Week 13 - GI

Question 1

What is a peptic ulcer?

Answer 1

A break in the mucosal lining, more than 5mm diameter and depth to the submucosa

Question 2

What skin conditions is associated with coeliac disease?

Answer 2

Dermatitis herpetiformis

Question 3

What infection might patients with cirrhotic liver disease get?

Answer 3

Spontaneous bacterial peritonitis - associated with spontaneous infection of ascites

Question 4

What is an acute abdomen?

Answer 4

Sudden onset of severe abdominal pain of less than 24 hours duration.
RUQ- biliary colic, acute cholangitis
RIF - ectopic pregnancy, acute appendicitis, ovarian cyst

Question 5

What are consequences of peptic ulceration?

Answer 5

Haemorrhage, perforation, fibrosis

Question 6

What characterises diffuse gastric cancer?

Answer 6

Linitis plastica (leather bottle stomach) 
(also has signet ring cells- malignancy with mucin vacuoles)

Question 7

What drug is a risk factor for gallstones?

Answer 7

Ceftriaxone

Question 8

What tumour marker would indicate pancreatic cancer?

Answer 8

CA19-9

Question 9

What tumour marker is present in colorectal cancer?

Answer 9

Carcinomembryonic antigen

Question 10

What tumour marker is present in hepatocellular carcinoma?

Answer 10

Alpha-fetoprotein

Question 11

What score assesses severity of liver cirrhosis?

Answer 11

Child-turcotte-pugh score

Question 12

What antibiotic is used in spontaneous bacteria peritonitis?

Answer 12

Ciprofloxacin

Question 13

What hepatitis is associated with travel?

Answer 13

Hepatitis A

Question 14

What type of vaccine is the hepatitis A?

Answer 14

Inactivated virus

Question 15

What can Hepatitis E cause in pregnant women?

Answer 15

Fulminant hepatitis

Question 16

What does Hep D need to survive?

Answer 16

Hepatitis B

Question 17

What might augmentin cause?

Answer 17

Acute cholestatic hepatitis

Question 18

Give an example of a liver cyst.

Answer 18

Von meyenberg complex (simple biliary hamartoma)

Question 19

What can itching be a sign of? (GI)

Answer 19

Primary biliary cirrhosis

Question 20

What might coeliac disease cause?

Answer 20

Enteropathy associated T cell lymphoma

Question 21

What does T3 mean?

Answer 21

Invasion through the muscular propria and into the sub-serosa or non-peritonelaised pericolic tissue

Question 22

What condition might present with aphthous oral ulcers?

Answer 22

Ulcerative colitis

Question 23

What drugs would you give in a patient with frequently severe relapses of UC? and what is a risk of it?

Answer 23

Azathioprine/6-mercaptopurine

Risk of lymphoma

Question 24

What is Crohn’s disease?

Answer 24

Chronic, transmural, inflammatory granulomatous disease from mouth to anus.

Question 25

What acute changes are seen in IBD?

Answer 25

Ulceration, crypt abscess formation, loss og goblet cells. acute inflammation

Question 26

What is localised peritonisitis caused by?

Answer 26

Underlying organ inflammation - appendicitis or cholecysitis

Question 27

What is generalised peritonitis caused by?

Answer 27

Perforation of an abdominal organ - perforated duodenal ulcer, ruptured appendix

Question 28

What drugs may cause cirrhosis?

Answer 28

Amiodarone, methotrexate, Na valproate

Question 29

What might cause hepatic encephalopathy?

Answer 29

GI bleeding, infections, constipation, electrolyte imbalance

Question 30

What might be a complication of Coeliac disease?

Answer 30

T cell lymphoma | Infections, osteoporosis, refractory coeliac disease, malignancy (adenocarcinomas - bowel, oesophagus)

Question 31

What is a complication of C.Diff infection?

Answer 31

Pseudomembranous colitis | Toxic megacolon

Question 32

How might you differentiate between inflammatory bowel disease and irritable bowel syndrome?

Answer 32

Faecal calprotectin Calcium binding protein derived from neutrophils Not disease specific

Question 33

How might infective colitis present?

