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Question 1
Incorrect
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A 45-year-old man with a history of intravenous (iv) drug abuse 16 years ago is referred by his doctor with abnormal liver function tests. He has significantly raised alanine aminotransferase (ALT). He tests positive for hepatitis C RNA and genotyping reveals genotype 1 hepatitis C. Liver biopsy reveals lymphocytic infiltration with some evidence of early hepatic fibrosis with associated necrosis.
Which of the following is the most appropriate therapy for this man?Your Answer: Ribavirin
Correct Answer: Direct acting antivirals (DAAs)
Explanation:Treatment Options for Hepatitis C: Direct Acting Antivirals and Combination Therapies
Hepatitis C is a viral infection that can lead to serious long-term health complications such as cirrhosis and liver cancer. Interferon-based treatments are no longer recommended as first-line therapy for hepatitis C, as direct acting antivirals (DAAs) have proven to be more effective. DAAs target different stages of the hepatitis C virus lifecycle and have a success rate of over 90%. Treatment typically involves a once-daily oral tablet regimen for 8-12 weeks and is most effective when given before cirrhosis develops.
While ribavirin alone is not as effective, combination therapies such as PEG-interferon α and ribavirin have been used in the past. However, for patients with genotype 1 disease (which has a worse prognosis), the addition of a protease inhibitor to the treatment regimen is recommended for better outcomes.
It is important to note that blood-borne infection rates for hepatitis C are high and can occur after just one or two instances of sharing needles during recreational drug use. Testing for hepatitis C involves antibody testing, followed by RNA and genotyping to guide the appropriate combination and length of treatment.
Overall, the combination of PEG-interferon, ribavirin, and a protease inhibitor is no longer used in the treatment of hepatitis C, as newer and more effective therapies have been developed.
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This question is part of the following fields:
- Gastroenterology
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Question 2
Correct
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A 50-year-old male is referred by his GP for an endoscopy due to recurrent indigestion. During the procedure, a small duodenal ulcer is discovered and Helicobacter pylori is found to be present. What is the recommended treatment for this patient?
Your Answer: Omeprazole, amoxicillin and metronidazole
Explanation:Helicobacter Pylori and Peptic Ulceration
Helicobacter pylori is a type of bacteria that is classified as a gram negative curved rod. It has been linked to the development of peptic ulceration by inhibiting the processes involved in healing. In fact, up to 90% of patients with duodenal ulceration and 70% of cases of peptic ulceration may be caused by Helicobacter infection.
To treat this condition, therapy should focus on acid suppression and eradication of Helicobacter. Triple therapy is the most effective treatment, which involves using a proton pump inhibitor like omeprazole along with two antibiotics such as amoxicillin and metronidazole or clarithromycin. This treatment is required for one week, and proton pump therapy should continue thereafter.
Overall, it is important to address Helicobacter pylori infection in patients with peptic ulceration to promote healing and prevent further complications.
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This question is part of the following fields:
- Gastroenterology
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Question 3
Incorrect
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For which of the following conditions is urgent referral for upper endoscopy necessary?
Your Answer: A 62-year-old male with a three month history of unexplained weight loss, tenesmus and a right abdominal mass
Correct Answer: A 73-year-old male with a three month history of dyspepsia which has failed to respond to a course of proton pump inhibitors
Explanation:Criteria for Urgent Endoscopy Referral
Criteria for urgent endoscopy referral include various symptoms such as dysphagia, dyspepsia, weight loss, anaemia, vomiting, Barrett’s oesophagus, family history of upper gastrointestinal carcinoma, pernicious anaemia, upper GI surgery more than 20 years ago, jaundice, and abdominal mass. Dysphagia is a symptom that requires urgent endoscopy referral at any age. Dyspepsia combined with weight loss, anaemia, or vomiting at any age also requires urgent referral. Dyspepsia in a patient aged 55 or above with onset of dyspepsia within one year and persistent symptoms requires urgent referral. Dyspepsia with one of the mentioned conditions also requires urgent referral.
In the presented cases, the 56-year-old man has dyspepsia with an aortic aneurysm, which requires an ultrasound and vascular opinion. On the other hand, the case of unexplained weight loss, tenesmus, and upper right mass is likely to be a colonic carcinoma. It is important to be aware of these criteria to ensure timely and appropriate referral for urgent endoscopy.
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This question is part of the following fields:
- Gastroenterology
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Question 4
Incorrect
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What is the correct statement regarding gastric acid secretion?
Your Answer: It reduces the risk of Zollinger–Ellison syndrome
Correct Answer: It is potentiated by histamine
Explanation:Understanding Gastric Acid Secretion: Factors that Stimulate and Inhibit its Production
Gastric acid, also known as stomach acid, is a vital component in the process of digesting food. Composed of hydrochloric acid, potassium chloride, and sodium chloride, it is secreted in the stomach and plays a crucial role in breaking down ingested food contents. In this article, we will explore the factors that stimulate and inhibit gastric acid secretion.
Stimulation of Gastric Acid Secretion
There are three classic phases of gastric acid secretion. The cephalic (preparatory) phase is triggered by the sight, smell, thought, and taste of food acting via the vagus nerve. This results in the production of gastric acid before food actually enters the stomach. The gastric phase is initiated by the presence of food in the stomach, particularly protein-rich food, caused by stimulation of G cells which release gastrin. This is the most important phase. The intestinal phase is stimulated by luminal distension plus the presence of amino acids and food in the duodenum.
Potentiation and Inhibition of Gastric Acid Secretion
Histamine potentiates gastric acid secretion, while gastrin inhibits it. Somatostatin, secretin, and cholecystokinin also inhibit gastric acid production.
Importance of Gastric Acid Secretion
Gastric acid secretion reduces the risk of Zollinger–Ellison syndrome, a condition characterized by excess gastric acid production that can lead to multiple severe gastric ulcers, requiring high-dose antacid treatment. Understanding the factors that stimulate and inhibit gastric acid secretion is crucial in maintaining a healthy digestive system.
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This question is part of the following fields:
- Gastroenterology
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Question 5
Correct
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A 56-year-old man comes to the Emergency Department with haematemesis. His friends report that he drank a large amount of alcohol earlier and had prolonged vomiting because he is not used to drinking so much. During the examination, his vital signs are: pulse 110 bpm, blood pressure 100/60 mmHg. There are no notable findings during systemic examination.
