Gastroenterology

Question 1

What drugs are used to maintain remission in Crohn’s?

Answer 1

Azathioprine or mercaptopurine is used first-line
Methotrexate 2nd line

Question 2

What drugs should be used to induce remission in Crohn’s?

Answer 2

Steroids 1st line
Enteral nutrition (if concerns about steroids eg in kids)
2nd line - Mesalazine

Question 3

What drugs are used to maintain remission in Ulcerative Colitis?

Answer 3

1st line - Aminosalicylate (e.g., oral or rectal mesalazine)
Following a severe relapse or ≥2 exacerbations in the past year - Azathioprine

Question 4

What drugs should be used to induce remission in acute mild to moderate Ulcerative Colitis?

Answer 4

(rectal) Aminosalicylate (Mesalazine) is 1st line
Add in oral mesalazine if extensive disease or if the above doesn’t work
2nd line - steroids

Question 5

What drugs should be used to induce remission in acute severe Ulcerative Colitis?

Answer 5

IV steroids (methylprednisolone)

Question 6

What are the features of Crohn’s?

Answer 6

• Entire gastrointestinal tract affected
• Transmural (full thickness) inflammation
• Skip lesions
• Perianal disease (skin tags & ulcers)

Question 7

What are the features of Ulcerative Colitis?

Answer 7

• Continuous inflammation limited to the colon and rectum
• Only superficial mucosa affected
• Crypt abscesses & pseudopolyps
• Mucous and blood in diarrhoea

Question 8

What other conditions are associated with inflammatory bowel disease?

Answer 8

Erythema nodosum
Pyoderma gangrenosum
Enteropathic arthritis
Primary sclerosing cholangitis (particularly with ulcerative colitis)
Red eye conditions

Question 9

What causes Haemochromatosis?

Answer 9

Autosomal recessive -mutation on human haemochromatosis protein (HFE) gene on chromosome 6

Question 10

What two blood tests should be done to diagnose Haemochromatosis?

Answer 10

Ferritin and Transferrin saturation

Question 11

How should an oesophageal vatical haemorrhage be managed?

Answer 11

ABCDE approach
Give Terlipressin, a vasopressin analogue
Prophylactic antibiotics
Endoscopy when stable + variceal band ligation

Question 12

What scoring system should be used to access the likelihood of an upper GI bleed?

Answer 12

Glasgow-Blatchford Bleeding Score

Question 13

What is the Rockall score used for?

Answer 13

Is used after endoscopy for upper GI bleed to estimate the risk of rebleeding and mortality.

Question 14

What are the most common causes of upper GI bleeds?

Answer 14

Peptic ulcers (the most common cause)
Mallory-Weiss tear
Oesophageal varices
Stomach cancers

Question 15

What is Rovsing’s sign?

Answer 15

In appendicitis - RIF pain on palpation of LIF

Question 16

What serotype (gene) is associated with coeliac disease?

Answer 16

HLA-DQ2

Question 17

How is primary biliary cholangitis treated?

Answer 17

Ursodeoxycholic acid
Colestyramine for symptoms of pruritus
Replacement of fat-soluble vitamins

Question 18

What do LFT’s and antibodies show in Primary biliary cholangitis?

Answer 18

Raised ALP
Anti-mitochondrial antibodies (AMA)
Anti-nuclear antibodies (ANA)

Question 19

What are the signs of Primary biliary cholangitis?

Answer 19

Often asymptomatic
Fatigue and Pruritus (itching)
Gastrointestinal symptoms and abdominal pain
Jaundice
Pale, greasy stools and dark urine

Question 20

What do the LFT’s show in an obstructive (cholestatic) pattern?

Answer 20

High bilirubin
High ALP
Normal ALT

Question 21

What do the LFT’s show in a hepatic injury pattern?

Answer 21

Very high ALT – between 200- 2000 U/L
Varying bilirubin
Slightly raised ALP – should be no higher than 2x normal.
Increased PT

Question 22

What is first-line in C.diff?

Answer 22

Oral vancomycin