GI

Question 1

How would SB obstruction look on an Xray?

Answer 1

Centrally located multiple dilated loops of gas filled bowel
Valvula conniventes (plicae circulares) are visible confirming that it is small bowel
No gas seen in the large bowel
Multiple dilated bowel loops

Question 2

What are the causes of SMO in adults?

Answer 2

Adhesions secondary to intra-abdominal surgery
Hernias
Malignancy
Crohn’s disease

Question 3

How do you treat UC to try and induce remission?

Answer 3

1) High dose PO mesalazine
2) + PO prednisolone
3) + PO tacrolimus

Question 4

How do you maintain remission in UC?

Answer 4

1) PO mesalazine

2) Azathioprine if needed

Question 5

What drug class is mesalazine in?

Answer 5

Aminosalicylate

Question 6

What are the two most likely causes of cholestatic jaundice?

Answer 6

Gallstones

Head of pancreas cancer

Question 7

What are the auto abs in systemic sclerosis?

Answer 7

Anti-centomere
Anti-SCL 70 (anti-topoisomerase)
ANA

Question 8

Give some drugs that can cause dyspepsia

Answer 8

Nitrates
Bisphosphonates
Corticosteroids
NSAIDs

Question 9

What are the ALARMS symptoms?

Answer 9

Anaemia 
Loss of weight 
Anorexia 
Recent onset 
Melena/haemetemesis 
Swallowing difficulty

Question 10

What investigations can you do with dysphagia?

Answer 10

CXR
Barium swallow
Manometry
OGD

Question 11

What is Barretts oesophagus?

Answer 11

When a proportion of normal distal squamous epithelium is replaced by metastatic columnar epithelium

Question 12

Give some neurological causes of dysphagia

Answer 12

CVA
Achalasia
MS
MND

Question 13

Define achalasia

Answer 13

Oesophageal peristalsis and failure of LOS relaxation due to reduction in ganglionic cells and degeneration of myenteric plexus
–> Impaired oesophageal emptying

Question 14

What is the gold standard test for achalasia?

Answer 14

Manometry

Question 15

What medical management can be used for achalasia?

Answer 15

CCB - nifedipine for SM relaxation

Question 16

What score can you use in upper GI bleed to assess mortality?

Answer 16

Rockall score

Question 17

What is a volvulus?

Answer 17

Volvulus is the rotation of the gut around its mesenteric axis

Question 18

What skin pathology do you see in coeliacs?

Answer 18

Dermatitis herpetiformis
= Itchy, stinging red papules + blisters
Dx with IgA presence on skin biopsy

Question 19

What are the complications of coeliacs?

Answer 19

Osteoporosis
Cancer
Infertility
Depression

Question 20

A patient compains of diarrhoea 5 times a day with small amounts of blood and mucus.
A barium enema shows loss of haustrations and a narrow, short colon that looks like a ‘lead pipe’
What could the dx be?

Answer 20

UC

Question 21

What are the criteria for dx IBS?

Answer 21

Pain relieved by deflation // altered bowel habit + 2:

• Mucus
• Worse when eating
• Bloating
• Strainging/urgency

Question 22

What treatments would you use for the following symptoms of IBS?

• Pain
• C
• D

Answer 22

• Pain = anti-spasmodics meberverine
• C = laxatives/linaclotide
• D = loperamide

Question 23

How do you treat a volvulus?

Answer 23

Sigmoidoscopy + flatus tube

Question 24

You have a 78 yr old male with known CVD and AF. He comes presenting with acute abdo pain, he’s had diarrhoea with blood PR and a fever.
What could be the cause?

Answer 24

Ischaemic of the lower GI tract

• Acute mesenteric ischaemia
• Chronic mesenteric ischaemia
• Ischaemic colitis

Question 25

You have a 78 yr old male with known CVD and AF. He comes presenting with acute abdo pain, he's had diarrhoea with blood PR and a fever. How would you investigate this?

Answer 25

CT | = investigation of echoic in ischaemic disease of the lower GI tract

Question 26

Acute mesenteric ischaemia is usually of which artery? | And which risk factor?

Answer 26

Commonly a mesenteric artery emboli or mesenteric venous obstruction RF: AF

Question 27

What is ischaemic colitis

Answer 27

Ischaemic colitis describes an acute but transient compromise in the blood flow to the large bowel. This may lead to inflammation, ulceration and haemorrhage. It is more likely to occur in 'watershed' areas such as the splenic flexure that are located at the borders of the territory supplied by the superior and inferior mesenteric arteries

Question 28

What would you see on an AXR of ischaemic colitis

Answer 28

'thumbprinting' may be seen on abdominal x-ray due to mucosal oedema/haemorrhage

Question 29

Give an example of a palliative surgical adjunct for colon cancer

Answer 29

Stents, surgical bypass and diversion stomas

Question 30

What are the 3 types of colon cancer? | genetics

Answer 30

- Sporadic (95%) - Hereditary non-polyposis colorectal carcinoma (AD) - Familial adenomatous polyposis (activation of K-ras oncogene and inhibition of p53 + DCC)

Question 31

What are the tumour markers associated with colon cancer?

Answer 31

CEA = carcinoembryonic antigen | Faecal occult blood in stool

Question 32

How can you estimate the 5 year survival in a person with colon cancer?

Answer 32

By using Duke's criteria

Question 33

How would you treat constipation? | C + M

Answer 33

``` C = increase activity, fluids and fibre M: 1) Bulk-forming laxatives = isphaghula 2) Osmotic laxatives = macrogol, lactulose 3) Stimulant laxatives = senna 4) Enema = phosphate enema ``` BOSE

Question 34

Cause of D due to hx: 1) Small children 2) Travelers 3) Salad 4) Poultry/shellfish 5) with HUS/ITP

Answer 34

1) Small children = Rotavirus 2) Travelers = Enterotoxic E.Coli 3) Salad = shigella 4) Poultry/shellfish = salmonella 5) with HUS/ITP = E.coli 0157