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gastro Flashcards

1
Q

what is a characteristic sign of gastric cancer on biopsy

A

signet ring cells

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2
Q

name 4 risk factors for gastric cancer

A

H.Pylori
atrophic gastritits
diet
smoking

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3
Q

give 2 signs of lymphatic spread of gastric cancer

A

left Supraclavicular lymph node - Virchow’s node
Periumbilical nodule - Sister Mary Josephs node

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4
Q

3 investigations indicating alcohol hepatitis

A

macrocytic anaemia
increased GGT
AST : ALT > 2:1

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5
Q

management of alcoholic hepatitis

A

glucocorticoids- prednisolone

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6
Q

dyspepsia - criteria for an urgent referral

A

all patients with dysphagia
all patients with upper abdominal mass consistent with stomach cancer
patients > 55 with weight loss + upper abdo pain, reflux and dyspepsia

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7
Q

t cell lymphoma is associated with an increased risk in patients with _____________?

A

coeliac disease

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8
Q

what are carcinoid tumours

A

they occur when liver metastases occur and seretonin is released into the systemic circulation

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9
Q

signs of a carcinoid tumour

A

flushing
diarrhoea
bronchospasm
hypotension

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10
Q

what medication can be used to help manage HCC

A

Sorafenib

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11
Q

how do gastric and duodenal ulcers present

A

gastric - epigastric pain worsened by eating
duodenal - epigastric pain when hungry, relieved by eating

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12
Q

prophylaxis for variceal haemorrhage

A

propranolol

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13
Q

how is life threatening C. Diff treated

A

oral vancomycin and IV metronidazole for 10-14 days

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14
Q

what is the first line treatment of C. Difficile

A

oral vancomycin for 10 days

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15
Q

which medications cause c diff

A

co-amoxiclav
cephalosporins - ceftriaxone
clindamycin
ciprofloxacin

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16
Q

what are the features of c difficile ? what is a complication of severe c difficile

A

diarrhoea
abdominal pain
raised WCC
severe C.difficile can lead to toxic megacolon

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17
Q

what is the second line therapy for c difficile

A

oral fidaxomicin

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18
Q

what is courvoisier’s law ?

A

it states that the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones.

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19
Q

what is the chief investigation for pancreatic carcinoma ? what sign may be present ?

A

high resolution CT scanning. double duct sign

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20
Q

what procedure is used to treat resectable pancreatic cancer

A

whipples resection - pancreaticoduodenectomy

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21
Q

A combination of liver and neurological disease points towards _________.

A

wilsons disease

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22
Q

what is the nature of inheritance of wilsons disease? which chromosome does it effect?

A

Autosomal recessive. chromosome 13

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23
Q

first line management of wilson’s disease

A

penicillamine = chelates copper

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24
Q

which blood test confirms pernicious anaemia

A

instrinsic factor antibodies

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25
Q

what is the pathophysiology of pernicious anaemia

A

antibodies to intrinsic factor + /- gastric parietal cells

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26
Q

which blood test also needs to be done in addition to TTG in patients whom coeliac diseases is suspected ?

A

IgA

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27
Q

4 findings on endoscopy suggesting coeliac disease

A

villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

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28
Q

liver failure post MI suggests ______.

A

Ischaemic hepatitis

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29
Q

which conditions can lead to budd chiari syndrome

A

underlying haematological disease such as -
polycythaemia rubra vera
thrombophilia
pregnancy
combined oral contraceptive

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30
Q

features of budd chiari syndrome

A

abdominal pain
ascites
tender hepatomegaly

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31
Q

which vitamin taken in high doses during pregnancy be teratogenic ?

A

Vitamin A

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32
Q

what is the management of barret’s oesophagus ?

A

high dose PPI therapy and endoscopic surviellence

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33
Q

all patients with suspected upper GI bleed recquire ______ within ____ of admission

A

endoscopy within 24 hours

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34
Q

what is the pathophysiology of primary biliary cholangitis

A

thought to be an autoimmune condition where interlobular bile ducts are damaged by a chronic inflammatory process causing progressive cholestasis which can progress to cirrhosis.

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35
Q

what are the clinical features of primary biliary cholangitis ?

A

asymptomatic
RUQ pain
itching
fatigue
cholestatic jaundice

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36
Q

which antibodies are specific for primary biliary cholangitis

A

AMA
raised serum IgM

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37
Q

first line management of PSC

A

ursodeoxycholic acid

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38
Q

give microscopic features of UC

A

ileocoecal valve to rectum, continous disease
no inflammation beyond submucosa
crypt abscesses

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39
Q

give microscopic features of crohns disease

A

mouth to anus –> skip lesions
inflammation of all the levels
goblet cells
granulomas

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40
Q

which conditions are associated with UC

A

PSC
Uveitis
colorectal cancer

UC can cause UC

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41
Q

which test is recommended for H.Pylori post eradication therapy

A

urea breath test

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42
Q

signs of vitamin C deficiency

A

easy bruising
bleeding and receding gumbs

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43
Q

UC or Crohns - granuloma

A

Crohns

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44
Q

UC or Crohns - granuloma

A

Crohns

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45
Q

Red flag symptoms for gastric cancer includes

A

new-onset dyspepsia in a patient aged >55 years
unexplained persistent vomiting
unexplained weight-loss
progressively worsening dysphagia/
odynophagia
epigastric pain

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46
Q

3 characteristic markers of autoimmune hepatitis

A

ANA
SMA
raised IgG

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47
Q

management of autoimmune hepatitis

A

steroids + other immunosuppressants like azathioprine
liver transplant

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48
Q

symptoms of a pharyngeal pouch

A

dysphagia
regurgitation
halitosis

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49
Q

management of pharyngeal pouch

A

surgical resection

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50
Q

investigation for a pharyngeal pouch

A

barium swallow with dynamic video fluoroscopy

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51
Q

which is the most common site affected in Ulcerative colitis ?

