GI Med

Question 1

how does hyperthyroidism affect the liver

Answer 1

presents with high transaminases and jaundice

Question 2

definitive diagnosis for AI Hep

Answer 2

liver biopsy

Question 3

management for AI hep

Answer 3

start high dose steroids

add azathioprine later

Question 4

what does liver biopsy show in AI hep

Answer 4

interface hepatitis (inflammation spilling over the portal tract limiting membrane to hepatocytes)

plasma cells

Question 5

duration of therapy in AI hep

Answer 5

at least 2 years after blood tests normalise

Question 6

treatment for peptic stricture

Answer 6

ppi if underlying GORD

balloon dilatation

Question 7

severe complication of balloon dilatation

Answer 7

oesophageal perforation

Question 8

investigation for oesophageal dilatation

Answer 8

CT with oral contrast

Question 9

initial treatment of severe acute ulcerative colitis

Answer 9

IV hydrocortisone

Question 10

initial treatment for mild acute ulcerative colitis

Answer 10

oral or rectal mesalazine

Question 11

clinical evidence of severe colitis

Answer 11

6 or more stools per day, bloody stools and pulse >90

Question 12

if no response to initial treatment for acute UC, what should you add

Answer 12

infliximab or IV ciclosporin

Question 13

contraindications to ciclosporin

Answer 13

hypertension

renal impairment

Question 14

maintenance therapy for UC

Answer 14

oral +/- topical mesalazine

Question 15

why send off blood glucose in chronic liver disease pt

Answer 15

blood glucose is an indicator of liver synthetic function

Question 16

management for acute oesophageal varix

Answer 16

fluid resus
IV vasopressin (terlipressin)
IV antibiotics
refer to endoscopy service

band ligation/sclerotherapy
TIPSS

Question 17

last resort for bleeding varices when endoscopy not available

Answer 17

Sengstaken-Blakemore tubes

Question 18

long term management for varices

Answer 18

non-cardioselective beta blockers

if not tolerated regular endoscopy and band ligation

Question 19

most common cause of portal hypertension

Answer 19

cirrhosis

Question 20

5 causes of macrocytic anaemia

Answer 20

pregnancy
alcohol
folate deficiency
b12 deficiency
hypothyroidism

Question 21

why does thiamine need to be given slowly

Answer 21

reduce incidence of anaphylaxis

Question 22

why do you not give glucose before thiamine

Answer 22

glucose can precipitate Wernicke’s

NB give if critically hypoglycaemic

Question 23

initial screening for AI hep

Answer 23

Autoantibodies

serum immunoglobulins

Question 24

maximum tumor size for Whipple’s procedure

Answer 24

3cm

Question 25

if whipple procedure contraindicated, what can you do?

Answer 25

percutaneous biliary stent insertion to relieve biliary obstruction gastrojejunostomy for gastric outlet/duodenal obstruction

Question 26

PBC symptoms

Answer 26

``` pruritis lethargy loss of appetite jaundice xanthelasma spider naevi splenomegaly ```

Question 27

investigations for PBC

Answer 27

``` LFT - minor increase AST/GGT. high ALP USS abdo serum lipids Antibodies viral hep screen blood clotting ```

Question 28

contraindications for USS liver biopsy

Answer 28

``` extensive ascites platelet <100 INR >1.3 HB<100 acute confusional state ```

Question 29

complications of PBC

Answer 29

``` malabsorption osteoporosis HCC liver failure haematemesis hypothyroidism ```

Question 30

initial treatment for PBC

Answer 30

cholestyramine for pruritis UDCA fat solube vitamns Steroids if inflammatory/AI overlap

Question 31

drug for Wilson's disease

Answer 31

penicillamine

Question 32

signs of chronic pancreaetitis

Answer 32

``` intermittent epigastric pain boring to back diarrhoea/malabsorption weight loss anaemia diabetes ```

Question 33

investigations for chronic pancreatitis

Answer 33

``` abdo x ray (calcifications) fbc lft serum albumin amylase CT MRCP ```

Question 34

complications of late stage chronic pancreatitis

Answer 34

``` carcinoma opiate addiction pseudocyst formation malabsorption diabetes ```

Question 35

AI hep antibodies

Answer 35

Smooth muscle | Liver kidney

Question 36

PBC antibodies

Answer 36

AMA

Question 37

what antibiotic can cause cholestasis?

Answer 37

macrolide antibiotics

Question 38

what would differentiated WCC show for macrolide induced cholestasis

Answer 38

increased eosinophils

Question 39

what drugs can cause drug induced liver disease

Answer 39

statins thiazolodinediones beta lactams

Question 40

symptoms of haemochromatosis

Answer 40

tiredness, arthralgia, hepatomegaly, slightly deranged LFTs, new diabetes, male

Question 41

investigations for haemochromotosis

Answer 41

iron studies high iron high serum ferritin low TIBC

Question 42

investigation for haemochromotosis complications

Answer 42

``` echo - cardiomyopathy ECG - cardiomyopathy genotyping liver biopsy - cirrhosis radiograph of joints - chondrocalcinosis hypogonadism/pituitary dysfunction ```

Question 43

Screening for chronic hepatitis related HCC

Answer 43

USS every 6 months +/- AFP