Gastroenterology — MCQs

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 1191: A patient with a history of alcohol dependence syndrome presents with sudden and unintentional weight loss. What is the most likely diagnosis?

A. Hepatic adenoma
B. Cholangiocarcinoma
C. Hepatocellular carcinoma (Correct Answer)
D. Alcoholic hepatitis

Explanation: ***Hepatocellular carcinoma*** - The **alpha-fetoprotein (AFP)** level of **600 ng/mL** is significantly elevated, suggesting a diagnosis of hepatocellular carcinoma, especially in a patient with a history of **alcohol dependence syndrome** [1]. - The **AST/ALT ratio of 0.5** indicates significant liver damage, commonly seen in chronic liver disease leading to **hepatocellular cancer**. *Alcoholic hepatitis* - Typically presents with **elevated AST and ALT**, usually with a ratio >2:1, which is not the case here [2]. - May cause weight loss, as alcoholic patients often lose weight due to self-neglect and poor dietary intake, but the **elevated AFP** is not characteristic of merely alcoholic hepatitis [3]. *Cholangiocarcinoma* - This type of cancer primarily presents with **biliary obstruction** symptoms, such as jaundice, which is not indicated here given **normal bilirubin levels**. - Does not typically lead to such high levels of **AFP**, making it less likely with the provided lab results. *Hepatic adenoma* - More commonly associated with **oral contraceptive use** or anabolic steroid use, not primarily alcohol dependence. - AFP levels are usually normal or only mildly elevated in hepatic adenoma, making this option less viable with an **AFP level of 600 ng/mL**.

Question 1192: A patient comes with abdominal pain, jaundice, and portal hypertension. Anastomosis between which of the following veins is seen?

A. Left colic vein and middle colic veins
B. Superior rectal and phrenic veins
C. Sigmoid and superior rectal veins
D. Esophageal veins and left gastric veins (Correct Answer)

Explanation: ***Esophageal veins and left gastric veins*** - This anastomosis is crucial in **portal hypertension**, as increased pressure in the **portal venous system** (e.g., due to liver cirrhosis) causes blood to back up into the **systemic venous circulation** through these collateral vessels. - This shunting creates **esophageal varices**, which can rupture and lead to life-threatening **upper gastrointestinal bleeding**, commonly presenting with **jaundice** and **abdominal pain** in liver disease. *Left colic vein and middle colic veins* - Both the left colic and middle colic veins are tributaries of the **inferior mesenteric vein** and **superior mesenteric vein**, respectively, and are part of the **portal system**. - While they form an anastomosis (via the **marginal artery of Drummond**), this connection is within the portal system and does not typically serve as a portosystemic shunt to decompress portal hypertension in the way esophageal varices do. *Superior rectal and phrenic veins* - The **superior rectal vein** drains into the **inferior mesenteric vein** (part of the portal system), and the **phrenic veins** drain into the **inferior vena cava** (part of the systemic system). - There is no direct significant portosystemic anastomosis between these two veins that would be clinically relevant in portal hypertension. *Sigmoid and superior rectal veins* - Both the **sigmoid veins** and the **superior rectal vein** are part of the **inferior mesenteric venous system**, which drains into the **portal circulation**. - While there are anastomoses between these veins within the mesenteric circulation, they are not a direct portosystemic shunt used to relieve pressure in portal hypertension causing the described symptoms.

Question 1193: Which of the following laboratory values is NOT a component of the MELD score?

A. Serum creatinine
B. Albumin (Correct Answer)
C. Serum bilirubin
D. International normalized ratio (INR)

Explanation: ***Albumin*** - **Albumin** is a component of the Child-Pugh score, which is also used to assess liver function, but it is **not included in the MELD score**. [2] - The MELD score specifically focuses on **renal function** (creatinine) and **liver synthesis/excretory function** (bilirubin and INR). [1] *Serum bilirubin* - **Serum bilirubin** is a key indicator of the liver's ability to excrete bile and is a **direct component** of the MELD score. [1], [2] - Higher bilirubin levels generally indicate **worse hepatocellular function** and are associated with a higher MELD score. *Serum creatinine* - **Serum creatinine** is a measure of **renal function** and is an important component of the MELD score. [1] - It reflects the severity of **hepatorenal syndrome** and the overall prognosis in patients with liver disease. [1] *International normalized ratio (INR)* - The **International Normalized Ratio (INR)** assesses the liver's synthetic function, specifically its ability to produce **clotting factors**. [2] - A higher INR indicates **impaired coagulation** due to liver dysfunction and is a direct component of the MELD score. [1]

Question 1194: A 35-year-old male presents with recurrent episodes of abdominal pain, jaundice, and fatigue and underwent MRCP. What will be the most likely diagnosis?