A

Rectum

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52
Q

how should a severe flare up of UC be treated

A

IV Corticosteroids

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53
Q

how would you initially diagnose H.Pylori

A

Carbon 13 urea breath test or stool antigen test

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54
Q

what are the 3 criteria for DKA

A

diabetes / hyperglycaemia
ketones
acidosis

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55
Q

which medications are used to induce remission in crohns disease

A

glucocorticoids ( oral /topical/IV)

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56
Q

What should be measured to best assess synthetic function of the liver

A

PT ( prothrombin time)

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57
Q

which are the most useful investigations used for monitoring the adequacy of treatment of haemachromatosis

A

ferritin + transferrin saturation

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58
Q

what is the management of Alcoholic ketoacidosis

A

Infusion of saline and thiamine

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59
Q

which is the first line medication used in Ascites ?

A

Spironolactone

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60
Q

isolated rise in bilirubin is seen in which condition

A

Gilberts syndrome

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61
Q

which medication should be avoided in suspected bowel obstruction and why

A

Metoclopramide as it has pro-kinetic properties that can stimulate peristalsis and perforation

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62
Q

which serology is requires for the diagnosis of Coeliac disease ?

A

TTG and EMA

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63
Q

how is C.Difficile infection diagnosed

A

by detecting C.Difficile toxin in the stool

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64
Q

clinical feature of achalasia

A

dysphagia of both liquids and solids

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65
Q

what sign is seen in Achalasia on barium swallow

A

Birds beak appearance

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66
Q

what medication is given as prophylaxis for upper GI bleed ?

A

Propranolol

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67
Q

what sign is seen on abdominal xray in ischaemic colitis

A

thumb printing

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68
Q

which part of the bowel is typically effected by ischaemic colitis

A

large bowel

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69
Q

what particular risk factors tends to be present in bowel ischaemia

A

atrial fibrillation

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70
Q

which condition presents with crypt abscesses in the bowel

A

UC

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71
Q

Which condition presents with goblet cells and granulomas of the bowel

A

crohns disease

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72
Q

what is the characteristic iron study profile that is seen in hereditary haemachromotosis

A

raised transferrin sats
raised ferritin
low TIBC

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73
Q

regurgitation of foul smelling liquid is seen in which condition

A

pharyngeal pouch

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74
Q

which haematological condition can aminosalicyclate drugs cause

A

Heinz body anaemia

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75
Q

what is the M rule for primary biliary cirrhosis

A
  • IgM
    -AMA
    Middle aged females
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76
Q

what is the first line management of primary biliary cirrhosis

A

Ursodeoxycholic acid

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77
Q

give 2 medications that are used first line in maintaining remission in crohns disease

A

Azathioprine
Mercaptopurine

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78
Q

which medication is used in patients with Crohns disease who develop a perianal fistula

A

oral metronidazole

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79
Q

when is a draining seton used?

A

It is used in the management of complex fistulae

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80
Q

what medication is used to manage ascites

A

aldosterone receptor antagonist

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81
Q

which receptors does loperamide act upon

A

opioid receptors

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82
Q

an isolated rise in bilirubin due to physiological stress is caused by -

A

gilberts syndrome

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83
Q

what is the adverse affect of aminosalicylates

A

agranulocytosis

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84
Q

what is the investigation of choice for suspected perianal fistula in patients with crohns disease

A

MRI Pelvis

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85
Q

What is the management of a perianal abscess

A

incision and drainage

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86
Q

give 4 causes of ulcerative colitis flare

A

stress
medications ( NSAIDs , antibiotics)
Cessation of smoking

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87
Q

how do you distinguish a severe UC Flare up from moderate-mild flare up ?

A

severe flare ups present with systemic involvement such as fever, tachycardia , anaemia, abdo tenderness etc

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88
Q

how do you manage a pharyngeal pouch?

A

surgical resection and repair

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89
Q

which is a common side effect of mesalazine

A

Acute pancreatitis

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90
Q

what are esophageal varices and what are they caused by

A

Dilated veins that arise due to portal HTN, secondary to cirrhosis.

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91
Q

what are the signs and symptoms of oesophageal varices ?

A

asymptomatic until a bleed occurs
haematemesis
melena
palpitations
syncope
hypotension

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92
Q

how are oesophageal varices investigated

A

endoscopy

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93
Q

which medication reduced portal HTN ?

A

Terlipressin

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94
Q

what are carcinoid tumours and where do they arise from

A

Carcinoid tumours are rare, slow growing neuroendocrine malignancies that arise from the enterochromaffin cells

most common site is appendix

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95
Q

what are the key features of carcinoid tumours ?

