Gastrointestinal

Question 1

What is the triple therapy for H.pylori eradication?

Answer 1

A PPI and 2 antibiotic combination- usually Lansoprazole, Clarithromycin and Amoxicillin

Question 2

What is the mechanism of action of ranitidine?

Answer 2

Suppresses acid production by antagonising H2 receptors

Question 3

What is the mechanism of action of Misoprostol and what is its common indication in terms of GI disease?

Answer 3

It is a synthetic prostaglandin analogue that has antisecretory and protective properties, promoting healing of gastric and duodenal ulcers.

Question 4

Give some signs seen in chronic iron-deficiency anaemia

Answer 4

Koilonychia, conjunctival pallor, atrophic glossitis, angular chelitis

Question 5

Run through the terminology used in diverticular disease and the differences between the terms: diverticulosis, diverticula disease and diverticulitis.

Answer 5

Diverticulosis = the presence of diverticula
Diverticular disease = implies they are symptomatic
Diverticulitis = refers to inflammation of a diverticulum (potentially by an infection)

Question 6

What type of surgical procedure might be performed in the case of a perforated diverticula?

Answer 6

Hartmann’s procedure. The most common indication for a Hartmann procedure is complicated diverticulitis. It involves surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy.

Question 7

Name three familial polyposis syndromes

Answer 7

FAP, HNPCC, Peutz-Jegher’s syndrome

Question 8

What is the risk of colon cancer in untreated FAP?

Answer 8

100% by 40 years (needs prophylactic total colectomy)

Question 9

Why do colonic polyps form in normal individuals?

Answer 9

For unknown reasons, but are increasingly common with age.

The adenoma-adenocarcinoma sequence is thought to be due to a ‘double-hit’ of the APC tumour suppressor gene

Question 10

Tell me briefly about FAP

Answer 10

FAP = familial adenomatous polyposis. Due to APC gene mutation causing thousands of polyps to form in teenage years.

Question 11

Tell me briefly about HNPCC

Answer 11

HNPCC = hereditary non-polyposis colon cancer. Aka lynch syndrome. Autosomal dominant mutation in DNA mismatch repair mechanism -> carries high risk of colon cancer amongst others (e.g. endometrial)

Question 12

Tell me briefly about Peutz-Jegher’s syndrome (PJS)

Answer 12

PJS is due to STK11 gene mutation which causes the development of benign hamartomatous polyps + hyperpigmentation of lips/ oral mucosa.

Question 13

What conditions does the term ‘gallstone disease’ encompass?

Answer 13

Biliary colic, cholecystitis, ascending cholangitis and pancreatitis

Question 14

Which type of drug class (that can be used in the treatment of diabetes) suppresses appetite and can aid weight loss?

Answer 14

GLP1 agonists e.g. liraglutide

Question 15

What are the three types of enteric infection?

Answer 15

Type 1 = non-inflammatory watery diarrhoea
Type 2 = inflammatory dysentery (blood, mucus, leukocytes in stool)
Type 3 = penetrating enteric fever (where you get systemic infection)

Question 16

What is the first line investigation for oesophageal reflux?

Answer 16

PPI trial

Question 17

What are Grey-turner’s and Cullen’s signs and when might they be seen?

Answer 17

Grey-turner’s sign = abdominal bruising on flanks.
Cullen’s sign = abdominal bruising in paraumbilical area
Both may be seen in acute pancreatitis

Question 18

What are the causes of acute pancreatitis and how can they be remembered?

Answer 18

I GET SMASHED

Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion stings, ERCP, Drugs

Question 19

What are the signs of volvulus on an abdominal x-ray?

Answer 19

Coffee-bean sign.
Sigmoid volvulus (more common) the ‘coffee bean’ typically points towards the RUQ.
Caecal volvulus the ‘coffee bean’ points more horizontally.
Tend to lose haustrations more with sigmoid volvulus than caecal.

Question 20

What is the most common cause of peritonitis?

Answer 20

A perforated viscus

Question 21

What is Rovsing’s sign and what is it associated with?

Answer 21

Can be seen in acute appendicitis. It is when the left lower quadrant is pressed and it elicits pain on the right side.