GI

Question 1

Wilsons disease

Answer 1

Slit lamp examination for Kayser-Fleischer rings
Reduced serum caeruloplasmin (as copper is not released out of the liver so does not need to bind to this protein)
Reduced total serum copper (this is because it’s bound to caeruloplasmin but free serum copper will be increased)
Increased 24 hr urinary copper excretion
Diagnosis confirmed by genetic analysis (ATP7B gene)

Question 2

Primary biliary cholangitis?

Answer 2

Immunology - AMA antibodies in 98%, smooth muscle antibodies in 30%, raised serum IgM
Imaging required to excused an extra hepatic biliary obstruction - RUQ USS or MRCP

Question 3

Alcoholic hepatitis?

Answer 3

LFTs - Raised gamma GT, AST:ALT >3

Question 4

Primary sclerosing cholangitis

Answer 4

ERCP or MRCP - show multiple biliary structures giving a beaded appearance)

(P-ANCA may be positive but not always and liver biopsy may show fibrous obliterative cholangitis described as onion skin - limited role for these!)

Question 5

Biliary colic

Answer 5

USS

Question 6

Haemachromatosis?

Answer 6

Iron studies - raised Transferrin and ferritin with low TIBC
Genetic testing for HFE in family members

Others:
LFTs
Molecular genetic testing for C282Y and H63D mutations
MRI

Question 7

Pancreatitis

Answer 7

Diagnosis = Characteristic pain + Serum amylase >3 times normal limit
(If late presentation >24 hours then lipase as it has a longer hold life)

USS imaging to assess aetiology

Question 8

Small bowel bacterial overgrowth syndrome

Answer 8

Hydrogen breath testing

Question 9

Hiatus hernia

Answer 9

Barium swallow
(note most pt will have it found during endoscopy incidentally due to the nature) of the symptoms

Question 10

Chronic pancreatitis

Answer 10

CT abdo (or abdo X-ray but this is less sensitive) - will show pancreatic calcification
Functional tests - faecal elastase

Question 11

Anal fissure

Answer 11

Examination

Question 12

IBD

Answer 12

colonoscopy + biopsy
(Not in the acute setting due to risk of perforation!!! Use flexible sigmoidoscopy instead)

Question 13

Perianal fistula?

Answer 13

Pelvis MRI

Question 14

Spontaneous bacterial peritonitis

Answer 14

paracentesis, with a raised neutrophil count of over 250 cells

Question 15

Coeliac disease

Answer 15

tissue transglutaminase (TTG) antibodies (IgA) and endomyseal antibody (IgA) to look for selective IgA deficiency, which would give a false negative coeliac result

Endoscopic intestinal biopsy - the ‘gold standard’ for diagnosis - this should be performed in all patients with suspected coeliac disease to confirm or exclude the diagnosis

(Note they must be eating glucose for 6 weeks before!)

Question 16

Pancreatic cancer

Answer 16

high-resolution CT scanning - double duct sign

Question 17

Chronic pancreatitis

Answer 17

CtT
(May also check faecal elastase)

Question 18

Chronic venous insufficiency or varicose veins

Answer 18

Venous duplex ultrasound

Question 19

Borrhave syndrome

Answer 19

CT comtrast swallow

Question 20

perforated peptic ulcer

Answer 20

Plain x-ray

Question 21

Meckels diverticulum

Answer 21

Radionuclide studies

Question 22

Oesophageal cancer diagnosis

Answer 22

Upper GI endoscopy

Question 23

Oespheagl cancer for locoregional staging

Answer 23

Endoscopic USS
Then CT scan of chest, abdo and pelvis

Question 24

Hartmanns procedure

Answer 24

sigmoid colectomy and formation of end stoma

Question 25

Investigating post-op to check anastomosis of colon does not leak

Answer 25

gastrografin enema