Gastroenterology

Question 1

What are the clinical features of Whipple’s disease and what is the name of the organism that it is caused by, how is it best diagnosed and how is it treated?

Answer 1

Joint pain (polyarthropathy), chronic cough, intermittent, low-grade fevers, abdominal pain, diarrhoea, weight loss. Increased skin pigmentation is seen in 50% of patients.
Organism: Tropheryma Whippeli (G+ bacillus)
Diagnosis: Jejunal Biopsy (PAS positive macrophages)
Treatment: Co-Trimoxazole or Doxycycline combined with Hydroxychloroquine for 1 year. Can also give Amoxicillin

Question 2

What is Hydatid Disease

Answer 2

Echinococcosis is a parasitic disease of tapeworms of the Echinococcus type.[1] The two main types of the disease are cystic echinococcosis and alveolar echinococcosis.[1] Less common forms include polycystic echinococcosis and unicystic echinococcosis.[1] The disease often starts without symptoms and this may last for years.[1] The symptoms and signs that occur depend on the cyst’s location and size.[1] Alveolar disease usually begins in the liver but can spread to other parts of the body, such as the lungs or brain.[1] When the liver is affected the person may have abdominal pain, weight loss, and turn slightly yellow from jaundice.[1] Lung disease may cause pain in the chest, shortness of breath and coughing.[1]

Question 3

Name 5 drugs which may be associated with cholestatic liver injury:

Answer 3

FACCC
1. Flucloxacillin
2. Azathioprine
3. Chlorpromazine
4. Captopril
5. Cyclosprine
Bonus: Penicillamine, OCP, Erythromycin

Question 4

Name 6 drugs which may be associated with hepatic liver injury:

Answer 4

P I P E R A

1. Paracetamol
2. Isoniazid
3. Phenytoin
4. Ethanol
5. Rifampicin
6. Allopurionol

Question 5

Name 3 drugs which may be associated with mixed hepatic/cholestatic liver injury:

Answer 5

1. Co-Amoxiclav
2. Sulphonamides
3. Sulfasalazine
   Bonus: Carbamazepine

Question 6

Name 5 causes of protein losing enteropathy

Answer 6

1. IBD
2. Pseudomembranous colitis
3. Sarcoidosis
4. CMV colitis
5. TB
   Bonus: connective tissue diseases

Question 7

What is Gilbert’s Syndrome? How is it treated?

Answer 7

Gilbert’s syndrome (GS) is a mild liver disorder in which the liver does not properly process bilirubin. Many people never have symptoms. Occasionally there is scleral icterus. Other possible symptoms include feeling tired, weakness, and abdominal pain.

Usually no treatment required, however sometimes Phenobarbital is used.