Gastroenterology

Question 1

What is the investigation for suspected gastric ulcers/H.pylori?

Answer 1

Urea breath test
(drink urea isotope, H,pylori converts into isotope CO2, which you breath out, and is detected)

Question 2

Prior to urea breath test for H.Pylori, you must ensure the patient does not have __ 4 weeks prior and __ 2 weeks prior

Answer 2

No Abx in preceding 4 weeks
No PPI in preceding 2 weeks

Question 3

What complication can arise from NET?

Answer 3

Carcinoid syndrome

Question 4

NET in GI tract may release serotonin, but not cause carcinoid syndrome. Why not? In which situation would carcinoid syndrome be caused?

Answer 4

Carcinoid tumours in GI tract - the serotonin gets 1st pass metabolised by liver so doesn’t enter systemic circulation.

However in the case of GI -> Liver metastases, the 1st pass metabolism is bypassed, which causes carcinoid syndrome.

(NB// non GI carcinoid tumours (e.g. lung) are less common and cause carcinoid syndrome as they release directly into circulation)

Question 5

What is the treatment for H.Pylori infection?

Answer 5

TRIPLE THERAPY
1) Amoxicillin
2) PPI
3) Another ABx (either macrolide or metro)

Question 7

What are the causes of acute liver failure?

What is a late sign of hepatic encephalopathy?

Answer 7

Paracetamol (most common in UK)
Alcohol
Viral hepatitis
Acute Fatty Liver of Pregnancy

Fetor hepaticus (sweet musty faecal breath, as toxins excreted via breathing instead of stool) - ew

Question 8

What is the most common cause of gastroenteritis UK?

Answer 8

C.Jejuni

Question 9

How do you treat C.Jejuni gastroenteritis?

Answer 9

Antibiotics are ONLY indicated if
- bloody
- severe diarrhoea (8 stools/day)
- ?prolonged

Question 10

Peri-anal pathology (e.g peri-anal skin tags or fistulae) a feature of which gut disease?

Answer 10

Crohn’s

Question 11

Which organism is responsible for PROLONGED WATERY DIARRHOEA following travel?

Answer 11

Giardia Lamblia

can be approx 2 weeks
Treat with metronidazole

(ETEC does not cause such prolonged symptoms, usually few days)

Question 12

Which organism responsible in gastroenteritis if short incubation time (ie. soon after eating affected food) and vomiting only, no diarrhoea

Answer 12

Staph Aureus

Question 13

Which Abx to treat Campylobacter infection?

Answer 13

Clarithromycin

Question 14

2ww referral criteria for Upper GI cancer?

Answer 14

Any new onset dysphagia (regardless of age or symptoms)

> 55 with weight loss and either reflux/dyspepsia/upper abdomen pain