GI

Question 1

What are the risk factors for hiatus hernias

Answer 1

• Increased intraabdominal pressure due to ascites/multuparity
• Obesity
• Increasing age

Question 2

What is the pathophysiology of hiatus hernias

Answer 2

sliding or rolling
sliding - gastro-oesophageal junction above diaphragm
rolling - GO junction below diaphragm, but separate part of stomach above diaphragm

Question 3

What are the symptoms of hiatus hernia

Answer 3

heartburn
dysphagia
chest pain
acid reflux
food reflux
burping
bloating
halitosis

Question 4

what investigation for hiatus hernia

Answer 4

barium swallow
ct
endoscopy
cxr

Question 5

how is hiatus hernia treated

Answer 5

medical - control GORD with PPI/famotidine

surgical - fundoplication

Question 6

define anal fissure, and where do they occur

Answer 6

tear in squamous lining of distal anal canal. most commonly in posterior midline

Question 7

what are the RFs for anal fissures

Answer 7

• constipation
• IBD
• STDs - HIV, syphilis

Question 8

What are the signs/symptoms of anal fissures

Answer 8

painful bright red PR bleeding

Question 9

what is management of acute anal fissures (<1 week)

Answer 9

soften stool - fluid intake increase, and high fibre diet. 
1. bulk forming laxatives
2. lactulose
lubricants before defecation
topical anaesthesia
analgesia

Question 10

what is mgmt of chronic anal fissure (>6 weeks)

Answer 10

topical GTN

referral for sphincterotomy/botox

Question 11

explain the pathophys of appendicitis

Answer 11

1. lymphoid hyperplasia or faecolith cause obstruction of appendiceal lumen
2. gut micro-organisms invade the appendiceal wall
3. Oedema, ischaemia, perforation

Question 12

what are the symptoms of appendicitis

Answer 12

• peri-umbilical pain migrates to RIF (mcburney’s pt)
• some vomiting
• mild pyrexia
• anorexia

Question 13

what signs would you find on examination of appendicitis

Answer 13

• localised peritonitis (generalised if ruptured)
  - rebound and percussion tenderness
• right-sided tenderness on PR exam
• Rovsing’s sign (LIF palpation -> RIF pain)
• Psoas sign - extension of hip causes pain

Question 14

how would appendicitis be investigated

Answer 14

FBC - neutrophilia
Urine dip - mild leukocytosis with no nitrites
USS - free fluid in abdomen - pathological in males

Question 15

what is treatment of appendicitis

Answer 15

laparoscopic appendicectomy

IV Abx

Question 16

define diverticulosis

Answer 16

outpouching in bowel wall (commonly sigmoid)

Question 17

what are RFs for diverticulosis

Answer 17

low fibre diet
increasing age
chronic constipation

Question 18

what are symptoms of diverticular disease

Answer 18

• altered bowel habit

- colicky left sided abdo pain

Question 19

how can diverticular disease be treated

Answer 19

high-fibre diet

Question 20

what are symptoms of diverticulitis

Answer 20

• LIF pain and tenderness
• anorexia
• N+V
• diarrhoea
• pyrexia

Question 21

what would you see on blood tests of diverticulitis

Answer 21

raised WBC, CRP

Question 22

how is diverticulitis managed

Answer 22

mild - oral Abx

severe - admit, NBM, IV Abx and fluids

Question 23

what are the complications of diverticulitis?

Answer 23

abscess formation
peritonitis
intestinal obstruction
perforation

Question 24

Explain the pathophysiology of coeliac disease

Answer 24

autoimmune condition caused by sensitivity to the protein gluten.
exposure leads to villous atrophy which leads to malabsorption

Question 25

which HLA are coeliac associated with

Answer 25

HLA DQ2 | HLA DQ8

Question 26

what symptoms of coeliac

Answer 26

- diarrhoea (steatorrhea, greasy, offensive) - weight loss/failure to thrive in children - fatigue - recurrent abdo pain, distention, cramping - unexplained anaemia, especially iron deficiency

Question 27

what blood tests for coeliac disease

Answer 27

1. Anti-Tissue transglutaminase (TTG) antibodies 2. Anti-Endomysial (EMA) antibodies These are both IgA so need to test for total IgA levels. If total IgA levels are low, and antiTTG/EMA levels are also low, this is a false negative. Do blood test for IgG version of antiTTG/antiEMA

Question 28

what is the gold standard for diagnosing coeliac

Answer 28

endoscopy with biopsy - duodenum mostly, but sometimes jejunum

Question 29

what would biopsy of coeliac disease show?

Answer 29

villous atrophy crypt hyperplasia increase in intraepithelial lymphocytes lamina propria infiltration with lymphocytes

Question 30

which group of patients is offered coeliac screening

Answer 30

newly diagnosed type 1 diabetes

Question 31

where does dermatitis herpetiformis typically affect

Answer 31

abdomen

Question 32

what neuro symptoms might coeliac present with

Answer 32

- epilepsy - cerebellar ataxia - peripheral neuropathy

Question 33

what complications of coeliac disease

Answer 33

- anaemia - osteoporosis - vitamin deficiency - ulcerative jujunitis - enteropathy-associated T-Cell lymphoma - non-hodgkin lymphoma - lactose intolerance - small bowel adenocarcinoma

Question 34

how can compliance with gf diet be tested?

Answer 34

anti TTG antibodies

Question 35

why PCV vaccine for coeliac every 5 years?

Answer 35

functional hyposplenism