GI

Question 1

Altered bowel habit- Differentials?

Answer 1

Acute gastroenteritis

Constipation

Diverticular disease

Colonic malignancy

IBD

Maldigestion/ malabsoprtion

Question 2

causes of constipation?

Answer 2

drugs- opiates/ analgesics

functional- IBD

mechanical obstruction- e.g. strictures

hypothyroidism

Question 3

neurological cause of chronic constipation?

Answer 3

parkinsons

Question 4

investigations for constipation?

Answer 4

Bloods- TFT and calcium

plain abdo X-ray

sigmoidoscopy- exclude mechanical cause

colonic transit study

Question 5

what is Hirschprungs disease?

Answer 5

neural disease that prevents peristalsis of the colon

Question 6

who is affected by Hirschprungs?

Answer 6

teenagers/ children

Question 7

management of hirshprungs?

Answer 7

high fibre diet

increased fluid intake

laxatives

Question 8

most common caustive agent of travellers diarhoea?

Answer 8

E.coli

Question 9

chronic hepatitis is hepatitis lasting how long?

Answer 9

> 6months

Question 10

characterisitics of hepatitis?

Answer 10

increased IgG levels

Antibodies against liver proteins

Mononuclear infiltrate within the liver

Question 11

histological characteristics of autoimmune hepatitis?

Answer 11

AIH 1- anti-smooth muscle antibodies (ASMAs)

AIH 2- liver kidney microsomal type 1 antibodies (LKM-1)

AIH 3- actin antibody, antinuclear antibodies

Question 12

Auto immune hepatitis is common in which groups?

Answer 12

M:F ratio 1:3

ages 10-20, and 45-70

Question 13

how do patients with AIH present?

Answer 13

50% with acute viral hepatits

non-specific: wgt loss, fatigue, abdo pain

liver specific: easy brusing, jaundice, hepatomegaly

Question 14

long term complication of oesophageal reflux?

Answer 14

barretts oesophagus

Question 15

which cells are present in Barretts oesophagus?

Answer 15

columnar epithelium

defined as >3cm of ce present at bottom of oesophagus

Question 16

bilirubin is produced from which molecule?

Answer 16

haem (frm haemoglobin)

Question 17

which cells make up the reticuloendothelial system that produce bilirubin?

Answer 17

macrophages in spleen

kupfer cells in liver

macrophages

renal tubular cells

Question 18

normal bilirubin levels

Answer 18

1-20 umol/l

jaundice usually detectable when reaches 50 umol/l

Question 19

causes of haemolytic jaundce (pre-hepatic)?

Answer 19

sickle cell anaemia

thallasemia

Question 20

what happens in hepatocellular jaundice (hepatic)?

Answer 20

liver is unable to excrete and/or conjugate bilirubin due to liver tissue damage

Question 21

what happens to the levels of conjugated and unconjugated bilirubin in hepatic jaundice?

Answer 21

both conjugated and unconjugated increase

Question 22

causes of hepatic jaundice?

Answer 22

cirrhosis

hepatitis

drug induced i.e. paracetamol

Question 23

what causes cholestatic juandice (post hepatic)?

Answer 23

obstruction in the bile duct

liver can conjuagte bilirbuin but cannot excrete it

Question 24

what happens to levels of conjugated an dunconjugated bilirubin in post hepatic jaundice?

Answer 24

increase in conjugated biirubin

causes very dark urine and pale stools

Question 25

causes of post hepatic jaundice?

Answer 25

primary biliary cirrhosis primary sclerosing chlangitis alcohol/ drugs hepatitis ...

Question 26

how would you diagnose post hepatic juandice?

Answer 26

ultrasound to detect obstruction in biliary tree- will usually just see dilated biliary tree then ERCP to get better image and hopefully treat

Question 27

if no obstruction is detected on ultrasound for post heptic jaunduce what should you check for?

Answer 27

test for Hep A, B and C check copper levels if \<40 yrs- WIlsons disease

Question 28

mutations in the genes coding for UDP-glucuronyl transferase results in which condition?

Answer 28

familial hyperbiliruninaemia

Question 29

causes of hepatomegaly?

Answer 29

malignancy RHF Alochol liver disease fatty liver amyloidosis excess iron hepatitis

Question 30

cuases of splenomegaly?

Answer 30

C- cancer H- haematoligical malignancy I- infection (CMV, HV, TB) C- congestion; portal hypertension A- autoimmune (RA, SLE) G- glycogen stroge disorders O- other, amyloidosis, sarcoidosis

Question 31

causes of cholangitis?

Answer 31

bacterial infection- causes ascending cholangitis primary sclerosing cholangitis carolis syndrome

Question 32

presentation of acute ascending cholangitis?

Answer 32

rigors, fever, abdo pain jaundice

Question 33

how do you manage acute ascending cholangitis?

Answer 33

IV antibiotics Urgent biliary drainage- endoscopically

Question 34

what causes acute cholecystitis?

Answer 34

blockage in cystic duct or neck of gallbladder very likely to be gallstones

Question 35

symtpoms of cholecystitis?

Answer 35

prolonged fever inc in WCC Murphys sign- pain in RUQ pain can radiate to shoulder tip

Question 36

how would you investigate cholecystitis?

Answer 36

FBC- inc in ESR, CRP and WCC serum amylase- raised in acute pancreatitis (complication) serum bilirubin ALP USS to detect stones

Question 37

how do you manage cholecystitis?

Answer 37

nil by mouth antibiotics- cefuroxime +/-metronidazole analgesic- diclofenac IV fluids consider surgery: cholescytectomy

Question 38

complications of cholecystitis?

Answer 38

bacterial infection → subsequent empyema perforation

Question 39

investigations in chronic cholecystitis?

Answer 39

MRCP- MRI imaging to look for stones US

Question 40

how is chronic cholecystitis treated?

Answer 40

ERCP- performed to remove stones from common bile duct cholecystectomy

Question 41

which vitamins are stored in the liver?

Answer 41

Vitamins A, D, E, K

Question 42

antibiotics most implicated with causing C. diff?

Answer 42

clindamhycin penicillins i.e. amoxicillin, ampicillin 3rd gen cephalosporins

Question 43

how is suspected C. diff investigated?

Answer 43

stool sample for enterotoxins produced by C. diff

Question 44

symtpoms of C. diff infection?

Answer 44

diarrhoea +/- blood abdo pain N&V is rare

Question 45

how is C. diff treated?

Answer 45

metronidazole 400mg for 8-10 days should inform GP so can be prescribed alongside antibiotics in the future