Gastro

Question 1

Crohn’s vs UC histology + endoscopy findings

Answer 1

Crohns:
Full wall thickness inflammation
Increased goblet cells, granulomas
Cobble-stone wall appearance on endoscopy

UC:
Inflammation restricted to submucosa
Decreased goblet cells + mucin, crypt abscesses
Pseudopolyps on endoscopy

Question 2

C. diff Rx

Answer 2

1st line PO vanc
2nd line fidaxomicin (or for recurrent)
3rd line PO vanc + IV metro (1st line in life-threatening)

Question 3

C. diff life-threatening signs

Answer 3

Hypotension
Ileus (even partial)
Toxic megacolon/CT severe disease

Question 4

PBC features

Answer 4

Associated with Sjogren’s, thyroid disease, systemic sclerosis, RA
Cholestatic jaundice
Middle-aged females most commonly
AMA M2 subtype
Raised IgM

Question 5

PBC Mx

Answer 5

Ursodeoxycholic acid
Cholestyramine for pruritis
Transplant (especially if bili>100)

Question 6

Barrett’s oesophagus RFs

Answer 6

GORD (top RF)
Male (7:1)
Smoking
Central obesity

Question 7

Barrett’s Mx

Answer 7

If metaplasia 3-5yrly endoscopy
If dysplasia radiofrequency ablation 1st line, then EMR

Question 8

Prophylaxis varices

Answer 8

Propranolol
EVL for medium-large varices, repeat OGD every 2wks until all banded
TIPSS

Question 9

UC acute Rx

Answer 9

Mild-moderate disease - 5-ASA (topical if sigmoid/rectal, systemic if further), PO steroids if no improvement 4wks
Severe - IV steroids, IV ciclosporin if CI or 72h no progress
Surgery if above not working

Question 10

HH iron studies picture

Answer 10

Transferring saturation >55% men, >50% women
Raised ferritin + iron
Low TIBC

Question 11

HH Rx and monitoring

Answer 11

Venesection 1st line
Desferrioxamine 2nd line

Aim to keep transferrin<50% and ferritin <50

Question 12

Coeliac histology

Answer 12

Villous atrophy
Crypt hyperplasia
Increased intraepithelial lymphocytes
Lymphocyte infiltration into lamina propria

Question 13

Oesophageal Ca most common type with RFs

Answer 13

Adenocarcinoma (lower 1/3)
GORD, Barrett’s, Obesity

SCC (upper 2/3)
Alcohol, achalasia, Plummer-Vinson, nitrosamine high diet

Question 14

Coeliac associated malignancy

Answer 14

Enteropathy-associated T cell lymphoma

Question 15

How long stop PPI prior to endoscopy

Answer 15

2wks

Question 16

SBP most common organism

Answer 16

E. coli

Question 17

SBP Rx

Answer 17

IV cefotaxime

Question 18

Meds stop prior to CLO/C13 Urea breath test

Answer 18

Abx 4wks, PPI/H2 2wks prior

Question 19

1st line laxative IBS

Answer 19

Bulk forming - ispaghula husk

Question 20

What is Peutz-Jegher’s

Answer 20

AD condition, hamartomas in GI tract
Pigmented lesions on lips, mucosa, face, palms soles

Question 21

H. pylori testing

Answer 21

13C urea breath test 1st line
Stool antigen test

Question 22

Gastric Ca RFs

Answer 22

H. pylori
Pernicious anaemia
Atrophic gastritis
Blood group A
Japanese/Chinese
Smoking

Question 23

Gastric Ca biopsy findings

Answer 23

Signet ring cells

Question 24

Pernicious anaemia Rx

Answer 24

If no neuro - IM B12 - 3 a week for 2wks then 3mthly B12
If neurology then more frequent

Question 25

Crohn's acute mx

Answer 25

Steroids 5-ASA 2nd line AZT as adjunct Metronidazole for perianal disease

Question 26

Crohn's long-term mx

Answer 26

AZT Methotrexate/sulfasalazine 2nd line Infliximab may be added

Question 27

Crohn's fistula Rx

Answer 27

Infliximab can help close Draining seton if complex

Question 28

Coagulopathy in liver failure

Answer 28

All except vWF and Factor VIII low Those 2 synthesised in endothelial cells so high as hepatically cleared normally Protein C + S deficient so prothrombotic as well as coagulopathy

Question 29

Most common extra-intestinal feature of IBD

Answer 29

Arthritis

Question 30

Iron studies in anaemia of chronic disease

Answer 30

Low iron Low transferrin Low TIBC

Question 31

What is a dieulafoy lesion

Answer 31

AV malformation - prominent artery in mucosa of stomach

Question 32

SBBOS RFs

Answer 32

DM Scleroderma Neonates with congenital GI abnormalities

Question 33

SBBOS dx

Answer 33

Hydrogen breath test

Question 34

SBBOS Rx

Answer 34

Rifampicin Co-amox/metronidazole also used

Question 35

SBP when to give prophylaxis

Answer 35

Cipro for cirrhosis and ascites with: Prev SBP Fluid protein <15 + HRS or Child Pugh 9+