Gastro

Question 1

Presentation of acute pancreatitis

Answer 1

LUQ pain, radiating to back
Jaundice N+V
Weight loss due to lack of pancreatic enzymes

Question 2

Causes of pancreatitis

Answer 2

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
High triglycerides/calcium
ERCP
Drugs

Question 3

Presentation of ascending cholangitis

Answer 3

Charcots triad: Fever
Jaundice
RUQ pain

Question 4

What is ascending cholangitis?

Answer 4

Inflammation of bile duct from bacteria ascending from duodenum.
Tends to occur if the bile duct is already partially obstructed by gallstones

Question 5

Treatment of chronic pancreatitis?

Answer 5

Analgesia, pancreatic enzymes (creon)

Question 6

Features chronic pancreatitis

Answer 6

Pain worse 30m after meal
Steatorrhoea
DM develops in most pt

Question 7

Management ascending cholangitis?

Answer 7

IV ABx
IV fluids
Biliary decompression + drainage with ERCP

Question 8

What effect does obstructive jaundice have on clotting?

Answer 8

Can lead to decreased absorption of vit K so check PT

Question 9

Symptoms of oesophageal ca?

Answer 9

Progressive dysphagia, weight loss, hoarse voice (invades recurrent laryngeal)

Question 10

Duodenal v gastric ulcers

Answer 10

• duodenal 4x more common
• D: relieved by eating, G: pain on eating
• gastric relieved by antacids

Question 11

2WW for dyspepsia?

Answer 11

>55
GI bleed
Weight loss
Dysphagia
IDA
Persistent vomiting
Epigastric mass

Question 12

Managment for dyspepsia with no alarm symptoms?

Answer 12

• stop drugs causing dyspepsia eg NSAIDs
• antacids
• lifestyle changes
• r/v 4 w

Question 13

Symptoms of simple GORD:

Answer 13

• less painful than ulcers
• precipitated by specific things eg spicy foods
• radiates up to chest/neck

Question 14

2ww pancreatic cancer

Answer 14

• > 40y with jaundice

Question 15

2ww oesophageal cancer

Answer 15

• dysphagia or
• aged >55 with weight loss AND
  1. dyspepsia OR
  2. upper abdo pain OR
  3. reflux

Question 16

Three inheritance of colon cancer?

Answer 16

• sporadic
• HNPCC (at risk of other cancers)
• FAP (removal of large bowel to form ileo-anal pouch in 20s)

Question 17

Symptoms of IBD?

Answer 17

• diarrhoea with blood and mucus
• frequent toileting
• urgency
• abdo pain
• may experience fatigue, weight loss, decreased appetite.

Question 18

How does UC occur?

Answer 18

It is an autoimmune condition. The body sees the gut as foreign and attacks it, therefore causing inflammation

Question 19

Cardinal symptom of UC?

Answer 19

bloody diarrhoea

Question 20

Extra-abdominal manifestations of IBD

Answer 20

Ank spond
PSC+ cholangiocarcinoma (esp UC)
Gallstones (esp crohns)
iritis/episcleritis/conjunctivitis
arthritis
Clubbing
erythema nodosum

Question 21

Investigations for IBD?

Answer 21

B: FBC, U+E, LFT, CRP, ESR, 
O: faecal calprotectin
X: AXR
E: NA
S: Flexi-sig/colonoscopy

Question 22

Presentation of Gallstone?

Answer 22

May be asymptomatic
May be colicky RUQ pain
May present as acute cholecystitis

Question 23

presentation of acute cholecystitis

Answer 23

RUQ pain
fever
vomiting
local peritonism
GB mass
murphys sign +

Question 24

Treatment of cholecystitis

Answer 24

Pain relief
IV ABx
Laparascopic cholecystectomy

Question 25

Crohns on biopsy

Answer 25

Skip lesions

Transmural granulomatous inflammation

Question 26

Symptoms of IBS

Answer 26

> 6m of:
Abdo pain
bloating
altered bowel habit

Question 27

Location of Crohn’s disease

Answer 27

Ileo-caecal area

Question 28

Location of UC

Answer 28

Distal colon

Question 29

Complication of UC

Answer 29

toxic megacolon, massive haemorrhage, colon cancer, bowel rupture

Question 30

Complications of Crohn’s

Answer 30

Stenosis, fisulae, granulomas, abscesses, colon cancer,

Question 31

Complication of IBD:

Answer 31

• Blood loss leads to anaemia
• Stoma formation
• rupture/perf of bowel wall
• Stricture
• fistulae
• granulomas
• toxic megacolon
• malnutrition
• bowel cancer

Question 32

Biopsy of coeliac?

Answer 32

villus atrophy of duodenum

crypt hyperplasia

Question 33

Markers of hepatic inflammation?

Answer 33

AST + ALT

Question 34

Markers of biliary congestion?

Answer 34

ALP + Bili

Question 35

Markers of synthetic liver function?

Answer 35

Albumin - produced by the liver
Clotting - liver produces clotting factors (fibrinogen/prothrombin)
Bilirubin - the liver metabolises into CB
Platelets - thrombocytopenia is the most common haem abnormality found in liver disease