Gastrointestinal Flashcards
(182 cards)
1
Q
What is the intestinal microflora?
A
A complex ecosystem of over 400 bacterial species. They prevent infection by interfering with pathogens
2
Q
What substances in the GI tract are defensive against mechanisms?
A
- Intestinal microflora
- Gastric acid
- Bile
3
Q
What is diarrhoea?
A
Passage of loose or watery stools, at at least three times in 24 hrs
4
Q
What is chronic diarrhoea?
A
Diarrhoea with symptoms of over 30 days
5
Q
What are the causes of infective diarrhoea?
A
- Intraluminal infection
- Systemic infections e.g. sepsis
6
Q
What are the non-infective causes of diarrhoea?
A
- Cancer
- Chemicals
- IBD
- IBS
- Endocrine dysfunction
- Radiation
7
Q
What is the most common cause of acute diarrhoea?
A
Intraluminal infection
8
Q
List some possible micro-organisms causing watery diarrhoea
A
- Bacteria= Vibrio cholerae, E coli, Clostridium perfringens, staph aureus
Viral= Rotavirus, norovirus
Parasitic= Giardia cryptosporidium
9
Q
List some possible micro-organisms causing bloody diarrhoea
A
- Bacterial= Shigella, salmonella, E coli
- Parasitic= Entamoeba histolytica
10
Q
Where are rotavirus outbreaks common?
A
Daycare centres/ nurserys
Most common in children
11
Q
Where are norovirus outbreaks common?
A
Hospitals, restaurants, cruise ships
12
Q
What is the most common cause of traveller’s diarrhoea?
A
E coli
13
Q
How is cholera treated?
A
Rehydration
14
Q
What are the clinical features of giardia duodenalis?
A
- Offensive diarrhoea
- Chronic
- Bloating
- Flatulence
- Abdominal cramps
15
Q
What is cholecystitis?
A
Gallbladder inflammation, cystic duct obstruction by gall stones
16
Q
What causes pyogenic liver abscesses?
A
- Biliary sepsis
- Hematogenous spread
17
Q
What are the clinical features of liver abscesses?
A
- Fever
- Right upper quadrant pain
- Nausea
- Vomitting
- Anorexia
- Weight loss
- Malaise
18
Q
How are liver abscesses diagnosed?
A
- Abdominal CT or ultrasound
- Blood cultures and E. histolytica serology
- Aspiration and culture of abscess material
19
Q
How are liver abscesses treated?
A
- Drainage and antibiotics
20
Q
What is peritonitis?
A
Inflammation of the visceral and parietal peritoneum or secondary to an infection
21
Q
What are the primary causes of peritonitis?
A
Underlying cirrhosis and ascites, TB peritonitis, PID
22
Q
What are the secondary causes of peritonitis?
A
Spillage from a viscus
23
Q
What are some possible causes of intraluminal obstruction?
A
- Tumour
- Diaphragm disease
- Meconium ileus
- Gallstone ileus
24
Q
What are the 4 cardinal signs of obstruction?
A
- Absolute constipation
- Colicky abdominal pain
- Abdominal distension
- Vomitting
25
What are some possible causes of intramural obstruction?
- Inflammatory= Crohns, diverticulitis
- Tumours
- Neural= Hirschsprung's disease
26
Where does diverticular disease most commonly occur?
Sigmoid colon
27
What are some possible causes of extraluminal obstructions?
- Adhesions
- Sigmoid Volvulus (loop)
- Peritoneal tumour
28
What are the symptoms of intestinal obstruction?
- Colicky pain
- Vomitting (early in proximal, late in large bowel)
- Constipation (early in distal, late in small bowel)
- Obstipation
- Abdominal distension
29
What is the commonest cause of small bowel obstruction?
Adhesion
30
What is the commonest cause of large bowel obstruction?
Colorectal malignancy
31
What is the most typical symptom of small bowel obstruction?
- Non- localised cramping pain
32
How is sigmoid Volvulus usually treated?
