Gastro + Abdo

Question 1

Pt with possible Hep C, what features (exam + Ix) would be suggestive of cirrhosis? (4)

Answer 1

1. APRI score >1
2. Fibroscan (>12.5)
3. Exam findings of liver disease (spider naevi, palmar erythema, gynaecomastia)
4. Reduced synthetic function on bloods (low plts, low alb, prolonged INR)

Question 2

You have treated a person with Hep C, when do complete monitoring?

Answer 2

Rpt HCV PCR 12wks after treatment
- if SVR (sustained virological response) + no cirrhosis + normal LFTs
= no ongoing monitoring

Question 3

What 3 situations require ongoing monitoring post successful treatment of Hep C?

Answer 3

1. Persistent abnormal LFTs - need work-up for other liver disease
2. Cirrhosis - will require long-term monitoring for cirrhosis suirvellance
3. Risk of re-infection - annual HCV PCR (not Abs)

Question 4

KFP: DDx for 4wks abdo pain after meals, mild jaundice + maybe weight loss as not eating (6)

Answer 4

1. Pancreatic cancer
2. CHolangiocarcinoma
3. Choledocolithiasis
4. Alcoholic hepatitis
5. Viral hepatitis (B, C, D)
6. HCC
7. Hepatic metastasis

Others probably not get marks
- cholecystitis or pancreatitis (4wks too long)
- Gastric cancer (doesnt explain jaundice)

Question 5

KFP: Pt with duodenal ulcer 2ndry to H.Pylori. What are 6 aspects of management?

Answer 5

1. HP7 triple therapy for 1-2wks
2. Rpt Urea breath test in 4wks after treatment to confirm eradication
3. Stop smoking if relevant
4. Stop NSAIDs if relevant
5. Reduce ETOH if relevant
6. Avoid triggering foods

Question 6

55F had routine blood tests. PMHx HTN on ramipril. Had cellulitis 2wks agio that cleared with oral Abx. Bloods ok, other than LFTs.
DDx (4)

Answer 6

1. Biliary obstruction (gallstone, head of pancreas tumour) - just give 1
2. Drug related cholestasis 2ndry flucloxaciillin
3. Primary Biliary Cirrhosis
4. Alcoholic cirrhosis (depending on hx)

Question 7

11yo with recurrent abdo pain, some associated nausea + dizziness. Happens at school mostly, never on weekend. No PMHx, examines normally
DDx? (6)

Answer 7

1. Functional abdo pain
2. Anxiety
3. Somatisation
4. IBS
5. Abdominal migraine
6. Child abuse

Question 8

Management steps for acute diverticulitis (1+1/3)

Answer 8

1. Conservative/no abx - clear oral fluids + review in 24-48hrs
2. Augmentin DF BD for 5/7 if Abx needed
   - Immunocompromised
   - Right sided diverticulitis
   - failure to respond after 72hrs of conservative

Question 9

Causes of conjugated hyperbiliruinaemia (3+6)

Answer 9

1. Obstructive
   - biliary atresia
   - gallstones
   - periampullary neoplasm (pancreas, distal cholangiocarcinoma)
2. Hepatic
   - Alcoholic liver disease
   - MAFLD
   - Autoimmune disorders - autoimmune hepatitis, PBS
   - Drug induced liver injury
   - Intra-hepatic mass
   - viral hepatitis