Gastroenterology

Question 1

Barretts oesophagus epithelial lining

Answer 1

columnar (normal is squamous)

Question 2

Stomach cells and associations
G
S
I
D

Answer 2

Gastrin - secretes HCL
Secretin
I CCK
D somatostatin

Question 3

Gilbert’s syndrome

Ix

Answer 3

Autosomal recessive

Ix - rise in bilirubin following prolonged fast OR nicotinic acid test

Question 4

C. DIff

a) cause
b) Ix

Answer 4

a) cephalosporins, clindamycin

b) Ix - C Diff Toxin (stool)

Question 5

C. Diff Mx

Answer 5

1st - Oral Vanc 10 days
2nd - oral Fidaxomicin
3rd (if life threatening) - oral Vanc + IV Metro
4th - consider surgery

Question 6

Hepatitis B serology
HBsAG (surface antigen)
Anti-HBs (surface antibody)
Anti-HBc (core antibody)
HBeAg

Answer 6

HBsAg - infected
Anti-HBs - immunity.
Anti-HBc - IgM current infection. IgG chronic infection.
HbeAg - marker of infectivity.

Question 7

Autoimmune hepatitis autoantibodies

Type 1, 2, 3

Answer 7

1 - ANA/ SMA - effects all
2 - LKM1 (anti liver/ kidney microsomal type 1 Ab) - children only
3 - soluble liver-kidney antigen - adults

Question 8

Duodenum absorbs what electrolytes (2)

Answer 8

iron, calcium

Question 9

H Pylori Mx

Answer 9

PPI + amoxicillin + metronidazole/ clarithromycin

Question 10

small bowel overgrowth syndrome
Ix
Mx

Answer 10

Hydrogen breath test - 1st line
Jejunal aspirate - gold standard
Mx - rifampicin

Question 11

Primary biliary cholangitis
Ix
Mx

Answer 11

Ix - Anti mitochondrial, Anti smooth muscle, raise IgM

Mx - ursodeoxycholic acid, liver transplant (if BR >100)

Question 12

H pylori Ix

Answer 12

Urea breath test

Question 13

Spontaneous bacterial peritonitis

a) most common bacteria
b) Mx
c) prophylaxis (protein <15)

Answer 13

a) e coli
b) IV Cefotaxime
c) Oral Ciprofloxacin

Question 14

Oesophageal/ gastric ca Ix

Answer 14

Endoscopic ultrasound

Question 15

Budd Chiari syndrome/ hepatic vein thrombosis Mx

Answer 15

1st - Ultrasound

Gold standard - hepatic venogram

Question 16

pancreatic ca Ix

Answer 16

CT high res CAP

Question 17

Barium swallow oesophagus results

a) dilated tapering
b) corkscrew
c) stricture with apple core effect

Answer 17

a) achalasia
b) oesophagitis
c) cancer

Question 18

Wilsons disease
Ix
Mx

Answer 18

Ix - reduced serum caeroplasmin

Mx - Penicillamine

Question 19

Pernicious anaemia (B12 def) Ix

Answer 19

Intrinsic factor antibodies

Question 20

Whipple's disease
Cause
HLA association
Jejunal biopsy
Mx

Answer 20

a) Tropheryma whippelii
b) HLA B27
c) deposition of macrophages containing Periodic acid-Schiff (PAS) granules
d) Co-trimoxazole

Question 21

Achalasia Ix gold standard

Answer 21

oesophageal manometry

Question 22

Wilson’s disease Features (3)

Answer 22

Young adult
Neuropsychitric symptoms
derranged LFTs

Question 23

Bile acid malabsorption
Ix
Mx

Answer 23

Ix - SeHCAT

Mx - cholestyramine

Question 24

Liver cirrhosis Ix

Answer 24

transient elastography

Question 25

Terlipressin MOA

Answer 25

constriction of splanchnic veins