Formative

Question 1

What mechanism is responsible at a cellular level for producing stomach acid?

Answer 1

H/K Adenosine Triphosphotase pumps

Question 2

55 yr old man with 6 wks h/o progressive painless juaundice and weight loos, abdominal palpation is normal. What most likely?

Answer 2

Pancreatic cancer (The progressive painless part gives it away)

Question 3

What would you find on an abdo x-ray in a patient with a small bowel obstruction?

Answer 3

Centrally distributed loops of bowel

Question 4

Ingredients in Oral Rehydration TherapY?

Answer 4

NaCl

Glucose

Question 5

What GI sign can result from Overdosing on paracetamol?

Answer 5

Jaundice

Question 6

What makes up each dissacharide?

Answer 6

Lactose - Glucose + Galactose
Sucrose - Glucose + Fructose
Maltose - 2 glucose

Question 7

cancer in middle third of oesophagus, what histological type is it?

Answer 7

PRobably squamous cell

Question 8

Effect of a Vagotomy on HCl secretion?

Answer 8

Decreases it:

• Loss of direct Vagal stimulation of Parietal Cells
• Loss of vagal stimulation of G cells to produce Gastrin
• Loss of vagal stimulation histamine release from ECL cells

Question 9

Effect of a vagotomy on Gastrin secretion

Answer 9

Loss of direct stimulation on G cells during cephalic phase

But some function remains due to distention/peptide induced stimulation of G cells

Question 10

Effect of a vagotomy on gastric motility?

Answer 10

REduces gastric emptying but some movement remains due to local enteric reflexes

Question 11

Effect of a vagotomy on defacation?

Answer 11

Impaired ability to defacate

• Vagus controls reflex contraction of rectum
• Sphincter tone

Question 12

Woman presents with 3wks of RUQ pain & progressive jaundice.
ALT/AST are normal but ALKP is raised.
What questions can you ask to narrow down your diagnosis?

Answer 12

• Alcohol history
• IV drug use history
• H/o gallstnes
• Characterisitcs of pain
• Previous episdoes of colic or jaundice
• Changes in stool
• urine colour & Changes in urine colour
• Are meals related to pain
• Tattoos
• Medication history
• Episodes of pyrexia
• Sexual contact
• TRavel Abroad
• Blood transfusion or products

Question 13

Normal ALT & AST but raised ALKP.

Is the jaundice hepatic or post-hepatic?

Answer 13

Post-hepatic.

ALKP is found in biliary epithelium so damage there increases it

Question 14

Causes of obstructive jaundice?

Answer 14

Gall stone in common bile duct
Tumour of common bile duct
Stricture of common bile duct
Carcinoma head of pancreas
Tumour of ampulla of vater
Tumour of common hepatic duct

Question 15

Complications of Gallstones?

Answer 15

acute cholecystitis
Chronic Cholecystitis
perforation of gall bladder wall
biliary peritonitis
empyema
mucocele
carcinoma of gall bladder
secondary biliary cirrhosis
jaundice
biliary colic
pancreatitis
small bowel obstruction

Question 16

Risk factors for Gall stones?

Answer 16

Fat (>30 bmi)
Female
Forty (>40 yrs)
Fertile (has children)
Diabetes
Small bowel resection or disease
Hyperlipidaemia

Question 17

Why is PTT prolonged in post-hepatic jaundice?

Answer 17

No bile in bowel

• > No fat soluble vitamin absorption
• > No Vit K
• > No clotting factors

Question 18

DDx haematemesis?

Answer 18

Oesophageal varices
Oesophageal carcinoma
Gastric Carcinoma
Mallory Weiss Tear
Peptic ulcer
Gastritis

Question 19

Describe the process of development of a gastric canceR?

Answer 19

Normal

• > Chronic Gastritis
• > Intestinal metaplasia
• > Dysplasia
• > Tumour

Question 20

Prognosis for gastric cancer?

Answer 20

Poor

20% 5 yr survival

Question 21

Eradication therapy for H Pylori?

Answer 21

Triple therapy:

• PPI (omeprazole)
• 2 antibiotics (Amoxicillin, Clarithromycin or metronidazole)

Question 22

complications of peptic ulcer?

Answer 22

Perforation
Bleeding
Stricture Formation

Question 23

How to diagnose coeliac?

Answer 23

Small bowel biopsy shows villous atrophy

Question 24

Skin condiiton associated with coeliac?

Answer 24

Dermatitis Herpetiformis