Gastro

Question 1

Antibiotics causing C diff

Answer 1

Clindamycin, cephs, augmentin, quinolones

Question 2

Which criteria are used for diagnosing IBS?

Answer 2

ROME criteria

Question 3

Features of Wilson’s disease

Answer 3

• liver: hepatitis, cirrhosis
• neurological: basal ganglia degeneration, speech and behavioural problems are often the first manifestations. Also: asterixis, chorea, dementia
• Kayser-Fleischer rings
• renal tubular acidosis (esp. Fanconi syndrome)
• haemolysis
• blue nails

Question 4

Constituents of Truelove and Witt’s criteria?

Answer 4

Ulcerative colitis is classified as ‘severe’ when the patient has blood in their stool, or is passing more than 6 stools per day plus at least one of the following features:

• Temperature greater than 37.8°C
• Heart rate greater than 90 beats per minute
• Anaemia (Hb less than 105g/ L)
• Erythrocyte sedimentation rate greater than 30 mm/hour

Question 5

What is in the Childs-Pugh classification?

Answer 5

Liver cirrhosis:

• Bilirubin
• Albumin
• Prothrombin
• Encephalopathy
• Ascites

Question 6

KCH criteria for liver transplant post paracetamol overdose?

Answer 6

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:

• prothrombin time > 100 seconds
• creatinine > 300 µmol/l
• grade III or IV encephalopathy

Question 7

How many patients with hep C become chronically infected?

Answer 7

80-85%

Question 8

What is SAAG used for?

Answer 8

The SAAG is used to determine if the ascites has been caused by portal hypertension or not. A raised SAAG (>11g/L) indicates that it is portal hypertension that has caused the ascites.

Question 9

Features of autoimmune hepatitis

Answer 9

• 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 10

What drugs do you have to stop for a urea breath test?

Answer 10

no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

Question 11

Most common cause of hepatocellular carcinoma?

Answer 11

hepatitis B most common cause worldwide

hepatitis C most common cause in Europe