How would you investigate this patient?

Question 1

GORD

Answer 1

endoscopy to diagnose and check for complications

check pH of oesophagus to confirm diagnosis§

Question 2

peptic ulcer

Answer 2

stool test = first line (for presence of H. pylori)

urea breath test - if H. pylori present, urea ingested converted to ammonia and absorbed by body

serum IgG - against H. pylori

endoscopy if >55

Question 3

Acute GI bleed

Answer 3

proctoscopy to look for anorectal disease (e.g. Piles)

sigmoidoscopy or colonoscopy for IBD, polyps, colon cancer, diverticula disease, ischaemic colitis, vascular esions, angiography for vascular abnormality (e.g. angiodysplasia)

TLDR endoscopy to look for cause of bleed

Question 4

Ulcerative Colitis

Answer 4

Faecal calprotectin: raised (differentiates from IBS)

FBC: leukocytosis in a flare

CRP/ESR: raised (inflammation)

Colonoscopy/biopsy: red and raw mucosa, no inflammation beyond submucosa. Pseudopolyps may be seen. Can also see crypt abscesses (due to neutrophil migration)

Question 5

Crohn’s

Answer 5

Blood tests:
Raised white cell count
Raised ESR/CRP
Thrombocytosis (high platelets)
Anaemia (secondary to chronic inflammation)
Low albumin (secondary to malabsorption)
Iron, B12, folate

Stool culture to exclude infection
Faecal calprotectin will be raised (antigen produced by neutrophils)

MRI to exclude small bowel disease

Question 6

IBS

Answer 6

Diagnosis of exclusion: no specific investigation
FBC
ESR and CRP
Coeliac serology

Question 7

Infective gastroenteritis

Answer 7

STOOL CULTURE: positive for causative bacteria

STOOL MICROSCOPY: for presence of RBCs and neutrophils

Question 8

Acute Pancreatitis

Answer 8

Serum amylase raised 3x

LFTs- high ALT indicates gallstone cause

Serum Lipase- high

Question 9

Chronic Pancreatitis

Answer 9

Serum amylase/ lipase often not raised

blood glucose secondary to endocrine dysfunction

LFTs to ensure no jaundice

low faecal elastase level (produced by pancreas)

CT imaging can show atrophy

Question 10

Gallstones

Answer 10

Abdominal Ultrasound

Question 11

Acute Hepatitis

Answer 11

LFTs: high AST/ALT up to 6 months post. bilirubin also high

FBC: leucopenia with relative lymphocytosis, PT prolonged in severe cases, increased ESR

Question 12

Appendicitis

Answer 12

Urinalysis to exclude renal/uro cause

also exclude pregnancy

FBC, CRP to assess for raised inflammatory markers

X-ray excludes perforation

CT or USS to diagnose but usually clinical

Question 13

Small and large bowel obstruction

Answer 13

urgent bloods inlcuding group and save to monitor electrolyte changes

venous blood gas for signs of ischameia (high lactate)

CT scan with IV contrast to diagnose

Question 14

Femoral hernia

Answer 14

surgical intervention required so pre-op investigations should be performed (FBC, ECG etc)

US if needed but often clinicall diagnosed

Question 15

Inguinal Hernia

Answer 15

typically clinical diagnosis

US if neccessary but rare