Gastro

Question 1

Four most common causes of LOWER GI haemorrhage

Answer 1

Haemorrhoids
Angiodysplasia
Diverticulosis
Carcinoma 
(Other, IBD, polyp, ischaemic colitis)

Question 2

Three most common causes of pancreatitis

Answer 2

Alcohol and gallstones  60-80%
Idiopathic - remaining 15%
(Post op, ERCP)
Other causes are 
Metabolic (hyperTAG, hypercalcaemia)
And 
Infectious ( mumps, vital hepatitis)
Drug induced (sulfonamide, thiazides)

Question 3

Most common causes of SBO

Answer 3

Adhesions

Hernias

Question 4

Most common causes of LBO

Answer 4

Strictures (diverticulitis)
Colorectal carcinoma
Volvulus

Question 5

Causes of liver toxic drugs - PAID MCV

Answer 5

Paracetamol
Amiodarone
Isoniazid (and other TB drugs)
Doxycycline and diclofenac - NSAID

Methotrexate
Chlorambucil
Valproate

Question 6

Liver screen for liver failure

Answer 6

Bloods: LFT, Bloods (low pt), lactate
Liver synthesis: INR, albumin,
Liver clearance: bilirubin

Paracetamol concentration 
Hepatitis serology 
A1AT
Copper studies 
Iron studies

Question 7

Two hereditary colorectal cancer syndromes

Answer 7

Familial adenomatous polyposis FAP
And
Hereditary non polyposis colorectal cancer HNPCC or Lynch syndrome

Question 8

What is the gene penetrance of FAP and HNPCC ( Lynch）

Answer 8

FAP: APC gene, autosomal dominant
HNPCC: mismatch repair gene - 6 in total, Amsterdam criteria (3 relatives within 2 generation, 1 with cancer before 50 yo)

Question 9

How often should FAP and HNPCC individuals be screened?

Answer 9

FAP: From 15 every 2 years colonoscopy, from 25 every 2 years gastroscope for jejunal polyps
HNPCC: From 25 every 2 years

Question 10

Four most common causes of upper GI haemorrhage

Answer 10

Peptic ulcer disease 
Varices
Oesophagitis
Mallory Weiss tears 
(Erosive gastritis, carcinoma, AV malformation)

Question 11

What is Duke’s criteria?

Answer 11

A- polyp not in muscularis propria
B- polyp extended in muscularis propria
C- polyp extended through MP and lymph node
D - extra colonal metastasis

Question 12

Man is Stabbed in 9ICS MAL. What organ?

Answer 12

Spleen

Question 13

Direct inguinal hernia enters canal through whAt structure?

Answer 13

Posterior wall of inguinal canal

Question 14

Indirect inguinal hernia enters canal through ?

Answer 14

Deep inguinal ring

Question 15

Cells producing HCl? Also produce what?

Answer 15

Parietal cells

Also intrinsic factor

Question 16

WhT makes Callot triangle ?

Answer 16

Inferior edge liver
Common hepatic duct
Cystic duct

Important to avoid cystic artery in cholecystectomy

Question 17

Structure directly posterior to Epiploic foremen ?

Answer 17

IVC

Question 18

Cholecystokinin release is triggered by

Answer 18

Acidic fatty chyme in duodenum

Question 19

Effects of cholecystokinin

Answer 19

Bile production

Stops stomach from emptying

Question 20

Blood supply of pancreas =

Answer 20

Blood supply pancreas =

Coeliac trunk + SMA

Question 21

Courvoisier’s law

Answer 21

Painless jaundice - and palpable gall bladder - unlikely to be gall stones

Question 22

Gastro oesophageal junction at

Answer 22

7 costal cartilage

Question 23

Deep inguinal ring relative to inferior epiploic gastric vessels

Answer 23

Lateral

Question 24

Retroperitoneal structures

Sad pucker

Answer 24

Head and body of pancreas
Kidneys 
Ascending descending colon 
Ureters
Adrenals 
Aorta and ivc 
Duodenal 2/3

Question 25

Portal triad

Answer 25

Portal vein
Hepatic artery
Common bile duct

Question 26

Hernia above and medial to pubic tubercle

Answer 26

Inguinal hernia

Question 27

Signs of acute liver failure

Answer 27

Hepatomegaly
Jaundice
Cerebral oedema 
Hepatic encephalopathy 
- fetor, AMS, asterexis, hyperreflexia