Gastro

Question 1

Crohns vs UC?

Answer 1

Crohns: non-bloody diarrhoea, abdominal pain (often right-sided), weight loss, and extraintestinal manifestations like oral ulcers or skin lesions; pei-anal disease eg skin tags, goblet cells

—> Tranny (transmural inflammation) granny (granulomas) skips (skip lesions) down the cobblestone (cobblestone appearance) alley

UC: Tender LLQ, bloody diarrhoea, abdominal pain, and a feeling of incomplete evacuation after defecation (tenesmus), urgency. Crypt abscess, psuedopolyps, colorectal ca

Question 2

At what ages and how often are FITs done as part of the colorectal screening programme?

Answer 2

Faecal immunochemical tests are sent every 2 years to all patients aged 60-74 years in England, 50-74 years in Scotland.

Question 2

Management of UC flare? severe vs mild-mod

Answer 2

definition of severe UC: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

In mild/moderate: topical (rectal) aminosalicylate. –> PO aminosalicylate (eg Sulfasalazine)–> steroid

Severe: hospital. IV steroids –> IV ciclosporin –> surgery

Question 3

What is pyoderma gangrenosum?

Answer 3

Inflammatory, not infection. An uncommon cause of very painful skin ulceration.
Associated with IBD.
Starts as pustule then ulcerates
Treat with steroids

Question 4

WHat is used for prevenetion of variceal high risk bleeds?

Answer 4

A non-cardioselective B-blocker (NSBB) is used for the prophylaxis of oesophageal bleeding eg carvedilol, propranolol

Question 5

Spider naevi vs telangiectasia

Answer 5

Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge

Question 6

Mx of crohns flare up?

Answer 6

Induce remission:
1st line - steroids
2nd line - 5-ASA (aminosalicylaes) eg mesalazine
3rd line - azathioprine/ mercaptopurine /methotrexte.
4th line - infliximab
Metronidazole is used if fistula present

Maintain remission:
1st line - azathioprine/ mercaptopurine - need to test TPMT
2nd line - methotrexate

Surgery:
ileocoecal resection if stricture, resections, draining seton

Question 7

How is SBP diagnosed?

Answer 7

In suspected SBP- diagnosis is by paracentesis. Confirmed by neutrophil count >250 cells/ul

Question 8

How do you interpret Hep B serology?

Answer 8

HBsAg normally implies acute disease (present for 1-6 months)

if HBsAg is present for > 6 months then this implieschronic disease(i.e. Infective)

Anti-HBs implies immunity (either exposure or immunisation). It is negative in chronic disease.

Anti-HBc implies previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. IgG anti-HBc persists.

HbeAg results from breakdown of core antigen from infected liver cells as is, therefore, a marker of infectivity. Marker of HBV replication and infectivity

Example results

previous immunisation: anti-HBs positive, all others negative

previous hepatitis B (> 6 months ago), not a carrier: anti-HBc positive, HBsAg negative

previous hepatitis B, now a carrier: anti-HBc positive, HBsAg positive

Question 9

Achalasia vs oeseophgeal stricture vs pharyngeal pouch??

Answer 9

Achalasia - relaxed lower sphincter. Progressive dysphagia of solids and liquids on onset. Get CP, wt loss, reflux.
Bird beak sign on barium swallow

Oesophageal stricture - Presents with difficulty swallowing solids then liquids.
Narrowing on barium swallow
Often due to GORD and so will hve hx of reflux

Pharyngeal pouch - intermittent dysphagia halitosis + nocturnal coughing

Question 10

Consequences of low vitamins:
A (Retinoids)
B3 (niacin)
c (Ascorbic acid)

Answer 10

A- night blindness
B3- Pellagra- dermatitis, diarrhoea, dementia
C- scurvy - gingivitis and bleeding

Question 11

Describe autoimmune hepatitis - bloods/ presentation/ ix?