A

Abdominal pain
Diarrhoea
flushing
wheezing
pulmonary stenosis

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96
Q

how are carcinoid tumours managed ?

A

pharmacological therapy such as Octreotide to inhibit tumour products

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97
Q

what is the difference between carcinoid syndrome and carcinoid tumour

A

in a carcinoid syndrome, liver metastases impairs hepatic excretion of serotonin increase serotonergic symptoms whereas in carcinoid tumours there is a neuro-endocrine tumour.

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98
Q

what are the key investigations for carcinoid tumours ?

A

hormone level assessments - 5 HIAA ( breakdown product of serotonin in urine)
imaging
tissue biopsy

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99
Q

give 2 dermatological, 2 ocular and 2 musculoskeletal manifestations of crohn’s disease

A

dermatological
erythema nodosum
pyoderma gangrenosum

ocular

anterior uveitis
episcleritis

MSK

arthritis
sacro-iliitis

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100
Q

what is the ‘’ string sign of Kantour’’

A

string like appearance of contrast filled narrowed terminal ileum and is suggestive of crohn’s disease

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101
Q

give 4 features of crohns on colonoscopy

A

skip lesions
cobblestone mucosa
rose thorn ulcers ( fistulae or abscesses)
Non-caseating granulomas

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102
Q

what is the first line management of crohn’s to induce remission ?
what can be added ?

what is used to maintain remission ?

A

Monotherapy with glucocorticoids ( prednisolone / IV Hydrocortisone)

Azathioprine or Mercaptopurine may be added on to induce remission.

Azathioprine or Mercaptopurine should be offered first line to maintain remission.

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103
Q

what is pre-hepatic jaundice? what are its causes ?

A

high levels of unconjugated bilirubin which is not water soluble so it can’t enter the urine.

causes include -

gilbert’s disease
haemolysis ( malaria / haemolytic anaemia)
drugs ( Rifampicin)

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104
Q

what is hepatic jaundice ? what are its causes ?

A

conjugated hyperbilirubinemia

viruses ( Hepatitis)
alcohol
cirrhosis
malignancy
haemochromatosis + A1AT
drugs ( pctmol, valproate, statins, TB drugs)

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105
Q

what is post-hepatic jaundice ? what are its causes ?

A

Impaired excretion of conjugated bilirubin making urine dark and stools pale
v high ALP

primary biliary cirrhosis
primary sclerosing cholangitis
bile duct gallstones / mirizzi’s syndrome
drugs ( nitrofurantoin, steroids, co amoxiclav, flucloxacillin)
malignancy ( pancreatic, cholangiocarcinoma)
biliary atresia

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106
Q

which patients should undergo urgent endoscopy in 2 weeks

A

ALARMS signs

Anaemia
Loss of weight
Anorexia
Recent onset of symptoms
melena / haematemesis
swallowing difficulties ( dysphagia)

( epigastric mass / difficulty swallowing)

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107
Q

which antibodies are positive in primary biliary cholangitis ?

A

AMA ( Anti mitochondrial antibodies)

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108
Q

give 4 long term complications of ulcerative colitis

A

colorectal cancer
cholangiocarcinoma
colonic strictures
primary sclerosing cholangitis

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109
Q

give 3 features of ulcerative colitis

A

diarrhoea containing blood / mucus
tenesmus / urgency
pain in LIF

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110
Q

acute exacerbation of UC can be assessed using _________

A

Truelove and Witt’s severity index

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111
Q

what signs are seen on imaging in UC

A

Colonoscopy –>continuous inflammation
loss of haustral markings
pseudo-polyps

Biopsy –> loss of goblet cells , crypt abscess, inflammatory cells

Barium enema –> lead pipe inflammation, thumb printing

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112
Q

what does positive HBsAg mean ?

A

positive hepatitis B surface antigen signifies current infection , either acute or chronic.

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113
Q

what do antiHBs and anti HBc signify?

A

Anti HBs –>previous infection/ previous vaccination
Anti HBc –> past infection/current infection

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114
Q

what is porphyria ? how does it present ? how is it diagnosed and treated ?

A

group of disorders resulting from defects in haem synthesis.

presents as abdominal pain, nausea, confusion and HTN

diagnosis = urinary porphobilinogen levels

supportive management

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115
Q

summarise melanosis coli

A

prolonged laxative abuse leading to dark brown pigmentation of macrophages in lamina propria

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116
Q

what are the four stages of hepatic encephalopathy

A
  1. altered mood, behaviour and disturbance of sleep
  2. drowsiness, confusion, slurred speech
  3. incoherence, asterix,restlessness,rousable
  4. coma
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117
Q

what is the management of giardiasis

A

Metronidazole

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118
Q

what is the management of upper GI bleed due to varices

A

Resuscitation + blood transfusion involving FFP
Terlipressin
IV Abx
variceal band ligation
sengstaken blakemore tube for severe

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119
Q

what is the long term prevention of variceal bleeding

A

non selective beta blockers and variceal band ligation
transjugular intrahepatic portosystemic shunt ( TIPSS)

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120
Q

how to manage mild - moderate disease in UC

A

Topical ASA
consider switching to oral ASA

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121
Q

how to manage severe UC

A

IV hydrocortisone

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122
Q

how does primary sclerosing cholangitis present ? what antibodies are positive

A

abnormal LFT’s
Juandice
RUQ pain
fatigue, weight loss, fevers and sweats
UC association

ANCA positive

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123
Q

what condition is trousseau syndrome associated with

A

Pancreatic cancer

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124
Q

how does entamoeba histolyca present ?

