Gastroenterology

Question 1

Screening for haemachromatosis

For general population?

For family members?

Answer 1

Screening for haemachromatosis

General population –> Transferrin saturation

Family members –> HFE genetic testing

Question 2

C diff treatment

If Moderate?

If Life threatening?

Answer 2

C diff infection

• Moderate –> PO Metronidazole
• Severe –> PO Vancomycin + IV Metronidazole

Question 3

What hormones do these cells produce

D cells

S cells

G cells

I cells

Answer 3

D cells –> Somatostatin

S cells –> Secretin

G cells –> Gastrin

I cells –> CCK

Question 4

Small bowel overgrowth syndrome - causes? Ix?

Answer 4

Small bowel overgrowth syndrome

Causes: Systemic sclerosis, Diabetes, Congenital

Ix: Hydrogen breath test

(hydrogen and methane correlate with amount of bacteria)

Question 5

H. pylori is associated with

Answer 5

Duodenal ulcers

Question 6

Chronic NSAID use is associated with

Answer 6

Gastric ulcers

Question 7

Gut anterial supply

Answer 7

Question 8

Intermittent dysphagia

Regurgitation

Bird’s beaking

Diagnosis? Ix? Tx?

Answer 8

Achalasia

[1] OGD

[2] Barium swallow (diagnostic)

Tx: CCBs + Surgical dilatation

Question 9

Regurgitation

Coughing up food

Halitosis

Diagnosis? Ix?

Answer 9

Pharyngeal pouch (Zenkers diverticulum)

Ix: Barium swallow or OGD

Tx: none required

Question 10

Iron deficieny anaemia + Dysphagia

OGD: Oesophageal webs

Diagnosis?

Answer 10

Plummer-Vinson syndrome

Question 11

Ix for peptic ulcer disease

Answer 11

< 55 years old and no red flags –> H. pylori Urea breath test

> 55 years old or red flags –> OGD + Biopsy

Question 12

H pylori eradication thearpy

Answer 12

Clarithromycin AND Amoxicillin AND Omeprazole

Clarithromycin AND Metronidazole AND Omeprazole

Question 13

Tx of hepatic encephalopathy

Answer 13

Oral Lactulose + Phosphate enema

Question 14

Autoimmune hepatitis

Antibodies

Answer 14

Type 1 –> Anti-smooth muscle antibody + ANA

Type 2 –> Anti-liver-kidney microsome Ab (ALKM-1)

Question 15

Ig levels in autoimmune hepatitis

Answer 15

Raised IgG

Question 16

RAH

RUQ abdo pain

Ascites

Tender hepatomegaly

Diagnosis? ix?

Answer 16

Budd-Chiari syndrome (hepatic vein outflow obstruction)

• Ix: USS Doppler Hepatic vein
• Tx: Thrombolysis (< 72hr) or ANticoagulation (>72hr)
• • Angioplasty

Question 17

Ascitic tap

↑ polymorphonuclear leucocytes (PMN) >250 mm3

Answer 17

==> Spontaneous Bacterial Peritonitis (SBP)

Question 18

Signs of portal hypertension

Answer 18

SAVE

• Splenomegaly
• Ascites
• Varices
  
  • Oesophageal varices (90%)
  • Caput medusa
  • Haemorrhoids
• Encephalopathy

Question 19

Signs of liver decompensation

Answer 19

JACE

• Jaundice
• Hypoalbuminaemia
  
  • Oedema
  • Ascites
• Coagulopathy → Bruising
• Encephalopathy

Question 20

Haemochromatosis

Cause

Ix

Answer 20

Haemochromatosis

Autosomal recessive mutation in HFE (or multiple blood transfusions)

HIGH Transferrin saturation

Perl’s stain or Prussain Blue stain for Iron

Tx: Venesection +/- Desferrioxamine

Question 21

Hydatid liver cyst

Cause/Risk factors

Ix

Tx

Answer 21

Hydatid liver cyst

• Echinococcus granulosus (Tapeworm) –> Sheep / Dogs on Farms
• Ix: Western blot
• Tx: Praziquantel

Question 22

Ix for portal hypertension

1st line

Gold standard

Answer 22

USS: [1st line investigation]

Hepatic venous pressure gradient (HVPG) measurement: [Gold standard]

Question 23

Wilson’s disease

Cause

Ix

Tx

Answer 23

Wilson’s disease

• Autosomal recessive –> mutation in ATP7B gene
• LOW Ceruloplasma
• HIGH Free Copper, HIGH urinary copper
• Tx
  
  • Zinc + Trientine

Question 24

Hepatitis B serology

Answer 24

Question 25

Antibodies in PBC

Answer 25

Ig**_M_** Anti-**_m_**itochondrial antibodies (PBC)

Question 26

Tx for PBC

Answer 26

Ursodeoxycholic acid

Question 27

PSC Associations

Answer 27

**PSC + UC** pANCA

Question 28

HLA DQ2 and DQ8

Answer 28

Coeliac disease

Question 29

Ix for Coeliac disease

Answer 29

_Coeliac disease_ **IgA anti-TTG** **OGD + Duodenal biopsy** increase intraepithelial lymphocytes Villous atrophy + Crypt hyperplasia

Question 30

**Mesenteric adenitis** Cause

Answer 30

**Mesenteric adenitis --\>** Yersinia enterocolitica

Question 31

Tx for C diff infection

Answer 31

_C diff infection_ (1) **PO Metronidazole** for 10-14 days (2) **PO Vancomycin** for 10-14 days If severe --\> **Oral Vancomycin + IV Metronidazole**

Question 32

Definition of **toxic megacolon**

Answer 32

**bowel diameter \>6cm** Barium enenma: **Lead piping** (loss of haustra)