Coloquio 2 (51-110)

A 50-year-old patient with known gallstones is referred to the hospital for acute abdominal pain. In laboratory results, amylase and lipase, aminotransferases and alkaline phosphatase were 3 times above normal values. An ultrasound scan shows gallstones. Bilirubin was 2 times above the normal value. What is the most sensible next course of action: Endoscopic ultrasound to confirm choledocholithiasis. MRCP. Emergency cholecystectomy. Diagnostic endoscopic cholangiopancreatography (ERCP).

Systemic inflammatory response syndrome (SIRS) is a syndrome of the early phase of acute pancreatitis and is a predictive factor for: (Which answer is not true?). A. Greater risk of local complications. B. Greater risk of damage to one or more organ systems. C. Higher risk of necrosis infection in the first 48 hours. D. Greater risk of severe acute pancreatitis. E. Higher risk of mortality.

A 30-year-old woman with known cholecystolithiasis who is awaiting elective cholecystectomy comes to the emergency department one month after severe acute biliary pancreatitis. At that time, ERCP was not performed, as EUZ did not confirm gallstones. She is febrile on admission. Abdominal CT with contrast medium confirms infected demarcated necrosis. What is the optimal treatment procedure?. A. We take blood cultures and refer her to a surgeon. B. An analgesic is prescribed, blood cultures are taken and she is referred to an infectious disease specialist. C. We perform ERCP, sphincterotomy, and insert a stent into the pancreatic duct. D. blood cultures are taken, antibiotics are introduced and percutaneous or endoscopic drainage is performed.

A 22-year-old woman is referred to the emergency clinic because of severe diffuse abdominal pain that lasts for several hours, accompanied by nausea and vomiting. She was hypotensive, tachycardic and febrile. Laboratory findings showed leukocytosis, normal bilirubin, minimally elevated aminotransferases and alkaline phosphatase. Amylase was elevated 3 times the normal value, lipase was normal. Small ascites was visible on ultrasound. The gallbladder was empty. What is the most likely diagnosis?. A. acute pancreatitis. B. Perforation of gastric ulcer. C. Perforation of the duodenal ulcer into the pancreas. D. Rupture of ectopic pregnancy.

52-year-old smoker, regularly drinks 2 to 3 glasses of wine daily for five years. In the last 6 months, he had an attack of pain in the upper part of the abdomen, which subsided after a few days of rest, and the pain has been constant for the last month. The pain increases with feeding. He lost 10 kg. Passes liquid, mushy, sticky, smelly stool several times a day. In the laboratory results, amylase is 2 times above normal values, lipase is 4 times above normal values. Blood sugar sugar 12mmol/L. What is not a correct diagnosis?. A. Autoimmune pancreatitis type 2. B. Exocrine pancreatic insufficiency. C. Alcoholic chronic pancreatitis. D. Acute onset of chronic pancreatitis.

A 47-year-old patient underwent an abdominal ultrasound due to problems with the prostate, steatosis of the liver and gall bladder, in which there is an 11 mm polyp, were described. He is very worried about the polyp. He is asking for your advice. a. he needs a cholecystectomy. b. have a CT scan with a contrast agent. c. you suggest treatment with ursodeoxycholic acid. d. due to the polyp, he needs ultrasound control, initially every 6 months.

The prognosis of a 45-year-old patient with a pancreatic neuroendocrine tumor and liver metastases depends mostly on: A But the presence of possible lung tumors. B grade of the tumor. C resectability of liver grafts. D the presence of somatostatin receptors.

In a 52-year-old man with no accompanying diseases, a 4 cm tumor in the antrum of the stomach was diagnosed gastroscopically. Histological findings showed infection with H. Pylory and adenocarcinoma intestinal type. A CT scan of the abdomen showed that the tumor was growing to the serosa and one enlarged lymph node. What is the most recommended treatment?. A. Total gastrectomy with D-2 lymphadenectomy. B. Subtotal gastrectomy with D-2 lymphadenectomy and eradication of H.Pylori infection. C. Neoadjuvant chemotherapy, subtotal gastrectomy with D-2 lymphadenectomy and eradication of H. Pylori infection. D. Neoadjuvant chemotherapy, total gastrectomy with D-2 lymphadenectomy.

