Gastroenterology

Question 1

Obesity + abnormal LFTs = ?

Answer 1

NAFLD

Question 2

Coeliac disease is associated with which cancer?

Answer 2

T cell lymphoma

Question 3

How does carcinoid syndrome affect the heart?

Answer 3

It can cause tricuspid insufficiency and pulmonary stenosis

Question 4

What are the criteria for treating a pt with ascites with regards to SBP prophylaxis?

Answer 4

Pts with ascites (with protein conc ≤ 15) should be given PO ciprofloxacin

(norfloxacin if cipro C/I)

Low protein = low IG + complement (as they are also proteins) ∴ ↑susceptibility to infections

Question 5

Memory tool:

How to remember treatment and prophylaxis of SBP (and coincidentally meningitis)

Answer 5

Treat = cefoTaxime
Prevent = ciProfloxacin

Question 6

What is the psoas sign?

Answer 6

RLQ pain with extension of R hip, or with flexion of R hip against resistance

Question 7

Why are 5-ASAs useful for UC but not Crohn’s?

Answer 7

They are broken down by colonic bacteria, so work locally in the colon and don’t affect other parts of the GIT

Question 8

Monitoring test for haemochromatosis?

Assume pt is treated with venesection

Answer 8

Ferritin and transferrin saturations

Question 9

Most common organism in SBP?

Answer 9

E.coli

> E.coli lives in the gut
In ascites, gut becomes ‘leaky’
E.coli colonises peritoneal cavity

Question 10

Cause of itch in cholestasis?

Answer 10

Increased bilirubin

Uraemic pruritus is associated with CHRONIC uraemia (i.e. CKD), not acute uraemia

Question 11

What antibodies are typically seen in autoimmune hepatitis?

Answer 11

Anti-nuclear antibodies (ANA)

Anti-smooth muscle antibodies (anti-SMA)

Question 12

Best investigation for acute liver failure?

Answer 12

Prothrombin time

Prothrombin has a shorter half-life than albumin, making it a better measure of acute failure

Question 13

Second line for acute Crohn’s flare, which is not responding to IV hydrocortisone?

Answer 13

Infliximab, adalimumab

Anti-TNF⍺ agents

Question 14

Life threatening C.diff tx

Answer 14

IV metronidazole + ORAL vancomycin

Question 15

What is a ‘lead pipe colon’?

Answer 15

Complete loss of haustral markings in distal colon, making it look like a smooth pipe on XR/barium enema

Question 16

What is pellagra and how does it present?

Answer 16

Vitamin B3 (niacin) deficiency

‘dermatitis, dementia, diarrhoea, eventual death’

Question 17

Sudden, severe abdominal pain + abdominal distension + tender hepatomegaly = ?

Answer 17

Budd-Chiari / hepatic vein thrombosis

Question 18

How do you differentiate between IDA and AoCD from bloods?

Answer 18

Both are microcytic anaemias.

TIBC is HIGH in IDA
TIBC is LOW in AoCD

In AoCD, ferritin is high, indicating the body is storing iron outside of the blood to keep it away from bacteria (in context of chronic infections) or blood loss (e.g. malignancies, CKD)
TIBC is low, indicating all iron is already bound to avoid being dispersed and lost.