What percentage of cases of chronic pancreatitis in the UK are due to alcohol excess?
Correct Answer D:
Chronic pancreatitis: Chronic pancreatitis is an inflammatory condition which can ultimately affect both the exocrine and endocrine functions of the pancreas. Around 80% of cases are due to alcohol excess with up to 20% of cases being unexplained.
Features:
Investigation:
Management:
A 28-year-old woman is diagnosed with constipation predominant irritable bowel syndrome. She occasionally experiences spasms of pain in the left iliac fossa.
Which one of the following is least likely to help her symptoms?
Correct Answer E: NICE recommend avoiding lactulose in the management of IBS.
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 23-year-old who is 10 weeks pregnant is reviewed by the midwife at the booking visit. This is her first pregnancy and she is well apart from some sickness which is worse in the morning and a generalized pruritus.
Bloods tests including the full blood count, hepatitis B, C and HIV serology are normal. A slight yellow tinge of her sclera is noticed and liver function tests are ordered:
What is the most likely diagnosis?
Correct Answer A: Morning sickness and pruritus are common in pregnant women .
Intrahepatic cholestasis of pregnancy would not occur in the first trimester. An ALP of 160 U/l is normal in a pregnant woman leaving the only abnormal result being the raised bilirubin (which usually falls in pregnancy). The most likely diagnosis is therefore Gilbert's syndrome.
Gilbert's syndrome:
Gilbert's syndrome is an autosomal recessive* condition of defective bilirubin conjugation due to a deficiency of UDP glucuronyl transferase. The prevalence is approximately 1-2% in the general population.
Investigation and management:
*The exact mode of inheritance is still a matter of debate.
Which one of the following statements regarding hepatocellular carcinoma is correct?
Correct Answer A:
Hepatocellular carcinoma:
Hepatocellular carcinoma (HCC) is the third most common cause of cancer worldwide. Chronic hepatitis B is the most common cause of HCC worldwide with chronic hepatitis C being the most common cause in Europe.
The main risk factor for developing HCC is liver cirrhosis, for example secondary* to hepatitis B & C, alcohol, haemochromatosis and primary biliary cirrhosis.
Other risk factors include:
Screening with ultrasound (+/- alpha-fetoprotein) should be considered for high risk groups such as:
Management options:
*Wilson's disease is an exception.
Which one of the following is least associated with primary biliary cirrhosis?
Correct Answer A: Whilst ulcerative colitis is associated with primary biliary cirrhosis this is less common than the other four options.
Primary sclerosing cholangitis is strongly associated with ulcerative colitis.
Primary biliary cirrhosis:
Primary biliary cirrhosis is a 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.
Associations:
Diagnosis:
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