A 50-year-old man presented with haematemesis and melaena. He had a history of excess alcohol intake for many years.



On examination, he was jaundiced with bilateral parotid enlargement, spider naevi and Dupuytren’s contractures. His pulse was 100 beats per minute and his BP was 95/60 mmHg. He had ascites and peripheral oedema.



While awaiting endoscopy, what is the most appropriate management?

A 67-year-old man with dysphagia was found at endoscopy to have lower oesophageal carcinoma.



For staging of local invasion in oesophageal cancer, which investigation is most sensitive?

A 55-year-old man with Crohn’s disease underwent an ileocaecal resection. The surgical procedure was technically straightforward. Three months later, he was reviewed in the clinic. His appetite remained good and the abdominal pain had settled, but he was troubled by diarrhoea with a daytime stool frequency of six per day. He also experienced faecal urgency 20–40 minutes after eating. The stool was watery but there was no blood or pus.



Investigations:



haemoglobin 125 g/L (130–180)

white cell count 5.6 × 109/L (4.0–11.0)

platelet count 256 × 109/L (150–400)

erythrocyte sedimentation rate 12 mm/1st h (<20)

serum vitamin B12 340 ng/L (160–760)

red cell folate 420 µg/L (160–640)

serum C-reactive protein 8 mg/L (<10)



What is the most likely cause for the diarrhoea?

A 44-year-old man presented with a 10-year history of ulcerative colitis. He was taking azathioprine 1.5 mg/kg and mesalazine 2.4 g daily. He reported that his bowels opened one to two times per day, with no rectal bleeding.



Investigations:



haemoglobin 106 g/L (130–180)

MCV 75 fL (80–96)

platelet count 164 × 109/L (150–400)

serum total bilirubin 43 µmol/L (1–22)

serum alanine aminotransferase 76 U/L (5–35)

serum alkaline phosphatase 328 U/L (45–105)

serum gamma glutamyl transferase 397 U/L (<50)

sigmoidoscopy                             quiescent colitis



What is the most important next investigation?