GI Q's

Question 1

intussusception

Answer 1

6/12 -3year
episodes of abdo pain and bloody ‘currant jelly’ stool, inconsolable crying
no abdo pain/tenderness between episodes
abdo u/s diagnostic

Question 2

E.Coli gastroenteritis

Answer 2

*watery diarrhoea that turns bloody within 3/7
*pts usually afebrile
*avoid abx and antidiahorreals

Question 3

chronic radiation proctitis

Answer 3

occurs 3/12 after hx of pelvic radiation
constipation, faecal incontinenece, faecal impaction
characterised by obliterative endarteritis and submucosal fibrosis
colonoscopy :–>rectal pallor, mucosal hemorrhage and telengectasia

Question 4

Coeliac disease extraintestinal features

Answer 4

*iron deficiency anaemia
* dermatitis herpetiformis –> papulovesicular pruritic rash on extensor surfaces

Question 5

hepatocellular pattern of injury during pregnancy. next investigation

Answer 5

• raised AST/ALT with normal ALP
• viral hepatitis screening even if normal at prenatal testing

Question 6

cause of blunt abdominal trauma with free peritoneal fluid on FAST

Answer 6

likely splenic laceration causing intraabdominal hemorrhage

Question 7

ovarian hyperstimulation syndrome

Answer 7

occurs when pt using clomiphene
exaggerated abnormal response to ovulation induction
U/S :- bilaterally enlarged cystic ovaries, increased doppler flow
can lead to ascites, pulmonary oedema

Question 8

acute appendicitis during pregnancy presentation

Answer 8

RLQ pain
fever, abdominal pain, N+V with normal adnexa, normal doppler flow on U/S

Question 9

pt presents with abdominal pain, chronic diarrhoea, anaemia and raised inflammatory markers. Diagnosis and diagnostic test

Answer 9

IBD
Colonoscopy

Question 10

proctalgia fugax

Answer 10

*recurrent episodes of rectal pain not related to *defecation lasting less than 30mins
*normal exam findings
*pts pain free between episodes
*likely 2o anal sphincter contraction or compression of pudendal nerve

Question 11

initial investigation for minimal red blood per rectum in young pt

Answer 11

anoscopy

Question 12

IBS

Answer 12

recurrent, chronic abdominal pain >1day per week for > 3/12
improve with defecation
change in frequency or form
constipation form more common
mgx with dietary modification and fibre i.e psyllium

Question 13

pancreatic ascites

Answer 13

*complication of chronic pancreatitis 2o leakjing off pancreatic fluid into peritoneum
*ascites no portal HTN
*peritoneal fluid –> serosanguinous/ straw coloured, high amylase, high protein, low serum albumin ascites gradient (SAAG)

Question 14

pyridoxine toxicity

Answer 14

*result of taking high dose of B6
*causes peripheral neuropathy

Question 15

riboflavin (B2) deficiency

Answer 15

should be suspected in malnourished pt with angular cheilitis, glossitis, stomatitis, normocytic normochromic anaemia, seborrhoeic dermatitis

Question 16

small bowel obstruction

Answer 16

• abdo pain, vomiting causing hypokalaemia
  *distended abdomen with hyperactive bowel sounds
  *tympany suggestive of SBO
• adhesions 2o previous surgery common cause

Question 17

older pt taking longterm PPI complication

Answer 17

B12 deficiency
investigate by testing for B12 levels or methylmalonic acid or homocysteine level if B12 inconclusive (elevated in B12 deficiency)

Question 18

major modifiable risk factor for severity of Crohn’s disease

Answer 18

smoking

Question 19

Trousseau sign

Answer 19

*migratory superficial thrombophlebitis (recurrent superficial venous thrombosis in unusual sites)
* assoc with pancreatic cancer

Question 20

Clostroides difficile not responding to medical mgx

Answer 20

• laparotomy especially if signs of complications
  *peritonitis
  *megacolon
  *raised lactate

Question 21

pleural effusion with greed pleural fluid after blunt force trauma

Answer 21

oesophageal rupture
requires emergency surgical consult

Question 22

mgx of asymptomatic inguinal hernia repair

Answer 22

watch and wait
surgery if becomes symptomatic or incarcerated

Question 23

femoral hernia

Answer 23

• below the inguinal line
• medial to the femoral vein
  *commoner in older women
  *nonpulsatile tympanic mass
• high risk of incarceration/ strangulation
• mgx:- surgery even for asymptomatic hernias

Question 24

mesenteric ischaemia

Answer 24

• acute severe abdominal pain out of proportion with examination findings
• anion gap metabolic acidosis
  *leucocytosis
• hx of coagulation risk e.g AF
  *Ix of choice :- mesenteric angiography

Question 25

acquired plt dysfunction seen in which conditions

Answer 25

*aspirin use *uraemia *liver disease *CABG

Question 26

Vitamin C deficiency

Answer 26

* symptoms appear after 3/12 * dietary deficiency 2o alcohol disorder, substance disorder, psychiatric illness, gastric bypass * cutaneous signs:- bruising, echymoses, coiled hairs *gingivitis, gum bleeding *poor wound healing

Question 27

eosinophilic oesophagitits

Answer 27

*Th2 response to dietary food antigen *intermittent, occurs in younger males 20's *associated with other atopic conditions * intermittent dysphagia of food *mgx:- dietary restriction, PPI, topical glucocorticoids

Question 28

appendiceal abscess

Answer 28

* in pts with acute appendicitis with symptoms for >5/7 *fever, leukocytosis *psoas sign

Question 29

acute mesenteric ischaemia lab findings

Answer 29

*inc HgB, leucocytosis *metabolic acidosis * high lactate *high amylase and Po4

Question 30

Faecal occult blood investigation

Answer 30

*upper endoscopy and colonoscopy if no cause found * in a child --> techtenium 99 pertechnetate scan ( mockers diverticulum likely cause) in adults of if Tc 99 hasn't found cause * capsule endoscopy if cause still not found *CT/MRI enterography

Question 31

solitary liver lesion likely cause

Answer 31

*metastaic cancer commonest cause of a mass in the liver

Question 32

pilonidal disease

Answer 32

*15-30 yrs olds *obese with sedentary lifestyle + deep intergluteal cleft *tender painful fluctuation mass superior to anus with mucoid, purulent, bloody discharge *

Question 33

full thickness rectal prolapse

Answer 33

* O/E:- erythematous mass with concentric ring that protrude out anus > with increased abdominal pressure * surgery treatment of choice for pts with debilitating symptoms (faecal incontinece, debilitating constipation)

Question 34

diverticulitis symptoms

Answer 34

*anorexia Constipation *N+V *abdo pain

Question 35

free air intraperitoneal cavity presentation

Answer 35

*sudden acute pain followed by improvement of the pain then generalised constant pain

Question 36

small bowel adhesion and strictures

Answer 36

*can cause SBO *pt will have hx of abdominal surgery or Crohn's disease

Question 37

duodenal haematoma

Answer 37

* c/o blunt force abdo trauma *worsneing emesis *CT abdo Ix of choice

Question 38

Turner's Syndrome assoc cardiac/vascular conditions

Answer 38

*aortic dissection *bicuspid aortic valve *coarctation of the aorta