Gastroenterology

Question 1

Causes of Dysphagia and Clues on Questions

Answer 1

Pharyngeal Pouch

1. Older Men ,
2. posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
3. if large then a midline lump in the neck that gurgles on palpation

Globus Hystericus

1. History of Anxiety
2. Painless and Relieved by Swallowing

Question 2

Ongoing Diahorrea Post Illeal Resection in Chron’s
What Medication to Give ?

Answer 2

Cholestyramine
Side Effect Cholesterol Gallstones and Constipation

Question 3

Carcinoid Tumour Initial Investigations and Management

Answer 3

5HT IAA and Chromogranin A

Octreotide and Cyproheptadine

Question 4

Zollinger Ellison Syndrome

Answer 4

Watery Diarrhoea —> Metabolic Alkalosis (Loss of Water , Increase in Aldosterone , K and H Excretion)
Ulcers not responding to PPI or H Pylori Eradication
Most Tumours Found in 1st Part of Duodenum

Question 5

Pancreatitis Predictors

Answer 5

First to rise within few hour-Amylase
Most specific and Sensitive, best after 24 hours-Lipase
Marker of severity-CRP and Hypocalcemia

Question 6

Hepatotoxic Drug Memonic
PANAMA

Answer 6

Paracetamol
Amiodarone
NSAIDs
Anti-Epileptic
Methotrexate
Antibiotics (Flocloxacillin Coamoxiclav Erythromycin)
Anti TB

MNEMONIC: PASS FOR
phenothiazines
antibiotics Flocloxacillin Coamoxiclav Erythromycin
anabolic steroids
sulphonylureas

FOR-
FIBRATES
OCPS
RARE- NIFEDIPINES.

Question 7

Whipple Disease Mnemonic ?

Answer 7

W: worn out joints, weight loss
H: hyperpigmentation HLAB27
I: intestinal malabsorption
P: pleurisy
P: pericarditis
L: lymphadenopathy
E: elevated macrophages with Periodic acid-Schiff (PAS) granules

IV Cetfriaxone for 2 weeks then Co - Trimoxiazole

Question 8

Esophageal Caancer SCC or Adenocarcinoma?

AND

Staging Modality ?

Answer 8

SCC - Upper 1/3 rd (HOARSENESS), Smokers, Smoked foods, Plummer Vinson Syndome

Adenocarcinoma - Lower 1/3rd , GORD, Barrets

Endoscopic USS

Question 9

Primary Biliary Cholangitis

Answer 9

IgM
AMA M2 Antibodies
Abdominal USS or MRCP TRO Obstruction
Ursodeoxycholic Acid / Liver Transplant if Bili > 100 /

Question 10

Hereditary Haemochromatosis

Gene
Investigations to quantify liver/cardiac iron ?
Low or High TIBC ?

Answer 10

HFE Gene on C6 (C282Y and H63D mutations)

MRI is generally used to quantify liver and/or cardiac iron

Low TIBC

Question 11

C Difficile Treatment

Answer 11

Oral Vancomycin 10 days
Oral Fidaxomicin
Oral vancomycin +/- IV metronidazole

If Recurrent

within 12 weeks : oral fidaxomicin
after 12 weeks : oral vancomycin OR fidaxomicin

bezlotoxumab monoclonal Antibody against C Diff Toxin B

Question 12

Gastric MALToma Treatment

Answer 12

H Pylori Eradication

Question 13

Eosinophilic Esophagitis

1. Features
2. Treatment

Answer 13

Young Men with PPI Resistant GORD with Allergies

Elemental Diet (Amino Acid Mix for 6 weeks)
Exclusion of 6 food groups (commonly identified allergens)
Targeted Diet (Excluding Allergy PERSONAL Triggers)

Topical Steroids (fluticasone and budesonide)

Question 14

Wilsons Disease

Answer 14

Autosomal Recessive
ATP7B Gene
Chromosome 13

Basal Ganglia deposition
Kayser-Fleischer rings
RTA
Blue Nails

Question 15

Sulfasalazine Side Effects

Rabbits Often Hop High, Making Laughs.

