GI

Question 1

Incompetent LOS, Barrier impairment, delayed oespahgeal clearance, heartburn and waterbrash

Answer 1

GORD

Question 2

Dyasphagia that is worse for solids than liquids

Answer 2

Benign osesphageal stricture

Question 3

Treatment for GORD

Answer 3

1) Antacid
2) Full dose PPI
3) Step down to H2 receptor antagonists then antacids

Question 4

More common in children, mucosal ring strictures or narrow calibrated oesophagus

Answer 4

Eosinophilic oesphagitis

Question 5

Halitosis, gurgling and barium swallow

Answer 5

Pharyngeal Pouch

Question 6

Manometry

Answer 6

Achalasia

Question 7

Episodic chest pain may mimic angina, treat using PPE

Answer 7

Oesophageal spasm

Question 8

Schatzki rings

Answer 8

Found at oesophago-gastric function–> benign strictures

Question 9

Most common benign tumour of the oesphagus

Answer 9

Leiomyoma

Question 10

Pathogenesis of oesophageal adenocarcinoma

Answer 10

Normal–> Oesophagitis–> Barrett’s–> Adenocarcinoma

Question 11

HLA DQ8, Small bowel, blunting of villi, flattening of epithelium, Marsh Score, Antibody test then biopsy, Dermatitis Herpetiformis

Answer 11

Coeliac

Question 12

Chronic, progressive malabsorption from the tropics, India, Malaysia, Indonesia, treat using tetracycline, presents similarly to coeliac disease, adults more than children

Answer 12

Tropical Sprue

Question 13

High numbers of coliforms, watery diarrhoea and steatorrhea due to vitamin B12 deficiency, hydrogen breath tests, tetracycline

Answer 13

Small bowel overgrowth

Question 14

Infiltration of small intestinal mucosa by “foamy” macrophages, middle aged men, PCR diagnosis, PAS positive macrophages, joint pain, arthritis, fevers, diaroea and lymphadenopathy

Answer 14

Whipple’s Disease

Question 15

Malaborption of vitamin B12 and bile salts, need parenteral nutrition and vitamin B12 supplements. Jejunum-colon or Jejunostomy.

Answer 15

Ileal Resection and short bowel syndrome

Question 16

Nausea, vomiting, adominal distension, alternating constipation and diarrhoea but no mechanical obstruction

Answer 16

Pseudoobstruction

Question 17

Most common congenital abnormality of the GI tract, failure of closure of the vitelline duct, 100cm of ileocaecal valve. complications in first 2 years of life. Can mimic appenditis

Answer 17

Meckel’s Diverticulum

Question 18

Can affect any part of GI tract, usually results from swallowing after coughing, PCR, RIPE, Granulomatous hepatitis occurs

Answer 18

Abdominal TB

Question 19

Patient with AF and abdominal pain. “Angina of the guts”, metabolic acidosis. Most commonly embolus from heart lodges and blocks the mesenteric artery. Complications: resolution, gangrene, fibrous stricture

Answer 19

Small bowel Ichaemia

Question 20

Acute sever abdominal pain, no abdominal signs, rapid hypovolaemia–> shock

Answer 20

Acute Small bowel Ischaemia

Question 21

When inflammation goes into the muscle layers, it loses tone and starts to distend

Answer 21

Toxic Megacolon

Question 22

Projective mad of scar tissue which develops from granulation tissue during healing process. Failed attempt of wall to heal naturally. Signs of previous intense inflammation

Answer 22

Pseudopolyps

Question 23

Rome Criteria and FODMAP

Answer 23

IBS

Question 24

Uncommon, autosomal dominant, APC gene, 90% of patients develop CRC by age 50

Answer 24

Familial Ademomatous Polyps

Question 25

Multiple hamartomatous polyps can occur in intestine and colon. Melanin pigementation of lips, mouth and digits. Autosomal dominant

Answer 25

Peutz-Jeghers Syndrome

Question 26

1/3rd inherited in autosomal recessve manner, harmatous polyps, 20% develop CRC before age 40

Answer 26

Juvenile Polyps

Question 27

Gastric pits elongated with replacement of parietal and chief cells with mucus secreting cells

Answer 27

Menetrier's Disease

Question 28

Autoimmune damage to parietal cells, gastric atrophy and loss of intrinsic factor leading to pernicious anaemia. Most commonly caused by H.pylori

Answer 28

Autoimmune Chronic Gastritis

Question 29

Ulcer at first part of duodenum on anterior wall

Answer 29

Chronic Duodenal ulcer

Question 30

Ulcer where 90% are located at the lesser curve within the antrum or at the junction between the body and astral mucosa

Answer 30

Chronic Gastric Ulcer

Question 31

Gram negative spiral bacteria, lives between mucus layers, gastric type epithelium, provokes local inflammatory response, causes depletion of somatostatin and increased G cell secretion

Answer 31

H.pylori

Question 32

Board like rigitity, sever, sudden pain, upper abdomen generally, free air under diaphragm

