Gastroenterology

Question 1

Causes of upper GI bleed

Answer 1

• oesophageal varices
• peptic ulcer disease

*Glasgow-Blatchford score used at first assessment and Rockall score used after endoscopy

Question 2

Blatchford score

Answer 2

Urea
Hb
Systolic blood pressure
Other

Question 3

Acute upper GI bleed

Blood results

Answer 3

A raised urea

Low Hb

Question 4

What does a urine dip of renal tract stones look like

Answer 4

Positive protein, leucocytes adn blood

Negative nitrites and B-HCG

Question 5

What is haemochromatosis

Answer 5

Autosommal recessive disorder of iron absorption and metablosim resulting in iron accumulation.
Inhertinace of mutations in teh HFE gene on both copies of chromose 6

Question 6

Haemochromatosis

Diagnositc tests

Answer 6

molecular genetic testing for the C282Y and H63D mutations

liver biopsy: Perl’s stain

Question 7

Haemochromatosis

Management

Answer 7

• venesection

- desferrioxamine

Question 8

Examples of vitamin deficiencies

Answer 8

• pellagra - vit b3, niacin
• beriberi - vit b1
• scurvy - vit c

Question 9

Pellagra features?

Answer 9

Sun burn like dermaititis rash
Diarrhoea
Cognitive deficit

Question 10

H pylori investigation

Answer 10

Urea breath test

- 4 weeks of no antibacterial or 2 weeks of no antisecreotry drugs e.g. PPI

Question 11

Chron’s disease

Histology

Answer 11

• increased goblet cells
• granulomas
• inflammation in all layers from mucosa to serosa

Question 12

Biliary colic

Answer 12

RUQ pain, intermittent, usually begins abruptly and subsides gradually. Attacks often occur after eating. Nausea is common.

It is sometimes taught that patients are female, forties, fat and fair although this is obviously a generalisation.

Question 13

Acute cholecystitis

Answer 13

Pain similar to biliary colic but more severe and persistent. The pain may radiate to the back or right shoulder.

The patient may be pyrexial and Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)

Question 14

Ascending cholangitis

Answer 14

An infection of the bile ducts commonly secondary to gallstones. Classically presents with a triad of:
fever (rigors are common)
RUQ pain
jaundice

Question 15

Gallstone ileus

Answer 15

This describes small bowel obstruction secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum.

Abdominal pain, distension and vomiting are seen.

Question 16

Cholangiocarcinoma

Answer 16

Persistent biliary colic symptoms, associated with anorexia, jaundice and weight loss.

• A palpable mass in the right upper quadrant (Courvoisier sign)
• periumbilical lymphadenopathy (Sister Mary Joseph nodes)
• left supraclavicular adenopathy (Virchow node)

Question 17

Acute pancreatitis

Answer 17

Usually due to alcohol or gallstones
Severe epigastric pain
Vomiting is common
Examination may reveal tenderness, ileus and low-grade fever
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare

Question 18

Pancreatic cancer

Answer 18

Painless jaundice is the classical presentation of pancreatic cancer.
However pain is actually a relatively common presenting symptom of pancreatic cancer. Anorexia and weight loss are common

Question 19

Amoebic liver abscess

Answer 19

Typical symptoms are malaise, anorexia and weight loss. The associated RUQ pain tends to be mild and jaundice is uncommon.

Question 20

Viral markers for Hep B

Answer 20

Surface antigen (HBsAg) – active infection
E antigen (HBeAg) – marker of viral replication and implies high infectivity
Core antibodies (HBcAb) – implies past or current infection
Surface antibody (HBsAb) – implies vaccination or past or current infection
Hepatitis B virus DNA (HBV DNA) – this is a direct count of the viral load

Question 21

When screening for hepatitis B, test what?

Answer 21

HBcAb (for previous infection) and HBsAg (for active infection). If these are positive then do further testing for HBeAg and viral load.

Question 22

What is melanosis coli

Answer 22

Melanosis coli is a disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages

It is associated with laxative abuse, especially anthraquinone compounds such as senna

Question 23

What electrolyte imbalance causes hyponatraemia

Answer 23

PPI

Question 24

Primary biliary cholangitis

Answer 24

M rule

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

Question 25

Hepatic encephalopathy management

Answer 25

Lactulose 1st line

With addition of rifaximin for secondary prophylaxis

Question 26

What medication should be avoided in bowel obstruction?

Answer 26

IV metoclopramide

Question 27

Adverse effects of aminosalicylate drugs

Answer 27

Aminosalicylates are associated with a variety of haematological adverse effects, including agranulocytosis - FBC is a key investigation in an unwell patient taking them.