GI

Question 1

Upper GI bleed

Answer 1

Blatchford score - can they be discharged or should they be admitted for treatment?

Question 2

Rockall score

Answer 2

Post endoscopy

Question 3

urgent endoscopy criteria

Answer 3

dysphagia
upper abdo mass consistent with cancer
>55 y/o + weight loss + reflux/dyspepsia, upper abdominal pain

Question 4

non-urgent endoscopy criteria

Answer 4

haematemesis
>55y/o + treatment resistant dyspepsia
>55y/o + upper adominal pain + low Hb
>55y/o N/V/reflux/dyspepsia + raised platelet count

Question 5

causes of liver decompensation in chronic liver disease

Answer 5

constipation
infection
electrolyte imbalances
dehydration
alcohol
upper GI bleed

Question 6

how is cirrhosis diagnosis commonly made?

Answer 6

transient elastography (a wave is passes through and stiffness of liver is measured) and acoustic radiation force imaging

liver biopsy was used but associated with high levels of bleeding

Question 7

erradication of H.pylori

Answer 7

7 day course of:

• PPI + amox + clari/ metron
• PPI + metro + clari (pen allergic)

Question 8

Murphy’s sign in gallstones?

Answer 8

patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive

• acute cholecystitis

Question 9

pernicious anemia management

Answer 9

IM B12 – loading 3x/week for 2 weeks then 3monthly

THEN replace folate afterwards (doing folate before can precipitate subacute degeneration of the spinal cord!!

Question 10

dysphagia achalasia vs oesophageal cancer

Answer 10

oesophageal cancer - solids first then liquids

achalasia - both solids and liquids

Question 11

what blood test value indicates upper GI bleed

Answer 11

urea

the blood gets digested

Question 12

plummer vinson syndrome

Answer 12

dysphagia (oesophageal webs)
irone deficiency anaemia
glossitis
cheilits

Question 13

Mx plummer vinson syndrome

Answer 13

iron supplements

dilate the oesophageal webs

Question 14

symptoms of cholangitis?

Answer 14

Charcots Triad: Jaundice, Fever, and RUQ Pain

Reynold’s Pentad: Jaundice, Fever, and RUQ Pain, Hypotension, and Confusion

Question 15

causes of ascites

Answer 15

SSAG = serum albumin - ascitic albumin

high gradient = hydrostatic pressure

• ***cirrhosis
• portal hypertension
  - - hepatic vein thrombosis (budd chiari)
• liver cancer
• HF (right heart failure)
• fatty liver of pregnancy

low gradient

• TB
• pancreatitis
• peritoneal carcinomas
• kidney failure (nephrotic syndrome_
• hypoalbuminemia (low protein)

Question 16

Mx ascites

Answer 16

salt restriction
diuretics - spironolactone
avoid NSAIDs, alcohol 
paracentasis
refractory: transjugular intrahepatic portosystemic shunt (TIPS), liver transplant

Question 17

complications of ascites

Answer 17

SBP (polymorphic nuclear cells >250/mL
- 3rd generation cephalosporin
- IV albumin 
hepatorenal syndrome
pleural effusion
GI bleeding

Question 18

what is dypepsia

Answer 18

indigestion

Question 19

budd chiari

Answer 19

thrombosis of hepatic veins

portal HTN

Question 20

genetic predisposition to to colorectal carcinoma

Answer 20

HNPCC (lynch syndrome)
peutz jeghers
FAP

Question 21

colorectal cancer - imaging

Answer 21

apple core lesion - double contrast Ba Enema

Question 22

staging for colorectal cancer

Answer 22

Duke’s

Question 23

where does colorectal cancer mets to?

Answer 23

liver, lung, bone, brain