A

Bloody diarrhoea
Liver Abscess
RUQ pain

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125
Q

which gene mutation is responsible for Gilberts syndrome

A

UDP Glucuronosyltransferase 1

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126
Q

how long should patients with C.Difficile have to isolate ?

A

at least 48 hours

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127
Q

what is Courvoisier’s law in the context of pancreatic cancer?

A

In the context of painless obstructive jaundice, a palpable gallblader is unlikely to be caused by gallstones.

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128
Q

what are the symptoms of haemochromatosis ?

A

fatigue
erectile dysfunction
arthralgia of the hands
bronze skin pigmentation
liver disease
cardiac failure

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129
Q

which vessels do a TIPS connect ?

A

Hepatic vein and portal vein

130
Q

what is the first and second line management of constipation

A

-first-line laxative: bulk-forming laxative first-line, such as ispaghula
=second-line: osmotic laxative, such as a macrogol

131
Q

what class of medication is terlipressin

A

vasopressin analogue

132
Q

what is the characteristing iron study profile seen in haemochromatosis ?

A

raised transferrin
raised ferritin
low TIBC

133
Q

what is a common side effect of trans jugular intrahepatic portosystemic shunt

A

exacerbation of hepatic encephalopathy

134
Q

what is the most likely cause of acute gastroenteritis caught from swimming pool

A

Giardia Lamblia

135
Q

_____________ needs to be assessed before offering azathioprine or mercaptopurine therapy in crohns disease

A

TPMT or Thioprine methyltransferase activity

136
Q

what medications cause pseudomembranous colitis

A

Co-amoxiclav
Ciprofloxacin
Clindamycin
Cephalosporin ( Ceftriaxone)

137
Q

what are the Glascow-Blatchford score and the Rockall score

A

Glascow Blatchford : used before endoscopy to assess patients with upper GI bleeds
Blatchford Before

Rockall score : Used after endoscopy to assess risk of rebleeding and mortality
Rockall repeat

138
Q

at what level of Hb should a blood transfusion take place in management of upper GI bleed

A

Hb < 70 g / l

139
Q

what is the management of Barret’s oesophagus ?

A

High dose PPI

metaplasia : Endoscopic surveillance with biopsies
dysplasia of any kind : endoscopic intervention

low grade : radiofrequency ablation

high grade : endoscopic mucosal resection

140
Q

what is the first and second line management of Hepatic encephalopathy

A

first line : Lactulose
add Rifaximin

141
Q

what are the grades of hepatic encephalopathy

A

grade 1 : irritability
grade 2 : confusion, inappropriate behaviours
grade 3 : incoherent, restless
grade 4 : coma

142
Q

what can precipitate hepatic encephalopathy ?

A

infection
GI bleed
constipation
drugs : sedatives, diuretics
hypokalaemia
renal failure
increased dietary protein

143
Q

what are the adverse effects of PPI

A

Hyponatraemia
hypomagnesaemia
osteoporosis
microscopic colitis
increased risk of c. diff

144
Q

what is Acalculous cholecystitis

A

gallbladder dysfunction caused by something other than gallstones - can occur in patients on total parental nutrition or having long periods of fasting where the gallbladder is not being stimulated properly by food to regularly empty leading to a build up of pressure

145
Q

how to differentiate between biliary colic, acute cholecystitis and cholangitis ?

A

Biliary colic : colicky abdominal pain worse after a meal with fatty foods
Acute cholecystitis : RUQ pain, fever, Murphy’s sign,
Cholangitis : severely, septic, jaundice and unwell patient

146
Q

how does a gallbladder abscess present

A

Prodromal illness and RUQ pain with swinging pyrexia.
Systemically unwell patient

147
Q

which 2 tests are best to accurately represent the synthetic function of the liver

A

prothrombin time and albumin level - with PT being more accurate

148
Q

what features can be seen in a patient with acute liver failure

A

Jaundice
Coagulopathy : raised PT
Hypalbuminaemia
hepatic encephalopathy
renal failure

149
Q

what is Plummer Vinson syndrome and how does it present

A

triad of -
dysphagia
glossitis
IDA

150
Q

what antibody is positive in primary sclerosing cholangitis

151
Q

what are the complications of primary sclerosing cholangitis

A

cholangiocarcinoma
increased risk of colorectal cancer

152
Q

how does Budd-Chiari syndrome present ? what is the initial investigation

A

sudden onset abdominal pain
ascites
tender hepatomegaly

Ultrasound with doppler flow studies

153
Q

what are the general features of hepatorenal syndrome ? How is it managed ?

A

doubling of serum creatinine to > 221 umol / L or halving of the creatinine clearance to less than < 20 ml/min over a period of < 2 weeks

treat with vasopressin analogues such as terlipressin

154
Q

how does Boerhaave syndrome present

A

severe vomiting thoracic pain and subcutaneous emphysema
= leads to alcoholic rupture

presents in middle aged men with a background of alcohol abuse

155
Q

what is the guidance around use of PPis before Upper Gi endoscopy

A

stop taking 2 weeks before endoscopy

156
Q

give 3 complications of constipation

A

overflow diarrhoea
acute urinary retention
haemorrhoids

157
Q

what is the first and second line management of overflow diarrhoea ?