What is the most likely cause of the haematemesis in this case?Your Answer: Mallory-Weiss tear
Explanation:Causes of haematemesis and their associated symptoms
Haematemesis, or vomiting of blood, can be caused by various conditions affecting the upper gastrointestinal tract. Here we discuss some of the common causes and their associated symptoms.
Mallory-Weiss tear
This type of tear occurs at the junction between the oesophagus and the stomach, and is often due to severe vomiting or retching, especially in people with alcohol problems. The tear can cause internal bleeding and low blood pressure, and is usually accompanied by a history of recent vomiting.Peptic ulcer disease
Peptic ulcers are sores in the lining of the stomach or duodenum, and can cause epigastric pain, especially after eating or when hungry. Bleeding from a peptic ulcer is usually associated with these symptoms, and may be mild or severe.Oesophageal varices
Varices are enlarged veins in the oesophagus that can occur in people with chronic liver disease, especially due to alcohol abuse or viral hepatitis. Variceal bleeding can cause massive haematemesis and is a medical emergency.Barrett’s oesophagus
This condition is a type of metaplasia, or abnormal tissue growth, in the lower oesophagus, often due to chronic acid reflux. Although Barrett’s mucosa can lead to cancer, bleeding is not a common symptom.Gastritis
Gastritis is inflammation of the stomach lining, often due to NSAIDs or infection with Helicobacter pylori. It can cause epigastric pain, nausea, and vomiting, and may be associated with mild bleeding. Treatment usually involves acid suppression and eradication of H. pylori if present.In summary, haematemesis can be caused by various conditions affecting the upper digestive system, and the associated symptoms can help to narrow down the possible causes. Prompt medical attention is needed for severe or recurrent bleeding.
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This question is part of the following fields:
- Gastroenterology
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Question 6
Incorrect
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A 42-year-old man with end-stage liver disease is admitted with a painful, distended abdomen. Examination findings: generalised abdominal tenderness and ascites. Temperature 37.5 °C.
Which intervention should be undertaken first?Your Answer: Commence spironolactone
Correct Answer: Diagnostic ascitic tap
Explanation:Management of Ascites: Importance of Prompt Investigation and Treatment of Spontaneous Bacterial Peritonitis
Ascites is a common complication in patients with end-stage liver disease and poor synthetic function. Spontaneous bacterial peritonitis (SBP) is a serious complication that can occur in these patients, leading to a high mortality rate. Prompt investigation and treatment are crucial in managing ascites and preventing SBP.
Diagnostic paracentesis tap should be performed promptly in any patient presenting with ascites, regardless of the time of day. A broad-spectrum antibiotic should be given immediately if there is a raised cell count consistent with SBP. Once SBP has been excluded or treated, therapeutic paracentesis may be considered for patients with large, tense, or resistant ascites.
During a diagnostic tap, various investigations should be performed, including cell count, microscopy, culture and sensitivity, cytology, protein and albumin, lactate dehydrogenase, glucose, and amylase. Additional investigations may be indicated based on the patient’s condition.
The most common cause of SBP is Escherichia coli, and oral ciprofloxacin or co-amoxiclav are recommended as first-line agents. Intravenous cephalosporins may be used if the patient is unwell. However, a diagnosis of SBP should be confirmed before starting treatment.
First-line medical management of ascites is spironolactone, which achieves better clinical results than furosemide. Furosemide may be used in conjunction with spironolactone in resistant ascites or where potassium rises due to spironolactone.
In summary, prompt investigation and treatment of ascites are crucial in managing SBP and preventing complications. A diagnostic paracentesis tap should be performed promptly, and appropriate investigations and treatment should be initiated based on the patient’s condition.
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This question is part of the following fields:
- Gastroenterology
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Question 7
Incorrect
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A 39-year-old man presents to Accident and Emergency with sudden onset vomiting and severe upper abdominal pain. On examination, he appears unwell, with a high heart and respiratory rate, and a temperature of 38.0°C. His blood pressure is 112/74 mmHg. He localises the pain to his upper abdomen, with some radiation to the back. His abdomen is generally tender, with bowel sounds present. There is no blood in his vomit. He is unable to provide further history due to the pain and nausea, but he is known to Accident and Emergency due to many previous admissions with alcohol intoxication. He has previously been normotensive, is a non-smoker and has not been treated for any other conditions.
Based on the information provided, what is the most likely diagnosis?Your Answer: Pulmonary embolism
Correct Answer: Acute pancreatitis
Explanation:Differential Diagnosis for Acute Upper Abdominal Pain: Considerations and Exclusions
Acute upper abdominal pain can be caused by a variety of conditions, and a thorough differential diagnosis is necessary to determine the underlying cause. In this case, the patient’s history of alcohol abuse is a significant risk factor for acute pancreatitis, which is consistent with the presentation of quick-onset, severe upper abdominal pain with vomiting. Mild pyrexia is also common in acute pancreatitis. However, other conditions must be considered and excluded.
Pulmonary embolism can cause acute pain, but it is typically pleuritic and associated with shortness of breath rather than nausea and vomiting. Aortic dissection is another potential cause of sudden-onset upper abdominal pain, but it is rare under the age of 40 and typically associated with a history of hypertension and smoking. Myocardial infarction should also be on the differential diagnosis, but the location of the pain and radiation to the back, along with the lack of a history of cardiac disease or hypertension, suggest other diagnoses. Nevertheless, an electrocardiogram (ECG) should be performed to exclude myocardial infarction.
Bleeding oesophageal varices can develop as a consequence of portal hypertension, which is usually due to cirrhosis. Although the patient is not known to have liver disease, his history of alcohol abuse is a significant risk factor for cirrhosis. However, bleeding oesophageal varices would present with haematemesis, which the patient does not have.
In conclusion, a thorough differential diagnosis is necessary to determine the underlying cause of acute upper abdominal pain. In this case, acute pancreatitis is the most likely diagnosis, but other conditions must be considered and excluded.
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This question is part of the following fields:
- Gastroenterology
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Question 8
Incorrect
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A 50-year-old man arrived at the Emergency Department with massive haematemesis. An emergency endoscopy revealed a bleeding gastric ulcer located on the lesser curvature of the stomach. Which vessel is most likely affected?
Your Answer: The left gastroepiploic artery
Correct Answer: The left gastric artery
Explanation:Arteries that supply the stomach: A brief overview
The stomach is a vital organ that requires a constant supply of blood to function properly. There are several arteries that supply blood to different parts of the stomach. Here is a brief overview of these arteries:
1. Left gastric artery: This artery supplies the lesser curvature of the stomach along with the right gastric artery. Bleeding at the lesser curvature of the stomach is most likely to be caused by these two arteries. The left gastric artery is one of the three branches that arise from the coeliac trunk.
