GASTRO GAP

Question 1

INV FOR ZOLLINGER ELLISON

Answer 1

Diagnosis
fasting gastrin levels: the single best screen test
secretin stimulation test

Question 2

Hepatic vs Cholestatic Picture

Answer 2

proportionate rise in ALT > proportionate rise in ALP = hepatitic
hePAtitic e alP kom thake

proportionate rise in ALT < proportionate rise in ALP = obstructive/cholestatic

Question 3

GI Enzymes:
MALTASE
SUCRASE
LACTASE

Answer 3

MALTase = 2 glucose - NestoMALT - Double Glucose= Glucose + Glucose
sucRase = glucose + fRuctose
LACtase = glucose + gaLACtose

Question 4

Alcoholic Liver Disease

Answer 4

gamma-GT is characteristically elevated
the ratio of AST:ALT is normally > 2, a ratio of > 3 is strongly suggestive of acute alcoholic hepatitis

Question 5

Jejunal villous atrophy causes

Answer 5

Jejunal villous atrophy

Whilst coeliac disease is the classic cause of jejunal villous atrophy there are a number of other causes you need to be aware of

Causes
coeliac disease
tropical sprue
hypogammaglobulinaemia
gastrointestinal lymphoma
Whipple’s disease
cow’s milk intolerance

Question 6

Hepa B Serology

Answer 6

‘S’ is sinister

HbsAg shows ongoing infection either Acute or chronic means sinister is there.

Anti-Hbs is anti sinister: means immunized against sinister through vaccine or developed immunity after sin.

‘C’ is caught: anti- Hbc means have caught the virus at some stage. not positive in vaccine. Igm is for 6 months then igG after 6 months implying chronic infection.

‘E’ for enfectivity. HbeAg means ongoing enfection.

Question 7

Inv for Primary Biliary Cholangitis

Answer 7

• anti-mitochondrial antibodies (AMA) M2 subtype are present in 98% of patients and are highly specific
• smooth muscle antibodies in 30% of patients
• raised serum IgM

imaging
required before diagnosis to exclude an extrahepatic biliary obstruction (typically a right upper quadrant ultrasound or magnetic resonance cholangiopancreatography (MRCP)

Question 8

Pancreatic Cancer Presentation

Answer 8

The patient’s history (weight loss, jaundice, pruritis and steatorrhea), examination (palpable gallbladder - Courvoisier’s sign) and blood tests (obstructive jaundice) are most suggestive of pancreatic cancer. High resolution CT is the diagnostic investigation of choice.

Question 9

Presentation of Biliary colic

Answer 9

The patient presents with colicky right upper quadrant pain after eating a fatty meal in the background of a raised body mass index. The likely diagnosis is biliary colic.

Question 10

Inv for Gilbert

Answer 10

Investigation and management
investigation: rise in bilirubin following prolonged fasting or IV nicotinic acid
no treatment required

Question 11

OGD finding of gastric cancer

Answer 11

Signet Ring

Question 12

Villousb adenoma

Answer 12

Diarrhoea + hypokalaemia → villous adenoma