Gastrointestinal

Question 1

Management of acute liver failure

Answer 1

30º tilt - to minimise ICP elevation
Intubation
NGT
Urinary cathether/CVC
Analgesia
Sedation
10% dextrose - for hypoglycaemia
Dialysis - for renal failure
Treatment of underlying cause

Question 2

Features of Korsakoff’s syndrome

Answer 2

Anterograde/retrograde amnesia
Aphasia, apraxia, agnosia
Confabulation
Lack of insight

Question 3

Causes of cirrhosis

Answer 3

HANDWAVE:

• Haemochromatosis
• Autoimmune - autoimmune hepatitis, PBC, PSC
• Non-alcoholic steatohepatitis (NASH)
• Drugs - amoxicillin, flucloxacillin, amiodarone, methotrexate
• Wilson’s disease
• Alpha-1 antitrypsin disease
• Viral hepatitis - hepatitis B, hepatitis C
• Ethanol

Question 4

Pathology of cirrhotic nodules

Answer 4

Fibrous bands subdivide liver parenchyma into regenerative nodules - micro/macro/mixed

Question 5

Serum albumin ascites gradient (SAAG)

Answer 5

SAAG = serum albumin - ascitic fluid albumin

> 11 g/L - transudate

Question 6

Causes of liver decompensation

Answer 6

DIGROCK:

• Dehydration
• Infection (SBP)
• GI bleeding
• Renal failure
• Opioids
• Constipation
• Killing liver by other means (benzodiazepines, hypoxia, surgery, hyponatraemia, hypokalaemia)

Question 7

Management of ascites

Answer 7

Fluid/salt restriction
Paracentesis
Transjugular intrahepatic portosystemic shunt (TIPS)

Question 8

Management of hepatic encephalopathy

Answer 8

Laculose

Rifaximin

Question 9

Most common pathogens in SBP

Answer 9

Gram-negative bacteria (E. coli, Klebsiella)

Question 10

Management of SBP

Answer 10

Ceftriaxone/cefotaxime (IV)

Question 11

Management of hepatorenal syndrome

Answer 11

Albumin

Question 12

Child-Pugh score

Answer 12

ABCDE:

• Albumin
• Total bilirubin
• Clotting time (PT)
• Distended abdomen (ascites)
• Hepatic encephalopathy

Question 13

Extraintestinal features of coeliac disease

Answer 13

Anaemia
Bleeding diathesis (vitamin K deficiency)
Osteoporosis
Neurological features (hypocalcaemia)
Hormonal disorders

Question 14

Pathological process in gastritis

Answer 14

Metaplasia

Question 15

Management of Crohn’s disease

Answer 15

Induction:

• Prednisolone
• Anti-TNF (infliximab)
• Immunomodulatory agents (azathioprine, mercaptopurine, methotrexate)

Maintenance:

• Anti-TNF
• Immunomodulatory agents

Question 16

Management of ulcerative colitis

Answer 16

Induction:

• Mesalazine + 5-ASA
• Corticosteroids

Maintenance:

• Mesalazine + 5-ASA
• Immunomodulatory agents

Question 17

Management of primary biliary cirrhosis

Answer 17

Ursodeoxycholic acid

Question 18

Management of GORD

Answer 18

Lifestyle modification:

• Limit trigger foods
• Eat smaller meals
• Avoid eating/drinking 2-3 hrs before bed/exercise
• Stop smoking
• Lose weight

Medications:

• PPI (esomeprazole, omeprazole, pantoprazole)
• H2 receptor antagonist (ranitidine)
• Antacid (Mylanta)

Surgery:
-Nissen fundoplication (upper stomach wrapped around LOS)

Question 19

Complications of GORD

Answer 19

• Reflux oesophagitis
• Oesophageal stricture
• Barrett’s oesophagus (requires monitoring)
• Oesophageal adenocarcinoma

Question 20

Avoid antibiotics in which gastroenteritis pathogen and why?

Answer 20

EHEC - may cause HUS

Question 21

H. pylori triple therapy

Answer 21

PPI - esomeprazole/omeprazole
Amoxicillin (or metronidazole)
Clarithromycin

Question 22

Location and epithelium of external vs. internal haemorrhoids

Answer 22

External: distal to dentate line; anoderm (specialised squamous epithelium)
Internal: proximal to dentate line; transitional epithelium

Question 23

Grades of haemorrhoids

Answer 23

1 - no prolapse
2 - prolapse upon bearing down with spontaneous reduction
3 - prolapse upon bearing down requiring spontaneous reduction
4 - irreducible prolapse

Question 24

PBC vs. PSC antibodies

Answer 24

PBC: AMA, ANA
PSC: ANA, pANCA, anti-SMA

Question 25

Transmission of viral hepatitis

Answer 25

A - faecal-oral B - sexual contact, vertical transmission (and other blood contact) C - IVDU (and other blood contact)

Question 26

Interpretation of HBV serology – HBsAg, anti-HBs, anti-HBc

Answer 26

HBsAg - active infection (acute or chronic) Anti-HBs - immune (due to vaccination or infection) Anti-HBc - active or previous infection

Question 27

Dukes' classification

Answer 27

A - no penetration of muscularis propria B - invasion of muscularis propria C - lymph node involvement D - distant metastasis

Question 28

TNM staging of colorectal cancer

Answer 28

``` Definitions: ♣T: • is – confined to mucosa • 1 – invasion of submucosa • 2 – invasion of muscularis propria • 3 – invasion of subserosa or beyond • 4 – invasion of adjacent organs or visceral peritoneum ♣N: • 1 – 1-3 lymph nodes • 2 – 4+ lymph nodes ♣M: • 1 – distant metastasis ``` ``` Stages: ♣0 – Tis, N0, M0 ♣I – T1/2, N0, M0 ♣IIA – T3, N0, M0 ♣IIB – T4, N0, M0 ♣IIIA – T1/2, N1, M0 ♣IIIB – T3/4, N1, M0 ♣IIIC – any T, N2, M0 ♣IV – any T, any N, M1 ```

Question 29

Most common cause of hepatocellular carcinoma

Answer 29

Chronic viral hepatitis