Gastroenterology

Question 1

Inducing remission in UC

Answer 1

1)Proctitis
- topical (rectal) aminosalicylate
- after 4 weeks, add an oral aminosalicylate
- add topical or oral corticosteroid
2) proctosigmoiditis and left-sided ulcerative colitis
- topical (rectal) aminosalicylate
- after 4 weeks, add a high-dose oral aminosalicylate OR switch to a high-dose oral aminosalicylate and a topical corticosteroid
- stop topical treatments and offer an oral aminosalicylate and an oral corticosteroid
3) extensive disease
- topical (rectal) aminosalicylate and a high-dose oral aminosalicylate
- after 4 weeks, stop topical treatments and offer a high-dose oral aminosalicylate and an oral corticosteroid

4)SEVERE colitis
-admit
- IV steroids are usually given first-line
(IV ciclosporin may be used if steroids are contraindicated)
- after 72 hours add IV ciclosporin to IV corticosteroids or consider surgery

Question 2

Maintenance of remission in UC

Answer 2

Following a mild-to-moderate ulcerative colitis flare:
1) proctitis and proctosigmoiditis
- topical (rectal) aminosalicylate alone (daily or intermittent) or
- an oral aminosalicylate plus a topical (rectal) aminosalicylate (daily or intermittent) or
- an oral aminosalicylate by itself: this may not be effective as the other two options
2)left-sided and extensive ulcerative colitis
- low maintenance dose of an oral aminosalicylate

3)Following a severe relapse or >=2 exacerbations in the past year
- oral azathioprine or oral mercaptopurine

Question 3

Inducing remission in Crohn’s disease

Answer 3

1st line- glucocorticoids (PO, topical or IV)
2nd line- 5-ASA drugs e.g. meslazine
3rd line- can add on azathioprine or mercaptopurine

NOTE: metro used for isolated peri-anal disease

Question 4

Maintaining remission in Crohn’s disease

Answer 4

1st line- azathioprine or mercaptopurine (NOTE: TPMT activity should be assessed before starting)
2nd line- methotrexate is used second-line

Question 5

What is the most useful investigations to monitor response to haemochromatosis management?

Answer 5

Ferritin and transferrin saturation

Question 6

What are the possible adverse effects of metoclopramide?

Answer 6

1) extrapyramidal effects
-acute dystonia e.g. oculogyric crisis
2) diarrhoea
3) hyperprolactinaemia
4) tardive dyskinesia
5) parkinsonism

Question 7

What are ALT, ALP and ALT/ALP ratio in hepatocellular disease (paracetamol OD)?

Answer 7

Raised (at least 2 fold) ALT, ALP normal, ALT/ALP high (5+)

Question 8

What are ALT, ALP and ALT/ALP ratio in Cholestatic disease?

Answer 8

Normal ALT. Raised ALP (at least 2 fold), ALT/ALP <2

Question 9

How do yo treat bile acid malabsorption?

Answer 9

Cholestyramine

Question 10

What are risk factors for small bowel bacterial overgrowth syndrome?

Answer 10

neonates, scleroderma, diabetes mellitus

Question 10

What are both types of oesophageal associated with?

Answer 10

Adenocarcinoma- Barrett’s oesophagus (US/UK)- lower third
Squamous cell carcinoma- Achalasia (third world)- upper two thirds

Question 11

What is TIBC in IDA vs in Anaemia of Chronic disease?

Answer 11

IDA- high TIBC
Anaemia of Chronic Disease- low/normal

Question 12

What is Peutz-Jeghers syndrome?

Answer 12

• Autosomal dominant
  -Hamartomatous polpypis in GI tract (mainly small bowel)
  -Can present as small bowel obstruction or GI bleeding
  -Pigmented lesions on lips, oral mucosa, face, palms and soles

Question 13

How do you treat a complex perianal abscess?

Answer 13

Seton placement