GI

Question 1

Give 3 differentials for an upper GI bleed?

Answer 1

Peptic ulcer
Mallory-Weiss tear
Gastroduodenal erosions
Oesophagitis
Oesophageal varices

Question 2

What is the score used to assess risk in upper GI bleeds and what is the criteria used?

Answer 2

Rockall score-assess risk of rebleeds and mortality

Preendoscopy
Age
Shock: BP and pulse
Comorbidity

Post endoscopy
Diagnosis
Signs of recent haemorrhage

Question 3

Give 5 steps in your management of an upper GI bleed?

Answer 3

High flow oxygen
2 wide bore cannulae (FBC, U&E, LFT, clotting and x-match 6 units)
IV fluid resus + transfusion
Urinary catheter
Urgent endoscopy

Question 4

Give 4 differentials of dysphagia in terms of mechanical and motility disorders?

Answer 4

Mechanical
Benign stricture
Malignant stricture
Pharyngeal pouch
Extrinsic pressure

Motility
Achalasia
Diffuse oesophageal spasm
Systemic sclerosis

Question 5

Give 2 diagnostic investigations you could do in a patient with dysphagia?

Answer 5

Endoscopy
Barium swallow
CXR
Bloods

Question 6

What are the risk factors for dyspepsia?

Answer 6

H.Pylori
NSAIDS
Smoking/Alcohol
Pregnancy
Obesity

Question 7

How do you manage new onset dyspepsia?

Answer 7

Refer for urgent endoscopy
Or
Antigen stool test for h.pylori
Antacids, stop NSAIDS, PPIs, Lifestyle changes

Question 8

When would you refer for endoscopy in a patient with dyspepsia?

Answer 8

>55y/o
Anaemia
Loss of weight
Anorexia
Recent onset of symptoms
Melaena or Haematemesis
Swallowing difficulty

Question 9

What are the possible complications of a peptic ulcer?

Answer 9

Bleeding
Perforation
Gastric ca

Question 10

What is the treatment regime for h.pylori eradication and how long?

Answer 10

PPI
Amoxicillin
Clarithromycin

1 week

Question 11

State 3 symptoms of GORD?

Answer 11

Heartburn
Belching
Acid brash
Water brash
Odynophagia

Question 12

Name 3 complications that could arise from GORD?

Answer 12

Oesophagitis
Benign stricture
Barrets oesophagus
Oesophageal ca

Question 13

Give 5 lifestyle changes to aid in treatment of GORD?

Answer 13

Weight loss
Smoking cessation
Raise bed head
Avoid alcohol
Avoid spicy foods
Avoid NSAIDs
Avoid hot drinks/coffee

Question 14

When would you suspect coeliac disease?

Answer 14

Patients presenting with diarrhoea + weight loss or anaemia

Question 15

Give 4 symptoms of coeliac disease?

Answer 15

Steatorrhoea
Diarrhoea
Abdo pain
Bloating
N&V
Weight loss
Fatigue
Weakness

Question 16

What are the antibodies present in coeliac disease?

Answer 16

Alpha gliadin
Transglutaminase
Anti-endomysial

Question 17

What are the histological changes seen in coeliac disease?

Answer 17

Villous atrophy

Crypt hyperplasia

Question 18

What is the treatment for coeliac disease?

Answer 18

Life long gluten free diet

Question 19

Describe bilirubin metabolism?

Answer 19

Bilirubin is formed from Hb breakdown
Conjugated by hepatocytes
Secreted into bile --> gut
Converted to urobillinogen
Reabsorbed and either taken up by liver or excreted by kidneys
Rest converted to stercobilin --> faeces

Question 20

How can you classify jaundice and name a cause for each?

Answer 20

Prehepatic-
Haemolytic anaemia
Congestive heart failure

Hepatic-
Hepatitis
Cirrhosis

Post hepatic-
Gall stone
Pancreatic ca
PBC

Question 21

What is Courvoisier’s law?

Answer 21

Palpable bladder + painless jaundice

Suggests a cause other than gallstones

Question 22

A patient presenting with jaundice. Give 3 things you would ask?

Answer 22

Alcohol
Travel
IV drug use
Sexual activity
Medications

Question 23

Give 3 signs seen in the hands of a patient with chronic liver disease?

Answer 23

Leuconychia
Clubbing
Palmar erythema
Dupuytrens contracture

Question 24

Name 3 causes of liver cirrhosis?

