Gastroenterology — MCQs

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 1201: A young man met with a motorbike accident and had injuries to ileum and jejunum. Therefore the entire ileum and partial jejunum were resected. Which of the following would the patient suffer from

A. Vitamin B12 malabsorption due to ileal resection (Correct Answer)
B. Atrophic gastritis unrelated to resection
C. Constipation due to dietary changes
D. No significant symptoms

Explanation: **Vitamin B12 malabsorption due to ileal resection** - The **terminal ileum** is the primary site for the absorption of **vitamin B12** (cobalamin) complexed with intrinsic factor [3]. - Its resection would directly lead to the inability to absorb this vitamin, resulting in **B12 deficiency** and associated symptoms like macrocytic anemia [3]. *Atrophic gastritis unrelated to resection* - **Atrophic gastritis** is a chronic inflammatory condition of the stomach lining leading to loss of glandular tissue and often impaired production of **intrinsic factor**. - While it can cause B12 malabsorption, it is an independent condition and not a direct consequence of ileum and jejunum resection. *Constipation due to dietary changes* - Resection of the ileum and jejunum primarily impacts **nutrient absorption** and can lead to diarrhea due or **short bowel syndrome** [1], rather than constipation. - While diet changes can affect bowel habits, prolonged **severe gastrointestinal resection** is more likely to cause malabsorption-related diarrhea [1], [2]. *No significant symptoms* - The **ileum** and **jejunum** are crucial for the absorption of most nutrients, including vitamins, minerals, fats, and carbohydrates [4]. - Resection of these segments, especially a significant portion, would lead to **malabsorption syndromes** with various severe symptoms, potentially including weight loss, diarrhea, and nutritional deficiencies [1], [4].

Question 1202: A 42-year-old patient with obstructive jaundice. Alp, Ggt, haptoglobin all increased. The most likely cause is:

A. Alcohol
B. Lead
C. Biliary obstruction (Correct Answer)
D. None of the options

Explanation: ***Alcohol*** - Chronic **alcohol consumption** leads to hepatic injury, causing cholestasis and increased levels of **Alkaline Phosphatase (ALP)** and **Gamma-glutamyl transferase (GGT)** [1, 2]. - Increased **haptoglobin** indicates hemolysis or hepatic dysfunction, commonly seen in alcohol-related liver disease [1]. *Lead* - Lead poisoning typically causes **anemia** and affects **erythropoiesis**, but does not generally increase ALP and GGT levels significantly. - The classic presentation involves **neurological** deficits and **peripheral neuropathy**, rather than obstructive jaundice. *Chronic rf* - Chronic renal failure primarily affects **uremia** and renal function tests, with minimal impact on liver function tests like ALP and GGT. - It is not directly associated with **increased haptoglobin**, which is usually elevated in liver disease. *None of the above* - This option implies that none of the listed causes could lead to the observed lab changes, which is incorrect as **alcohol** is a known cause [1, 2]. - Enhancing liver damage from substances other than alcohol is not applicable based on the information given.

Question 1203: Common cause of chronic pancreatitis

A. Chronic alcohol (Correct Answer)
B. Chronic pancreatic calculi
C. pancreas divisum
D. Gall bladder stones

Explanation: ***Chronic alcohol*** - **Chronic alcohol consumption** is the most common and well-established cause of chronic pancreatitis, accounting for a significant majority of cases [1]. - Alcohol induces premature activation of pancreatic enzymes within the acinar cells, leading to recurrent inflammation, fibrosis, and eventual pancreatic destruction [1]. *Chronic pancreatic calculi* - While **pancreatic calcifications** (calculi) are a common finding in chronic pancreatitis, they are typically a *consequence* of the disease process rather than its primary cause [1]. - These calculi often develop due to protein plug formation and subsequent calcification in the ducts, exacerbated by recurrent inflammation [1]. *pancreas divisum* - **Pancreas divisum** is a congenital anomaly where the dorsal and ventral pancreatic ducts fail to fuse, leading to the majority of pancreatic secretions draining through a smaller accessory papilla. - While it can be a rare cause of recurrent acute pancreatitis or, less commonly, chronic pancreatitis, it is far less frequent than chronic alcohol abuse. *Gall bladder stones* - **Gallbladder stones (cholelithiasis)** are a common cause of *acute pancreatitis* when they obstruct the common bile duct or pancreatic duct. - They are generally not a direct cause of *chronic* pancreatitis unless recurrent acute episodes lead to irreversible pancreatic damage, making alcohol the leading primary cause [1].

Question 1204: Which statement is true regarding Crohn's disease?

A. Rectum is not involved
B. Crohn's disease typically presents with skip lesions. (Correct Answer)
C. Cobblestone appearance is a classic endoscopic finding.
D. Caseating granulomas are a characteristic histological feature.

