Gastro med

Question 1

Autoimmune hepatitis is most Commonly seen in which Demographic

Answer 1

Young women

Question 2

What is the role of biopsy in autoimmune hepatitis

Answer 2

Needed for diagnosis, guidelines recommend obtaining a histological sample for diagnosis + prognosis unless there is a significant complication

Question 3

Type I autoimmune hepatitis presents with Which raised biomarkers

Answer 3

ANA
and/or
Anti-smooth-muscle antibodies (SMA)
Also IgG

Question 4

What is the minimum recommended treatment duration for autoimmune hepatitis

Answer 4

Two years

Question 5

Management for autoimmune hepatitis revolves around

Pharmacology

Answer 5

Steroids + other immunosuppressants e.g. azathioprine

Question 6

In Autoimmune hepatitis which groups of patients may you consider lifelong therapy?

Answer 6

Those who have cirrhosis, severe initial presentation or history of prior relapse

Question 7

What type of drug is azathioprine

Answer 7

Immunosuppressive

Inhibits purine synthesis

Question 8

What is the guidance for transplant patients taking azathioprine Who become pregnant

Answer 8

Continue taking azathioprine, while there is reports of premature birth and low birth weights these risks are outweighed by the benefit of the drug

Question 9

What are the steps when confirming NG Tube placement

Answer 9

• Obtain Aspirate
• PH test (1-5.5)
• If aspirin can’t be obtained then a chest x-ray must be done

Question 10

Most important investigation for a patient with Dysphagia Is?

Answer 10

Upper GI endoscopy

Unless there is A compellingreason not to

Question 11

What is the treatment of choice for patients presenting with symptomatic benign peptic Strictures

Answer 11

Balloon dilation
Treatment of underlying cause Is also needed so PPIs in the case of reflux Caused Strictures

Question 12

What are the extraintestinal manifestations of Ulcerative colitisThat are not related to the activity of the colitis

Flares happen independently

Answer 12

• sacroileitis/ankylosing spondylitis
• Primary sclerosing cholangitis

Question 13

What is the first line management for acute severe colitis

Answer 13

IV hydrocortisone

Question 14

In acute colitis for patient has not responded to IV hydrocortisone what are the management options

Answer 14

Next line = Iv Ciclosporine
Infliximab may be considered ifThis is inappropriate or contraindicated

Question 15

What defines mild disease for Ulcerative colitis

Answer 15

Fewer than four Stools a day, No systemic disturbance, normal CRP and ESR

Question 16

What defines severe disease in Ulcerative colitis

Answer 16

More than six Stools a day With evidence of systemic disturbance

Question 17

Once Ulcerative colitis is in remissionWhat is the first-line treatment for mild disease

Answer 17

Mesalazine

This can be given orally or Rectally

Question 18

What blood tests can be used to assess Synthetic liver function?

Answer 18

• LFTs
• Serum albumin
• Prothrombin time
• Glucose

Question 19

Describe the management steps for a variceal haemorrhage

Answer 19

• ABC patient should be resuscitated prior to endoscopy
• correct clotting: FFP, vitamin K
• Vasoactive agents = Terlipressin
• Prophylactic antibiotics
• Endoscopy-Band ligation Escalate to Transjugular Intrahepatic Portosystemic Shunt (TIPSS)

Question 20

Sengstaken-Blakemore tube Is?

Answer 20

last resort For variceal haemorrhage when endoscopy is not immediately available and the patient is at risk of death from exsanguination

Question 21

What is the long-term management for patients had a variceal bleed Or has Evident oesophageal varices?

Answer 21

Noncardioselective beta-blocker’s a first-line treatment and prevention of variceal bleeds.

When not tolerated/contraindicated regular endoscopic band ligation