A

1st line : disimpaction regime with osmotic laxatives such as lactulose or macrogol ( with macrogol being first line)

2nd line : add stimulant laxative such as senna

158
Q

what is the first and second line management of constipation ?

A

1st line : bulk forming laxative such as isphagula husk

2nd line : osmotic laxative such as macrogol

159
Q

investigation of choice for suspected pharyngeal pouch

A

Barium swallow combined with dynamic video fluoroscopy

160
Q

What is the formula for alcohol units

A

Alcohol units = volume x ABV/1000

161
Q

What medications are used first line to induce remission in crohns disease

A

Glucocorticoids ( oral, topical or IV)

162
Q

what medications are used to maintain remission for Crohns disease

A

stop smoking
azathioprine / mercaptopurine

2nd line methotrexate

163
Q

what needs to be assessed before commencing methotrexate to maintain remission in crohns

A

+TPMT activity

164
Q

what are the long term complications of crohns disease

A

small bowel cancer
colorectal cancer
osteoporosis

165
Q

how would you distinguish IDA vs Anaemia of chronic disease

A

TIBC : high in IDA, low / normal in Anaemia of chronic disease

Ferritin : decreased in IDA, normal / increased in AOCD

Serum iron : decreased in both

166
Q

what is the biochemical marker of melena

A

raised urea

167
Q

what are the symptoms of perforated peptic ulcer
how would you investigate this

A

epigastric pain , later becoming more generalised
syncope

investigated with upright / erect CXR

168
Q

how would you distinguish alcoholic ketoacidosis from diabetic ketoacidosis

A

alcoholic ketoacidosis : normal / low glucose concentration
diabetic ketoacidosis : high glucose

169
Q

how do you manage alcoholic ketoacidosis

A

Infusion of saline and thiamine

170
Q

how does hepatomegaly present in

  1. cirrhosis
  2. malignancy
  3. right heart failure
A
  1. cirrhosis : early disease , decreases in size later, non tender firm liver
  2. malignancy = metastatic spread or primary : hard, irregular liver edge
  3. Right heart failure : firm, smooth tender liver edge - might be pulsatile
171
Q

what is the nature of inheritance of hereditary haemochromatosis

A

autosomal recessive

172
Q

what kind of picture does non alcoholic fatty liver disease present on LFT’s

A

obesity + abnormal LFTS ( abnormal ALT generally greater than AST ,GGT)

173
Q

what LFTs are abnormal in alcoholic liver disease

A

GGT characteristically raised
AST : ALT generally >3 suggests acute alcoholic hepatitis >2 generally

174
Q

what is the management of alcoholic hepatitis

A

Glucocorticoids ( prednisolone)
pentoxyphylline

175
Q

what is the eradication regime of H.pylori

A

PPI + amoxicillin + ( ciarithromycin / metronidazole) for 7 days

176
Q

what method is use to screen patients with liver cirrhosis ? who is offered screening

A

Transient elastography / Fibroscan

screening is suggested to be offered to

  • Hep C infection
    -men drinking > 50 units / week. women > 35 units / week
  • diagnosis of alcohol related liver disease
177
Q

what investigations are recommended in patients newly diagnosed with cirrhosis

A

upper endoscopy to check for varices
liver ultrasound every 6 months +/- alpha fetoprotein to check for HCC

178
Q

what is gallstone ileus and how does it present ?

A

small bowel obstruction that is secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum
It presents with abdominal pain, distension and vomiting
pain abdominal film shows small bowel obstruction and air in the biliary tree

179
Q

what is Mirizzi’s syndrome and how does it present

A

gallstone within the bladder compresses the bile duct to cause an obstructive jaundice

180
Q

how does a cholangiocarcinoma present ?

A

persistent biliary colic symptoms associated with anorexia, jaundice and weight loss

181
Q

which antibodies are +ve in Auto-immune hepatitis

A

ANA/SMA/LMKA2 antibodies

182
Q

how is autoimmune hepatitis treated

A

Steroids
liver transplantation

183
Q

which is an important raised finding in auto-immune hepatitis

184
Q

what conditions are associated with coeliac disease ?

A

I Don’t Take Apples, I take Oranges

IgA deficiency
Down syndrome
Turner’s syndrome
Autoimmune thyroid disease and auto-immune hepatitis
IgA nephropathy
T1DM
other auto-immune conditions ( Sjogrens, MG, Addison’s disease)

185
Q

which disease should t1dm and autoimmune thyroid disease patients be screened for

A

Coeliac disease

186
Q

what is the investigation of choice for pancreatic cancer

A

High resolution CT

187
Q

what is the gold standard diagnosis for coeliac disease and which part does it focus on ?

A

Endoscopic intestinal biopsy is the gold standard for coeliac disease and focuses mainly on the duodenum and also on the jejunum

188
Q

what findings on biopsy are suggestive of coeliac disease

A

villous atrophy
crypt hyperplasia
increase in ILE
lamina propria infiltration with lymphocytes

189
Q

how does Ulcerative Colitis present on Barium enema ?

