Gastro

Question 1

Ulcerative Colitis extraintestinal ass

Answer 1

Primary sclerosing cholagitis

Question 2

endoscopy findings in UC

Answer 2

ulceration with preservation of adj mucosa-> pseudopolyps

Question 3

UC Mx- Mild to Mod

Answer 3

Mild: <4stool day, only small amount of blood
Mod: 4-6 stool/day, varying amountof blood, no systemic upset

topical/ rectal aminosalicylate -> add po aminosalicylate -> po or topical corticosteroid

Question 4

UC Mx- severe

Answer 4

> 6 blood stool/day + systemic upset

admit in hospital
iv steroid!! 1st line
iv ciclosporin if steroid CI OR add if no improvement after 72hrs

Question 5

Maintenance Mx for UC

Answer 5

mild-mod:
proctitis topical aminosalicylate OR po aminosalicylate + rectal aminosalicylate

extensive UC: low maintenance dose po aminosalicylate

severe relap or >2 exacerbation: po azithioprine OR po mercaptopurine

Question 6

LFT for AFLD & US findings

Answer 6

ALT> AST
increased echogenicity on US

Question 7

Coeliac Disease associated disease + strongly ass with which immuno

Answer 7

dermatitis herpetiformis, DM1, autoimmune hepatitis

HLA-DQ2, HLA- DQ8

Question 8

Dx Coeliac disease: serology + gold standard

Answer 8

need to take gluten for at lest 6 weeks

Serology: TTG-Ab IGA 1st line, Eendmyseal Ab IgA, Anti-gliadin, anti-casein Ab

Endoscopic intestinal biopsy=> GOLD STD traditionally taken from duodenum
Histo: villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes, laminia propria infiltration with lymphocytes

Question 9

How to calculate alcohol units

Answer 9

Volume ml x ABV (in decimal) divided by 1000

Question 10

Haemochromatosis definition and genetic inheritance

Answer 10

AR disorder of iron absorption and metabolism

HFE gene on chromosome 6

Question 11

Iron studies in haemochormatosis

Answer 11

Decreased TIBC, increased transferrin saturation M >55%, >50% F
Ferritin high later on

Question 12

Mx haemochromatosis

Answer 12

1st line: gene section weekly monitor adequacy of venesection transferring saturation aim <50%, serum ferritin concentration <50yg/L

2nd line: deferrioxamine

Question 13

LFT and mx alcoholic liver disease

Answer 13

High GGT
AST:ALT >2 , ratio >3 strongly suggests acute alcoholic hepatitis

Mx: glucocorticoids (prednisolone) often used in acute episodes of alcoholic hepatitis

Question 14

Autoimmune hepatitis classification

Answer 14

Type I: ANA and SMA adult and children

Type II: LKM1 Ab children only

Type III: soluble liver kidney Ag adults middle age

Question 15

Lab findings in Autoimmune hepatitis and other Ix

Mx

Answer 15

ANA/ SMA/ LKM1 Ab/ increased IgG

Liver biopsy: piecemeal necrosis, bridging necrosis

Steroid other immunosuppressants

Question 16

Non-alcoholic fatty liver disease progression and LFT findings

Answer 16

Steatosis, stratohepatitis fat with inflammation, progressive disease- fibrosis and liver cirrhosis

LFT: ALT>AST

Question 17

Inheritance of Wilson’s disease

Answer 17

Increased copper absorption and decreased copper excretion

AR, defect ATP7B gene on chromosome 13

Question 18

Ix esp lab findings in `wilsons disease

Answer 18

Keyer -fleischer Ring

Decreased serum ceruloplasmin- carries cupper
Decreased total serum copper, free non-ceruloplasmin bound serum copper increased

Increased 24 hour Cu excretion

Question 19

Mx Wilson’s disease

Answer 19

Penicillamine chelates Copper 1st line

Trentine hydrochloride alternate chelating agent may become 1st line in future. Tetrathiomolybolate newer agent

Question 20

Ass disease with primary biliary cholangitis

Answer 20

Sjogren 80%

RA, systemic sclerosis, thyroid disease

Question 21

Ix os primary biliary cholangitis

Answer 21

High ALP, aMA Ab- anti mitochondrial M2 Ab, high IgM
US and MRCP

Question 22

Mx of primary biliary cholangitis

Answer 22

1st line: ursodeoxycholic acid
Pruritus: chilestyramine
Liver transplant if Bb >100

