Gastrointestinal Extra

Question 1

Inguinal Hernia presentation

Answer 1

Lateral to epigastric vessels

Groin lump appears on pressure or when patient is lying down

Question 2

Metoclopramide Contraindication and Side effects

Answer 2

CI- Bowel obstruction

SE- Parkinsonism/ hyperprolactinaemia

Question 3

Variceal Haemorrhage Treatment (5 things)

Answer 3

• GENERALLY TIPS surgery
• FFP/ Vitamin K to correct clotting
• Then vasoactive agents-
  1) TERLIPRESSIN
  2) OCTREOTIDE
• Prophylactic antibiotics reduce mortality in patients with liver CIRRHOSIS (QUINOLONES given for cirrhosis patients with upper GI bleeding)
• Prophylaxis of variceal haemorrhage- PROPANOLOL reduces rebleeding and mortality

Question 4

7 reasons for HEPATOMEGALY

Answer 4

• Cirrhosis- non-tender, firm liver which decreases in size later
• Malignancy- hard, irregular liver edge- metastatic spread or primary hepatoma
• Right heart failure- firm, smooth, tender liver edge- MAY be PULSITILE
• Viral hepatitis/ MALARIA
• Haematological malignancies, haemochromatosis
• Primary BILIARY CIRRRHOSIS
• SARCOIDOSIS/ AMYLOIDOSIS

Question 5

GI embryology

Answer 5

FOREGUT-

• Mouth to proximal half od duodenum
• Coeliac trunk blood supply

MIDGUT-

• Distal half of duodenum to SPLENIC FLEXURE of colon
• Superior mesenteric artery blood supply

HINDGUT-

• Descending colon to rectum
• Inferior mesenteric artery blood supply

Question 6

Wilson’s Disease Copper Deposition manifestations (7 things)

Answer 6

• Due to increased copper absorption and decreased hepatic copper excretion
• LIVER- hepatitis/ cirrhosis
• BASAL GANGLIA DEGENERATION (particularly putamen and globus pallidus)
• Kayser-Fleischer rings in iris
• Renal tubular acidosis
• HAEMOLYSIS
• BLUE NAILS

Question 7

Investigations of Wilson’s Disease

Answer 7

• Reduced SERUM CERULOPLASMINS
• Reduced TOTAL SERUM COPPER
• but INCREASED FREE serum copper

-Increased 24 hours Urinary copper excretion

Question 8

Management of Wilson’s Disease

Answer 8

PENCILLAMINE (first line)
Trientine Hydrochloride
Tetrathiomolybdate

Question 9

Prostate gland

• separation from rectum
• Blood supply
• Lymphatic drainage
• Innervation

Answer 9

• Separated from rectum by DENONVILLIERS FASCIA
• Blood- INFERIOR VESICAL ARTERY (from internal iliac), PROSTATIC VENOUS PLEXUS (to paravertebral veins)
• Lymphatic drainage- Internal Iliac

Innervation- Inferior hypogastric plexus

Question 10

ABDOMINAL AORTA relations-

Posterior
Anterior
Left Lateral
Right Lateral

Answer 10

Posterior- L1-L4 vertebrae

Anterior= 3L, 3P, IT

• Lesser Omentum
• Liver
• Left Renal Vein
• Pancreas
• Parietal peritoneum
• Peritoneal cavity
• Inferior mesenteric vein
• Third part of duodenum

Right lateral-

• Azygos vein
• Inferior vena cava
• Cisterna chyli
• Right crus of diaphragm

Left lateral-

• Fourth part of duodenum
• Duodenal-jejunal flexure
• Left sympathetic trunk