2. Right gastroepiploic artery: This artery, along with the left gastroepiploic artery, supplies the greater curvature of the stomach.
3. Left gastroepiploic artery: This artery, along with the right gastroepiploic artery, supplies the greater curvature of the stomach.
4. Gastroduodenal artery: This artery is a branch off the common hepatic artery that supplies the duodenum, head of the pancreas, and greater curvature of the stomach.
5. Short gastric arteries: These are four or five small arteries from the splenic artery that supply the fundus of the stomach.
Understanding the different arteries that supply the stomach is important for diagnosing and treating various medical conditions related to the stomach.
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This question is part of the following fields:
- Gastroenterology
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Question 9
Incorrect
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A 61-year-old man has been admitted to a General Surgical Ward, following an endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis. The procedure took place approximately two hours ago and went well, without complications. The patient is now complaining of central abdominal pain, radiating to the back.
His observations are normal. Examination is significant for central abdominal pain. His blood tests are significant for an amylase level of 814 u/l. His pre-ERCP amylase level was 89 u/l.
What is the most likely diagnosis?Your Answer: Anaphylaxis
Correct Answer: Acute pancreatitis
Explanation:Complications of ERCP: Post-ERCP Pancreatitis, Papillary Stenosis, Anaphylaxis, Duodenal Pneumostasis, and Oesophageal Perforation
Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure used to examine the bile ducts and pancreatic ducts. However, like any medical procedure, ERCP is not without risks. Here are some of the possible complications of ERCP:
Post-ERCP Pancreatitis: This is a common complication of ERCP, with an incidence of approximately 2-3%. It is characterized by abdominal pain that radiates to the back and a significant elevation in amylase levels. Treatment involves analgesia, hydration, and bowel rest.
Papillary Stenosis: This is a late complication of ERCP that occurs in approximately 2-4% of patients. It is treated with endoscopic management, such as stenting or balloon dilation.
Anaphylaxis: Although rare, anaphylactic reactions to contrast agents used during ERCP can occur. Symptoms include respiratory compromise and hypotension, and treatment involves adrenaline and airway support.
Duodenal Pneumostasis: This complication refers to a collection of air in the duodenal wall and is typically recognized during the procedure. The procedure should be stopped to avoid bowel perforation.
Oesophageal Perforation: This is a rare complication of ERCP that typically presents with chest pain, mediastinitis, and cardiovascular instability.
In conclusion, while ERCP is a useful diagnostic and therapeutic tool, it is important to be aware of the potential complications and to take appropriate measures to prevent and manage them.
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This question is part of the following fields:
- Gastroenterology
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Question 10
Correct
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A 40-year-old woman presents with sudden onset of abdominal pain for the past 6 hours. The pain is rapidly worsening and is more severe in the right upper quadrant. She has no significant medical history and denies any recent illnesses or similar episodes in the past. She is sexually active and takes an oral contraceptive pill. Upon examination, her blood pressure is 120/80 mmHg, pulse rate 85 bpm, respiratory rate 16/min, and body temperature 37.5 ºC. The sclera is icteric. Tender hepatomegaly and shifting abdominal dullness are noted. Blood tests reveal elevated total and direct bilirubin, alanine aminotransferase, and aspartate aminotransferase. Partial thromboplastin time and prothrombin time are within normal limits. Mild to moderate abdominal ascites is found on an ultrasound study.
What is the most likely cause of her condition?Your Answer: Occlusion of the hepatic vein
Explanation:Differential diagnosis of a patient with abdominal pain, hepatomegaly, and ascites
Budd-Chiari syndrome and other potential causes
When a patient presents with abdominal pain, tender hepatomegaly, and ascites, one possible diagnosis is Budd-Chiari syndrome, which can have an acute or chronic course and is more common in pregnant women or those taking oral contraceptives. In the acute form, liver function tests show elevated bilirubin and liver enzymes. However, other conditions should also be considered.
Ruptured hepatic adenoma can cause intraperitoneal bleeding and shock, but it does not explain the liver function abnormalities. Occlusion of the portal vein may be asymptomatic or cause mild symptoms, and liver function tests are usually normal. Fulminant viral hepatitis typically has a prodromal phase and signs of liver failure, such as coagulopathy. Drug-induced hepatic necrosis, such as from paracetamol overdose or halothane exposure, can also lead to fulminant liver failure, but the patient’s history does not suggest this possibility.
Therefore, while Budd-Chiari syndrome is a plausible diagnosis, the clinician should also consider other potential causes and obtain more information from the patient, including any medication use or exposure to hepatotoxic agents.
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This question is part of the following fields:
- Gastroenterology
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Question 11
Incorrect
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A 28-year-old man, diagnosed with ulcerative colitis (UC) 18 months ago, presents with 2-day history of progressively worsening abdominal pain and bloody diarrhoea. He is currently passing motion 11 times per day.
On examination, there is generalised abdominal tenderness and distension. He is pyrexial, with a temperature of 39 °C; his pulse is 124 bpm.
Investigations:
Investigation Result Normal value
Haemoglobin (Hb) 90 g/l 135–175 g/l
White cell count (WCC) 15 × 109/l 4–11 × 109/l
Erect chest X-ray Normal
Plain abdominal X-ray 12-cm dilation of the transverse colon
He also has a raised C-reactive protein (CRP).
What would be the most appropriate initial management of this patient?Your Answer: IV hydrocortisone, LMWH, IV fluids, IV infliximab
Correct Answer: Intravenous (IV) hydrocortisone, low-molecular-weight heparin (LMWH), IV fluids, reassess response after 72 hours
Explanation:Management of Toxic Megacolon in Ulcerative Colitis: Medical and Surgical Options
Toxic megacolon (TM) is a rare but life-threatening complication of ulcerative colitis (UC) characterized by severe colon dilation and systemic toxicity. The initial management of TM involves aggressive medical therapy with intravenous (IV) hydrocortisone, low-molecular-weight heparin (LMWH), and IV fluids to restore hemodynamic stability. Oral mesalazine is indicated for mild to moderate UC or for maintenance of remission. If the patient fails to respond to medical management after 72 hours, urgent surgery, usually subtotal colectomy with end ileostomy, should be considered.
Infliximab and vedolizumab are second-line management options for severe active UC in patients who fail to respond to intensive IV steroid treatment. However, their role in the setting of TM is unclear. LMWH is required for UC patients due to their high risk of venous thromboembolism.
