A 43-year-old man is reviewed in the gastroenterology clinic. He has had troublesome dyspepsia for the past six months which has not settled with proton pump inhibitor therapy. During the review of systems he also reports passing 6-7 watery stools per day. An OGD 3 weeks ago showed gastric erosions and ulcers.
Which one of the following investigations is most likely to be diagnostic?
Correct Answer C: CT abdomen has a sensitivity of only 50% for primary tumours in Zollinger-Ellison syndrome (ZES).
Normal levels of fasting gastrin in untreated ZES are extremely rare.
Zollinger-Ellison syndrome: Zollinger-Ellison syndrome is condition characterized by excessive levels of gastrin, usually from a gastrin secreting tumour usually of the duodenum or pancreas. Around 30% occur as part of MEN type I syndrome.
Features:
Diagnosis:
You are asked to review a 24-year-old man who has been admitted with an exacerbation of Crohn's disease. Despite prednisolone and mesalazine therapy for the past 3 weeks he is still passing 6-7 watery stools per day.
He has lost a considerable amount of weight during this period. On examination he is apyrexial, haemodynamically stable and his abdomen is soft and non-tender.
What is the most appropriate next step?
Correct Answer D:
Crohn's disease: management: Crohn's disease is a form of inflammatory bowel disease. It commonly affects the terminal ileum and colon but may be seen anywhere from the mouth to anus.
General points:
Active disease:
Perianal disease:
A 59-year-old female with a history of hypothyroidism presents with fatigue. Blood tests reveal the following:
What is the most appropriate investigation to perform next?
Correct Answer D: Macrocytic anaemia in a patient with a history of hypothyroidism points towards a diagnosis of pernicious anaemia.
Pernicious anaemia: investigation:
Investigation:
Schilling test:
Which one of the following is least associated with hepatosplenomegaly?
Correct Answer E: Infective endocarditis normally causes an isolated splenomegaly. Theoretically severe infective endocarditis may cause right heart failure and hence hepatomegaly but this would be unusual.
Causes of hepatosplenomegaly:
*the latter stages of cirrhosis are associated with a small liver
Which one of the following is least associated with the development of colorectal cancer in patients with ulcerative colitis?
Correct Answer E:
Ulcerative colitis: colorectal cancer: Overview:
Factors increasing risk of cancer:
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