Which ABx do you give for acute diverticulitis?
7-10 days of: (Augmentin DF or metronidazole), plus: (ciprofloxacin or bactrim). If no good after 2-4 days, CT abdo performed for extent of disease. (NOT endoscopy or barium enema - risk of perf in acute phase). If abscess >4cm present, treat with percut catheter drainage. Surgery if catheter drainage not possible.
What's the best investigation choice for acute diverticulitis not improving on several days of ABx?
CT abdo. You don't want endoscopy or barium enema --> risk of perf in the acute phase
Serum amylase > 3x ULN is almost diagnostic of?
The most common cause of acute pancreatitis is? Second most common cause? and most common cause of chronic pancreatitis?
Acute 1st - Gallstones, 2nd - ETOH
Barium swallow which shows 'cork-screw' appearance of oesophagus, due to uncoordinated contractions = what Dx?
Diffuse oesophageal spasms
What's the Mx of diffuse oesophageal spasms?
What intervention may reduce the incidence of future complications of diverticulosis?
High fibre diet & fibre supplements
What are the most common causes of obscure GI bleed in those 40 yrs old? (name 2 for each)
What's the best investigation to evaluate small bowel pathology?
Capsule endoscopy. This is superior to small bowel follow through, fluoroscopy, gastroscopy or CT gastroscopy.
T/F? Capsule endoscopy is superior to gastroscopy (endoscopy) for evaluation of small bowel pathology
For which hepatitis (A - E) would you treat with antivirals in the acute phase? Which antivirals would you use, and for how long?
Hep C - treat with pegIFN for 6-24 weeks - decreases risk of chronic viral hepatitis. If this doesn't clear HCV RNA in 3/12, add in ribavirin.
T/F? Antiviral therapy is indicated in acute HBV
False; you let the body clear the infection itself (>90%).
Which drug has been found in RCTs to be effective in reversing opioid induced adynamic ileus? (without significant systemic effects)
Alvimopan (may not be on PBS)
T/F? With regards to treatment of chronic HBV, a combination of peg-IFN plus nucleos(t)ide analogue (ie tenofovir or entecavir) is more successful than either alone in disease remission & eradication
False, equivalent if you give single or combined therapy, so okay to give single, eg entecavir.
T/F? Statins are C/I in those with cirrhosis
False, not C/I in cirrhosis. They do cause transaminitis, but rarely cause true hepatitis.
What's the most important prognostic factor (ie predicts worst outcome) in someone with alcoholic hepatitis?
What intervention has been shown to reduce short-term mortality in people with alcoholic hepatitis & encephalopathy?
Methylpred for 1/12 (32mg/daily)
T/F? With regards to acute alcoholic hepatitis & encephalopathy, pentoxifylline, a TNF-inhibitor, has been shown to reduce short term mortality by reducing risk of?
What's the best imaging choice for appendicitis?
CT abdo (as per UTD) - more sens & spec than other imaging modalities
What's first-line medication for SBP? How about secondary prevention after SBP episode?
Cefotaxime IV (also can use ceftriaxome or augmentin DF), followed by norfloxacin oral to prevent recurrence
What's the intervention of choice to prevent encephalopathy for someone with cirrhosis who has an acute GI bleed?
Name the 3 absolute indications for surgery in UC
1) Severe haemorrhage
What's the next step once you have clinically diagnosed GORD?
Start empiric PPI - if pt conditions improves (usually within a week), confirms diagnosis.
What other features on history would prompt you to do endoscopy on someone with GORD?
- Presence of dysphagia
GORD symptoms refractory to PPIs should be investigated by what test? (hint: NOT endoscopy)
Dyspnoea, platypnoea, and orthodeoxia in a pt with cirrhosis suggests what condition?
Platypnoea - increased dyspnoea in the erect posture
This is the classic triad for what condition? 1) CLD, and 2) increased alveolar-arterial gradient on room air, and 3) intrapulm R to L shunt due to vascular dilatation
How is hepatopulmonary syndrome diagnosed?
Contrast-enhanced echo showing shunt (sensitive test)
What's the treatment for hepatopulmonary syndrome?
No specific treatment. Liver transplant can help
What's the investigation of choice for chronic pancreatitis?
MRCP - shows dilated ducts with calculi or strictures or pseudocysts. Not as sensitive as ERCP, but not as invasive. You'd pull out ERCP if there's no calcification on plain XR and no steatorrhoea.