Gastroenterology

Question 1

What two categories can ascitic fluid be grouped into?

Answer 1

The causes of ascites can be grouped into those with a <11 g/L or a gradient >11g/L:

1) SAAG > 11g/L
(indicates portal hypertension)

2) SAAG <11g/L

Question 2

What are the causes of a SAAG>11g/L?

Answer 2

Liver disorders are the most common cause
- cirrhosis/alcoholic liver disease
- acute liver failure
- liver metastases

Cardiac
- right heart failure
- constrictive pericarditis

Other causes
- Budd-Chiari syndrome
- portal vein thrombosis
- veno-occlusive disease
- myxoedema

Question 3

What are the causes of a SAAG<11g/L?

Answer 3

Hypoalbuminaemia
nephrotic syndrome
severe malnutrition (e.g. Kwashiorkor)

Malignancy
peritoneal carcinomatosis

Infections
tuberculous peritonitis

Other causes
pancreatitis
bowel obstruction
biliary ascites
postoperative lymphatic leak
serositis in connective tissue diseases

Question 4

How do you manage ascites medically?

Answer 4

1) reducing dietary sodium
fluid restriction is sometimes recommended if the sodium is < 125 mmol/L
2) aldosterone antagonists: e.g. spironolactone

Question 5

How do you screen for haemochromatosis?

Answer 5

Screening for haemochromatosis
1) general population: transferrin saturation > ferritin
2) family members: HFE genetic testing

Question 6

Which gene mutation is affected in haemochromatosis?

Answer 6

HFE mutation

Question 8

What is the typical iron study profile in patient with haemochromatosis?

Answer 8

transferrin saturation > 55% in men or > 50% in women
raised ferritin (e.g. > 500 ug/l) and iron
low TIBC

Question 9

What is the triad typically found in Plummer-Vinson syndrome?

Answer 9

Triad of:
1) dysphagia (secondary to oesophageal webs)
2) glossitis
3) iron-deficiency anaemia

Question 10

How is Plummer-Vinson syndrome treated?

Answer 10

Treatment includes iron supplementation and dilation of the webs

Question 11

Which immunoglobulins are prevalent in autoimmune hepatitis?

Answer 11

IgG
(ANA, SMA, LKM-1), increased transaminases (AST and ALT) and compatible liver histology