Phase II - GI

Question 1

Give 4 functions of the liver.

Answer 1

1. Glucose and fat metabolism.
2. Detoxification and excretion.
3. Protein synthesis e.g. albumin, clotting factors.
4. Defence against infection.

Question 2

Name 3 things that liver function tests measure.

Answer 2

1. Serum bilirubin.
2. Serum albumin.
3. Pro-thrombin time.

Question 3

Name an enzyme that increases in the serum in cholestatic liver disease (duct and obstructive disease).

Answer 3

Alkaline phosphatase.

Question 4

What enzymes increase in the serum in hepatocellular liver disease?

Answer 4

Transaminases e.g. AST and ALT.

Question 5

Name two hepatocellular enzymes.

Answer 5

Transaminases e.g. AST and ALT.

Question 6

Name a cholestatic enzyme.

Answer 6

Alkaline phosphatase.

Question 7

What enzyme is responsible for ‘mopping up’ reactive intermediates of paracetamol and so prevents toxicity and liver failure?

Answer 7

Glutathione transferase.

Question 8

What are the potential consequences of hepatocyte regeneration in someone with liver cirrhosis?

Answer 8

Neoplasia and therefore HCC. Hepatocyte regeneration is liable to errors.

Question 9

Give 3 causes of iron overload.

Answer 9

1. Genetic disorders e.g. haemochromatosis.
2. Multiple blood transfusions.
3. Haemolysis.
4. Alcoholic liver disease.

Question 10

What protein is responsible for controlling iron absorption?

Answer 10

Hepcidin.

Levels of this protein are decreased in haemochromatosis.

Question 11

What can cause peritonitis?

Answer 11

1. Bacterial infection due to a perforated organ; spontaneous bacterial peritonitis; infection secondary to peritoneal dialysis.
2. Non-infective causes e.g. bile leak; blood from ruptured ectopic pregnancy.

Question 12

Name a cause of pelvic inflammatory disease.

Answer 12

A complication of chlamydial infection.

Question 13

Give 4 reasons why liver patients are vulnerable to infection.

Answer 13

1. They have impaired reticulo-endothelial function.
2. Reduced opsonic activity.
3. Leukocyte function is reduced.
4. Permeable gut wall.

Question 14

Describe the progression from normal epithelium to colorectal cancer.

Answer 14

1. Normal epithelium.
2. Adenoma.
3. Colorectal adenocarcinoma.
4. Metastatic colorectal adenocarcinoma.

Question 15

Give 4 groups at risk of diarrhoeal infection.

Answer 15

1. Food handlers.
2. Health care workers.
3. Children who attend nursery.
4. Persons of doubtful personal hygiene.

Question 16

What is the criteria for dyspepsia?

Answer 16

> 1 of the following:

• Postprandial fullness.
• Early satiation.
• Epigastric pain/burning.

Question 17

Give 5 causes of dyspepsia.

Answer 17

1. Excess acid.
2. Prolonged NSAIDS.
3. Large volume meals.
4. Obesity.
5. Smoking/alcohol.
6. Pregnancy.

Question 18

Give 5 red flag symptoms that you might detect when taking a history from someone with dyspepsia.

Answer 18

1. Unexplained weight loss.
2. Anaemia.
3. Dysphagia.
4. Upper abdominal mass.
5. Persistent vomiting.

Question 19

What investigations might you do in someone with dyspepsia?

Answer 19

1. Endoscopy.
2. Gastroscopy.
3. Barium swallow.
4. Capsule endoscopy.

Question 20

What is the management for dyspepsia if the red flag criteria has been met?

Answer 20

1. Suspend NSAID use and review medication.
2. Endoscopy.
3. Refer malignancy to specialist.

Question 21

What is the management for dyspepsia without red flag symptoms?

Answer 21

1. Review medication.
2. Lifestyle advice.
3. Full dose PPI for 1 month.
4. Test and treat h.pylori infection.

Question 22

What kind of lifestyle advice might you give to someone with dyspepsia?

Answer 22

1. Lose weight.
2. Stop smoking.
3. Cut down alcohol.
4. Dietary modification.

Question 23

Give a potential consequence of anterior ulcer haemorrhage.

Answer 23

Acute peritonitis.

Question 24

Give a potential consequence of posterior ulcer haemorrhage.

Answer 24

Pancreatitis.

Question 25

What would be raised in the blood tests taken from someone with primary biliary cirrhosis?

Answer 25

1. Raised IgM. 2. Raised ALP. 3. Positive AMA.

Question 26

What 4 features would you expect to see in the blood test results taken from someone who has overdosed on paracetamol.

Answer 26

1. Metabolic acidosis. 2. Prolonged pro-thrombin time (due to coagulability). 3. Raised creatinine (renal failure). 4. Raised ALT.

Question 27

Name 4 fat soluble vitamins.

Answer 27

A, D, E and K.

Question 28

Why might someone with primary biliary cirrhosis experience itching as a symptom?

Answer 28

Because there is a build up of bilirubin.

Question 29

Are most liver cancers primary or secondary?

Answer 29

Secondary - they have metastasised to the liver from the GI tract, breast and bronchus.

Question 30

Where have most secondary liver cancers arisen from?

