Gastro

Question 1

What investigation would you perform for suspected chronic pancreatitis?

Answer 1

Faecal elastase

Question 2

What is the tumour marker for pancreatic cancer?

Answer 2

CA19-9

Question 3

42 yr old woman presents with crampy RUQ pain after a big curry night out with the lasses. She also has nausea and has vomited 3 times. Diagnosis?

Answer 3

Biliary colic

Question 4

What symptoms form Charcot’s triad referring to acute cholangitis ?

Answer 4

RUQ pain
Jaundice
Fever (w rigors)

Question 5

What is Murphy’s sign and what does it indicate ?

Answer 5

Pressure below costal margin mid clavicular line. When asked to beathe in patient winces and stops breathing in. Sign of Acute cholecystitis

Question 6

Bowel obstruction, which causes more frequent colicky pain, large or small?

Answer 6

Small bowel (cycle every 2-3mins)

Large bowel cycles every 10-15mins

Question 7

If a patient reports dark urine and pale stools, what is the likely diagnosis?

Answer 7

Obstructive Jaundice

Question 8

What causes Leuchonychia?

Answer 8

Hypoalbuminaemia as a result of chronic liver disease

Question 9

What is the twisting of the bowel called?

Answer 9

Volvulus

Question 10

What are the A->J of chronic liver disease?

Answer 10

Asterixis
Bruising
Clubbing
Dupytrens
Erythema (palmar)
Fetor Hepatticus
Gynaecomastia
Hair Loss
Icterus 
Jaundice
Leuconychia

Question 11

What are the possible causes of abdominal distention ?

Answer 11

Fat 
Foetus 
Faeces 
Flatus 
Fluid (ascites)

Question 12

What are the 3 C’s (+I) of hepatomegaly?

Answer 12

Cancer, Cirrhosis, Cardiac (CCF, pericarditis) Infiltration (Amyloid, Sarcoid, Haemochromatosis)

Question 13

What are the 5 categories of liver disease cause?

Answer 13

Alcohol
Autoimmune
Drugs
Viruses 
Biliary Disease

Question 14

What are the 4 causes of splenomegaly?

Answer 14

Portal Hypertension
Haematological
Infection
Inflammation

Question 15

List 5 causes of epigastric pain

Answer 15

Gastric Ulcer 
GORD 
Pancreatitis 
AAA
Gastritis 
MI?

Question 16

List 5 causes of RUQ pain:

Answer 16

Hepatits
Cholecystitis
Cholangitis 
Gallstones 
Abcess

Question 17

What might be the clues on examination that this patient has obstruction ?

Answer 17

Nausea, vomiting, constipation.
High pitched, tinkling bowel sounds.
? Previous surgery
?Tender, irreducible femoral hernia in the groin

Question 18

What is Courvoisier’s sign ?

Answer 18

A palpable gallbladder in the presence of painless jaundice is unlikely to be gallstones. Cholangiocarcinoma

Question 19

What is the most appropriate prophylactic medication for preventing vatical bleeds?

Answer 19

Propranolol - This is the correct answer. A non-cardioselective β blocker (NSBB) is used for primary and secondary prevention of bleeding in oesophageal varices. They act by causing splanchnic vasoconstriction, reducing portal blood flow.

Question 20

What drugs would you give in acute GI bleed?

Answer 20

Antibiotics 
Terlipressin (to cause splanchnic vasoconstriction )

Question 21

What is the most specific tumour marker for colorectal cancer?

Answer 21

CEA (Serum Carcinoembryonic antigen)

Question 22

What are the most common causes of LBO and SBO respectively?

Answer 22

SBO - Adhesions and hernias

LBO - Carcinoman and volvulus