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gastro Flashcards

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1
Q

what stimulates g cells to release gastrin

A

luminal peptides

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2
Q

plummer vinson syndrome

A

Triad of:
dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia

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3
Q

primary billiary cholangitis, CFs, symptoms, treatment, Ix

which autoimmune condition is also seen in 80% of PBC pts

A

middle aged females, IgM, ALP, raised bilirubin

CFs:
pruitus, clubbing, hepatosplenomegaly

Ix: bloods, MRCP (exclude extrahepatic cause)

Treatment: ursodeoxycholic acid- slow progression
cholestyramine- itching
fat soluvle vit supplementation
Liver transplant if bili>100

MOST associated w sjogrens

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4
Q

wilsons disease associated with which type of anaemia?

A

haemolytic anaemia

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5
Q

keiser fleischer rings =— what condition

A

wilsons disease

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6
Q

wilsons disease

A

symptoms;
hepatitis, cirrhosis, speech/psych problems

kayser fleischer rings

BLOODS:
reduced caeruloplasmin
reduced total serum copper
increased 24hr urinary copper excretion
ATP7B gene

Mx
penicillamine- chelates copper

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7
Q

Hep b serology
HBsAg

anti-HBc
Anti-HBs

IgM anti-HBc negative

A

HBsAg = ongoing infection, either acute or chronic if present > 6 months

anti-HBc = caught, i.e. negative if immunized

Anti-HBs = immunity

IgM anti-HBc negative= chronic infection

IgM anti-HBc positive= acute infection

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8
Q

what is budd chiari syndrome

A

hepatic vein thrombosis

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9
Q

what is budd chiari syndrome caused by

A

polychythaemic rubra vera
thrombophillia- protein c resistance, antithrombin 3 def
pregnancy
COCP

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10
Q

triad of symptoms budd chiari syndrome

A
  1. abdominal pain: sudden onset, severe
  2. ascites → abdominal distension
  3. tender hepatomegaly
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11
Q

c diff morphology

A

gram positive rod

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12
Q

alphafetoprotein elevated in Hepatocellular carcinoma or cholangiocarcinoma

A

hepatocellular carcinoma

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13
Q

underlying aetiology of hepatorenal syndrome?

A

Splanchnic vasodilation

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14
Q

hepatorenal syndrome treatment

A

vasopressors analogue -eg terlipressin
liver transplant
20% albumin
transjugular intrahepatic portosystemic shunt

Terlipressin= vasopressor= splanchnic CONSTRICTION

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15
Q

Boerhaave syndrome

A

severe vomiting causing oesophageal rupture – chest pain and shock

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16
Q

raised conjugated bilirubin, black liver

A

Dubin-Johnson syndrome

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17
Q

which anti emetic can cause tardive dyskineseia

A

metoclopramide

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18
Q

which anti emetic can cause tardive dyskineseia

A

metoclopramide

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19
Q

Familial adenomatous polyposis which chromosome is mutated

A

chromosome 5

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20
Q

elderly patient who has a history of aortic stenosis presents with rectal bleeding. A colonoscopy shows multiple small, flat, erythematous lesions with scalloped edges

A

Angiodysplasia

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21
Q

a man who presents with intussusception is noticed to have multiple polyps on colonoscopy. These are later shown to be hamartomatous. He also has pigmented lesions on his lips and palms

A

Peutz-Jeghers syndrome

LKB1 or STK11

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22
Q

Whipple’s disease

A

Tropheryma whippelii infection. It is more common in those who are HLA-B27 positive and in middle-aged men.

jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules

Management
oral co-trimoxazole for a year ., sometimes preceded by a course of IV penicillin

W-weight loss , worn out joints
H- Hyper pigmentation , Hyperactive bowel(diarrhea)
I- Inadequate absorption of minerals , vitmains
P-pleurisy
P-Pericarditis
L-Lymphadenopathy
E-elevated macrophages on Biopsy

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23
Q

Diarrhoea, weight loss, lymphadenopathy, arthralgia, fever in a question is most likely to indicate:

A

whipples disease

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24
Q

mesalazine or sulfasalazine more likely to cause acute pancreatitis?

