Gastroenterology

Question 1

Management of non-variceal bleeding:

Variceal bleeding:

Answer 1

No PPI prior to endoscopy -> given afterwards.

Management of variceal bleeding: Terlipressin and prophylactic antibiotics (prior to endsocopy)

Band ligation and injection
TIPS may be offered if bleeding from varices not controlled

Question 2

Alcoholic liver disease
Investigation findings:
Management:

Answer 2

Gamma-GT classically elevated
AST (2X) : ALT (3X is suggestive of acute alcoholic hepatitis)

Prednisolone
Pentoxyphyline is sometimes used

Question 3

Aminosalicylates important side effect:

Answer 3

Agranulocytosis -> Check FBC

Question 4

ASCITES:
Main differentiator:

SAAG >11

SAAG <11

Answer 4

SAAG > 11 indicates portal hypertension

Liver disorders
Cardiac
Other: Budd Chiari syndrome, portal vein thrombosis, veno-occlusive disease, myxoedema

Hypoalbuminaemia
Malignancy
Infections
Other: Pancreatitis, bowel obstruction, biliary ascites

Question 5

UC management:
Proctitis
Proctosigmoiditis
Extensive disease

SEVERE colitis:

Answer 5

Proctitis: rectal mesalazine

Proctosigmoiditis: Rectal mesalzaine

Extensive disease: Rectal mesalazine plus high-dose oral aminosalicylate

In general: if remission not achieved in 4 weeks, add oral aminosalicylate

If remission still not achieved, stop topical, oral aminosalicylate and add oral steroid

Should be treated in hospital: IV steroids usually given first line
IV ciclosporin may be used if steroids are contraindicated

Question 6

UC management: Maintaining remission
Proctitis and proctosigmoiditis:
Left-sided and extensive UC:

Answer 6

Proctitis and proctosigmoiditis:
Topical (rectal) aminosalicylate or rectal AS with oral AS
(monotherapy with oral is not as effective)

Oral aminosalicylate

Question 7

What is Budd-Chiari syndrome
Usually seen in:
Features:
Investigation of choice:

Answer 7

Hepatic vein thrombosis

Context of procoagulant conditions - polycythaemia, thrombophillia, pregnancy, COCP (20% cases)

Triad of: Abdominal pain // Ascites // Tender hepatomegaly

US with Doppler flow studies = very sensitive

Question 8

Features of carinoid tumours:

investigation:

Answer 8

Metastases are present in the liver and release serotonin into the systemic circulation

Flushing
Diarrhoea
Bronchospasm
Hypotension

Urinary 5-IHAA
Plasma chromogranin

Management: Somatostatin analogues octreotide

Question 9

C.difficile severity scale - based on:
Classed into:

Diagnosis

Management:

Answer 9

WCC

Mild: normal WCC
Moderate: WCC <15 3-5 loose stools/day
Severe: WCC > 15, AKI, temperature
Life-threatening: hypotension, partial or complete ileus, toxic megacolon

Made by detecting CDT C.dif toxin

First episode: oral vancomycin 10 days
second line: Fidaxomicin
Third-line oral vancomycin plus Iv metronidazole

Recurrent episode: Fidaxomicin

Life threatening: Oral vancomycin and IV metronidazole