Gastro

Question 1

Hep B during Pregnancy

Answer 1

1. Vaccination
2. IVIG with in the first 12 hrs
3. Tenofovir if high viral load (>28ks)
4. Tenovivir if active disease or cirrhosis

Question 2

Hepatic Encephalopathy and lactose

Answer 2

• reduction in pH

Question 3

Which of the following marker would indicate thiopurine resistance?
Use of azathoprine

Answer 3

A low 6-TGN and a high 6-MMP would indicate that the patient has Thiopurine resistance and therefore the management would be to add allopurinol and reduce thiopurine dose.

Question 4

Endoscopy screening in Barrett’s

Answer 4

• No dysplasia: 3–5 years
• Low-grade dysplasia: 6–12 months
• High-grade dysplasia in the absence of eradication therapy: 3 months.

Question 5

Recurrent C.Diff infection management

Answer 5

The infusion of donor feces was significantly more effective for the treatment of recurrent C. difficile infection than the use of vancomycin.

Question 6

Colorectal Ca screening in 1st degree relative +ve

Answer 6

• FOBT every 2 years from age 50.
• People with no personal history of bowel cancer, colorectal adenomas or ulcerative colitis and no confirmed family history of CRC or has one first- or second-degree relative with CRC diagnosed at age 55 years or older.
• Two main types of FOBT are available: guaiac and faecal immunochemical tests. Immunochemical tests are preferred as they have greater sensitivity and higher uptake.

Question 7

Inactive hepatitis B surface antigen (HBsAg) carrier state.

Answer 7

– HBsAg and HBcAb are positive.
– normal liver enzymes (AST and ALT)
– HBeAg and HBV DNA are negative
– HBeAb is positive ****
– asymptomatic

Question 8

Chronic hepatitis B, which is divided into HBeAg positive and HBeAg negative chronic hepatitis B

Answer 8

HBeAg positive:
– HBsAg positive.
– HBV DNA positive
– liver enzymes are persistently or intermittently elevated
HBeAg negative(Precore mutant):
– HBsAg positive.
– HBV DNA positive
– liver enzymes are persistently or intermittently elevated

Question 9

Resolved chronic hepatitis B (Past infection

Answer 9

– HBsAg negative
– HBsAb positive
– normalization of ALT and AST
– very low levels of HBV DNA(less than 10,000 copies/ml)

Question 10

H.Pylori Irradication

Answer 10

1) PPI + clarithromycin + amoxycillin for 10-14 days
If Failed
2) PPI + Bismuth + Tetracycline + Metronidazole for 10-14 days.
Then therapy: PPI + Amoxycillin for 5 days,
then followed by PPI + Clarithromycin + Tinidazole for 5 days.
Susceptibility driven therapy.
Salvage therapy: Levofloxacin (either triple or sequential) or Rifabutin triple therapy.

Question 11

Multitarget Stool DNA testing for colorectal cancer

Answer 11

• KRAS mutations
• aberrant NDRG4 and BMP3 methylation,
• β-actin
• hemoglobin immunoassay.

Question 12

Leptin function

Answer 12

1) Inhibits food intake
- reduces the expression of neurotransmitters that increase food intake ie: Neuropeptide Y and agouti-related peptide.
2) Increases energy expenditure.

Question 13

Indications for Liver transplant - HCC

Answer 13

Hepatocellular carcinoma
– single lesion between 2 to 5 cm or
– no more than three lesions, the largest of which is less than 3 cm, and no radiographic evidence of extrahepatic disease.
– Liver transplantation should be viewed as the treatment of choice for selected patients with hepatocellular carcinoma who are not candidates for surgical resection and in whom malignancy is confined to the liver

Question 14

• Cirrhosis

Answer 14

Cirrhosis:
– referred for transplantation when they develop evidence of hepatic dysfunction (Child Pugh Score > 7 and MELD > 10) or when they experience their first major complication (ascites, variceal bleeding, or hepatic encephalopathy)

Question 15

Indications for Liver transplant Hepatorenal syndrome:

Answer 15

– Patients with type I hepatorenal syndrome should have an expedited referral for liver transplantation