Gastroenterology (incl hepatic)

Question 1

Dysphagia -
differentials
gold standard investigation

Answer 1

oesophageal cancer, acahlasia, oesophagitis, pharyngeal pouch, myasthenia gravis
manometry

Question 2

what is achalasia
what would 3 investigations show
4 potential management options

Answer 2

loss of ganglions, causing failure of LOS and peristalsis

1. manometry: inc LOS tone, doesn’t relax
2. barium swallow: bird’s beak expanded oesophagus
3. CXR: wide mediastinum, fluid level
4. pneumatic balloon dilation
5. surgery - heller cardiomyotomy
6. botox injection
7. ca channel blocker (nifedipine)

Question 3

Assocations with H.Pylori (4)

Answer 3

PUD
gastric cancer
B cell lymphoma of MALT tissue
atrophic gastritis

Question 4

red flags in dyspepsia

Answer 4

ALARMS
Anaemia 
Loss of weight 
Anorexia
Recent onset progressive 
Melaena/haematemesis 
Swallow problem 
>55/mass/persistent vomiting

Question 5

H.Pylori manage

Answer 5

PPI
Amoxicillin
Metronidazole/clarithromycin

Question 6

RF for Barrett’s
What type of cell?
Management

Answer 6

GORD, male, obese, smoker
Columnar (instead of squamous)

high dose PPI
if metaplasia: endoscopic surveillance every 3-5y
if dysplasia: endoscopic mucosal resection/radiofrequency ablation

Question 7

management of a peptic ulcer

3 causes

Answer 7

adrenaline and cauterisation

1. PUD
2. Drugs (NSAIDs, steroids, SSRI, bisphosphonates)
3. Zollinger Ellison Syndrome

Question 8

many duodenal ulcers + diarrhoea + malabsorption

what is it?
investigations?

Answer 8

Zollinger-Ellison syndrome (tumour of duodenum/pancreas which secretes loads of gastrin)
Ix: fasting gastrin, stimulation test of secretin

Question 9

what is gastroparesis

sara b

Answer 9

delayed gastric emptying secondary to poorly controlled diabetes
N&V, feel full after only small amount, loss appetitie

Question 10

causes of oesophgeal perforation
investigation
management

Answer 10

severe vom (Boerhaave) or trauma (foreign body, post-endoscopy)
Ix: CXR and contrast swallow
Mx: NG compression and NJ feed. Abx. PPI

Question 11

IBS:
pain?
constipation?
diarrhoea?

second line

Answer 11

pain: antispasmodic. mebeverine, peppermint oil
Constipation: laxative NOT lactulose
Diarrhoea: loperamide hydrochloride

2. TCA

Question 12

Lifestyle recommendations for IBS

Answer 12

inc fluid, regular small meals, dec processed meals, low caffeine alcohol, low FODMAP