Solve Class Exam-1(Gastrointestinal .pdf

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1. Q.1. A 30 years old male came with sudden upper abdominal pain that radiates to back.
Considering this as an acute pancreatitis as your provisional diagnosis, how will you investigate
him for complete evaluation.5
Solve-Exam-1(GIT)
Investigations
•To establish the Dx
•To find out causes
•To Stablish severity
•To serchcomplications
•To exclude D/D
The diagnosis is based on raised serum amylase or lipase concentrations and ultrasound or CT
evidence of pancreatic swelling.

2. Q.2. Define adherence and write down the factors that affecting adherence. 1.5+3.5=5
Adherence is defined as ‘the extent to which a person’s behaviour, in terms of taking medications,
following diets or executing lifestyle changes, coincides with medical or health advice’.
The term ‘adherence’ is used in preference to ‘compliance’ because it focuses on whether a person
actively adheres to the regimen rather than passively follows the doctor’s orders.
Factors affecting adherence:
Negative factors:
• Older adolescent
• Mental health issues with care-giver
• Family conflicts
• Complex therapy
• Medication with side-effects
• Denial of illness

3. Positive factors
• Positive family functioning
• Close friends
• Intemallocus of control
• Treatment with immediate benefits
• Patient's belief in seriousness of illness and efficacy of treatment
• Physician empathy
Q.3.Write a short note about “Role of upper GIT endoscopy in medicine”. 5
Upper gastrointestinal endoscopy :
This is performed under light sedation, or using only local anaestheticthroat spray after the
patient has fasted for at least 4 hours. With the patient in the left lateral position, the entire
oesophagus(excluding pharynx), stomach and 1st two parts of duodenum can be seen.

5. Q.4. Write down the management of functional dyspepsia? 5
Clinical features :Symptoms such as bloating, early satiety, loss of appetite, nausea, vomiting or
retching, epigastric pain or epigastric burning etc
Investigations:
•All patients should be checked for H. pylori infection
•Patients with alarm features should undergo endoscopy to exclude mucosal disease.
•Ultrasound scan may detect gallstones.
•Others routine : CBC, Thyroid test etc
Management
•Up to 10% of patients benefitfrom H. pylori eradication therapy and this should be offered to
infected individuals.
•Idiosyncratic and restrictive diets are of little benefit but smaller portions and fat restriction may
help.

6. Drug treatment :
•Prokinetic drugs (e.g. metoclopramide), fundusrelaxingdrugs (e.g. buspirone) orcentrally acting
neuromodulators (e.g. mirtazapine) can be used in postprandial distress syndrome.
•Acid suppression medication (e.g. PPI) and tricyclic antidepressants (e.g. amitriptyline) may be
used in epigastric pain syndrome.
Patients with major psychological disordersthat result in persistent or recurrent symptoms may
require behaviouralor other formal psychotherapy
Q.5. How will you clinically evaluateaa 34 years female came with complaints about
abdominal discomfort, bloating and occasional nausea, who have no functional component. 5
Key Point :
34y old Female
C/C: Discomfort, bloating and nausea
From above scenario my Provisional Dx is Dyspepsis. And iwill consider following etiology for my Dx.
GI cause: Gallstones,Hepaticdisease (hepatitis), NUD, IBS etc
Non GI cause: Renal failure, Drugs, Hypercalcaemia,Psychological(anxiety, depression), Alcohol etc

8. Rome IV criteria for diagnosis of irritable bowel syndrome
Recurrent abdominal pain at least 1 day per week on average in the last 3 months (onset at least 6 months before
diagnosis), associated with two or more of the following:
•Related to defecation
•Onset associated with a change in frequency of stool
•Onset associated with a change in form (appearance) of stool
Alarm features in suspected irritable bowel syndrome
•Age >50 years
•Unintentional weight loss
•Nocturnal symptoms
•Recent change in bowel habit
•Palpable abdominal mass or lymphadenopathy
•Family history of colon cancer or inflammatory bowel disease
•Anaemia
•Evidence of overt gastrointestinal bleeding (i.e. melaena or fresh blood in stools (haematochezia)
Q.6. Write down the Rome IV criteria of IBS, with it’s alarm features.5

