Gl #4 Category-wise Questions (NEW!!!) » Gastroenterology > Gl #4 | ee Cicurrent Review Answered [lj Correct Ml Incorrect 1 Question Category: Gastroenterology & Gl Surgery ‘Ayoung patient presented with pallor and lethargy. Laboratory investigations show following results: hypochromic. microcytic anaemia, low calcium and high INR. What investigation will donext? © CTabdomen © Blood culture ©. Ultrasound abdomen jadin antibodies © Stool microscopy and culture Skip question torresCategory-wise Questions (NEW!!!) > Gastroenterology > Gl #4 Bees 2s 6 7 8 ow Cicurrent i Review/Skip [Answered [ll Correct Ml incorrect 1. Question Category: Gastroenterology & GI Surgery Ayoung patient presented with pallor and lethargy. Laboratory investigations show following results: hypochromic microcytic anaemia, low calcium and high INR. What investigation will do next? CT abdomen Blood culture Ultrasound abdomen Stool microscopy and culture Incorrect This patient has findings consistent with malabsorption syndrome leading to deficiency of fat soluble vitamins like vitamin K deficiency (high INR), vitamin D deficiency {low calcium) and iron deficiency anaemia, These are consistent with a possible diagnosis of coeliac disease. So the next step should be to check anti-gliadin antibodies. Ideally, serological screening tests for coeliac disease includes anti-tissue transglutaminase |zA antibody and anti-deaminated gliadin IgG antibody. ‘The combination of these two tests gives a high degree of sensitivity and specificity. A small intestinal biopsy is required to establish a diagnosis of celiac disease. Tscan and ultrasound of the abdomen are not helpful in the diagnosis of suspected celiac disease Blood culture and stool microscopy would not help in confirming the diagnosis of suspected celiac disease. References: ‘Uhttpsi//www.ncbi.nim.nih.gov/books/NBK553106/ 2shttps://www.uptodate.com/contents/approach-to-the-adult-patient-with-suspected: malabsorption#H2038851378 DdGl #4 Category-wise Questions (NEW!!!) » Gastroenterology > GI#4 CB: ser 8 ew Cicurrent Review /! ip Answered [| Correct MI Incorrect 2. Question Category: Gastroenterology & Gl Surgery ‘21-year-old female is diagnosed with acute appendicitis and is planned to undergo a laparoscopic appendectomy. All blood results are unremarkable. What will you consider for antibiotic prophylaxis? ©. Intravenous Cephazolin and gentamicin ©. Oral ciproftoxacin ©. Clindamycin ©. Intravenous metronidazole, and cephazolin or gentamicin, © Doxycycline3094 5 6 7 8 9 10 Cicurrent (Review /Skip fll Answered MB Correct MM incorrect 2.Question Category: Gastroenterology & GI Surgery ‘21-year-old female is diagnosed with acute appendicitis and is planned to undergo a laparoscopic appendectomy. All blood results are unremarkable. What will you consider for antibiotic prophylaxis? Intravenous Cephazolin and gentamicin Oral ciprofloxacin Clindamycin Intravenous metronidazole, and cephazolin or gentamicin Doxycycline Incorrect Asingle dose of antibiotic is usually sufficient as prophylaxis for a surgical procedure involving manipulation of abdominal viscera However, if the procedure is not completed within 3 hours of initiating prophylaxis, a second dose should be given if ashort-acting antibiotic is used. In practice, itis very difficult to establish prospectively that any operation will be a clean procedure as. unexpected pathology may be encountered or intraoperative contamination may occur. Meta-analysis of trials has shown that prophylaxis is appropriate in all patients undergoing abdominal surgery. Metronidazole plus either gentamicin or cefazolin are the best choice prophylaxis for colorectal surgery and appendectomy. References: ‘Uhttps://www.nebinim.nih gov/books/NBK6917/Gl #4 Category-wise Questions (NEW!!!) » Gastroenterology > Gl #4. BBM: :: 722» Cicurrent Review /! ip Answered [| Correct MI Incorrect 3. Question Category: Gastroenterology & GI Surgery Which of the following is the most common organism seen in spontaneous bacterial peritonitis? O Escherichia coli (Staphylococcus aureus © Enterococcus species © Streptococcus viridans O Clostridium difficileGl #4 Category-wise Questions (NEW!!!) » Gastroenterology > Gl #4. Bes 67 28 2 w Cicurrent Review/Skip [ll Answered Ml Correct Ml Incorrect 3. Question Category: Gastroenterology & GI