Gastro teaching

Question 1

IBD
i) name three bloods and three special tests that may be done to ix? which will be raised in IBD?
ii) what is the investigation of choice? which type has skip lesions and which is continous?
iii) name three things that should be given in an acute flare? what drug is given to manage?
iv) name a complication of IBD? what imaging can be done for this?
v) what criteria is used to grade the severity of the flare?

Answer 1

i) FBc, UE, CRP
stool culture, fecal calprotectin, c diff culture
raised fecal calprotectin
ii) ix with colonoscopy
crohns has skip and UC is continous
iii) acute flare - IV fluid resus, analgesia, VTE prophylaxis if admitted
give IV hydrocortisone
iv) toxic megacolon - do AXR and look for dilated bowel loops
v) truelove and witts criteria

Question 2

UC
i) what blood marker is used in TLW? how many days should IV hydrocortisone be given for?
ii) what should the patient be discharged on? what other drug is given?
iii) what is second and third line tx?
iv) what is given first line in crohns?
v) what other condition is UC associated with?

Answer 2

i) ESR
5 days of IV hydrocortisone
ii) discharge on tapering dose of oral pred - 40mg and taper by 5mg every week
also give aminosalicyclate - mesalazine (PR if rectal or PO if extensive)
iii) then immmodulator eg azathioprine then biologics eg infliximab
iv) CD dont get aminos - give immodulator first line eg aza
v) UC assoc with primary sclerosing cholangitis

Question 3

PSC
i) what is it? which IBD does it couple with? name three ways it can px?
ii) what picture is seen on LFTs? who does it usually px in?
iii) which antibods are positive?
iv) what is imaging choice and what will be seen?
v) how may it be treated

Answer 3

i) bile ducts become scarred then narrowed/blocked
couples with UC
px with pruritis, fatigue, icterus
ii) cholestatic LFTs (high ALP) usually presents in males over 40yrs
iii) pANCA positive
iv) do US abdo and see billiary duct dilatation
v) tx with ERCP for strictures but need liver transplant

Question 4

UPPER GI BLEED
i) how may a variceal bleed present? what is done in initial mx? (3) name four bloods done
ii) how does IV terlipressin work? what may also be given prophylactically if there is excess ETOH? what ix needs to be done urgently?
iii) what score is done before imaging? what does it indicate?
iv) name four non variceal causes of UGI bleeding?
v) what can be done during OGD for oes varices? (2)

Answer 4

i) px with bright red blood vomit and collapse
initial - A-E, call for senior, o2 or IV fluid, consider MHP, ECG
bloods - FBC, UE, CRP, cross match 6 units, coag screen
ii) terlipressin causes compression of splanchnic circ (veins that are bleeding)
prophylactic IV tazocin if ETOH for SBP
OGD urgently
iii) do glasgow blatchford score for likelihood of UGI bleed
iv) non variceal - PUD, mallory weiss tear, anti coag, aorto enteric fistula post EVAR
v) band or inject adrenaline

Question 5

LIVER DISEASE
i) what are four signs of decomp LF? (JAVE) what is included in a non invasive liver screen?
ii) name three common, uncommon and auto immune causes of cirrhosis?
iii) what is AST:ALT ratio in ETOH LD? what is it in NAFLD? what other ix should be done in NAFLD?

Answer 5

i) Jaundice, Ascites, Varices, Encephalopathy
non invasive - LFT, AST, INR, FBC, ferritin, TTG, clotting, viral serology, cholesterol
ii) common - ETOH, NAFLD, viral hep
uncommon - alpha 1 anti-tryp defic, wilsons, HCT
autoimmine - PSC, PBC, glycogen storage diseases
iii) ETOH - AST:ALT 2:1
NAFLD - ALT higher
also do ix for other metabolic syndromes eg diabetes

Question 6

DYSPEPSIA
i) name two conditions that need to be ruled out?
ii) name three red flags that warrants 2ww OGD?
iii) what mx is given first? (3) what is done of this doesnt work? what if this is negative?

Answer 6

i) rule out malignancy and PUD
ii) weight loss, increased age, nausea and vom, high plats, dysphagia
iii) lifestyle/gaviscon/review in 4 weeks
if unsucessful - do h pyolori breath test
if negative give PPI and H2 blocker

Question 7

COELIAC DISEASE
i) name four presenting features?
ii) what specific antibodies should be tested? (2) what should be doen if this is inconclusive?
iii) what is seen on imaging?
iv) what is main tx? what organ is at risk? what is given to mitigate this?
v) what dem condition is risk? what is tx?

Answer 7

i) diarrhoea, bloat, fatigue, steatorhea, mouth ulcers
ii) anti TTG and IgA titre
if inconc - do OGD and duodenal biopsy
iii) see villous atrophy and crypt hyperplasia
iv) gluten avoidance
risk of hyposplenism - give one off pneumococcal vaccine
v) risk of dermatitis herpetiformis - eczema like rash on extensor surfaces - tx with dapsone