Answer 24

Chronic alcohol abuse
Chronic HBV or HCV infection
Autoimmune disease eg. PBC

Question 25

How is the severity of cirrhosis graded?

Answer 25

Child-Pugh score

Question 26

Name 2 possible complications of cirrhosis?

Answer 26

Hepatic failure Portal hypertension Hepatocellular carcinoma

Question 27

What are the steps taken in management of cirrhosis?

Answer 27

Alcohol abstinence Good nutrition Regular US and alpha fetoprotein screening for HCC (carcinoma) Ascites-low salt, fluid restriction, diuretics Liver transplant is definitive treatment

Question 28

What is the questionnaire used to screen for alcoholism?

Answer 28

``` CAGE Cut down? Annoyed by criticism? Guilty about drinking? Eye opener to steady nerves in the morning? ```

Question 29

What are the differences between UC and Crohns? 5 things

Answer 29

``` UC vs. CROHNS Rectum + colon vs. any part of tract Continuous vs. skip lesions Superficial vs. transmural Pseudopolyps vs. cobblestone Goblet cell depletion vs. granulomas Cured with surgery vs. surgery not curative ```

Question 30

Name 4 extra intestinal signs seen in IBD?

Answer 30

``` Clubbing Oral ulcers Erythema nodosum Conjunctivitis Iritis Large joint arthritis Ankylosing Spondylitis ```

Question 31

What investigations would you order in a suspect UC patient?

Answer 31

``` Bloods-anaemia, inflammation, cultures Stool culture-rule out infection AXR-no faecal shadows, mucosal thickening, colonic dilatation CXR-perforation Sigmoidoscopy-inflamed, friable mucosa Rectal biopsy ```

Question 32

Name 3 complications of UC?

Answer 32

``` Perforation Bleeding Toxic dilatation of colon Venous thrombosis Colonic cancer ```

Question 33

What are the indications for surgery in UC?

Answer 33

Perforation Massive haemorrhage Toxic mega colon Failure to respond to medical therapy

Question 34

How can you induce remission and maintain in IBD?

Answer 34

``` Course of steroids (prednisalone) 5 ASAs (sulfasalazine or mesalazine) Azothioprine as steroid sparing Methotrexate in Crohns TNF alpha inhibitors (infliximab) Surgery ```

Question 35

Broadly identify 5 causes of diarrhoea and give an example for each?

Answer 35

IBD-Crohns and UC INFECTIVE bacterial-Staph, salmonella, e.coli INFECTIVE viral-Rotavirus, CMV, HSV MALIGNANCY-colon ca MALABSORPTION-coeliac, lactose intolerance, pernicious anaemia MEDICATION-antibiotics and antacids

Question 36

Give 3 things you could assess for severity in UC? What is this criteria called?

Answer 36

``` Stool frequency Rectal bleeding Temperature Pulse rate Haemoglobin levels ESR/CRP ``` Truelove and Witts

Question 37

What is the pathology that paracetamol causes liver damage?

Answer 37

Paracetamol > toxic metabolite >glutathione converts to inactive form In overdose, glutathione runs out so toxic metabolite builds up causing hepatocyte necrosis

Question 38

Give 3 causes of; acute hepatitis and chronic hepatitis?

Answer 38

Acute Viruses, alcohol, drugs, metabolic Chronic Viruses, autoimmune disease, alcohol, drugs

Question 39

What is the inheritance pattern of hereditary haemochromatosis?

Answer 39

Autosomal recessive

Question 40

Give 2 organs affected by haemochromatosis?

Answer 40

Heart Pancreas Pituitary gland

Question 41

AST:ALT >2 ? AST:ALT <1 ?

Answer 41

Alcoholic liver disease Nonalcoholic fatty liver disease or Hepatitis C

Question 42

Give 3 symptoms of large bowel obstruction?

Answer 42

``` Abdominal pain Abdominal distension Vomiting Fecal vomiting Constipation ```

Question 43

Give 4 causes of large and small bowel obstruction?

Answer 43

``` Large bowel: Hernias IBD Diverticulitis Neoplasm ``` Small bowel: Adhesions Hernias Volvulus

Question 44

Patient with suspected bowel obstruction, name an investigation you would do?

Answer 44

AXR

Question 45

What is the immediate management of bowel obstruction?

Answer 45

``` Drip and Suck NGT and IV fluids Analgesia Catheterise to monitor fluid balance Surgery ```