Fluids and decompression
33
What does the apc protein do in normal life?
It binds to beta catenin and removes it to keep the levels low
34
What happens if there is mutated apc protein?
The beta catenin levels will rise, causing an unregulation in genes that cause epithelial proliferation= adenoma and carcinoma of the colon
35
What genetic diseases are associated with colorectal carcinoma?
- Familial adenomatous polyposis
| - Lynch syndrome
36
How is colorectal cancer staged?
Dukes classification
37
Why does tumour of the colon metastasise to the liver?
The venous drainage of the colon spreads directly to the portal system of the liver, allowing spread
38
What is anorexia nervosa?
Restriction of energy intake relative to requirements leading to significant low body weight in the context of age, sex, developmental and physical health with an intense fear of gaining weight
39
What is bulimia nervosa?
Recurrent episodes of binge eating characterised by eating in a discrete amount of time large amounts of food, with a sense of lack of controlled during an episodes. Recurrent inappropriate compensatory behaviour in order to prevent weight gain (purging).
40
What is diarrhoea?
The passage of loose/watery stool 3 or more times in 24 hrs
41
What is the Bristol stool chart?
A scale of stool consistency with 1 being very dry and solid, and 7 being very watery
42
What are the possible non infective causes of diarrhoa?
- Neoplasm
- Hormonal
- Inflammation
- Irritable bowel
- Anatomical
- Radiation
- Chemical
43
Briefly explain the chain of infection
- Reservoir
- Agent
- Host
44
Which types of hepatitis are foecal-oral spread?
A and E
45
What are some common organisms that cause blood diarrhoea?
Shigella
| Salmonella
46
What are some common organisms that cause non-bloody diarrhoea?
Rotavirus
| Adenovirus
47
What virus causes cholera?
Vibrio cholerae
48
What are the symptoms of cholera?
Severe watery diarrhoea
Vomitting
Thirst
Leg cramps
49
What are common causes of diarrhoea in children?
- Rotavirus or norovirus
- E coli
- Salmonella or shigella
- Cryptosporidium
50
An 87 year old resident of a care home presents with confusion, altered consciousness, dehydration and diarrhoea. What is it likely to be?
- Norovirus
- Diverticulitis
- UTI
- Rotavirus
- C. Diff
51
How does antibiotic-associated c.diff occur?
Broad spectrum antibiotics kill the normal gut microbiome, allowing c.diff to be able to grow, causing diarrhoeal illness
52
How can you reduce spread of c.diff?
- Control antibiotic usage
- Wash hands, don gloves etc
- Surveillance and case finding
- Isolate patients
53
How is c.diff infection treated?
Metronidazole
| Stop C antibiotic
54
What are the at risk groups for diarrhoeal illness?
- Persons of doubtful personal hygiene
- Children who attend pre-school
- People work in food preparation
- HCW/ Social care staff looking after vulnerable people
55
What is ascites?
An accumulation of excess serous fluid within the peritoneal cavity
56
How much fluid is normally present in the peritoneal cavity in men?
None
57
How much fluid is normally present in the peritoneal cavity in women?
20ml
58
What are the causes of transudates ascites?
- Low plasma protein concs= malnutrition, nephrotics
- High venous pressure= Congestive cardiac failure
- Portal hypertension
59
What are the causes of exudates ascites?
- Peritoneal malignancy
- Tuberculous peritonitis
- Budd-Chiari syndrome
60
What are the clinical features of ascites
- Abdominal distension
- Nausea
- Constipation
- Wasting
- Pain
- Jaundice
61
How are ascites treated?
- Treat specific cause
- Sodium restriction
- Diuretics
- Paracentesis
- Indwelling drain
62
What are the two parts of the peritoneum?
- The visceral peritoneum
| - The parietal peritoneum
63
What are the functions of the peritoneum?
- Visceral lubrication
- Fluid and particulate absorption
- Pain perception
- Inflammatory and immune response
- Fibrinolytic activity
64
What pathogens cause peritonitis?
