Gastroenterology

Question 1

Woman presents with colicky central abdo pain, distension, N+V, palpable lump in groin.

Answer 1

Small bowel obstruction secondary to femoral hernia

Question 2

Sickle cell patient with jaundice

Answer 2

Gallstones (increased chance)

Question 3

DDx anorectal bleeding

Answer 3

Bright red blood of stool/paper

HAEMORRHOIDS - no abdo Sx, itchy, mass on defecation

ANAL FISSURE - severe pain, anal spasm, midline skin tag

RECTAL PROLAPSE - incontinence, mass on defecation/standing

Question 4

DDx rectosigmoid bleeding

Answer 4

Darker blood +/- clots on/in stool

RECTAL TUMOUR - FLAWS, change in BH, tenesmus, old

PROCTOCOLITIS - infective

DIVERTICULITIS - >65, recurrent LIF pain, bloating, constipation/diarrhoea, painless haematochezia

Question 5

DDx proximal colonic bleeding

Answer 5

Dark red blood IN stool / altered blood

COLONIC TUMOUR - FLAWS, change in BH, tenesmus, elderly

ANGIODYSPLASIA - >65, haematochezia, renal Dx, vWD, aortic stenosis

Ischaemic colitis - >60, crampy diarrhoea, self-limited haematochezia, Hx HTN/DM

Question 6

DDx Inflammatory bowel disease

Answer 6

ULCERATIVE COLITIS = young adults, blood/mucus in stool, LEFT-sided, bloody diarrhoea, systemic Sx

CROHN’S DISEASE = extraintenstinal Sx, mouth ulcers, colicky pain (RIF), weight loss, systemic features, rectal bleeding RARE

Question 7

Toxic megacolon

Answer 7

Massive dilatation of colon (>6cm) with thicked walls on AXR

ACUTE abdo pain, distension, diarrhoea, blood-stained stools, fever, tachycardia

Question 8

Cutaneous manifestations of MALABSORPTION

Answer 8

Ichthyosis (dry scaly skin)
Eczema
Oedema

Question 9

Cutaneous manifestations of LIVER DISEASE

Answer 9

Jaundice
Spider naevia
Palmar erythema
Leukonychia

Question 10

Cutaneous manifestations of CROHN DISEASE

Answer 10

Perianal abscess
Fistulae
Skin tags
Apthous ulcers

Question 11

Cutaneous manifestations of ULCERATIVE COLITIS

Answer 11

Erythema nodosum

Pyoderma gangrenosum

Question 12

Cutaneous manifestations of SARCOIDOSIS

Answer 12

Erythema nodosum

Lupus pernio

Question 13

Infective gastroenteritis

Clostridium difficile

Answer 13

Gram-positive commensal

Flares up with broad-spectrum ABx

Severe diarrhoea, dehydration, electrolyte imbalance, death

METRONIDAZOLE / VANCOMYCIN

Question 14

Infective gastroenteritis

Campylobacter jejuni

Answer 14

Contaminated food + unpasteurised milk

2-5day incubation

Profuse and BLOODY diarrhoea (+/- pus)

GBS

Question 15

Short history of vomiting? Possibility of eating contaminated food?

Answer 15

Staphylococcus aureus

Question 16

HIV risk patient has profuse diarrhoea - organism?

Answer 16

Cryptosporidium

Question 17

Older patient presents with profuse diarrhoea with mucus and hypokalaemia - diagnosis

Answer 17

Villous adenoma

Question 18

Outline the serology of Hepatitis B

Answer 18

HBsAg —> earliest serological marker, detected within 4 weeks of acute infection (NB: if found after 6 months, pt is chronic carrier)

HBcAg –> found in patients with prior HepB infection

HBeAg –> acute and chronic –> HIGH levels of infectivity

HBcAb –> acute and chronic infeciton –> HIGH with low HBeAg suggests low infectivity

Question 19

MCC of upper GI bleed?

Answer 19

Peptic ulcer disease (specifically duodenal if asked)