Prompt recognition and management of TM is crucial to prevent mortality. A multidisciplinary approach involving gastroenterologists, surgeons, and critical care specialists is recommended for optimal patient outcomes.
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This question is part of the following fields:
- Gastroenterology
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Question 12
Incorrect
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A 35-year-old accountant has been recently diagnosed with haemochromatosis following a year-long history of fatigue, irritability and bronzing of the skin. She would like to know more about the prognosis of the condition and is concerned about the risks of passing on the condition to any children that she may have in the future.
Which of the following statements best describes haemochromatosis?Your Answer: Coexisting arthritis is usually the result of gout
Correct Answer: There is an increased risk of hepatocellular carcinoma
Explanation:Haemochromatosis is a genetic disorder that causes the body to absorb too much iron, leading to iron overload and deposition in vital organs such as the liver and pancreas. It is inherited in an autosomal recessive manner, with a frequency of homozygotes in the population of 1:500. The disorder is most commonly found in Celtic nations. Symptoms typically present in the third to fourth decade of life in men and post-menopause in women and include weakness, fatigue, skin bronzing, diabetes, cirrhosis, and cardiac disease. Treatment involves venesection, and in severe cases, liver transplantation may be necessary. Haemochromatosis increases the risk of developing liver cirrhosis and hepatocellular carcinoma by up to 200-fold. Iron deposition in the pancreas can also lead to diabetes, and patients with haemochromatosis who develop diabetes usually require insulin treatment. Arthropathy associated with haemochromatosis is the result of pseudogout, as iron deposits impair cartilage nutrition and enhance the formation and deposition of calcium pyrophosphate dehydrate crystals. Heterozygotes for the HFE gene typically do not develop cirrhosis and remain asymptomatic due to the disorder’s low penetrance.
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This question is part of the following fields:
- Gastroenterology
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Question 13
Incorrect
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A 45-year-old woman with a known tumour in the superior (first) part of the duodenum complains of right upper quadrant pain and jaundice. A CT scan of the abdomen reveals that the tumour is causing obstruction of the biliary tree by pressing against it. Which segment of the biliary tree is most likely to be impacted?
Your Answer: Right hepatic duct
Correct Answer: Common bile duct
Explanation:Anatomy of the Biliary Tree: Location and Function of the Common Bile Duct, Common Hepatic Duct, Left Hepatic Duct, Cystic Duct, and Right Hepatic Duct
The biliary tree is a network of ducts that transport bile from the liver and gallbladder to the small intestine. Understanding the anatomy of the biliary tree is important for diagnosing and treating conditions that affect the liver, gallbladder, and pancreas. Here is a breakdown of the location and function of the common bile duct, common hepatic duct, left hepatic duct, cystic duct, and right hepatic duct:
Common Bile Duct: The common bile duct is the most likely to be occluded in cases of biliary obstruction. It descends posteriorly to the superior part of the duodenum before meeting the pancreatic duct at the ampulla of Vater in the descending part of the duodenum. The gastroduodenal artery, portal vein, and inferior vena cava are also located in this area.
Common Hepatic Duct: The common hepatic duct is formed by the junction of the left and right main hepatic ducts and is located in the free margin of the lesser omentum. It is found at a further superior location than the duodenum.
Left Hepatic Duct: The left hepatic duct drains the left lobe of the liver and is found above the superior part of the duodenum.
Cystic Duct: The cystic duct extends from the gallbladder to the common hepatic duct, which it joins to form the common bile duct. It lies further superior than the superior part of the duodenum.
Right Hepatic Duct: The right hepatic duct drains the right functional lobe of the liver. It joins the left hepatic duct to form the common hepatic duct. It is found superior to the level of the superior part of the duodenum.
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This question is part of the following fields:
- Gastroenterology
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Question 14
Incorrect
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A 54-year-old man with persistent dyspepsia was being evaluated at the nearby medical center. While performing oesophago-gastro-duodenoscopy (OGD), the endoscopist inserted the endoscope until it reached the oesophageal hiatus of the diaphragm.
At which vertebral level is it probable that the endoscope tip reached?Your Answer: T8
Correct Answer: T10
Explanation:The Diaphragm and its Openings: A Vertebral Level Guide
The diaphragm is a dome-shaped muscle that separates the thoracic and abdominal cavities. It plays a crucial role in breathing and also contains several openings for important structures to pass through. Here is a guide to the vertebral levels of the diaphragm openings:
T10 – Oesophageal Hiatus: This opening allows the oesophagus to pass through and is located at the T10 vertebral level. A helpful mnemonic is that ‘oesophagus’ contains 10 letters.
T7 – No Openings: There are no openings of the diaphragm at this level.
T8 – Caval Opening: The caval opening is located at the T8 vertebral level and allows the inferior vena cava to pass through. A useful way to remember this is that ‘vena cava’ has 8 letters.
T11 – Oesophagus and Stomach: The oesophagus meets the cardia of the stomach at approximately this level.
T12 – Aortic Hiatus: The aortic hiatus is located at the T12 vertebral level and allows the descending aorta to pass through. A helpful mnemonic is that ‘aortic hiatus’ contains 12 letters.
Knowing the vertebral levels of the diaphragm’s openings can be useful for understanding the anatomy of the thoracic and abdominal cavities.
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This question is part of the following fields:
- Gastroenterology
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Question 15
Incorrect
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A 20-year-old male has been referred by his doctor due to experiencing severe bloody diarrhoea on and off for the past three months. After undergoing a barium enema, it was discovered that he has multiple ulcers and signs of inflammation that extend from his rectum to the mid transverse colon. A colonoscopy was performed and biopsies were taken from various sites, revealing acute and chronic inflammation that is limited to the mucosa. What is the most probable diagnosis for this patient?
Your Answer: AIDS-associated diarrhoea
Correct Answer: Ulcerative colitis
Explanation:Differences between Ulcerative Colitis and Crohn’s Disease
Ulcerative colitis (UC) and Crohn’s disease are both types of inflammatory bowel disease that can cause bloody diarrhoea. However, UC is more likely to result in the passage of blood. The onset of UC usually begins in the distal part of the colon and progresses towards the proximal end. On the other hand, Crohn’s disease can affect any part of the gastrointestinal tract and can skip areas, resulting in disease occurring at different sites.
