Gastroenterology

Question 1

Which mnemonic helps differentiate Crohn’s disease and what does it stand for?

Answer 1

NESTS
N: No blood or mucus (PR bleeding less common)
E: Entire GI tract affected
S: Skip lesions on endoscopy
T: Terminal ileum most affected and Transmural inflammation
S: Smoking is a risk factor

Question 2

Which mnemonic helps differentiate ulcerative colitis and what does it stand for?

Answer 2

CLOSEUP:

C: Continuous inflammation
L: Limited to colon and rectum
O: Only superficial mucosa affected
S: Smoking may be protective
E: Excrete blood and mucus
U: Use aminosalicylates
P: Primary sclerosing cholangitis

Question 3

What condition is ulcerative colitis particularly associated with?

Answer 3

Primary sclerosing cholangitis.

Question 4

What skin conditions can occur with inflammatory bowel disease?

Answer 4

Erythema nodosum
Pyoderma gangrenosum

Question 5

What eye conditions are associated with IBD?

Answer 5

Episcleritis
Scleritis
Anterior uveitis

Question 6

What stool test is around 90% sensitive and specific for IBD in adults?

Answer 6

Faecal calprotectin.

Question 7

What is the investigation of choice for diagnosing IBD?

Answer 7

Colonoscopy with multiple intestinal biopsies.

Question 8

What is the first-line treatment for mild to moderate acute ulcerative colitis?

Answer 8

Aminosalicylates (e.g., oral or rectal mesalazine).

Question 9

What is the first-line treatment for severe acute ulcerative colitis?

Answer 9

Intravenous steroids (e.g., IV hydrocortisone).

Question 10

What surgical procedure is curative for ulcerative colitis?

Answer 10

Panproctocolectomy (removal of the large bowel and rectum).

Question 11

What are the two surgical options after a panproctocolectomy?

Answer 11

Permanent ileostomy
Ileo-anal anastomosis (J-pouch)

Question 12

What is the first-line treatment for inducing remission in an exacerbation of Crohn’s disease?

Answer 12

Steroids (e.g., oral prednisolone or IV hydrocortisone).

Question 13

What is an alternative treatment to steroids for inducing remission in Crohn’s disease, especially in children?

Answer 13

Enteral nutrition.

Question 14

What are the first-line options for maintaining remission in Crohn’s disease?

Answer 14

Azathioprine
Mercaptopurine

Question 15

What are the surgical options for Crohn’s disease?

Answer 15

Resecting the distal ileum
Treating strictures
Treating fistulas

Question 16

List three red flag features in GORD (in addition to dysphagia) that may indicate a need for an urgent two-week wait referral.

Answer 16

Weight loss
Treatment-resistant dyspepsia
Upper abdominal mass on palpation

Question 17

What is the most common type of hiatus hernia?

Answer 17

Sliding hiatus hernia (Type 1).

Question 18

What bacteria is associated with gastritis, ulcers, and an increased risk of stomach cancer?

Answer 18

Helicobacter pylori (H. pylori).

Question 19

Name two methods used to test for H. pylori infection.

Answer 19

Stool antigen test
Urea breath test

Question 20

What is the typical treatment for H. pylori infection?

Answer 20

Triple therapy with a proton pump inhibitor and two antibiotics (e.g., amoxicillin and clarithromycin) for 7 days.

Question 21

What is Barrett’s oesophagus and why is it significant?

Answer 21

Barrett’s oesophagus is a condition where the lower oesophageal epithelium changes from squamous to columnar, increasing the risk of oesophageal adenocarcinoma.

Question 22

What is the treatment for Barrett’s oesophagus to monitor or prevent progression to cancer?

Answer 22

Endoscopic monitoring
Proton pump inhibitors
Endoscopic ablation (e.g., radiofrequency ablation)

Question 23

What is Zollinger-Ellison syndrome?

Answer 23

A rare condition where a duodenal or pancreatic tumour secretes excessive gastrin, leading to severe dyspepsia, peptic ulcers, and diarrhoea.

Question 24

What genetic condition is associated with Zollinger-Ellison syndrome?

Answer 24

Multiple endocrine neoplasia type 1 (MEN1).

Question 25

What types of medications increase the risk of bleeding from a peptic ulcer?

Answer 25

Non-steroidal anti-inflammatory drugs (NSAIDs) Aspirin Anticoagulants (e.g., DOACs) Steroids SSRI antidepressants

Question 26

How can chronic microscopic bleeding from a peptic ulcer affect the blood?