A

Loss of Haustrations
superficial ulceration , ‘‘pseudopolyps’’
long standing disease : colon is narrow and short ‘‘drainpipe colon’’

190
Q

what cancers are HNPCC associated with

A

CEO
Colorectal
Endometrial
Ovarian

CP - males
colorectal
pancreatic

191
Q

what is the first line treatment of campylobacter

A

self limiting
clarithromycin if severe

192
Q

how do thrombosed haemorrhoids present ? how are they managed?

A

typically present with significant pain and a tender lump
examination reveals a purplish, oedematous, tender subcutaneous perianal mass
if patient presents within 72 hours then referral should be considered for excision. Otherwise patients can usually be managed with stool softeners, ice packs and analgesia. Symptoms usually settle within 10 days

193
Q

how is cholecystectomy managed

A

early laparoscopic surgery

194
Q

Antibiotic prophylaxis should be given to patients with ascites if:

which one

A

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

ciprofloxacin / norfloxacin

195
Q

management of spb

A

IV Cefotaxime

196
Q

diagnosis of SPB

A

neutrophil count > 250 cells/ ul

197
Q

how does an inguinal hernia present?

A

groin lump
superior and medial to pubic tubercle

198
Q

how to differentiate between indirect and direct hernia ?

A

if it protrudes after reducing - direct

199
Q

mx of inguinal hernia

A

treat patients even if asymptomatic

200
Q

features of campylobacter

A

prodrome: headache malaise
diarrhoea: often bloody
abdominal pain: may mimic appendicitis

201
Q

where are diverticula most commonly found

A

sigmoid colon

202
Q

pigmented gallstones are associated with

203
Q

what is the management of an acute anal fissure

A

stool softening
dietary advice, bulk forming laxatives

204
Q

what is the management of a chronic anal fissure

A

GTN
sphincterotomy

205
Q

2 medications used in management of alcoholic liver disease

A

glucocorticoids
pentoxyphylline

206
Q

diagnosis of auto-immune haemolytic anaemia

A

positive direct antiglobulin test (Coombs’ test).

207
Q

Irreducible, painful lump inferolateral to the pubic tubercle → ?

A

strangulated femoral hernia

208
Q

how to differentiate femoral vs inguinal hernia

A

femoral hernias, which are inferolateral to the pubic tubercle, from inguinal hernias which are supermedial to the pubic tubercle;

209
Q

what factors indicate severe pancreatitis

A

age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

210
Q

how to distinguish incarcerated vs strangulated hernias

A

incarcerated= not painful

211
Q

what is renyolds pentad

A

Reynold’s pentad = Charcot’s triad plus hypotension and confusion

212
Q

features of primary biliary cholangitis

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

213
Q

Lateral anal fissure?

A

look for other causes

214
Q

most sensitive test for hiatus hernia

A

barium swallow

215
Q

what are the two kinds of hiatus hernia

A

sliding : 95% of hiatus hernias where the gastroesophageal junction moves above the diaphragm

rolling : gastroesophageal junctions remains below the diaphragm but a separate part of the stomach herniates through the oesophageal hiatus

216
Q

management of hernias

A

all patients benefit from conservative management e.g. weight loss
medical management: proton pump inhibitor therapy
surgical management: only really has a role in symptomatic paraesophageal hernias

217
Q

how often are patients with coeliac disease given the pneumococcal vaccine

A

every 5 years

218
Q

what is the management of biliary colic

A

elective laparoscopic cholecystectomy

219
Q

investigation of choice for pancreatic cancer

A

high resolution CT Scan of the pancreas

220
Q

what is the management of acute cholecystitis

A

early laparoscopic cholecystectomy - within 1 week of diagnosis

221
Q

most appropriate antibody to aid diagnosis of pernicious anaemia

A

intrinsic factor antibodies

222
Q

which laxative should be avoided in ibs

223
Q

achalasia increases the risk of which type of cancer

A

squamous cell carcinoma of oesophagus

224
Q

which deficiencies are coeliac disease associated with

A

iron
folate
vitamin B12

225
Q

what is Richter hernia and how does it present?

A

absence of symptoms of obstruction even if there is strangulation , metabolic acidosis present with a firm mass on abdominal wall and central abdominal pain

226
Q

how does staph aureus gastroenteritis present

A

severe vomiting and short incubation period

227
Q

how to manage congenital inguinal hernia

A

Should be surgically repaired soon after diagnosis as at risk of incarceration

228
Q

how to manage infantile umbilical hernia

A

The vast majority resolve without intervention before the age of 4-5 years

229
Q

anaemia of chronic disease

A

normocytic anaemia with low serum iron, low TIBC but raised ferritin in a patient with a chronic illness

230
Q

what is the diagnostic investigation for necrotising enterocolitis ?

A

abdominal xray

231
Q

what is the most common cause of ascending cholangitis ?

232
Q

what is the management of ascending cholangitis ?

A

Intravenous antibiotics
ERCP after 24-48 hours

233
Q

what is the presentation of anal fissures? What is the most common site that they occur on ?

A

painful, bright red rectal bleeding
90% of anal fissures occur on the posterior midline

alternative location - consider alternative diagnosis like crohns disease

234
Q

what is the management of an acute anal fissure ?

