Pancreatitis + coeliac disease

Question 1

Symptoms of acute pan

Answer 1

Stabbing-like, epigastric pain radiating to the back. Vomiting

Question 2

Signs of acute pan

Answer 2

hypovolaemia
Fever

Question 3

Severity of acute pancreatitis

Answer 3

modified Glasgow criteria
Score of >=3 is bad

Question 4

What amkes up the MGC?

Answer 4

PaO2 < 8kPa (60mmHg)
Age > 55 years
Neutrophils - WBC >15 x109/l
Calcium < 2mmol/l
Renal function - Urea > 16mmol/l

Enzymes - AST/ALT > 200 iu/L or LDH > 600 iu/L

Albumin < 32g/l
Sugar - Glucose >10mmol/L

Question 5

Management of acute pancreatitis

Answer 5

Aggressive fluid resuscitation with crystalloids to maintain urine output > 30 mL/hour.

Catheterisation.

Analgesia: Strong opioids are often necessary.

Anti-emetics

Question 6

What indicates severe diarrhoae in patients with coeliac disease

Answer 6

Steatorrhoea

Weight loss or failure to thrive in children

Question 7

Management of coeliac disease

Answer 7

lifelong commitment to a gluten-free diet

Question 8

Serum amylase is used for what

Answer 8

Acute pan

Question 9

Faecal elastase is used for what

Answer 9

Chronic pan

Question 10

Investigation to identify the underlying cause for his change in bowel habit

Answer 10

Faecal elastase

Question 11

definitive test for diagnosing celiac disease is what?

Answer 11

duodenal biopsy

Question 12

First line investigations for coeliac disease is wat

Answer 12

serum immunoglobulin IgA TTGA and total IgA

Question 13

A 32-year-old patient presents in clinic with a 2 month history of persistent diarrhoea, bloating and weight loss. She has not had any fevers. On examination, her abdomen is soft and non-tender throughout. Bowel sounds are present. There are a number of itchy red vesicles on her elbows and knees bilaterally. Blood tests reveal the diagnosis of coeliac disease.

What is the most likely diagnosis of her skin condition?

Answer 13

Dermatitis herpetiformis

Question 14

Clinical features of upper GI bleed

Answer 14

haematemesis (vomiting of blood or coffee-ground-like material) and/or melena (black, tarry stools).

Question 15

A 46-year-old woman receives a new diagnosis and attends her GP for follow-up and advice. Which diagnoses would require the GP to carry out serological testing for coeliac disease?

Answer 15

autoimmune thyroid disease or type 1 diabetes. Graves dieseae

Question 16

Definitive diagnosis for Mallory–Weiss tear

Answer 16

oesophagogastroduodenoscopy (OGD)

Question 17

What is Mallory Weiss tear?

Answer 17

a small tear in the mucosa of the lower oesophagus and is usually caused by violent vomiting. The history is typically that of a prolonged period of severe vomiting, followed by an episode of haematemesis. non tender

Question 18

Dermatitis herpetiformis is managed with what?

Answer 18

dapsone

Question 19

A 66 year old male with a history of alcohol excess presents with a 2 month history of upper abdominal pain and weight loss. He also describes pale stools that are difficult to flush away.

What is the most likely cause of his symptoms?

Answer 19

Chronic pancreatitis

Question 20

Rectal involvement suggests what?

Answer 20

UC

Question 21

A 67-year-old gentleman with known cirrhosis secondary to alcohol liver disease is admitted to the Emergency Department with haematemesis. He is haemodynamically unstable with a heart rate of 120bpm and a blood pressure of 100/60 mmHg. He is treated for a variceal bleed with intravenous fluids, given one unit of blood and started on antibiotics. His observations stabilise and he is listed for an oesophago-gastro-duodenoscopy (OGD) later that day.

What is the most appropriate medical management prior to OGD?

Answer 21

Piperacillin/ Tazobactam/ Terlipressin

Question 22

A 30-year-old man presents to his GP complaining of 2 weeks of burning chest pain which he experiences only when laying down in bed at night. His partner has also told him he has notable halitosis in recent months, which he finds embarrassing.

What is the most likely diagnosis?

Answer 22

Gastro-oesophageal reflux

Question 23

A 57-year-old male presents to the Emergency Department with confusion and abdominal pain. He is unable to give any information about his medical history, due to his confusion. Blood tests identify significantly deranged liver function tests.

On examination, what clinical sign may suggest that this is an acute rather than chronic form of liver disease?

Answer 23

Tender, smooth hepatomegaly

Question 24

A 39 year old woman collapses in the corridor of the cardiology ward. It is safe to approach and a nearby doctor goes to her aid.

First step to perform is what?

Answer 24

Try to elicit a response from the patient

Question 25

A 42-year-old man presents with chronic diarrhoea, weight loss, and abdominal bloating. Which of the following is a common cause of gastrointestinal malabsorption, and therefore responsible for his symptoms?

Answer 25

Coeliac disease

Question 26

A 32 year old female is seen in the gastroenterology clinic. She has had symptoms of recurrent abdominal pain for the last seven months that seem to occur approximately every other day. She is passing loose stools three times per day, and feels that the pain is relieved by defaecation. She denies any rectal bleeding or weight loss, and does not have a family history of bowel cancer. Next best investigation is what?

Answer 26

Tissue transglutaminase antibodies

Question 27

definitive diagnostic test for coeliac disease

Answer 27

Oesophagogastroduodenoscopy (OGD) with small bowel biopsy - gold standard