Gastro - Pass med

Question 1

Haemachromatosis

-genetic pattern

Answer 1

• Autosomal recessive iron accumulation

- lethargy, arthralgia, bronze skin, DM,

Question 2

Mesenteric ischaemia vs Ischaemic colitis

Answer 2

Both - abdo pain, diahrohea, rectal bleeding, fever, bloods - elevated white blood cell and lactic acidosis
Diagnosis - CT scan

M - embolism occulsion of artery supplying small bowel. Hx Afib.

• Pain is severe, sudden onset, out of keeping with physical exam
• Urgent surgery,

I - acute compromise of blood flow to large bowel, leads to inflammation, ulceration and haemorhage.

• Thumbprintign may be seen on abdo xray due to oedema/haemorahge
• supportive management, surgery if conservative mesarues fail

Question 3

how long before gastroscopy do you stop proton pump inhibitor?

Answer 3

2 weeks (as can mask serious pathology)

Question 4

Urgent endoscopy - suspicion of gastric cancer

Non-urgent

Answer 4

• all patients with dysphagia or upper abdo mass consistent w stomach cancer
• > 55 w weight loss and one of (upper abdo pain, reflux, dyspepsia)

Non-urgent - patients with haematemeiss
-patient ?55 - treatement resistant dyspesis, upper abdo pain low hb levels, raised platelet count w other gastro signs. .

Question 5

What anti-emtic should you avoid in bowel obstruction?

Answer 5

metoclopramide

Question 6

Pernicious anaemia

Answer 6

• SOB, fatigue, lethargy
• lemon tinge skin
• vibration sensation loss - due tot he low B12 levels (loss of reflex or weakness)

Question 7

gilberts syndrome

Answer 7

autosomal recessive of defective bilirubin conjugation due to UDP glucuronly transferase -

• hyperbillirubinaemia
• jaundice

Question 8

Spontaneous bacterial peritonitis - what do you give long term treatment

Answer 8

-If patinets have had SBP with fluid protein less than 15 ,then get antibiotic prolyaxis of ciprofloxacin

Question 9

Carcionoid syndrome

Answer 9

carcinoid tumours - occur when metastases are present in the liver and release serotonin into systemic circulation.

• diarrhoea, palpitations, flushing , bronchospasm, hypotension
• nueroendocrine tumour
• serotonin secretions causes this
• only occurs once tumour has metastasised to liver as this is where seritonin undergoes first pass metabolims.

inv - urinary 5-Hiaa
-plasma chromogranin

Question 10

H.pylori - eradication therapy

Answer 10

-urea breath test

Question 11

Malnutrtion score

Answer 11

MUST
0BMI <18.5
Unintentional weight loss great than 10% in last 3-6 monhts
BMI - <20 and unintentioanl weight loss great hern 5% within 3-6monhts

-MUST - can reduec risk of pressure sores

Question 12

What anti-emetic medication is too be avoided ein parkinsons

Answer 12

-metoclopramide

Question 13

When to give antibiotics for SBP in ascities?

Answer 13

patients who have had an episode of SBP
patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
NICE recommend: ‘Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved’

Question 14

Marker for hepatocellular carcinoma

Answer 14

Alpha feropotein (afp)

Question 15

type 1 vs type 2 hepatorenal failure

Answer 15

type 1 - within 2 weeks

type 2- gradual decline

Question 16

Crones

Answer 16

Inducing remission - glucocorticoids (5asa secondary)
azathioprine, mercaptopurine can be used as add ons

Maintenance -
azathioprine or mercaptopurine is used first-line to maintain remission
methotrexate is used second-line
5-ASA drugs (e.g. mesalazine) should be considered if a patient has had previous surgery

Question 17

Giardia

Answer 17

floating stool due to fat malabsortpon

Question 18

wilsons disease

Answer 18

-has low serum copper because it is deposited in the tissues
and also reduced caeruloplasmin

Question 19

autoimmune hepatitis

Answer 19

Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)