Explanation: ***Continuous lesion visualized in endoscopy*** - Crohn's disease typically presents with **discontinuous lesions**, also known as **skip lesions**, which are not found in continuous patterns [1]. - This statement fails to align with the characteristic **cobblestone mucosa** appearance of the disease seen during endoscopy. *Rectum is not involved* - While Crohn's disease primarily affects the **ileum** and **colon**, it can indeed involve the **rectum**, although it is more common in ulcerative colitis [1]. - Hence, rectal involvement is possible in Crohn's, opposing this statement. *Non caseating granulomas* - Crohn's disease is known for the presence of **non-caseating granulomas**, which are a pathological hallmark of the condition. - This statement incorrectly describes a feature that is, in fact, true for Crohn's. *Cobblestone appearance* - The characteristic **cobblestone appearance** is typical in Crohn's disease due to the patchy involvement of the intestinal mucosa. - This statement is also true, as it accurately describes a prominent finding in Crohn's disease.

Question 1205: All of the following are features of Zollinger Ellison syndrome except:

A. Severe diarrhoea
B. Beta cell tumours of the pancreas (Correct Answer)
C. Very high acid output
D. Intractable peptic ulcers

Explanation: ***Beta cell tumours of the pancreas*** - Zollinger-Ellison syndrome (ZES) is caused by **gastrinomas**, which are **neuroendocrine tumors** that typically arise from the **gastrin-producing G cells**, not the insulin-producing beta cells, of the pancreas or duodenum. - While pancreatic tumors are common in ZES, they are specifically **gastrinomas**, leading to excessive gastrin secretion. *Severe diarrhoea* - This is a common feature of ZES resulting from the **high acid output** reaching the small intestine. - The excessive acid inactivates pancreatic lipase, leading to **maldigestion** and stimulates fluid and electrolyte secretion, causing secretory diarrhea. *Very high acid output* - ZES is characterized by the **overproduction of gastrin**, which stimulates the parietal cells of the stomach to secrete large amounts of **hydrochloric acid**. - This leads to a significantly **increased basal and maximal acid output** in the stomach. *Intractable peptic ulcers* - The extremely high gastric acid secretion in ZES causes **multiple, recurrent, and often refractory peptic ulcers**, which can be located in atypical sites such as the jejunum. - These ulcers are typically difficult to treat with standard anti-ulcer medications due to the persistent gastric hypersecretion.

Question 1206: A 55 years old male with a known history of gallstones presents with chief complaints of severe abdominal pain and elevated levels of serum lipase with periumbilical ecchymosis. All of the following are prognostic criteria to predict the severity of acute pancreatitis except:

A. Serum GGT (Correct Answer)
B. Serum LDH
C. Base deficit
D. Age

Explanation: ***Serum GGT*** - **Serum GGT (gamma-glutamyl transpeptidase)** is primarily used to evaluate liver and bile duct function and cholestasis, not as a direct prognostic indicator for acute pancreatitis severity. - While gallstones are mentioned, GGT elevation in this context would suggest the cause of pancreatitis rather than its severity. *Age* - **Age older than 55 years** is a significant prognostic factor in various scoring systems like Ranson's criteria and the APACHE II score, indicating a higher risk of severe disease and complications [1]. - Older patients generally have less physiologic reserve and are more prone to organ failure during severe pancreatitis [1]. *Serum LDH* - **Elevated serum LDH (lactate dehydrogenase)**, specifically above 350 IU/L, is one of Ranson's criteria for assessing the severity of acute pancreatitis within the first 48 hours. - It suggests significant tissue damage and necrosis, which correlates with worse outcomes. *Base deficit* - A **base deficit greater than 4 mEq/L** is an indicator of metabolic acidosis and is included in prognostic scoring systems for acute pancreatitis, such as the modified Glasgow criteria. - It reflects poor tissue perfusion, hypovolemia, and potentially severe systemic inflammation.

Question 1207: Which of the following is used to decrease the duration and severity of acute diarrhea?

A. Zn (Correct Answer)
B. Mg
C. Fe
D. Ca

Explanation: ***Zn*** - **Zinc supplementation** has been shown to reduce the **duration** and **severity** of acute diarrhea, particularly in children in developing countries [1]. - It plays a crucial role in **immune function** and **intestinal integrity**, which helps in recovery from diarrheal episodes [1]. *Mg* - **Magnesium** is an essential mineral, but it is not directly used to decrease the duration or severity of acute diarrhea. - In fact, high doses of magnesium can act as a **laxative** and may worsen diarrhea. *Fe* - **Iron** is vital for red blood cell formation and oxygen transport, but it does not directly impact the duration or severity of acute diarrhea. - Iron supplementation is primarily used to treat **anemia**. *Ca* - **Calcium** is important for bone health and various metabolic processes, but it is not a primary intervention for reducing the duration or severity of acute diarrhea. - While sometimes used for mild digestive issues, it does not have the same evidence base as zinc for acute diarrhea.

Question 1208: If 90% of the jejunum and ileum is removed, which of the following features will NOT be seen?

