Gastro

Question 1

Typical PMH and Hx for mesenteric ischaemia (usually small bowel)

Answer 1

Vascular pathology: dm, hypertension, diabetes, smoking.

Hx: acute severe pain that’s out of keeping with exam findings. Can have blood, diarrhoea, fever.

Question 2

Inv and tx for mesenteric ischaemia

Answer 2

Raised lactate
CT
Tx: surgery

Question 3

Scoring systems for cirrhosis

Answer 3

Child-Pugh score (bilirubin, albumin, PT, encephalopathy and ascites are worst prognostic indicators)

MELD score

Question 4

How can ischaemic hepatitis occur?

Answer 4

Septic shock, acute hypoperfusion can cause an AKI from tubular necrosis and ischaemic hepatitis,

Question 5

Investigation findings for ischaemic hepatitis

Answer 5

Marked rise in ALT

May have deranged Us and Es from AKI

Question 6

Triad of Budd-Chiari syndrome

Answer 6

Acute severe abdo pain,
Ascites,
Hepatomegaly

Question 7

Pathophysiology and causes of Budd-Chiari

Answer 7

Polycythaemia,
Combined pill
Pregnancy
Thrombophilia
Describes hepatic vein thrombosis. US.

Question 8

Investigation findings for alcoholic liver disease

Answer 8

Raised GGT

AST markedly higher than ALT, ratio > 3 strongly suggests alcoholic hepatitis

Question 9

Mx of alcoholic hepatitis

Answer 9

Use Maddrey’s discriminant function to determine who will benefit from tx, based on PT and bilirubin.
Glucocorticoids (pred.)

Question 10

Mx of UC (mild-moderate/severe)

Grading system for flare ups

Answer 10

Try love and Witt’s criteria
Mild-moderate: topical (if proctitis)/oral aminosalicylate to treat flare up and maintain remission.
Severe: Steroids then AZA to maintain remission

Question 11

How does spontaneous bacterial peritonitis present?

Answer 11

Abdo pain, fever, ascites

Question 12

What investigations are required for spontaneous bacterial peritonitis?

Answer 12

Paracentesis shows high neutrophils

Question 13

What organism is most commonly found in SBP?

Answer 13

E.coli

Question 14

Mx of SBP

Answer 14

IV cefotaxime

Question 15

Pathological process of Primary biliary cholangitis

Answer 15

Autoimmune. Chronic inflammation causes progressive cholestasis, potentially ending in cirrhosis.

Question 16

Demographic and sx of Primary Biliary Cholangitis

Answer 16

Typically itching in middle aged women.

Often asymptomatic till late stages when they develop itching and fatigue. May have signs of liver failure.

Question 17

Investigations for PBC

Answer 17

Anti-mitochondrial antibodies (AMA) M2 subtype

Raised serum IgM

Question 18

Mx of PBC

Answer 18

Ursodeoxycholic acid slows progression

Cholestyramine relieves pruritus

Question 19

Complications of PBC

Answer 19

Variceal haemorrhage from portal hypertension,
Increased risk of hepatocellular carcinoma,
Osteoperosis

Question 20

Pathology of haemochromatosis

Answer 20

Autosomal recessive condition. Disorder of iron absoprtion/metabolism, so iron accumulates.

Question 21

Presentation of heamochromatosis

Answer 21

Often asymptomatic in early disease.
First signs are often fatigue, arthralgia and erectile dysfunction due to hypogonadism from liver cirrhosis .
Bronzed skin.
Hepatic: cirrhosis, hepatomegaly.

Question 22

Most common inherited colorectal cancer

What other cancer does it predispose to?

Answer 22

HNPCC

Endometrial cancer

Question 23

What vaccine is recommended to coeliacs?

Answer 23

Pneumococcal vaccine every 5 year, due to functional hyposplenism.

Question 24

Roles of spleen

Answer 24

Creates lymphocytes

Removes/recycles old/damaged rbcs