Answer 33

``` Short history of diarrhoea ± vomiting Abrupt onset ± resolution of Sx Systemic upset and fever Travel, ill contacts, immunocompromised. Stool culture and C.diff toxin assay (need 4) ```

Question 34

How might ischaemic colitis present?

Answer 34

Abrupt onset pain, bloody diarrhoea ± SIRS IV fluids ± antibiotics CV disease, Heart failure, elderly

Question 35

What does 'Back wash ileitis' mean?

Answer 35

When the terminal ileum is involved in Ulcerative colitis | severe cases

Question 36

What type of oesophageal cancer is smoking and drinking associated with? What is the other type?

Answer 36

Squamous carcinoma Adenocarcinoma - GORD and obesity

Question 37

When would you use the Seattle protocol?

Answer 37

Diagnosing Barretts oesophagus | 4 biopsies every 2cm

Question 38

What type of cells are seen in Diffuse gastric cancer that can be described as 'individual malignant cells with mucin vacuoles'.

Answer 38

Signet ring cells

Question 39

What are the types of gastric cancer?

Answer 39

Diffuse - Women <50 (signet ring cells) | Intestinal - Elderly men (end result of inflammation causing dysplasia)

Question 40

What is the Glasgow-Blatchford score used for?

Answer 40

Based on clinical presentation. Risk of having an upper GI bleed, in a suspected bleed. > 0 is high risk

Question 41

What is the Rockall score used for?

Answer 41

Calculates the risk of a re-bleed if patients get endoscopied

Question 42

How might someone with an upper GI bleed present? | ABATED for upper GI bleed management

Answer 42

Melaena, coffee ground vomit, haematemesis, haemodynamic instability

Question 43

How would you manage a patient with variceal bleeding?

Answer 43

1. Restore circulating volume, transfuse once Hb <7g/dL 2. Endoscopy 3. Ciprofloxacin + Terlipressin, endoscopic banding (1st Line), TIPS

Question 44

What would you give for prophylaxis of variceal bleeding?

Answer 44

Beta blockers or band ligation | Same for prevention of re-bleed

Question 45

How would you manage uncontrolled variceal bleeding?

Answer 45

Sengstaken tube

Question 46

Define Tenesnus.

Answer 46

A feeling of fullness in the rectum even after opening your bowels

Question 47

Who would get screened for bowel cancer?

Answer 47

50-74 every 2 years Faecal immunochemistry test to look for human Hb Then 2 weeks wait referral to colonoscopy

Question 48

What are the options for pre-exposure prophylaxis to Hep A? | Hep A can cause Acute liver failure

Answer 48

Inactivated virus - Hep A vaccine | If vaccine allergic. <4 weeks to travel, confers 3-6 months immunity - Hep A immunoglobulin - Pooled Ig

Question 49

Hepatitis E can cause neurologic features, give an example.

Answer 49

Guillain barre syndrome

Question 50

How would you treat Hep E?

Answer 50

Ribavirin

Question 51

What does sAg mean?

Answer 51

Active infection

Question 52

What does eAg mean?

Answer 52

Highly infections, high risk of CLD, HCC, highly infectious | Indicates viral réplication

Question 53

What is is used in Hep Vaccines?

Answer 53

sAg

Question 54

What does cAb mean?

Answer 54

Previous infection

Question 55

What does HBV DNA?

Answer 55

Viral load

Question 56

In assessing Ascites via a diagnostic tap, what can you look for?

Answer 56

Cell count - > 500WBC/cm3 >250 neutrophils | Serum ascites albumin gradient - Sr MINUS ascites albumin. (high SAAG) LOW protein ascites >11g/L - portal hypertension

Question 57

What symptoms might lead you to believe a patient has acute pancreatitis?

Answer 57

Constant epigastric pain that may radiate to the back Relieved when leaning forward Guarding of the abdomen

Question 58

List some types of pancreatic cysts.

Answer 58

Intraductal papillary mutinous neoplasm - in continuity with the main pancreatic duct, dysplastic papillary lining secreting mucin Mucinous cystic neoplasm - 'ovarian type stroma' Serous cyst adenoma - no mucin, almost always benign

Question 59

What are some causes of acute cholestasis?

Answer 59

Hep A and E Drug induced Extrahepatic biliary obstruction

Question 60

What are some causes of Chronic hepatitis?

Answer 60

Hep B and C (D) Genetic depositions - Wilsons, haemochromatosis AI

Question 61

How could you grade mental state in encephalopathy?

Answer 61

Conns score (west haven classification)