In an 80-year-old man with atrophic gastritis, a 2-cm lesion was found in the body of the stomach. The histological result of the biopsy showed adenocarcinoma. Abdominal CT did not show tumor growth into the submucosa. What is the recommended treatment?. A. Endoscopic submucosal dissection. B. Endoscopic resection with electrocoagulation loop. C. Total gastrectomy. D. Neoadjuvant chemotherapy and total gastrectomy.

A 65-year-old patient with a cyst in the pancreas questions the appropriateness of surgical treatment due to fear of cancer. You referred him for an EUZ and a biopsy, which shows a 3 cm mucinous cyst. The cyst has grown in size over the past 6 months. Surgical treatment of a cystic change of the pancreas is necessary: a. In a 4 cm serous cystadenoma. b. At 7 cm asymptomatic pseudocyst. c. In the case of a 2 cm pancreatic cyst, if the CEA in the cyst content is very low. d. In intraductal papillary mucinous neoplasm (IPMN) of the main duct.

A 60-year-old man with chronic alcoholic pancreatitis was admitted because of 3-month-long pain in the umbilical region, which increased after eating. He has been abstinent for 6 months. He takes opioid analgesics usually while eating when the pain increases. MRI showed changes characteristic of chronic pancreatitis. The pancreatic duct was dilated to 8 mm, with a 4 mm stone and a short narrowing in the area of the head and neck of the pancreas. What is the most optimal treatment?. A. Use of short-acting opioid analgesics in combination with NSAIDs. B. Distal pancreatectomy. C. PERT- replacement therapy with pancreatic enzymes and proton pump inhibitors. D. ERCP- dilatation of the pancreatic duct and removal of stones.

A 72-year-old patient with known carcinoma of the tail of the pancreas who is receiving gemcitabine is brought to the emergency room. In the laboratory results that he brings with him, your attention is drawn to the value of bilirubin - total bilirubin 127, direct bilirubin 112. During the ultrasound examination of the abdomen, they describe six liver tumors up to 3 cm in size, the primary tumor is not shown due to its location, wider bile ducts are visible in the liver, the patient has two cysts in the left kidney, otherwise the findings are unremarkable. What is the most likely cause of jaundice?. A liver failure due to liver tumors. B obstruction due to pancreatic tumor pressure on the bile duct. C paraneoplastic autoimmune hemolytic anemia. D Gilbert's syndrome. E gemcitabine-induced cholestatic liver injury.

A 30-year-old man started to have pain in the epigastrium four hours ago after an overnight stay, he has no fever, no vomiting and no diarrhea. RR 120/70, heart rate 70/min, saturation 98%, in laboratory values he has elevated amylase and lipase (>3x above normal value). The following are considered in the diagnostic processing: A. Immediate abdominal CT with iv KS to confirm the diagnosis. B. Abdominal ultrasound immediately to rule out biliary etiology (gallstones). C. Abdominal CT with iv KS after two to five days, if his condition did not improve after conservative treatment to assess the severity of the disease, show possible complications and help when deciding on further treatment. D. MRCP to assess the severity and extent of the disease, show complications and decide on further action treatment.

A 61-year-old man without symptoms with a pathological hepatogram and a hypoechoic change in the tail of the pancreas found on US needs further diagnostics: A. MRCP to assess the connection of the lesion to the main pancreatic duct. B. Abdominal CT with iv KS to delineate the disease and assess the potential resectability of the tumor. C. Nothing, as US is a sufficient diagnostic method. D. Endoscopic US.

R0 gastric cancer resection means: a. The surgeon performed a radical operation. b. There is no macroscopically visible residual tumor. c. There is no microscopically visible residual tumor. d. There is no microscopically or macroscopically visible remnant of the tumor.

The extent of gastric resection for cancer depends on: a. Localizations of stomach cancer. b. Pathohistological classifications of cancer according to Lauren. c. Clinical TNM stage. d. All of the above.

A 60-year-old patient is hospitalized in the intensive care unit due to respiratory failure as part of severe pneumonia. He is intubated and mechanically ventilated. After the nasogastric tube is inserted, a small amount of liquid similar to coffee grounds flows through it. Gastroscopy shows a diffusely edematous and erythematous gastric mucosa with numerous shallow erosions along the entire stomach. What is the most likely cause of the changes found?. A. H. pylori infection. B. Injury caused by nasogastric tube insertion. C. Stress gastritis. D. Drug-induced gastritis.