Surgery Which of the following is the most common organism seen in spontaneous bacterial peritonitis? Escherichia coli Staphylococcus aureus Enterococcus species Streptococcus viridans Clostridium difficile Correct In spontaneous bacterial peritonitis, the most common organism is Escherichia coli. Gram-positive bacteria, including Streptococcus viridian, Staphylococcus aureus, and Enterococcus species can also be found in the ascitic culture. References: ‘Uhttps://www.nebi.nlm.nih.gov/pme/articles/PMC2697093/ odGl #4 Category-wise Questions (NEW!!!) » Gastroenterology > Gl #4. Gonos: :-» Cicurrent Review/Skip [ll Answered Ml Correct Ml Incorrect 4, Question Category: Gastroenterology & Gl Surgery ‘Acute cholangitis has a current mortality rate of 5 to 40 percent in Australia Which of the following is not a poor prognostic determinant? ©. Acute renal failure (© Failure to respond to conservative management Hypotension O Irritable bowel syndrome O Liver abscess = ontCategory-wise Questions (NEW!!!) > Gastroenterology > Gl#4. Cicurrent (© Review /Skip fl Answered MB Correct MM incorrect Review Question Conard 4.Question Category: Gastroenterology & GI Surgery Acute cholangitis has a current mortality rate of 5 to 40 percent in Australia. Which of the following is not apoor prognostic determinant? Acute renal failure Failure to respond to conservative management Hypotension Irritable bowel syndrome Liver abscess 'y for acute cholangitis is 5 to 40 percent-Poor prognostic determinants in acute cholangitis resulting in this high mortality rate include: 41. Age more than 70. 2: Female gender. 3: Fallure to respond to conservative management. 4- Concurrent medical conditions like liver abscess hypoalbuminaemia,thrombocytopenia.cirrhosis,inflammatory bowel disease and high malignant strictures. Irritable bowel syndrome is not of any prognostic significance for the outcome of acute cholang! References: 1/ https://omcgastroenterol.biomedcentral. com/articles/10.1186/s12876-016-0428-14Tab1 2 https:/www.researchgate.net/publication/6472190_Epidemiology_and_Prognostic_Determinants_of Patients_with_ DedGl #4 Category-wise Questions (NEW!!!) > Gastroenterology > GI#4 goons: > Cicurrent Review /! rn <= ip Answered [| Correct MI Incorrect 5. Question Category: Gastroenterology & GI Surgery ‘A.82-year-old presents with progressive dysphagia for solids and liquids over 2 years. He is still able to tolerate Solid food and there have been no episodes of bolus impaction. He also denied having any dyspepsia symptom. There has been a 2 kilogram weight loss over 6 months. Oesophageal manometry demonstrates increased tertiary wave activity and decreased the amplitude of contractions. What is the most likely diagnosis? Scleroderma © Diffuse cesophageal spasm O Presbyoesophagus © Achalasia O. Ulcerative refiux oesophagitis Sasi =‘82-year-old presents with progressive dysphagia for solids and liquids over 2 years. He is still able to tolerate solid food and there have been no episodes of bolus impaction. He also denied having any dyspepsia symptom. There has been a 2 kilogram weight loss over 6 months. Oesophageal manometry demonstrates increased tertiary wave activity and decreased the amplitude of contractions. What is the most likely diagnosis? Scleroderma Diffuse oesophageal spasm Presbyoesophagus Achalasia Ulcerative reflux oesopha} Incorrect In the given context above, given the age of patient (Age 82), symptoms and manometry finding, the most likely diagnosis for him is presbyoesophagus. Presbyoesophagus is term that used to describe the manifestations of degenerating motor function in the aging esophagus. Age-related anatomic changes in the oesophagus include hypertrophy of the skeletal muscle at the upper third, decrease in myenteric ganglion cells that coordinate peristalsis, and perhaps increased smooth muscle thickness. The amplitude of oesophageal contractions during peristalsis decreases, but the movernent of food is not impaired. Abnormal peristalsis after swallowing and non-peristaltic repetitive contractions, at one time, attributed to old age and called presbyesophagus are now thought to be due to disease processes. Secondary oesophagal contractions (induced by oesophageal distension) appear to be greatly reduced Secondary contractions contribute to clearance of refluxed