GI learning from pastest

Question 1

What are the key features of Acute Fatty Liver of Pregnancy?

Answer 1

• 3rd Trimester
• Hypoglycaemia
• Disseminated intravascular coagulation
• elevated WCC, low albumin
• Need to correct low glucose, coagulopathy and deliver immediately

Question 2

What is the clinical presentation of intrahepatic cholestasis of pregnance?

Answer 2

2nd/3rd trimester
raised bile acids >10
pruritis

Question 3

how do you treat intrahepatic cholestasis of pregnancy (ICP)?

Answer 3

Ursodeoxycholic acid
delivery

Question 4

What are the clinical features of haemochromatosis?

Answer 4

Increased iron absorption due to HFE mutation leads to excess iron deposition in skin, pancreas, joints, heart, liver, pituitary, adrenals.
- increased skin pigmentation
- diabetes
- pituitary dependant hypothyroidism and impotence
-abnormal LFTs
- joint pain

AUTOSOMAL RECESSIVE

Tests with
- Transeferrin saturation
- HFE gene analysis
- Liver biopsy to assess extent of cirrhosis associated.

Treated with venesection. Liver transplant considered if severe cirrhosis.

Question 5

What test are done for haemochromatosis?

Answer 5

• Transeferrin saturation
• HFE gene analysis
• Liver biopsy to assess extent of cirrhosis associated.

Question 6

What are the features of oesophageal candidiasis ? (endoscopy findings, symptoms, causes etc)

Answer 6

Symptoms:
heartburn
dysphagia

Endoscopy:
adherent white patches

Associated with HIV.
Not resolved by PPI.

Question 7

What are the key features of lymphocytic colitis?

Answer 7

Sertraline use
non-bloody diarrhoea
loperamide is first line therapy

Question 8

What are the markers of poor prognosis in the Glasgow criteria for alcoholic and gallstone pancreatitis?

Answer 8

1. Age >55
2. Albumin <32
3. Calcium <2
4. Glucose >10
5. LDH > 600
6. Urea >16.1
7. WBC > 15
8. PO2 < 8

A score of 3 or more is high risk for severe pancreatitis

Question 9

What are the causes of pancreatitis? (GET SMASHED)

Answer 9

Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune disease
Scorpion sting
Hypercalcaemia
Hyperlipidaemia
Drugs e.g. GLP-1, Azathioprine,

Question 10

What conditions are associated with Auto-immune hepatitis?

Answer 10

Hashimoto’s
Keratoconjunctivitis sicca
Rheumatoid arthritis
ulcerative colitis

Question 11

What is the treatment of autoimmune hepatitis

Answer 11

1. high dose corticosteroids
2. Azathioprine and occassionally ciclosporin are used as steroid sparing agents in remission.
3. Liver transplant in end stage hepatic failure.

Question 12

What would the bloods show in autoimmune hepatitis?

Answer 12

Elevated IgG
Normal (or some elevation) IgM.
Elevated ANA and Antismooth muscle.

Question 13

How do patients with familial mediterranean fever present?

Answer 13

• autosomal recessive.
• recurrent episodes of fever and peritonitis that mimic an acute surgical abdomen so may have had a laparotomy
• they are well between episodes
• Colchicine is an effective treatment.

Question 14

How do patients with carcinoid syndrome present and diagnoses?

Answer 14

A neuroendocrine tumour releasing serotonin, bradykinin and histamine.
- facial flushing
- diarrhoea
- intermittent bronchospasm / wheeze
-facial telangiectasia
- tricuspid regurgitation

Diagnosed by measuring an increase in urinary 5-hydroxyindoleacetic acid (a metabolism of serotonin)

Question 15

What test can help to rule differentiate between anaemia of chronic disease and IDA?

Answer 15

Bone marrow biopsy can estimate the iron content and rule out IDA if it is normal.

(EPO is reduced in anaemia of chronic disease. but in CKD low EPO and IDA can co-exist.)

Question 16

What is Gilbert’s Syndrome?

Answer 16

Caused by a deficiency of the enzyme which conjugates bilirubin. Results in rise in bilirubin during times of illness. Goes back to normal in a couple of weeks.

Question 17

What is Whipple’s Disease caused by?

Answer 17

Tropheryma Whippeli

Symptoms include:
1. Athralgia of large joints
2. Arthritis
3. Intermittent Diarrhoea
4. Colicky Abdo pain
5. CNS changes

Macrophages stain positive with periodic acid-Schiff (PAS) stain.

Question 18

What is the most sensitive indicator of liver damage following paracetamol overdose?

Answer 18

1. prolonged prothrombin time >100s
2. Serum Creatinine >300
3. pH<7.3

Question 19

ALP can be high in liver failure or elevated bone turnover. Is it a biliary or hepatic marker?

Answer 19

Biliary

Question 20

What is post transfusion purpura?

Answer 20

Purpuric rash that occurs after a transfusion. Usually results in a fall in platelets. Treated with high does IV immunoglobulin.

Question 21

How might Hepatitis A present in a pregnant woman?

Answer 21

recent travel
fever
rise in ALT > 1000
RUQ pain
Jaundice

Question 22

What is HELLP syndrome?

Answer 22

HELLP is the hepatic manifestation of pre-eclampsia.

• Haemolysis
  -Elevated Liver enzymers
  -Low Platelets

Occurs after 20wks and associated with hypertension > 140/90

Haemolytic anaemia within liver sinusoids causes hepatic ischaemia and transaminitis (elevated liver enzymes).

Question 23

What are the indications of Faecal Occult Blood testing?

Answer 23

• Patients aged 50 or over with unexplained abdo pain or weight loss.
• Patients aged under 60 with a change in bowel habit or iron deficiency anaemia.
• Patients aged 60 or over who have anaemia in the absence of iron deficiency