A 50-year-old patient with known alcoholic liver cirrhosis, after several bleedings from large esophageal varices, is again brought to the IPP because of profuse hematemesis. On arrival he is hypotensive, anemic. The gentleman is adequately hemodynamically stabilized and an emergency gastroscopy is arranged. Which of the medicines should be administered befo. A. Somatostatin 250 mcg or terlipressin 2 g iv and broad spectrum an antibiotic. B. Proton pump inhibitor. C. Norepinephrine 250 mcg iv. D. All of the above.

A 68-year-old woman comes to the IPP because of hematemesis and melena. It is about a lady who receives acetylsalicylic acid in therapy for primary preventive cardiovascular disease and Ibuprufen for knee pain, otherwise she has no associated diseases. On a PPI, he receives a bolus of a proton pump inhibitor (80 mg iv). Gastroscopically, a shallow stomach ulcer with a visible blood vessel was found, appropriate hemostasis was performed, and she was admitted to the Intensive Care Unit for observation. What is the most appropriate course of action?. A. Due to severe pain in the knees, which, according to her, is not alleviated by other drugs, we are forced to continue the therapy with Ibuprufen, the acetylsalicylic acid is discontinued, and a proton pump inhibitor is prescribed in continuous infusion. B. We observe the lady for three days and discharge her home with the same medications, without the proton pump inhibitor due to the side effects it can cause when taking it for a long time. C. Prescribe a proton pump inhibitor in a continuous infusion for 72 hours, then we move on to oral dosing. We check the indications for taking acetylsalicylic acid, if there are none, we discontinue it, otherwise we continue with it, we replace Ibuprufen with an analgesic that is not from the NSAID group. D. We prescribe a proton pump inhibitor in a continuous infusion for 72 hours, then we move on to oral dosing. We check the indications for taking acetylsalicylic acid, if there are none, we discontinue it, otherwise we continue with it, we replace Ibuprufen with an analgesic that is not from the NSAID group, we take a stool sample to prove the Helicobacter pylori antigen, if it is positive, we treat the infection empirically.

A 68-year-old lady was brought to the IPP with an ambulance because of profuse hemohesia. He has known coronary heart disease, diabetes on oral therapy, hypertension and hyperlipidemia. In therapy, he receives antihypertensives, Aspirin 100 mg/day, metformin and a statin. On examination, she is afebrile, hypotensive (80/50 mmHg), tachycardic (125/min), the abdomen is soft and painless. In the laboratory, hemoglobin 80 g/L, the rest of the laboratory is within normal limits. After hemodynamic stabilization, an urgent gastroscopy is performed, which does not show the origin of the bleeding. After the gastroscopy, the patient begins to bleed profusely and develops a state of shock. Which investigation is most appropriate?. A. Urgent colonoscopy. B. Consultation with surgeons, referral for CTA and attempted embolization. C. Emergency surgery. D. Repeat gastroscopy.

A 55-year-old woman with fecal incontinence has a weaker anal sphincter on anorectal manometry , but no sensory deficits. What is the most appropriate treatment?. A. Surgical repair of the sphincter. B. Botox injection. C. 'Biofeedback' therapy. D. Colostomy.

A 50-year-old man, otherwise healthy, came for examination due to problems with flatulence lasting a year. He has to excuse himself and leave the room at work several times every day due to the discharge of strongly smelly winds. He has already tried eating a gluten-free diet and probiotic yogurts. He describes his eating habits: he eats a bowl of cereal with milk every morning, and only lean meat and vegetables for lunch and dinner. He had a colonoscopy done last year, the results were said to be normal. What is the most likely cause of his problems?. A. Lactose intolerance. B. Celiac disease. C. Functional flatulence. D. Sorbitol.

A 53-year-old patient underwent an esophagogastroduodenoscopy a few hours ago due to endoscopic dilatation of a benign stenosis, perforation of the distal part of the esophagus occurred . The patient was hemodynamically stable, received an infusion of fluids and an antibiotic, and a withdrawal period was instituted. The method of selecting the surgical treatment of perforation is: a) abutment insertion. b) thoracotomy, esophageal suture, covering with a muscle flap. c) thoracoscopy with drainage of the pleural space and mediastinum. d) exclusion surgery of the esophagus with an esophagostomy on the neck and delayed reconstruction of the digestive tract. e) thoracolaparotomy and covering the perforation with part of the stomach.