A

stool softening - dietary advice and bulk forming laxatives
lubricants
topical anaesthetics and analgesia

presents under 1 week

235
Q

what is the management of a chronic anal fissure

A

topical GTN
not effective after 8 weeks ? consider secondary care referral : sphincteromy

236
Q

what is the definition of travellers diarrhoea ? what is the most common cause ?

A

at least 3 loose to watery stools in 24 hours with or without one of : abdominal cramps, fever, nausea, vomiting or blood

most common cause - E. Coli

237
Q

which bacteria causes acute food poisoning ? under what time limit does this usually happen?

A

staph. aureus and bacillus cereus

1-6 hours

238
Q

which bacterial causes diarrhoea after consumption of rice

A

bacillus cereus

239
Q

what are the features of campylobacter diarrhoea ? What are its complications?

A

flu like prodrome : followed by crampy abdominal pains, fever and diarrhoea

mimics appendicitis

complications - GBS

240
Q

which bacteria’s cause diarrhoea with an incubation period beyond 7 days ? how do you distinguish between them ?

A

Giardiasis and amoeba
giardiasis = prolonged non bloody diarrhoea
amoebiasis = gradual onset non bloody diarrhoea

241
Q

how does cholera present

A

profuse watery diarrhoea
severe dehydration

242
Q

what bacterias causing gastroenteritis have an incubation period of -

12-48 h
48-72

A

salmonella, E.Coli
shigella, campylobacter

243
Q

what is the first line management of constipation in IBS

A

Isphagula husk

244
Q

which is the most prominent symptom of crohns in kids

A

abdominal pain

245
Q

which IBD are gallstones associated with?

A

crohns disease

246
Q

what is a rare ocular feature associated with pancreatitis

A

Ischaemic Purtscher retinopathy - causing temporary or permanent blindness

247
Q

diagnostic test for acute pancreatitis

A

serum lipase

248
Q

how to identify the cause of acute pancreatitis

A

trans-abdominal ultrasound

249
Q

difference between incarcerated and strangulated hernia

A

incarcerated -cannot be reduced
strangulation - pain + not haemodynamically stable

250
Q

what is the management of an inguinal hernia ?

A

treat medically fit patients even if asymptomatic
hernia truss - for patients not fit for surgery
mesh repair - unilateral inguinal hernias : open approach
bilateral and recurrent : laparoscopic repair

251
Q

what is the medical management of campylobacter jejuni

A

clarithromycin

252
Q

how do you assess an inguinal hernia

A

press on deep inguinal ring and ask patient to cough

253
Q

what is the picture of biliary colic in gallstones on LFT’s

A

No fever and LFT’s , inflammatory markers and normal

254
Q

what white cell might be seen in acute appendicitis

A

neutrophil predominant leukocytosis

255
Q

diagnostic sign of alcoholic hepatitis

A

AST: ALT > 2

256
Q

What i s the manahement of haemorrhoids

A

soften stools - increase dietary fibre and fluid intake
topical local anaesthetics and steroids
outpatient - rubber band ligation

257
Q

what is the presentation and management of acutely thrombosed external haemorrhoids

A

significant pain
purplish, oedematous tender subcutaenous perianal mass

within 72 h - consider referral for excision

post 72 h : consider referral for exision and manage with stool softeners, ice packs and analgesia

258
Q

how to prevent spread of c diff

A

side room , wear disposable gloves + aapron 48 h

259
Q

what organisms cause post splenectomy sepsis

A

Streptococcus pneumoniae
Haemophilus influenzae
Meningococci

260
Q

what are the complications of acute pancreatitis

A

peripancreatic fluid collections
pseudocysts
pancreatic necrosis
pancreatic abscess

261
Q

what is ischaemic hepatitis

A

acute hypoperfusion that usually follows an inciting event such as a cardiac arrest and causes a marked increase in aminotransferases

262
Q

which anatomical landmark allows the categorisation of a bleed during urgent endoscopy

A

ligament of Treitz

263
Q

what investigation can be useful for diagnosing and monitoring severity of liver disease

A

transient elastography

264
Q

what is the management of achalasia

A

pneumatic balloon dilation is the first option
Heller cardiomyotomy if recurrent or persistent symptoms

265
Q

what happens to serum ceruloplasmin and total serum copper in wilsons disease

266
Q

plummer vinson syndrome

A

triad of iron deficiency anaemia, dysphagia due to oesophageal webs
atrophic glossitis

267
Q

management of barrets dysplasia

A

endoscopic intervention

268
Q

what are the features of budd chiari syndrome ? how is investigated

A

abdominal pain - sudden onset and severe
ascites - abdominal distension
tender hepatomegaly

investigation : ultrasound with doppler flow studies

269
Q

side effects of metoclopramide

A

extra-pyramidal
diarrhoea
hyperprolactinaemia
tardive dyskinesia
parkinsonism

270
Q

autoimmune hepatitis on blood tests

A

raised ALT:AST, AMA negative

271
Q

c/i to metoclopramide

A

bowel obstruction

272
Q

what is small bowel bacterial overgrowth syndrome

A

excessive amounts of bacteria in the small bowel causing GI symptoms

Risk factors -
congenital GI abnormalities
scleroderma
DM

273
Q

management of small bowel bacterial overgrowth syndrome

A

correct disorder
rifaximin ( antibiotic therapy)

