Gastro

Question 1

Features of Crohn’s Disease

Answer 1

o	Diarrhoea
o	Crampy abdo pains
o	Perianal disease
o	Oral ulceration
o	Malabsorption
o	Obstruction

Question 2

Most common extra-intestinal feature in Crohn’s

Answer 2

arthritis

Question 3

Nutritional causes of peripheral neuropathy

Answer 3

o Alcohol
o B12 deficiency
o B6 EXCESS

Question 4

Urgent TWR OGD indications

Answer 4

o Anyone with dysphagia
o Anyone with upper abdo mass consistent with gastric cancer
o >55yo and weight loss + dyspepsia/epigastric pain/reflux

Question 5

Definition, cause, and histology of melanosis coli

Answer 5

• Melanosis coli = disorder of pigmentation of bowel wall
o Histology ~pigment-laden MPs
o ~laxative abuse, especially Senna

Question 6

Genetics and complications of haemochromatosis

Answer 6

HFE gene

o Reversible:
 CM
 Skin discolouration

o	Irreversible:
	DM
	Arthritis
	Hypogonadism
	Liver cirrhosis

Question 7

How do the levels of clotting factors change in coagulopathy of liver disease?

Answer 7

all clotting factors low except 8 which is high

Question 8

What is the most significant risk factor for HCC?

Answer 8

Hep C virus

Question 9

Management of UC (induce remission/maintain remission)

Answer 9

INDUCE REMISSION
o Mild/moderate:
 Topical +/- oral aminosalicylate always first line depending on severity. Match up to colonoscopy findings

o If severe
 IV steroids

MAINTAIN REMISSION: aminosalicylates

Question 10

Top cause of HCC; UK + worldwide

Answer 10

o Hep B worldwide

o Hep C UK

Question 11

Granulomas are characteristic of Crohn’s or UC?

Answer 11

Crohn’s

Question 12

Pseudopolyps are characteristic of Crohn’s or UC?

Answer 12

UC

Question 13

Features of Giardia? (incubation period, management)

Answer 13

longest incubation period ~4days

Rx: metronidazole

Question 14

Indications and treatment for SBP prophylaxis

Answer 14

Ascites + protein <15

Rx: PO Cipro or Norfloxacin

Question 15

Nutritional source of vitamin D

Answer 15

oily fish

Question 16

Alcohol vitamin deficiency Rx

Answer 16

Give THIAMINE
(Vit B coStrong is not in guidelines)

Question 17

Beefy red and sore tongue, yellow-tinge to skin

PMH: gastrectomy

Answer 17

Pernicious anaemia

Question 18

Dx of IBS

Answer 18

Abdo pain + altered stool form + 2 of the following:

• passage of rectal mucus
• altered stool passage (straining, urgency, incomplete evacuation)
• Sx worsened by eating
• Abdo distension/hardness/bloating

Question 19

45yo woman with secondary amenorrhoea and deranged LFTs

Answer 19

AI hepatitis

antibodies can attack smooth muscle

Question 20

Instructions prior to 13c urea breath test

Answer 20

No ABx for 4 weeks prior

No PPI for 2 weeks prior

Question 21

Incubation period for norovirus

Seasonal period for norovirus

Answer 21

36-72h

Winter

Question 22

Features and deficiency in pellagra

Answer 22

Dermatitis + dementia + diarrhoea

Vitamin B3/niacin deficiency

Question 23

Diarrhoea + skin symptoms + howel-jolly bodies

Answer 23

Coeliac disease

Howel Jolley bodies related to splenic atrophy in Coeliac - also seen in splenectomy

Question 24

Gastric cancer RFs

Answer 24

Smoking
H pylori
Gastritis
Adenoma

NB. Alcohol not an independent RF for gastric ca

Question 25

Causes of mouth ulcers

Answer 25

Crohns Coeliac Behcet's HIV

Question 26

Female with positional nausea + GORD. | Dx + Ix?

