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Question 1

Melanosis Coli

Answer 1

Pigmentation of the bowel wall.
Histology demonstrates pigment-laden macrophages.
It is linked with lax active abuse, especially anthrax quinone compounds such as senna.

Question 2

Acute pancreatitis investigations:

Answer 2

↑ in semi amylase and lipase (more than 3 times the normal ). CT scan with contrast lipase is more specific than amylase.
- amylase usually more then 1000 u/ml

Question 3

Acute pancreatitis treatment:

Answer 3

• IV fluid - nutritional support - analgesia - IV antibiotics if severe - surgery only when pancreas are necroses - switch to parental feeding is oral feeds tolerated,

Question 4

Primary sclerosing cholongitis

Answer 4

• Stiffening and hardening and inflammation of the bile duct. This causes an obstruction while thing bile from liver to intestine.
• well established link with ulcerative colitis.
• risk factors: male, age 30-40, UC and family history
• jaundice, chronic RUQ pain pruritis, fasigne, hepatomegaley / cirrhosis signs.
• Lf T: cholestatic picture → cholestasis, alkaline phosphates ↑↑, bilirubin ↑. Alt + AST ↑ progress to hepatitis, autoantibodies p-anca ↑,, ANCA ↑, ACL ↑,
• diagnosis - MRCP

Question 5

Chronic Pancreatitis investigation and treatment ?

Answer 5

Investigation: Faecal elastase as low exocrine pancreatic insufficiency.
USG if suspected biliary
CT abdomen with contrast - pancreatic calcifications
Serum Amylase

Treatment: analgesics, pancreatic enzyme supplements, fat soluble vitamins

Question 6

Ascending cholangitis?

Answer 6

Charcot’s triad: jaundice - fever, right upper quadrant pain,
↑ bilirubin+ alp

Question 7

Peptic Ulcer presentation, cause, investigations and therapy?

Answer 7

Presentation: epigastric pain and nausea
Aetiology: H pylori, NSAIDs, zollinger Ellison Syndrome, smoking and alcohol.
Investigation: H pylori testing (C13 urea breath test, stool antigen serology), endoscopy
Treatment: PPI (omeprazole), amoxicillin, Clarithromycin

Question 8

Medication that can worsen GERD and oesophagitis?

Answer 8

Biphosphonates and NSAIDs

Question 9

Recurrent rectal pain in absence of any organic disease?

Answer 9

Proctalgia fugaX.

Question 10

Barrett’s oesophagus!

Answer 10

Squamous to columnar metaplasia of the lower oesophagus and it increases the risk of adenocarcinoma
Causes: chronic GERD. hiatus hernia,
Rf: smoking, obesity and alcohol
“The columns are coming”

Question 11

Achalasia card ia? Investigation?

Answer 11

Initial→ endoscopy
Gold standard → manometny (shows high resting pressure of lower spinchter)
Barium swallow → only if manometer unavailable → birds beak appearance

Question 12

Achalasia card ia → complications and treatment?

Answer 12

Complications: aspiration pneumonia + oesophageal cancer
Rx: heller myotomy -pneumatic dilatationcip patient unfit for sungely), endoscopic injection of botulinum.

Question 13

Diffuse oesophageal spasm?

Answer 13

Uncoordinated oesophageal contractions
- intermittent and unpredictable chest pain!!!
- dysphagia. More pronounced with cold liquids.
Ix:
Initial - endoscopy
Oesophageal manometry - gold standard
Barium swallo- corkscrew pattern

Rx: Nitrates, calcium channel blockers (nifedipine), botulinum toxin injection

Question 14

Plummer Vinson Syndrome Triad?

Answer 14

Iron deficiency anaemia + atrophic glossitis + oesophageal webs

Question 15

Plummer-vinson syndrome presentation and treatment?

Answer 15

• presentation: painless intemnitent lysphagia, solids followed by liquids, lethargy, tiredness and pallor.
• treatment: oral iron replacement and endoscopic dilation for persistent dysplasia.

Question 16

Oesophageal VARICES clinical presentation?

Answer 16

Asymptomatic: patient may have oesophageal VARICES without symptoms
Bleeding: the most serious complication characterised by:
-Haematemesis
-Melena
-Hypertension tachycardia and shock severe case
Signs of chronic liver disease (example jaundice ascites spider naevi)

Question 17

Gold standard diagnosis for oesophageal VARICES.

Answer 17

Endoscopy

Question 18

Megaloblastic anaemia, why pick B12 deficiency?

Answer 18

History of gastrectomy
History of vegan diet (inadequate dietary intake of B12)
Pins and needles sensation in the limbs
Peripheral of vibratory sense and position
Cognitive changes

Question 19

Why pick folate deficiency in megaloblastic anaemia?

Answer 19

Poor diet (lack of green vegetables)

Question 20

Patient who is older than 55 years old with DYSPEPTIC symptoms/reflux/pain and weight loss and consumption of alcohol what to do?

Answer 20

Do an oesophageal gastro duodenoscopy (endoscopy) to rule out oesophageal and gastric cancer