammation of the gallbladder

Question 33

What would the stool and urine of someone with obstructive jaundice look like and why?

Answer 33

Dark urine, pale stool. As bilirubin can't leave via bile duct, more goes to kidneys and no bilirubin in stool

Question 34

What is Courvoiser's sign?

Answer 34

A palpable gallbladder but with painless jaundice. Suggests it isnt gallstones but malignancy of gallbladder or pancreatic head instead

Question 35

What is cholangitis?

Answer 35

Infection of bile duct, obstructive jaundice with infection

Question 36

What is Charcot's triad?

Answer 36

jaundice, fever/rigors and right upper quadrant pain - cholangitis

Question 37

How is pancreatitis diagnosed?

Answer 37

2 out of 3 of typical symptoms, pancreatic enzymes>3x upper limit of normal and radiographic evidence

Question 38

What is glasgow score for pancreatitis?

Answer 38

PANCREAS * P-po2 <8k Pa * A- age>55 * N-neutrophils>15 * C-calcium<2 * R-renal function>16 (urea) * E- enzymes; LDH>600/AST>20 A - Albumin <32g/dl S - sugar >10 if greater than 3 then severe pancreatitis

Question 39

What score for pancreatitis splits into three categories mild, moderate and severe and is based on degree of organ failure?

Answer 39

Atlanta score

Question 40

What is GET SMASHED acronym for pancreatits?

Answer 40

Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion bites Hypertryglyceridaemia / lipidaemia ERCP Drugs (steroids, sodium valproate, azathioprine, opiates)

Question 41

Cullen's sign vs Gray Turner's sign?

Answer 41

Cullen's bleeding around umbilicus Gray Turner's bleeding around flanks

Question 42

What infectious diarrhoea causing agent can antibiotics pre dispose to?

Answer 42

C.difficile

Question 43

C difficile treatment?

Answer 43

Mild, moderate and severe = 1st line oral vancomycin, 2nd line fidaxomicin Complicated = oral vancomycin and IV metronidazole Life threatening = oral vancomycin and IV metronidazole, faecal microbiota transplant and consider colectomy

Question 44

If a patient with UC has had severe relapse of greater than 2 exacerbations in the past year, what should they be given to maintain remission?

Answer 44

oral azathioprine or oral mercaptopurine

Question 45

What malignancy does pernicious anaemia predispose you to?

Answer 45

gastric carcinoma (due to the chronic atrophic gastritis that occurs over time)

Question 46

What's the M rule for primary biliary cholangitis?

Answer 46

IgM, anti-mitochondrial antibodies M2 subtype, middle aged females (presents in middle aged women with jaundice, itch and fatigue)