Gi investigations

Question 1

Malignant Tumours of the Oesophagus

Answer 1

• Endoscopy and biopsy
• Staging - CT, PET scan

Question 2

peptic ulcer disease

Answer 2

H. pylori breath test OR stool antigen test

endoscopy if red flag

Question 3

malabsorption

Answer 3

• Bloods - FBC, coagulation, LFTs, albumin, calcium/magnesium
• Stool culture
• Endoscopy
• US/CT/MRI

Question 4

oral cancer

Answer 4

1. Biopsy - TNM staging
2. Imaging

Question 5

malnutrition MUST score

Answer 5

• BMI
• weight loss score
• acute disease effect score
• overall risk

Question 6

gastroenteritis

Answer 6

Stool culture samples
endoscopy + biopsy

Question 7

Crohn’s

Answer 7

Colonoscopy + biopsy

• ↑ CRP
• ↓ albumin and platelets
• ↓ B12 if terminal ileum affected
• Faecal calprotectin test - specific for inflammation in the bowel, can distinguish between IBS and IBD

CT/AXR/USS - often used in acute attacks

Question 8

UC

Answer 8

bloods
- ↑ CRP
- ↓ albumin
- Faecal calprotein test

AXR
-In an acute flare AXR or CT can be used to assess for toxic megacolon/bowel perforation

colonoscopy + biopsy

Question 9

IBS

Answer 9

rome IV criteria
Recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months associated with 2 or more of the following:
- Improvement with defaecation
- Onset associated with change in frequency of stool
- Onset associated with a change in the form of stool

bloods - Used to rule out other causes, should be normal

AXR

Question 10

acute appendicitis

Answer 10

History
- USS - Distended, calcified appendix
- CT - Wall thickening, distended lumen

Question 11

acute diverticulitis

Answer 11

• CT
• Bloods - elevated CRP

Question 12

alcoholic liver disease hepatitis

Answer 12

Bloods

• LFTs - AST > ALT, ↑ GGT
• Prolonged PT, ↓ albumin and ↑ bilirubin suggest end stage ALD (cirrhosis)

-ultrasound

Question 13

acute cholecystitis

Answer 13

• USS
• MRCP and/or ERCP if further clarification needed

Bloods
- LFTs - ALP > ALT/AST, ↑ bilirubin
- FBC and CRP - raised (inflammatory response)
- Amylase - to check for pancreatitis

**If patient presentation same for cholycstitis and billary colic, In blood test, if inflammatory markers raised, it is cholecystitis*

Question 14

acute pancreatitis

Answer 14

• Serum amylase - 3x the upper limit of normal is diagnostic
• LFTs - if cholestatic indicates gallstone aetiology
  -USS
  -CT
  -AXR

Question 15

Cholangiocarcinoma

Answer 15

Cholestatic - ALP > ALT/AST, ↑ GGT and bilirubin

Imaging

• USS
• MRCP
• Spiral CT/ERCP/PTC

Question 16

hepatitis

Answer 16

serology - relevant IgM usually detectable by onset of illness

hep B
- Hepatitis B surface antigen (HBsAg) present in blood of all infectious individuals, present for 6+ months in chronic infection
- Hepatitis Be antigen (HBeAg) usually presents in highly infectious individuals
- Hep B IgM more likely to be present in recently infected cases
- Anti-HBs present in immunity (vaccine or past infection)

.Hepatitis C

• Serology
• If serology positive → PCR (HCV RNA)
  
  • (+) serology but (-) PCR = past infection
  • (+) serology and (+) PCR = current infection