acid. Diminution of these contractions, combined with decreased lower oesophagal sphincter tone, results in increased gastric acid exposure. The sensation of distension, and possibly tissue damage, in the distal oesophagus, is also impaired with age. Thus many older patients with severe reflux oesophagitis seen at endoscopy have surprisingly little symptomatology. Nevertheless, indigestive symptoms can also impair nutritional status as seen in the context above. (Patient had 2kg weight loss over 6 months) Achalasia is an uncommon disorder with an annual incidence of approximately 1.6 cases per 100,000 Individuals and prevalence of 10 cases per 100,000 individuals. Achalasia can occur at any age, but is usually diagnosed in patients between 25 and 60 years. Men and women are affected with equal frequency. Achalasia should be suspected in the following patient: Dysphagia to solids and li Heartburn unresponsive toa trial of proton pump inhibitor therapy for four weeks #Retained food in the esophagus on upper endoscopy «Unusually increased resistance to passage of an endoscope through the esophagogastric junctionAchalasia results from progressive degeneration of ganglion cells in the myenteric plexus in the esophageal wall leading to failure of relaxation of the lower esophageal sphincter (LES) accompanied by a loss of peristalsis in the distal esophagus. The etiology of primary or idiopathic achalasia is unknown. Secondary achalasia is due to diseases that cause esophageal motor abnormalities similar or identical to those of primary achala: as such amyloidosis, sarcoidosis, neurofibromatosis, eosinophilic esophay is or multiple endocrine neoplasia type 2B. manometric fi Aperistalsis in the distal two-thirds of the esophagus - In patients with achalasia, aperistalsis is seen in the smooth muscle portion of the body of the esophagus. Swallows may elicit no esophageal contraction or may be followed by simultaneous contractions with amplitudes <40 mmHg. «Incomplete LES relaxation - Incomplete LES relaxation distinguishes achalasia from other disorders associated with aperistalsis. In normal individuals, there is complete relaxation of the LES after a swallow (toa level <8 mmHg above gastric pressure). In contrast, in pati nts with achalasia, LES relaxation in response toa swallow may be incomplete or absent with a mean swallow-induced fall in resting LES pressure to a nadir value of >8 mmHg above gastric pressure. Elevated resting LES pressure - Loss of inhibitory neurons in patients with achalasia can cause resting LES pressures to rise to hypertensive levels (above 45 mmHg). ‘The diagnosis of achalasia is established by the presence of aperistalsis in the distal two-thirds of the esophagus and incomplete lower esophageal sphincter relaxation on manometry (elevated median integrated relaxation pressure by high-resolution manometry). In patients with typical achalasia symptoms (dysphagia to solids and liquids and regurgitation of bland undigested food or saliva) and equivocal manometric findings, the diagnosis is supported by aperistalsis, dilation of the esophagus, narrow esophagogastric junction, and poor emptying on barium esophagram, hence achalasia is unlikely diagnosis for this patient. Scleroderma, or systemic sclerosis, is a chronic connective tissue disease generally classified as one of the autoimmune rheumatic diseases. The word “scleroderma’ comes from two Greek words: “sclero” meaning hard, and “derma” meaning skin. Hardening of the skin is one of the most visible manifestations of the disease. The disease has been called “progressive systemic sclerosis,’ but the use of that term has been discouraged since it has been found that scleroderma is not necessarily progressive. The disease varies from patient-to- patient. Esophageal dysfunction is present in 50 to 80 percent of patients with systemic sclerosis (SSc). SScleads to atrophy of the smooth muscle in the lower two-thirds of the tubular esophagus and the lower esophageal sphincter. On pathological examination, the muscle of the lower esophagus may be partly replaced by fibrous tissue. The lamina propria and submucosa often contain increased quantities of collagen, and the mucosa frequently shows the inflammatory changes of esophagitis. However, esophageal muscle dysfunction in $Sc may be secondary