1001. 23/09/20

Question 1

What is meant by the truelove and Witts criteria?

Answer 1

Assessment of ulcerative colitis

• motions per day
• rectal bleeding
• temperature
• resting pulse
• hemoglobin
• ESR

Question 2

What is the picture of bloods in UC?

Answer 2

CRP usually normal
Albumin low and platelets high
Fetal calprotectin= gut inflammation of unspecified region

Question 3

What is the treatment line in UC?

Answer 3

1. 5ASA- sulphasalizine, mesalazine
2. Thiopurines- azathioprine, methotrexate
3. Biologics- adalimumab, infliximab

Question 4

How do 5 ASA’s work in UC?

Answer 4

Reduce inflammation

Question 5

How do thiopurines work?

Answer 5

Deactivate a process in T lymphocytes in order to reduce inflammation

Question 6

How does infliximab work?

Answer 6

TNF-alpha antagonist

Question 7

What bloods tests are done when commencing thiopurines?

Answer 7

Blood test daily, weekly, then monthly

Question 8

What is screened for before thiopurines are commenced?

Answer 8

HEP B/C, HIV, TB, TMPT (metabolic enzyme)

If they’ve not had EBV then don’t give azathioprine due to more lymphoma

Question 9

What do you give for an acute flare of IBD?

Answer 9

Steroids

Question 10

Those with IBD are at an increased risk of cancer. How are they screened?

Answer 10

After 8 years of diagnosis they are called back every 1-5 years (depending on severity)

Question 11

What non GI and NOT Eye conditions are UC related to

Answer 11

Erythema nodosum- shins red and circular. relates to disease activity

Pyoderma gangrenosum- very not nice not related to disease activity

Arthritis- small joints- related to disease activity,
large joints- not related to disease activity

Ankylosing spondylitis- not related to disease activity

Primary sclerosing cholangitis

Question 12

What eye conditions are related to UC?

Answer 12

Episcleritis- not sight threatening

Scleritis- sight threatening (steroids)

Uveitis- sight threatening (steroids)

Question 13

Discuss the surgical treatments for UC and Crohn’s?

Answer 13

UC- usually cut out colon and leave rectal pouch. Rectum will remain inflamed. Can join up gut after 1 year.

UC- surgery usually not indicated as will need multiple surgeries and not curative. May also lead to small gut syndrome

Question 14

What is common with crohn’s?

Answer 14

Structures and obstructions

Question 15

What are the long term conditions of UC?

Answer 15

Toxic megacolon (3,6,9)
Deterioration
Sepsis

Everyone in UC that comes into hospital gets an abdo film

Question 16

What is ALT a sign of?

Answer 16

Hepatocyte death

caused by viral hepatitis, hypotension, paracetamol overdose

Question 17

What is AST a sign of?

Answer 17

Mitochondrial death (alcohol or established cirrhosis)

Question 18

What is alk phos and ggt a sign of?

Answer 18

Biliary epithelial inflammation

obstruction (e.g. stones)
infiltration (psc)
Congestion (pregnancy)

Question 19

What is high bilirubin a sign of?

Answer 19

Rapid RBC death or gilbert’s syndrome

Question 20

What do the AST:ALT ratios show?

Answer 20

2: 1- indicates alcohol related liver disease
1: 1- likely ischemic
1: 2- paracetamol

Question 21

How is fatty liver treated?

Answer 21

Diabetic control
weight loss
Vit E

Question 22

What two hepatitis’ go together?

Answer 22

Hep B and D

Question 23

What hepatitis are related to sexual and needles?

These are the only hepatitis treated with antivirals

Answer 23

Hep B and C

Question 24

What Hepatitis can be spread through the household?

Answer 24

Hep B

Question 25

What is the treatment for HEP A, D and E

Answer 25

A- self limiting, supportive care

D-peginterferon-a

?ribavirin

Question 26

Why is alpha fetoprotein tested for in the liver screen?

Answer 26

Both HCC and metastasis cause this to be released
Pregnant women excrete it
May be elevated due to downs nd…

Question 27

Why is alpha 1 antitrypsin tested for in the lvier screen?

Answer 27

Leads to an elastase break down in the lungs and liver

Accelerates emphysema and cirrhosis process

Question 28

How is hCT treated?

Answer 28

Venesection
Iron chelating agents
Reduce dietary intake

Question 29

Why is caeruloplasmin tested for in a liver screen?

Answer 29

Wilson’s disease- presents under 40 typically

Copper deposition in the liver
Low serum copper (urinary)
Low caeruloplasmin
Gold rings before the eye

Question 30

How is wilson’s disease treated?

Answer 30

Penicillamine (copperchealation)

Question 31

If patient has a raised GGt and MCV what is the likely diagnosis?

Answer 31

Alcohol excess

Question 32

What hepatitis can be caught through pork consumption?

Answer 32

Hep E

Question 33

What antibodies are tested for in a liver screen.

What does this show?

Answer 33

IgA-Alcohol

IgG-Autoimmune hepatitis (need liver biopsy to confirm)

IgM- Primary biliary cholangitis

Question 34

What autoantibodies are tested for and why?

Answer 34

ANA/Smooth muscle- autoimmune hep
LKM- autoimmune hep
Anti-mitochondrial antibody- PBC
ANCA- PSC