Gastrointestinal

Question 1

1st line tx for mild-moderate flare of ulcerative colitis

Answer 1

Topical (rectal) aminosalicylates

oral possible if rectal declined

Question 2

fts of moderate flare of ulcerative colitis

Answer 2

• 4-6 bowel movements/day
• b/w mild - severe blood in stools
• no pyrexia (<37.8C)
• pulse <90
• no anaemia
• ESR <30

Question 3

Management of acute severe flare/first presentation of ulcerative colitis

Answer 3

IV prednisolone

Question 4

2nd line tx for moderate flare ulcerative colitis

Answer 4

oral prednisolone/any corticosteroid

Question 5

indication for surgery for ulcerative colitis

Answer 5

acute severe UC admitted to hospital

Question 6

mild ulcerative colitis flare fts

Answer 6

• < 4 stoold/day

- small amount of PR blood

Question 7

severe falure of ulcerative colitis fts

Answer 7

• > 6 blood stools per day

- systemic upset (purexia, tachy, anaemia, raised inflam markers)

Question 8

Inducing remission of Crohn’s first line

Answer 8

• glucocorticoids
• +/- azathioprine

Question 9

2nd line tx - inducing remission in Crohn’s

Answer 9

5-ASA drugs (mesalazine)

Question 10

When is infliximab used to tx Crohn’s

Answer 10

• refractory disease
• fistulating Crohn’s

Question 11

Drug tx for isolated peri-anal disease in Crohn’s

Answer 11

Metronidazole

Question 12

Maintaining remission in Crohn’s

Answer 12

• quit smoking
• azathioprine/mercaptopurine (1st line)
• methotrexate (2ndline)

Question 13

What test should be done before starting azathioprine/mercaptopurine

Answer 13

thiopurine methyltransferase (TPMT)

Question 14

Classic diverticulitis fts

Answer 14

• LLQ pain
• diarrhoea
• fever

Question 15

Classic presentation of UC

Answer 15

• chronic ( +/-bloody) diarrhoea
• crampy abdo pain
• weight loss
• faecal urgency
• tenesmus

Question 16

Classic fts Crohn’s disease

Answer 16

• chronic diarrhoea
• crampy abdo pain
• malabsorption
• mouth ulcers
• perianal disease
• intestinal obstruction

Question 17

Classic presentation coeliac children

Answer 17

• failure to thrive
• chronic diarrhoea
• abdominal distension

Question 18

Classic presentation coeliac adults

Answer 18

• lethargy
• anaemia
• weight loss
• chronic diarrhoea
• co-existing auto-immune conditions

Question 19

Basic pathophys of haemochromatosis

Answer 19

disorder of iron aborption and metabolism = iron accumulation

Question 20

Fts of haemochromatosis
1- early
2- reversible complications
3- irreversible complications

Answer 20

1- asymptomatic; fatigue, erectile dysfunction, arthralgia (hands)
2- bronze skin pigmentation; cardiomyopathy (but progress to cardiac failure - 3); chronic liver disease with hepatomegally (but progress to cirrhosis or hepatocellular deposition - 3)
3- DM; hypogonadotrphic hypogonadism (cirrhosis + pituitary dysfunction); arthritis

Question 21

Genetic/ other Ca a/w pancreatic cancers

Answer 21

• hereditary non-polyposis colorectal carcinoma
• multiple endocrine neoplasia
• BRCA2 gene
• KRAS gene mutation

Question 22

Main type of pancreatic tumour

Answer 22

> 80% adenocarcinomas

Question 23

Endoscopy findings Crohn’s

Answer 23

deep ulcers
skip lesions
‘cobble-stone’

Question 24

Endoscopy findings UC

Answer 24

widespread ulceration
preservation of adjacent mucosa (appearance of polyps - ‘pseudopolyps’)

Question 25

Radiology Crohn's 1. type used 2. findings

Answer 25

1. Small bowel enema (specifically looking at terminal ileum) 2. Kantor's string sign = strictures; prox bowel dilatation; 'rose thorn' ulcers; fistulae

Question 26

Radiology UC 1. type used 2. findings

Answer 26

1. barium enema 2. loss of haustrations; sup ulcerations 'pseudopolyps'; long standing disease = narrow and short colon ('drainpipe colon')

Question 27

Histology Crohn's

Answer 27

inflammation in all layers of mucosa - incr goblet cells - granulomas

Question 28

Histology UC

Answer 28

No inflammation beyond submucosa (excl fulminant disease) - inflam cell infiltrate in lamina propria - neut migrate through walls of glands - form crypt abscesses - depletion of goblet cells and mucin from gland epithelium - granulomas are infrequent

Question 29

Lesion pattern in Crohn's

Answer 29

anywhere from mouth to anus +/- skip lesions

Question 30

Lesion pattern in UC

Answer 30

start at rectum and spreads proximal, nevery beyond ileocaecal valve continuous disease

Question 31

Complications Crohn's

Answer 31

- obstruction - fistula - colorectal cancer

Question 32

Complications UC

Answer 32

colorectal cancer (higher than Crohn's) toxic megacolon

Question 33

Classic fts of Crohn's

Answer 33

- diarrhoea (non bloody) - weight loss (> than UC) - upper GI sx - mouth ulcers - perianal disease - abdo mass palpable in RIF

Question 34

Classic fts of UC

Answer 34

- bloody diarrhoea more common - abdo pain in LLQ - tenesmus

Question 35

Fts of mesenteric ischaemic (acute)

Answer 35

- sudden onset severe abdo pain out of keeping with physical exam - rectal bledeing - diarrhoea fever - bloods= elevated WCC; lactic acidosis - commonly BG of AF (thrombus of artery, i.e SMA)

Question 36

Mx of acute mesenteric ischaemia

Answer 36

Urgent surgery

Question 37

Pathophys of ischaemic colitis

Answer 37

acute but transient compromise in blood flow to large bowel can lead to inflammation, ulceration and haemorrhage > likely in 'watershed' areas (splenic flexure)

Question 38

viral hepatitis presentation

Answer 38

- N&V, anorexia - myalgia - lethargy - RUQ pain foreign travel or IVDU

Question 39

Presentation of congestive hepatomegaly

Answer 39

only painful if stretched (commonly due to congestive heart failure) if severe - cirrhosis

Question 40

Biliary colic presentation

Answer 40

- pain: RUQ, intermittent, aburpt onset, subsides gradually - attacks occur after eating - commonly: nausea risk factors: female, forties, fat, fair, fertile

Question 41

Acue cholecystitis

Answer 41

- biliary pain (RUQ, intermittent, acute onset after food) but > severe and persistent - +/- radiation to R shoulder - +/- fever - Murphy's positive

Question 42

Ascending cholangitis presentation

Answer 42

- fever (rigors) - RUQ pain - jaundice

Question 43

gallstone ileus presentation

Answer 43

abdominal pain abdominal distension vomiting (SBO 2ry impacted galstone)

Question 44

cholangiocarcinoma presentation

Answer 44

- persistent bilicary colic - anorexia - jaundice - weight loss - palpable mass in RUQ (Courvoisier) - periumbilical lymphadenopathy (sister May Joseph nodes) - left supraclavicular adenopathy (Virchow node)

Question 45

Acute pancreatitis presentation

Answer 45

- severe epigastric pain - vomiting common - +/- ileus, tenderness, low grade fever +/- Periumbilical discolouration (Cullen's sign) /flank (Grey-Turner's sign) -- rare