Gastro 2

Question 1

The auto antibodies for autoimmune hepatitis?
type I (2)

type II (1) just kids

type III (1 antigen)

also get a raised Ig…

Answer 1

type 1 - Anti smooth muscle
ANA

type 2 - Anti-liver/kidney microsomal type 1 antibodies (LKM1)

Type III =Soluble liver-kidney antigen

IgG

Question 2

Haemochromatosis blood results :
transferrin saturation
ferritin
Total iron binding capacity

Answer 2

transferrin saturation - high
ferritin - high
Total iron binding capacity- low

Question 3

what vitamin is deficient?

Pellagra
Beriberi
Scurvy

Answer 3

Pellagra - vitamin B3, niacin. strict vegan (Dermatitis, diarrhoea, dementia/delusions, leading to death)

Beriberi - thiamine (vitamin B1)
wet beriberi (presenting with tachypnoea, dyspnoea and pedal oedema) and dry beriberi (presenting with pain, paresthesia and confusion). Wernicke–Korsakoff syndrome is a subtype of dry beriberi.

Scurvy - vitamin C (anaemia, bleeding gums and bruising/petechiae of the skin.)

Question 4

characteristic electrolyte disturbances seen in patients with refeeding syndrome (3) PRIOR TO EATING

Answer 4

• hypophosphataemia
• hpokalaemia
• hypomagnesaemia (predispose to torsades de pointes)

Question 5

characteristic electrolyte disturbances seen in patients with refeeding syndrome (3) PRIOR TO EATING

Answer 5

• hypophosphataemia
• hpokalaemia
• hypomagnesaemia (predispose to torsades de pointes)

Question 6

Sister-mary joseph nodule seen in 2 cancers

Answer 6

gastric and cholangiocarcinoma

Question 7

what are the better antibodies when investigating pernicious anaemia?

Answer 7

Intrinsic factor antibodies are better than gastric parietal antibodies

Question 8

Electrolyte hallmarks of refeeding syndrome (3)

Answer 8

LOW PHOSPHATE
low potassium
low magnesium

and fluid shifts are the hallmarks of refeeding syndrome

Question 9

Bile-acid malabsorption may be treated with

Answer 9

cholestyramine- bile acid sequestrant

Question 10

drug-induced cholestasis

Answer 10

oral contraceptive pill
co-amoxiclav, phenothiazines, sulphonylureas, fibrates and anabolic steroids.

Question 11

Iron defiency anaemia vs. anaemia of chronic disease: TIBC is high in IDA, and low/normal in anaemia of chronic disease

Question 12

Alcoholic ketoacidosis is managed with

Answer 12

infusion of saline and thiamine

Question 13

pseudomembranous colitis = C.difficile

Question 14

Management Crohns Acute
1
2
3.

Refractory = (mab)
Isolted peri-anal fistula =

Answer 14

1. Glucocoirticoids
2. • add 5ASA
3. • add azathioprine or mercaptopurine or methotrexate

Refractory = Infliximab
Isolted peri-anal fistula = Metronidozole

Question 15

Maintaining Crohns Remission

1. conservtaive
   2 first line (2 options)
2. second line

Answer 15

1. STOP SMOKING!
2. Azathioprine or mercaptopuring
3. Methotrexate

Question 16

Grading of hepatic encephalopathy

Answer 16

Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma

Question 17

Spontaneous Bacteria Infection

Treatment abx =
Prevent abx =

Answer 17

cefoTaxime to Treat
ciProfloxacin to Prevent

Question 18

Re-feeding syndrome management (hypophosphate)

serum phosphate level <0.80 mmol/L.

mild (∼0.64–0.80 mmol/L) =

moderate (∼0.32–0.64 mmol/L) =

severe (<0.32 mmol/L).

Answer 18

mild - ‘’
mod - need to be asymp. Oral Phosphate Sandoz®

severe - Intravenous phosphate replacement or symp!!

Question 19

In ceoliac you get normocytic anaemia- what are you deficient in? (3) where are each of them absorbed?

Answer 19

iron, folate and vitamin B12 deficiency

although folate deficiency is more common than vitamin B12 deficiency).

• B12 is absorbed in the terminal ileum

Folate is absorbed in the duodenum and jejunum.

Iron is mainly absorbed in the duodenum.