Gastro

Question 1

What ix to diagnose portal hypertension?

Answer 1

Hepatic venous pressure gradient >5mmHg diagnostic

Question 2

when to restart aspirin for secondary CV prevention after bleeding PUD 2’ aspirin use?

Answer 2

1-7 days after initiation of PPI and cessation of bleeding

Question 3

when is repeat upper endoscopy repeated to verify ulcer resolution?

Answer 3

• persistent symptoms after 8-12/52 of therapy
• ulcers of unknown cause
• did not undergo gastric ulcer biopsy during the initial upper endoscopy

Question 4

diagnosis of autoimmune pancreatitis involves?

Answer 4

• presence of narrowed main pancreatic duct and parenchymal swelling (sausage shaped pancreas) on imaging

+

disease response to glucocorticoids

Question 5

Type 1 vs Type 2 autoimmune pancreatitis?

Answer 5

Type 1: high igG4 positive cells in pancreatic tissue +/- High serum IgG4

type 2: normal IgG4 positive cell counts

Question 6

treatment of type 1/2 autoimmune pancreatitis?

Answer 6

glucocorticoids

• usually high dose oral prednisone tapered over 2-3 months

Question 7

tx of autoimmune pancreatitis?

Answer 7

prednisolone + azathioprine
- usually treat for 2-3 years before consideration of withdrawal

Question 8

what liver lesion can be caused by OCP?

Answer 8

hepatic adenomas
- should stop OCP and undergo f/u imaging to confirm stability or regression in lesion size

Question 9

in patients with selective IgA deficiency, what ix to test for coeliac disease?

Answer 9

IgG antibodies to deamidated gliadin peptide or TTG

Question 10

what ix is required to diagnose small intraheptic duct stenosis in PSC?

Answer 10

liver biopsy

• when MRCP negative for large bile duct stenosis, may still be small duct PSC

Question 11

when to start screening for colorectal cancer in patients with IBD?

Answer 11

surveillance colonoscopy should be done 8 years after diagnosis and then every 1 - 2 years thereafter

Question 12

what other specific cancer to screen for in women with IBD?

Answer 12

pap smear annually to screen for cervical cancer

Question 13

what are causes of ascites with high SAAG (ie >11g/L)

Answer 13

cirrhosis and non cirrhotic causes e.g. heart failure

Question 14

how to differentiate between ascites caused by cirrhosis vs heart failure?

Answer 14

total protein level in cirrhosis ascites is low: <25g/L

total protein level in cardiac ascites is high > 25g/L

Question 15

most common cause of cholestatic hepatitis causing obstructive LFT derangement?

Answer 15

drug induced liver injury

Question 16

need for follow up of incidental fundic gland polyps seen on endoscopy?

Answer 16

no follow up required

funds gland polyps are the most common benign epithelial gastric polyp

Question 17

when to restart warfarin in patients with GI bleeding after endoscopic treatment?

Answer 17

within 7 days after discontinuation

Question 18

screening for colon cancer/stomach and small bowel cancers in Lynch syndrome?

Answer 18

Lynch syndrome: caused by mutations in mismatch repair genes MLH1, MSH2, MSH6, PMS2

colonoscopy from age 20-25,
upper endoscopy from age 30-35

Question 19

what size of gallbladder polyps would you be worried about?

Answer 19

size >1cm - Risk factor for malignancy
- should treat with cholecystectomy

*gallbladder polyps associated with gallbladder stones or PSC more likely to be neoplastic regardless of polyp size

Question 20

tx of functional dyspepsia not responsive to trial of PPI?

Answer 20

tricyclic antidepressant

Question 21

treatment of persistent H pylori infection after initial tx with triple therapy?

Answer 21

Bismuth + metronidazole, tetracycline + PPI

Question 22

ix to diagnose gastroparesis?

Answer 22

4 hour gastric scintigraphy

Question 22

what medications may cause microscopic colitis?

Answer 22

NSAIDs, PPIs, SSRIs

Question 23

management of microscopic colitis?

Answer 23

• discontinue potentially causative medications
• symptomatic tx with loperamide
• possibly progression to oral budesonide

Question 24

after GI bleeding, when to continue and when to stop aspirin afterwards?

Answer 24

aspirin for primary prevention of CVD should be stopped aspirin for secondary prevention of MI/Stroke should be restarted as soon as haemostasis is achieved

Question 25

when to do cholecystectomy in patients who have had gallstone pancreatitis?

Answer 25

cholecystectomy before hospital discharge

Question 26

what antibiotics are indicated for infected pancreatic necrosis?

Answer 26

- carbapenem alone (e.g. imipenem) or - quinolone, ceftazidime, cefepime + metronidazole

Question 27

when to start screening colonoscopy in patients with first degree relative with colon cancer or advanced polyp

Answer 27

age 40 or 10 years earlier than the age at which relative was diagnosed

Question 28

what is menetrier disease?

Answer 28

overproduction of TGF alpha stimulates EGF and proliferation of epithelial cells -> leading to protein losing hypertrophic gastropathy, presenting with epigastric pain, weight loss, nausea/vomiting, oedema

Question 29

diagnosis of menetrier disease?

Answer 29

low albumin, upper endoscopy with biopsy: giant mucosal folds in gastric fungus and body - should also test for CMV, h pylori

Question 30

what is the mechanism of action of cetuximab?

Answer 30

monoclonal antibody that targets EGFR

Question 31

SIBO: how does this affect B12/ folate levels?

Answer 31

Usually high folate (may be elevated due to bacterial synthesis), low B12

Question 32

mx of hydatid liver cyst?

Answer 32

albendazole + surgery

Question 33

what tx for secondary prophylaxis for patients who are at high risk of c diff infection?

Answer 33

can given oral vancomycin prophylaxis for those receiving systemic abx

Question 34

first line tx of achalasia?

Answer 34

endoscopy + pneumatic dilation

Question 35

where are majority of gastrinomas found?

Answer 35

duodenum - minority in pancreas

Question 36

how to differentiate between gastrinomas and other causes of hypergastrinaemia?

Answer 36

secretin stimulation test - gastrinoma cells release gastrin in response to secretin, while secretin inhibits normal gastric G cells

Question 37

how often to repeat colonoscopy in patients with UC and PSC?

Answer 37

yearly