Upper GI

Question 1

Patient presents with flushed appearance, weight loss and raised serotonin levels

Answer 1

Carcinoid

Question 2

Sudden onset chest, neck and upper abdo pain. Hypotensive and tachycardia. Surgical emphysema present in suprasternal notch and CXRRR shows pneumomdeiastinum

Answer 2

Oesophageal perforation

Question 3

What is Mirizzi syndrome?

Answer 3

common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder

Question 4

Which artery is most likely causing haemorrhage in first part of duodenum?

Answer 4

Gastroduodenal artery

Question 5

CXR shows rertrocardiac gas filled viscus with a double air-fluid level

Answer 5

Gastric volvulus

Question 6

Preferred treatment for patient with oesophageal carcinoma in middle to lower third of oesophagus?

Answer 6

Ivor-lewis procedurer

Question 7

What tumour is the most common in the appendix and terminal ileum and what is it?

Answer 7

Carcinoid

A neuroendocrine tumour producing serotonin.

Question 8

Which tumour commonly occurs in the ileum and how are they treated?

Answer 8

Lymphoma

Primary are resected and secondary lymphomas are treated with chemo.

Question 10

What causes ongoing epigastric abdo pain and raised amylase in chronic pancreatitis?

Answer 10

pseudocyst

Collection of amylase rich fluid enclosed within fibrous or granulation tissue.

Question 11

What is a highly selective vagotomy procedure?

Answer 11

Aims to remove only the vagal stimulation to the parietal cell mass in the body of the stomach to reduce acid secretion but preserve gastric emptying

Question 12

What is Billrorth I procedure?

Answer 12

Removal of pylorus, and the distal stomach is anastomosed directly to the duodenum which results in better protein and fat digestion compared to a Billroth II procedure; however results in higher level of gastric outlet obstruction

Question 13

What is Roux-en-Y procedurer?

Answer 13

commonly used in weight loss surgery.

Creation of small stomach pouch ensures that large amount of food cannot be consumed and bypassing the duodenum means that fat absorption is greatly reduced

Question 14

What is truncal vagotomy?

Answer 14

eliminating the vagal stimulation to the stomach which reduces acid secretion but leads to gastric paralysis which requirers a further prqccedurrer such as pyloroplasty or gastrojejunostomy to be performed to ensurer adequate stomach drainage

Question 15

What is Billroth II?

Answer 15

anastomosis of the greater curvature of the stomach to the first part of the jejunum following resection of the lower end of the stomach. indicated in refractory peptide ulcer disease and gastric adenocarcinoma

Question 16

Presentation of adenocarcinoma in the oesophagus?

Answer 16

lower third of oesophagus

Associated with:
- smoking
- alcohol
- obesity
- Barrrett’s oesophagus
- GORD
- neostigmine ingestion

Question 17

Presentation of squamous cell carcinoma in the oesophagus?

Answer 17

upper two thirds of oseophagus

Associated with:
- smoking
- alcohol
- achalasia
- coeliac disease
- Plummer-vinson syndrome

Question 18

What is achalasia?

Answer 18

Oesophageal motility disorder where there is failure of lower oesophageal sphincter relaxation and loss of oseophageal peristalsis

Bird’s beak appearance in barium swallow

Question 19

Most common complication following a splenectomy?

Answer 19

Thrombocytosis

Question 20

Features of hyposplenism?

Answer 20

Howelll-Jolly bodies and pappenheimer bodies

Question 21

Features of hypersplenism?

Answer 21

Anaemia
Thromboccytopenia
Leucopenia

Question 22

What are the causes of cholangitis

Answer 22

Gallstones
Head of pancreas malignancy
Primary sclerosing cholangitis
Cholangiocarcinoma
Bile duct stricture

Question 23

What are the potential complications of obstructive jaundice?

Answer 23

AKI
Sepsis
Encephalopathy
Coagulopathy
Hepatic failure
Renal failure
Malabsorption

Question 24

What are gallstones made from?

Answer 24

Cholesterol and bile

Question 25

Describe the metabolism of billirubin

Answer 25

Bilirubin is a byproduct of red blood cell metabolism it travels bound to albumin to the liver where it is conjugated to glucuronic acid Then it is excreted through bile into the bowel where it is further metabolised into urobilinogen and stercobilinog.

Question 26

What is barretts oesophagus

Answer 26

affects the lower this of the oesophagus and is characterised by metaplasia of the stratified squamous epithelium to simple columnar epithelium

Question 27

Causes of peptic ulcer disease

Answer 27

H. Pylori Ischaemia Burns Stress Alcohol Smoking

Question 28

Differences between gastric and duodenal ulcers

Answer 28

Gastric ulcer 50yr Pain on eating not-cyclic pain relieved by vomiting Duodenal Ulcer 25-30yr Pain relieved by eating cyclic no vomiting

Question 29

Management of peptic ulcer disease

Answer 29

Stop smoking Reduce alcohol Avoid NSAIDs PPI

Question 30

Define Troisier's sign and what does this indicate?

Answer 30

Enlarged hard left supraclavicular lymph node which indicates a metastatic abdominal malignancy

Question 31

Predisposing factors to gastric carcinoma

Answer 31

H.pylori Blood group A Low vit C Hypergammaglobinaemia Gastric polyp Penicious anaemia

Question 32

Types of hiatus hernias

Answer 32

Sliding Roling

Question 33

Presentations of different types of hiatus hernias

Answer 33

Sliding: dyspepsia and vomiting Rolling: dyspepsia, odynophagia, dyspnoea on eating, dyspnoea on bending down

Question 34

Complications of hiatus hernia

Answer 34

Incarceration Strangulation Gastric volvulus

Question 35

Most common primary liver tumour and tumour marker

Answer 35

Hepatocellular carcinoma Alpha-fetoprotein (AFP)

Question 36

Surgical treatment options for pancreatic tumour?

Answer 36

Whipple's procedure Pancreaticodudenoectomy