Gastroenterology

Question 1

Abdominal Migraine

Answer 1

Children
Nausea, vomiting, migraine and abdo pain
Tx: triptans

Question 2

Referral for diarrhoea?

Answer 2

> 4wks

No cause found

Question 3

Treatment of diarrhoea with antidiarrhoeal (loperamide-opioid) agents should never be given to?

Answer 3

Children

Question 4

Children with diarrhoea and blood in stool?

Answer 4

Haemolytic uraemic syndrome

*May occur after gastroenteritits

Question 5

Transient Lactose intolerance may occur?

Answer 5

Following GE in children

Question 6

Constipation definition?

Answer 6

> /= 2 of the following >/= 3mnths;

• straining at defeacation for >/=25%
• = 2 bowel movements per week
• A sensation of incomplete evacuation (tenesmus) >/= 25%
• Lumpy +/- Hard stool >/= 25%

Question 7

Constipation Referral?

Answer 7

> 6wks

Question 8

Occult presentation of constipation

Answer 8

Common in Elderly;

Confsuion
Urinary Retention 
Abdominal Pain
Overflow Diarrhoea 
Loss of appettite and nausea

Question 9

Which drugs predispose to constipation?

Answer 9

opioids
Antacids- calcium or aluminium
Antidepressants
Iron
Antiparkinsonian drugs
Anticholinergics
Anticonvulsants
Antihistamines
Calcium antagonists

Question 10

Urgent Referral to GI team specializing in malignancy?

Upper GI Symptoms

Answer 10

• Dysphagia
• Unexplained upper abdo pain + weight loss +/- back pain
• Upper abdo mass w/t dyspepsia
• Obstructive Jaundice (narrowed bile/pancreatic duct)

Consider:

• persistent vomiting and weight loss in the abscence of dyspepsia
• Unexplained worsening of dyspepesia and barretts oesophagus; known dysplasia, atrophic gastritis, intestinal metaplasia, or peptic ulcer surgery >20yr ago

Question 11

Urgent specialist referral/ urgent endoscopy?

Upper GI Symptoms

Answer 11

> 55yr with unexplained cause, persistent, recent-onset dyspepsia alone

• don’t allow symptoms to persist >4-6wks
• • H.pylori status should not affect decision to refer

Consider: Dyspepsia w/t;

• Chronic GI bleeding
• Dysphagia
• Progressive unintentional weight loss
• Persistent Vomiting
• Iron deficiency anameia
• Epigastric Mass
• Suspicious barium meal result

Question 12

Refer urgently to a lower GI malignancy team if?

Lower GI Symptoms urgent referral <2wks

Answer 12

Any age;

• Right lower abdo mass consistent with large bowel involvement
• Palpable rectal mass
• Unexplained iron deficiency anaemia

> 40yrs;
Rectal Bleeding w/t change of bowel habit- looser or increased stool frequency >6wks

> 60yrs;
Rectal Bleeding >6wks without symptoms
-Change in bowel habit- looser or increased stool frequency > 6wks without rectal bleeding

Question 13

Functional Dyspepsia

Answer 13

Non Ulcer Dyspepsia

Question 14

Before Testing for H.Pylori you should?

Answer 14

Tests: Serology, Urea Breath test, Faecal Antigen Test

“wk washout PPI period before testing

Question 15

Triple Therapy Includes?

Answer 15

PPI (Omeprazole) + Amoxicillin + Clarithyromycin/ Metronidazole

Question 16

Medications causing dyspepesia?

Answer 16

CCB
Nitrates (angina)
Theophyllines (Resp)
Bisphosphonates (Bone)
Corticosteroids
NSAIDS
SSRIs

Question 17

Drugs causing GORD

Answer 17

NSAIDS
TCAs
SSRIs
Iron supplements
Anticholinergics
Nitrates
Alendronic Acid

Question 18

Management GORD

Answer 18

• Lifestyle advice
• PPI double dose if remains symptomatic for further 1mnth
• H2 Receptor antagonist (ranitidine)
• +/- prokinetic (domperidone) for 1mnth

Question 19

Acute Gastritis

Answer 19

Type A: Entire stomach, pernicious aneamie, pre-malignant
Type B: antrum +/- duodenum, H.pylori
Type C: Irritants e.g NDSAIDS, alcohol

Question 20

Acute Gastritis Management

Answer 20

Treat the cause

Acid Suppression- H2 antagonist or PPI 4-8wks

Question 21

Treatment of peptic ulcers in patients taking NSAIDS

Answer 21

• Stop NSAIDS or switch to paracetamol, lower dose
• Gastric Protection: PPI or Misoprostol (PG)
• Full dose PPI or H2 2 mnths

Question 22

Zollinger Ellisson Syndrome

Answer 22

Gastrin-secreting pancreatic adenoma
ass. w/t peptic ulcers
Suspect: multiple drug resistant peptic ulcers ass. w/t staetorrhoea +/- diarrhoea

Question 23

Duodenal vs gastric ulcers

Answer 23

Duodenal : relieved by food, worse at night, weight gain, waterbrash (saliva fills mouth)
Gastric: worse after food, Relieved by antacids or lying flat, weight loss

Question 24

Appendicitis during pregnancy?

Answer 24

Appendix displaced- pain paraumbilical region/ subcostally

If suspect, admit immediately

Question 25

Appendicitis vs Mesenteric adeinitis

Answer 25

Well, hourly review

Unwell, admit

Question 26

Referral for colonoscopy (CRC)

Answer 26

> 35yrs; Repeat age 55yrs

• 2x first degree relatives hx CRC
• 1x first degree relative CRC Hx < 45yrs

Question 27

Refer for specialist follow up and genetic counselling? (CRC)

Answer 27

->2 x first degree relatives Hx CRC
or
FAP
Juvenille Polyposis
Peutz Jegher Syndrome (dark freckles-lips, oral mucosa, face , palms + soles)
HNPCC: >/= 3 family memebers CRC, >/= 2 generations, >/= 1 affected < 50yrs

Question 28

CRC Screening should be considered in?

Answer 28

UC

PMHx

Question 29

Most common cause of GE in children?

Answer 29

Rotavirus

Question 30

Which pathogen causes the winter vomiting virus?

Answer 30

Norovirus

Question 31

When should you check serum IgA in a patient you suspecct to have coeliac disease?

Answer 31

IgA def common amongst coeliacs
False -ive results for IgA TTG/EMA testing
If deficient request IgG TTG/EMA

Question 32

When should you admit patients with IBD acutely?

Answer 32

Severe abdo pain
Severe diarrhoea (>/=8/day) +/- bleeding
Dramatic weight loss
Fever > 37.5, tachycardia > 90bpm

Question 33

Medications causing raised AST/ALT

Answer 33

Penicillins, Minocycline
Anti-fungals
Statins
Anti-epileptics
NSAIDS