Gastroenterology

Question 1

Signs of peritonitis?

Answer 1

Tender
Reflex guarding
Absent bowel sounds
Pyrexia
Percussion tenderness
Extremely unwell
Distant local sign (e.g.rosvig's sign)

Question 2

Main causes of obstruction?

Answer 2

Tumours, adhesions, hernia

Question 3

Signs of shock?

Answer 3

Pale, sweaty ISHOCKS
Increased respiratory rate
Sinus tachycardia
Hypotension 
Oliguria
Cold
Klammy
Slow capillary refill

Question 4

Signs of severe shock

Answer 4

Acidotic, confused, cyanotic (blue)

Question 5

Types of shock

Answer 5

Distributive
Hypovolaemic
Cardiogenic
Obstructive (e.g. PE)

Question 6

Signs of intestinal obstruction

Answer 6

Abdominal pain
Vomiting
Distention
Absolute constipation

Question 7

Modified hartmann’s v hartmann’s procedure?

Answer 7

Modified: cross-staple rectum
Original: rectum brought out to make a fistula

Question 8

What is an anterior resection?

Answer 8

Resection of ‘high’ rectal cancer.

Question 9

Anterior resection v. Abdominal-perineal resection?

Answer 9

AP resection (abdomino-perineal) is for a low rectal cancer: creates an imperforate anus and end colostomy. Anterior resection = no stoma, anastomose colon, needs around 4-5cm from anal verge before cancer.

Question 10

Complications of stomps

Answer 10

Fluid losses
Odour
Ulcer
Leak
Stenosis
Hernias and prolapse
Ischaemia
Terminal ileum losses (B12, bile salts absorption) 
Sexual/psych problems.

Question 11

Indication for end ileostomy?

Answer 11

Extensive ulcerative colitis, large bowel crohn’s, familial polyposis coli => panproctocolectomy

Question 12

Screening bloods for malabsorption?

Answer 12

MCV, CRP, Vit B12, Red cell folate, ferritin.
Albumin, Immunoglobulins
Magnesium
Alk Phos
Vit D, PTH

Question 13

Tests for fat malabsorption?

Answer 13

Glucose hydrogen breath test, lactulose hydrogen breath test, C13 breath test.

Question 14

Features of bacterial overgrowth malabsorption?

Answer 14

Fat malabsorption, Vit ADE def, Mg def,

Excess: folate, Vit K, colonic SCFA

Question 15

Specific features of pancreatic exocrine deficiency?

Answer 15

Fat malabsorption, Vit ADEK def

Excess: colonic SCFA

Question 16

Which HLA type is associated with coeliac disease?

Answer 16

HLA DQ2 or DQ8 (>95% of coeliacs are one of these)

Question 17

Markers of Coeliac disease?

Answer 17

Anti- TTG
Anti-endomysial antibody
Serum IgA
IgA and IgG anti-gliadin antibody

Question 18

Complications of coeliac disease:

Answer 18

2x long term risk of malignant disease (usually T cell intestinal lymphomas) Other inc: GI, breast carcinomas, or oesophageal squamous cell carcinoma

Question 19

Conditions associated with coeliac disease?

Answer 19

Lymphocytic gastritis, selective IgA deficiency, T1DM, Sjögren’s syndrome, autoimmune thyroiditis.

Question 20

Causes of acute pancreatitis?

Answer 20

Gallstones
Ethanol
Trauma
Steroids/smoking
Mumps (and other viruses)
Autoimmune
Scorpion sting
Hyperlipidaemia, hypothermia, hyperparathyroidism
ERCP
Drugs: azathioprine, valproate, cytotoxic

Question 21

Causes of chronic pancreatitis?

Answer 21

Alcohol
Smoking
Obstruction: tumour, trauma, cystic fibrosis, developmental abnormality
Premature enzyme activation: mutation of trypsin
Recurrent acute pancreatitis

Question 22

Causes of inflammatory gastroenteritis

Answer 22

CESSY
Campylobacter
E. Coli 0157
Shigella
Salmonella
Yersinia

Question 23

Causes of acute (watery) diarrhoea

Answer 23

Viruses: Norovirus, rotavirus
Bacteria: Vibrio cholera, ETEC, EPEC
(salmonella, C. Dificile, campylobacter)
Parasites: giardia, cryptosporidium

Question 24

Part of gut affected by watery diarrhoeal illness?

Answer 24

Jejunum

Question 25

Causes of chronic watery diarrhoea

Answer 25

C. Dificile Campylobacter Giardia Cryptosporidium

Question 26

Approx time for acute v chronic diarrhoea

Answer 26

<14 or >14d

Question 27

Causes of dysentery

Answer 27

``` C.dificile + Campylobacter E. Coli o157 Shigella Salmonella Yersinia + Entamoeba histolyticus (Vibrio parahaemolyticus) ```

Question 28

Is smoking protective for UC or Crohn's

Answer 28

UC

Question 29

Signs of peritonitis?

Answer 29

``` TRAPPED Tender Reflex guarding Absent bowel astounds Pyrexia Percussion pain Extremely unwell Distant-local sign (e.g. Rosvig's) ```

Question 30

Management of acute pancreatitis?

Answer 30

Ix: FBC, U+E, amylase, Supine AXR, erect CXR Drip and suck; IV fluids, NBM, NG tube Pain control ±IV antibiotics if severe

Question 31

Modified Glasgow Scoring System for pancreatitis?

Answer 31

``` 8 features in first 24h = prognostic (severe attack≥3). (NOT serum amylase) PANCREAS PaO2 <9 Albumin <32 Neutrophils/WCC >15 Calcium <2 Renal function (urea>16) Enzymes AST>200 Glucose >10 ```

Question 32

Causes of splenomegaly?

Answer 32

Mild: glandular fever, rheumatoid, myeloproliferative (polycythemia rubra vera), pernicious anaemia, Moderate: lymphoma, CLL, portal HTN, haemolytic anaemia (esp congenital) Massive: myelofibrosis, CML, chronic malaria

Question 33

Post splenectomy management:

Answer 33

Pneumococcal vaccine Meningococcal vaccine B and C HIB (Haemophilus B) vaccine Pen V 250mg BD for at least 2y (usually life) Medicalert bracelet/card + counsel re fever.

Question 34

Causes of unilateral kidney enlargement?

Answer 34

Renal cell carcinoma (Wilms in kids) Hydronephrosis (obstruction) Simple cyst Asymmetrical polycystic disease