- E coli
- Streptococci
- Enterococci
- Clostridium spp.
- Bacteriodes spp.
65
Simon, a 57-year-old banker, comes in to the surgery complaining of pain immediately below the ribs. After a taking a history, he tells you the pain is typically worse at night and when he’s hungry but has found that a glass of milk seems to help. He had a MI 3 years ago and takes aspirin daily. What is this history suggestive of?
Duodenal Ulcer
66
Hernia is a type mechanical intestinal obstruction, name 3 sites where you might see a hernia?
Inguinal (direct/indirect),
- Femoral,
- Umbilical,
- Incisional (site of previous surgical incision)
67
A doctor is performing an abdominal examination of a patient with suspected bowel obstruction.
When they percuss an area of the bowel they hear tympanic sounds. What does this indicate is the contents of the bowel in this area?
Air/ Gas
68
What 3 factors would you consider when deciding whether to perform an operation for oesophageal cancer?
Is the patient medically fit / age / co-morbidities
- Has the cancer spread? / Metastasis / Severity of the cancer
- Is the cancer resectable
69
Describe 3 differences between Ulcerative colitis and Crohn’s disease?
- Location: UC- Large Bowel Only (1), Crohn’s anywhere in GI tract
- Appearance: UC= continuous Crohn’s patchy/ skip lesions
- Histology: UC- mucosa only Crohn’s- transmural
- Granulomatous: UC not Crohn’s is
- Serology: UC 70% ANCA Crohn’s 70% ASCA
70
Patients with Crohn’s disease are often put on long term steroids. What are 2 side effects this may have?
- Weight Gain
- Decreased Density of Bone / Osteoporosis
- Increased risk of infection / Immunosuppression
- Hyperglycaemia/ Link to causing DM+ HTN
- Effects growth (caution use in younger people)
- Skin Thinning
- Fluid Retention/ Oedema
71
Other than to digest food give 3 functions of the stomach
- Kill Microbes
- Secrete intrinsic factor / enable B12 absorption
- Store and/or Mix food
- Secrete and active proteases
- Produce stomach acid
- Regulate emptying into the duodenum
72
A 65-year-old woman presents to A&E with a 2-day history of progressive Right Upper Quadrant pain that she rates as 9/10. She reports experiencing fever, and being unable to eat or drink due to nausea and abdominal pain at baseline, exacerbated by food ingestion. Her pain is not relieved by bowel movement and is not related to food. She has not recently taken antibiotics, nor does she use nonsteroidal anti-inflammatory drugs (NSAIDs) or drink alcohol. On examination, she is febrile at 39.4°C; seated BP is 97/58 mmHg; standing BP is 76/41 mmHg. She seems confused. Jaundice. What can this specific set of symptoms be classified as?
Reynold's pentad of ascending cholangitis
73
Define malabsorption
Inadequate absorption of nutrients/food in/by the small intestines
74
Which three medications are given to manage a H.Pylori Infection in a patient with dyspepsia?
- Amoxicillin
- Clarithromycin
- Omeprazole
75
A patient presents with slate-grey skin, several signs of chronic liver disease and a ferritin level> 1mg.
What is their diagnosis?
Haematochromatosis
76
Describe the pain of a patient suffering from appendicitis?
Initially a diffuse pain around the centre of the abdomen/umbilicus (1) then localises to the right iliac fossa
77
Name two antibodies involved in coeliac disease?
- IgA Tissue Transglutaminase (tTg)
| - IgA Anti-Endomysial (EMA)
78
What are the symptoms of gastro-duodenal ulcer?
Non-specific pain
79
What are the layers of the gastric wall?
- Gastric epithelial cells with mucin (Mucosa)
- Submucosa
- Muscle
- Subserosa
- Serosa
80
What results from mucosal ischaemia?
- The cells will not produce mucin
| - Thus there is no protection against acid, so epithelial cell necrosis
81
What are the layers of the bowel wall?
- Mucosa
- Submucosa
- Muscularis externa
- Serosa
82
What is the action of H2 blockers?