Tumors of the neck of the esophagus are rarely treated surgically. If resection is indicated, simultaneous (multiple answers are correct): a) pharyngolaryngectomy b) neck lymph node dissection c) resection with esophagogastric anastomosis at the neck d) permanent tracheostomy e) reconstruction of the digestive tract by transposition of a tubular tied gastric graft. A abcd. B abde. C bcde. D acde. E abc.

The characteristics of pancreatic pseudocyst are: A. salivary fluid surrounded by epithelium B. develops more often in biliary than in alcoholic pancreatitis C. occurs four or more weeks after the onset of the disease D. all patients have symptoms due to the predocyst E. the pseudocyst is usually sterile. A. a, c. B. a, b. C. c, e. D. b, c,. E. a,e.

A 20-year-old woman comes to the gastroenterology clinic because, after returning from a trip to Russia, she developed non-bloody diarrhea lasting more than two months, accompanied by cramping pains in the lower abdomen and weight loss. We refer her for gastroscopy and colonoscopy. In the antrum there are aphthous changes in the stomach, there are individual ulcers in the terminal ileum and along the colon, parts of the colon mucosa are healthy. Pathohistological examination describes active inflammation and non-caseous granulomas. What seems the most likely diagnosis: a) Tuberculosis. b) Behçet's disease. c) GIT damage due to receiving NSAIDs. d) Crohn's disease. e) Ulcerative colitis.

What is considered chronic inflammatory bowel disease: T1. It usually appears between the ages of 20 and 40. T2. One third of patients become ill before the age of 18. T3. It never occurs after the age of 65. T4. Age at diagnosis is a prognostic factor. T5. In patients who get sick as children, the disease goes away by the age of 30. a. T1, T3. b. T1, T2, T4. c. T1, T2, T5. d. T4, T5. e. T1, T4, T5.

A 25-year-old patient fell ill with abdominal pain. He often has diarrhea, up to 5 times a day. He did not notice any blood in the stool. Diarrhea greatly hinders him, as he has to go to the toilet twice at night. After passing the stool, the abdominal pain subsides. He also has urgent urges to defecate, which greatly hinders him in his daily work. After 3 months he visited the doctor. In addition to stomach pains, the rush is marked by extreme fatigue. He lost weight from 85 kg to 81 kg in three months. On clinical examination, the abdomen was slightly tender in the ileocecal region, but there was no clear palpable resistance. To distinguish between functional disorders and organic disease, the following sequence of tests is suitable as the first test in this age group: • a. Computed tomography, in case of positive findings then colonoscopy. • b. Colonoscopy, in case of urgent findings, fecal calprotectin for confirmation of the diagnosis. • c. Fecal calprotectin, in case of a negative result, a colonoscopy. • d. Fecal calprotectin, in case of a positive result, a colonoscopy. • e. Colonoscopy, and in case of positive findings, computed tomography.

Objectives of treatment of chronic inflammatory bowel disease: T1. Clinical remission defined as passing stool up to 4 times a day with less blood in the stool. T2. Endoscopic remission, which means that patients with Crohn's disease do not have ulcers, and patients with ulcerative colitis do not have erosions. T3. Biochemical remission, because it means that patients have normal values of inflammatory parameters (eg C-reactive protein). T4. Healing of perianal fistulas is a goal in patients with Crohn's disease. T5. Normal laboratory results are a guarantee that the disease is properly treated. • a. T1, T2. • b. T2, T3, T4. • c. T2, T5. • d. T2, T3, T4, T5. • e. T3, T4.

Treatment of chronic inflammatory bowel disease: T1. Mesalazine is used to treat ulcerative colitis and Crohn's disease. T2. TNF alpha inhibitors act exclusively on the gut and therefore have no systemic side effects. T3. Drugs for the treatment of chronic inflammatory bowel disease are discontinued during pregnancy , as they are teratogenic (with the exception of methotrexate, which is not teratogenic). T4. Systemic steroids are well tolerated by patients, so they can be used throughout treatment. T5. Patientsreceiving thiopurines (azathioprine, 6-mercaptopurine) should avoid the sun, as the drug increases the possibility of skin cancer. • a. T1, T3. • b. T2, T4. • c. T5. • d. T1, T2, T5. • e. T2, T5.