Histologically, Crohn’s disease affects the entire thickness of the bowel wall, while UC typically only affects the mucosa. This means that Crohn’s disease can cause more severe damage to the bowel wall and lead to complications such as strictures and fistulas. In contrast, UC is more likely to cause inflammation and ulceration of the mucosa, which can lead to symptoms such as abdominal pain and diarrhoea.
In summary, while both UC and Crohn’s disease can cause similar symptoms, there are important differences in their presentation and histological features. these differences is crucial for accurate diagnosis and appropriate management of these conditions.
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This question is part of the following fields:
- Gastroenterology
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Question 16
Incorrect
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A 65-year-old man presents with symptoms of early satiety, nausea and abdominal fullness. He has lost 6 kg in weight over the past 3 months. There is no other past medical history of note. On examination, he looks very thin and there is a palpable epigastric mass.
Investigations:
Investigation Result Normal value
Haemoglobin 101 g/l 135–175 g/l
White cell count (WCC) 5.9 × 109/l 4–11 × 109/l
Platelets 140 × 109/l 150–400 × 109/l
Sodium (Na+) 141 mmol/l 135–145 mmol/l
Potassium (K+) 4.3 mmol/l 3.5–5.0 mmol/l
Creatinine 170 μmol/l 50–120 µmol/l
Alanine aminotransferase (ALT) 35 IU/l 5–30 IU/l
Alkaline phosphatase 68 IU/l 30–130 IU/l
Upper gastrointestinal endoscopy reveals a smooth mass in the body of the stomach with normal-looking mucosa overlying it. Multiple biopsies: spindle cell tissue, cells undergoing multiple mitoses.
Which of the following is the most likely diagnosis?Your Answer: Gastric leiomyosarcoma
Correct Answer: Gastrointestinal stromal tumour (GIST)
Explanation:Gastrointestinal Stromal Tumours (GISTs) vs Other Gastric Conditions
Gastrointestinal stromal tumours (GISTs) are the most common tumours of mesenchymal origin in the gastrointestinal tract, with approximately 50-70% occurring in the stomach. They are histologically characterized by spindle cells, epithelioid-like cells, or mixed spindle-epithelioid cells. GISTs tend to occur in individuals above the age of 40 and are equally common in men and women. Biopsy specimens are stained with DOG1 for identification, and surgical resection is the preferred treatment option. Systemic chemotherapy with imatinib is an alternative for patients who cannot undergo complete surgical resection. Disease survival rates at the 5-year stage range from 30-60%.
Other gastric conditions, such as gastric carcinoma, Helicobacter pylori gastritis, gastric leiomyosarcoma, and gastric lipoma, may present with similar symptoms but have different endoscopic and histological findings. Gastric carcinomas are most often adenocarcinomas, while Helicobacter pylori gastritis is the most common cause of gastritis worldwide. Gastric leiomyosarcoma is a differential diagnosis for GISTs, but GISTs are more common. Gastric lipomas would not present with the same combination of findings seen in GISTs.
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This question is part of the following fields:
- Gastroenterology
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Question 17
Incorrect
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A 35-year-old woman was brought to the Emergency Department with confusion. She has a history of manic illness. There is no evidence of alcohol or drug abuse. Upon examination, she displays mild jaundice and signs of chronic liver disease, such as spider naevi and palmar erythema. Additionally, there is a brownish ring discoloration at the limbus of the cornea.
Blood tests reveal:
Investigation Result Normal value
Bilirubin 130 μmol/l 2–17 µmol/l
Alanine aminotransferase (ALT) 85 IU/l 5–30 IU/l
Ferritin 100 μg/l 10–120 µg/l
What is the most likely diagnosis based on this clinical presentation?Your Answer: Viral hepatitis
Correct Answer: Wilson’s disease
Explanation:Differential diagnosis of a patient with liver disease and neurological symptoms
Wilson’s disease, haemochromatosis, alcohol-related cirrhosis, viral hepatitis, and primary sclerosing cholangitis are among the possible causes of liver disease. In the case of a patient with Kayser-Fleischer rings, the likelihood of Wilson’s disease increases, as this is a characteristic sign of copper overload due to defective incorporation of copper and caeruloplasmin. Neurological symptoms such as disinhibition, emotional lability, and chorea may also suggest Wilson’s disease, although they are not specific to it. Haemochromatosis, which is characterized by iron overload, can be ruled out if the ferritin level is normal. Alcohol-related cirrhosis is less likely if the patient denies alcohol or drug abuse, but this information may not always be reliable. Viral hepatitis is a common cause of liver disease, but in this case, there are no obvious risk factors in the history. Primary sclerosing cholangitis, which is a chronic inflammatory disease of the bile ducts, does not present with Kayser-Fleischer rings. Therefore, a careful evaluation of the patient’s clinical features, laboratory tests, and imaging studies is necessary to establish the correct diagnosis and guide the appropriate treatment.
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This question is part of the following fields:
- Gastroenterology
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Question 18
Incorrect
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A 50-year-old man who has recently had a gastrectomy is informed that he will experience a deficiency in vitamin B12. What is the probable physiological reasoning behind this?
Your Answer: Failed gastric emptying
Correct Answer: Loss of intrinsic factors
Explanation:Effects of Gastrectomy on Nutrient Absorption and Digestion
Gastrectomy, whether partial or complete, can have significant effects on nutrient absorption and digestion. One of the most important consequences is the loss of intrinsic factors, which are necessary for the absorption of vitamin B12 in the ileum. Intrinsic factor is produced by the gastric parietal cells, which are mostly found in the body of the stomach. Without intrinsic factor, vitamin B12 cannot be absorbed and stored in the liver, leading to megaloblastic anemia and potentially serious complications such as dilated cardiomyopathy or subacute degeneration of the spinal cord.
Another consequence of gastrectomy is the loss of storage ability, which can cause early satiety and abdominal bloating after meals. This is due to the fact that the stomach is no longer able to hold as much food as before, and the remaining small intestine has to compensate for the missing stomach volume.
Achlorohydria is another common problem after gastrectomy, as the parietal cells that produce hydrochloric acid are also lost. This can lead to a range of symptoms such as abdominal bloating, diarrhea, indigestion, weight loss, malabsorption, and bacterial overgrowth of the small intestine.
Failed gastric emptying is not a major concern after gastrectomy, as it is unlikely to cause vitamin B12 deficiency. However, increased upper GI gut transit can affect the rate of nutrient absorption and lead to symptoms such as diarrhea and weight loss. Overall, gastrectomy can have significant effects on nutrient absorption and digestion, and patients should be closely monitored for any signs of malnutrition or complications.
