GI

Question 1

What are the contents of the spermatic cord?

Answer 1

Vas deferens
Arteries
Veins
Pampiniform plexus
Genital branch of genito-femoral nerve

Question 2

What is the mx for inguinal hernias?

Answer 2

Should always be repaired surgically due to risk of complications (particularly high if indirect hernia)

Question 3

RFs for inguinal hernia

Answer 3

Obesity
Constapation
Chronic cough
Heavy lifting 
Male

Question 4

Comps associated with hernias

Answer 4

Incarcerated/irreducible
Strangulation
Obstruction

Question 5

How would a strangulated femoral hernia px?

Answer 5

Red, tender, tense
Irreducible
Colicky abdo pain

Question 6

What is an incisional hernia?

Answer 6

Follow the breakdown of muscle closure post surgery

Question 7

What are the red flag features of dyspepsia?

Answer 7

Anaemia
Loss of weight
Anorexia
Recent onset or progressive 
Melaena/ haematemesis
Swallowing difficulty

Question 8

When should you refer for endoscopy a pt presenting with dyspepsia?

Answer 8

Dysphagia
OR
>55 with persistent/ALARM features

Question 9

Aet of dyspepsia

Answer 9

PUD (mainly DUODENAL rather than gastric)
Gastritis
Functional (non-ulcer) dyspepsia
Malignancy
Oesophagitis/GORD

Question 10

Outline the management steps for a first presentation of dyspepsia in a patient under 55 with no alarm sx or dysphagia

Answer 10

1) Stop precipitating drugs, lifestyle changes, OTC antacids
2) No improvement - test for H.pylori
3) If -ve - trial PPI 4 weeks
4) no improvement - long term tx or endoscopy

Question 11

What drugs are given to tx H.pylori?

Answer 11

PPI
Amoxicillin
Clarithromycin

Question 12

How is H.pylori tested for?

Answer 12

Carbon-13 urea breath test

Question 13

Major RFs for duodenal ulcers

Answer 13

H.pylori

Drugs (NSAIDs, steroids, SSRIs)

Question 14

RFs gastric ulcers

Answer 14

H.pylori
NSAIDs
stress

Question 15

What do chief cells of the stomach secrete?

Answer 15

Pepsinogen

Question 16

What do parietal cells of the stomach secrete?

Answer 16

Intrinsic factor and HCl

Question 17

What is the main comp of GORD?

Answer 17

Barrets oesophagus

Question 18

Why might urea rise in patients with an upper GI bleed?

Answer 18

Due to protein meal (not due to renal failure)

Question 19

Causes of small bowel obstruction?

Answer 19

ADHESIONS

HERNIAS (e.g. femoral)

Question 20

Causes of large bowel obstruction

Answer 20

Colon Ca
Constipation
Volvulus
Diverticular stricture

Question 21

Mx of obstruction

Answer 21

'drip and suck'
analgesia
Blood tests (incl. amylase)
AXR
CXR
CT 
Surgery

Question 22

What sign on AXR indicates sigmoid volvulus?

Answer 22

Coffee bean sign

Question 23

How is sigmoid volvulus managed?

Answer 23

Flatus tube or sigmoidoscopy

Question 24

Which part of the intestine does diverticular disease most commonly affect?

Answer 24

Sigmoid colon

Question 25

Which Ix is best for confirming diverticulitis?

Answer 25

CT | Avoid colonoscopy as risk perforation in acute setting

Question 26

How does diverticular disease and diverticulitis px?

Answer 26

Altered bowel habit +- left-sided colic relieved by defecation diverticulitis = pyrexia, raised WCC, raised CRP, peritonism (sometimes)

Question 27

What is the mx for mild attacks of diverticulitis?

Answer 27

Fluids (bowel rest) +- abx

Question 28

How is severe diverticulitis mx?

Answer 28

Admit for analgesia, NBM, IV fluids, IV abx

Question 29

Comps of diverticulitis

Answer 29

Abscess formation | Perforation

Question 30

Ix in peritonitis

Answer 30

CXR Amylase USS/CT to confirm dx

Question 31

Mx of a patient with generalized peritonitis

Answer 31

IV fluids and abx | Consider need for surgery

Question 32

Mx for anal fissure

Answer 32

Lidocaine ointment GTN ointment Plenty of fibre, fluids Laxatives

Question 33

Ix for anal fistula

Answer 33

MRI

Question 34

Mx for haemorrhoids

Answer 34

Prevent constipation Topical anaesthetic Rubber band ligation Haemorrhoidectomy if large

Question 35

Which part of the bowel does acute mesenteric ischaemia affect?

Answer 35

Small bowel

Question 36

What is the classic presentation of acute mesenteric ischaemia/

Answer 36

Acute, severe abdo pain No/minimal abdo signs Rapid hypovolaemia and shock

Question 37

What will an ABG show in acute mesenteric ischaemia?

Answer 37

Metabolic acidosis | Raised Hb due to plasma loss

Question 38

Mx for acute mesenteric ischaemia

Answer 38

IV fluids IV abx LMWH Then surgery to remove necrotic bowel

Question 39

How does chronic mesenteric ischaemia px? (rare)

Answer 39

``` 'Intestinal angina' Severe, colicky post-prandial abdo pain decreased weight (as not eating) PR bleeding N & V ```

Question 40

How does ischaemic colitis px?

Answer 40

Lower left-sided abdo pain +- bloody diarrhoea

Question 41

What is the gold standard test for ischaemic colitis?

Answer 41

Lower GI endoscopy

Question 42

Common causes of malabsorption

Answer 42

Coeliac Chronic pancreatitis Crohns disease

Question 43

Which serotype group is coeliac associated with?

Answer 43

HLA DQ2

Question 44

How are histological findings in coeliac disease classified?

Answer 44

Marsh criteria

Question 45

What histological type of cancer is gastric cancer?

Answer 45

Adenocarcinoma

Question 46

What is Trosiers sign?

Answer 46

Palpable Virchows node - sign of gastric cancer

Question 47

Histology of colon cancer

Answer 47

Adenocarcinoma

Question 48

How can treatment response be monitored in colon ca?

Answer 48

carcinoembryonic antigen (CEA) levels

Question 49

Ix for suspected colon ca

Answer 49

PR exam Colonoscopy (CT if can't tolerate) FBC and LFT

Question 50

What are the extra-intestinal manifestations of crohns?

Answer 50

``` erythema nodosum pyoderma gangrenosum arthritis anterior uveitis conjunctivitis ```

Question 51

Which form of IBD is associated with an increased risk due to smoking?

Answer 51

Crohns

Question 52

What are the comps of crohns disease?

Answer 52

``` Small bowel obstruction Toxic dilatation Abscess formation Fistulae Perforation Colon Ca ```

Question 53

How is UC managed?

Answer 53

PR aminosalicylates (e.g. mesalazine)