Gastro 2

Question 1

achalasia surgical mx?

Answer 1

heller cardiomyotomy

Question 2

Mx of achalasia?

Answer 2

balloon dilatation
heller cardiomyotomy

botoulinum toxin

nitrates / CCB

Question 3

alcoholic hepatitis signs

Answer 3

GGT raised
ast:alt ratio >2

Question 4

small intestinal bacterial overgrowth is developed by?
RF

Answer 4

DM

autonomic neuropathy

scleroderma

Question 5

how to differentiate between Alcoholic ketoacidosis and Diabetic ketoacidosis?

Answer 5

normal / low glucose

with ketones

Question 6

mx of alcoholic ketoacidosis?

Answer 6

non-diabetic euglycaemic

infusion of saline and thiamine

Question 7

why do coeliacs need pneumococcal vaccine?

Answer 7

hyposplenism

Question 8

neuroendocrine tumour

Answer 8

secrete serotonin

diarrhoea
bronchial NET > SS
liver mets > SS

Question 9

Ix carcinoid syndrome / NET

Answer 9

Investigation
urinary 5-HIAA
plasma chromogranin A y

Question 10

signet ring cells

Answer 10

gastric adenocarcinoma

large vacuole containing mucin

Question 11

suspected pharyngeal pouch
Investigation?

Answer 11

barium swallow w fluoroscopy

Question 12

chronic mesenteric ischaemia?

Answer 12

colicky post prand meal

abdominal bruit
weight loss

Question 13

Bowel Ischaemia RF

Answer 13

age
A fibrillation
CVD; smoke/ HTN/ DM
cocaine

Question 14

Ix bowel ischaemia

Imaging of choice?

Answer 14

CT

Question 15

acute mesenteric ischaemia?

Answer 15

small bowel ischaemia
Afib

Question 16

ischaemic colitis?

Answer 16

acute but transient

large bowel

Question 17

what is a watershed area?
what sign on xray?

Answer 17

splenic flexure
SMA /IMA

thumbprinting on xray
mucosal oedema / haemorrhage

Question 18

budd chiari syndrome
Imaging?

Answer 18

hepatic vein thrombosis

> USS with doppler flow studies

Question 19

what is the triad for budd chiari syndrome

Answer 19

abdominal pain
ascites
tender hepatomegaly

Question 20

Causes of budd chiari syndrome

Answer 20

polycythaemia rubra vera
thrombophilia activated protein C
pregnancy COCP

Question 21

Pyogenic Liver Abscess mx?

Answer 21

drainage
abx

Question 22

which organism in liver abscess?

Answer 22

e coli (adults)

staph aureus (children)

Question 23

what abx?

Answer 23

amoxicillin
ciprofloxacillin
metronidazole

Question 24

Reintroduce gluten for at least _______ and arrange serological tests

Answer 24

6 weeks

Question 25

toxic megacolon

Answer 25

transverse colon >6cm in diameter systemic upset Ix: abdo Xray

Question 26

role of endoscopy after a Upper GI bleed?

Answer 26

endoscopy within 24 hours

Question 27

Resus upper GI bleed active bleeding? if on warfarn?

Answer 27

ABC wide bore IV access 2 platelet transfusion Prothrombin complex concentrate

Question 28

FFP given in upper gi bleed when?

Answer 28

fibrinogen <1g/l INR >1.5

Question 29

C diff RF

Answer 29

abx > clindamycin >cephalosporins PPI

Question 30

dysphagia

Answer 30

difficulty swallowing

Question 31

odynophagia?

Answer 31

pain on swallowing

Question 32

Truelove and Witts severity index what is it for? what is the criteria?

Answer 32

UC 37.8^C 90 beats per minute Anaemia (105g/L) ESR >30 Temp Rate Uh (neami) EESR >30

Question 33

Dx of Oesophageal cancer?

Answer 33

upper GI endoscopy w biospy USS CT-Scan fdg-pet ct

Question 34

PSC has what antibodies?

Answer 34

p- ANCA

Question 35

what is PSC?

Answer 35

inflammation and fibrosis intra and extra hepatice bile ducts

Question 36

gold standard Ix for PSC?

Answer 36

MRCP ERCP - more invasive > beaded

Question 37

peutz jeghers syndrome what lesions on colonoscopy?

Answer 37

hamartomas

Question 38

co amoxiclav

Answer 38

amoxicllin clavulanate hepatotoxic = cholestasis

Question 39

Treatment for oesophageal cancer operable?

Answer 39

t1n0mo surgical resection ivor lewis oesophagectomy adjuvant chemo

Question 40

Neoadjuvant chemoradiotherapy followed by surgical resection oesophageal cancer

Answer 40

locally advanced cancers to downstage it

Question 41

metoclopramide

Answer 41

d2 receptor antagonist pro kinetic = promotes gut peristalsis

Question 42

how does Metoclopramide decrease nausea?

Answer 42

promotes gut peristalsis 5-HT3/5 which inhibits chemoreceptor trigger zone of the medulla

Question 43

SAAG >11 ascites

Answer 43

portal htn > cirrhosis >RHF > budd chiari

Question 44

SAAG <11

Answer 44

hypoalbumin > nephrotic syndrome malnutrition

Question 45

therapeutic abdo paracentesis?

Answer 45

albumin cover needed ciprofloxacin <15g/l of protein

Question 46

bulk forming laxative?

Answer 46

isphagula usk

Question 47

osmotic laxative

Answer 47

macrogol

Question 48

UC histology

Answer 48

depleted goblet cells and mucin from gland epithelium

Question 49

crohns hsitology

Answer 49

goblet cell increased granuloma

Question 50

carcinoid syndrome can affect the heart how?

Answer 50

right side of the heart > tricuspid insufficiency >pulmonary stenosis

Question 51

Mx of perianal fistula

Answer 51

oral metronidazole seton drain > metronidazole >ciprofloxacin

Question 52

pre-operative workup for a patient undergoing a Nissen fundoplication for treatment-resistant GORD

Answer 52

oesophageal manometry oesophageal pH