Gastroenterology

Question 1

What cancer can H.Pylori cause?

Answer 1

MALToma and gastric lymphoma

Question 2

Zollinger Ellison Syndrome

• define
• presentation
• investigation
• management

Answer 2

gastrin secreting tumour most commonly found in small intestine or pancreas
- refractory PUD
- abdo pain
- diarrhoea
Inv: fasting serum gastrin
Management- high dose PPI, tumour resection

Question 3

corkscrew oesophagus in?

Answer 3

oesophageal spasm

Question 4

Plummer Vinson syndrome

Answer 4

Oesophageal web

iron def anaemia

Question 5

Pharyngeal pouch

- presentation

Answer 5

dysphagia, regurg, halitosis and gurgling sounds

Question 6

Oesophageal ca

• pathophysiology
• presentation
• investigation
• treatment

Answer 6

1) Adenocarcinoma (lower 3rd) and SCC (upper and middle 3rd)
2) progressive dysphagia, retrosternal chest pain, hoarseness
3) upper GI endoscopy
BA swallow- apple core stricture
4) oesophagectomy

Question 7

ALARMS symptoms for OGD

Answer 7

Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Melaena
Swallowing difficulty

Question 8

Presentation and classic appearance on barium swallow of achalasia

Answer 8

1. dysphagia to liquids and solids, regurg esp @ night, substernal cramps
2. bird’s beak

Question 9

management of achalasia

Answer 9

calcium channel blockers

Question 10

classic complication of UC

Answer 10

toxic megacolon

Question 11

what might you see on small bowel imaging in crohns?

Answer 11

• skip lesions
• rose thorn ulcers
• cobble stoning
• string sign of kantor

Question 12

inducing remission in UC?

Answer 12

if distal colitis use rectal salicyclates
otherwise
first line: oral aminosalicyclates
second line: oral pred

Question 13

maintaining remission in UC?

Answer 13

first line: 5ASAs

second line- azathioprine

Question 14

inducing remission in crohns?

Answer 14

glucocorticoids

5-ASAs second line

Question 15

maintaining remission

Answer 15

first line: azathioprine
second line: methotrexate
use 5-ASAs if previous surgery

Question 16

what is PSC?

- investigations?

Answer 16

inflammation and fibrosis of intra and extra hepatic bile ducts- associated with UC
- ERCP- shows ‘beaded appearance’

Question 17

rash associated with coeliac disease

Answer 17

dermatitis herpetiformis

Question 18

Management of varices

Answer 18

if stable -> propanolol
if bleeding -> Terlipressin
ligation and banding via urgent endoscopy

Question 19

Kings college hospital criteria in acute hepatitis if paracetamol induced

Answer 19

pH <7.3 24hr after ingestion 
or all of 
- PT >100s
- creat >300
- grade 3/4 encephalopathy

Question 20

Kings college hospital criteria in acute hepatitis if non-paracetamol induced

Answer 20

PT >100s
or 3/5 of
- drug-induced
- age <10 or >40
- >1 week from jaundice to encephalopathy
- PT >50s
- bilirubin >300

Question 21

treatment of PBC

Answer 21

ursodeoxycholic acid

Question 22

what is in the child-pugh classification?

Answer 22

1. encephalopathy
2. bilirubin
3. ascites
4. prothrombin time

Question 23

management of encephalopathy

Answer 23

lactulose

Question 24

what is SAAG

Answer 24

serum albumin ascites gradient

SAAG >=1.1g/dL indicates portal HTN

Question 25

treatment of Hep C

Answer 25

PEGinteferon + ribavarin

Question 26

Autoimmune hepatitis - epidemiology - diagnosis - associations - management

Answer 26

- young women - liver biopsy - hashimotos, DM, pernicious anaemia, PSC, UC - prednisolone and azathioprine

Question 27

Budd- chiari syndrome - define - causes - presentation - management

Answer 27

hepatic vein obstruction resulting in ischaemia and liver damage causes: HCC, congenital, hypercoaguable states Pres: RUQ pain, hepatomegaly, ascites, jaundice Rx: anticoagulant and treat ascites

Question 28

Hereditary haemochromatosis - inheritance - diagnosis - management

Answer 28

- autosomal recessive - high serum ferritin and genetic testing - Rx: venesection

Question 29

Symptoms of hereditary haemochromatosis

Answer 29

``` Type 1 DM arthritis chronic liver disease slate-grey discolouration - dilated cardiomyopathy ```

Question 30

Wilson's disease - inheritance - features - diagnosis - management

Answer 30

- autosomal recessive - kaiser-fleischer rings, liver disease, parkinsonism, renal tubular damage - low serum caeruloplasmin and low serum copper - penicillamine

Question 31

Presentation of PBC

Answer 31

middle aged women with other autoimmune diseases presents with liver fibrosis/cirrhosis, xanthelasma and ascites

Question 32

autoantibodies in PBC

Answer 32

AMA (most specific) | ANA

Question 33

Presentation of liver cancer | - tumour markers?

Answer 33

- RUQ pain, nausea, vomiting, jaundice, weight loss | - AFP

Question 34

what is cholangiocarcinoma - tumour marker? - management?

Answer 34

cancer of bile ducts, presents with painless obstructive jaundice - CA 19-9 - resection but usually palliativ care

Question 35

``` Vitamin Deficiencies A B1 B3 B6 B12 C D K ```

Answer 35

``` A- night blindness & total blindness B1- wet (heart failure) dry (wernickes) B3- diarrhoea, dermaitis, dementia B6- sensory neuropathy B12- glossitis, peripheral neuropathy C- scurvy D- osteomalacia K- bleeding ```