Gastroenterology Module 5

What is the primary mechanism of action of bulevirtide in the treatment of hepatitis D?

A 45-year-old man develops stage III cancer of the caecum. His father died of metastatic bowel cancer associated with the presence of multiple polyps throughout the colon.

The most likely underlying inherited genetic abnormality is in the:

Hepcidin and ferroportin regulate systemic iron absorption by inhibiting:

Liver transplant is indicated in all of these conditions except?

Pancreatic enzymes are involved in digestion of protein. They are released as proenzymes into the duodenal lumen where they are activated.

The enzyme that plays an important role in activating the proenzymes is:

Which of the following patient group will most likely benefit from treatment with cetuximab?

Which statement is correct regarding gastrin?

Where is CCK secreted from?

Our body produces endogenous glucose via these mechanisms except?

What is the optimal treatment regimen for acute Hepatitis C?

A female patient presents with new onset ascites. Portal and hepatic vein pressures are determined at the time of transjugular liver biopsy. Portal vein pressure is 32 mmHg and free hepatic vein pressure is 12 mmHg.

What is the aetiology of this patient’s ascites?

The following condition is unlikely to cause a raised fasting serum gastrin of 1200 pg/ml [0-180]:

A 35 year old man sees a gastroenterologist due to ongoing epigastric pain which has failed to respond to twice daily dosing of oral omeprazole.

He has a fasting gastrin level of 650 pg/ml (Normal range 0-180 pg/ml).

Why is his gastrin level elevated?

In patients with chronic pancreatitis, which of the following lifestyle modification will help reduce the risk of developing pancreatic calcifications?

This medication is likely to be most effective when used as prophylaxis against post ERCP pancreatitis (PEP)

Which is the most useful serological test to diagnose autoimmune pancreatitis?

The Cytotoxic-Associated Gene A or Cag A positive H.pylori is mostly associated with which type of condition?

The following condition is not associated with vitamin B12 deficiency?

Coeliac disease is associated with HLA

The following condition causes a lower resting lower esophageal sphincter, except?

A 45-year-old man presents with a one-week history of anorexia, vomiting and abdominal pain. He denies any fever, but has noted his sclerae to be icteric in the last three days. There is a history of intravenous drug use to the age of 25 years. There are no recent prescribed or over-the-counter medications. He drinks the equivalent of 100 g of alcohol per day, with frequent heavy intake on weekends.

Examination confirms icterus, but there are no peripheral stigmata of chronic liver disease. There is moderate to severe tenderness in the right upper quadrant. The liver is percussed at 18 cm in the midclavicular line. There is no splenomegaly. Cardiovascular, respiratory and peripheral nervous system examinations are normal.

Routine blood tests show:

• white cell count 12.5 x 109/L [3.5-10.5]
• haemoglobin 145 g/L [125-165]
• platelet count 345 x 109/L [150-450]
• sodium 132 mmol/L [135-150]
• potassium 4.1 mmol/L [3.5-5.0]
• urea 8.2 mmol/L [3.5-8.0]
• creatinine 0.10 mmol/L [0.06-0.10]
• bilirubin 125 μmol/L [7-21]
• alkaline phosphatase (ALP) 235 U/L [40-110]
• gamma glutamyltranspeptidase (GGT) 976 U/L [10-40]
• aspartate transaminase (AST) 780 U/L [15-40]
• alanine transaminase (ALT) 560 U/L [15-40]
• albumin 34 g/L [35-45]

The most likely explanation for this clinical scenario is:

A 45-year-old woman presents with a three-year history of recurrent rash, characterised as palpable purpura over both legs. Some of these lesions have ulcerated.

Laboratory results include:

• Serum creatinine 0.10 mmol/L [0.06-0.11]
• alanine transaminase (ALT) 51 U/L [15-50]
• aspartate transaminase (AST) 64 U/L [15-45]
• hepatitis C antibody positive
• cryoglobulins positive with 8% cryoprecipitate
• Urinalysis is normal.

Which of the following is the most appropriate management?

A 30-year-old medical officer sustains a needle-stick injury while treating a trauma patient in the emergency department. She had undergone a three-dose course of hepatitis B vaccine 10 years earlier and one year following this course was documented to be hepatitis B surface antibody (HbsAb)-positive. However, on repeat testing (done as a result of this incident), the medical officer is now found to be HbsAb-negative. The source patient in the needle-stick injury is known to be an intravenous drug user, and is shown to be hepatitis B surface antigen (HbsAg)-positive on baseline serology. Human immunodeficiency virus (HIV) and hepatitis C serology are negative.

In addition to counselling, which of the following is the most appropriate immediate action following this needle-stick injury?

A 40-year-old man was found to have elevated liver enzymes and positive hepatitis C serology since 2000. Liver biopsy showed chronic active hepatitis consistent with hepatitis C.

He now presents with purpuric rash on his knee, joint pains and Raynauds phenomenon.

Which one of the following is the most appropriate next investigation?

A 67-year-old man has recently commenced haemodialysis for renal failure as a result of chronic glomerulonephritis. He receives immunisation with three separate doses of hepatitis B vaccine according to the recommended protocol. Six weeks after the third dose, his anti-hepatitis B surface antigen antibody level is negative.

Which one of the following is the most appropriate course of action?

What is the best interpretation for the following serological results?

• Hepatitis B surface antigen Not detected
• Hepatitis B surface antibody Detected
• Hepatitis B core antibody Detected
• Hepatitis B e antigen Not detected
• Hepatitis B e antibody Detected

A 44 year old man has chronic HBV infection with evidence of cirrhosis which has decompensated.

He is commenced on treatment with lamivudine.

On commencement of treatment his HBV viral load is 10 ^{x 8}  (very high).

12 weeks later his viral load is 10 ^{x 4}

6 months later his viral load is 10 ^{x 5}

and ALT is still elevated.

What is the most appropriate next step in his management?

What is the strongest indication for commencing antiviral therapy in a patient with Hepatitis B?

The following Hepatitis B genotype carries the worse outcome:

What defines chronicity in Hepatitis B infection?