gastroenterology

Question 1

duodenal biopsy findings in coeliac: (4)

Answer 1

villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

Question 2

when to give SBP (spontaneous bacterial peritonitis) prophylaxis?

abx of choice?

Answer 2

previous SBP
ascites and protein concenration </=15g/L

patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome

give ciprofloxacin/ norfloxacin

Question 3

Crohn’s extra intestinal manifestation

Answer 3

gallstones (due to reduced bile acid reabsorption

Question 4

Crohn’s histology

Answer 4

inflammation in all layers from mucosa to serosa
increased goblet cells
granulomas

on endoscopy skin lesions “cobblestone appearance”

Question 5

Crohn’s radiology
ix & findings

Answer 5

small bowel enema

strictures: ‘Kantor’s string sign’
proximal bowel dilation
‘rose thorn’ ulcers
fistulae

Question 6

UC extra-intestinal associations

Answer 6

PSC (primary sclerosing cholangitis)

higher risk of CRC

Question 7

UC histology

Answer 7

No inflammation beyond submucosa (unless fulminant disease) - inflammatory cell infiltrate in lamina propria
neutrophils migrate through the walls of glands to form crypt abscesses
depletion of goblet cells and mucin from gland epithelium
granulomas are infrequent

“pseudopolyps on endoscopy”

Question 8

UC radiology

ix and findings

Answer 8

barium enema

loss of haustrations
superficial ulceration, ‘pseudopolyps’
long standing disease: colon is narrow and short -‘drainpipe colon’