Gastroenterology

Question 1

What is Croup and what is it identified by?

What causes it

Answer 1

URTI in 6mth-3yrs, identified by stridor, barking cough, fever and coryzal symptoms.

The stridor is due to a combination of laryngeal oedema and secretions.

Mainly causes byparainfluenza viruses

Question 2

Managment of Croup in infants is?

What is the additional emergency treatment?

Answer 2

Single dose Dexamethasone.

Emergency: nebulised adrenaline and humidified O₂

Question 3

What condition should you screen for in someone with Type 1 Diabetes?

What HLA strands is it associated with?

Answer 3

Coeliacs

HLA-DQ2

HLA-DQ8

Question 4

How can Chrons disease cause Gallstones?

Answer 4

Terinal ileitis.

this is the section of the bowel where bile salts are reabsorbed. When this area is inflamed and the bile salts are not absorbed and people are prone to development of gallstones

Question 5

What investigations would support Crohns?

Answer 5

• raised inflammatory markers: ESR and CRP
• increased faecal calprotectin
• anaemia
• low vitamin B12 and vitamin

Question 6

What is carcinoid Syndrome

Answer 6

Due to a neuroendrocrine tumour slow growing (mainly in epithelial linign of lungs and gut) that secretes hormones.

This causes flushing, diarrhoea and SOB.

Question 7

Why is liver involvement neccessary for carcinoid syndrome?

Answer 7

The liver is a primary and secondary site for carcinoid tumours of neuroendocrine cells, and by causing liver dysfunction you reduce the livers ability to metabolise the excess of hormones produced.

Therefore the carcinoid syndrome can take effect

Question 8

How do the hormones produced by carcinoid tumours cause symptoms?

Answer 8

• Bradykinin and histamine: vasodilators that cause flushing and itching
• Serotonin:
  
  • fibrosis: tricuspid regurg and pulmonary stenosis
  • Bronchoconstriction: asthma and SOB
  • Decr. tryptophan, decr niacin, pellegra

Question 9

What are the treatment options for carcinoid syndrome?

Answer 9

• Octreotide: somatostatin analouge that bind to ss receptors and inhibits them
• Cyroheptadine for diarrhoea

Question 10

What investigations confirm Carcinoid syndrome?

Answer 10

• urinary 5-HIAA
• plasma chromogranin A y
• Decreased Niacin in Blood

Question 11

What are the two things you need to do to diagnose coeliacs, and describe them in depth

Answer 11

Immunology:

• tissue transglutaminase (TTG) antibodies (IgA)
• endomyseal antibody (IgA)
• anti-casein antibodies are also found in some patients

Jejunal Biopsy:

• villous atrophy
• crypt hyperplasia
• increase in intraepithelial lymphocytes

Question 12

What are the symptoms of a Pharyngeal pouch?

Answer 12

• dysphagia
• regurgitation
• aspiration
• neck swelling which gurgles on palpation
• halitosis

Question 13

Where anatomically do you get a pharyngeal pouch?

Answer 13

Posteromedially diverticulates through Kilians hiscense, a triangular area in the wall of the pharynx between thyropharyngeus and cricopharyngeus

Question 14

What does the urea breath test check for, and when can you not use it?

Answer 14

Helicobactor Pylori

• The urea is broken down by H. pylori urease

Should NOT be done is the patient has taken a PPI or antibiotic

Question 15

What are the main tests used to confirm H.pylori infection?

Answer 15

• Stool antigen test
• Urea breath test
• Rapid urease test; colour change
• Gastric biopsy

Question 16

Raised bilirubin with an abnormal INR is strongly indicitive of?

Answer 16

Alcoholic Hepatitis

Question 17

What is the underlying gene causing haemachromatosis and how is it inherited?

Answer 17

HFE gene that is autosomally reccessive.

Question 18

Although it is not particularly penetrating, what are the presenting symptoms of Haemachromotosis?

Answer 18

• early symptoms include fatigue, erectile dysfunction and arthralgia (often of the hands)
• ‘bronze’ skin pigmentation
• diabetes mellitus
• liver: stigmata of chronic liver disease, hepatomegaly, cirrhosis, hepatocellular deposition)
• cardiac failure (2nd to dilated cardiomyopathy)
• hypogonadism (2nd to cirrhosis and pituitary dysfunction - hypogonadotrophic hypogonadism)
• arthritis (especially of the hands)

Question 19

Painless jaundice is a common presentation of?

Answer 19

Pancreatic Cancer

Question 20

What is a gallstone ileus?

Answer 20

This describes small bowel obstruction secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum.

Abdominal pain, distension and vomiting are seen.

Question 21

A 55-year-old gentleman presents to his GP with weight loss and vague right upper quadrant pain. This has been developing over the past few weeks, and he appears slightly jaundiced. He has a past medical history of hepatitis B and is known to the hepatology team at the local hospital. You refer him urgently to hospital.
What follow up blood test is he likely to require to monitor for recurrence of hepatocellular carcinoma?

Answer 21

AFP; alpha-fetoprotein

it’s produced by regenerating liver cells and can be used to monitor recurrence of HCC.

It is worth noting that AFP is not always raised at diagnosis, and in these cases, it might prove less reliable as a recurrence marker.

Question 22

What is the main risk factor for developing Hepatocellular carcinoma?

Answer 22

Liver Cirrhosis

eg; secondary to Hep B/C, alcohol, haemachromatosis and primary biliary cirrhosis

Question 23

Causes of Acute Liver Failure

Answer 23

• paracetamol overdose
• alcohol
• viral hepatitis (usually A or B)
• acute fatty liver of pregnancy

Question 24

Features of Acute Liver Failure

Answer 24

• jaundice
• coagulopathy: raised prothrombin time
• hypoalbuminaemia
• hepatic encephalopathy: confusion and hepatic flap
• renal failure is common (‘hepatorenal syndrome’)

Question 25

What are the 3 main types of colorectal cancer

Answer 25

1. Sporadic (95%)
2. Hereditary Non-polyposis colorectal carcinoma (5%)
3. Familial Adematous Polyposis (1%)

Question 26

What is the most common associated cancer with HNPCC and what is the criteria used to aid diagnosis

Answer 26

• Endometrial Cancer

The amsterdam criteria is often used

1. minimum 3 family members with
2. Cases span 2 generations
3. at least one case dx by age 50

Question 27

What is Primary Sclerosing Cholangitis?

Answer 27

Unknown etiology that causes inflammation and fibrosis of the intra and extra hepatic bile ducts

Gives it a beaded appearance on ERCP imaging!

Question 28

PSC has a strong association with the condition _______

Answer 28

Ulcerative colitis. 80% of PSC ptients have UC