Last min Gastroenterology Passmedicine

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Gastroenterology
Wilson's disease - serum caeruloplasmin is decreased
24hr oesophageal pH monitoring is gold standard investigation in GORD
E. coli is the most common cause of travellers' diarrhoea
H. pylori eradication:
 PPI + amoxicillin + clarithromycin, or
 PPI + metronidazole + clarithromycin
Causes of villous atrophy (other than coeliacs): tropical sprue, Whipple's, lymphoma,
hypogammaglobulinaemia
Coeliac disease - tissue transglutaminase antibodies first-line test
Deterioration in patient with hepatitis B - ? hepatocellular carcinoma
Dysphagia affecting both solids and liquids from the start - think achalasia
Flucloxacillin + co-amoxiclav are well recognised causes of cholestasis
Gastric MALT lymphoma - eradicate H. pylori
Give 50% of normal energy intake in starved patients (> 5 days) to avoid refeeding syndrome
Hepatocellular carcinoma
 hepatitis B most common cause worldwide
 hepatitis C most common cause in Europe
Obese T2DM with abnormal LFTs - ? non-alcoholic fatty liver disease
Paracetamol overdose - high risk if chronic alcohol, HIV, anorexia or P450 inducers
Peutz-Jeghers syndrome - autosomal dominant
Primary biliary cirrhosis - the M rule
 IgM
 anti-Mitochondrial antibodies, M2 subtype
 Middle aged females
Screening for haemochromatosis
 general population: transferrin saturation > ferritin
 family members: HFE genetic testing
The gold standard test for achalasia is oesophageal manometry
Ulcerative colitis - the rectum is the most common site affected
Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks

Whipple's disease: jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff
(PAS) granules
Zollinger-Ellison syndrome: epigastric pain and diarrhoea
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Drug mechanism of action
Ondansetron - 5-HT3 antagonist
Inflammatory bowel disease: key differences
Ulcerative colitis - primary sclerosing cholangitis
Crohn's disease – granulomas
Stereotypical histories (gastroenterology)
A 45-year-old man is being investigated for diarrhoea, weight loss and
arthralgia. Jejunal biopsy shows deposition of macrophages containing
PAS-positive granules - Whipple's disease
A 30-year-old woman presents with foul smelling oily diarrhoea,
abdominal bloating, fatigue and weight loss. On examination she has
papulovesicular lesions on the extensor aspects of her arms - coeliac
disease
Stereotypical histories (hepatobiliary disorders)
A 65-year-old man with a history of chronic hepatitis b infection
presents with symptoms and signs of liver cirrhosis. Alpha-fetoprotein is
elevated. - hepatocellular carcinoma
Stereotypical histories (upper gastrointestinal disorders)
A patient with a history of heartburn presents with odynophagia. There
no weight loss, vomiting or anorexia - oesophagitis

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