Gastroenterology

Question 1

What score is used to help determine the prognosis of upper gastrointestinal bleeds? What are its components

Answer 1

The Rockall score.

The score consists of five categories:

1. age
2. shock
3. co-morbidity
4. diagnosis and
5. evidence of bleeding (the latter two can only be categorised after endoscopy).

Question 2

What score is used to predict the need for intervention (for example, transfusion, endoscopy) in upper GI bleeds?

Answer 2

Blatchford score

Question 3

95% of what types of lesions stain positive for CD117 (c-KIT)?

Answer 3

GIST

Question 4

How may refeeding syndrome present?

Answer 4

Patients may present with symptoms ranging from weakness to alterations in mental state, neurological abnormalities (dysarthria, diplopia) and rhabdomyolysis. The triad of electrolyte abnormalities of hypophosphataemia, hypokalaemia and hypomagnesaemia are characteristic

Question 5

What finding on colonic biopsy in the case of refractory diarrhoea, fever despite steroids and immunomodulation in IBD flare would be suggestive of CMV colitis?

Answer 5

intranuclear inclusion bodies

Question 6

What type of a laxative is Lactulose?

Answer 6

osmotic

Question 7

What is Co-danthramer?

Answer 7

Co-danthramer is a combination of danthron (a stimulant laxative) and poloxamer 188 (a stool softener) and is a popular choice for constipation in palliative care

It is licensed only for use in patients with a terminal illness and should not be given to those who are incontinent (of urine or faeces) due to the risk of developing a ‘danthron burn’ through prolonged contact with the skin

Question 8

What is Goodsall’s Rule?

Answer 8

Goodsall’s rule states that anterior fistulas open internally at the same clock face as their external opening while posterior fistulas open at 6 o’clock.

Question 9

Describe the Todani Classification

Answer 9

Choledochal cysts are usually diagnosed in the neonatal period but a few are delayed until adulthood. The Todani classification is used to define these:

Type 1 - a fusiform dilation of the common hepatic duct (CHD)
Type 2 - a diverticulum of the CHD
Type 3 - a choledochcele
Type 4 - describes extension into the intrahepatic ducts
Type 5 - intrahepatic cystic disease only.
Type 1 is the most common and Type 4 the second most common.

Resection and reconstruction is advised to prevent recurrent cholangitis, pancreatitis, and malignant change.