Gastro

Question 1

How to calculate units?

Answer 1

% of alcohol x ml / 1000

Question 2

How to calculate anion gap?

Answer 2

(sodium + potassium) - (bicarbonate + chloride)

A normal anion gap is 8-14 mmol/L

Question 3

Side effects of mesasazine etc?

Answer 3

mesalazine is still however associated with side-effects such as GI upset, headache, agranulocytosis, pancreatitis*, interstitial nephritis

Question 4

a SAAG of > 11 indicates what?

Answer 4

Portal hypertension

Question 5

how to calculate saag

Answer 5

Serum albumin - ascites albumin

Question 6

Antibodies in autoimmune hepatitis?

Answer 6

ANA/SMA/LKM1 antibodies, raised IgG levels

Question 7

Preferred method of Rx if dysplastia noticed at endoscopy?

Answer 7

Radiofrequency ablatio

Question 8

Changes in Barretts

Answer 8

Squamous replaced by columnar

he columnar epithelium may resemble that of either the cardiac region of the stomach or that of the small intestine (e.g. with goblet cells, brush border)

Question 9

Test of choice for bile salt malabsorption

Common cause of chronic diarrhoea

Answer 9

nuclear medicine test using a gamma-emitting selenium molecule in selenium homocholic acid taurine or tauroselcholic acid (SeHCAT)

Question 10

Ix of Budd Chiari ?

Answer 10

USS with Doppler flow

Question 11

Ix of Carcinoid tumour?

Answer 11

Urinary 5HIAA

Question 12

Disease showing villous atrophy?

Answer 12

Coeliac

Question 13

Malignancy assoc with coeliac?

Answer 13

enteropathy-associated T-cell lymphoma of small intestine

Question 14

Crohns pathology

Answer 14

Inflam all layers
Goblet cells
Granulomas

Question 15

UC path

Answer 15

No inflam beyond sub-mucosa
Crypt abccesses

Question 16

is uveitis more common with UC or Crohns

Answer 16

UC

Question 17

What is the only ‘itis’ to occur in Crohn’s

Answer 17

Episcelritis

Question 18

Unrelated to disease activity Arthritis: polyarticular, symmetric
Uveitis
Pyoderma gangrenosum
Clubbing
Primary sclerosing cholangitis

Answer 18

Crohns and UC

Question 19

How to maintain remission in Crohns/

Answer 19

Azathiprione

STOP SMOKING

Question 20

What is used in refractory and fistulting crohns

Answer 20

Infliximab

Question 21

Rx of symptomatic anal fistulae in crohns

Answer 21

metronidazole

Question 22

what do you need to assess before starting azathioprine

Answer 22

TPMT levels

Question 23

Testing for H Pylori

Answer 23

initial diagnosis: NICE recommend using a carbon-13 urea breath test or a stool antigen test, or laboratory-based serology ‘where its performance has been locally validated’
test of cure:
there is no need to check for H. pylori eradication if symptoms have resolved following test and treat
however, if repeat testing is required then a carbon-13 urea breath test should be used

Question 24

Who do you refer urgently with dyspepsia?

Answer 24

Patients aged >= 55 years who’ve got weight loss, AND any of the following:
upper abdominal pain
reflux
dyspepsia

Question 25

Dysphagia of both solids and liquids from the start?

Answer 25

Think achalasia

Question 26

Rx of gallstone ileus?

Answer 26

Laparotomy and removal of the gallstone from small bowel, the enterotomy must be made proximal to the site of obstruction and not at the site of obstruction. The fistula between the gallbladder and duodenum should not be interfered with.

Question 27

Gold standard test for GORD?

Answer 27

24* oesophageal ph monitoring

Question 28

Inheritance of haemachromatosis

Answer 28

Autosomal recessive

Question 29

What features of haemachromatosis are reversible with Rx?

Answer 29

Cardiomyopathy Skin pigmentation

Question 30

Blood results in haemachromatosis?

Answer 30

transferrin saturation > 55% in men or > 50% in women raised ferritin (e.g. > 500 ug/l) and iron low TIBC

Question 31

Treatment of haemachromatosis?

Answer 31

Venesection, keep t sats below 50% Desferrioxamine 2nd line

Question 32

Rx of hepatic encephalopathy

Answer 32

Lactulose + Rifaxamin antibiotics such as rifaximin are thought to modulate the gut flora resulting in decreased ammonia production

Question 33

Cholangiocarcinoma Dx

Answer 33

Persistent biliary colic symptoms, associated with anorexia, jaundice and weight loss. A palpable mass in the right upper quadrant (Courvoisier sign), periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node) may be seen

Question 34

Most common cause of HCC in Europe?

Answer 34

Chronic Hep C

Question 35

Who should you screen for HCC?

Answer 35

patients liver cirrhosis secondary to hepatitis B & C or haemochromatosis men with liver cirrhosis secondary to alcohol

Question 36

Management of hepatorenal syndrome?

Answer 36

Terlipressin and IV albumin Think if doubling of creatinine to >221

Question 37

Drainpipe colon on barium?

Answer 37

UC

Question 38

What biliary pathology more common in UC?

Answer 38

Primary sclerosing cholangitis

Question 39

Primary scleroing choalngitis facts

Answer 39

Think Sclerosing = Stuart More common in men Intra and extra-hepatic LT complication -= cirrhosis / cholangiocarcnoma "Onion skin fibrosis" on ducts

Question 40

Primary biliar cirrhosis antibodies?

Answer 40

AMA Associations: Other autoimmune problems e.g. sjogrens / RA

Question 41

TIBC

Answer 41

raised in iron deficiency anaemia (IDA) raised in pregnancy and by oestroge

Question 42

Anaemia of chronic disease

Answer 42

normochromic/hypochromic, normocytic anaemia reduced serum and TIBC normal or raised ferritin

Question 43

Melanosis coli is a disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages. Associations?

Answer 43

Laxative abuse