to ancuronal abnormality rather than excessive collagen deposition. Manometric findings in patients with SSc include a hypotensive lower esophageal sphincter with a low resting sphincter pressure (<0 mm Hg) and low-amplitude (<30 mmHg) contractions in the distal smooth muscle portion of the esophagus, or aperistalsis. Hypotensive peristaltic contractions are associated with ineffective esophageal transit. Patients with advanced disease may have diminished peristalsis in the upper skeletal muscle portion, Common disease manifestations for scleroderma as such fatigue, arthralgia, myalgia, butterfly rash or kidney disease were not seen in the context patient making the diagnosis unlikely. The manometric fini ig given in the context patient also docs not suggestive for scleroderma with esophageal involvement. All other options were incorrect. Reference: aGl #4 Category-wise Questions (NEW!!!) » Gastroenterology > GI#4 goons: ip Answered [| Correct MI Incorrect Cicurrent Review /! rn <= 6. Question Category: Gastroenterology & GI Surgery ‘A 60-year-old lady comes to see you for her “tummy pains”Pain is localised in epigastric region and is worse after eating food and relieved by antacids.{t has been there for the last 2 years and is getting worse.She is non-smoker non-alcoholic She has not seen any doctor for the last five years as she feels healthy. Which of the following is the best next step in her management? Test for H.pylori ©. Refer for upper Gl endoscopy O Consic life style modification Consider four weeks of H2 receptor blockers Consider four weeks of PPIs =a onsGl #4 Category-wise Questions (NEW!!!) > Gastroenterology > Gl#4 augo::- (Cicurrent (i) Review/Skip [lj Answered [Correct Ml Incorrect Review Question Quiz Summary 6. Question Category: Gastroenterology & GI Surgery ‘A 60-year-old lady comes to see you for her “tummy pains"Pain is localised in epigastric region and is worse after eating food and relieved by antacids.{t has been there for the last 2 years and is getting worse.She is non-smoker non-alcoholic She has not seen any doctor for the last five years as she feels healthy. Which of the following is the best next step in her management? Test for H.pylori Refer for upper Gl endoscopy Consider life style modification Consider four weeks of H2 receptor blockers Consider four weeks of PPIs Incorrect This patient has persistent epigastric pain which gets worse with food.[t has been there for 2 years and is now getting worse.The possibility of upper gastrointestinal malignancy can not be ruled out in long-stan dyspepsia. As she is above 55 years of age, so she needs a referral toa gastroenteralogist for upper Gl endoscopy. Any patient, who is elder than 55 years and develops persistent symptoms of dyspepsia must have an upper GI ‘endoscopy as a first step.H pylori can be tested after a biopsy from stomach tissue during endoscopy. References: ‘Uhttp://www.imagingpathways.health.wa.gov.au/index.php/imaging: pathways/gastrointestinal/gastrointestinal /dyspepsia#pathway NextGl #4 Category-wise Questions (NEW!!!) » Gastroenterology > GI#4 Haan Cicurrent Review/Skip [ll Answered Ml Correct Ml Incorrect 7. Question Category: Gastroenterology & Gl Surgery ‘A.42-year-old lady presented with an incidental finding of calcified gallbladder on abdominal ultrasound.She has mild dyspepsia and no other symptoms What will be the best next step in her management? ERCP No further action needed Prophylactic cholecystectomy MRI CT angiogram Incorrect Prophylactic cholecystectomy is warranted in a patient with the calcified gallbladder:This calcified gallbladder is also called porcelain gallbladder. Porcelain gallbladder refers to calcification in the wall of the gallbladder, and presents a substantial risk for gallbladder cancer. Cholecystectomy is recommended in fit patients. References: ‘Unttpsi//wwwrracep.ore.au/afp/2013/july/biliary-pain/ 2shttps://wwweuptodate.com/contents/porcelain-gallbladderGl #4 Category-wise Questions (NEW!!!) » Gastroenterology > GI#4 BaangGes :- Cicurrent Review /! Leela Quiz Summary ip Answered [| Correct MI Incorrect 8, Question Category: Gastroenterology & GI Surgery ‘A25-year-old male presented for review in your office. His father was diagnosed with colon cancer at the age of 35 and his uncle was diagnosed with colon cancer at the age of 