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RACP 2022 Written > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Which of the following is first line treatment for Hepatitis C in Australia?
A. Sofosbuvir + velpatasvir + voxilaprevir
B. Grazoprevir + elbasvir
C. Glecapravir + pibrentasvir
D. Ledipasvir + sofsbuvir

A

C. Glecapravir + pibrentasvir for 8-12 weeks (Maviret)

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2
Q

Which class of HCV drug is glecaprevir?

A

NS3/4A protease inhibitor

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3
Q

What class of drug is sofosbuvir?

A

Nucleoside (NS5B) polymerase inhibitor (in Epclusa - better in Adv Liver Disease - rather then Maviret)

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4
Q

What class of drug is voxilaprevir? When is it indicated?

A

NS3/4A protease inhibitor
Add to velpatasvir (NS5a inhbitor) + sofosbuvir (Nucleoside NS5B polymerase inhbitor) Epclusa* for refractory HCV - VOSEVR

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5
Q

What class of drug is Velpatasvir?

A

NS5a inhibitor

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6
Q

What class of drug is dasabuvir?

A

Non-nucleoside NS5B polymerase inhibitor

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7
Q

Lanafibranor may be useful in which condition?

A

peroxisome proliferator–activated receptor agonist that reduces ballooning and lobular inflammation in NASH

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8
Q

Which of the following biologics is not helpful in UC?
A. Vedolizumab
B. Tofacitnib
C. Secukinumab
D. Ozanimod

A

C. Secukinumab - anti IL-17a, used in ank spond and psoriatic arthritis

Vedolizumab = anti-integrin a4B7, Tofacitnib =JAK inhibitor, Ozanimod = S1P receptor modulator

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9
Q

Where is iron absorbed?

A

Duodenum

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10
Q

Where is calcium absorbed?

A

Duodenum

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11
Q

Where is B12 absorbed?

A

Terminal ileum

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12
Q

Where are bile salts absorbed?

A

Terminal ileum

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13
Q

Where is folate absorbed?

A

Duodenum

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14
Q

Which class of HCV drugs should not be used in decompensated liver disease?

A

NS3/4a protease inhibitors, due to raised drug levels in setting of hepatic failure

Drug classes ending with -evir (i.e. glecaprevir, voxilaprevir, grasoprevir)

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15
Q

Which coagulation factors are not made in the liver?

A

FVIII (endothelial cell production), FXIIIa (megakaryocytes)

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16
Q

Biopsy findings of primary sclerosing cholangitis

Associated lab and disorder?

A

Degeneration of small bile ducts with periductal Sclerosis/fibrosis
Onion skin pattern

p-ANCA, IBD (UC++)

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17
Q

Biopsy findings of primary biliary cholangitis (same as primary biliary cirrhosis)

Antibody?

A

Bile duct degeneration with periductular GRANULOMATOUS inflammation
“Florid” bile duct lesions

Anti-Mitochondrial antibody (sMall bile ducts)

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18
Q

Inhibitors of gastrin release

A

• Gastric pH <2
• Somatostatin
• Calcitonin
• Gastric inhibitory polypeptide (GIP)
• Glucagon
• Vasoactive inhibitory peptide (VIP).

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19
Q

Stimulators of gastrin release

A

L-Amino acids (i.e. phenylalanine, tryptophan, cysteine, tyrosine)
• Vagal stimulation
• Gastric distension
• Epinephrine (adrenaline)
• Calcium
• Acetylcholine

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20
Q

Biopsy findings of autoimmune hepatitis and assoicated antibodies?

A

lymphocytic piecemeal necrosis

ANA - antinuclear antibody
SMA - anti-smooth muscle
Anti- LKM
AMA - anti-mitochrondrial Ab

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21
Q

Anti-integrins with a role in IBD

A

Vedolizumab (a4B7)
Abrilumab (a4B7)
Etrolizumab (anti-B7)
Ontamalimab (MADCAM)

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22
Q

Jak inhibitors with a role in IBD

A

Filgotinib (JAK1)
Tofacitinib (in UC)
Upadacitnib

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23
Q

Treatment of primary biliary cholangitis

A

Ursodeoxycholic acid).

24
Q

What is Gilbert Syndrome

Treatment?

A

Autosomal recessive disorder of unconjugated hyperbilirubinemia due to mutation in UGT1A1

Causes episodes of jaundice

Generally no treatment needed - avoid irinotecan

25
Q

Disorders associated with PBC

A

Sjogrens (most common)
Autoimmune thyroiditis
CREST
RA

26
Q

Treatment of eosinophilic colitis

A

Dietary modification (elimination)
Steroids

27
Q

Main antibodies associated with T2 AIH

A

Anti-liver/kidney microsomal-1 (anti-LKM-1) antibodies

Anti-liver cytosol-1 (anti-LC1) antibodies

28
Q

Main antibodies associated with T1 AIH

A

Anti-smooth muscle antibody (ASMA)
ANA

29
Q

Micronutrient deficiency causing high output cardiac failure

A

B1 - “wet beri beri”

Dry beri beri = neurologic complications (i.e. convulsions, weakness, numbness, hyperreflexia)

30
Q

PAS-positive macrophages on small bowel biopsy is representative of what?