Block the proton pump in g cells, so less acid is produced, reducing risk of ulcers
83
What do G cells in the stomach produce?
Gastrin (Stimulates acid)
84
What do parietal cells in the stomach produce?
Gastric acid
| Intrinsic factor
85
What do chief cells in the stomach produce?
Pepsinogen
| Gastric lipase
86
What do D cells in the stomach produce?
Somatostatin (Inhibits acid)
87
What do enterochromaffin-like cells in the stomach produce?
Histamine
88
What is the action of aspirin?
Inhibits prostaglandins (by inhibiting COX2)
89
What does an enteric coat do?
Mean the tablet is dissolved by bases, so shouldn't act within the stomach, so reducing chances of gastric ulcer
90
How does aspirin cause gastric ulcers?
It inhibits cox 2, meaning that there is increased gastric acid production
91
How does H. Pylori cause gastric ulcers?
- It lives within the mucin layer of the stomach
- Produce inflammatory cytokines, which cause neutrophil polymorphs to go into the gastric cells
- This causes inflammation and less mucin production, so erosion of the epithelial cells
92
List some causes of peptic ulcers
```
H Pylori
Bile reflux
Alcohol
NSAIDs
Increased acid production= stress
```
93
What causes the pain in peptic ulceres?
The acid has dissolved the peithelial cells, so acid can get onto nerves
94
How can peptic ulcers result in haemorrhage?
The ulcer can work its way down to an artery, causing bleeding into the stomach
95
How can peptic ulcers result in peritonitis?
The ulcer can work its way down into the peritoneum, resulting in acid secretion into the cavity, which can cause peritonitis and pancreatitis
96
List some common causes of malabsorption?
- Pancreatic insufficiency
- Defective bile secretion
- Bacterial overgrowth
- Coeliacs
- Crohns
- Giardia lamblia
- Surgery
- Lactose intolerance
- Lymphatic obstruction
97
What are the symptoms of malabsorption?
- Weight loss without diet changes
- Fatty stool
- Anaemia
98
How would pancreatitis cause malabsorption?
No or limited digestive enzymes are released
99
How would cystic fibrosis cause malabsorption?
Thickening of the bile within the pancreatic bile duct so less digestive enzymes released
100
How would gall stones cause malabsorption?
Causes bile duct obstruction so digestive enzymes aren't added
101
How can coeliac's disease cause malabsorption?
Villi are very short or not presen due to villous atrophy and crypt hyperplasia, so less absorptive area
102
How can crohn's disease cause malabsorption?
- Inflammatory damage to lining of bowel causing cobblestone mucosa with significant reduction in absorptive surface area
103
What are people with coeliac's disease allergic to specifically?
Gliadin protein
104
How would giardia lamblia infection cause malabsorption?
- Extensive surface parasitation will coat the surface of villi thus reducing area for absorption
105
Where does Crohn's disease affect?
Anywhere from the mouth to the anus- can skip regions
106
Where does ulcerative colitis affect?
Just the colon and/or rectum (continuous)= distal to the iliocaecal valve
107
What is disaccharidase deficiency?
Lactose intolerance
108
What can cause lymphatic obstruction?
Lymphoma
| TB
109
What is the microscopic appearance of Crohn's disease?
- Inflammation through all layers of the bowel
| - Granulomas present in 50-60%
110
What is the microscopic appearance of Ulcerative colitis?
- Mucosal inflammation
- No granulomata
- Depleted goblet cells
111
What are the complications of Crohn's?
- Malabsorption
- Obstruction
- Perforation
- Fistulas
- Fissures and skin tags in anus
- Colorectal cancer
- Amyloidosis (rare)
112
What are some complications of ulcerative colitis?
- Fatty changes in liver
- Blood loss
- Toxic dilation
- Colorectal cancer
- Joint problems= ankylosing spondylosis and arthritis
- Eye problems
- Skin rashes
113
What is the gold standard diagnosis for Coeliac disease?