Answer 15

Rabbits Often Hop High, Making Laughs.

R: Rashes.
O: Oligospermia.
H: Headache.
H: Heinz-body anaemia.
M: Megaloblastic anaemia.
L: Lung fibrosis.

Question 16

Which factor is Supra-Normal in Liver Disease ?

Answer 16

Factor 8

Question 17

PPI

1. MOA ?
2. Side Effects

3 ups and 3 downs

Answer 17

1. Irreversible blocker at H+/K+ ATPase of the gastric parietal cell
2. low Na
   low Mg
   ow plavix,

high c.diff
high osteoporosis
high colitis (Microscopic Colitis)

Question 18

Villous Adenoma

Answer 18

Watery Diahorrea + Hypokalemia + Microcytic Anemia

Metabolic acidosis

Question 19

Cholangiocarcinoma Causes !!!

Answer 19

Hep B most common cause worldwide
Hep C most common cause in Europe

Question 20

Sporadic (How many %)
HNPCC
FAP
Putz Jager Syndrome

Answer 20

95% Sporadic
Eg : activation of the K-ras oncogene, deletion of p53 and DCC tumour suppressor genes

Autosomal Dominant
MSH (60%)
MLH (30%)

Autosomal Dominant
APC Ongogene in C5

Autosomal Dominant
Serine threonine kinase LKB1 or STK11

Question 21

Gastric Cancer Endoscopic Biopsy finding

Answer 21

Signet Ring Cells - large vacuole of mucin which displaces the nucleus to one side

More Signet Cells Worse Prognosis

Question 22

Antibiotics for how long vs PPI for how long ?

Answer 22

4 weeks off Antibiotics
2 weeks off PPI

Question 23

Types of Bariatric Surgery

Answer 23

Primary Restrictive -

Laparoscopic Assisted Gastric Banding
Sleeve Gastrectomy
Intragastric Balloon

Primarily Malabsorptive

Biliopancreatic diversion with duodenal switch

Mixed

Roux-en-Y gastric bypass surgery

Question 24

When to offer Fibro scan ?

Answer 24

1. Hep C
2. > 50 units / week (Men) or >35 units / week (Women)
3. Alcoholic Related Liver Disease

Question 25

Pancreatic Cancer 1. Investigation of Choice 2. Associated Paraneoplastic Syndrome ? 3. Treatment

Answer 25

1. HRCT (Gold Standard) 'Double Duct' Sign on High Resolution CT Trousseau Sign (Migratory Thrombophlebitis) Whipples Procedure ERCP + Stenting for Palliation

Question 26

Which Pathology is least associated with HCC ?

Answer 26

Wilsons Disease

Question 27

VIPoma 1. Features 2. Pathophysiology 3. Most Common Location

Answer 27

VIPoma 1. Vasodilate 2, Inhibits Gastric Motility and GI secretion 3. Increase INTESTINAL Secretions Watery Diahorrea Hypokalemia (Lose K+) NAGMA (Lose HCO3-) Achlorhydria --> Low HCL and HCL needed to convert Fe3+ to Fe2+ in the Duodenum to be absorbed ---> Microcytic Anemia 3. Pancreas All -oma are on Islet Cell Tumours

Question 28

Gastrinoma 1. Features 2. Ix

Answer 28

MANY MANY Ulcers THAT GO BEYOND 1st Part of DUODENUM a. Not responding to PPI b. Not responding to H,. Pylori Watery Diahorrea + METABOLIC ALKALOSIS + HEMETEMESIS !!! (From Ulcers) Ix - Secretin Stimulation Test (Gastrin IS NOT inhibited) CT

Question 29

Alcoholic Ketoacidosis

Answer 29

1. Metabolic acidosis 2. Elevated anion gap 3. Elevated serum ketone levels 4. Normal or low glucose concentration

Question 30

Bacterial Peritonitis 1. Most Common Organism 2. Treatment vs Prophylactic

Answer 30

1. E.Coli 2. IV Cefotaxime vs Prophylaxis if : Episode of SBP Fluid protein <15 g/l + either Child-Pugh score of at least 9 or hepatorenal syndrome (until ascites resolved)