GI symptoms

Question 1

Causes of bloody diarrhoea

Answer 1

Vacular - ischaemic colitis
Infective
Inflammatory - UC, Crohn’s
Neoplastic - CRC, polyps

Question 2

Infective causes of bloody diarrhoea

Answer 2

Campylobacter
Shigella, salmonella
Pseudomembranous colitis
E.coli, amoeba

Question 3

Rx diarrhoea

Answer 3

Treat cause, oral/IV rehydration, codeine/loperamide

Question 4

Complications of psuedomembranous colitis

Answer 4

Paralytic ileus
Toxic dilatation
Multi-organ failure

Question 5

Drug causes of pseudomembranous colitis

Answer 5

Clindamycin
Cephalosporins
Ciprofloxacin
Co-amox

Question 6

Severe psuedomembrane colitis has at least 1 of

Answer 6

WCC > 15
CR >50% above baseline
Temp >38.5
Clinical/radiological evidence of severe colitis

Question 7

Rx psuedomembranous colitis

Answer 7

Stop causative abx
1. Metronidazole 400mg TDS PE
2. Vancomycine 125mg QDS PO
Severe - vanc 1st increase to 250mg

Question 8

Rx constipation

Answer 8

Drink more, increase fibre
Bulking - bran/cellulose/ispaghula husk
Osmotic - lactulose, MgSO4
Stimulant - Senna, docusate sodium

Question 9

Rome criteria IBS

Answer 9

Abdo discomfort/pain >1week + 2 of:
-relieved by defecation 
-change in stool frequency/form
\+2 of:
-urgency 
-incomplete evacuation 
-abdo bloating 
-mucous PR 
-worsening symptoms after food

Question 10

Rx IBS

Answer 10

Exclusion diets
Bulking agents for constipation and diarrhoea
Antispasmodics, amitriptyline, CBT

Question 11

Mx new onset dyspepsia (conservative steps)

Answer 11

OGD if >55 or ALARMS features
Conservative for 4 weeks:
-Stop drugs (NSAIDS, CCBs, steroids, bisphophonates)
-Lose weight, stop smoking+alcohol
-Antacids (magnesium trisilicate, gaviscon)

Question 12

Test for H.pylori (1st line) and subsequent management

Answer 12

Breath/serology/stool antigen
Breath test first line, serology remains +ve after eradication
+ve: eradication therapy, consider OGD if no improvement
-ve: PPI trial for 4weeks, OGD if not improvement

Question 13

H pylori eradication therapy

Answer 13

PAC500 - PPI, amox 1g, clari 500mg BD

PMC250 - PPI, metron 400mg BD, clari 250mg

Question 14

Location of ulcer more in duodenum or GU

Answer 14

Duodenum

Question 15

Affect result of 13c breath test

Answer 15

• Within 4 weeks of antibacterial treatment

- Within 2 weeks of PPI

Question 16

What is Zollinger Ellison syndrome and its location?

Ix and Rx

Answer 16

Gastrinoma (gastrin secreting adenoma)
Found in pancreas
Increased fasting gastrin levels
High dose PPI

Question 17

Location of gastric ulcers

Answer 17

Lesser curvature

Elsewhere often malignant

Question 18

Peptic ulcer Rx (not H. pylori)

Answer 18

Full dose acid suppression for 1-2 months, low dose acid suppression

Question 19

Extra oesophageal GORD symptoms

Answer 19

Nocturnal asthma
Chronic cough
Laryngitis, sinusitis

Question 20

Rx GORD

Answer 20

Conservative - as for dyspepsia
Medical - PPI na d H2RA
Surgical - Nissen fundoplication

Question 21

Indications for surgery in GORD

Answer 21

All 3 of;

• severe symptoms
• refractory to medical therapy
• confirmed reflux

Question 22

Causes of dysphagia

Answer 22

Inflammatory
-tonsilitis, oesophagitis, ulcer
Mechanical block
-Luminal: FB, benign stricture (Plumer Vinson web)
-Mural: malignant stricture, pharyngeal pouch
-Extra mural: lung ca, hernia, goitre
Motility disorder
-Local: achalasia, oesophageal spasm, nutcracker oesophagus, bulbar palsy
-Systemic: systemic sclerosis, MG

Question 23

Ix dysphagia

Answer 23

bloods, CXR, OGD

Barium swallow, oesophageal manometry

Question 24

Cause of achalasia and Ix findinds

Answer 24

Degeneration of myenteric plexus
Ix:
-Ba swallow - dilated tapering oesophagus, bird’s beak
-CXR - widened mediastinum
-Manometry - failure to relax + reduced peristalsis

Question 25

Complication and Rx achalasia

Answer 25

Complication - Oesophageal SCC
Med - CCBs, nitrates
Intervention - endoscopic balloon dilation, botulinum toxin
Surg - Heller’s cardiomyotomy

Question 26

Ix and Rx pharngeal pouch/Zenker’s diverticulum

Answer 26

barium swallow

excision, endoscopic stapling

Question 27

Ix on diffuse oesophageal spasm and symptoms

Answer 27

Barium swallow shows corkscrew oesophagus

Intermittent chest pain

Question 28

Rectal bleeding differential

Answer 28

DRIPING A
Diverticulae 
Rectal - Haemorrhoids 
Infection
Polyps
Inflammation - UC, Crohns
Neoplasm
Gastric/upper bowel bleeding
Angio - ischaemic colitis, HHT

Question 29

Cause of upper GI bleed

Answer 29

PUD, erosion, oesophagitis
Varices
Mallory weiss tear
Ca stomach/oesophagus

Question 30

Scores used in upper GI bleed

Answer 30

Rockall score - prediction of rebleeding and mortality

Glasgow Blatchford score (GBS) - chance of needing medical attention

Question 31

Criteria of GBS

Answer 31

HUB (Hb, urea, BP) + other parameters (pulse>100, melena, syncope, hepatic disease, cardiac failure)

Question 32

Rockall scoring features

Answer 32

ASC-ED: Age, shock, co-morbidities, endoscopic signs of bleeding, diagnosis
8 risk of death
Pre-endoscopy - ASC, if over 3 indication for surgery
Post-endoscopy - ASC ED, if over 6 indication for surgery

Question 33

Causes of portal HTN

Answer 33

Pre-hepatic: portal vein thrombosis
Hepatic: cirrhosis (80% in UK), schisto (commonest worldwide), sarcoidosis
Post hepatic - Budd-chiari, constrictive pericarditis

Question 34

Bleed prevention in oesophageal varices

Answer 34

Primary - B blocker, endoscopic banding

Secondary - B blocker, banding, TIPSS (transjugular intrahepatic porto-systemic shunt)

Question 35

Acute management of upper GI bleed - variceal

Answer 35

ABCDE - transfuse, correct clotting
Offer endoscopy with 24h of admission to all upper GI bleeds
Variceal bleed
1. terlipressin IV + prophylactic abx
2. banding/sclerotherapy
3. Sengstaken-Blakemore tube (balloon tamponade)

Question 36

Acute management of upper GI bleed - non-variceal

Answer 36

Adrenaline, thermal/laser coagulation, fibrin glue, endoclips

Question 37

Post endoscopy for upper GI bleed Mx

Answer 37

Omeprazole, NMB 24h, H pylori test