Gastro

Question 1

Malabsorption Hx

Answer 1

Steatorrhoea
Weight loss
Weakness (hypoK)
Anaemia (iron, B12)
Osteomalacia
Glossitis, angular stomatitis
Bruising (vit K)
Oedema
Peripheral neuropathy
Rash (czema, dermatitis herpetiformis, erythema nodosum, pyoderma gangenosum)
Amenorrhoea (low potein)

Question 2

Malabsorption Ix

Answer 2

1. low iron, prolonged PT, low Ca, low cholesterol, low carotene, +ve Sudan stool stain
2. faecal fat >7g/d or faecal elastase
3. hydrogen breath test (glucose or lactulose) - bacterial overgrowth
4. SeHCAT test for bile salts (ileum disease)

Question 3

Coeliac disease Mx

Answer 3

• Gluten free diet (Sx improve in weeks, SB healing and normal anti-TTG in months)
• Lack of response - Ix lactose intolerance, pancreatic insuff, SB bacterial overgrowth, refractory sprue (give steroids), T cell lymphoma
• Pneumovaccine (hyposplenism)
• OP

Question 4

Complications of UC

Answer 4

Local - toxic megacolon, perf, haemorrhage, strictures, cancer
Eyes - ant uveitis, conjunctivitis, episcleritis
Liver - fatty liver, PSC, cirrhosis, bile duct ca, amyloid
Haem - anaemia, VTE
MSK - arthritis, Ank spond
Skin - erythema nodosum *active, pyoderma gangrenosum, ulcers

Question 5

Complications of CD

Answer 5

Local - anorectal fistula, obstruction terminal ileum, cancer
Gallstones
Renal - urate or oxalate stones, pyelonephritis from fistulas, amyloid
Malabsorption
Osteomalacia
(Also: liver, eyes, haem, MSK, skin)

Question 6

Mx of UC

Answer 6

Mild-mod: sulfasalazine/mesalazine
Maintenance: AZA or 6MP
Acute severe UC: ABx, steroids, cyclosporin, Infliximab, -> colectomy (curative)
Proctitis - topical/enema steroid or sulfas

Question 7

Mx of CD

Answer 7

Stop smoking
Mild-mod: SSZ/MSZ
Maintenance: AZA or 6MP, or MTX
Fistulating/refractory: Infliximab/adalimumab *caution T cell lymphoma
Colonic - SSZ/MSZ
Iliocolonic - oral budesonide
Ileal with diarrhoea - cholestyramine
Severe perianal/fistulae - metronidazole or cipro, AZA

Question 8

Causes of cirrhosis

Answer 8

Alcohol
NASH
Viral - hep B, C, D
AI
Drugs - methyldopa, chlorpromazine, isoniazid, nitrofurantoin, PTU, MTX, amiodarone
Genetic - Haemochromatosis, Wilsons, a1 antitrypsin, CF
Biliary - PSC, PBC
Budd-Chiari
CCF

Question 9

Complications of cirrhosis

Answer 9

Portal HTN
SBP
Hepatic encephalopathy
Hepatorenal syndrome
Hepatopulmonary syndrome
HCC
Portal vein thrombosis

Question 10

Child Pugh

Answer 10

Scoring of 2 (Childs B 7-9): 
Alb 28-35
Ascites moderate
Bili 35-50
Encephalopathy grade 1-2
INR 1.7-2.2

Question 11

Complications of Hep C

Answer 11

Cryoglobulinaemia
Porphyria cutanea tarda
Cutaneous necrotising vasculitis
MPGN
Lichen planus
Hashimotos
B-cell lymphoma
Polyarthritis