50. His baseline investigations including fasting blood glucose, full blood count, renal function tests, liver function tests and iron studies are all normal. What will you advise him? Colonoscopy now Colonoscopy every year © Colonoscopy every three years Colonoscopy every five years from 50 till 70 years of age © Colonoscopy every five years from 45 to 74 years of age‘25-year-old male presented for review in your office. His father was diagnosed with colon cancer at the age of 35 and his uncle was diagnosed with colon cancer at the age of 50. His baseline investigations including fasting blood glucose, full blood count, renal function tests, liver function tests and iron studies are all normal. What will you advise him? Colonoscopy now Colonoscopy every year Colonoscopy every three years Colonoscopy every five years from 50 till 70 years of age Colonoscopy every five years from 45 to 74 years of age Incorrect ‘The screening for colorectal cancer should be done according to risk category. From the context, this patient has one first-degree relative with a history of colon cancer at the age of 35 and another second-degree relative has history of colon cancer at the age of 50. This patient falls into moderate risk category and was asymptomatic, so iF OBT should be done for him every two years from 40 to 49 years of age, colonoscopy every five years from 50 to 74 years of age along with Aspirin for at least 2.5 years commencing at age 50 until 70 years of age. Kindly refer the below table: Biennial faecal occult blood test (FOBT) can reduce colorectal cancer (CRC) mortality by 16%. The original trials of FOBT screening used the gualac-based FOBT, but this has been superseded by the more sensitive and specific Faecal immunochemical test (Ie FOBT). Organised screening by IFOBT is recommended for the asymptomatic (average risk} population from 50 years of age every two years until 74 years of age with repeated negative findings. In November 2017, the National Health and Medical Research Council (NHMRC) endorsed anew national guideline on CRC prevention and screer ing, Screening recommendations, which used to be determined solely on lifetime risk of CRC, now also account for absolute risk of cancer in the short term. Risk assessment should Include determining the number and type of relatives affected by CRC, and age at diagnosis (refer to Table below). The new guideline also changed the recommendations on CRC screening modality in people at moderate risk of CRC. Of note, FOBT is now recommended for people in this group from 40 to 49 years of age and colonoscopy five-yearly from 50 to 74 years of age. Digital rectal examination (DRE) is not recommended as a screening tool, but is important in evaluating patients who present with symptoms (eg rectal bleeding). Colonoscopy is not recommended as a screening test for people at average risk of CRC.No randomised controlled trial (RCT) has evaluated the effect of colonoscopy on CRC mortality. Colonoscopy has indirect and direct harms, including, rarely, death from the procedure (one in 10,000-14,000 colonoscopies). Harm may be caused by the bowel cleanout prior to the procedure (eg dehydiration, electrolyte imbalances), sedation used. ‘during the procedure (eg cardiovascular events), or the procedure itself (eg infection, colonic perforations, bleeding). There is insufficient evidence about the use of computed tomography (CT) colonography, faecal deoxyribonucleic acid (DNA) or plasma circulating DNA tests to recommend them as alternatives to FOBT for CRC screening.The 2017 NHMRC-endorsed guideline also examined an updated systematic review of trial evidence on the effects of low-dose aspirin on CRC incidence and mortality. The guideline development group considered evidence relating to the additional benefits from reduction in cardiovascular disease risk and potential adverse effects {ie haemorrhagic stroke, gastrointestinal bleeding, peptic ulcer). Overall, it was found that the benefits of taking low-dose aspirin outweighed the harms, and the guideline recommends that aspirin should be actively considered in all people aged 50-74 years. Whois at risk? What should be done? How often? Category 1 - Average or slightly increased risk (<1% 10-year risk of CRC; 95-98% of the population) Asymptomatic people with: Immunochemical