A

Whipple’s disease (Tropheryma whipplei)

31
Q

Main deficiencies in SIBO

A

A, B12 (cobalamin consumption), K

Folate is elevated due to increased bacterial production

32
Q

What does a raised HPVG represent?

A

Raised HVPG (>5mmhg) = hepatic cause of portal HTN
>10 = varices, >12 = variceal bleeding

33
Q

Which hepatitis c genotype is elbasvir plus grazoprevir recommended for?

A

G1 and 4

34
Q

Which hepatitis c genotype is sofusbavir plus ledapasvir recommended fro?

A

G1

35
Q

Most specific antibody for AIH

A

Anti-SLA/LP

36
Q

First line therapy for unresectable stage C HCC

A

Atezolizumab (anti-PL1) + bevacizumab

37
Q

Transplant criteria in HCC

A

2-3 nodules all <3cm OR single lesion <5cm
ECOG 0
No macrovascular invasion, regional nodal spread or distal mets

38
Q

S/E of JAK inhibitors

A

VTE and herpes zoster - increased compareed with other biologics

Best described for tofacitinib

39
Q

Bareets esophagus - Intestinal metaplasia distal oesphage when to scope?

A

No dysplasia:” 3-5 years
Low grade dysplasia 6-12 months
High-grade dysplasia in the absence eradication therapy 3 months

40
Q

Most Common long term complication liver transplantation?

A

Metabolic syndrome, 50% will develop.

41
Q

Components of Child-Pugh

A

A albumin
B bilirubin
C coag
D drain the asciites
E encephalopathy

42
Q

IBD extra intestinal dependant on disease?

A

oral ulcer
erythema nodosum
large join arthritis
episcleritis

43
Q

IBS extra intestinal independaent of GI disease

A

Primary sclerosing cholangitis
Ank Spon
Uveitis
PYoderma gangrenosum
Kidney stones
gall stones

44
Q

Ustekinumab target and disease?

A

IL-12 and IL-23 p40 subunit - Crohn’s disease

45
Q

Hormones that stimulate appetite

A

Ghrelin, AgRP, NPY

46
Q

Most nutrients take place in jejunum where are these exceptions instead absorbed?
Iron
VIt B12 and bile salts
Water/lipids
Na
Ca
Frucotse

A

Iron - Duodenum
Vit B12/Bile sats = terminal ileum
Water/lipids passive diffusion all SI
Na - active transport
Ca - duodenum and upper small intestine.
Frutose - faciliated diffusion

47
Q

Common cause responsible to GERD?

A

Transient relaxations fo lower oesphageal sphincter
GERD: p.w heartburn, endoscopy, Ambulatory pH monitoring. 4-8 weeks PPI at start.

48
Q

Drugs cuasing hepatocellular picture:

A

paracetamol, ioniaside, valproate, phenytoin, statins, ETOH, amiodarone, methyldopa

49
Q

Drugs causing cholestatic picture

A

Abx: Aug DF, erythromycin, flucloxacillin, methotrexate, amiodarone, sulphonyllureas, fibrates, chlorpromazine

50
Q

What is SA-AG cut off and what are common causes < then vs > then?

A

> 11 - cirrhosis cardiac failure, nephrotic syndrome
<11 malignancy pancreatitis and tuberculosis

51
Q

Causes of hypergastrinameia?

A

Gastrin, released from G cells in Antrum
1. prolonged PPI (most common)
2. Atrophic gastritis - pernicious anemia, H pylori
3. Vagotomy or small bowel resection
4. Gastrin secreting tumor (ZES) - Gastrinoma >1000
5. Renal Failure
6. HyperCa
7. Hyperlipidemia

52
Q

HLA assoicated with Coeliac Disease

A

DQ2 and DQ8, strong negative predictive value. Useful to rule out

53
Q

Which Liver Disease HCC Rare?

A

AIH (autoimmune hepatitis) primary billary cirrhosis (PBC) and Wilsons Disease

54
Q

Wilsons Disease
inheritance?
enzyme defect?
classic presentation?
serum copper and ceruloplasmin?
Treatment:

A

AUtosomal recessive disase
enxyme ATP7B
hepaitis, cirrhosisi and pyshciatric disorders
high 24hr urine copper excretion
low serum copper and low ceruloplasmin
Tx: liver trientine and zine, just neuro zinc.

55
Q

Enzyme target for AIH type II and antibody that predicts worse outcome?

A

Cyp450 2D6, Anti - LMK enzyme.

RACP 2022 Written (21 decks)

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