Gastroenterology

Question 1

what is primary biliary cirrhosis and who does it affect?

Answer 1

autoimmune disorder
predominantly affects women (especially those aged 40-50)

Question 2

what are the diagnostic conditions for the diagnosis of PBC?

Answer 2

all patients with PBC have:

• antimitochondrial autoantibodies
• raised serum alkaline phosphatase

Question 3

How do patients with PBC often present?

Answer 3

pruritus
fatigue
jaundice can be present at a later stage
some patients have xanthelasma

Question 4

what is primary hemochromatosis?
what is its genetic pattern?

Answer 4

autosomal recessive disorder
absorption of too much iron that accumulates in liver (hepatomegaly), pancreas, heart, pituitary and joints

Question 5

what is the most common presentation of hemochromatosis?

Answer 5

usually more tanned than normal
incidental finding of abnormal liver enzymes or raised ferritin level
symptoms rare in women of childbearing age due to menstrual losses and pregnancy compensating for increased iron
men present in 40’s/50’s with non-specific symptoms (loss libido, hypogonadism - secondary to dysfunction of pituitary gland. ) may present with diabetes or arthritis

Question 6

what vitamin needs to be given to alcoholics?

Answer 6

thiamine - vit B1 - IV as poorly absorbed orally in alcohol dependents

Question 7

why is thiamine low in alcoholics?

Answer 7

poor oral diet
thiamine is a coenzyme in alcohol metabolism

Question 8

what can thiamine deficiency lead to?

Answer 8

Wernicke encephalopathy

Question 9

what does a presentation of painless jaundice suggest?

Answer 9

carcinoma of head of pancreas

Question 10

what are the features of pancreatic cancer?

Answer 10

painless jaundice
pale faeces (due to lack of stercobilinogen)
dark urine (unconjugated hyperbilirubinemia)
weight loss

Question 11

what is Barrett oesophagus?

Answer 11

prolonged injury (due to acid reflux) results in normal squamous epithelium of lower oesophagus being replaced by columnar epithelium 
this predisposes to malignancy

Question 12

who is oesophageal candidiasis likely to present in?

Answer 12

diabetics
high sugar levels allow yeast to grow

Question 13

what are the symptoms of chronic liver disease (A-J)

Answer 13

A- asterixis (liver flap)
B- bruising
C-clubbing
D- dyputren’s contracture
E- erythema (palmar)
F- fetor hepaticus (musty smell of breath)
G- gynacomastia
H- hairloss
I- itching (pruitis)
J- jaundice

Question 14

what are caput medusae?

Answer 14

abdominal distended superficial veins
direction below umbillicus towards the legs