Gastroenterology

Question 1

Transplanted kidney - reasons

Answer 1

UK - DM, glomerulonephritis, PKD

Question 2

Kidney transplant - barriers

Answer 2

Donor matching
Malignancy
Ongoing deep seated infection or vasculitis
Obesity

Question 3

Renal transplant - medication complications

Answer 3

Steroids - thin skin, easy bruising, cushingoid
Ciclosporin - hirsuitism, gingival hyperplasia
Tacrolimus - tremor
Glucose intolerance
HTN
Increased infection, haematological and skin malignancy

Question 4

Chronic liver disease - causes

Answer 4

UK commonest - ALD, NAFLD
Globally - viral hepatitis
Others:
- AI - AIH, PBC, PSC
- Haemochromatosis, alpha-1 antirypsin
- Drugs

Question 5

Cirrhosis - ix

Answer 5

Hx - drugs, ETOH, travel + family
Bloods -
Synthetic - coag, albumin, glucose
BBV, ferritin, caeruloplasmin
ANA, AMA, smooth muscle, anti-LKM1
AFP
USS + doppler + ascitic tap
Fibroscan / CT
+/- biopsy

Question 6

Ascites tests

Answer 6

SAAG - if high (>1.1 = portal hypertension)
- If low - malignancy, cancer, pancreatitis
MC+S
Amylase / lipase
Cytology

Question 7

Causes high albumin ascites

Answer 7

Cirrhosis
CCF
Budd-Chiari
Nephrotic
Meig’s

Question 8

Low albumin ascites causes

Answer 8

TB
Malignancy
Pancreatitis

Question 9

Ascites causes

Answer 9

Portal hypertension
Vascular - budd-chiari, CCF, constrictive pericarditis
Low albumin, protein losing enteropathy, malnutrition
Peritoneal disease - Meig’s, TB, malignancy
Other - Pancreatic leak, advanced hypothyroidism

Question 10

PBC antibody and complications, and treatment

Answer 10

AMA +ve

Cirrhosis + associated complications
HCC

Ursodeoxycholic acid
Cholestyramine - pruritus
Transplant

Question 11

Hepatosplenomegaly

Question 12

Hepatomegaly

Question 13

Splenomegaly - causes

Answer 13

Mild
Myelofroliferative, portal HTN, haemolytic anaemia, infections (EBV, endocarditis, hepatitis)

Mod
Myelo / lymphoproliferative. Gauchers and amyloidosis

Massive
Myeloproliferative - CML and myelofibrosis
Tropical infections - malaria, visceral leishmaniasis)

Question 14

Splenomegaly ix

Answer 14

Blood film. LDH.
Autoimmune screen
Thin and thick films. Blood cultures.
Osmotic fragility tests
HIV screen.
USS abdomen
? CT CAP - if ? malignant
+/- bone marrow trephine

Question 15

Splenectomy indications

Answer 15

Rupture
ITP
Hereditary spherocytosis

Question 16

Splenomegaly mx

Answer 16

Treat cause
Vaccination - encapsulated organisms (pneumococcus, meningococcus, haemophilus influenzae)
Lifelong penicillin

Question 17

Transplanted liver indications

Answer 17

Acute - paracetamol overdose, Hep A / B

Cirrhosis causes

HCC

Question 18

Liver signs which do not resolve post transplant

Answer 18

Duptyrens contracture
Splenomegaly
Gynaecomastia

Question 19

Polycystic kidney disease - extra renal issues

Answer 19

HTN
Renal failure
Proteinurea or haematuria
Liver or pancreatic cysts
Cerebral aneurysms

Question 20

PKD genetics

Answer 20

AD
80% Type 1 - chromosome 16
Type 2 - chromosome 4 - later onset, less severe, slower progression
Infantile PKD - autosomal recessive, less common

Question 21

ADPKD management

Answer 21

BP control - ACEi
Lipid control
High fluid, low salt diet
Tolvaptan - vasopressin receptor antagonist
RRT / transplant

Question 22

ADPKD nephrectomy indications

Answer 22

Make room for transplant kidney
RCC
Chronic infection + pain
Significant haematuria

Question 23

Why no peritoneal dialysis in ADPKD?

Answer 23

Bulk + volume of fluid
Increases cyst infection rate

Question 24

Ascites - causes

Answer 24

I

Question 26

Inflammatory bowel disease

Question 28

Abdominal mass

Question 29

Hereditary spherocytosis genetics + mechanism

Answer 29

Autosomal dominant. Chromosome 8. Spherocyte -> haemolysis

Question 30

Spherocytosis presentation / complications / treatment

Answer 30

Jaundice, anaemia, splenomegaly Screening Aplastic crises - infection Anaemia Pigment gallstones and cholecystitis Folic acid Recurrent transfusion Splenectomy Cholecystectomy

Question 31

Sphercoytosis ix

Answer 31

FBC, reticulocytes and MCH Blood smear - spherocytes and haemolysis LDH and haptoglobin Coombs test - exclude immune mediated EMA binding test or osmotic fragility test

Question 32

Combined pancreatic - kidney transplant benefits Pancreatic drainage post transplant

Answer 32

Cures both pancreatic and kidney disease Improves complications (not retinopathy) Improves survival Into small bowel. Used to be bladder -> reflux pancreatitis, and UTIs.