Gastrointestinal system

Question 1

Criteria used for prognosticating chronic liver disease and cirrhosis

Answer 1

Child-Pugh classification

Question 2

The 5 clinical features of Child-Pugh classification

Answer 2

1. Total bilirubin
2. Serum albumin
3. Prothrombin time or INR
4. Ascites
5. Hepatic encephalopathy

Question 3

Complication of reflux esophagitis that can lead to progressive obstruction

Answer 3

peptic esophageal stricture

Question 4

Antibiotic given in preparation for emergency appendectomy

Answer 4

single dose 3rd gen cephalosporin

Question 5

Risk factor in patients with primary jejunal lymphoma

Answer 5

coeliac disease

(particularly tumors in proximal jejunum)

Crohn - usually in the distal ileum
FAP - duodenal

Question 6

Most common cause of early postoperative fever, particularly in heavy smokers

Answer 6

pulmonary atelectasis

Question 7

Virus associated with hepatocellular carcinoma

Answer 7

Hep B

Question 8

DOC for chronic hep B

Answer 8

Lamivudine over 12 months

Question 9

Sudden passage of large amount of blood, with or without fecal material is characteristic of

Answer 9

Diverticular disease

Question 10

systemic venous circulation develops around the umbilicus due to shunting of obstructed portal circulation

Answer 10

caput medusae

Question 11

Bleeding from esophageal varices in the australian community is most commonly due to _____

Answer 11

alcoholic liver disease

Question 12

Uncommon condition where thrombosis of larger hepatic veins, sometimes secondary to polycythemia can cause hepatic venous congestion, marked ascites and progression to hepatic cirrhosis and liver failure

Answer 12

Budd-Chiari syndrome

Question 13

Classic tetrad of intestinal obstruction

Answer 13

Abdominal colic, vomiting, constipation, distention

Question 14

Xray appearance: large bowel gaseous dilatation cut off at the sigmoid without rectal gas.

Answer 14

Colon CA with obstruction

Question 15

Xray findings: Inverted U loop of dilated gas-filled signmoid colon

Answer 15

sigmoid volvulus

Question 16

Xray findings: luminal boluses with accompanying colonic dilatation

Answer 16

fecal impaction

Question 17

Xray findings: diffuse distention of small and large bowel

Answer 17

drug-induced pseudo obstruction

Question 18

Xray findings: markedly dilated small bowel loops with fluid levels in the absence of distal large bowel gas

Answer 18

Adhesion-obstruction

Question 19

Meckel diverticulum rule of 2s

Answer 19

2% of individuals
2 feet from ileocecal valve
2 inches long
2 inches wide

Question 20

Most important factor contributing to postoperative wound disruption/subcutaneous dehiscence of deep wound layers

Answer 20

paralytic ileus - increases intra-abdominal pressure with abdominal distention

Question 21

predisposes to intusussception in ADULTS

Answer 21

metastatic melanoma deposit

Question 22

predisposes to intusussception in CHILDREN

Answer 22

enlarged peyer patches

Question 23

Life-threatening complication of ulcerative colitis

Answer 23

toxic megacolon

Question 24

Clinical features: Vomiting, polyhydramnios, abdominal distention, aspiration

Answer 24

Tracheoesophageal fistula

Question 25

Congenital malformation of abdominal wall leading to exposure of abdominal contents

Answer 25

gastroschisis

Question 26

Persistent herniation of bowel into umbilical cord due to failure of herniated intestines to return to body cavity during devt

Answer 26

omphalocele

Question 27

Covering in omphalocoele

Answer 27

peritoneum, amnion of umbilical cord

Question 28

Congenital hypertrophy of pyloric smooth muscle

Answer 28

pyloric stenosis

Question 29

When does pyloric stenosis present/develop?

