Gastroenterology 3

Question 1

Usually prodromal illness and right upper quadrant pain
Swinging pyrexia
Patient may be systemically unwell
Generalised peritonism not present
=

Answer 1

Gallbladder abscess

Question 2

Dyspepsia guidelines
Endoscopically proven oeseophagitis (3)

Answer 2

1. Full dose PPI 1-2 months
2. If response then low dose treatment PRN
3. If not response then double dose PPI for 1 month

Question 3

Endoscopically negative reflux disease mx (3)

Answer 3

1. Full dose PPI 1 month
2. If response then low dose treatment PRN
3. If no response then H2RA or prokinetic for 1 month

Question 4

Haemochromatosis features:
AR/AD
Chromosome
Gene

Triad of sx

Features (6)
Reversibile (2)
Nonreversible (4)

Answer 4

Chrm 6 HFE gene
AR, genetic mutation of HFE gene on chrm 6 (HaEmachromatoSIX), leading to the build up excess iron

1. Bronze pigmentation
2. Cirrhosis
3. DM

Reversible
1. Bronze skin pigmentation
Heart
2. Cardiomyopathy/ cardiac failure

Non reversible
Bones
3. Arthralgia
Endo
4. Liver disease
5. DM
6. Hypogonadotrophic hypogonadism

Question 5

Budd Chiari triad:

Answer 5

1. AP - sudden on set severe
2. Ascited
3. Tenderhepatomegaly

Question 6

Budd Chiari causes (4)

Answer 6

Anything haematological
1. Thrombophillia
2. Polycythaemia rubra vera
3. Pregnancy
4. COCP

Question 7

Haemochromatosis Ix (2)
Liver biopsy finding

Answer 7

Ix transferrin saturation, genetic testing
Perl’s stain

Question 8

Typical iron study profile in patient with haemochromatosis

transferrin saturation
ferritin
TIBC

Answer 8

transferrin saturation > 55% in men or > 50% in women
raised ferritin (e.g. > 500 ug/l) and iron
low TIBC

Question 9

Mx haemochromatosis (2)

Answer 9

Venesection
Desferrioxamine

Question 10

H pylori associations (4)

Answer 10

Peptic ulcer disease
Gastric cancer
B cell lymphoma of MALT tissue
Atrophic gastritis

Question 11

H pylori eradication mx (2)

Answer 11

7 day course of PPI + amoxi + clarithro/metro
or if pen allergic PPI + clarithro + metro

Question 12

HBsAg 1-6 months =
HBsAg > 6months =
Anti-HBs =
Anti-HBc =
HbeAg =

Answer 12

HBsAg 1-6 months = acute disease
HBsAg > 6months = chronic disease
Anti-HBs = exposure or immunisation
Anti-HBc = previous/ current infection
HbeAg = marker of infectivity

Question 13

What is Courvoisier sign?
What is Sister Mary Joseph nodules
What is Virchow’s node?
Seen in which ca?

Answer 13

Palpable mass in RUQ
Periumbilical lymphadenopathy
Left supraclavicular adenopathy
Cholangiocarcinoma

Question 14

Typical symptoms are malaise, anorexia and weight loss. The associated RUQ pain tends to be mild and jaundice is uncommon.

Answer 14

Amoebic liver abscess

Question 15

Most common cause of HCC worldwide and UK?

Answer 15

Chronic hep B
Chronic hep C

Question 16

Screening for HCC? Ix (2)
Which cohort of patients? (2)

Answer 16

US +/- AFP

Pts with liver cirrhosis secondary to hep B&C or haemochromatosis

Men with liver cirrhosis secondary to ETOH

Question 17

Pigmented freckles on the lips, face, palms and soles =
AR/AD
What is it?

Answer 17

Peutz-Jeghers
AD
Numerous haemartomatous polyps

Question 18

Common presentation for Peutz-Jegher’s syndrome?

Answer 18

SBO secondary to intussusception

Question 19

Pancreatic ca investigation of choice
What might it show?
Mx

Answer 19

High resolution CT
Double duct sign
Mx Whipple’s resection

Question 20

dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia =

Answer 20

Plummer Vinson syndrome

Question 21

NALFD incidental finding seen on US, what blood test might you do next?

Answer 21

ELF (enhanced liver fibrosis) blood test to check for advanced fibrosis

Question 22

Extrapyramidal effects of metoclopramide (4)

Answer 22

Oculogyric crissi
Hyperprolactinaemia
Tardive dyskinesia
Parkinsonism

Question 23

What is melanosis coli?
Histo
Associated with?

Answer 23

Disorder of pigmentation of the bowel
Histology: pigment laden macrophages
Associated with laxative abuse (especially senna)

Question 24

Define malnutrition (3)
Screening test

Answer 24

BMI <18.5
Unintentional weight loss >10% within 3-6 months
BMI <20 and unintentional weight loss >5% within 3-6 months

MUST score

Question 25

Ischaemia of GI tract Ix

Answer 25

CT

Question 26

Acute mesenteric ischaemia is usually caused by?
What is chronic mesenteric ischaemia?

Answer 26

Embolism
Intestinal angina - colicky intermittent AP

Question 27

Thumbprinting on AXR may be seen in?

Answer 27

Ischaemic colitis

Question 28

Name two unconjugated hyperbilirubinaemia versus conjugated

Answer 28

Gilbert’s, Crigler-Najjar = unconjugated
Dubin-Johnson syndrome + Rotor syndrome = conjugated

Question 29

AR
Iranian Jews
Grossly black liver
Benign

Answer 29

Dubin Johnson

Question 30

IBS how to diagnose

Answer 30

AP relieved by defecation or associated with altered bowel frequency in addition to 2 of the 4:
- altered stool passage (straining, urgency, incomplete)
- bloating
- worse by eating
- mucus

Question 31

IBS patient with constipation who are not responding to conventional laxatives can have which medication?

Answer 31

Linaclotide

Question 32

IBS second line management

Answer 32

TCA