Gastro

Question 1

Patient with Crohns and illeal resection develops kidney stones, what is the composition

Answer 1

Ca oxalate

NB applies to ileal resection for any reason

Question 2

Drugs that commonly cause dyspepsia

Answer 2

Steroids
NSAIDs
Nitrates
Theophyllines
Bisphosphonates
Ca channel blockers

Question 3

Treatment of reflux in pregnancy

Answer 3

Antacids and alginates

Note: theses are widely used and as far as is possible to tell are safe. 2nd line tx would be H2 blockers. Conflicting reports about PPIs in pregnancy

Question 4

1st line treatment of ascites?

Answer 4

Depends on severity
if v large volume and symptomatic: paracentesis
if less severe: dietary salt restriction and spironolactone

Question 5

Patients with irritable bowel syndrome often have food intolerance T/F

Answer 5

T

Other features: increased intestinal contractile and electrical activity with increased sensitivity to visceral stimulation

Question 6

Patients with achalasia are at increased risk of which malignancy

Answer 6

squamous cell carcinoma of the oesophagus

Question 7

What effect has theophylline on the lower oesophageal sphincter

Answer 7

Theophylline lowers the pressure of the lower oesophageal sphincter.

Question 8

Pellegra what deficiency and presentation

Answer 8

Niacin (B3)

Dementia
Dermatitis
Diarrhoea
Death

Question 9

Presentation of scurvy

Answer 9

Perifollicular haemorrhage
Bleeding gums
Poor wound healing
Corkscrew hair

Question 10

What is the 2 year mortality rate of SBP

Answer 10

50%

Question 11

Neutrophils over what on an ascitic tap support diagnosis of SBP?

Answer 11

> 250cell/mm

Question 12

SBP is typically multiorganism T/F

Answer 12

F - typically mono organism (typically gram -ve)

NB initial tx with broad spec abx such as cefotaxime

Question 13

Mgmt of a pre meno female presenting with Fe def anaemia?

Answer 13

If no significant FHx bowel Ca, no upper GI symptoms and negative coeliac screen, trial oral Fe replacement first.

Note: def of significant fam hx is two affected first-degree relatives or just one first-degree relative affected before the age of 50 years.

Question 14

A patient undergoes appendectomy and about a year later presents with abdominal pain and is found to have a caecal mass. What is the most likely diagnosis?

Answer 14

Actinomycosis

Abdominal and pelvic actinomycosis usually follows introduction of the organism through surgery (for example, laparotomy, perforation, cholecystitis) or from intrauterine device placement.
Can also have cervicofacial, thoracic or CNS infections

Question 15

What is the most common site of carcinoid tumor in the bowel?

Answer 15

Terminal ileum

Question 16

How is the hepatic venous pressure gradient calculated and what is the relevance?

Answer 16

Free - wedged venous pressure

Normal 1-5. If normal in portal hypertension is the obstruction must be pre-sinusoidal. Hence, not related to post-sinusoidal intrinsic liver disease such as cirrhosis or post-hepatic venous obstruction (HV thrombosis).

Question 17

Typical presentation of Budd Chiari syndrome

Answer 17

Triad of
-abdominal pain
-ascites
-hepatomegaly
which develop over several months

Note: aetiology is obstruction of the main hepatic veins by thrombus

Question 18

Presentation of acute and chronic portal vein thrombosis

Answer 18

Acute: abdominal pain, fever and signs of mesenteric infarction
Chronic: presentation is with complications of portal hypertension, although ascites is rare.

Question 19

Aspirin must be stopped 7 days prior to an endoscopic procedure T/F

Answer 19

F

Aspirin is not associated with the same degree of bleeding as clopidogrel and may be continued in those already taking it even prior to endoscopic intervention with a high risk of bleeding.

Note: if on clopidogrel stop 7 days prior - depending on indication for clopidogrel may need to discuss with cardiologist

Question 20

Ddx for elevation of transaminases to > 100 x ULN

Answer 20

Paracetamol overdose
or
Ischaemic hepatitis

Question 21

The use of phenytoin is not recommended in patients with underlying liver impairment. T/F

Answer 21

T

Therefore not used in status epilepticus secondary to alcohol withdrawal.