Choose all the correct statements regarding ulcerative colitis: • Patients are usually older than 70 years • Pathological changes are limited to the mucosa of the large intestine • The terminal ileum and colon are most often affected • It often occurs in certain families • Can be complicated by fistulas • Gastrointestinal involvement is federal. • A. a, c, d. • B. a, d, f. • C. a, c, e. • D. b, d, f. • E. b, c, d.

The skin of a 32-year-old patient, who is being treated for ulcerative colitis, started to itch badly. Jaundice appeared. He had lost 5 kg in the last month, but attributed it to the stress of becoming unemployed. At the age of 15, he was diagnosed with ulcerative colitis, and with maintenance treatment in the last two years, he has not had a relapse. Laboratory findings show elevated bilirubin and alkaline phosphatase. The most likely diagnosis is: • Choledocholitis. • Hepatotoxicity of drugs. • Colon carcinoma metastases. • Primary sclerosing cholangitis. • Carcinoma of the head of the pancreas.

A 62-year-old female patient comes to the clinic because of diarrhea that started 3 days ago. She noticed blood in the stool twice. So far he was healthy, but 7 days ago she finished the antibiotic treatment (amoxicillin+clavulanic acid), which she was receiving due to inflammation of the tooth root. What is the most likely diagnosis?. • a. It is very likely that the patient has ulcerative colitis, so we immediately refer her to colonoscopy with biopsies. • b. Hemorrhoidal bleeding is most likely, so the patient is referred to a proctologist for hemorrhoid ligation. • c. It is most likely an infectious colitis, so we prescribe ciprofloxacin and order her to have a follow- up examination. • d. It could be diarrhea associated with antibiotics, so Clostridium difficile and toxin A/B. • e. Due to bloody diarrhea, he needs immediate hospital treatment and immediate endoscopic diagnosis.

A 45-year-old female patient has problems with bloating and occasional diarrhea. The body weight is constant, she did not notice blood in the stool. She has never had surgery, has not recently traveled or taken antibiotics. She hasn't changed her diet recently, she cooks herself, she drinks three cups of coffee with a lot of milk at work. She noticed that the diarrhea subsided when she went on vacation recently. Coprocultures, anti-tissue transglutaminase antibodies, and anti-endomysial antibodies are negative. A recent CT scan of the abdomen was within normal limits. What is the most likely cause of her problems. • food allergy. • bacterial overgrowth in the small intestine. • lack of lactase. • chronic pancreatitis. • ulcerative colitis.

A 76-year-old woman comes to the gastroenterology outpatient clinic for examination due to 6 months of watery diarrhea accompanied by crampy abdominal pain. She passes loose stools 6 to 8 times a day, and is occasionally incontinent. He denies weight loss, hemohesia, nausea and vomiting. She has rheumatoid arthritis and takes ibuprofen for joint pain. She underwent a colonoscopy 3 years ago, which was unremarkable. On clinical examination, the abdomen is soft and painless. Serology for celiac disease is negative. Infectious samples of diarrhea are excluded. We refer the patient for a colonoscopy because it is your working diagnosis?. • a) ulcerative colitis. • b) adenocarcinoma. • c) microscopic colitis. • d) diverticulosis of the colon. • e) celiac disease.

A 48-year-old patient with celiac disease comes to the clinic because of persistent abdominal pain, bloating and diarrhea. She was diagnosed with celiac disease 5 years ago. At that time, elevated levels of anti-tissue transglutaminase antibodies and villous atrophy were found in biopsy specimens. He says that he has followed a strict gluten-free diet since his diagnosis. Body weight is constant. Redetermine the level of anti-tissue transglutaminase antibodies that are elevated. What is the most likely cause of the symptoms the lady is reporting ?. • consumption of gluten. • microscopic colitis. • refractory celiac disease. • ulcerative jejunitis. • non-celiac gluten sensitivity.

Which of the following foods should celiac patients avoid?. rice. corn. barley. to beg.

A 67-year-old patient was scheduled for a segmental resection of the colon due to a large adenoma that could not be removed endoscopically. Intraoperatively, the ileum was damaged, for which a segmental resection of the ileum was performed with ileocolic anastomosis. After the operation, he was referred to gastroenterology clinic for diarrhea. Coprocultures and stool calprotectin are negative, loperamide did not improve symptoms. What is the most likely cause of diarrhea?. • chronic inflammatory bowel disease. • lack of bile acids. • osmotic diarrhea due to unabsorbed bile acid salts. • secretory diarrhea due to unabsorbed salts of bile acids. • osmotic diarrhea due to malabsorption of simple carbohydrates.

