GI (Week 13)

Question 1

What are the two major classifications of liver disease based on area?

Answer 1

Diffuse (e.g. acute hepatitis)

Focal (space occupying lesion)

Question 2

Define ‘fulminant’

Answer 2

Severe acute inflammation, rapidly progressing to liver failure

Question 3

What does ‘acute on chronic’ mean?

Answer 3

Chronic disease presenting as acute exacerbations with evidence of underlying chronicity

Question 4

What are the three hallmarks of liver cirrhosis?

Answer 4

Diffuse
Fibrosis
Nodule formation

Question 5

Name two microscopic features of acute hepatitis

Answer 5

Diffuse hepatocyte swelling
Spotty necrosis (dead hepatocytes)
Inflammatory cell infiltrate

Question 6

Give an example of a non-neoplastic focal liver lesion

Answer 6

Liver cysts

Question 7

Give an example of one benign and one malignant focal neoplasm in the liver

Answer 7

Benign: Haemangioma
Malignant: Hepatic adenoma

Question 8

Which two types of hepatitis can only occur acutely?

Answer 8

A and E

Question 9

Name three features of decompensated cirrhosis

Answer 9

Jaundice
Ascites
Encephalopathy

Question 10

What is the route of transmission and incubation period of hepatitis A?

Answer 10

Faeco-oral route

30 day incubation

Question 11

In hepatitis E genotype 1 infection, what is the significance in pregnant women?

Answer 11

Higher mortality

Question 12

In hepatitis E genotype 3 infection, what other symptoms can be seen?

Answer 12

Neurological e.g. Guillain-Barre syndrome

Question 13

What can chronic infection of hepatitis B lead to?

Answer 13

Chronic liver disease

Question 14

What does surface antigen in the blood indicate in Hepatitis B serology?

Answer 14

Current Hep. B infection

Question 15

What does surface antibody indicate in Hep. B serology?

Answer 15

The patient has encountered the virus or vaccine and has made an immune response.

NO CURRENT INFECTION

Question 16

What does core antibody indicate in Hep. B serology?

Answer 16

Only made if the patient has suffered the virus by direct infection

Question 17

What does IgM in Hep. B virus indicate?

Answer 17

New infection

Question 18

What does IgG in Hep. B virus indicate?

Answer 18

Someone who has been infected previously (e.g. 2 months ago)

Question 19

What is unique about hepatitis D infection?

Answer 19

Single stranded RNA virus which requires hepatitis B infection to survive

Question 20

Which type of hepatitis is most common in Scotland and injecting drug users?

Answer 20

Hepatitis C

Question 21

What is MRCP imaging?

Answer 21

MRI scan of the bile duct

Question 22

How do gallstones cause acute pancreatitis?

Answer 22

They become trapped in the Ampulla of Vater and cause bile reflux

Question 23

Name the layers of the GI tract

Answer 23

Mucosa
Submucosa
Muscularis propria
Adventitia

Question 24

Define Barrett’s oesophagus

Answer 24

Metaplasia in response to mucosal injury, changing from squamous into glandular

Question 25

What are the main risk factors for squamous carcinoma?

Answer 25

Smoking and drinking

Question 26

What are the main risk factors for adenocarcinoma of the oesophagus?

Answer 26

GORD and obesity

Question 27

Name three causes of chronic gastritis

Answer 27

Autoimmune Bacterial Chemical

Question 28

Name three causes of upper GI bleeding

Answer 28

Peptic ulcer Oesophagitis Varices

Question 29

What does Terlipressin do in terms of varice treatment?

Answer 29

Splanchnic vasoconstriction (avoid in dehydration)

Question 30

Name three complications of ulcerative colitis

Answer 30

Toxic dilatation Iritis Increased malignancy risk

Question 31

Define Crohn's disease

Answer 31

Chronic inflammatory condition affecting anywhere from mouth to anus

Question 32

Name three drug treatments of Crohn's disease

Answer 32

Thiopurines Methotrexate Biologics (Infliximab)

Question 33

Give three features of Crohn's disease

Answer 33

Granulomas Skip lesions Transmural ulceration

Question 34

Give three features of UC

Answer 34

Diffuse inflammation Inflammed centre on mucosa From rectum to left side

Question 35

Why does low albumin occur in inflammation?

Answer 35

Cytokines degrade albumin

Question 36

Name three drugs which must be considered when a patient presents with GI bleeding?

Answer 36

NSAIDs (ulcer) Iron (dark stool) Aspirin (anti-platelet so increases bleeding risk)

Question 37

Why can a patient with cancer have elevated platelets?

Answer 37

Initially platelets are low but bone marrow kicks in to combat this and in cancer states overcompensates

Question 38

In cancer treatment, what name is given to the process of giving chemo/radiotherapy in conjunction with surgery?

Answer 38

Neo-adjuvant therapy

Question 39

What is an AP resection?

Answer 39

Abdomino-pertioneal resection, removing rectum, sigmoid colon and anus