Answer 30

1. The Gi tract. 2. Breast. 3. Bronchus.

Question 31

Describe the aetiology of HCC.

Answer 31

Most HCC is in patients with cirrhosis. This is often due to HBV/HCV and alcohol.

Question 32

Give 5 symptoms of HCC.

Answer 32

1. Weight loss. 2. Anorexia. 3. Fever. 4. Malaise. 5. Ascites.

Question 33

What investigations might you do on someone who you suspect has HCC?

Answer 33

1. Bloods: serum AFP may be raised. 2. US or CT to identify lesions. 3. MRI. 4. Biopsy if diagnostic doubt.

Question 34

Describe the treatment for HCC.

Answer 34

1. Surgical resection of solitary tumours. 2. Liver transplant. 3. Percutaneous ablation.

Question 35

How long after infection with hepatitis B virus is HBsAg present in the serum for?

Answer 35

HBsAg will be present in the serum from 6 weeks - 3 months after infection.

Question 36

How long after infection with hepatitis B virus is anti-HBV core (IgM) present in the serum for?

Answer 36

Anti-HBV core (IgM) slowly rises from 6 weeks after infection and its serum level peaks at about 4 months.

Question 37

Name 3 diseases that lead to heamolytic anaemia and so a raised unconjugated bilirubin and pre-hepatic jaundice.

Answer 37

Causes of haemolytic anaemia: 1. Sickle cell disease. 2. Hereditary spherocytosis/elliptocytosis. 3. GP6D deficiency. 4. Hypersplenism.

Question 38

How would you know if an individual had been vaccinated against hepatitis B?

Answer 38

They would have anti-HBVs IgG in their serum.

Question 39

What type of anaemia do you associate with alcoholic liver disease?

Answer 39

Macrocytic anaemia.

Question 40

Name a protozoa that can cause amoebic liver abscess?

Answer 40

Entemoeba histolytica.

Question 41

What are the symptoms of entemoeba histolytica?

Answer 41

- RUQ pain. - Bloody diarrhoea. - Fever and malaise. Often the patient has a history of foreign/rural travel.

Question 42

What is the treatment for entemoeba histolytica?

Answer 42

Metronidazole.

Question 43

What is the treatment for mild/moderate UC?

Answer 43

Mesalazine.

Question 44

A 4-year-old girl presents with diarrhoea and is hypotensive. What is the physiological reason that fluid moves from the interstitium to the vascular compartment in this case?

Answer 44

Reduced hydrostatic pressure. Fluid will move from the interstitium into the plasma if there is an increase in osmotic pressure or a decrease in hydrostatic pressure. As this patient is hypotensive it is more likely to be the latter.

Question 45

What drug would you give to someone that has overdosed on paracetamol?

Answer 45

IV N-Acetyl-Cysteine.

Question 46

Where is folate absorbed?

Answer 46

In the jejunum.

Question 47

Where is vitamin B12 absorbed?

Answer 47

In the terminal ileum.

Question 48

Where is iron absorbed?

Answer 48

In the duodenum.

Question 49

Give 5 histological features of a malignant neoplasm.

Answer 49

1. High mitotic activity. 2. Rapid growth. 3. Border irregularity. 4. Necrosis. 5. Poor resemblance to normal tissues.

Question 50

What hormone is responsible for the production of gastric acid?

Answer 50

Gastrin.

Question 51

A patient’s oedema is caused solely by their liver disease. State one possible pathophysiological mechanism for their oedema.

Answer 51

Hypoalbuminaemia.

Question 52

List two stool tests a GP might request to help differentiate between the different causes of diarrhoea.

Answer 52

1. Stool culture. | 2. Faecal calprotectin.

Question 53

What investigations might you do in someone with inflammatory bowel disease?

Answer 53

1. Bloods - FBC, ESR, CRP. 2. Faecal calprotectin - shows inflammation but is not specific for IBD. 3. Flexible sigmoidoscopy. 4. Colonoscopy.

Question 54

What 2 products does haem break down in to?

Answer 54

Haem -> Fe2+ and biliverdin.

Question 55

What enzyme converts biliverdin to unconjugated bilirubin?

Answer 55

Biliverdin reductase.

Question 56

What is the function of glucuronosyltransferase?

Answer 56

It transfers glucuronic acid to unconjugated bilirubin to form conjugated bilirubin.

Question 57

What protein does unconjugated bilirubin bind to and why?

Answer 57

Albumin. It isn't H2O soluble therefore it binds to albumin so it can travel in the blood to the liver.

Question 58

What does conjugated bilirubin form?

Answer 58

Urobilinogen.

Question 59

What is responsible for the conversion of conjugated bilirubin into urobilinogen?

Answer 59

Intestinal bacteria.

Question 60

What can urobilinogen form?

Answer 60

1. It can go back to the liver via the enterohepatic system. 2. It can go to the kidneys forming urinary urobilin. 3. It can form stercobilin which is excreted in the faeces.

Question 61

Give 3 causes of duct obstruction.

Answer 61

1. Gallstones. 2. Stricture (narrowing) e.g. malignant, inflammatory. 3. Carcinoma. 4. Blocked stent.