faecal occult blood test Every two years (iFOBT; |, A) from 50 to 74 + nopersonal history of bowel years of age cancer, colorectal adenomas, Low-dose aspirin (100-300 mg daily) (Practice Point) inflammatory bowel disease or _shoulld be actively considered to prevent family history of colorectal cancer CRC™ Aspirin for at least (cre) 2.5 years commencing at 50 oR until 70 years + one first-degree or one first- of aget degree and one second-degree relative with CRC diagnosed aged 255 years Category 2 - Moderately increased risk (1-4% 10-year risk of CRC; 2-5% of the population) ‘Asymptomatic people with: iFOBT iFOBT every two years from 40 to * onefirst-degreerelative with CRC Colonoscopy 49 years of age diagnosed aged <55 years Low-dose aspirin (100-300 mg daily) Colonoscopy every OR should be actively considered five years from 50 + two first-degree relatives with to 74 years of age colorectal cancer diagnosed at any Aspirin for at least age 25 years + onefirst-degree relative and at commencing at age least two second-degree relatives 50 until 70 years of diagnosed with colorectal cancer age! at any ageCategory 3 - High risk (relative risk of -4-20% Asymptomatic people with: + at least three first-degree or second-degree relatives with CRC, with at least one relative diagnosed aged <55 years + at least three first-degree relatives with CRC diagnosed at any age People with high-risk familial syndromes, Lynch syndrome: + three or more first-degree or second-degree relatives on the same side of the family diagnosed with CRC or other Lynch syndrome-related cancers$ (suspected Lynch syndrome} OR + twoor more first-degree or second-degree relatives on the same side of the family diagnosed with CRC, including any of the following high-risk features ‘+ multiple CRC in the one person = CRC aged <50years A family member who has or had Lynch syndrome-related cancer People with familial polyposis syndromes: + at least one first-degree or second-degree relative with CRC, with a large number of adenomas throughout the large bowel* ‘1% of the population)! Refer to familial cancer clinic for genetic risk assessment High-risk familial syndromes Refer to familial cancer clinic for genetic risk assessment and genetic screening of affected relatives Refer to bowel cancer specialist to plan appropriate surveillance and dose of aspirin Familial polyposis syndromes Refer to fami cancer clinic for genetic risk assessment and genetic screening of affected relatives Refer to bowel cancer specialist to plan appropriate surveillance and chemoprevention iFOBT every two years from 35 to 44 years of age Colonoscopy every five years from 45 to 74 years of age Frequency and sta wage of colonoscopic surveillance will be determined by specialist team Starting age and dose of aspirin will be determined by ist teamll spet Frequency and sta ing age of colonic surveillance and chemoprevention willbe determined by specialist team“The choice to take aspirin should be personalised based on age, sex and potential reduction in cardiovascular events, cerebrovascular events and thrombotic stroke. The individual should take into account the potential . Aspirin should be avoided in patients with current dyspepsia, ks of taking asp! any history of peptic ulcer, aspirin allergy, bleeding diathesis, an increased risk of gastrointestinal haemorrhage (eg associated with use of oral anticoagulants or antiplatelet agents), or renal i pairment. +The benefit may extend to older ages with longer duration of use. The benefit for cancer prevention (though shorter for cardiovascular risk] is evident only after 10 years of initiation, so a life expectancy of at least 10 years should be taken into consideration in the advice to use aspirin. +Approximately 5% of all CRCs and 10-15% of CRCs diagnosed in people aged <50 years are caused by high-risk germline mutations. Genetic knowledge is rapidly expanding and new discoveries are likely to explain cases of heritable predisposition for which a mutation cannot currently be identified. Genetic testing for familial cancer syndromes is undergoing rapid change as technology improves and costs for more extensive testing strategies drop. Testing strategies are moving towards testing a panel of genes covering all polyposis conditions, or a non-polyposis Lynch panel, or both where