Gastro 2

Question 1

Diagnosis and test
multiple gastroduodenal ulcers
diarrhoea
malabsorption

Answer 1

Zollinger Ellison Syndrome
- fasting gastrin levels
secretin stimulation

Question 2

Diagnosis and investigation
flushing
diarrhoea
bronchospasm
RHV stenosis
Cushings

Answer 2

Carcinoid syndrome
Ix: Urinary 5-HiAA
Plasma chromogranin A y

Question 3

Diagnosis and management
flushing
diarrhoea
bronchospasm
RHV stenosis
Cushings

Answer 3

Carcinoid syndrome
Octreotide
cyproheptadine (diarrhoea)

Question 4

Young female
Amenorrhea, fatigue
SMA +Ve
Diagnosis and management

Answer 4

autoimmune hepatitis
Type 1
Mx: steroids or azathioprine
liver transplant

Question 5

Alcoholic frank haematemasis
Diagnosis and management

Answer 5

Variceal haemorrhage
M : resuscitate
terlipressin
Prophy Abx if cirrhosis
TIPS

Question 6

middled aged women with itch
PHx Sjorgrens or RA

Likely bloods and diagnosis

Answer 6

AMA +Ve raised IgM
Primary biliary cholangitis

Question 7

middled aged women with itch
PHx Sjorgrens or RA

Diagnosis and Management

Answer 7

Primary Biliar cholangitis
MRCP to exclude obstruction

Ursodeoxycholic acid
Cholestyramide (itch)
increased risk of hepatocellular ca

Question 8

What would high urea in GI bleed indicate?

Answer 8

Upper GI source

Question 9

Which type of colon cancer are APC, p53 and DCC associated with?

Answer 9

sporadic

Question 10

Which type of colon cancer are MSH2 and MLH1 associated with and what history

Answer 10

HNPCC
3 x family members over 2 generations
<50

Question 11

What type of colon cancer is APC suppressor on Ch5 associated with

Answer 11

FAP
hundreds polyps by 30-40
total colectomy in 20s

Question 12

60 year old with painless jaundice
Diagnosis, management

Answer 12

CT pancreas
Likely pancreatic Ca (pancreatic head)
Whipples
ERCP with stents

Question 13

Isolated rise in bilirubin following stress
Diagnosis

Answer 13

Gilberts

Question 14

Middled aged female with dysphagia liquids and solids
Diagnosis and management

Answer 14

Achalasia
Confirmed with manometry
Pneumatic balloon dilation
Heller cardiomyotomy if persistent

Question 15

Middle aged male with dysphagia, vomiting and weight loss
PHx: asthma

Likely diagnosis

Answer 15

Eosinophilic oesophagitis

Question 16

Endoscopy: high eosinophils, furrows, reduced vasculature and strictures
Diagnosis and management

Answer 16

Eosinophilic oesophagitis
dietary modifications->fluticasone->oesophageal dilatation

Question 17

Cirrhosis pt with ascites, abdo pain and fever
Investigations and likely diagnosis

Answer 17

paracentesis - neutrophils >250 + E.coli
SBP

Question 18

Cirrhosis pt with ascites, abdo pain and fever
Likely diagnosis and management

Answer 18

SBP
IV cef
prophylaxis: PO cipro or norflox

Question 19

sudden onset severe abdo pain + ascites and hepatomegaly
PHx: PCV, thrombophilia, pregnant, COCP
Investigation and diagnosis

Answer 19

US doppler
Budd-Chiari Syndrome (hepatic vein thrombosis)

Question 20

Post cholecystectomy diarrhoea and abdo pain
Diagnosis and management

Answer 20

post cholecystectomy syndrome
low fat diet, cholestyramine

Question 21

Male, lethergy, polyuria and polydipsia, peripheral oedema, tanned skin

Likely diagnosis and genetic associations

Answer 21

Haemochromatosis
Ch6 HFE
autosomal recessive

Question 22

Perianal itch in multiple household members
likely cause and management

Answer 22

threadworms - enterobius vermicularis
mebendazole
anthelmintic and hygiene measures

Question 23

Middle aged man with malabsorption, arthralgia, blurred vision
PHx SLE
How would you confirm diagnosis + treatment

Answer 23

jejunal biopsy: macrophages containing PAS
Whipples
Mx: 1 year co-trimox