Gastro-HPB

Question 1

What is the primary function and source of gastrin?

Answer 1

stimulate gastric acid release, G cells

Question 2

What is the stimulation, primary function and source of CCK?

Answer 2

instestinal aa etc, stimulate GB contraction, I cells in jejunum/ileum

Question 3

What is the stimulation, primary function and source of secretin?

Answer 3

intraluminal acid, stimualte pancreatic HCO3 release, S cells in duodenum/jeunum

Question 4

What is the stimulation, primary function and source of somatostatin?

Answer 4

intraluminal fat/bile salt, inhibit gastric acid, gastrin, pancreatic enzyme/hormone release, D cells in pancreas. also inhibit GH release

Question 5

Where is squamous cell carcinoma of the oesophagus mostly found and what are the risk factors?

Answer 5

Upper 2/3 of oesophagus. smoking, alcohol, achalasia

Question 6

Where is adenocarcinoma of the oesophagus mostly found and what are the risk factors?

Answer 6

Lower 1/3 of oesophagus. Barret’s oesophagus/GORD

Question 7

What investigation is best for staging and potential treatment of oesophageal cancer

Answer 7

Endoscopic ultrasound

Question 8

What is the key pathological feature behind Zollinger-Ellison syndrome?

Answer 8

excess gastrin levels from gastrinoma causing severe upper GI tract ulceration

Question 9

Screening test for Zollinger-Ellison syndrome?

Answer 9

raised fasting gastrin level

Question 10

What HLA antigen is Coeliac’s associated with?

Answer 10

HLA-DQ2/HLA-DA8

Question 11

What is the name and inheritance pattern of the genetic cause of aggressive colorectal cancer and ovarian cancer?

Answer 11

Hereditary non-polyposis colorectal cancer/Lynch syndrome. Autosomal dominant

Question 12

What is used for rescue therapy in acute severe IBD flare ups and what are the indications for this?

Answer 12

Infliximab, a TNF-alpha antagonist, is indicated when:
1. Persistent colon distension
2. >8 bowel movement/day
3. CRP > 45

Question 13

What is used for maintenance therapy in Crohn’s and UC, respectively?

Answer 13

Crohn’s = azathioprine/mercaptopurine
UC = aminosalicylate TOP/PO

Question 14

What needs to be checked before starting azathioprine or mercaptopurine?

Answer 14

TPMT activity

Question 15

What is the first line choice to induce remission in Crohn’s and UC?

Answer 15

Crohn’s = corticosteroids
UC = aminosalicylates

Question 16

What is used to manage diarrhoea post-colectomy in Crohn’s?

Answer 16

Cholestyramine

Question 17

What is the cause of Whipple’s disease and what HLA antigen is it associated to?

Answer 17

T. Whippelli, HLA-B27

Question 18

What is the diagnostic feature and treatment for Whipple’s disease?

Answer 18

macrophages with PAS granules on jejunal biopsy, co-trimoxazole

Question 19

What is the key pathological feature of angiodysplasia and how does it therefore present?

Answer 19

Vascular deformity of the GI tract. Present as upper or lower GI bleed

Question 20

How is SB overgrowth syndrome diagnosed and treated?

Answer 20

Hydrogen breath test, rifampicin

Question 21

What is the mechanism of Terlipressin?

Answer 21

vasopressor receptor antagonist - promote splanchnic vasoconstriction

Question 22

What is the SAAG cut-off for a transudate ascites and what are these caused by?

Answer 22

11g/L, portal hypertension

Question 23

auto-Ab associated with PBC?

Answer 23

AMA

Question 24

first line investigation in PBC?

Answer 24

USS liver/MRCP to r/o extrahepatic biliary obstruction

Question 25

Which viral hepatitis is particularly dangerous in pregnancy?

Answer 25

Hepatitis E

Question 26

What serology findings would you expect to see in the following phases of Hepatitis B?
1. Acute infection
2. Chronic infection
3. Previous infection/carrier
4. Vaccinated

Answer 26

1. HBsAg, HBV DVA
2. HBsAg, anti-HBc IgG
3. anti-HBs, anti-HBc IgG
4. anti-HBs