Answer 29

2 weeks after birth ==>projectile non-bilious vomiting d/t buildup of stomach pressure

Question 30

Olive like mass on palpation of abdomen (pediatric)

Answer 30

Pyloric stenosis

Question 31

treatment of pyloric stenosis

Answer 31

myotomy

Question 32

Acid damage to gastric mucosa d/t imbalance between acid environment and mucosal defenses

Answer 32

Acute gastritis

Question 33

Ulcers caused by hypovolemia and subsequent decreased stomach blood flow due to Severe burns

Answer 33

Curling ulcer

Question 34

Ulcers formed by increased vagal stimulation and increased Ach due to Increased intracranial pressure

Answer 34

Cushing ulcer

Question 35

Gastric ulcer vs erosion

Answer 35

erosion - epithelial loss | ulcer- mucosal

Question 36

most common cause of vitamin B12 deficiency

Answer 36

Chronic autoimmune gastritis (d/t lack of intrinsic factor, which is needed for VB12 absorption)

Question 37

Chronic gastritis Autoimmune vs h. Pylori based on location

Answer 37

autoimmune - fundus and body | Hpylori - antrum

Question 38

Mechanism of injury in H pylori gastritis

Answer 38

H pylori sits on top of the epithelium (no invasion) and produces damage via ureases and proteases

Question 39

CA Risk in chronic h pylori gastritis

Answer 39

Gastric adenocarcinoma, MALT lymphoma (due to production of germinal centers)

Question 40

Treatment in chronic h pylori gastritis

Answer 40

Triple therapy: PPI + Clarithromycin* + Amoxicillin* *may be replaced with metronidazole if with contraindication For 14 days

Question 41

Epigastric pain that improves with meals

Answer 41

Peptic ulcer disease

Question 42

solitary mucosal ulcer in proximal duodenum or distal stomach

Answer 42

Peptic ulcer disease

Question 43

2 complications of PUD on the POSTERIOR wall

Answer 43

1) rupture and bleeding from gastroduodenal artery | 2) acute pancreatitis

Question 44

Epigastric pain that worsens with meals

Answer 44

Gastric ulcer

Question 45

Most common location of gastric ulcer

Answer 45

Lesser curvature

Question 46

Risk of bleeding in gastric ulcer from which artery?

Answer 46

Left Gastric artery

Question 47

Features of benign gastric ulcer on endoscopy

Answer 47

Small, punched out appearance, margins flat

Question 48

Features of malignant gastric ulcer on endoscopy

Answer 48

Large, with irregular ”heaped-up” margins

Question 49

Subtypes of gastric CA

Answer 49

1) intestinal type | 2) diffuse type

Question 50

CA in which Signet ring cells infiltrate gastric wall producing desmoplasia (lintis plastica)

Answer 50

Diffuse type gastric adenocarcinoma

Question 51

Bilateral ovarian metastases of gastric CA diffuse type

Answer 51

Krukenburg tumor

Question 52

GI congenital disorder highly associated with Down Syndrome

Answer 52

Duodenal atresia

Question 53

hernia most likely to strangulate

Answer 53

femoral hernia - obliquely tortous track and narrow rigid neck

Question 54

Typical march of symptoms in acute appendicitis

Answer 54

``` mild bowel upset abdominal pain anorexia nausea and vomiting moderate fever focal peritonitis ```

Question 55

Colorectal CA screening for patients with NO risk factors

Answer 55

annual FOBT or sigmoidoscopy in patients over 50 years old

Question 56

Colorectal CA screening for those with above average risk (no personal history, with 1st or 2nd degree relative)

Answer 56

5 yearly colonoscopy and annual FOBT in intervening years

Question 57

Colorectal CA in patients with familirs with FAP or HNPCC

Answer 57

Annual or biennial colonoscopy, commencing at 25 yo (HNPCC); annual sigmoidoscopy from the age of 10 then every 3 years from the age of 35 (FAP)

Question 58

Double bubble sign on xray

Answer 58

duodenal atresia