GI Medicine 5

Question 1

Pharyngeal Pouch

1. What clinical features are seen?
2. What investigations are done?

Answer 1

1. • dysphagia
   • regurgitation
   • aspiration
   • neck swelling with gurgling on palpation
   • halitosis
2. barium swallow with dynamic fluoroscopy

Question 2

What are the SEs of PPIs?

Answer 2

• hyponatraemia / hypomagnasaemia
• osteoporosis
• microscopic colitis
• increased risk of c. difficile infection

Question 3

Pyogenic liver abscesses

1. What is the most common cause in
   a) children
   b) adults
2. How is it managed?

Answer 3

1. a) staph aureus
   b) e. coli
2. drainage + ABx
   amoxicillin + ciprofloxacin + metronidazole
   if pen allergic: ciprofloxacin + clindamycin

Question 4

1. What are the metabolic consequences of refeeding syndrome?
2. What should be done if a patient is seen as high risk?

Answer 4

1. • hypophosphataemia
   • hypokalaemia and hypomagnasaemia - can lead to torsades de pointes
2. if a patient has not eaten for 5 days do not give more than 50% of requirements for next 2 days

Question 5

Small Bowel Bacterial Overgrowth Syndrome

1. What are the RFs?
2. What clinical features are seen?
3. What investigations can be done?
4. How is it managed?

Answer 5

1. • diabetes
   • congenital GI abnormalities
   • scleroderma
2. • chronic diarrhoea
   • abdominal pain + bloating
   • flatulence
3. • hydrogen breath test
   • trial ABx
4. rifaximin

Question 6

Spontaneous Bacterial Peritonitis

1. What clinical features are seen?
2. How is it diagnosed?
3. How is it managed?
4. When and what should prophylactic antibiotics be given?
5. What is a marker of poor prognosis?

Answer 6

1. ascites + abdo pain + fever
2. paracentesis: neutrophil count >250
3. IV cefotaxime
4. • previous SBP
   • ascites fluid protein <15g/l and Child-Pugh score >9 or hepatorenal syndrome

give oral ciprofloxacin

5. alcoholic liver disease

Question 7

What are villous adenomas?

Answer 7

colonic polyps with malignant potential secreting large amounts of mucous (possibly leading to electrolyte disturbances)

Question 8

Whipple’s Disease

1. What is it?
2. What clinical features are seen?
3. What is seen on investigation?

Answer 8

1. multi-system disorder caused by tropheryma whippelii infection
2. • weight loss + diarrhoea (due to malabsorption
   • joint-pain (large joints)
   • pleurisy
   • pericarditis
   • lymphadenopathy

mnemonic: Whipple’s (j looks like i)
3. jejunal biopsy shows deposition of macrophages containing periodic acid-Schiff granules

Question 9

Wilson’s Disease

1. What is it?
2. When is the typical onset of disease?
3. What clinical features are seen?
4. What is seen on investigation?
5. How is it treated?

Answer 9

1. autosomal recessive disorder causing increased copper in tissues
2. 10-25
3. • liver: hepatitis, cirrhosis (presentations complaint in children)
   • neuro: (presenting complaint in young adults)
     basal ganglia degeneration - speech and psychiatric problems
   • Kayler-Fleischer rings (garen/brown deposits in outside of iris)
   • blue nails
   • hemolysis
   • renal tubular necrosis
4. • decreased caeruloplasmin
   • decreased total serum copper (as carried by caeruloplasmin)
   • increased 24hr urine copper
5. penicillamine (chelates copper)

Question 10

Zollinger-Ellison Syndrome

1. What is it?
2. What CFs are seen?
3. How is it diagnosed?

Answer 10

1. excessive gastrin (usually due to gastrin secreting duodenal or pancreatic tumour)
   - > can occur as part of MEN 1
2. • ulcers (multiple)
   • malabsorption
   • diarrhoea
3. • fasting gastrin levels
   • secretin stimulation test