A 54-year-old female is diagnosed with primary biliary cirrhosis. What is her increased risk of developing hepatocellular cancer, compared to a standard population?
Correct Answer E:
Primary biliary cirrhosis: features:
Primary biliary cirrhosis is chronic liver disorder typically seen in middle-aged females (female:male ratio of 9:1).
The aetiology is not fully understood although it is thought to be an autoimmune condition. Interlobular bile ducts become damaged by a chronic inflammatory process causing progressive cholestasis, which may eventually progress to cirrhosis. The classic presentation is itching in a middle-aged woman.
Clinical features:
Complications:
A 71-year-old man presents with two year history of intermittent problems with swallowing. His wife has also noticed he has halitosis and is coughing at night. He has a past medical history of type 2 diabetes mellitus but states he is otherwise well. Of note his weight is stable and he has a good appetite. Clinical examination is unremarkable.
What is the most likely diagnosis?
Correct Answer C: Given the two year history and good health oesophageal cancer is much less likely.
Pharyngeal pouch:
A pharyngeal pouch is a posteromedial diverticulum through Killian's dehiscence. Killian's dehiscence is a triangular area in the wall of the pharynx between the thyropharyngeus and cricopharyngeus muscles. It is more common in older patients and is 5 times more common in men.
Features:
A 27-year-old woman with chronic left iliac fossa pain and alternating bowel habit is diagnosed with irritable bowel syndrome. Initial treatment is tried with a combination of antispasmodics, laxatives and anti-motility agents. Unfortunately after 6 months there has been no significant improvement in her symptoms.
According to recent NICE guidelines, what is the most appropriate next step?
Correct Answer A: NICE recommend considering psychological interventions after 12 months. Tricyclic antidepressants should be used in preference to selective serotonin reuptake inhibitors.
Irritable bowel syndrome: management: The management of irritable bowel syndrome (IBS) is often difficult and varies considerably between patients. NICE issued guidelines in 2008.
First-line pharmacological treatment - according to predominant symptom:
Second-line pharmacological treatment:
Other management options:
General dietary advice:
A 29-year-old man presents with a nine day history of watery diarrhoea that developed one week after returning from India. He had travelled around northern India for two months. On examination he is apyrexial and his abdomen is soft and non-tender.
What is the most likely causative organism?
Correct Answer B: The incubation period and prolonged, non-bloody diarrhoea point towards giardiasis.
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.
Incubation period:
*vomiting subtype, the diarrhoeal illness has an incubation period of 6-14 hours
Which one of the following is least useful in assessing the severity of a patient with liver cirrhosis?
Correct Answer A:
Child-Pugh classification of liver cirrhosis:
The Child-Pugh classification is a scoring system to assess the severity of liver cirrhosis:
Summation of the scores allows the severity to be graded either A, B or C:
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