Which one of the following medications is least associated with dyspepsia?
Correct Answer D:
Drugs causing dyspepsia:
Causes:
The following drugs may cause reflux by reducing lower oesophageal sphincter (LOS) pressure:
*Calcium channel blockers and nitrates are occasionally used in the management of achalasia, itself a cause of dyspepsia, because of their effect on the LOS.
A 23-year-old man develops watery diarrhoea 5 days after arriving in Mexico.
Which one of the following is the most likely responsible organism?
Correct Answer D: E. coli is the most common cause of travellers' diarrhoea.
Gastroenteritis: Gastroenteritis may either occur whilst at home or whilst travelling abroad (travellers' diarrhoea) Travellers' diarrhoea may be defined as at least 3 loose to watery stools in 24 hours with or without one of more of abdominal cramps, fever, nausea, vomiting or blood in the stool. The most common cause is Escherichia coli.
Another pattern of illness is 'acute food poisoning'. This describes the sudden onset of nausea, vomiting and diarrhoea after the ingestion of a toxin. Acute food poisoning is typically caused by Staphylococcus aureus, Bacillus cereus or Clostridium perfringens.
Stereotypical histories:
Incubation period:
*Vomiting subtype, the diarrhoeal illness has an incubation period of 6-14 hours.
A 44-year-old man is diagnosed with a duodenal ulcer. CLO testing performed during the gastroscopy is positive for Helicobacter pylori.
What is the most appropriate management to eradicate Helicobacter pylori?
Correct Answer C:
H. pylori eradication:
The BNF recommends a regimen containing amoxicillin and clarithromycin as first-line therapy.
Helicobacter pylori: Helicobacter pylori is a Gram negative bacteria associated with a variety of gastrointestinal problems, principally peptic ulcer disease.
Associations:
The role of H pylori in Gastro-oesophageal reflux disease (GORD) is unclear - there is currently no role in GORD for the eradication of H pylori.
Management - eradication may be achieved with a 7 day course of:
A 25-year-old woman develops deranged liver function tests following the introduction of a new drug.
Which of the following drugs is the most likely cause?
Correct Answer B: The liver function tests suggest a hepatitis rather than cholestasis. Sodium valproate may be associated with such a picture.
Drug-induced liver disease: Drug-induced liver disease is generally divided into hepatocellular, cholestatic or mixed. There is however considerable overlap, with some drugs causing a range of changes to the liver.
The following drugs tend to cause a hepatocellular picture:
The following drugs tend to cause cholestasis (+/- hepatitis):
Liver cirrhosis:
*Risk may be reduced with erythromycin stearate.
Primary sclerosing cholangitis is most associated with:
Primary sclerosing cholangitis:
Primary sclerosing cholangitis is a biliary disease of unknown aetiology characterized by inflammation and fibrosis of intra and extra-hepatic bile ducts.
Features:
Investigation:
Complications:
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