the phenotype is unclear. SLynch syndrome-related cancers include endometrial, ovarian, gastric, pancreatic, urothelial, renal pelvic small intestine, biliary tract, brain, sebaceous gland adenomas and keratoacanthomas. Waspirin at 600 mg/day reduced Lynch syndrome cancer incidence by 50-68% in the Colorectal Adenoma/Carcinoma Prevention Programme 2 (CAPP2) trial, Follow-up of the low-dose aspirin randomised controlled trials (RCTS) suggests low-dose aspirin (100 mg/day) also reduces cancer incidence by half. *There are several rare polyposis syndromes, some of which are associated with other cancers (eg fa adenomatous polyposis is associated with duodenal, gastric, desmoid, brain, thyroid cancers and hepatoblastoma). CAPP2, Colorectal Adenoma/Carcinoma Prevention Programme 2; CRC, colorectal cancer; FOBT, immunochemical faecal occult blood test; RCT, randomised controlled trial References: 1/ https://vww.racgporg.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp Buidelines/guidelines-for-preventive-activities-in-general-pr/early-detection-of-cancers/colorectal-cancer er-screening-In-australia 2shttps://wwwr 1 racgp org au/ajgp/2018/december/colorectal-caGl #4 Category-wise Questions (NEW!!!) > Gastroenterology > GI#4 BeGengcgeos » Cicurrent Review /! ip Answered [| Correct MI Incorrect 9. Question Category: Gastroenterology & Gl Surgery ‘A 76-year-old female presented with a history of constipation over last few weeks. She has been passing the wind and denied nausea and vomiting. On examination, her abdomen is soft and non-tender. Past medical history Includes appendectomy 30 years ago, hypertension and mild chronic renal failure.Her current medications include ramipril and metoprolol. What is the most common likely cause of this presentation? Chronic renal failure © Dietary constipation © Bowel obstruction ©. Sigmoid volvulus © DrugabuseGI #4 Category-wise Questions (NEW!!!) > Gastroenterology > Gl#4 BEBSEBEEB © Cicurrent (© Review /Skip fl Answered MB Correct Ml incorrect 9. Question Category: Gastroenterology & GI Surgery A76-year-old female presented with a history of constipation over last few weeks. She has been passing the wind and denied nausea and vomiting. On examination, her abdomen is soft and non-tender. Past medical history Includes appendectomy 30 years ago, hypertension and mild chronic renal failure Her current medications include ramipril and metoprolol. What is the most common likely cause of this presentation? Chronic renal failure Dietary constipation Bowel obstruction Sigmoid volvulus Drug abuse Incorrect ‘The most common cause of simple constipation s related to bad and faulty dietary habits. In the presence of normal abdominal examination, bowel obstruction and sigmoid volvulus are unlikely. New onset of constipation in an elderly should also be investigated with sigmoidoscopy and colonoscopy to rule out malignancy which is less common but a serious diagnosis to exclude. Drugs can lead to constipation as welll (eg calcium channel blockers) however this patient is not taking any of these. References: ‘Uhttps://wwwrch.org au/clinicalguide/guideline index/Constipation/ NextGl #4 Category-wise Questions (NEW!!!) > Gastroenterology > Gl #4 Cicurrent Review/Skip [ll Answered Ml Correct Ml Incorrect 10. Question Category: Gastroenterology & Gl Surgery Which of the following is the commonest cause of large bowel obstruction is Australia? O Diverticulitis Food impaction O. Volvulus of sigmoid colon Colon cancer © Foreign bodyGl #4 Category-wise Questions (NEW!!!) > Gastroenterology > Gl #4 BEG8 Cicurrent Review/Skip [ll Answered Ml Correct Ml Incorrect 10. Question Category: Gastroenterology & GI Surgery Which of the following is the commonest cause of large bowel obstruction is Australia? iverticulitis Food impaction Volvulus of sigmoid colon Colon cancer Foreign body Incorrect ‘The most common cause of large bowel obstruction is colon cancer in 75% of cases in Australia. Other causes of large bowel obstruction include diverticulitis, sigmoid volvulus and acute pseudo-obstruction of the colon (Ogilvie syndrome). Food impaction and foreign body are very rarely seen as cause of large bowel obstruction. References: ‘Uhitps://www.msdmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical- gastroenterology/intestinal-obstruction Quiz Summary