Anatomy & Physiology
Where is bile stored before it is released into the small intestine?
Gallbladder
Name two lifestyle factors that increase gastric ulcer risk.
Smoking, alcohol consumption, prolonged NSAID use
Which lifestyle advice is important for patients with IBD?
a) Manage stress and eat a balanced diet
b) Drink only fizzy drinks
c) avoid exercise
d) Eat no fruit or vegetables at all times
a) Manage stress and eat a balanced diet
Most people with ulcerative colitis are recommended to follow a healthy, balanced diet and drink plenty of fluids. This is to avoid dehydration and ensure you get all the nutrients you need. Managing stress may reduce the frequency of symptoms.
Which blood test can help detect anaemia from slow GI bleeding
Full Blood Count (HB)
72M comes to the ward vomiting a dark brown liquid that looks like coffee grounds. He has bad knees and takes ibuprofen every day. BP 98/60, HR 118. What 3 signs show he is becoming unwell?
Low blood pressure, fast heart rate, vomiting blood.
Name two accessory organs of the digestive system
Liver, Pancreas (also Gallbladder)
I- Idiopathic (unknown)
G- Gallstones/ Genetic
E- Ethanol
T- Trauma (Penetrating)
S- Steroids
M- Mumps
A- Autoimmune
S- Scorpion Sting
H- Hyperlipideamia/ Herpcalcaemia
E- ERCP
D- Drugs
Are all potential causes of what common Gastro Disease?
Pancreatitis
Which treatment can permanently cure end-stage liver failure?
Liver Transplant
(Strict criteria which include MDT and psychological assessments)
MDT includes: surgeons, hepatologists (liver doctors), anaesthetists, intensive care specialists, liver transplant coordinators, a dietician, social worker and in some cases a psychiatrist.
Which imaging test is used to assess liver stiffness non-invasively
Fibroscan
Why might patients with liver cirrhosis bruise easily
The damaged liver produces fewer clotting factors, leading to increased bleeding and bruising risk
What is the main role of the large intestine?
a) Absorb water and form faeces
b) Produce digestive enzymes
c) Absorb protein
d) Break down fats
a) Absorb water and form faeces
Which bacteria is most strongly linked to gastric ulcers
Helicobacter pylori. (H. Pylori)
Why should corticosteroids generally not be used long-term in IBD
Risk of side effects such as osteoporosis, infection, and adrenal suppression; they are for flare control, not maintenance
Which symptom in a cirrhotic patient suggests hepatic encephalopathy?
Confusion or forgetfulness
58F, has liver disease. Today she is more sleepy and confused. Her stomach looks bigger and she has yellow skin. NEWS 0. Which medication would you prioritise to give?
a) IV paracetamol
b) lactulose
c) levothyroxine
d) bisoprolol
Rationale:
For liver disease patients, high risk for hepatic encephalopathy (build up of toxins), which could cause confusion and drowsiness.
Which chronic liver disease is caused by replacement of healthy tissue with scar tissue
Liver cirrhosis
Why can portal hypertension cause oesophageal varices
Increased pressure in the portal vein causes blood to back up into smaller veins, such as those in the oesophagus, which can swell and rupture
What 2 observations would you do to those who has or suspected to have pancreatitis?
(If your answer include NEWS; which bit specifically)
Pain (Analgesia: usually IV)
Fluid balance (strict fluid balance as risk of AKI)
Blood Glucose
In liver cirrhosis, why is careful medication dosing important?
The damaged liver metabolises drugs less effectively, increasing toxicity risk.
How might gallstones contribute to acute pancreatitis?
Gallstones can block the pancreatic duct, causing enzyme backup and inflammation.
Patients known to have cirrhosis are at risk portal hypertension. If Portal Hypertension is not managed, what common complication in this category of patients at risk of?
Variceal bleeding, ascites, and encephalopathy
(Any of these 3 answers correct)
Which metabolic condition is strongly linked to non-alcoholic fatty liver disease?
Type 2 diabetes mellitus (related to lifestyle factors and body's resistance to insulin)
Patient admitted with on going nausea and vomiting. Treat as viral Gastroenteritis. You observed that they are prescribed to have Ramipril, metformin and loperamide in your morning meds rounds with BP 95/50 symptomatic. What would you do?
a) encourage fluid intake, check fluid balance and give meds as prescribed, consider antiemetic
b) encourage fluid intake, check fluid balance, withhold meds and reassess in 1-2 hours
c) encourage fluid intake, check fluid balance, withhold meds and consider asking for IVT and antiemetic
d) encourage fluid intake, check fluid balance, withhold meds, consider asking for IVT and antiemetic and check BM
d) encourage fluid intake, check fluid balance, withhold meds, consider asking for IVT and antiemetic and check BM
(then reassess in 30- 60 min)
Dehydration could be a cause of a patient being constipated. Patient admission weight 80kg. How would you calculate if patient has met their ideal daily fluid requirement?
a) 50ml/kg
b) 30ml/kg
c) 40ml/kg
d) 60ml/kg
b) 30ml/kg
If a patient is 80kg. Ideal daily fluid requirements = 2400mls
(30ml x 80kg = 2400ml)
25M, has ulcerative colitis. Today he has been to the toilet 12 times with blood in his stool. He has tummy pain and feels unwell. BP 104/68, HR 124, T 38.1. What should you monitor closely?
a) stool chart, food chart, daily weight
b) stool chart, fluid balance, CIWA
c) stool chart, fluid balance, NEWS
c) stool chart, fluid balance, NEWS
Rationale:
Stool chart- close monitoring will show if treatment is working or not
Fluid balance- high risk of AKI as could become dehydrated from motions and pyrexia
NEWS- as you would monitor for scoring and risk of further deterioration