GI

Question 1

Primary sclerosing cholangitis

Answer 1

Structuring of intra and extra-hepatic ducts
ANCA positive
associated with IBD, colorectal cancer, cholangiocarcinoma, gallbladder malignancy, hepatic fibrosis leading to HCC.
On imaging, beading and structuring of the biliary tree is seen.

Question 2

Primary biliary cholangitis

Answer 2

Anti-mitochondrial antibody is positive

Question 3

MALT Lymphoma

Answer 3

Though to be primarily derived from H.pylori infection. May be associated with paraproteins and pseudohyponatremia. H.pylori eradication allows for complete remission in 80% of cases in localized cases. Originate from B cells.

Question 4

Whipple’s Disease

Answer 4

Whipple’s disease is a rare bacterial infection that affects the small intestine and can impact other organs in the body:
Symptoms
Symptoms include joint pain, abdominal pain, diarrhea, fever, weight loss, and skin darkening in areas exposed to light. Symptoms often start slowly, and gastrointestinal symptoms may occur years later. Neurological symptoms include dementia, headaches, seizures, and abnormalities of eye and facial muscle movements.
Causes
Caused by the bacterium Tropheryma whipplei,(gram positive/equivocal bacillus) Whipple’s disease mainly affects middle-aged white men. The risk factors are unknown, but it may be associated with occupational exposure to animals and soil.
Biopsies of tissue samples from the small bowel show expanded villi containing macrophages staining positive with periodic acid-Schiff stain.
Treatment
Whipple’s disease can be treated with antibiotics, such as trimethoprim/sulfamethoxazole or penicillin. If left untreated, the disease is progressive and can be fatal.
Diagnosis
A small-bowel biopsy is the most common way to diagnose Whipple’s disease. Other tests include a complete blood count (CBC), polymerase chain reaction (PCR) test, upper GI endoscopy, and small bowel enteroscopy.
Relapses
Relapses are common and can occur years after treatment. Up to 40% of patients may relapse, and relapses are more common in patients with central nervous system involvement.

Question 5

Treatment of hepatitis C

Answer 5

Daclastavir and sofosbuvir
interferon alpha and ribavarin may also be used
Sofosbuvir is used in combination with ribacvarin

Question 6

Hepatorenal syndrome

Answer 6

Hepatorenal syndrome (HRS) is the development of renal failure in patients with advanced chronic liver disease [1] and, occasionally, fulminant hepatitis, who have portal hypertension and ascites. Estimates indicate that at least 40% of patients with cirrhosis and ascites will develop HRS during the natural history of their disease.
The International Club of Ascites (ICA) proposed revised diagnostic criteria of HRS-acute kidney injury (AKI) (previously HRS type 1) in 2015, including the following [23] :
Diagnosis of cirrhosis and ascites
Diagnosis of AKI according to ICA-AKI criteria
No response after 2 consecutive days of diuretic withdrawal and plasma volume expansion with albumin 1 g/kg body weight
Absence of shock
No current or recent use of nephrotoxic drugs (nonsteroidal anti-inflammatory drugs [NSAIDs], aminoglycosides, iodinated contrast media, etc)
No macroscopic signs of structural kidney injury, as defined as an absence of proteinuria (>500 mg/day); absence of microhematuria (>50 red blood cells per high-power field [RBCs/hpf]); normal findings on renal ultrasonography

Question 7

Pancreatitis

Answer 7

fecal elastin