A. Primary biliary cirrhosis
B. Caroli’s disease
C. Primary sclerosing cholangitis (Correct Answer)
D. Recurrent pyogenic cholangitis

Explanation: **Primary sclerosing cholangitis** - **MRCP (Magnetic Resonance Cholangiopancreatography)** in primary sclerosing cholangitis (PSC) typically shows characteristic **"beading"** and **strictures** of the biliary tree due to inflammation and fibrosis. - The combination of **recurrent abdominal pain**, **jaundice**, and **fatigue** in a relatively young male strongly suggests PSC, especially given its association with inflammatory bowel disease, which is common in this demographic [1]. *Primary biliary cirrhosis* - This condition primarily affects **small intrahepatic bile ducts** and is more common in **middle-aged women** [1]. - While it causes fatigue and jaundice, the classic MRCP findings of PSC (beading and strictures) are not typically seen, and it's associated with **anti-mitochondrial antibodies (AMA)** [1]. *Caroli’s disease* - This is a rare congenital disorder characterized by **segmental cystic dilatation of the intrahepatic bile ducts** [1]. - MRCP would show these **cystic dilations** rather than the diffuse strictures and beading seen in PSC. *Recurrent pyogenic cholangitis* - Also known as oriental cholangiohepatitis, it is characterized by recurrent episodes of **cholangitis** and **intrahepatic gallstones**, mostly seen in Asian populations. - While it presents with recurrent abdominal pain and jaundice, MRCP would show **intrahepatic calculi** and **dilated bile ducts**, not the stricturing pattern of PSC.

Question 1195: Which of the following statements is incorrect regarding King's Criteria for acute fulminant liver failure?

A. Age <10 years or >40 years
B. Jaundice <7 days (Correct Answer)
C. INR >3.5
D. Serum bilirubin >17.5 mg/dl

Explanation: Jaundice <7 days - This statement is **incorrect** because King's College Criteria for non-acetaminophen-induced acute liver failure uses **jaundice duration of >7 days** as a poor prognostic factor. - A short duration of jaundice (<7 days) before the onset of encephalopathy is generally associated with a **better prognosis**. *Age <10 years or >40 years* - This is a **correct** statement of King's Criteria, as **age less than 10 or greater than 40 years** are considered poor prognostic indicators. - These age groups are associated with a higher risk of adverse outcomes in acute liver failure. *INR >3.5* - This is a **correct** component of King's Criteria, indicating **severe coagulopathy** and poor liver synthetic function. - An **INR greater than 3.5** is a key predictor of non-survival without transplantation in non-acetaminophen-induced acute liver failure. *Serum bilirubin >17.5 mg/dl* - This is a **correct** criterion, as a **serum bilirubin level exceeding 17.5 mg/dl** is a significant marker for poor prognosis. - High bilirubin levels reflect severe hepatocellular dysfunction and impaired metabolic capacity of the liver.

Question 1196: 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 1197: MRP2 associated with which of the following?

A. Rotor syndrome
B. Dubin-Johnson syndrome (Correct Answer)
C. Crigler-Najjar syndrome
D. Gilbert syndrome

Explanation: No changes were made to the original explanation because the available references provided insufficient evidence to support the specific claims about the MRP2 gene and the characteristic 'dark liver' appearance of Dubin-Johnson syndrome. While the references discuss hyperbilirubinemia and mentions Gilbert and Crigler-Najjar syndromes [1], they do not explicitly detail the MRP2 mutation or the pathology of Dubin-Johnson and Rotor syndromes necessary for high-accuracy medical citation [2].

