Gastroenterology

Question 1

Pharyngeal pouch

Answer 1

Intermittent dysphagia (mainly to solids), regurgitation of undigested foods, halitosis, aspiration and weight loss.
Inx: Barium swallow

Question 2

Coeliac disease

Answer 2

1st line inx: Serum immunoglobulin IgA tissue transglutaminase antibody
Gold standard for dx: Small bowel biopsy

Question 3

Medications contributing to dyspepsia

Answer 3

NSAIDs, Aspirin, Bisphosphonates

Question 4

Cholecystitis

Answer 4

Inflammed gallbladder due to gallstones blocking cystic duct
Right upper quadrant pain, radiates to chest or back
Pain often triggered by eaten
Pain might be worse on deep inspriation (positive Murphy’s sign)

Question 5

Ischaemic colitis

Answer 5

Acute rapid onset, left=side upper severe abdominal pain and rectal bleeding
A past medical history of atrial fibrillation puts a patient at risk of a thrombotic or embolic event.

Question 6

Primary biliary cirrhosis

Answer 6

Symptoms: tiredness, itching of skin
Bloods: slight raise in liver enzymes, **positive mitochondrial antibodies **

Question 7

Ulcerative colitis

Answer 7

Recurrent lower abdominal pain associated with rectal bleeding
Bleeding is less common with Crohn’s disease (CD) but almost universal in ulcerative colitis (UC). Ulcerative colitis most commonly presents between the ages of 15 and 25, and presenting symptoms are typically diarrhoea and bleeding per rectum.

Question 8

Stool MC&S results

Answer 8

Gram-negative rod: E. coli - inhabitants of our intestines, and they form part of our normal gut flora
Gram-positive, spherical: S. aureus
Gram-positive, spore forming, rod: *Bacillus Cereus *
Gram-positive rod: Listeria monocytogenes - spread by consumption of unpasteurized dairy products or deli meats
Flagellated protozoan parasite: Giardia

Question 9

Most common viral cause of gastroenteritis in children

Answer 9

Rotavirus

Question 10

Pruritis ani

Answer 10

Idiopathic pruritis ani can be a troublesome problem for people.
Management involves eliminating risk factors and improving perianal hygiene.
Active treatments include methylene blue, capsaicin cream, topical hydrocortisone and topical tacrolimus.

Question 11

Primary biliary cholangitis

Answer 11

• Chronic disease in which the small bile ducts in the liver become injured and inflamed and are eventually destroyed
• Treatment:
  First-line treatment for all patients with primary biliary cholangitis is oral ursodeoxycholic acid (UCDA),

A second-line licensed treatment is obeticholic acid (OCA) and this may be used either as an adjunctive therapy if there is an inadequate response to UCDA alone, or as an alternate therapy if UCDA is not tolerated or if symptomatic relief is not achieved.

Question 13

According to the British Society of Gastroenterology, which SINGLE gastroenterological condition are probiotics MOST likely to be beneficial for

Answer 13

IBS

Question 14

IBS

Answer 14

Irritable bowel syndrome typically presents with symptoms of alternating constipation and diarrhoea, abdominal pain and abdominal bloating. Pain tens to improve with defacation.