Distal duodenal biopsy showing atrophy of the villi and crypt hyperplasia
114
How prevalent is coeliac disease?
Roughly 1%
115
How does lactose intolerance cause diarrhoea and flattulance?
The lactose cannot be digested as there is disaccharidase deficiency, so the lactose is instead digested by bacteria, causing CO2 release
116
What are the classic clinical features of Coeliac disease?
- Diarrhoea
- Steatorrhoea
- Weight loss
- Failure to thrive
117
What is Barrett's oesophagus?
Metaplastic columnar mucosa within the oesophagus due to recurrent acid exposure
118
What is the epithelial lining of the oesophagus?
Stratified squamous epithelium
119
A 74 year old man presents with a change in bowel habit and anaemia. On colonoscopy it is seen that he has a large tumour in his large bowel which travels into the lumen, and on CT he has metastases in the liver. What Duke's stage is his cancer?
Dukes D
120
What is Dukes A colorectal cancer?
Invasion of the colorectal cancer into but not through the bowel wall
121
What is Dukes C colorectal cancer?
Colorectal cancer with involvement of the lymph nodes
122
What is Dukes D colorectal cancer?
Colorectal cancer with widespread metastases (Liver, spleen etc)
123
Which of the following is false regarding colorectal cancer..
A) Bowel cancer screening is offered to people aged 60+
B) The majority of cancers occur in the proximal colon
C) FAP and HNPCC are two inherited causes of colon cancer
D) Proximal cancers usually have a worse prognosis
E) Patients with PSC and UC have an increased risk of developing colon cancer
Correct answer = B
124
What is Dukes B colorectal cancer?
Invasion of the cancer through the bowel wall but without any metastases
125
A 50 year old man presents with dysphagia. Which one of the following suggests a benign nature of the disease
A) Weight loss
B) Dysphagia to solids initially then both solids and liquids
C) Dysphagia to solids and liquids from the start
D) Anaemia
E) Recent onset of symptoms
C
126
A 32 year old lady complains of a 6 month history of bloating and diarrhoea. Her small bowel biopsy shows villious atrophy and crypt hyperplasia. What is it most likely to be?
Coeliac disease
127
What are the Marsh stages used for?
Histological staging of villious atrophy for coeliac's disease
128
```
A 19 year old girl presents with abdominal pain and loose stool. Which of the following would suggest IBS
A) Anaemia
B) Nocturnal diarrhoea
C) Weight loss
D) Blood in stool
E) Abdominal pain related to daefacation
```
Correct answer= E
129
What is the Rome IV criteria?
The way IBS is diagnosed
Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months. Related to defecation, associated with a change in frequency and form of stool
130
Which statement is true regarding H pyolri
A) It is a gram positive bacteria
B) HP prevalence is similar in developing and developed countries
C) 15% of patients with duodenal ulcer are infected with H pylori
D) PPIs should be stopped a week before a H pylori stool antigen test
E) It is associated with an increased risk of gastric cancer
Correct answer = E
131
A 56 year old man presents with abdominal distension adn shortness of breath. Examination revealed fever, tense distended abdomen and shifting dullness. He also has dullness to percussion in right base lung. Several spider naevi are seen on his chest. What is the most important test in managing this patient?
Ascitic tap
To ensure there isnt spontaneous bacterial peritonitis
132
Which of the following features best distinguishes ulcerative colitis from Crohn's disease
A) Ileal involvement
B) Continuous colonic involvement on endoscopy
C) Non caseating granuloma
D) Transmural inflammation
E) Perianal disease
Correct answer= B
133
```
A 68 year old lady presents with abdominal pain and distention. She last opened her bowel 5 days ago. She has a poor appetite and has lost weight recently. She drinks and smokes regularly. She previously had abdominal hysterectomy and diverticulosis. On examination there is tympanic percussion throughout. There is a small left groin lump with a cough impulse. Which of the following is not the likely cause
A) Colon cancer
B) Adhesions
C) Ascites
D) Diverticulitis
E) Strangulated hernia
```
Correct answer= C
This is because there wouldn't be tympanic percussion due to the fluid present
134
A patient drinks 4 pints (568 ml) of beer (4%) a day, and 2 standard (175ml) glasses of red wine (13%) on Saturday and Sunday additionally. How many units is he drinking a week?
