Gastroenterology

Question 1

What are the major gastrointestinal hormones involved in food digestion?

Answer 1

Gastrin, Cholecystokinin (CCK), Secretin, Vasoactive Intestinal Peptide (VIP), and Somatostatin.

Question 2

What is the source and stimulus for Gastrin secretion?

Answer 2

G cells in the antrum of the stomach. Stimulus: Distension of the stomach, swallowing, vagus nerve stimulation, luminal peptides/amino acids, acetylcholine, and histamine. Inhibited by low antral pH and somatostatin.

Question 3

What are the actions of Gastrin?

Answer 3

Increases HCl, pepsinogen, and intrinsic factor secretion; increases gastric motility; stimulates parietal cell maturation.

Question 4

What is the source and stimulus for Cholecystokinin (CCK) secretion?

Answer 4

I cells in the upper small intestine. Stimulus: Partially digested proteins and triglycerides.

Question 5

What are the actions of Cholecystokinin (CCK)?

Answer 5

Stimulates gallbladder contraction, increases secretion of enzyme-rich fluid from the pancreas, relaxes the sphincter of Oddi, decreases gastric emptying, and induces satiety.

Question 6

What is the source and stimulus for Secretin secretion?

Answer 6

Source: S cells in the upper small intestine. Stimulus: Acidic chyme and fatty acids.

Question 7

What are the actions of Secretin?

Answer 7

Increases secretion of bicarbonate-rich fluid from the pancreas and liver; decreases gastric acid secretion.

Question 8

What is the source and stimulus for Vasoactive Intestinal Peptide (VIP) secretion?

Answer 8

Source: Small intestine and pancreas. Stimulus: Neural stimulation.

Question 9

What are the actions of Vasoactive Intestinal Peptide (VIP)?

Answer 9

Acts as a vasodilator, regulates smooth muscle activity, epithelial cell secretion, and gastrointestinal blood flow; stimulates secretion by the pancreas and intestines; inhibits acid secretion.

Question 10

What is the source and stimulus for Somatostatin secretion?

Answer 10

Source: D cells in the pancreas and stomach. Stimulus: Fat, bile salts, and glucose in the intestinal lumen.

Question 11

What are the actions of Somatostatin?

Answer 11

Inhibits all gastrointestinal endocrine secretions, decreases acid and pepsin secretion, decreases gastrin secretion, decreases pancreatic enzyme secretion, decreases insulin and glucagon secretion, and stimulates gastric mucous production.

Question 12

What is VIPoma?

Answer 12

A vasoactive intestinal polypeptide (VIP)-secreting tumor, mainly occurring in the pancreas, causing symptoms like watery diarrhea, dehydration, hypokalemia, and achlorhydria.

Question 13

What is the treatment for VIPoma?

Answer 13

Somatostatin analogs, codeine for diarrhea, and surgical resection for non-metastatic tumors.

Question 14

What are the indications for upper GI endoscopy in GERD?

Answer 14

Age > 55 years, symptoms > 4 weeks, dysphagia, relapsing symptoms, and weight loss.

Question 15

What is the gold standard test for diagnosing GERD?

Answer 15

24-hour esophageal pH monitoring.

Question 16

What is Barrett’s esophagus?

Answer 16

Metaplasia of the lower esophageal mucosa, where squamous epithelium is replaced by columnar epithelium, associated with GERD and increased risk of esophageal adenocarcinoma.

Question 17

What is the management of Barrett’s esophagus?

Answer 17

High-dose PPIs for 8-12 weeks, endoscopic surveillance, cryotherapy, and esophagectomy in severe cases.

Question 18

What are the risk factors for esophageal cancer?

Answer 18

Smoking, alcohol, GERD, Barrett’s esophagus, achalasia, Plummer-Vinson syndrome, and rare associations like celiac disease and scleroderma.

Question 19

What is Achalasia?

Answer 19

Failure of esophageal peristalsis and relaxation of the lower esophageal sphincter due to degenerative loss of ganglia from Auerbach’s plexus.

Question 20

What is the gold standard test for diagnosing Achalasia?

Answer 20

Esophageal manometry.

Question 21

What is the treatment for Achalasia?

Answer 21

Heller cardiomyotomy, balloon dilation, botulinum toxin injection, and drug therapy with nifedipine or nitrates.

Question 22

What is Boerhaave’s syndrome?

Answer 22

Spontaneous esophageal rupture, often due to vomiting, presenting with severe epigastric pain, pleural effusion, and respiratory distress.

Question 23

What is the diagnostic test for esophageal rupture?

Answer 23

Gastrografin swallow.

Question 24

What is the acute treatment for variceal hemorrhage?

Answer 24

ABC resuscitation, correction of clotting, vasoactive agents (terlipressin), prophylactic antibiotics, endoscopic variceal band ligation, and Sengstaken-Blakemore tube if uncontrolled.

Question 25

What is the prophylaxis for variceal hemorrhage?