Question 1198: The differentiating feature between IBS and organic GI disease is:

A. Pain abdomen
B. Mucus in stools
C. Diarrhea
D. Presence of inflammation indicated by elevated stool calprotectin (Correct Answer)

Explanation: ***Presence of inflammation indicated by elevated stool calprotectin*** - Elevated **stool calprotectin** is a reliable biomarker for **gastrointestinal inflammation**, indicating an **organic GI disease** such as inflammatory bowel disease (IBD). - **Irritable bowel syndrome (IBS)** is a functional disorder and typically does not involve **inflammation**, so stool calprotectin levels would be normal. *Diarrhea* - **Diarrhea** can be a symptom of both **IBS** (specifically IBS-D) and various **organic GI diseases** (e.g., Crohn's disease, ulcerative colitis, celiac disease) [1]. - Therefore, its presence alone does not differentiate between a functional and an organic cause [1]. *Pain abdomen* - **Abdominal pain** is a cardinal symptom of **IBS**, specifically related to bowel movements [1]. - It is also a very common symptom in many **organic GI diseases**, making it a non-specific differentiating feature. *Mucus in stools* - **Mucus in stools** can occur in **IBS**, often due to increased colonic transit or irritation, but without underlying inflammation [1]. - It can also be present in **organic GI diseases**, particularly those involving inflammation or structural changes in the bowel.

Question 1199: Most common type of gallstone is?

A. Pure cholesterol stones (Correct Answer)
B. Pigment stones
C. Calcium bilirubinate
D. Mixed stones

Explanation: ***Mixed stones*** - Mixed gallstones, typically composed of **cholesterol** and **pigment**, are the most prevalent type, accounting for about 70-80% of cases [1]. - They are often associated with **biliary stasis** and **inflammation**, contributing to their formation. *Pigment stones* - Pigment stones are less common, usually representing about 10-20% of gallstones [1]. They are primarily formed from **bilirubin** and are associated with conditions causing **hemolysis**. - They may lead to **complications**, but their overall incidence is lower compared to mixed stones. *Calcium bilirubinate* - These stones are a type of **pigment stone**, formed in conditions like chronic hemolytic anemia, but they are relatively rare overall [1]. - They specifically result from **excess bilirubin**, unlike the mixed stones' composition which includes **cholesterol**. *Pure cholesterol stones* - Pure cholesterol stones occur in about 10-15% of cases, developing primarily due to **supersaturation of cholesterol** in bile. - They are less common than mixed stones and typically present as **large, yellowish stones** in the gallbladder.

Question 1200: A patient with a history of chronic liver disease presents with abdominal distension, jaundice, and pruritis. Ascitic fluid analysis revealed a neutrophil count >650 per cubic mm. What is the most likely diagnosis?

A. Spontaneous bacterial peritonitis (Correct Answer)
B. Malignant ascites
C. Tubercular ascites
D. Intestinal obstruction

Explanation: ***Spontaneous bacterial peritonitis*** - The combination of **chronic liver disease**, **ascites**, and a significantly elevated ascitic fluid **neutrophil count (>250 cells/mm³ is diagnostic)**, in this case, >650 cells/mm³, is highly indicative of spontaneous bacterial peritonitis (SBP). - SBP is a common and serious complication in patients with **cirrhosis** and ascites, characterized by bacterial infection of ascitic fluid without an obvious source. *Malignant ascites* - While malignant ascites can occur in chronic liver disease (e.g., from hepatocellular carcinoma), the ascitic fluid analysis would typically show **cytology positive for malignant cells** and often a **low neutrophil count** unless secondarily infected. - The primary differentiator here is the very high neutrophil count suggesting an acute inflammatory/infectious process. *Tubercular ascites* - Tubercular ascites might present with ascites and abdominal distension, but the ascitic fluid analysis usually shows a **lymphocytic predominance** (high lymphocyte count) rather than a high neutrophil count. - Diagnosis typically involves **adenosine deaminase (ADA) levels**, acid-fast bacilli smear, or culture of ascitic fluid. *Intestinal obstruction* - Intestinal obstruction primarily causes **abdominal pain, distension, nausea, vomiting**, and constipation, with a clinical picture distinct from SBP. - While it can lead to ascites in rare cases (e.g., from bowel ischemia or perforation), the ascitic fluid would not characteristically show such a high neutrophil count unless there was associated perforation and peritonitis.

Practice by Chapter

Esophageal Disorders

Practice Questions

Peptic Ulcer Disease

Practice Questions

Inflammatory Bowel Disease

Practice Questions

Irritable Bowel Syndrome

Practice Questions

Malabsorption Syndromes

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Pancreatitis (Acute and Chronic)

Practice Questions

Gastrointestinal Bleeding

Practice Questions

Liver Diseases and Cirrhosis

Practice Questions

Viral Hepatitis

Practice Questions

Biliary Tract Disorders

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Gastrointestinal Motility Disorders

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Gastrointestinal Malignancies

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