73
135
A 71 year old man was admittedto hospital with pneumonia after he returned from a cruise. He was treated with a week of co-amoxiclav. On day 7 he started having diarrhoea 10 times a day without blood. He feels unwell and is dehydrated. He has flexible sigmoidoscopy which showed colonies of white pathogens in his bowel. What is the likely organism?
C. Diff
136
A 52 year old lady presents with fatigue and itching. She has pale stool and dark urine. She suffers from rheumatoid arthritis and hypercholesterolaemia. She shows spider naevi and hepatomegaly. Her bloods show raised ALP and bilirubin, with positive AMA and raised IgM. What is the most likely diagnosis?
Primary biliary cholangitis (not PSC as she is AMA +ve and has raised IgM). It is associated with RA.
137
```
A 16 year old girl is admitted with vomitting and abdominal pain. She reports taking 20 paracetamol tablets after her boyfriend split up with her. Which one of the following would you not expect to see
A) Metabolic acidosis
B) Prolonged prothrombin time
C) A raised creatinine
D) Hyperglycaemia
E) ALT 1000
```
D
Would show hypoglycaemia sinse overdose will inhibit glucose producion
138
What is the foregut supplied by (nervous and arterial)?
Coeliac trunk
| Greater splanchnic nerve (T5-T9)
139
What is the midgut supplied by (nervous and arterial)?
SMA
| Lesser splanchnic nerve (T10-T11)
140
What is the hindgut supplied by (nervous and arterial)?
IMA
| Least splanchnic nerve (T12)
141
What does the transpyloric plane of Addison cross?
T1= Gallbladder, pancreas, pylorus, duodenal-jejunal flexure, kidneys
142
Where is McBurney's point?
2/3 of the way from the umbilicus to the anterior superior iliac spine. This is where the appendix lies
143
A patient with a weight of 105 kg and a height of 1.9m would class as what BMI category?
Overweight
144
What are the fat soluble vitamins?
ADEK
145
What is HLA DQ2 associated with?
Coeliac's disease
146
List some diseases associated with HLA B27
Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, Reactive arthritis, SLE.
147
What is NOD2 associated with?
IBD
148
List some general diseases associated with HLA genes
SLE, Rheumatoid arthritis, IBD, T1DM, Multiple sclerosis
149
If a patient has diarrhoea, weight loss and anaemia, what are some differentials?
Coeliacs
Cancer
IBD
IBS
150
What conditions are associated with mucous in stool?
IBS, Colorectal carcinoma, Gastroenteritis, Ulcerative colitis
151
You susspect a patient has IBD. Give two ways of differentiating
pANCA may be positive in UC but will be negative in crohns
| Colonoscopy to view macroscopic differences
152
```
Which of the following has continuous lesions...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
UC
153
```
Which of the following can be managed with TCAs...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
IBS
154
```
Which of the following has transmural lesions...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
Crohns
155
```
Which of the following has no nocturnal diarrhoea...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
IBS
156
```
Which of the following shows villous Atrophy...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
Coeliac's
157
```
Which of the following is more likely to have mucoid Diarrhoea...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
UC
| Can also get it in IBS
158
```
Which of the following has dermatitis herpetiformis...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
Coeliac's
159
```
Which of the following is a pANCA positive IBD...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
UC
160
```
Which of the following has smoking as a protective factor...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
UC
161
```
Which of the following is tTG and EMA positive...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
Coeliacs
162
```
Which of the following has 3 distinct subtypes...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
IBS
163
```
Which of the following would use methotrexate to maintain remission...
