GIT

Question 1

When to do colon cancer screening

Answer 1

Average risk: FOBT every 2 years for patients aged 50-74
Moderate risk: colonoscopy every 5 years for patients aged 50 or 10 years before first relative developed it
High risk; refer for genetic testing and to bowel cancer specialist for surveillance

Question 2

GERD treatment

Answer 2

• LOW, stop smoking, alcohol, fatty foods, coffee, tea, chocolate, carbonated drinks, eat at least 3 hrs before bed
• avoid anticholinergics, theophylline, nitrates, CCB, doxycycline
• elevate head of bed/wedge pillow
• Antacid
• PPI (4 weeks, 30-60 mins before food)
• H2RA (8 weeks)

Question 3

ALARMS symptoms GERD

Answer 3

Anaemia 
Loss of weight 
Anorexia 
Recent onset of progressive symptoms 
Melena/hematemesis 
Swallowing difficulty 

> 55 also

Question 4

Acute pancreatitis tests

Answer 4

FBC, ESR, CRP, lipase, glucose, Ca, LFT, X-Ray, ultrasound, ERCP

Question 5

Treatment for acute pancreatitis

Answer 5

Admit to hospital
Bed rest, nil orally, nasogastric suction if vomiting, IV fluids and morphine
May require ERCP if obstructive picture

Question 6

Investigations and management for chronic pancreatitis

Answer 6

Faecal elastase 
CT and U/S 
MRCP 
PCM 
Pancreatic enzyme supplements for steatorrhea

Must ask about malabsorption, diabetes, weight loss, steatorrhoea

Question 7

Rome III diagnostic criteria for IBS

Answer 7

In the past 3 months, patient has had abd discomfort for at least 3 days per month with 2/3 of:

• relieved by defecation
• onset associated with change in stool frequency
• onset associated with a change in form of stool

Question 8

IBS testing

Answer 8

FBC, ESR, stool MC&S, colonoscopy

Question 9

Ddx for IBS

Answer 9

Bowel infection, spicy food, lactose, excess-fiber wheat products, high fatty foods, carbonated drinks, laxative overuse, antibiotics, analgesics, psychological factors

Question 10

Coeliac disease testing

Answer 10

Increased faecal fat
Duodenal biopsy - villous atrophy
Total IgA level
IgA anti-endomysial, IgA transglutaminase, IgA antigliadin antibodies

Question 11

Celiac disease management

Answer 11

Diet: high complex carb and protein, low fat, gluten-free
Treat specific deficiencies
Give pneumococcal vaccines

Gluten stuff: standard bread, flour, biscuits, cake, oatmeal, wheat, bran, stock cubes, gravy

Question 12

Investigations and management for bowel cancer

Answer 12

PE, waist circumference
DRE 
FBC, CRP, ESR, CEA, LFT 
colonoscopy + biopsy 
CXR 
ECG and AXR
Refer to gastro for CT scan

Question 13

Diverticular disease tests

Answer 13

FBC, ESR, colonoscopy, CT abdomen, AXR if acute

Question 14

Diverticulitis management

Answer 14

Mild: bowel rest (fluids only) + antibiotics

If fluid and pain intolerable; admit for analgesia, NBM, IV fluids + antibiotics

Question 15

Diverticular disease management

Answer 15

• high fiber diet like cereal, wholemeal, multigrain bread, fruits and vege
• antispasmodic: mebeverine 135mg TDS PO

Question 16

Diagnosis of cholecystitis

Answer 16

Ultrasound: for gallstones, not cholecystitis
HIDA scan: obstructed cystic duct
WCC and CRP

Question 17

Management of cholecystitis

Answer 17

Bed rest 
IV fluids 
NBM 
Analgesia 
Antibiotics 
Cholecystectomy 

If septic, ampicillin + gentamicin

Question 18

Acute appendicitis investigations and management

Answer 18

FBC, CRP, CT scan
Refer for appendicectomy
Piperacillin/tazobactam starting 1 hour pre-op

Question 19

AGE management

Answer 19

Rest
Diet - low-fat food
Avoid alcohol, coffee, tea, fatty and fried, spicy foods, raw vege and fruit
Keep hydrated
ORS 2-3L if mild-mod dehydration
Metoclopramide/prochlorperazine if severe vomiting
Loperamide

Question 20

Common antibiotics for diarrhoea

Answer 20

Ciprofloxacin