Question 23

Relationship between primary sclerosing cholangitis and UC

Answer 23

UC 4% pts have PSC
PSC 80% pts have UC

Question 24

Ix of primary sclerosing cholangitis

Answer 24

WRCP/ MrCP std dx multiple biliary strictures beaded appearance

P-ANCA maybe +

Question 25

PBC vs PSC

Answer 25

PBC- intrahepatic bile duct inflammation, AMA, ursodeoxycholic acid improves survival PSC- intra and extra hepatic bile duct inflammation Ass with UC, ursodeoxycholic acid does not improve survival

Question 26

Mirrizi syndrome

Answer 26

Common hepatic duct obstruction caused by extrinsic compression from impacted stone in cystic duct/ infundibuoum of gall bladder

Question 27

Ix and mx of bile acid malabsorption

Answer 27

SeHCAT: nuclear medicine test using gamma emitting molecule scan done 7d apart to assess retention/ loss of radiolabelled SeHCAT Mx: bile acid sequestration- cholestyramine

Question 28

Most common cause of HCC world and Europe

Answer 28

World help B, Europe help C

Question 29

Endoscopy findings of UC and CD

Answer 29

UC: widespread ulceration with preservation of adjacent mucosa which has appearance of polyps CD: deep u,cert skip lesions cobble stone like appearance

Question 30

Classification of UC

Answer 30

Mild: <4 stools/day, small amount of blood Mod: 4-6 stools/day, varying amount of blood, no systemic upset Severe: >6 stools/day and feature of systemic upset.

Question 31

Maintenance of left sided/ extensive UC and following severe relapse/ >2 exacerbation in post year

Answer 31

Left sided + extensive UC: low maintenance dose of po aminosalicylate Following severe relapse/ >2 exacerbation in past year:po azathioprine or po mercaptopurine.

Question 32

Associated sx in CD and uC

Answer 32

CD and UC: arthritis, erythema nodosum, osteoporosis CD: episcleritis UC: pSC, uveitis

Question 33

1st line for maintaining remission for CD

Answer 33

Azathioprine/ mercaptopurine

Question 34

Associated disease in coeliac disease

Answer 34

Dermatitis herpetiformis, autoimmune disorder: type 1 DM, autoimmune hepatitis, HLA-DQ2 and HLA-DQ8

Question 35

How long to you have to take gluten before dx of coeliac disease

Answer 35

6 weeks

Question 36

H pylori dx

Answer 36

Urea breath test - may be used to check H pylori eradication Rapid urease test CLO test

Question 37

Mx of Barrett’s oesophagus

Answer 37

High dose PPI Endoscopic surveillance with biopsies for metaplasia If dysplasia- 1st line radiofreq ablation esp for low grade dysplasia . Endoscopic mucosal resection

Question 38

Which score to use in UGIB

Answer 38

Glasgow blatchford score OP/IP mx Rock all score

Question 39

Peru’s jeghers syndrome inheritance

Answer 39

AD numerous polyps in HI tract Haemartomatous polyp in GI tract mainly SMALL bowel- SBO or intussusception and increased GI bleeding

Question 40

Ix pancreatic cancer

Answer 40

CT investigation of choice

Question 41

Ascites Ix

Answer 41

SAAG serum ascites albumin gradient >11g/L and <11g/L >11g/L: liver disorder are the most common cause- cirrhosis/ alcoholic liver disease, acute liver failure, liver metastases, cardiac rt heart failure, constrictive pericarditis, other causes- budd chairing syndrome, portal vein thrombosis, venom-occlusive disease, myxoedema] <11g/L: hypoalbuminaemia- nephrotic sy, severe malnutrition, malignancy , infection tuberculous peritonitis, other causes- pancreatitis, vowel obstruction, biliary ascites, postoperative lymphatic leak, serositis in connective tissue disease

Question 42

Mx ascites

Answer 42

Fluid restrict is Na- <125mmol/l Aldosterone ATG spironolactone, albumin cover HAS, decreased paracentesis-induced circulatory dysfunction & mortality, paracentesis induced circulatory dysfunction Prophylactic abx

Question 43

Virchow’s node, sister Mary Joseph node

Answer 43

Virchows node left supraclacivular LN Sister Mary Joseph’s Node

Question 44

Pernicious anaemia Ix and ass disease

Answer 44

Ab to intrinsic factor +/- gastric parietal cells Ass disease: thyroid, DM1, addisons, RA, viltiligo

Question 45

Ix carcinoid tumour

Answer 45

Urinary 5-HIAA Plasma choreographing A

Question 46

Mx of carcinoid tumour

Answer 46

Somatostatin analogue Diarrhoea:cryproheptadine