Master Specialist Gastroenterology (GES5171)
for DHA Speciality

A 58-year-old man with a 3-day history of severe epigastric pain radiating to the back, vomiting, and no alcohol use is admitted. He takes ramipril for hypertension and atorvastatin. Examination: BP 118/74 mmHg, HR 104/min, temperature 37.8°C, BMI 34 kg/m². Serum amylase 980 U/L (reference

A 34-year-old woman presents with a 6-month history of intermittent bloody diarrhoea, urgency, and tenesmus. She has no recent antibiotic use or travel. Examination: HR 88/min, BP 112/70 mmHg, temperature 36.9°C, weight stable. Haemoglobin 108 g/L, CRP 18 mg/L, albumin 38 g/L. Stool culture and Clostridioides difficile toxin are negative. Flexible sigmoidoscopy shows continuous erythema and loss of vascular pattern from the rectum to the sigmoid colon with contact bleeding. What is the most appropriate initial treatment?

A 58-year-old man with Child-Pugh B cirrhosis and a prior variceal bleed 8 months ago presents with melena and a haemoglobin of 78 g/L. He is haemodynamically stable after resuscitation. He is on propranolol 40 mg twice daily for variceal prophylaxis. Upper endoscopy shows large oesophageal varices with stigmata of recent haemorrhage but no active spurting. Which is the most appropriate immediate management?

A 34-year-old woman at 26 weeks' gestation presents with a 3-day history of bloody diarrhoea, urgency, and a CRP of 68 mg/L. She has a known diagnosis of ulcerative colitis maintained on mesalazine. Flexible sigmoidoscopy confirms moderate active distal colitis. She has no signs of sepsis and fetal monitoring is normal. Which is the most appropriate treatment for her flare?

A 62-year-old man with atrial fibrillation on warfarin (INR 2.4) presents with an acute upper GI bleed from a duodenal ulcer with a visible vessel, which is successfully treated with dual endoscopic therapy. He is haemodynamically stable. His HAS-BLED score is 3 and CHA2DS2-VASc is 4. Which is the most appropriate management of his anticoagulation?