274
Q

management of hepatic encephalopathy

A

lactulose
add rifaximin

275
Q

diagnostic investigation for primary sclerosing cholangitis

276
Q

Stopping medications before OGD (1-4):

A

1 day = gaviscon
2 weeks = PPIs
3 days = ranitidine
4 weeks = antibiotics

277
Q

Testing for H. pylori infection

A

carbon-13 urea breath test or a stool antigen test

278
Q

Mx of acute phosphotaemia

A

IV infusion of potassium

279
Q

causes of budd chiari syndrome

A

polycythaemi rubra vera
thrombophilia
pregnancy
cocp

280
Q

Child-Pugh score

A

A - albumin
B - bilirubin
C - clotting
D - distention (ascites)
E - encephalopathy

281
Q

differentiating between perforated ulcer and bleed

A

perforation would have signs of peritonitis, rigidity and gaurding

282
Q

The combination of deranged LFTs combined with secondary amenorrhoea in a young female strongly suggest

A

autoimmune hepatitis

283
Q

The best test to see whether iron overload is present is

A

transferrin saturation

284
Q

signs of acute liver failure

A

jaundice
raised PT
hypoalbuminaemia
hepatic encephalopathy
renal failure
sweet fecal breath

285
Q

what is peutz Jeghers syndrome

A

autosomal dominant condition characterised by hamartomatous polyps in the GI tracted and associated with pigmented freckles on the lips, face, palms and soles

286
Q

presenting feature of peutz jeghers syndrome

A

small bowel obstruction due to intussuception

287
Q

globus pharyngis

A

Globus pharyngis (also known as globus hystericus) is the persistent sensation of having a ‘lump in the throat’, when there is none. Symptoms are often intermittent and relieved by swallowing food or drink. Swallowing of saliva is often more difficult.

288
Q

ppi adverse effects

A

hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections

289
Q

Patients with GORD being considered for fundoplication surgery require

A

oesophageal pH and manometry studies

290
Q

management of bleeding ulcers despite endoscopic therapy

A

laparotomy and surgical exploration

291
Q

riboflavin ( vitamin B2) Deficiency

A

angular cheilitis - cracking, itching crusting

292
Q

triggers for liver decompensation

A

constipation
infection
electrolyte disturbances
dehydration
upper GI bleeds
increased alcohol intake

293
Q

Type 1 hepatorenal syndrome

A

rapidly progressive
doubling of serum creatinine

294
Q

type 2 hepatorenal syndrome

A

slowly progressive
poor prognosis

295
Q

cause of hepatorenal syndrome

A

splanchnic vasodilation which reduces systemic vascular resistance

296
Q

mx of hepatorenal syndrome

A

vasopressin analogues - terlipressin

297
Q

patients requiring non urgent endoscopy

A

treatment resistant dyspepsia
raised platelets
haematemesis

298
Q

_________________is the single strongest risk factor for the development of Barrett’s oesophagus

299
Q

what picture does paracetamol overdose cause on LFT’s

A

hepatocellular -
high ALT, normal ALP, ALT/ALP high

300
Q

what liver condition can COCP cause

A

gallstones

301
Q

strongest association for h pylori

A

duodenal ulceration

302
Q

appropriate test for small bowel overgrowth syndrome

A

hydrogen breath testing

303
Q

Zollinger ellison syndrome

A

excessive levels of gastrin secondary to gastrin secreting tumour.
MEN1
multiple gastroduodenal ulcers
diarrhoea
malabsorption

fasting gastrin levels and secretin stimulation test

304
Q

results for wilsons disease

A

ALT raised, urinary copper raised, serum ceruloplasmin raised

305
Q

what are the cardiac effects of carcinoid syndrome

A

pulmonary stenosis and tricuspid insufficiency

306
Q

how does C. diff present on colonoscopy

A

yellow plaques on the intra-luminal wall

307
Q

Primary sclerosing cholangitis can have positive

308
Q

viral hepatitis

A

nausea, vomiting, anorexia, myalgia, lethargy
RUQ pain
foreign travel
IVDU

309
Q

peutz jeghers syndrome

A

AD
polyps in gi tract and pigmented freckles on the lips, face, palms and soles

310
Q

Ongoing diarrhoea in Crohn’s patient post-resection with normal CRP

A

Cholestyramine

311
Q

A recurrent episode of C. difficile within 12 weeks of symptom resolution should be treated with

A

oral fidaxomicin

312
Q

Surgical treatment of achalasia -

A

Heller cardiomyotomy

313
Q

pathophysiology of hepatic encephalopathy

A

Ammonia crossing the blood-brain barrier

314
Q

In young men the two most common causes of lower abdominal pain are

A

appendicitis and testicular problems (infection and torsion).

315
Q

HBeAg is a marker of

A

viral replication and infectivity

316
Q

complication of transoesophageal fistula

A

benign oesophageal stricture

317
Q

long term complication of omeprazole

A

hypomagnesaemia

318
Q

refeeding syndrome definition

A

metabolic abnormalities which occur on feeding a person following a period of starvation.

319
Q

Plummer Vinson:

A

Plummers DIE: Dysphagia, Iron deficiency anemia, Esophageal webs

320
Q

which is the only test recommended for h.pylori eradication

A

urea breath test

321
Q

which antibiotics cause cholestasis

A

co-amoxiclav, erythromycin, flucloxacillin

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