Gastroenterology

Question 1

What is acute pancreatitis?

Answer 1

Inflammation of the pancrease due to pancreatic tissue corrosion from pancreatic enzymes which leads to necrosis

Question 2

Key symptoms of acute pancreatitis

Answer 2

Epigastric pain raidiating to back
Vomiting
Jaundice
Peri-umbilical hyper pigmentation (cullens)
Flanks discolouration (greys-turners)

Question 3

Investigations for pancreatitis?

Answer 3

Blood test:
- amylase
- lipase
(3x upper limit)

Pancreatic ultrasounds

Question 4

Causes of acute pancreatitis

Answer 4

Idiopathic
Gallstones
Ethanol
Testosterone
Steroids
Mumps
Autoimmune
Scorpion venom
Hyperglycaemia, hypercalcaemia, hypertriglyceridaemia, hypothermia
ERCP
Drugs (furosemide, bendroflumothiazide, Mesalazine, sodium valproate, steroids)

Question 5

Management of pancreatitis

Answer 5

Fluid resus
Analgesia
Enteral nutrition
Surgical management depending on cause

Question 6

What are the 3 main types of colon cancer?

Answer 6

1. Sporadic
2. HNPCC (hereditary non-polyposis colon cancer)
3. Familial adenomatous polyposis

Question 7

What is HNPCC and what syndrome is it known as?

Answer 7

Hereditary non-polyposis colon cancer - Lynch syndrome

Question 8

is Lynch autosomal dominant or recessive?

Answer 8

Autosomal dominant

Question 9

Which area of colon does lunch syndrome impact?

Answer 9

Proximal colon usually

Question 10

What other cancer is related to HNPCC?

Answer 10

Endometrial

Question 11

What criteria is used to diagnose someone with HNPCC?

Answer 11

Amsterdam
1. Least 3 family members with colon cancer
2. Cases span 2 generations
3.one case before 50

Question 12

Which investigations are done for pancreatitis?

Answer 12

1. Serum Amylase
2. Serum lipase - longer half-life so better for later presentations
3. Imaging - ultrasound imaging for aetiology

Question 13

Ranson score and APACHE 2 score is indicative of what ?

Answer 13

Acute pancreatitis

Question 14

What else causes raised amylase?

Answer 14

acute pancreatitis and small bowel obstruction

Question 15

what is small bowel obstruction?

Answer 15

obstruction of the small bowel stop food, liquid and air going through

usual cause is adhesions

symptoms:
- bloating
- pain
- nausea and vomiting
- inability to eat food

investigations:
- abdominal xray
- abdominal CT for diagnostic confirmation

Management:
- NBM
- NG tube
- IV fluids
- surgery if peritonitis or acutely unwell

Question 16

what is large bowel obstruction?

Answer 16

food liquid and air struggling to get through the large bowel

usual cause is a tumour but can be:
- volvulus
- diverticular disease

symptoms:
- bloating
- pain
- nausea vomiting
- no stools or farts
- peritonism maybe

investigation:
- abdominal xray
- ct scan

management;
- NBM
- IV fluids
- NG tube
surgery if peritonitic

Question 17

what’s the maximum normal diameter for a large bowel?

Answer 17

55mm

Question 18

what’s the maximum normal diameter for small bowel?

Answer 18

35mm