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This question is part of the following fields:
- Gastroenterology
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Question 19
Incorrect
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A 45-year-old alcoholic presents to the Emergency Department with retrosternal chest pain, shortness of breath and pain on swallowing after a heavy drinking session the night before. He reports having vomited several times this morning, after which the pain started. He denies any blood in the vomit and has no melaena. On examination, he is febrile and tachypnoeic and has a heart rate of 110 bpm. A chest X-ray reveals a left-sided pneumothorax and air within the mediastinum.
Given the likely diagnosis, what is the most appropriate management to treat the underlying cause of his symptoms?Your Answer: Proton pump inhibitor (PPI)
Correct Answer: Urgent surgery
Explanation:Management of Suspected Oesophageal Rupture
Suspected oesophageal rupture is a medical emergency that requires urgent intervention. This condition is more common in patients with a history of alcohol excess and can be associated with a triad of vomiting, chest pain, and subcutaneous emphysema. Symptoms include retrosternal chest/epigastric pain, tachypnoea, fever, pain on swallowing, and shock. A chest X-ray reveals gas within soft tissue spaces, pneumomediastinum, left pleural effusion, and left-sided pneumothorax. Without rapid treatment, the condition can be fatal.
Antibiotics are necessary to treat the infection that may result from oesophageal rupture. However, they will not address the underlying cause of the infection.
Chest drain insertion is not the correct management for pneumothorax secondary to oesophageal rupture. A chest drain would not resolve the underlying cause, and air would continue to enter the pleural cavity via the oesophagus.
Proton pump inhibitors (PPIs) are not appropriate for suspected oesophageal rupture. PPIs would be the correct management for a suspected perforated ulcer. However, the history of acute-onset pain following vomiting is more in keeping with oesophageal rupture.
Urgent endoscopy is not appropriate for suspected oesophageal rupture. Endoscopy risks further oesophageal perforation, and there is no report of haematemesis or melaena, making this a less likely cause of the patient’s symptoms.
Management of Suspected Oesophageal Rupture: Antibiotics, Chest Drain Insertion, PPIs, and Endoscopy
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This question is part of the following fields:
- Gastroenterology
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Question 20
Correct
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A 50-year-old woman presents to the Gastroenterology Clinic with constipation that has worsened over the past six weeks. She reports straining during defecation. She has a feeling of incomplete evacuation. She has two children who were born via vaginal delivery without history of tears. She has had bladder suspension surgery. On examination, her abdomen is soft and non-distended without palpable masses.
On digital rectal examination, she has an empty rectum. Her resting anal tone is weak but her squeeze tone is normal. She does not relax the puborectalis muscle or the external anal sphincter when simulating defecation; she also has 4-cm perineal descent with straining.
What is the most appropriate investigation to carry out next?Your Answer: Magnetic resonance defecography
Explanation:Magnetic resonance defecography is the most appropriate investigation for a patient with abnormal pelvic floor muscle tone, perineal descent, and symptoms of incomplete evacuation during defecation. This test evaluates global pelvic floor anatomy and dynamic motion, identifying prolapse, rectocele, and pelvic floor dysfunctions. Other tests, such as abdominal ultrasound, barium enema, colonoscopy, and CT abdomen, may not provide sufficient information on the underlying pathology of the patient’s symptoms.
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This question is part of the following fields:
- Gastroenterology
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Question 21
Incorrect
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A 40-year-old woman presents to the Gastroenterology Clinic for a follow-up appointment after a liver biopsy. She was referred by her General Practitioner two weeks ago due to symptoms of fatigue, myalgia, abdominal bloating and significantly abnormal aminotransferases. The results of her liver biopsy and blood tests confirm a diagnosis of autoimmune hepatitis (AIH).
What should be the next course of action in managing this patient?Your Answer: Cholestyramine
Correct Answer: Azathioprine and prednisolone
Explanation:Treatment Options for Autoimmune Hepatitis: Azathioprine and Prednisolone
Autoimmune hepatitis (AIH) is a chronic liver disease that primarily affects young and middle-aged women. The cause of AIH is unknown, but it is often associated with other autoimmune diseases. The condition is characterized by inflammation of the liver, which can progress to cirrhosis if left untreated.
The first-line treatment for AIH is a combination of azathioprine and prednisolone. Patients with moderate-to-severe inflammation should receive immunosuppressive treatment, while those with mild disease may be closely monitored instead. Cholestyramine, a medication used for hyperlipidemia and other conditions, is not a first-line treatment for AIH.
Liver transplantation is not typically recommended as a first-line treatment for AIH, but it may be necessary in severe cases. However, AIH can recur following transplantation. Antiviral medications like peginterferon alpha-2a and tenofovir are not effective in treating AIH, as the condition is not caused by a virus.
In summary, azathioprine and prednisolone are the primary treatment options for AIH, with liver transplantation reserved for severe cases. Other medications like cholestyramine, peginterferon alpha-2a, and tenofovir are not effective in treating AIH.
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This question is part of the following fields:
- Gastroenterology
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Question 22
Correct
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A 32-year-old man presents with complaints of heartburn and epigastric pain that are affecting his daily routine. Upon endoscopy, a shallow ulcer is observed on the posterior aspect of the first part of the duodenum. Which artery is most likely to be eroded by the ulcer?
Your Answer: Gastroduodenal artery
Explanation:Arteries of the Gastrointestinal Tract
The gastrointestinal tract is supplied by several arteries, each with its own unique function and potential for complications. Here are some of the main arteries and their roles:
1. Gastroduodenal artery: This artery is often the culprit of gastrointestinal bleeding from peptic ulcer disease. It is the first branch of the common hepatic artery and runs behind the first part of the duodenum.
2. Short gastric artery: A branch of the splenic artery, this artery supplies the cardia and superior part of the greater curvature of the stomach.
3. Splenic artery: One of the three main branches of the coeliac trunk, this artery supplies the pancreas body and tail. It is at high risk of bleeding in severe pancreatitis due to its close proximity to the supero-posterior border of the pancreas.
4. Left gastric artery: Another branch of the coeliac trunk, this artery supplies the lesser curvature of the stomach along with the right gastric artery.
5. Left gastroepiploic artery: This artery, also a branch of the splenic artery, supplies much of the greater curvature of the stomach.
Understanding the roles and potential complications of these arteries is crucial in the diagnosis and treatment of gastrointestinal disorders.
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This question is part of the following fields:
- Gastroenterology
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Question 23
Incorrect
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A 47-year-old man is admitted with acute epigastric pain and a serum amylase of 1500 u/l. His IMRIE score confirms acute pancreatitis. On examination, a large ecchymosis is observed around the umbilicus.