A. Steatorrhoea
B. Diarrhoea
C. Weight gain (Correct Answer)
D. Megaloblastic anemia

Explanation: ***Weight gain*** - Extensive **resection of the jejunum and ileum** (90% removal) significantly reduces the absorptive surface area of the small intestine [3]. - This severe malabsorption of nutrients, including fats and carbohydrates, would lead to **weight loss** due to calorie deficit, not weight gain [2]. *Steatorrhoea* - The ileum is crucial for the absorption of **bile acids**; its extensive removal leads to bile acid malabsorption [1]. - Reduced bile acid reabsorption impairs **fat emulsification and absorption**, resulting in increased fat in the stool and causing steatorrhoea [1]. *Diarrhoea* - Loss of significant length of the ileum and jejunum reduces the ability to absorb water and electrolytes, leading to increased luminal fluid [3]. - The unabsorbed bile acids reaching the colon also act as **secretagogues**, further contributing to osmotic and secretory diarrhea. *Megaloblastic anemia* - The terminal ileum is the primary site for the absorption of **vitamin B12** (cobalamin), which binds to intrinsic factor produced by the stomach. - Extensive ileal resection would severely impair vitamin B12 absorption, leading to a deficiency that manifests as **macrocytic, megaloblastic anemia** [2].

Question 1209: All of the following may lead to gall bladder carcinoma except which of the following?

A. Gall Bladder Polyps
B. Typhoid carriers
C. Echinococcus Granulosus Infection (Correct Answer)
D. Exposure to carcinogens like nitrosamine

Explanation: ***Echinococcus Granulosus Infection*** - Echinococcus granulosus is primarily associated with **hydatid cyst formation**, not directly linked to gallbladder carcinoma. - This infection typically affects the **liver** rather than inducing malignant transformation in the gallbladder. *Typhoid carriers* - Chronic infection with **Salmonella typhi** in carriers can cause **gallbladder inflammation** and is a risk factor for gallbladder cancer. - Typhoid carriers retain the bacteria in the gallbladder, leading to chronic irritation and potentially malignant changes. *Gall Bladder Polyps* - Certain types of gallbladder polyps, especially those larger than **1 cm**, have a significant risk of undergoing malignant transformation. - They are associated with **chronic inflammation** and may progress to cancer if not monitored. *Exposure to carcinogens like nitrosamine* - Nitrosamines are known **carcinogens** that can induce protein modifications leading to DNA damage, contributing to gallbladder cancer. - Long-term exposure to such chemicals can result in **cellular mutations** in the gallbladder epithelial lining.

Question 1210: A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:

A. Splenic Vein Thrombosis (Correct Answer)
B. Bleeding
C. Gastric Outlet Obstruction
D. Perforation

Explanation: ***Splenic Vein Thrombosis*** - The patient's symptoms (epigastric pain worsening with spicy food, relieved by bending forward) are highly suggestive of **pancreatitis**, not peptic ulcer disease [1]. **Splenic vein thrombosis** is a known complication of chronic pancreatitis due to inflammation and compression of the splenic vein [2]. - While pancreatitis can cause significant morbidity, **splenic vein thrombosis** is a specific vascular complication associated with prolonged inflammation of the pancreas, leading to localized portal hypertension and potentially isolated gastric varices. *Perforation* - **Perforation** (specifically of a peptic ulcer or potentially surrounding bowel in severe pancreatitis) is a severe complication that can occur in conditions causing abdominal pain, but it is not the *exception* among the given options for the likely underlying condition indicated by the patient's symptoms (pancreatitis) [3]. - This complication typically leads to **peritonitis**, a medical emergency requiring immediate surgical intervention [3]. *Bleeding* - **Bleeding** (e.g., from a pancreatic pseudocyst rupturing into the gastrointestinal tract or from localized varices secondary to portal hypertension in pancreatitis) is a recognized complication of the patient's likely underlying condition [1]. - Gastrointestinal bleeding can also result from **gastric erosions** or ulcers exacerbated by ongoing inflammation. *Gastric Outlet Obstruction* - **Gastric outlet obstruction** can occur as a complication of severe or chronic pancreatitis, often due to **inflammation**, **fibrosis**, or **pseudocyst formation** compressing the duodenum [1]. - This typically presents with **postprandial vomiting** and early satiety, which can arise in the context of chronic pancreatic inflammation.

Practice by Chapter

Esophageal Disorders

Practice Questions

Peptic Ulcer Disease

Practice Questions

Inflammatory Bowel Disease

Practice Questions

Irritable Bowel Syndrome

Practice Questions

Malabsorption Syndromes

Practice Questions

Pancreatitis (Acute and Chronic)

Practice Questions

Gastrointestinal Bleeding

Practice Questions

Liver Diseases and Cirrhosis

Practice Questions

Viral Hepatitis

Practice Questions

Biliary Tract Disorders

Practice Questions

Gastrointestinal Motility Disorders

Practice Questions

Gastrointestinal Malignancies

Practice Questions

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