Answer 26

Sliding hiatus hernia | Barium meal

Question 27

Saint's triad

Answer 27

Sliding hiatus hernia + gallstones + diverticular disease | with atypical abdominal symptoms

Question 28

Rx of <55 with dyspepsia

Answer 28

Review meds causing dyspepsia Lifestyle advice Test and treat for H. pylori OR 4/52 PPI

Question 29

Name and details of classification for oesophagitis

Answer 29

``` LOS ANGELES classification A- <5mm mucosal breaks B- >5mm breaks C- breaks extending between the tops of 2 mucosal folds but <75% circumference D- circumferential breaks (>75%) ```

Question 30

Cheilitis | Causes?

Answer 30

Inflammation of lips + perioral skin: - dry lips - painful cracks at angles of mouth - erythema ``` Ax: nutritional deficiency sun exposure dryness drug-related ```

Question 31

How long to fast prior to OGD

Answer 31

4-6hours

Question 32

Type 1 vs Type 2 AI hepatitis

Answer 32

Type 1: age 45-70 Anti-smooth muscle Anti-nuclear Type 2: 2-14yo ABs to liver and kidney microsomes (anti-LKM) and liver cytosol antigen (anti-LC1)

Question 33

Rx for AI hepatitis

Answer 33

Azathioprine | Glucocorticoids

Question 34

Infertility in men secondary to drug

Answer 34

sulfasalazine ~hypospermia

Question 35

IV treatment for UC that can cause severe allergies

Answer 35

Infliximab

Question 36

What are the Milan criteria and what are they for?

Answer 36

HCC patients suitable for liver transplant 1 nodule <5mm OR 2-3 nodules <3mm

Question 37

Colorectal cancer risk goes up __ years after development of inflammation in IBD

Answer 37

10

Question 38

Which AI disease and malignancy is associated with UC? Which tumour marker is raised?

Answer 38

PSC Cholangiocarcinoma Ca 19-9

Question 39

Xeropthalmia | Px and Ax?

Answer 39

Prolonged vitamin deficiency in children Common in Africa Causes dry cornea, thickened conjunctivae, deficient tear film, blindness

Question 40

USS: normal liver with hyperechoic well-circumscribed lesion

Answer 40

Haemangioma - commonest benign tumour of the liver

Question 41

USS pancreas: hypo echoic mass | MRI: T1 hypo enhancement, T2 hyperenhancement

Answer 41

Suggests fluid filled ie. pancreatic pseudocyst

Question 42

Signs of alcoholic ketoacidosis Complications

Answer 42

Confusion, dehydration, lethargy, malnourishment, fruity breath Kussmauls +ve pH <7.3 HCO3 <15 Complications: cerebral oedema, coma

Question 43

Carcinoid syndrome features, pathology, Dx test, Rx

Answer 43

Ftrs: abdo pain, diarrhoea, RUQ pain, flushing, R heart failure Path: 5HT secretion from tumour at neural crest originating at TI or appendix, can cause pulmonary stenosis due to fibrosis Dx test: urinary 5HIAA Rx: octreotide - blocks release of tumour mediators

Question 44

Management of Crohn's

Answer 44

Induce remission: - Glucocorticoid (IV/TOP/PO) - Enteral feed with elemental diet instead or as well as - 2nd line: 5-asa drugs eg. mesalazine - Mercaptopurine/Azathio as an add on - Infliximab if refractory - Metronidazole for isolated perianal disease Maintain remission: - STOP smoking - 1st: Aza/Mercapto - 2nd: Methotrexate - Consider mesalazine if had surgery

Question 45

First line Ix if suspect UC/IBD

Answer 45

Flexi Sig | Not colonoscopy!

Question 46

AI hepatitis RX and conrtaindicated med

Answer 46

Azathioprine Ciclosporin Transplant Steroids NB. IFN C/I'd

Question 47

IBS Dx tool

Answer 47

Rome criteria