Answer 26

It can lead to iron deficiency anaemia, resulting in low haemoglobin, low mean cell volume (MCV), and low ferritin.

Question 27

What is gastric outlet obstruction and how does it present?

Answer 27

Gastric outlet obstruction is a narrowing of the stomach exit due to scarring and strictures, leading to early fullness after eating, upper abdominal discomfort, abdominal distension, and vomiting after meals.

Question 28

How can gastric outlet obstruction be treated?

Answer 28

It may be treated with balloon dilatation during an endoscopy or surgery.

Question 29

How can you differentiate between gastric and duodenal ulcers based on eating patterns and pain?

Answer 29

Eating worsens the pain in gastric ulcers, while in duodenal ulcers, pain improves immediately after eating but worsens 2-3 hours later.

Question 30

What is the most common cause of upper gastrointestinal bleeding? Name four other potential sources of upper GI bleeding.

Answer 30

Peptic ulcers. Mallory-Weiss tear (tear of the oesophageal mucosa) Oesophageal varices (due to portal hypertension in liver cirrhosis) Stomach cancer Gastritis or esophagitis

Question 31

What factors does the Glasgow-Blatchford score take into account?

Answer 31

Haemoglobin Urea Systolic blood pressure Heart rate Presence of melaena Syncope Liver disease Heart failure

Question 32

What is the purpose of the Rockall score?

Answer 32

It estimates the risk of rebleeding and mortality after endoscopy.

Question 33

What factors does the Rockall score include?

Answer 33

Age Features of shock (e.g., tachycardia, hypotension) Co-morbidities Cause of bleeding Endoscopic findings of recent bleeding

Question 34

What does the mnemonic ABATED stand for in the management of upper GI bleeding?

Answer 34

A – ABCDE approach B – Bloods (FBC, U&Es, INR, LFTs, crossmatch) A – Access (2 large bore cannulas) T – Transfusions (as needed) E – Endoscopy (within 24 hours) D – Drugs (stop anticoagulants and NSAIDs)

Question 35

When are platelets given in UGIB?

Answer 35

When there is active bleeding plus thrombocytopenia (platelet count <50).

Question 36

What is given to patients on warfarin who are actively bleeding?

Answer 36

Prothrombin complex concentrate.

Question 37

What additional treatments are needed if oesophageal varices are suspected?

Answer 37

Terlipressin Broad-spectrum antibiotics

Question 38

When should a proton pump inhibitor (PPI) be used in upper GI bleeding?

Answer 38

After endoscopy for non-variceal bleeding, as per NICE guidelines (2016).

Question 39

What criteria are required for an IBS diagnosis according to NICE?

Answer 39

A history of at least 6 months of abdominal pain or discomfort with one of the following: - Pain or discomfort relieved by opening the bowels - Bowel habit abnormalities - Stool abnormalities (e.g., watery, loose, or hard) and At least two of the following: - Straining, urgency, or incomplete emptying - Bloating - Symptoms worse after eating - Passing mucus

Question 40

What is recommended for constipation in IBS?

Answer 40

Bulk-forming laxatives (e.g., ispaghula husk). Lactulose should be avoided due to bloating.

Question 41

What is prescribed for abdominal cramps in IBS?

Answer 41

Antispasmodics such as mebeverine, alverine, hyoscine butylbromide, or peppermint oil.

Question 42

Which antibodies are related to Coeliac Disease?

Answer 42

Anti-tissue transglutaminase antibodies (anti-TTG) Anti-endomysial antibodies (anti-EMA) Anti-deamidated gliadin peptide antibodies (anti-DGP)

Question 43

Which human leukocyte antigen (HLA) genotypes are associated with Coeliac Disease?

Answer 43

HLA-DQ2 and HLA-DQ8.

Question 44

What skin condition is associated with Coeliac Disease?

Answer 44

Dermatitis herpetiformis, an itchy, blistering skin rash, often on the abdomen.

Question 45

What neurological symptoms can rarely present with Coeliac Disease?

Answer 45

Peripheral neuropathy Cerebellar ataxia Epilepsy

Question 46

What is the first-line blood test for diagnosing Coeliac Disease?

Answer 46

Total immunoglobulin A (IgA) levels Anti-tissue transglutaminase antibodies (anti-TTG)

Question 47

What are the main complications of untreated Coeliac Disease?

Answer 47

Nutritional deficiencies Anaemia Osteoporosis Hyposplenism (increased infection risk) Ulcerative jejunitis Enteropathy-associated T-cell lymphoma (EATL) Non-Hodgkin lymphoma Small bowel adenocarcinoma