Gastroenterology

Question 1

What kind of oesophageal cancer is associated with GORD and Barretts

Answer 1

Adenocarcinoma is rapidly rising cause of oesophageal Ca in UK- associated with GORD/Barretts

Squamous cell carcinoma is most common type in developing world, associated with alcohol/smoking etc

Question 2

Management of Crohns Disease: inducing vs maintaining remission

Answer 2

Stop smoking

Inducing Remission:
- Glucocorticoids (topical/po/IV) - budesonide is an alternative
- 5 ASA drugs- ie mesalazine
- azathioprine or mercaptopurine*may be used as an add-on medication to induce remission but is not used as monotherapy. - Methotrexate is an alternative to azathioprine
- infliximab is useful in refractory disease and fistulating Crohn’s. Patients typically continue on azathioprine or methotrexate
- metronidazole is often used for isolated peri-anal disease

Maintaining remission:
- azathioprine or mercaptopurine is used first-line to maintain remission
- methotrexate 2nd line

Surgery for complications

Question 3

What blood results would you see in hepatocellular, cholestatic vs mixed disease

Answer 3

Hepatocellular: hepAT = raised AlT
ALT - raised at least 2 fold
ALP normal
ALT/ALP ratio 5+

Cholestatic:
ALT normal
ALP raised at least 2 fold
ALT/ALP ratio <2

Mixed:
ALT raised at least 2x
ALP raised at least 2x
ALT/ALP ratio 2-5

Question 4

What drugs are risk factors for c.diff?

Answer 4

Clindamycin
PPIs
second gen cephalosporins ie cefuroxime

Question 5

What are the features of carcinoid tumours?

Answer 5

flushing (often the earliest symptom)
diarrhoea
bronchospasm
hypotension
right heart valvular stenosis (left heart can be affected in bronchial carcinoid)
other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing’s syndrome
pellagra can rarely develop as dietary tryptophan is diverted to serotonin by the tumour

Question 6

What is the management of carcinoid tumours?

Answer 6

somatostatin analogues e.g. octreotide
diarrhoea: cyproheptadine may help

Question 7

What are the best investigations for carcinoid tumours?

Answer 7

urinary 5-HIAA
plasma chromogranin A y

Question 8

Features of Giardia infection

Answer 8

Giardia causes fat malabsorption, therefore greasy floating stool can occur. Abdo pain, diarrhoea and bloating/ It is resistant to chlorination, so risk of transfer in swimming pools.

Question 9

What is the most common cause of hepatocellular carcinoma in the UK?

Answer 9

Hep C - C=Continential ie most common in europe
Hep B- B= gloBe ie most common worldwide