Answer 32

Peritonitis

Question 33

Abdominal discomfort, satiety and loading after meals. Overlap between peptic ulcers and IBS

Answer 33

Dyspepsia

Question 34

Defective gastric emptying wihtout mechanical obstruction

Answer 34

Gastroparesis

Question 35

Pathogenesis of Stomach cancer

Answer 35

Normal--> Chronic Gastritis--> Chronic Gastritis Atropy, Intestinal Metaplasia, Dysplasia, Neoplasia

Question 36

Grey Turner's Sign or Cullen's Sign, GETSMASHED, Enzyme mediated autodigestion

Answer 36

Acute Pancreatitis

Question 37

A collection of fluid may accumulate in the lesser sac following inflammatory rupture of the pancreatic duct. After 6 weeks, this matures to form a fibrous cap. This can compress into surrounding structures

Answer 37

Pancreatic fluid collection develops into Pseudocyst causing pseudoaneurysm

Question 38

Raised serum amylase

Answer 38

Acute Pancreatitis

Question 39

Fibrosis and destruction of exocrine pancreatic tissue. Diabetes mellitus occurs in later stages. Alcohol misuse, middle ages men. Loss of exocrine function. Thin, malnourished with epigastric pain and skin pigmentation (chronic use of hot water bottle)

Answer 39

Chronic Pancreatitis

Question 40

Most cpmmon Pancreatic carcinoma

Answer 40

Adenocarcinoma

Question 41

Palpable gallbladder

Answer 41

Courvoiser's Sign

Question 42

Disrupted and dilated anal cushions, typically at 3,7,11 o'clock. Fresh bright red blood, painless. Band ligation, sclerosants.

Answer 42

Haemorrhoids

Question 43

Tear in the anal canal due to passage of a constipated stool, "like passing glass through pack passage". GTN ointment to relax sphincter

Answer 43

Anal Fissure

Question 44

A tract communictaes between the skin and anal canal and presents as an abscess which doesn't heal. Glued or "Laid open"

Answer 44

Anal Fistula

Question 45

The mucosa may protrude through the anal canal. Bleeding and mucus PR. Incontinence and poor anal tone

Answer 45

Rectal Prolapse

Question 46

Abdominal pain, rebound tenderness, absent bowel sounds, high neutrophil count, broad spectrum antibiotics,, paracentesis required for diagnosis

Answer 46

Spontanous Bacterial Peritonitis

Question 47

Faecal oral, over crowding and poor sanitation. No chronic infection. Gold top serology.

Answer 47

Hepatitis A

Question 48

Chronic infection is common. Progression from chronic hepatitis to cirrhosis occurs 20-40 years

Answer 48

Hepatitis C

Question 49

Similar presentation to Hepatitis A

Answer 49

Hep C

Question 50

Liver is enlarged, even in presence of cirrhosis

Answer 50

Alcoholic Liver Disease

Question 51

Syndromes of Alcoholic Liver disease

Answer 51

Fatty Liver, Alcoholi Liver Disease and Cirrhosis

Question 52

2 hit pathogenesis

Answer 52

1) Steatosis 2) Steatohepatitis -NAFLD

Question 53

Insidious onset, ASMA and AMA

Answer 53

Autoimmune Type 1

Question 54

Anti LKM

Answer 54

Autoimmune Type 2

Question 55

Middle aged women, insidious onset, IgM elevation. AMA. Ursodexycholic acid

Answer 55

Primary Biliary Cirrhosis

Question 56

Onion skin fibrosis, young men, high risk of CRC

Answer 56

Primary Sclerosing Cholangitis

Question 57

Malignant hepatocytes surrounded by dense fibrous storm, no Hep B or Cirrhosis. Surgical Resection

Answer 57

Fibrolamellar Hepatocellular carcinoma

Question 58

Most common benign liver tumours, asymptotic, diagnosis by US then CT

Answer 58

Haemangiomas

Question 59

Fever, rigors, leukocytosis, abdominal pain in RUQ. Due to biliary obstruction or empyema of gallbladder. Needle aspiration under US. Empirical broad spectrum antibiotics with pus drainage.

Answer 59

Liver Abscess

Question 60

Requires weekly venesection

Answer 60

Haemochromatosis

Question 61

Requires lifelong Penicillamine

Answer 61

Wilsons

Question 62

Autosomal dominant, mutation in promoter region of UDP-glucuonyl transferase. Decreased conjugation of bilirubin and accumulation of unconjugated bilirubin

Answer 62

Gilbert's Syndrome

Question 63

Large bowel: TH1 and TH2 mediated TH1 mediated

Answer 63

- 1&2 UC | - 1 Crohn's

Question 64

ROME criteria

Answer 64

Used in IBS

Question 65

- Bleeding PR - Obstruction occurs early - Tenesmus and altered bowel habit

Answer 65

Left sided colorectal cancer

Question 66

- Weight loss | - Anaemia

Answer 66

Right sided colorectal cancer