Abdomen Notes

Question 1

Autoimmune hepatitis:
features? (5)
treatment? (2)

Answer 1

• signs of chronic liver disease
• acute hepatitis: fever, jaundice, etc (25%)
• amenorrhoea (common)
• ANA/SMA/LKM1 antibodies, raised IgG levels
• liver biopsy: inflammation extending beyond limiting plate
• steroids, other immunosuppressants, e.g. azathioprine
• liver transplant

Question 2

Coeliac disease:
definitive diagnosis? (1)
conditions associated? (2)

Answer 2

normally combination of immunology and biopsy but mainly= duodenal biopsy

• dermatitis herpetiformis (vesicular, pruritic skin eruption)
• autoimmune disoders (type 1 DM/ autoimmune hepatitis/ Graves)
• have to eat gluten diet 6 weeks prior to test
• tissue transglutaminase (TTG) and antibodies (IgA)
• needed to look for selective IgA deficiency, which would give a false negative coeliac result
• IgA deficiency (common in Coeliacs) would mean that anti-tTG antibodies are low (both low)

Question 3

Coeliac disease:

what does positive biopsy show? (4)

Answer 3

• villous atrophy
• crypt hyperplasia
• increase in intraepithelial lymphocytes
• lamina propria infiltration with lymphocytes

Question 4

Ulcerative colitis:
main side effect amiosalicylate, mesalazine?
others? (6)

Answer 4

agranulocytosis
- do FBC

upset, headache, agranulocytosis, pancreatitis*, interstitial nephritis

Question 5

Janundice causes and poo/wee colour of:
pre-hepatic?
hepatic?
post-hepatic?

Answer 5

PRE = normal wee + poo

• Gilbers
• haemolytic anaemia

HEPATIC = dark urine + normal poo

• hereditary hepatitis
• drug induced hepatitis
• acute hepatitis
• infecitous hepatitis
• neoplasm

POST = dark urine + pale poo
bile duct obstruction
- lithases/ stenosis
- pancreatitis 
- cholanglocarcinoma
- duodenal/pancreatic mass/ neoplasm/ abscess
- cholecystitis/colangitis

Question 6

Alcohol and the liver:
typical progression? (3)
usual liver test results? (1)
management? (1)

Answer 6

alcoholic fatty liver disease –> alcoholic heptitis –> cirrhosis

AST:ALT ratio of 2:1 usually with raised gamma-GT

• glucocorticoids (e.g. perdnisolone)

Question 7

Barretts oesophagitis:
what is it?
management? (3)

Answer 7

• metaplasia of the lower oesophageal mucosa, with the usual squamous epithelium being replaced by columnar epithelium
• risk of progressin to adenocarcinoma
• endoscopic surveillance with biopsies if metaplasia (but not dysplasia) every 3-5 years
• PPI
• if dysplasia –> endoscopic mucosal resection and radiofrequency ablation