For colon adenomas, the following applies (choose a combination of the correct answers): A. They can arise as part of familial adenomatous polyps B. We treat them with endoscopic removal C. Most colorectal cancers originate from adenomas D. The basic treatment is surgical E. They are the cause of repeated inflammation, pain and bleeding. 1. a, b, c. 2. a, c, d. 3. c, d, e. 4. b, c, d. 5. a, b, e.

In which groups of people are the risk of developing colorectal carcinoma higher? A. Patients with colon adenomas B. Patients with chronic inflammatory bowel disease C. Patients after surgery for colorectal carcinoma D. Positive family history for colorectal carcinoma E. Patients with chronic constipation. 1. a, b, c, d. 2. a, b, d, e. 3. a, c, d, e. 4. a, b, c, e. 5. b, d, e.

A 24-year-old female patient was referred for a colonoscopy by her chosen doctor due to hemohesia lasting 2 months, where numerous adenomas were found throughout the large intestine. Genetic testing confirmed that it was familial adenomatous polyposis (FAP) syndrome. The patient comes for a consultation regarding further action and treatment options. Which statement is NOT correct?. a) treatment is operative. b) preventive colectomy is performed before the age of 40. c) after total colectomy, further endoscopic examinations are no longer necessary. d) it is also necessary to perform an endoscopy of the upper gastrointestinal tract. e) screening genetic testing of relatives is mandatory.

A 56-year-old patient with adenocarcinoma of the large intestine will definitely receive adjuvant chemotherapy after surgical resection, if the pathohistological examination of the surgical resectate determines that it is a stage III disease. Which of the following findings describes stage III colon adenocarcinoma?. A But the tumor grows into the muscularis proprio, the lymph nodes are not involved, there are no distant tumors, the tumor is completely removed (T2 N0 M0 R0). B, the tumor outgrows the muscularis proprio, 32 lymph nodes were surgically removed, adenocarcinoma metastases in one (1/32), there are no distant tumors, the tumor was completely removed (T3 N1a M0 R0). C the tumor outgrows the intestinal wall and spreads to the (removed) spleen, no metastases in the lymph nodes, no distant metastases, the tumor is completely removed (T4b N0 M0 R0). D the tumor outgrows the muscularis proprio, 18 lymph nodes were surgically removed, adenocarcinoma tumors were present in six (6/18), the tumor was completely removed, distant tumors in the liver (T3 N1 M1 R0). E the tumor grows into the muscularis proprio, the lymph nodes are not involved, there are no distant tumors, the tumor extends into the resection edge and probably not completely removed (T2 N0 M0 R1).

Surgical treatment of stage II or III colorectal cancer usually means: A. Right-sided hemicolectomy B. Resection of the sigmoid C. Total colectomy D. Total mesorectal excision of the rectum E. Cecotomy with appendectomy. A: a, b, e. B: a,c,d,. C: b, c, e. D: a, b, d. E: b, c, d.

The most appropriate surgical technique in the case of a complex perineal fistula in a patient with Crohn's disease is: a. fistulectomy. b. formation of a temporary colostomy. c. abdominoperineal excision of the rectum. d. setting up the Seton drainage.

Which of the following statements regarding anal carcinoma is false?. a. it is caused by HPV infection. b. as a rule, it is first treated with radiochemotherapy. c. it is adenocarcinoma. d. before starting the treatment, it is necessary to limit the disease. e. the disease is diagnosed by clinical examination.

An 18-year-old man has been noticing a foul-smelling discharge from the foramen in the right lower quadrant of the abdomen for the past 8 weeks. 4 months ago, he had an appendectomy due to sudden severe pain in the right lower quadrant of the abdomen and CT signs of appendicitis. What is the most likely diagnosis: a) intestinal perforation. b) Crohn's disease. c) Ulcerative colitis. d) Tuberculosis. e) Indeterminate colitis.