Answer 11

may present with signs of chronic liver disease
acute hepatitis: fever, jaundice etc (only 25% present in this way)
amenorrhoea (common)
ANA/SMA/LKM1 antibodies, raised IgG levels
liver biopsy: inflammation extending beyond limiting plate ‘piecemeal necrosis’, bridging necrosis

Question 12

What is charcots triad? WHich condition does it occur in?

Answer 12

ascending cholangitis triad: fever, jaundice and right upper quadrant pain

Question 13

Which ulcer is relived by eating?

Answer 13

duodenal

Question 14

When should prophylactic abx be started for ascites? which abx?

Answer 14

Patients with ascites and protein concentration <= 15 g/L / Child-Pugh score of at least 9/ hepatorenal syndrome

they should be given oral ciprofloxacin or norfloxacin as prophylaxis against spontaneous bacterial peritonitis

Question 15

What blds do you do to monitor response to haemochromatosis mx?

Answer 15

Ferritin and transferrin saturation (most useful also for diagnosis) are used to monitor treatment in haemochromatosis (venesection)

Question 16

What extra-intestinal manifestation of IBD colerates to flare ups?

Answer 16

erythema nodosum

Question 17

Describe primary biliary cholangitis?

Answer 17

Classically seen in middle aged women
Present with jaundice, raised ALP, pruritius

AMA - anti-mitochondrial antibodies highly specific (98%), raised IgM
Associated with sjogrens (80%)

first-line: ursodeoxycholic acid
cholestyramine if itchy, fat soluble vitamins, eventually liver transplant
Associated with HCC

Question 18

What should be given before OGD in UGIB?

Answer 18

Terlipressin and prophylactic abx

Post UGIB if NOT variceal bleed eg if ulcer give PPI

Question 19

Where is biopsy taken from to prove diagnosis of coeliacs?

Answer 19

Jejunum

Question 20

How do you test for h pylori?

Answer 20

Urea breath test
should not be performed within 4 weeks of abx or within 2 weeks of ppi/ h2 antag

Question 21

What condition is Melanosis coli found on biopsy of colon?

Answer 21

chronic use or abuse of anthraquinone-containing laxatives, such as senna or cascara.

Question 22

Curlings vs cushings ulcer?

Answer 22

Curling’s ulcer is a recognised complication of severe burns. It is a gastric ulcer caused by necrosis of the gastric mucosa, usually due to hypovolaemia. They carry a high rate of bleeding and mortality.

A Cushing’s ulcer is a stress ulcer that occurs in the aftermath of severe head trauma.

Question 23

What is the most commonly effected site in ulcerative colitis?

Answer 23

Ulcerative colitis - the rectum is the most common site affected

Question 24

What cancer does barretts put you at risk of vs achalasia?

Answer 24

Whilst Barrett’s oesophagus increases the risk of oesophageal adenocarcinoma, achalasia increases the risk of squamous cell carcinoma of the oesophagus.

Question 25

What is Peutz-Jeghers syndrome?

Answer 25

autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract. It is also associated with pigmented freckles on the lips, face, palms and soles

Question 26

Treatment for wilsons disease?

Answer 26

penicillamine

Question 27

What cancer is coeliacs associated with

Answer 27

Coeliac disease increases the risk of developing enteropathy-associated T cell lymphoma of SI

Question 28

When should PO and rectal 5ASA be started for UC?

Answer 28

In a mild-moderate flare of ulcerative colitis extending past the left-sided colon, oral aminosalicylates should be added to rectal aminosalicylates, as enemas only reach so far

Question 29

How to maintain remission in UC?

Answer 29

Following a mild-to-moderate ulcerative colitis flare
proctitis and proctosigmoiditis
topical (rectal) aminosalicylate alone (daily or intermittent) or
an oral aminosalicylate plus a topical (rectal) aminosalicylate (daily or intermittent) or
an oral aminosalicylate by itself: this may not be effective as the other two options
left-sided and extensive ulcerative colitis
low maintenance dose of an oral aminosalicylate

Following a severe relapse or >=2 exacerbations in the past year
oral azathioprine or oral mercaptopurine