What clinical sign does this examination finding demonstrate?Your Answer: Tinel’s sign
Correct Answer: Cullen’s sign
Explanation:Common Medical Signs and Their Meanings
Medical signs are physical indications of a disease or condition that can aid in diagnosis. Here are some common medical signs and their meanings:
1. Cullen’s sign: This is bruising around the umbilicus that can indicate acute pancreatitis or an ectopic pregnancy.
2. McBurney’s sign: Pain over McBurney’s point, which is located in the right lower quadrant of the abdomen, can indicate acute appendicitis.
3. Grey–Turner’s sign: Discoloration of the flanks can indicate retroperitoneal hemorrhage.
4. Troisier’s sign: The presence of Virchow’s node in the left supraclavicular fossa can indicate gastric cancer.
5. Tinel’s sign: Tingling in the median nerve distribution when tapping over the median nerve can indicate carpal tunnel syndrome.
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This question is part of the following fields:
- Gastroenterology
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Question 24
Correct
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A 43-year-old woman presents with haematemesis. She has vomited twice, producing large amount of bright red blood, although the exact volume was not measured. On examination, you discover that there is a palpable spleen tip, and spider naevi over the chest, neck and arms.
What is the diagnosis?Your Answer: Oesophageal varices
Explanation:Causes and Management of Upper Gastrointestinal Bleeding
Upper gastrointestinal bleeding can be caused by various conditions, including oesophageal varices, Mallory-Weiss tear, peptic ulcer, gastric ulcer, and oesophagitis. In cases of suspected oesophageal varices, examination findings of splenomegaly and spider naevi suggest chronic liver failure with portal hypertension. Immediate management includes resuscitation, PPI levels, and urgent endoscopy to diagnose and treat the source of bleeding. Peptic ulcer is the most common cause of serious upper GI bleeding, but sudden-onset haematemesis of large volume of fresh blood is more suggestive of a bleed from oesophageal varices. OGD can diagnose both oesophageal varices and peptic ulcers. Oesophagitis may cause pain but is unlikely to lead to significant haematemesis.
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This question is part of the following fields:
- Gastroenterology
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Question 25
Incorrect
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A 16-year-old girl presents to Accident and Emergency with sudden onset abdominal pain. The pain is severe, and has now localised to the right iliac fossa. She has a temperature of 37.6°C (normal 36.1–37.2°C). Other observations are normal. The surgical registrar comes to review this patient. During her examination she flexes and internally rotates her right hip, which causes her pain. She states that this girl’s appendix lies close to the obturator internus muscle.
What is the name of the clinical sign the registrar elicited?Your Answer: Rovsing’s sign
Correct Answer: Cope’s sign
Explanation:Abdominal Signs and Their Meanings
Abdominal signs are physical findings that can help diagnose certain conditions. Here are some common abdominal signs and their meanings:
Cope’s Sign (Obturator Sign)
This sign indicates appendicitis and is elicited by flexing and internally rotating the hip. It suggests that the inflamed appendix is close to the obturator internus muscle.Murphy’s Sign
This sign is a test for gallbladder disease. It involves palpating the right upper quadrant of the abdomen while the patient takes a deep breath. If there is pain during inspiration, it suggests inflammation of the gallbladder.Pemberton’s Sign
This sign is seen in patients with superior vena cava obstruction. When the patient raises their hands above their head, it increases pressure over the thoracic inlet and causes venous congestion in the face and neck.Psoas Sign
This sign is a test for appendicitis. It involves extending the patient’s leg while they lie on their side. If this reproduces their pain, it suggests inflammation of the psoas muscle, which lies at the border of the peritoneal cavity.Rovsing’s Sign
This sign is another test for appendicitis. It involves palpating the left iliac fossa, which can reproduce pain in the right iliac fossa. This occurs because the nerves in the intestine do not localize well to an exact spot on the abdominal wall.In summary, abdominal signs can provide valuable information in the diagnosis of certain conditions. It is important to understand their meanings and how to elicit them properly.
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This question is part of the following fields:
- Gastroenterology
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Question 26
Incorrect
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A 56-year-old man presents with progressively worsening dysphagia, which is worse for food than liquid. He has lost several stones in weight and, on examination, he is cachexia. An oesophagogastroduodenoscopy (OGD) confirms oesophageal cancer.
Which of the following is the strongest risk factor for oesophageal adenocarcinoma?Your Answer: Alcohol
Correct Answer: Barrett's oesophagus
Explanation:Understanding Risk Factors for Oesophageal Cancer
Oesophageal cancer is a type of cancer that is becoming increasingly common. It often presents with symptoms such as dysphagia, weight loss, and retrosternal chest pain. Adenocarcinomas, which are the most common type of oesophageal cancer, typically develop in the lower third of the oesophagus due to inflammation related to gastric reflux.
One of the risk factors for oesophageal cancer is Barrett’s oesophagus, which is the metaplasia of the squamous epithelium of the lower oesophagus when exposed to an acidic environment. This adaptive change significantly increases the risk of malignant change. Treatment options for Barrett’s oesophagus include ablative or excisional therapy and acid-lowering medications. Follow-up with repeat endoscopy every 2–5 years is required.
Blood group A is not a risk factor for oesophageal cancer, but it is associated with a 20% higher risk of stomach cancer compared to those with blood group O. A diet low in calcium is also not a risk factor for oesophageal carcinoma, but consumption of red meat is classified as a possible cause of oesophageal cancer. Those with the highest red meat intake have a 57% higher risk of oesophageal squamous cell carcinoma compared to those with the lowest intake.
Ulcerative colitis is not a risk factor for oesophageal cancer, but it is a risk factor for bowel cancer. On the other hand, alcohol is typically a risk factor for squamous cell carcinomas. Understanding these risk factors can help individuals take steps to reduce their risk of developing oesophageal cancer.
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This question is part of the following fields:
- Gastroenterology
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Question 27
Correct
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An 80-year-old man presented with progressive dyspepsia and weight loss. Endoscopy revealed a stenosing lesion that bled easily. A biopsy and histopathological examination revealed adenocarcinoma of the oesophagus.
Which of the following is the most likely aetiological factor?Your Answer: Gastro-oesophageal reflux disease (GORD)
Explanation:Factors Contributing to Oesophageal Cancer
Oesophageal cancer is a common and aggressive tumour that can be caused by various factors. The two most common types of oesophageal cancer are squamous cell carcinoma and adenocarcinoma. In developed countries, adenocarcinoma is more prevalent, while squamous cell carcinoma is more common in the developing world.