Question 22

Hepatotoxic in high doses even in fairly advanced chronic liver disease paracetamol can be used safely as long as doses do not exceed 2-3 g per day. T/F

Answer 22

T

Note: main exception to this is alcoholic liver disease where the patient continues to drink, in this setting induction of enzymes and depletion of glutathione increases the chances of hepatotoxicity.

Question 23

Primary biliary cirrhosis is treated with steroids T/F

Answer 23

F

Note: Mainstay of treatment is ursodeoxycholic acid. Despite extensive research, no role for immune suppression in PBC.

Question 24

Mgmt of pt with Na 118, on diuretics with b/g alcoholic liver disease and ascites

Answer 24

If serum sodium is ≤120 mmol/L diuretic therapy should be stopped and patients should receive volume expansion with colloid or normal saline

Note: fluid restriction only used in patients who are clinically euvolaemic, not on diuretics and have severe hyponatraemia with a normal serum creatinine.
Na126-135 mmol/L: No specific intervention other than careful monitoring
Na121-125 mmol/L where the serum creatinine is normal, diuretic therapy may be continued but may need to be reduced with a view to stopping if necessary.

Question 25

Abdominal cramps, bloating and flatulence accompanied by yellow, frothy, greasy and offensive-smelling diarrhoea (steatorrhoea). Likely infection?

Answer 25

Giardia

Note: Fever and vomiting are less usual. Diarrhoea may be chronic if undiagnosed and can lead to small bowel malabsorption. Cryptosporidium is usually self limiting if occurs in non immunosuppressed

Question 26

Ameobic dysentry causes ___ diarrhoea

Answer 26

bloody

Question 27

Urea breath test sensitivity and specificity?

Answer 27

90% sensitivity and 96% specificity for H. pylori

Question 28

Anti-mitochondiral antibodies are positive in 95% of cases of ___

Answer 28

primary biliary cirrhosis

Question 29

Anti-liver kidney microsomal antibodies are found in ___

Answer 29

autoimmune chronic hepatitis

Question 30

Mgmt of patients over the age of 55 with persistent and unexplained dyspepsia of recent onset?

Answer 30

Referred for urgent endoscopy as suspected cancer

Note: urgent is within 2 weeks, can be OPD

Question 31

Gold std of diagnosis of primary sclerosing cholangitis (PSC)?

Answer 31

ERCP

Note: in practise most pts with get MCRP first

Question 32

Liver lesion on CT described as hypovascular with central scarring. Most likely dx?

Answer 32

Cholangiocarcinoma

Question 33

Most common complication of ERCP?

Answer 33

Pancreatitis

Question 34

In tx of hep C what genotypes are likely to have good response to interferon therapy?

Other good prognostic factors?

Answer 34

Genotypes 2 and 3 have a far better response to treatment than genotype 1.

After that:
Females
Younger age
Lack of cirrhosis
Non black origin
Low hepatic Fe

Question 35

Which is assoc with inflammatory bowel disease - primary biliary cirrhosis or primary sclerosing cholangitis?

Answer 35

Primary sclerosing cholangitis

Question 36

Deomgraphic in primary biliary cirrhosis?

Answer 36

90% are middle age females

Note: there is also an assoc with AI disease

Question 37

Patients with Peutz-Jeghers syndrome require colonoscopy every ___ years after the age of __ for evaluation of the presence of polyps and polypectomy.

Answer 37

Every 2 yrs
After age of 25

Question 38

Decompensated liver failure is an indication for transjugular intrahepatic portosystemic shunt. T/F

Answer 38

F

Note: it is an contraindication

Question 39

Intractable ascites is an indication for transjugular intrahepatic portosystemic shunt. T/F

Answer 39

T

Question 40

What LFTs typically seen in alcoholic liver disease?

Answer 40

AST more than twice the level of ALT

Question 41

Indications for referral to liver center in paracetamol overdose

Answer 41

Any of:
An arterial pH <7.3
INR >2.0 at or before 48 hours or >3.5 at or before 72 hours s (or prothrombin time >50 seconds)
Oliguria
Creatinine >200 µmol/L
Hypoglycaemia
Any degree of encephalopathy 48 hours after ingestion is also an indication.