A 31-year-old patient with ulcerative colitis comes to the clinic for a regular check-up. He passes stool once a day, without blood. He uses mesalazine to treat the disease granules. He has pain in his ankle and wrist. He denies joint damage. On clinical examination, both painful joints are swollen and tender to pressure. a. Joint problems are not related to ulcerative colitis, cooling and paracetamol are recommended. b. We recommend exercising the affected joint in hot water twice a day for 14 days. c. *It is most likely enteropathic arthritis as part of chronic inflammation intestinal diseases. d. The most likely diagnosis is rheumatoid arthritis. e. It is probably septic arthritis due to immunosuppression (mesalazine).

A 25-year-old man presented with perianal discharge. In addition, he has had problems with diarrhea and abdominal pain for 6 months. Active inflammation in the terminal ileum and a 5 cm perianal abscess are described on MRI . What is the correct course of action?. a) antibiotic treatment and referral to a surgeon. b) probiotics. c) biological therapy. d) additional imaging diagnostics. e) antibiotic and corticosteroid treatment.

A 62-year-old man visits the emergency department because of persistent sharp pain in the left lower quadrant of the abdomen lasting 2 days. He denies nausea, vomiting, weight loss, diarrhea and haemochezia. He has an elevated body temperature of 38 degrees. C, pulse 105/ min, blood pressure value is 110/55 mmHg. The abdomen is soft and very tender to palpation in the left lower quadrant. In the laboratory, we find leukocytosis and an elevated CRP value, the hemoglobin value is normal. The patient is referred for a CT scan of the abdominal organs. What do we find out?. a) appendicitis. b) ulcerative colitis. c) Mecekel's diverticulum. d) colon malignancy. e) diverticulitis.

A 17-year-old student with regular periods is again referred to the specialist gastroenterology outpatient clinic due to chronic anemia with a feeling of bloating and occasional diarrhea. 6 months ago, her celiac disease antibody titers (Ig A TtG) were taken, which were within the limits normal; they also performed a gastroscopy with the removal of biopsies of the duodenal mucosa, which were also normal. Despite this, the patient's problems continued, so she was consulted friends tried a gluten-free diet, after which the problems eased. On a regular basis a systematic examination revealed persistence of anemia in the patient (MCV 100 fL). The patient is convinced that she has celiac disease and requests a repeat gastroscopy. Which one is most suitable next step?. Repeat gastroscopy with biopsies. We explain to the patient that in case of asymptomatic celiac disease, a gastroscopy is required on a gluten-free diet unnecessary. Colonoscopy. We explain to the patient that the cause of the problems is non-celiac gluten sensitivity, and that a repeat gastroscopy is pointless. The patient is prescribed therapy with vitamin B12 im, as this may be the cause of persistent anemia.

A 60-year-old patient with arterial hypertension and depression comes to the gastroenterology clinic for an examination because she has had problems with abdominal pain, constipation, bloating and a feeling of tension in her abdomen for 7 months. She has a poor appetite and has lost 12 kilograms. Symptoms are more pronounced after a meal. Blood she didn't notice in the mud. She had a colonoscopy a year ago, which was free peculiarities. On examination, the abdomen is slightly tense and tender in the lower half. What is the most appropriate next step in the diagnostic process?. a) repeat the colonoscopy. b) CT imaging of abdominal organs and small pelvis. c) gastroscopy. d) X-ray imaging of gastric emptying. e) no additional investigations are necessary.

A 14-year-old student with regular periods is again referred to a specialist gastroenterology outpatient clinic due to chronic anemia with a feeling of bloating and occasional diarrhea. 6 months ago, her celiac disease antibody titers (Ig A TtG) and inflammatory parameters were taken from her, as well as, which were within normal limits; they also performed a gastroscopy with biopsies of the duodenal mucosa, which were also normal. Patients the problems continued, so on her mother's advice, she tried a gluten-free diet, after which the problems eased. On a regular systematic review the patient was again diagnosed with anemia (MCV 90 fL). What is the most likely cause of the patient's anemia?. a) Celiac disease. b) Chronic inflammatory bowel disease. c) Juvenile menorrhagia. d) Non-celiac gluten sensitivity. e) Whipple's disease.