Gastro-oesophageal reflux disease (GORD) is the most common predisposing factor for oesophageal adenocarcinoma. Acid reflux can cause irritation that progresses to metaplasia, dysplasia, and eventually adenocarcinoma. Approximately 10-15% of patients who undergo endoscopy for reflux symptoms have Barrett’s epithelium.
Cigarette smoking and chronic alcohol exposure are the most common aetiological factors for squamous cell carcinoma in Western cultures. However, no association has been found between alcohol and oesophageal adenocarcinoma. The risk of adenocarcinoma is also increased among smokers.
Achalasia, a condition that affects the oesophagus, increases the risk of both adeno and squamous cell carcinoma. However, dysphagia is not mentioned as a contributing factor.
Limited evidence suggests that excessive fruit and vegetable consumption may be protective against both types of cancer. Helicobacter pylori infection, which can cause stomach cancer, has not been associated with oesophageal cancer.
Factors Contributing to Oesophageal Cancer
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This question is part of the following fields:
- Gastroenterology
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Question 28
Incorrect
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A 58-year-old woman presents to the Emergency Department with abdominal pain, fever and two episodes of vomiting. She states that she has had previous episodes of right upper-quadrant pain with radiation to the right shoulder blade but has never sought medical attention for this.
Her past medical history is significant for obesity and hypertension.
Examination reveals an obese abdomen with tenderness in the right upper quadrant and epigastric region. No jaundice is evident.
Observations are as follows:
Temperature 38.5°C
Heart rate 87 beats per minute
Respiratory rate 19 breaths per minute
SpO2 98% (room air)
Blood pressure 145/86 mmHg
Laboratory results reveal an elevated white cell count and C-reactive protein. An abdominal ultrasound reveals multiple gallstones in the body of the gallbladder. The gallbladder is thickened, with the largest stone measuring 17 mm.
Which of the following is the most appropriate next step in management?Your Answer: Percutaneous cholecystostomy
Correct Answer: Laparoscopic cholecystectomy
Explanation:Differentiating between surgical interventions for gallbladder disease
Gallbladder disease can present in various ways, and the appropriate surgical intervention depends on the specific clinical scenario. In the case of acute cholecystitis, which is characterized by right upper quadrant pain, fever, and an elevated white cell count, immediate surgical input is necessary. Laparoscopic cholecystectomy is the recommended course of action, but it is important to wait for the settling of acute symptoms before proceeding with surgery.
Exploratory laparotomy, on the other hand, is indicated in patients who are haemodynamically unstable and have a rigid, peritonitic abdomen on examination. If the patient has a soft abdomen without haemodynamic instability, exploratory laparotomy is not necessary.
Endoscopic retrograde cholangiopancreatography (ERCP) is indicated in patients who have common bile duct stones. However, if the patient has gallstones in the body of the gallbladder, ERCP is not the appropriate intervention.
Intravenous (IV) proton pump inhibitors, such as pantoprazole, are indicated in patients suffering from severe peptic ulcer disease, which typically presents with deep epigastric pain in a patient with risk factors for peptic ulcers, such as non-steroidal anti-inflammatory use or Helicobacter pylori infection.
Finally, percutaneous cholecystostomy is mainly reserved for patients who are critically unwell or are poor surgical candidates. This procedure involves the image-guided placement of a drainage catheter into the gallbladder lumen with the aim of stabilizing the patient so that a more measured surgical approach can be taken in the future.
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This question is part of the following fields:
- Gastroenterology
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Question 29
Incorrect
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Which statement about kernicterus is not true?
Your Answer: May cause a chronic syndrome of athetosis, gaze disturbance and hearing loss
Correct Answer: Diagnosis requires the histological confirmation of yellow staining of brain tissue on autopsy caused by fat soluble unconjugated hyperbilirubinaemia
Explanation:Hyperbilirubinemia and its Effects on Infants
Hyperbilirubinemia, a condition characterized by high levels of bilirubin in the blood, can have severe consequences for infants. In some cases, intracellular crystals may be observed in the intestinal mucosa of affected infants, which may be related to gastrointestinal bleeding. However, the most significant long-term effects of hyperbilirubinemia are neurological in nature. Infants who experience marked hyperbilirubinemia may develop a chronic syndrome of neurological sequelae, including athetosis, gaze disturbance, and hearing loss.
Even if the affected infant survives the neonatal period, the effects of hyperbilirubinemia may persist. If the infant subsequently dies, the yellow staining of neural tissue may no longer be present, but microscopic evidence of cell injury, neuronal loss, and glial replacement may be observed in the basal ganglia. These findings highlight the importance of early detection and treatment of hyperbilirubinemia in infants to prevent long-term neurological damage.
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This question is part of the following fields:
- Gastroenterology
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Question 30
Incorrect
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A General Practice is conducting an audit on the number of elderly patients with gastrointestinal symptoms who were referred for endoscopy without a clear clinical indication.
Which of the following intestinal diseases necessitates blood tests and small intestinal biopsy for precise diagnosis?Your Answer: Whipple’s disease
Correct Answer: Coeliac disease
Explanation:Diagnostic Biopsy Findings for Various Intestinal Conditions
When conducting a biopsy of the small intestine, various changes may be observed that can indicate the presence of certain conditions. However, it is important to note that these changes are not always specific to a particular disease and may be found in other conditions as well. Therefore, additional diagnostic tests may be necessary to confirm a diagnosis.
Coeliac disease is one condition that can be suggested by biopsy findings, which may include infiltration by lymphocytes and plasma cells, villous atrophy, and crypt hyperplasia. However, positive serology for anti-endomysial or anti-gliadin antibodies is also needed to confirm gluten sensitivity.
Abetalipoproteinemia, Mycobacterium avium infection, Whipple’s disease, and intestinal lymphangiectasia are other conditions that can be diagnosed based on biopsy findings alone. Abetalipoproteinemia is characterized by clear enterocytes due to lipid accumulation, while Mycobacterium avium infection is identified by the presence of foamy macrophages containing acid-fast bacilli. In Whipple’s disease, macrophages are swollen and contain PAS-positive granules due to the glycogen content of bacterial cell walls. Finally, primary intestinal lymphangiectasia is diagnosed by the dilation of lymphatics in the intestinal mucosa without any evidence of inflammation.
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This question is part of the following fields:
- Gastroenterology
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