GP Gastrology

Question 1

A 35 year old woman presents with jaundice, RUQ pain and pruitis: whats this presentation typical of?

Answer 1

Primary Sclerosing Cholangitis

biliary disease of unknown aetilogy causing inflammation and sclerosis of the biliary tree.

Question 2

What is the most common association for patients with PSC to have?

Answer 2

80% of patients with PSC have Ulcerative colitis

**additional risk of complication of cholangiocarcinoma

Question 3

What are the appropriate blood tests to order to confirm/rule out a diagnosis of coeliac?

Answer 3

• Tissue transglutaminase (TTG) antibodies
• Endomyseal (EMAs) antibody
  
  • both IgA
  • **however some patients are severely IgA deficient
• anti-casein antibodies are also found in some patients
• anti-gliadin antibody tests NOT recommended by NICE

Question 4

Who is most vulnerable to develop Spontaneous bacterial Peritonitis?

Answer 4

Patients with ascites.

Most commonly due to liver cirrhosis

Question 5

When is it indicated to give prophylactic antibodies against spontaneous bacterial peritonitis?

**and what antibiotics do you use?

Answer 5

When the patient has ascites

+ a protien conc <15 g/L or

+ a previous episode of SBP or

+ child pugh score of 9 or more

They should be given ciprofloxacin or norfloxacin prophylactically

Question 6

What tests do you need to make a diagnosis of spontaneous bacterial peritonitis?

Answer 6

• Paracentesis of the ascitic fluid with show
  
  • Neutrophil cound >250 cells u/l
  • Positive organism culture (usually E.coli)

Question 7

What should you look for on abdominal xray to confirm toxic megacolon?

Answer 7

• Transverse Colon >6cm
• Additional signs of systemic upset

Question 8

Which of iron, folate and B₁₂ are those with coeliac disease deficient in?

Answer 8

All three.

This is because coeliacs causes villous atrophy in all regions of the bowel (although maximum impact is seen in the duodenum)

• B12: absorbed in the terminal ileum
• Folate: in the duodenum and jejunum
• Iron: mainly in the duodenum

Question 9

What HLA strands are associated with coeliacs?

Answer 9

HLA-DQ2 and HLA-DQ8

Question 10

What conditions are associated with coeliacs disease?

Answer 10

• Autoimmune thyroid disease
• Dermatitis Herpetiformis
• Irritable Bowel Syndrome
• Type 1 Diabetes

Question 11

What are the three types of bowel ischaemia thatcan occur?

Answer 11

• Acute Mesenteric Ischaemia: sudden, acute, impacts small bowel (typically due to an embolis)
• Chronic Mesenteric Ischaemia: uncommon, thought of as ‘intestinal angina’
• Ischaemic colitis: acute but transient, affects the small bowel.

Question 12

What vessel is usually impacted in acute mesenteric ischaemia and what is the treatment?

Answer 12

The superior mesenteric artery

Tx is surgery, however prognosis is often poor if surgery is delayed.

Question 13

What vessels are more likely to be impacted in ischaemic colitis?

Answer 13

More common in the watershed ares such as the splenic flextures

• located at the borders of the territory supplied by the superior and inferior mesenteric arteries.

Question 14

how to diagnose ischaemic colitits?

Answer 14

• Thumbprinting can be seen on abdominal xray due to mucosal heamorrhage/oedema

Question 15

Raised transferrin saturation and ferritin, with low TIBC

This is a characteristic blood result of what disease and why do we get these results?

Answer 15

Haemachromatosis

this is a condition which produces increased iron, leading to increasingly saturated transferrin and raised ferritin.

As ‘TIBC’ refers to total iron binding capacity on transferrin binding sites, this is actually decreased.

Question 16

Haemachromotosis is caused by a gene mutation of the ____ gene.

On xray joints will show evidence of _______

Answer 16

Haemachromotosis is caused by a gene mutation of the HFE gene.

On xray joints will show evidence of chondrocalcinosis

Question 17

What investigations will help diagnose Chrohns disease?

Answer 17

• Faecal calceprotein
• Raised inflammatory markers
• Anaemia
• Low B12 and vitamin D

Question 18

What is it called when you have a sweet, faecal breath, and what is this an indicative of?

Answer 18

Fetor Hepaticus: this is indicative of liver failure

a late sign of hepatic encephalopathy

Question 19

Features of Wilsons Disease

Answer 19

Liver: hepatitis, cirrhosis

Neurological: basal ganglia degeneration, speech, behavioural and psychiatric problems

asterixis, chorea, dementia

Kayser Fleischer rings

Renal Tubular Acidosis

Haemolysis

Blue Nails

Question 20

What tests could prove a diagnnosis of Wilsons Disease

Answer 20

Reduced serum caeruloplasmin

Reduced Serum copper (counter-intuitive, but 95% of plasma copper is carried by caeruloplasmin)

Increased 24-hour urinary copper excretion

Question 21

Really high amylase is an indication of…..

Answer 21

Pancreatitis!

Think of the anagram GET SMASHED

Question 22

Intestinal angina is also know as what?

What is the classical triad seen in this disease?

Answer 22

Also known as Chronic Mesenteric Ischaemia

Triad of:

1. Severe, colicky, post-prandial pain
2. Weight loss
3. Abdominal bruit

However this pathology can also be relatively non-specific!
Usually results from long-standing atherosclerotic disease of 2 or more mesenteric vessels

Question 23

Associations with Helicoabctor Pylori?

Answer 23

• Peptic Ulcer Disease: Duodenal and gastric
• Gastric Cancer
• B cell thyomas of MALT tissue (80% regression with treatment)
• Atrophic Gastritis

Question 24

Management of H. Pylori?

Answer 24

Triple Therapy of

PPI + amoxicillin + clarithromycin OR

PPI + metronidazole + clarithromycin

***statins and clarithromycin don’t mix!

Question 25

How to diagnose for H. Pylori involvement?

Answer 25

• Stool antigen test or
• Carbon-13 urea breath test. (Recommended to confirm eradication)