Gastroenterology

Question 1

Irritable bowel syndrome

Answer 1

Abdominal pain associated with defecation.
Change in bowel habit either hard or loose.
Increased or decreased frequency in stools.
Age <50
No red flag symptoms ie. bleeding ,anaemia,

Question 2

Rick factors for NSAID induced PUD

Answer 2

Age >65
Previous Ulcer
H.Pylori presence
Concurrent Aspirin, anticoagulant, SSRI, Steroids
Smoking

Question 3

Prophylactic PPI

Answer 3

Consider in patients taking NSAID or aspirin low term with additional risk factors including:
- Previous Ulcer
- Old age
- Concurrent anticoagulant, SSRI, Steroids
- Smoking.

Also consider testing for and eradicating H.pylori

Question 4

Evaluate for malnutrition / consequence of malabsorptive diarrhoea

Answer 4

• Ferritin
• Albumin
• INR (prothrombin time)
• B12/ folate
• Vitamin D level
• Cholesterol
• Anaemia

Question 5

Causes of B12 deficiency

Answer 5

Pernicious anaemia
Chronic pancreatitis / pancreatice insufficiency
Crohns Disease
Prior gastric surgery
SIBO

Question 6

Coeliac disease treatment

Answer 6

Exclusion of wheat, rye and barley.

Rebiopsy in 3 months

*Pneumococcal vaccine due to concurrent hyposplenism

Look for an treat osteoporosis

Question 7

Cancer screening in Inflammatory Bowel Disease

Answer 7

Pancolitis -> Screening colonoscopy from 7 years

Left sided colitis -> Screening colonoscopy from 15 years

Question 8

Crohns disease treatment

Answer 8

Budeosonide if ileocolonic disease
*Also consider cholestyramine for bile sale malabsorption in ileocolonic disease.

Prednisolone -> Small bowel disease

Azathioprine or MTX as sparing agents / maintenance therapy

Biologics

Question 9

Polyp surveillance

Answer 9

1-2 polyps -> 5 Yearly
3-10 polyps or >10mm -> 3 yearly

Question 10

Complications Haemochromatosis

Answer 10

Cirrhosis and HCC
Polyarthropathy - Typically involves 2/3rd MCP
Dilated cardiomyopathy
Conduction defects
Diabetes mellitus

Question 11

Investigations suggestive haemochromatosis

Answer 11

Ferritin >300
TF sats >60%

Question 12

Criteria to consider liver transplant

Answer 12

Childs Pugh >6 (Class B)
MELD >10 (Bili, INR, Cr, Na)
Previous life threatening variceal haemorrhage
Encephalopathy
HRS

Question 13

Contraindications to transplant

Answer 13

Active malignancy including cholangiocarcinoma
Advanced cardiac, respiratory or renal disease
Active systemic infection
HIV
Ongoing alcohol intake

Question 14

Complications liver transplant

Answer 14

Infection
Rejection
Mineral bone disease
Metabolic disease from immunosuppresion
Skin and other cancers
Biliary strictures

Question 15

Differential massive hepatomegaly

Answer 15

NAFLD
Metastasis
Myeloproliferative disease
Right heart failure (also tender)
Hepatocellular carcinoma

Question 16

Ddx Renal masses

Answer 16

Bilateral
- APCKD
- Hydronephrosis
- Amyloidosis
- Lymphoma
- Acromegaly

Unilateral
- Obstruction -> hydronephrosis
- RCC
- Renal vein thrombosis

Question 17

Adult polycystic disease complications

Answer 17

Splenic Cysts
Hepatic Cysts
Subarachnoid haemorrhage Secondary to intracranial aneurysm

Question 18

Splenomegaly Causes

Answer 18

CML
Myeloproliferative Disease
Leukaemia
Lymphoma
Amyloidosis
Portal Hypertension
Glycogen storage disease
Infection: EBV,
Rheumatoid arthritis

Question 19

Hepatosplenomegaly

Answer 19

Chronic liver disease with portal hypertension
CML, Myeloproliferative disease, lymphoma
Infection: EBV
Amyloidosis
Acromegaly

Question 20

Differentiate a spleen

Answer 20

Can’t get above
Downward excursion on inspiration
Splenic notch
Not ballot able

Question 21

Signs of chronic liver disease

Answer 21

• Spider naevi
• Gynecomastia
• Hair loss
• Jaundice
• Clubbing
• Hepatosplenomegaly
• Caput medusa
• Bruising
• Palmar erythema