Gastroenterology and Hepatology

Question 1

First line Tx in MALToma

Answer 1

H pylori eradication (induces remission in up to 70% of patients) and then biopsy every three months. If not works, can use imatinib and rituximab in combination

Question 2

Antibiotics and presentation Entamoeba histolytica

Answer 2

Metronidazole. Up to 1 - 3 week of bloody diarrhoea

Question 3

Antibiotics in campylobacter and salmonella

Answer 3

Quinolones or cephalosporins

Question 4

Treatment of anal fissure

Answer 4

1. Soften stool through fibre diet 2. GTN ointment 3. Lidocaine ointment 4. Oral amlodipine / Botox injections

Question 5

Hep A effect on hepatocytes

Answer 5

Necrosis

Question 6

How does alcohol cause a hypo?

Answer 6

Alcohol impacts pancreatic microcirculation and leads to release of insulin and over shoot of first phase insulin release

Question 7

Pharmacological tx of varices

Answer 7

Question 8

Interventional tx for varices

Answer 8

Question 9

Interventions for consequences of portal hypertension

Answer 9

Question 11

Whipple’s disease

Answer 11

Triad: chronic cough, weight loss with steatorrhoea and arthritis

Biopsy will show infiltration of lamina propria with PAS macrophages

Up to two years of antibiotics such as co-trimoxazole required

Infection with tropheryma whipplei

Question 12

Tropical sprue presentation

Answer 12

diarrhoea, abdominal pain and weight loss but no chronic cough

Question 13

Treatment UC vs CD

Answer 13

Question 14

Ix and Tx for PSC

Answer 14

Progressive bile duct inflammation, stricutring and cholestasis, best visualised using MRCP

“rosebead appearance”

also antibodies: p-ANCA (but AMA in PBC is much more diagnostic)

60-70% in those with UC

Presentes with fatigue and pruritus, obstructive jaundice and cirrhosis. but can be asx.

tx: cholestyramine relieves pruritus, ursodeoxycholic acid, antibiotics for bacterial cholangitis

Question 15

Difference creon and cholestyramine

Answer 15

Creon: Pancreatic insufficeincy diarrhoea

Cholestyramine: bile acid diarrhoea, which is seen due to malabsorption related to Crohn’s or small bowel resection

Question 16

Modern Hep B and Hep C treatment

Answer 16

Hep B: nucleotide analogue e.g. tenofovir

Question 17

Bacterial overgrowth sx, side effects and tx

Answer 17

Early satiety, bloating and intermittent diarrhoea, increase in flatulence.

Positive lactulose hydrogen breath test

B12 deficiency (and macroblastic anaemia) can be due to bacteria using B12 for their metabolism.

Tx: rifaximin - alternatives metronidazole and tetracyclines

Question 18

Flare up of UC steroids fail within 72 hours

Answer 18

If not dialted to more than 6cm, then may attempt cyclosporin to induce remission

Question 19

What are contraindications to trnascutaneous liver biopsy?

Answer 19

ascites, INR > 1.6, platelets <60,

Question 20

well recognised complication of coeliac disease

Answer 20

splenic atrophy

Question 21

Mechanism that prevents reflux

Answer 21

Question 22

How do you recognise and manage serious paracetamol overdose?

Answer 22

INR

Bilirubin

Hepatic encepahlopathy

worsenins acidosis

worsening kidney disease

Question 23

Kings college criteria

Answer 23

Question 24

Carcinoid syndrome dx

Answer 24

24 hr HIAA urine