9. Q.7.Write down the principle of management of a suspected case of acute non variceal upper GI
bleeding in brief. 5
1. Intravenous access
2. Initial clinical assessment
3. Basic investigations
4. Resuscitation
5. Oxygen
6. Antithrombotic drugs modifications
7.Proton pump inhibitor (PPI) therapy
8.Endoscopy
9.Monitoring
10.Radiology and surgery
11.Eradication

10. Q.8. A 60 years old male complaints about constipation for last 3 months.
What are the etiological factors you will consider for him and when you will consider urgent
colonoscopy for this patient? 3.5+1.5=5
From above scenario my dx is Chronic Constipation.
I will consider following etiology for this :
Gastrointestinal causes:
•Dietary: Lack of fibresand/or fluid intake etc
•Structural : Colonic carcinoma, Diverticular disease etc.
Non GI Tract disease
•Neurological : Multiple sclerosis, Spinal cord lesions, Cerebrovascular accidents, Parkinsonism etc
•Metabolic/endocrine: Diabetes mellitus, Hypercalcaemia, Hypothyroidism etc
•Drugs
•Others: Any serious illness with immobility, Depression etc
Immediate colonoscopy : concerning symptoms (e.g. rectal bleeding, pain or weight loss).

11. Q.9. A 38 years old obeaspatient complaints about heartburn and regurgitation with occasional
chest infections for last 4 months.
a) Write down the worgingfeatures for this patient you will ask. 1.5
b) What are the indications of investigations for this patient? 1.5
c) Write down the indications of surgery for this patient. 2
Dx : GERD:
a) Worrying features for this patient :
Ans : Dysphagia, Weight loss & Anaemia.
b)Indications of investigations :
Ans :
•Patients present over the age of 50–55 years,
•Symptoms are atypical
•Worrying symptoms
•Complication is suspected.
Endoscopy is the investigation of choice

12. c) Indications of surgery for this patient.
Ans :
•Patients who fail to respond to medical therapy
•Who are unwilling to take long-term PPIs
•Whose major symptom is severe regurgitation.
Surgery: laparoscopic fundoplication

13. Q.10. Write a short note about the pharmacological treatment of IBD. 5

14. OSPE Station-1
A 60 years old male came with recurrent upper abdominal pain several times per year for last 6
years. He is also diabetic for last 3 months.
Look at the image given blow and answer the questions.
a) What is your diagnosis? 1
b) Write down 4 (four) history you want to ask in this case. 2
c) Write down 4 investigations for this case. 2
d) Write down 6 complications of your primary diagnosis. 3
e) Write down about pain management options for him? 2

15. A : Chronic Calcified pancreatitis with DM
B : 4 history: Alcohol, Drugs, Obesity, CKD, Recurrent Rt Upper abdominal pain, F/O Malabsorption etc
C: 4 investigations :
•Ultrasound
•Computed tomography
•Abdominal X-ray
•Magnetic resonance cholangiopancreatography
•Endoscopic ultrasound
•RBS
•RFT etc
Complications of chronic pancreatitis:
•Pseudocysts and pancreatic ascites
•Obstructive jaundice
•Duodenal stenosis
•Portal or splenic vein thrombosis leading to segmental portal hypertension and gastric varices
•Peptic ulcer
•Secondary diabetes mellitus

16. Pain Mx :
•Abstinentfrom alcohol
•NSAIDs
•Pregabalinand tricyclic antidepressants at a low dose.
•Oral pancreatic enzyme supplements
•Surgicalor endoscopic pancreatic therapy
•Coeliac plexus neurolysis
•Totalpancreatectomy.