Answer 25

Propranolol and endoscopic variceal band ligation (EVL).

Question 26

What is the Rockall scoring system used for?

Answer 26

Stratifying patients with gastrointestinal bleeding into high and low-risk groups based on age, comorbidities, shock, endoscopic abnormalities, and evidence of bleeding.

Question 27

What is Meckel's diverticulum?

Answer 27

A vestigial remnant of the omphalomesenteric duct, located in the terminal ileum, which can contain ectopic gastric mucosa and cause complications like bleeding, diverticulitis, and obstruction.

Question 28

What is the diagnostic test for Meckel's diverticulum?

Answer 28

Tc-99m pertechnetate scan.

Question 29

What are the associations of Helicobacter pylori?

Answer 29

Peptic ulcer disease, gastric cancer, B-cell lymphoma of MALT tissue, and atrophic gastritis.

Question 30

What is the treatment for H. pylori eradication?

Answer 30

Triple therapy with a PPI, amoxicillin, and clarithromycin or metronidazole for 7 days.

Question 31

What is Zollinger-Ellison syndrome?

Answer 31

A condition characterized by excessive gastrin secretion, usually from a gastrin-secreting tumor in the duodenum or pancreas, causing multiple gastroduodenal ulcers and diarrhea.

Question 32

What is the diagnostic test for Zollinger-Ellison syndrome?

Answer 32

Fasting gastrin levels on 3 different days and secretin stimulation test.

Question 33

What are the risk factors for gastric cancer?

Answer 33

Chronic H. pylori infection, blood group A, gastric adenomatous polyps, pernicious anemia, smoking, alcohol, and dietary factors like salty, spicy, and smoked foods.

Question 34

What is non-alcoholic fatty liver disease (NAFLD)?

Answer 34

A spectrum of liver disease ranging from steatosis to steatohepatitis (NASH), fibrosis, and cirrhosis, often associated with obesity and insulin resistance.

Question 35

What is the management of NAFLD?

Answer 35

Lifestyle changes (weight loss, low-fat diet), supervised exercise, and monitoring. Medications like pioglitazone and orlistat may be used in some cases.

Question 36

What is autoimmune hepatitis?

Answer 36

A chronic liver disease of unknown etiology, most common in young females, associated with other autoimmune disorders and hypergammaglobulinemia.

Question 37

What is the treatment for autoimmune hepatitis?

Answer 37

Steroids and immunosuppressants like azathioprine.

Question 38

What is the most common cause of hepatocellular carcinoma (HCC) worldwide?

Answer 38

Chronic hepatitis B.

Question 39

What is the treatment for hepatocellular carcinoma (HCC)?

Answer 39

Surgical resection or liver transplantation for localized disease. Non-surgical options include percutaneous ethanol injection, TACE, and radiofrequency ablation.

Question 40

What is primary biliary cirrhosis (PBC)?

Answer 40

A chronic liver disease characterized by immune-mediated destruction of intrahepatic bile ducts, leading to cholestasis, fibrosis, and cirrhosis, often associated with antimitochondrial antibodies (AMA).

Question 41

What is the treatment for primary biliary cirrhosis (PBC)?

Answer 41

Ursodeoxycholic acid, cholestyramine for pruritus, fat-soluble vitamin supplementation, and liver transplantation in advanced cases.

Question 42

What is primary sclerosing cholangitis (PSC)?

Answer 42

A chronic cholestatic liver disease characterized by inflammation and fibrosis of intra- and extrahepatic bile ducts, often associated with ulcerative colitis.

Question 43

What is the gold standard diagnostic test for PSC?

Answer 43

ERCP, though MRCP is often used initially due to its non-invasive nature.

Question 44

What is Gilbert's syndrome?

Answer 44

An autosomal recessive condition causing mild unconjugated hyperbilirubinemia due to a deficiency of UDP glucuronyl transferase.

Question 45

What is the management of Gilbert's syndrome?

Answer 45

No treatment is required. Phenobarbitone can be used in severe cases.

Question 46

What is Budd-Chiari syndrome?

Answer 46

Obstruction of hepatic venous outflow, often due to thrombosis, leading to hepatomegaly, ascites, and abdominal pain.

Question 47

What is the treatment for Budd-Chiari syndrome?

Answer 47

Anticoagulation, portocaval shunts, TIPSS, and liver transplantation.

Question 48

What is hereditary hemochromatosis?

Answer 48

An autosomal recessive disorder of iron metabolism leading to iron accumulation in organs like the liver, heart, and pancreas, caused by mutations in the HFE gene.

Question 49

What is the treatment for hereditary hemochromatosis?

Answer 49

Repeated venesection to remove excess iron, iron chelation with desferrioxamine in rare cases, and liver transplantation in advanced disease.

Question 50

What is the diagnostic test for hereditary hemochromatosis?

Answer 50

Elevated transferrin saturation (>45%), genetic testing for HFE mutations, and liver biopsy with Perl's stain for iron quantification.