Gastro 2

Question 1

Other conditions associated with Coeliac disease?

Answer 1

Autoimmune thyroid
Dermatitis herpetiformis
T1DM
1st degree relatives

Question 2

Complications associated with coeliac disease?

Answer 2

Anaemia- iron, B12, folate deficiency
Osteoporosis
Lactose intolerance
T-cell lymphoma of small intestine
subfertility
hypersplenism

Question 3

How is coeliac diagnosed in children?

Answer 3

-jejunal biopsy showing subtotal villous atrophy
-anti-endomysial and anti-gliadin antibodies for screening

Question 4

Investigations for diagnosis of coeliac in adults?

-Serology
-Biopsy (gold-standard)

Answer 4

Serology:
-First line serological tests such as anti-TTG IgA antibody and IgA level, followed by anti-TTG IgG, anti-endomyseal antibody,

Biopsy:
-Oesophago-gastroduodenoscopy (OGD) and duodenal/jejunal biopsy

Question 5

Histology finds on biopsy for coeliac?

Answer 5

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

Question 6

Common sites for colon cancer?

Answer 6

rectal: 40%
sigmoid: 30%

Question 7

At what ages is the colorectal cancer screening offered?

Answer 7

Every 2 years to all men and women aged 60 to 74 years in England

Question 8

Investigation for perforated gastric ulcer?
Findings in CXR?

Answer 8

Plain erect CXR
5% of patients with a perforated peptic ulcer will have free air under the diaphragm

Question 9

Investigations for pancreatitis?

Answer 9

Amylase >3x the upper limit
Lipase -> longer half-time than amylase and may be useful for presentations >24 hours

Imaging:
Diagnosis of acute pancreatitis can be made without imaging if characteristic pain + amylase/lipase > 3 times normal level
If imaging needed-> USS

Question 10

Factors indicating severe pancreatitis?

Answer 10

Hypoxia
>55
Hypocalcaemia
Hyperglycaemia
Neurophilia
Elevated LDH and AST

Question 11

Causes of pancreatitis?
GET SMASHED

Answer 11

G- gallstones
E- ethanol
T- trauma

S- steroids
M- mumps
A- autoimmune
S- scorpion venom
H- hypertriglyceridaemia, hyperchylomicronaemia, hypercalcaemia, hypothermia
E- ERCP
D- drugs (azathioprine, mesalazine*, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)

Question 12

Complications of pancreatitis?

Answer 12

Pancreatic fluid collections
Pseudocysts- may need CR, ERCP, MRI, USS and treated with endoscopic or surgical cystogastrostomy or aspiration
Pancreatic necrosis
Pancreatic abscess

Question 13

Acute pancreatitis management?
Conservative
Surgical

Answer 13

Fluid resus- with crystalloids
Analgesia
NBM
Abx- not offer prophylactic abx

Surgery:
-Patients with acute pancreatitis due to gallstones - early cholecystectomy
-Patients with obstructed biliary system due to stones-> early ERCP
-Patients who fail to settle with necrosis and have worsening organ dysfunction may require debridement, fine needle aspiration is still used by some
-Patients with infected necrosis should undergo either radiological drainage or surgical necrosectomy. The choice of procedure depends upon local expertise