Passmedicine Gastroenterology Review Part 2

Comprehensive flashcards covering key diagnoses, investigations, and management guidelines from the Part 2 Gastroenterology lecture notes.

What is the treatment of choice for Small Bowel Bacterial Overgrowth Syndrome (SBBOS)?

Rifaximin is the treatment of choice due to relatively low resistance; Co-amoxiclav or metronidazole are effective alternatives.

Which combination of vitamin/folate levels is characteristic of Small Bowel Bacterial Overgrowth?

Low Vitamin B12 and high Serum Folate (bacteria absorb B12 and synthesize folate).

What are the common risk factors for Small Bowel Bacterial Overgrowth?

Motility delay (diabetes, scleroderma), anatomical issues (strictures, jejunal diverticula), and immune-related deficiencies (IgA deficiency).

Which investigation is considered the first-line screening test for Haemochromatosis in the general population?

Transferrin saturation.

What is the typical management for Haemochromatosis when ferritin levels are >1,000 microgram/L?

Venesection (phlebotomy), typically 400-500 ml every 1-2 weeks initially.

What clinical sign on a barium study is classically associated with terminal ileal Crohn's disease?

Kantor's string sign (a long, narrowed segment of terminal ileum).

What is the diagnostic investigation of choice for Wilson's disease?

Serum caeruloplasmin (low levels present in 90%) and 24-hour urinary copper excretion (elevated).

What are the first-line and alternative chelating agents used to treat Wilson's disease?

Penicillamine is traditional first-line; Trientine hydrochloride is an alternative for those intolerant or allergic to penicillamine.

What is the management of choice for Barrett's Oesophagus with low-grade or high-grade dysplasia?

Endoscopic eradication therapy, specifically Radiofrequency Ablation (RFA) or Endoscopic Mucosal Resection (EMR).

Which test is used to confirm a diagnosis of bile acid malabsorption?

SeHCAT scan (selenium homocholic acid taurine test); retention <15% at 7 days is positive.

What is the appropriate first-line antibiotic treatment for a non-life-threatening first episode of C. difficile?

Oral Vancomycin for 10 days.

What should be the treatment if a C. difficile infection recurs within 12 weeks of symptom resolution?

Oral Fidaxomicin.

Which drug is the preferred vasoactive agent in the initial management of suspected variceal bleeding?

Terlipressin.

What is the first-line treatment for autoimmune hepatitis?

Prednisolone, typically followed by maintenance therapy with Azathioprine.

What are the characteristic features of Primary Biliary Cholangitis (PBC)?

Itching (pruritus), fatigue, raised Alkaline Phosphatase (ALP), and positive Anti-Mitochondrial Antibodies (AMA).

What is the classical triad and diagnostic finding for Whipple's disease?

Triad: Diarrhoea, weight loss, and arthralgia. Diagnosis: Duodenal biopsy showing PAS-positive macrophages in the lamina propria.

What pathognomonic feature appears on an abdominal X-ray in Sigmoid Volvulus?

The 'coffee bean' sign.

Which serious side effect is uniquely associated with Mesalazine usage in ulcerative colitis?

Acute pancreatitis (mesalazine carries a higher risk than sulfasalazine).

What is the treatment for Gastric MALT lymphoma?

Eradication of Helicobacter pylori (triple therapy: PPI + Amoxicillin + Clarithromycin/Metronidazole).

What are the common clinical features and the treatment for Fabry disease?

Features: Acroparaesthesia (burning pain), angiokeratomas, and cardiac/renal involvement. Treatment: Enzyme replacement therapy.