Gastroenterology

Question 1

Alcoholic Liver Disease

1. CAGE questions
2. What questionnaire can be used to screen people for harmful alcohol use?
3. A score of what gives an indication of harmful use?
4. Complications of alcohol
5. Investigations
6. General management of ALD
7. What score can be used to score the patient on their withdrawal symptoms?
8. What drug is commonly used to combat the effects of alcohol withdrawal?
9. Presentation of delirium tremens
10. Features of Wernicke’s encephalopathy
11. Features of Korsakoff’s syndrome

Answer 1

1. Cut down? Annoyed? Guilty? Eye opener?
2. AUDIT questionnaire
3. 8 or more
4. Liver disease, Wernicke-Korsakoff encephalopathy, cirrhosis, alcohol dependence and withdrawal, pancreatitis, alcoholic cardiomyopathy
5. FBC, LFTs, clotting, U+Es, US, fibroscan, endoscopy, CT and MRI, liver biopsy
6. Stop drinking, detoxification regime, thiamine and high protein diet, steroids (if severe hepatitis), treat complications of cirrhosis
7. CIWA-Ar
8. Chlordiazepoxide
9. Acute confusion, agitation, tremor, hallucinations, tachycardia, hypertension, ataxia, arrhythmias
10. confusion, oculomotor disturbances, ataxia
11. memory impairment, behavioural changes

Question 2

Liver Cirrhosis

1. Causes
2. Investigations
3. ELF test - what does it measure?
4. Signs of cirrhosis on US
5. Screening for HCC
6. What score can be used to indicate the severity of cirrhosis and prognosis?
7. What factors are taken into account in this score?
8. General management of cirrhosis
9. Complications of cirrhosis
10. Treatment of stable varices
11. Treatment of bleeding varices
12. What type of ascites does cirrhosis produce?
13. Management of ascites
14. Most common organisms causing SBP
15. Management of hepatic encephalopathy

Answer 2

1. Alcoholic liver disease, hepatitis B, hepatitis C, NAFLD (most common causes)
2. LFTs, coagulation, U+Es, liver screen to establish cause, AFP, ELF test, US, fibroscan, endoscopy, CT and mRI, liver biopsy
3. HA, PIIINP, TIMP-1
4. nodularity of liver surface, corkscrew appearance of hepatic arteries, enlarged portal vein with reduced flow, ascites, splenomegaly
5. 6 monthly with AFP and US
6. Child-Pugh score
7. Bilirubin, albumin, encephalopathy, ascities, INR
8. Screening for HCC, endoscopy every 3 years to check for varices, high protein low sodium diet, MELD score every 6 months, consider transplant, managing complications
9. Malnutrition, portal HTN, HCC, hepatic encephalopathy, varices, ascites, hepatorenal syndrome, SBP
10. Propranolol, elastic band ligation, injection of sclerosant. TIPS
11. Vasopressin analogues, correction of coagulopathy, prophylactic ABx, urgent endoscopy with injection of sclerosant or elastic band ligation . When endoscopy fails, a sengstaken-blakemore tube can be inserted
12. Transudative
13. Low sodium diet, spironolactone, paracentesis, prophylactic antibiotics, consider TIPS/transplant if refractory
14. E.coli, K.pneumoniae, gram positive cocci
15. Laxatives, antibiotics eg. rifaximin, nutritional support

Question 3

NAFLD

1. Risk factors
2. Investigations
3. Management of NAFLD

Answer 3

1. Obesity, poor diet, T2DM, high cholesterol, middle age, smoking, HTN
2. liver US, ELF test, NAFLD fibrosis score, fibroscan
3. Weight loss, exercise, smoking cessation, control of diabetes, BP, cholesterol, stop drinking, vitamin E or pioglitazone

Question 4

Hepatitis

1. Presentation
2. What is the most common hepatitis worldwide?
3. Hep A: DNA or RNA virus?
4. Transmission?
5. Management?
6. Prevention?
7. Hep B: DNA or RNA virus
8. Transmission?
9. Screening for hepatitis - which viral markers?
10. Management?
11. Prevention?
12. Hep C: DNA or RNA virus?
13. Testing?
14. Management?
15. Hep D: DNA or RNA virus?
16. What is significant about it?
17. Hep E: DNA or RNA virus?
18. Transmission?
19. Management?
20. Prevention?
21. Autoantibodies in type 1 AIH
22. Autoantibodies in type 2 AIH
23. Treatment

Answer 4

1. Pain, fatigue, pruritus, muscle and joint aches, N+V, jaundice, fever
2. Hepatitis A
3. RNA
4. Faecal-oral
5. Analgesia, notify public health
6. Vaccination
7. DNA
8. direct contact with blood or bodily fluids, vertical transmission
9. HBsAg, HBcAb
10. Screen for other BBV, referral, notify to public health, lifestyle, testing for cirrhosis and HCC, antiviral meds, liver transplant
11. Vaccination - part of 6 in 1
12. RNA
13. Hep C antibody, RNA testing
14. Screen for other BBV, referral, public health, lifestyle, testing for cirrhosis and HCC, antiviral treatment with DAAs, liver transplant for end-stage
15. RNA
16. Need to have HBV co-infection
17. RNA
18. Faecal-oral route
19. None
20. None
21. ANA, anti-smooth muscle, anti soluble liver antigen
22. Anti-LKM1, anti-LC1
23. high dose steroids