extra

Question 1

what is the role loperamide

Answer 1

Loperamide is used to firm stool

Question 1

what is the role of Ursodeoxycholic acid

Answer 1

Ursodeoxycholic acid disperses cholesterol and is used in the dissolution of gallstones and to treat primary biliary cirrhosis.

Question 2

role of Cholestyramine

Answer 2

Cholestyramine is used to treat itch in patients with liver disease (and also has an effect in lowering cholesterol)

Question 3

role of calprotectin

Answer 3

Calprotectin is a measure of gastrointestinal inflammation (think of it like CRP for the bowel)

Question 4

what is the SeHCAT scan

Answer 4

the SeHCAT scan measures bile salt reabsorption, and is a test used to investigate chronic diarrhoea

Question 5

what group is gallstone ileus common in and how does it present

Answer 5

Gallstone ileus is more common in the elderly and presents with evidence of small bowel obstruction (secondary to impacted calculus) –

Question 6

chronic pancreatits symptoms vs acute pancreatitis

Answer 6

Chronic pancreatitis will have a longer history of pain, often after meals or drinking alcohol and is associated with weight loss, and malabsorption.

Question 7

intestinal ischacemia differentiated from acute pancreatitis

Answer 7

Ischamiea pain not relieved by sitting and is often associated with rectal bleeding.

Question 8

when is MRCP useful

Answer 8

if gallstones a likely aetiology especially if the biliary tree is dilated and stones need to be demonstrated (MRCP) and removed (ERCP).

Question 9

what is malignant ascites

Answer 9

Malignant ascites is found in patients with malignancies in the peritoneum which lead to ascites, via increased production of peritoneal fluid and concurrent decreased resorption.

Question 10

when is bowel perforation common

Answer 10

Bowel perforation would be more likely in a patient with a known gastrointestinal disease such as Crohn’s disease or ulcerative colitis, or as a complication of bowel surgery.

Question 11

what is the presentation of Haemoperitoneum

Answer 11

Haemoperitoneum would be more likely following blunt or penetrating trauma, or from a ruptured blood vessel, and would unlikely be associated with a fever. Furthermore, the patient would be expected to be haemodynamically unstable.

Question 12

gilbert vs NAFLD

Answer 12

Like non-alcoholic fatty liver disease, Gilbert syndrome can also present as jaundice following fasting. Indeed, dehydration, intercurrent disease, menstruation, and strenuous exertion can all trigger episodes in predisposed patients. In Gilbert syndrome, however, unconjugated bilirubin is typically elevated, whilst liver enzymes concentrations are normal. This is because Gilbert syndrome is caused by a mutation in the enzyme responsible of bilirubin conjugation with glucoronic acid (UGT1A1). When stressors increasing bilirubin production are present, UGT1A1 is overwhelmed and serum unconjugated bilirubin rises.

Question 13

which disease is unlileky with a normal ferritin

Answer 13

haemochromatosis - although it should always be considered in patients with both abnormal LFTs and diabetes.

Question 14

Which imaging modality for bowel obstruction

Answer 14

abdominal x-ray
- may present with vomiting and constipation

Question 15

which imaging too for large bowel pathology?

Answer 15

Colonoscopy is required to assess the large bowel for signs of pathology (e.g. in the case of bleeding, diverticulum or suspicion of colorectal cancer.)

Question 16

what is hepatorenal syndrome and how does it present?

Answer 16

a type of functional kidney impairment that occurs in patients with advanced liver disease. The key features include ascites, low urine output, and a significant increase in serum creatinine.

Question 17

first line drug for hepatorenal syndrome and mechanism?

Answer 17

Terlipressin, a vasopressin analogue, is the recommended first-line treatment for HRS according to UK guidelines. It works by inducing splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow.

Question 18

Role of ocreotide

Answer 18

Octreotide is primarily used to manage variceal bleeding and certain types of tumours such as somatostatinomas and carcinoid tumours.

Question 19

Uses of propranolol (specifically in GI/Liver)

Answer 19

Propranolol typically used for primary prophylaxis against variceal bleeding in cirrhotic patients or for treating hypertension or certain arrhythmias.

Question 20

role of Acetylcysteine

Answer 20

Acetylcysteine is an antioxidant used mainly for paracetamol overdose;

Question 21

role of dopamine

Answer 21

Dopamine, while being a renal vasodilator that can theoretically improve renal perfusion, has not been found to be beneficial in the treatment of hepatorenal syndrome according to multiple clinical trials.

Question 22

which diseases do stopping smoking have most impact on in gi/liver

Answer 22

primary biliary cirrhosis and alcoholic liver disease,

Question 23

do statins help NAFLD

Answer 23

While statins can lower cholesterol levels and reduce cardiovascular risk, they have not been proven to reverse or halt the progression of NASH specifically.

Question 24

role of Sulfonylureas

Answer 24

Sulfonylureas are a class of medications used in type 2 diabetes management

Question 25

Which class of diabetic drugs can be counterproductive in NAFLD

Answer 25

Sulfonylureas - these medications could potentially exacerbate weight gain which would be counterproductive in managing NASH.

Question 26

Why should aspirin and naproxen be avoided in cirhottic patients

Answer 26

due to the risk of acute renal failure and bleeding (unless in low-dosage in patients whose cardiovascular disease risk outweighs the cirrhosis disease burden).

Question 27

when should