Passmedicine GI 2

Question 1

A 45-year-old man presents to the emergency department with haematemesis. He looks dishevelled and smells strongly of alcohol. On examination, the doctor identifies palmar erythema, spider naevi and jaundiced sclera. His observations show he is tachycardic and tachypnoeic, his blood pressure is 90/55 mmHg. What is the most likely cause of the patient’s haematemesis?

Answer 1

Oesophageal varices

Question 2

What is the most common organism found on ascitic fluid culture for spontaneous bacterial peritonitis?

Answer 2

E.coli

Question 3

What is spontaneous bacterial peritonitis and who does it usually decelop in?

Answer 3

Spontaneous bacterial peritonitis is a form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis.

Question 4

Features of spontaneous bacterial peritonitis

Answer 4

• ascites
• abdominal pain
• fever

Question 5

Diagnosis of spontaneous bacterial peritonitis

Answer 5

paracentesis: neutrophil count > 250 cells/ul

Question 6

Management of spontaneous bacterial peritonitis

Answer 6

intravenous cefotaxime

Question 7

Examples of antibiotics which can cause clostridium difficile

Answer 7

clindamycin, penicillins (amoxicillin) and 3rd generation cephalosporins

Question 8

A 65-year-old man presents with severe upper abdominal pain, fever, and vomiting. He is diagnosed with acute pancreatitis. Which of the following liver function tests is raised disproportionately in pancreatitis?

Answer 8

Amylase

Question 9

What is the cause of the majority of cases of acute pancreatitis in the UK?

Answer 9

Gallstones and alcohol

Question 10

In addition to IBD, other causes of a raised faecal calprotectin include:

Answer 10

• bowel malignancy
• coeliac disease
• infectious colitis
• use of NSAIDs

Question 11

Which vessel is mainly responsible for the blood supply to the bile duct?

Answer 11

Hepatic artery

Question 12

Presentation of a mallory-weiss tear

Answer 12

painful episodes of haematemesis

Question 13

What can cause a Mallory-Weiss tear?

Answer 13

Any episode of repeated forceful vomiting

Question 14

r Stent is a 57-year-old man who has been admitted for an elective laparoscopic right hemicolectomy. During the anaesthetic clinic he is found to have a number of comorbidities. There include:

• A protein C deficiency
• Constipation
• A latex allergy
• Coronary artery disease
• Moderately raised intracranial pressure due to a benign space occupying brain tumour.

Which of these is an absolute contraindication to laparoscopic surgery?

Answer 14

Raised intracranial pressure

Question 15

Typical presentation of acute pancreatitis

Answer 15

Severe, sharp pain that radiates to the back