A 42-year-old woman is suing because of chronic diarrhea, fatigue and involuntary weight loss. Symptoms observed for the second year. She has already tried several diets, but only noticed relief after a gluten-free diet; now he has been gluten-free for 6 months. Physical examination is within normal limits, as well as basic biochemical tests, hemogram and inflammatory parameters. Based on the anamnesis, we suspect celiac disease, so blood is also taken for Ig A antibodies against tissue transglutaminase, the titer of which is typical elevated. That's why you decide to have a gastroscopy and take biopsies of the duodenum. The mucosa is macroscopically normal, as is the histopathological examination of biopsies. What is the most appropriate next step in defining the patient's problems?. a)The patient is scheduled for a follow-up examination in 3 months, at which time she should eat a normal diet. b) Determine the presence of HLA DQ2 and DQ 8 alleles; a positive result confirms the diagnosis of celiac disease. c) we refer her to CT entrography. d) We advise the patient to have a gluten load test for 2-6 weeks, then repeat the gastroscopy and biopsies of the duodenal mucosa are taken again. e) Repeat serological testing with Ig A tTg.

The 55-year-old lady has been noticing problems with chronic diarrhea and feeling bloated after meals and involuntary weight loss for several years . She inquired about the symptoms online and decided on a gluten-free diet. She noticed a significant improvement on a gluten-free diet symptoms. A regular examination by a personal physician showed: hemoglobin 107 g/L, MCV 77 fL. You decide to undergo a gastroscopy to diagnose anemia, which shows a histological pattern of biopsies consistent with celiac disease (Marsh 3b). What findings does he describe histopathological findings?. a) Granuloma inflammation. b) Lymphocytosis. c) Crypt hyperplasia. d) Hypertrophy of villi. e) Reduced ratio between villus size and crypt depth.

Fiber therapy is most effective for which form of irritable bowel syndrome?. a) when the leading symptoms are abdominal pain and diarrhea. b) when the leading symptoms are abdominal pain and constipation. c) when the leading symptom is constipation. d) when the leading symptom is diarrhea. e) when the leading symptoms are abdominal pain, constipation and bloating.

A 35-year-old patient has problems with dyspepsia and paresthesia of the lower limbs. Body weight is constant, she did not notice bleeding from the gastrointestinal tract. Upon in-depth questioning, she says that she has Crohn's disease, for which she has not had any major problems for a long time, nor does she take medication, as she was operated on. Hemoglobin is 90 g/L, hypersegmented neutrophilic granulocytes are visible in the blood smear. A deficiency of which nutrient is the most likely cause of the problem?. a) iron. b) vitamin B12. c) vitamin C. d) folic acid. e) niacin.

A 52-year-old woman was referred to the emergency room because of diarrhea, fatigue, and weight loss. He also mentions progressive dyspnea and cough. Twice a week, he drinks one glass of wine with dinner. During the clinical examination, blood pressure was found to be 105/65 mmHg, pulse 95/min, body mass index 18 kg/m2 . In the status, elevated central venous pressure, moderate ascites with hepatomegaly and moderate pretibial edema stand out. In the ECG, the low voltage of the QRS complexes stands o An ultrasound of the heart describes thickened walls of both ventricles and severe diastolic dysfunction. What is the most likely diagnosis?. a) exocrine pancreatic insufficiency. b) celiac disease. c) amyloidosis. d) anorexia. e) bacterial growth in the small intestine.

A 67-year-old patient was scheduled for a segmental resection of the colon due to a large adenoma that could not be removed endoscopically. Intraoperatively, the ileum was damaged, for which a segmental resection of the ileum with ileocolic anastomosis was performed. After the operation, he was referred to the gastroenterology clinic because of diarrhea. Coprocultures and stool calprotectin are negative, loperamide did not improve symptoms. What is the most likely cause of diarrhea?. a) chronic inflammatory bowel disease. b) lack of bile acids. c) osmotic diarrhea due to unabsorbed salts of bile acids. d) secretory diarrhea due to unabsorbed salts of bile acids. e) osmotic diarrhea due to malabsorption of simple carbohydrates.

A 26-year-old female patient was referred for capsule endoscopy due to recurrent melena. She is healthy and takes no medication. Gastroscopy was within normal limits, and colonoscopy showed remnants of melena in the right hemicolon, but a possible source of bleeding could not be found even after thorough lavage. Terminal ileoscopy was within normal limits. Capsule endoscopy showed a double lumen in the ileum with ulceration in the narrower of the lumens. There were no other mucosal changes. What is the most likely cause of recurrent bleeding?. a) hypersecretion of gastric acid from the ectopic gastric mucosa. b) chronic inflammatory bowel disease. c) adenocarcinoma of the ileum. d) lymphoma of the small intestine. e) medicinal failure.