ascites

Question 1

ascitic tap contrindication / paracentesis

Answer 1

DIC - bleeding from gums, low fibrinogen and raised d dimer

Question 2

does alpha 1 tripsin disease cuase a liver problem

Answer 2

yes liver disease

Question 3

A 60-year-old lady is admitted with a new diagnosis of an ileal neuroendocrine tumour with liver metastases. The junior doctor is called to review her because she has dropped her blood pressure. On examination, she is flushed and wheezing. Her observations show a heart rate of 140bpm, a respiratory rate of 26, a blood pressure of 90/60mmHg, oxygen saturations of 92% on room air, temperature 37.2 and a blood glucose of 25. She suspects a diagnosis of carcinoid crisis.

What is the most appropriate management?

Answer 3

Octreotide

Octretodie is a somatostatin analogue, which blocks the release of serotonin and counters its peripheral effects. It is used in the treatment of carcinoid syndrome and crisis

Question 4

what is hereditary haemochromatosis

resulting in what sx

Answer 4

This is the correct answer. Hereditary haemochromatosis (HH) is a genetic condition of increased intestinal iron absorption that results in
joint pains (especially in 2nd & 3rd MCP joints)
erectile dysfunction
slate-grey skin pigmentation
cirrhosis
dilated cardiomyopathy
osteoporosis.

Question 5

hereditary haemochromatosis seen in what type of people

Answer 5

It usually presents in men in middle age
A ferritin level of over 1mg/L and transferrin saturation of over 45% are highly suggestive of HH –

tx is regular venesection(removal of blood)

Question 6

mx of hep a

Answer 6

conervatibely- complete recovery in 6 months

Question 7

what is melanosis coli

Answer 7

Melanosis coli is a finding usually associated with chronic laxative abuse, where colonoscopy reveals the presence of dark brown pigmentation of the macrophages in the lamina propria. It is usually caused by agents that contain Senna and may be reversed on stopping ingestion of these drugs.

Pathophysiology
Drugs such as Senna become active on reaching the large bowel, where they act to cause necrosis and cell apoptosis, leading to the characteristic changes in colour seen on colonoscopy.

The finding in itself is not dangerous, but careful diagnosis and management of the underlying conditions is essential to prevent further damage to the bowel and to allow regeneration of the cells in the lower gastrointestinal tract.

Question 8

what is zollinger ellison syndrome

Answer 8

Zollinger Ellison syndrome is the development of several ulcerations in the stomach and duodenum due to uncontrolled release of gastrin from a gastrinoma. This usually presents on the pancreas, but can also occur in the duodenum

Abdominal pain and diarrhoea are the main symptoms, typically in the epigastric region. Ulceration of the duodenum can often lead to gastrointestinal bleeding. They do not respond to simple PPIs which is evidenced in this gentleman.

A screening test of raised gastric pH or raised gastrin levels would be the initial screening test, however, a provocative test such as a secretin stimulation test is needed for diagnosis.