Gastro 1

Question 1

Side effects of PPI

Answer 1

1. Hyponatraemia
2. Osteoperosis
3. Microscopic collitis
4. INCREASE C.DIFFE INFECTION!

Question 2

What drugs increase risk of C.diffe? (2)

Answer 2

1. Clindamycin (classically)
2. Now Cephlasporins
3. PPI

Question 3

C. diffe management

1st line
2nd line
3rd line

Life threatening- (2)

Answer 3

1st line - ORAL vancomycin
2nd line - oral fidaxomicin except if life threatening
3rd line - oral vancomycin +/- IV metronidazole

Life threatening- oral vancomycin AND IV metronidazole
specialist advice - surgery may be considered

Question 4

How does ischaemic colitis present?

Answer 4

Sudden onset diffuse abdo pain after a meal, intermittent and severe pain, pain out of proportion to clinical findings)

As well as predisposing factors: prev. myocardial infarction, atrial fibrillation, hypertension

Question 5

Features of achalasia?
1. STEM!
.2
3.
4.

malignant change?

Answer 5

1. STEM! dysphagia of BOTH liquids and solids
2. typically variation in severity of symptoms
3. heartburn
4. regurgitation of food
   may lead to cough, aspiration pneumonia etc

malignant change in small number of patients

Question 6

What do you need to do before having an appendectomy?

Answer 6

Give prophylactic IV ABX! (e.g. Co-amoxiclav TDS pending no penicillin allergy)

Question 7

How do you differentiate between the 4 different familial CRC diseases?

Peutz-Jeghers syndrome (2)
FAP
Gardner’s Syn
Lynch Syn

Answer 7

Peutz-Jeghers syndrome
- numerous hamartomatous polyps in GI
- pigmented freckles on the lips, face, palms and soles

FAP
Gardner’s Syn
Lynch Syn

Question 8

Familial CRC- what are the genetic patterns and genes affected in each

Question 9

Familial CRC- what are the genetic patterns and genes affected in each

Peutz-Jeghers syndrome (2)
FAP
Gardner’s Syn
Lynch Syn

Answer 9

Peutz-Jeghers syndrome
- Auto Dom
- Codes for serine threonine kinase LKB1 or STK11

FAP
Gardner’s Syn
Lynch Syn

Question 10

Plummer Vinson Syndrome

what is it?
what do you get?

Answer 10

(oesophageal web) may occur in association with iron deficiency anaemia (although rare).

Get dysphagia

Question 11

Criteria for malnutrition:
1. BMI of…

2. Unintentional weight loss of… in how long?
3. If BMI < …. then weight loss of…

Answer 11

1. BMI of less than 18.5
2. Unintentional weight loss greater than 10% within the last 3-6 months is diagnostic of malnutrition
3. If BMI < 20 and unintentional weight loss greater than 5% within the last 3-6 months

Question 12

Which part of the bowel is most likely to be affected by ischaemic colitis?

And what artery?

Answer 12

splenic flexure

If its hypoperfusion:
Splenic flexure is in between vascular supply of midgut and hindgut (SMA and IMA) - more likely to be affected as in ‘watershed’ area

If its an emboli:
The Sup Mesenteric A. is the first branch off aorta- and the splenic flexure is the furthest point in this blood supply so it’ll get lodged there.

Question 13

IBS what first-line investigation should you rule out first?

Answer 13

Anti-TTG just to rule out ceoliac

Question 14

Coaliac disease can cause what bone condition and why?

Answer 14

Osteomalacia secondary to lack of Vit D absorption from GI due to villous atrophy

Question 15

What is the guidance for max weekly alcohol intake

what about if preg/ planning on preg?

Answer 15

No more than 14 units
If you do as much as 14 units then spread it evenly over 3 days or more

For both men and women

safest approach is do not drink at all and if do keep to a minimum as can lead to long-term health affects for kid, more you drink the greater the risk

Question 16

When looking at the history of dysphagia and a barium swaloow what would point to oesophageal cancer over achalasia?

Answer 16

Achalasia- smooth bieds beak and both solids AND liquids affected!!

Cancer- Irreg- APPLE CORE SIGN and mainly solids first have trouble, obvs FLAWS

Question 17

What can affect coeliac screening antibody test?

Question 18

Autoimmune hepatitis management (2)

How do you diff clinically between Auto-immune Hep and PBC (2)

Answer 18

Management- steroids +/- Immunosurpression azathioprine

Auto Hep
- ANA +ve
- Amenorrhoea in girls

PBC
- AMA +ve
- ANA +ve

Question 19

What is and how does it Boerhaave syndrome present?