A) IBS
B) UC
C) Crohn's
D) Coeliac's
```
Crohns
164
A patient presents with diarrhoea, abdominal pain and bloating for the past 7 months. Her stool is pale and floats and has a "vile stench". She has Hashimoto's Thyroiditis. What investigation should be offered to her definitively confirm her diagnosis?
```
Duodenal biopsy (shows villous atrophy and crypt hyperplasia)
=to confirm coeliac's disease
```
165
A woman presents with left lower quadrant abdominal pain with episodes of bloody and mucoid diarrhoea. You send for a colonoscopy and biopsy; and her results come back showing continual inflammatory lesions extending from the rectum. What is the first line management to induce remission?
5-aminosalicylic acid= Sulphasalazine or Olsalazine
= Likely to be ulcerative collitis
166
```
A 13 year old child presents in a&e with severe pain and vomitting. The pain has migrated over the last few hours around their umbillicus to a sharp pain in her RLQ. She has guarding and tenderness in this area. Which of the following is the least common cause of acute appendicitis
A) Trauma
B) Metastases
C) Worms
D) Bezoars
E) Lymphoid hyperplasia
```
Metastases
= Most common would be facecloths
167
An elderly gentleman presents to A&E with constant pain in his abdomen and distension. He has not passed wind or emptyed his bowels for 3 days. He has no bowel sounds and is known to have colorectal carcinoma. What would be the first investigation?
Abdominal X ray
(CT is gold standard but not as easy)
= Obstruction
168
What is the most common cause of large bowel obstruction in the UK?
Malignancy
169
```
Which of the following is the most common cause of diarrhoea in adults...
A) Norovirus
B) C. Jejuni
C) Rotavirus
D) E. Coli
E) Salmonella
```
A
170
How is H. Pylori eradicated?
Triple Therapy
- PPI e.g. lansoprasole
- 2 of; Metronidazole, bismuth, amoxicillin, tetracycline, clarithromycin
171
What is the chemotherapy regime for gastric/ oesophageal cancer?
ECF
| = Epirubicin, cisplatin and 5-Flurouracil
172
```
What is the first line test for coeliac disease
A) FBC
B) HLA DQ2 genotyping
C) Serology
D) Duodenal Biopsy
E) Colonoscopy
```
C
173
If a patient presents with a PMH of atrial fibrilation, and has abdominal pain. What should be your first thought.
Mesenteric ischaemia
174
```
Glenis is a 78 year old lady with a 3 hour history of severe and worsening abdominal pain. On examination, she is very uncomfortable but there are few findings. She has a PMH of HTN and AF. What is the most likely diagnosis?
A) Pancreatitis
B) Gastroenteritis
C) Peritonitis
D) Volvulus
E) Mesenteric Ischaemia
```
E
175
Which type of inguinal hernia is medial to the inferior epigastric vessels?
Direct or Indirect
Direct
176
What are the three groups that we use when considering the possible causes of intestinal obstruction? Give an example of each.
- Intraluminal= Tumours, gallstone ileus,
- Intramural= Crohn's, Diverticulitis
- Extraluminal= Volvulus, Adhesions
177
What is the most common type of colorectal cancer? What examination must be performed in suspected colon cancer?
Adenocarcinoma
| - Digital rectal exam (30% of colon cancer can be palpated with the finger)
178
List five non-infective causes of diarrhoea.
- Neoplasm
- Hormonal
- Inflammatory
- Radiation
- Irritable bowel
- Chemical
- Anatomical
179
Diarrhoea is the second leading cause of death in children under 5 globally. What is the underlying reason for this?
Poor sanitation
180
What organism can cause dyspepsia and how do we test for it?
Helicobactor pylori which is most commonly detected using a stool antigen test before initiation of treatment.
181
What two medications are used to treat dyspepsia?
H2 blockers such as ranitidine and proton pump inhibitors (PPIs) such as omeprazole.
182
How is coeliac's disease screened for?
First line bloods tests are immunoglobulin A tissue transglutaminase antibody and total IgA. IgA Endomysial antibody can be used if IgA tTGA is unavailable
