Gastroenterology

Question 1

What is rigler’s sign?

Answer 1

On AXR, can see both sides of the bowel wall due to gas inside and outside of the lumen

Question 2

What is the function of chief cells and what do they look like on histological staining?

Answer 2

Vagal stimulation > pepsinogen (converted to pepsin by HCl) + gastric lipase
Eosinophilic (purple) cytoplasm

Question 3

What is the function of parietal cells and what do they look like on histological staining?

Answer 3

Secrete HCl and intrinsic factor (for B12 absorption)

Pale cytoplasm, located in fundus

Question 4

What do G cells secrete and what is the function of this hormone?

Answer 4

Stomach distension > gastrin > HCl secretion

Question 5

Which hormones stimulate HCl secretion from parietal cells in the stomach?

Answer 5

Histamine (most significant contributor)
Gastrin
Acetylcholine

Question 6

Where are the following nutrients absorbed?

(a) B12
(b) Folate
(c) Iron
(d) Ethanol
(e) Thiamine

Answer 6

(a) Ileum
(b) Jejunum
(c) Duodenum
(d) 20% in stomach, 80% in duodenum + jejunum
(e) Jejunum

Question 7

What factors decrease the absorption of folate from the gut?

Answer 7

OCP, vegan diet, alcohol, phenytoin

Question 8

What is the classic triad of late haemochromatosis?

Answer 8

Skin pigmentation, diabetes mellitus, liver cirrhosis

Question 9

What LFT abnormalities are present in alcoholic liver disease?

Answer 9

Elevated GGT, AST:ALT >2

Question 10

What LFT abnormalities are present in viral hepatitis?

Answer 10

Hepatocellular picture: increased ALT, AST > GGT, ALP

AST:ALT <1

Question 11

What LFT abnormalities indicate a cholestatic picture?

Answer 11

Increased GGT, ALP > AST, ALP

Question 12

What does elevated alpha fetoprotein indicate?

Answer 12

Hepatocellular carcinoma
Germ cell tumours
Metastatic cancers of the liver

Question 13

What blood test findings would indicate immunity and current infection with HBV?

Answer 13

Anti-HBsAg present = immune
HBsAg present = current infection
HBcAg present = recent or current infection (not immunity)

Question 14

What is the Child-Pugh score based on?

Answer 14

Ascites
Encephalopathy
Albumin
INR
Bilirubin

Question 15

What is the first-line management for portal hypertension?

Answer 15

Non-selective beta-blockers (e.g. propanolol)

Question 16

What are the diagnostic features of coeliac disease?

Answer 16

Anti-transglutaminase antibodies (Anti-tTG)
Villous atrophy on biopsy
Antiendomysial IgA antibodies

Question 17

What investigations can be ordered to investigate dysphagia?

Answer 17

1. Endoscopy
2. Barium Swallow
3. Manometric Assessment

Question 18

What is achalasia?

Answer 18

Disorder of the lower oesophageal sphincter (unable to relax)

Question 19

What is Barrett’s oesophagus?

Answer 19

Metaplasia of epithelium in lower oesophagus due to chronic reflux oesophagitis

Question 20

What are the causes of acute blood diarrhoea?

Answer 20

C - Campylobacter
H - Haemorrhagic E. Coli
E - Entamoeba histolytica
S - Salmonella
S - Shigella

Question 21

What foods may contain staph aureus?

Answer 21

Unrefrigerated meat + dairy products (e.g. custard, potato salad, mayonaise)

Question 22

Which bacteria is associated with a ‘rose spot’ rash that precedes the onset of diarrhoeal illness?

Answer 22

Salmonella Typhi (typhoid fever)

Question 23

What is the most common cause of viral diarrhoea in children < 3 years?

Answer 23

Rotavirus

Question 24

What protozoans are known to cause traveller’s diarrhoea?

Answer 24

Giardia
Entamoeba histolytica
Cryptosporidium
Cyclospora

Question 25

What is the triple therapy for H. Pylori erradication?

Answer 25

Amoxycillin, Clarithromycin, high-dose PPI (e.g. omeprazole)

Question 26

During H. Pylori eradication, should aspirin be ceased?

Answer 26

Aspirin can be continued with PPI cover

Question 27

Which organs are retroperitoneal?

Answer 27

``` S - Suprarenal (adrenal) glands A - Aorta / IVC D - Duodenum (parts 2-4) P - Pancreas U - Ureters C - Colon (ascending + descending) K - Kidneys E - Oesophagus R - Rectum ```

Question 28

What conditions may be associated with autoimmune pancreatitis?

Answer 28

``` Hashimoto's thyroiditis (hypothyroidism) Vitiligo Sjogren's syndrome Primary sclerosing cholangitis Inflammatory bowel disease ```

Question 29

What conditions may cause an isolated rise in ALP?

Answer 29

``` Bone disease (e.g. Paget's disease, malignancy, fractures) Severe cardiac disease Systemic inflammation Biliary tract / liver disorders Third trimester of pregnancy ```

Question 30

What causes an elevation of GGT?

Answer 30

``` Excessive alcohol intake Enzyme induction (e.g. anticonvulsants) Liver disease (in conjunction with other enzymes) ```

Question 31

Give 3 differential diagnoses for hypoalbuminaemia.

Answer 31

Liver cirrhosis Malnutrition / starvation / coeliac disease Nephrotic syndrome Haemodilution in pregnancy Malignancy (increasing rate of degradation)

Question 32

What key social history information must be gathered from a patient with suspected liver disease?

Answer 32

Alcohol consumption IV drug use, tattoos and piercings Weight / BMI

Question 33

What is the management for acute alcoholic pancreatitis?

Answer 33

Analgesia IV fluid Completely rest bowel (NBM) to avoid stimulation Give thiamine and treat alcohol withdrawal

Question 34

What are the clinical features of cholestasis?

Answer 34

Jaundice of skin / icterus of sclera Pruritis / scratch marks Dark urine Pale stools

Question 35

What percentage of people with chronic HCV infection will develop cirrhosis?

Answer 35

20%

Question 36

How is hydration status determined?

Answer 36

``` Urine output (quantity and colour) HR and BP Capillary refill Oral mucosa Skin turgor ```