GI - Other investigations

Question 1

12 year old boy presents to the GP with his mother who is concerned her son is not developing at the same rate as his friends at school. He also complains daily of stomach pain which is particularly worse after eating cereal and bread. What is the diagnostic test for the most likely cause of his symptoms?

Answer 1

Endoscopy with duodenal biopsy

this endoscopy must be done whilst still on a gluten-containing diet

findings - crypt hypertrophy and villous atrophy

Question 2

12-year-old boy presents to the GP with his mother who is concerned her son is not developing at the same rate as his friends at school. He also complains daily of stomach pain which is particularly worse after eating cereal and bread. What is the next best test considering the most likely diagnosis?

Answer 2

Screen for coeliac disease
The tests need to be done whilst the patient is still having a gluten diet
Check the following:
* Total IgA
* Anti-TTG
* Anti-EMA

Question 3

12 year old boy has recently been diagnosed with coeliac disease - which of the below is the best way of monitoring his disease?
A) Total IgA
B) Yearly Endoscopy
C) Anti-TTG
D) Anti-EMA

Answer 3

C) Anti-TTG

Can be used to monitor after diagnosis

Question 4

25 year old woman presents to A&E with sudden onset epigastric pain radiating to her back. This is also associated with nausea and vomiting. She currently drinks around 10 glasses of wine per day. Considering the most likely diagnosis, what is the first line investigation for the patient?

Answer 4

Blood test
Lipase <3xULN along with abdominal pain is enough to diagnose acute pancreatitis

Ultrasound can be used to determine the cause

CHECK THIS???

Question 5

What stool test can be used to test for pancreatic exocrine insufficiency?

Answer 5

Faecal elastase

This is normally found in high concentrations (>200) in faeces – it acts to breakdown collagen (if there are low levels then the patient may present with diarrhoea)
Low levels = pancreatic insufficiency

Question 6

A 22 year old female comes into GP presenting with bloody stools. All tests come bakc normal except for a raised faecal calprotectin.
Considering the most likely diagnosis, what is the diagnostic test?

Answer 6

Colonoscopy

this patient is likely suffering from IBD

Faecal calprotectin is a marker of bowel inflammation

Question 7

A 62 year old man presents to the GP with a new change in bowel habit. He also has associated unexplained weight loss. What is the next best step?

Answer 7

QFIT

Question 8

A 62 year old man presents to the GP with a new change in bowel habit. He also has associated unexplained weight loss. What is the diagnostic test for the most likely diagnosis?

A) Colonoscopy
B) QFIT
C) Anoscopy
D) Faecal elastase

Answer 8

A - colonoscopy

Question 9

What is the best imaging modality for visualising the pancreas?

Answer 9

CT abdomen

Question 10

A 25 year old male comes in with suspected gallstones. LFTs are done and come back abnormal - what is the next best step?

Answer 10

Abdominal ultrasound

Question 11

a 45 year old woman comes to the ED with acute abdominal pain that radiates to her back. She also has nausea and vomiting. She is tachycardic and guards her abdomen on palpation. Which of the following would be expected to be positive?

A) ALP
B) Amylase
C) AST
D) Faecal calprotectin
E) Faecal elastase

Answer 11

B) Amylase

Question 13

A man presents to ED with acute epigastric pain and vomiting birhgt red blood. You suspect an upper GI bleed. What scoring system can be used to assess GI bleeds?

Answer 13

Blatchford score
- BP
- Hb
- BUN
- Other (pulse, melaena, liver disease, syncope, cardiac failure)