Each one of the following is a risk factor for gastric cancer, except:
Correct Answer B:
Gastric cancer:
Epidemiology:
Associations:
Investigation:
Crohn's disease is associated with each one of the following findings, except:
Correct Answer A: IBD: histology This histological differences between ulcerative colitis and Crohn's are summarized below:
Ulcerative colitis:
Crohn's:
Which one of the following is most associated with the development of acute pancreatitis?
Correct Answer A: Hyperchylomicronaemia may be caused by hereditary lipoprotein lipase deficiency and apolipoprotein CII deficiency. It predisposes to recurrent attacks of acute pancreatitis.
Acute pancreatitis: causes:
The vast majority of cases in the UK are caused by gallstones and alcohol: Popular mnemonic is GET SMASHED:
*pancreatitis is 7 times more common in patients taking mesalazine than sulfasalazine
A 42-year-old dentist is reviewed in the medical clinic complaining of persistent lethargy. Routine bloods show abnormal liver function tests so a hepatitis screen is sent. The results are shown below:
What do these results most likely demonstrate?
Correct Answer D: Given the deranged liver function tests these results most likely indicate previous hepatitis B vaccination with active hepatitis C infection. However, around 15% of patients exposed to the hepatitis C virus clear the infection.
It would therefore be necessary to perform a HCV PCR to see if the virus is still present There is currently no vaccination for hepatitis C.
Hepatitis C:
Hepatitis C is likely to become a significant public health problem in the UK in the next decade. It is thought around 200,000 people are chronically infected with the virus. At risk groups include intravenous drug users and patients who received a blood transfusion prior to 1991 (e.g. haemophiliacs).
Transmission:
Features:
Management of chronic infection:
Complications of treatment:
A 25-year-old man with a history of Crohn's disease is reviewed in clinic. Over the past week he has developed painful perianal ulcers. On examination numerous shallow ulcers can be seen with a small number of skin tags.
What is the most appropriate first-line treatment?
Correct Answer B: Please see the British Society of Gastroenterology guidelines for more details.
Crohn's disease: management
Crohn's disease is a form of inflammatory bowel disease. It commonly affects the terminal ileum and colon but may be seen anywhere from the mouth to anus.
General points:
Active disease:
Perianal disease:
Surgery:
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