Answer 19

Rupture of his oesophagus

Severe vomiting → oesophageal rupture

Question 20

Painless jaundice how to diff Cholangiocarcinoma (3 signs) vs Pancreatic cancer

Answer 20

Pancreatic cancer until proven otherwise, its more common
- just painless jaundice
- pain can be quite common

Cholangiocarcinoma
- palpable mass in the right upper quadrant (Courvoisier sign)
- periumbilical lymphadenopathy (Sister Mary Joseph nodes)
- left supraclavicular adenopathy (Virchow node)

Question 21

First line investigation for pancreatic cancer

Answer 21

High resolution CT abdo

Question 22

What are the typical features of a pharyngeal pouch (5)

Investigation (1)

Management (1)

Answer 22

1. Dysphagia
2. Regurg
3. Halitosis- smelly breathe
4. Neck swelling which gurgles on palp.
5. Aspiration

Investigation- Barium swallow

Management- Surgery

Question 23

Who gets prophylytactic antiobiotics if peritonits? (2)

What abx?

Answer 23

oral ciprofloxacin or norfloxacin

• patients who have had an episode of SBP
• patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome

NICE recommend: ‘Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’

Question 24

Most common type of inherited colorectal cancer:

Answer 24

Hereditary non-polyposis colorectal carcinoma- Lynch

Question 25

Upper GI 2ww referral -Dyspepsia Urgent First thing to rule out... All with All with + Age and 1 from: (3) Non-urgent All with... Age who have - or - or - -

Answer 25

Red flags: 2ww endo - All with dysphagia - All with upper abdo mass (gastric cancer) Patients >= 55yo AND one from: - upper abdominal pain - reflux - dyspepsia Non-Urgent - All patients with haematemesis Patients aged >= 55 years who've got: - treatment-resistant dyspepsia or - upper abdominal pain with low haemoglobin levels or - raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain - nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain

Question 26

Metabolic ketoacidosis and normal glucose, think....

Answer 26

Alcoholic ketoacidosis

Question 27

Upper GI bleed from oesophageal varicose vein- you've corrected clotting and awaiting OGD, what can you do while waiting?

Answer 27

Sengstaken-Blakemore tube has oesophageal and gastric balloons which can be inflated to tamponade the variceal bleeding. It is inserted through the nose.

Question 28

if we think its alcoholic hep what do we look at on LFT?

Answer 28

The AST/ALT ratio in alcoholic hepatitis is 2:1

Question 29

Alcohol units formula if given ml

Answer 29

Alcohol units = volume (ml) x % ABV / 1,000

Question 30

pathognomonic secondary osteoarthritis STEM for Haemochromatosis (2)

Answer 30

hook-like osteophytes at the 2nd and 3rd digits at the metacarpophalangeal joints slate-grey appearance of the skin.

Question 31

Iron defiency anaemia vs. anaemia of chronic disease

Answer 31

Obvs both microcytic TIBC is high in IDA low/normal in anaemia of chronic disease

Question 32

Investigation for C.diffe Screening test = Diagnostic test for active =

Answer 32

Screening test = C. difficile antigen positivity only shows exposure to the bacteria, rather than current infection Diagnostic test for active = C. difficile toxin (CDT) in the stool

Question 33

Acute Liver failure- synthetic function tests (2) Which is better indicator in the acute scenario?

Answer 33

Prothrombin time (PT) increase Hypoalbuminaemia Prothrombin has a shorter half-life than albumin, making it a better measure of acute liver failure

Question 34

Most common type of oesophageal cancer?

Answer 34

adenocarcinoma arises in the lower third of the oesophagus, near the gastro-oesophageal junction.

Question 35

autoimmune hepatitis who is it seen in? Type 1 antibody (2) Affects who? Type 2 Antibody (1) Affects who? Type 3 Antibody (1) Affects who?

Answer 35

young females. Recognised associations include other autoimmune disorders, hypergammaglobulinaemia and HLA B8, DR3. Type 1 antibody: - ANA - Anti-smooth muscle (SMA) Affects both adults and kids Type 2 Antibody: LKM1- Anti-liver/kidney microsomal type 1 Affects who? just kids Type 3 Antibody: Soluble liver-kidney antigen Affects who? Affects adults in middle-age for all also raised IgG

Question 36

Viral hep what Ig is raised? Management (2)

Answer 36

IgG steroids, other immunosuppressants e.g. azathioprine liver transplantation

Question 37

Plummer-Vinson syndrome. triad

Answer 37

triad of - dysphagia - glossitis - iron-deficiency anaemia (some definitions additionally include cheilitis in the syndrome).

Question 38

Small bowel bacterial overgrowth syndrome (SBBOS) Risk factors for SBBOS (3) Diagnostic (3) 1st line- 2 other options Management (1)

Answer 38

Risk factors for SBBOS neonates with congenital gastrointestinal abnormalities scleroderma diabetes mellitus Diagnosis hydrogen breath test small bowel aspiration and culture: this is used less often as invasive and results are often difficult to reproduce clinicians may sometimes give a course of antibiotics as a diagnostic trial Antibiotic therapy: rifaximin Co-amoxiclav or metronidazole are also effective

Question 39

A transjugular intrahepatic portosystemic shunt procedure connects which two vessels?

Answer 39

connects the hepatic vein to the portal vein