A

mesalaizine

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25
causes of cause of jejunal villous atrophy
Jejunal villous atrophy coeliac disease tropical sprue hypogammaglobulinaemia gastrointestinal lymphoma Whipple's disease cow's milk intolerance
26
which antibiotic can cause cholestasis
co amxiclav
27
which monoclonal antibody targets c diff
Bezlotoxumab
28
hereditary non-polyposis colorectal carcinoma HNPCC inheritance pattern
autosomal dominant DNA Mismatch repair
29
HNPCC associated with which other type of cancer
endometrial
30
FAP which chromosome affected
is a rare autosomal dominant condition which leads to the formation of hundreds of polyps by the age of 30-40 years. CHROMOSOME 5 APC gene
31
way to remember coeliac HLA genes
That person with coeliac disease is da cutie (DQ2) and quiet (Q8)
32
which chromosome haemochromatosis and which deficiency causes it>
haemachromotoSIS (SIX) HFE deficient
33
first line management NAFLD
weight loss
34
ischaemic colitis- most likely to affect ?part of colon
splenic flexure superior and inferior mesenteric arteries.
35
secondary prophylaxis of hepatic encephalopathy medications
lactulose rifaximin
36
how to remember recessive vs dominant
MRDS- MR Denotes Surgeon (Metabolic-Recessive; Dominant-Structural)
37
UC- which part of colon most commonly affected
terminal ileum
38
Cholestasis Drugs:
Choleostasis Drugs: FAt-E CRAPS (Steatorrhea) - Fibrates - Antibiotics (penicillin, co amox, erythromycin, fluclox) - Erythromycin - COCP - Rare (nifepdipine) - Anabolic steroids/testosteorne - Phenothiazides - Sulphonylureas
39
nicotinic acid test tests which condition
gilberts syndrome
40
what type of anaemia common in alcoholics
macrocytic
41
heart condition as result of hypomagnesia in refeeding syndrome
torsade des pointes
42
first line type of gastric band surgery
laparoscopic-adjustable gastric banding (LAGB)
43
eosinophilic oesophagitis management
DIET and steroids fluticasone
44
which laxative is carcinogenic
co danthramer
45
diarrhoea + pigment laden macrophages on colonoscopy=?
laxative abuse
46
reversal dabigatran
Idarucizumab (Praxbind)
47
avoid which type of laxative and what laxative in iBS
avoid lactulose and stimulant laxatives
48
chronic pancreatitis gold standard Ix
CT pancreas- look for calcification
49
management eosinophilic oesophagitis
diet modification fluticasone topical steroid
50
which monoclonal antibody can be used for c diff?
bezlotoxumab
51
Small bowel bacterial Overgrowth investigation test and abx treatment
hydrogen breath test rifiximin
52
what indicates severe pancreatitis (6)
age > 55 years hypocalcaemia hyperglycaemia hypoxia neutrophilia elevated LDH and AST
53
macrocytic anaemia + hypothyroid = what type of anaemia
pernicious anaemia
54
crohns=
GOBLET AND GRANULOMAS kantors string sign rose thorn ulcers proximal bowel dilation
55
where do VIPomas arise from
pancreas
56
thumbprinting assosicated with?
ischaemic colitis
57
risk factors for oesophageal cancer: SCC vs adenocarcinoma
SCC= smoking, alcohol, plummer vinson, achalasia Adenocarcinoma= barretts oesophagus
58
what reduces mortality in alcoholic pts with UGI bleed
prophylactic abx
59
how to tell if pt has secondary haemochromatosis vs primary
secondary= older pts, ass'd with regular blood transfusions, new onset diabetes
60
pancreatitis cause= hyper triglyceride or hyper cholesterol
HIGH TRIGYLCERIDS=== RISK FOR PANCREATITIS (not high cholesterol)
61
drugs causing hepatocellular damage- can lead to hepatitis-- ALT is more increased
paracetamol sodium valproate, phenytoin MAOIs halothane anti-tuberculosis: isoniazid, rifampicin, pyrazinamide statins alcohol amiodarone methyldopa nitrofurantoin
62
coeliac investigation
You cannot interpret TTG level in coeliac disease without looking at the IgA level
63
how to test exocrine function in chronic pancreatitis pt
faecal elastase
64
Post-cholecystectomy syndrome
recognised complication of cholecystectomies. Typically symptoms of dyspepsia, vomiting, pain, flatulence and diarrhoea occur in up to 40% patients post surgery. Cholestyramine, to bind the excess bile acids and thus preventing lower gastrointestinal signs
65
abx prophylaxis for patients with ascites
to prevent spontatnious bacterial peritonitis : PO ciprofloxacin or norfloxacin most common bac= e coli
66
causes of NAFLD (5)
Associated factors obesity type 2 diabetes mellitus hyperlipidaemia jejunoileal bypass sudden weight loss/starvation
67
is gilberts syndrome conjugated or unconjugated bili
gilberts= unconjugated
68
haemochromatosis Ix bloods
transferrin and ferritin
69
how to differentiate HNPCC and FAP
hundreds of polyps= FAP, caused by nutation in tumour suppressory gene ACP
70
double duct sign==?dilatation of the common bile duct and pancreatic ducts.
pancreatic cancer
71
PPI side effects and MOA
incr c diff risk MICROscopic colitis hypo natremia hypo magnesia osteoporosis MOA= Proton pump inhibitors (PPI) cause irreversible blockade of H+/K+ ATPase of the gastric parietal cell.
72
Spontaneous bacterial peritonitis cfs group most at risk tx ix
form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis. Features ascites abdominal pain fever Diagnosis paracentesis: neutrophil count > 250 cells/ul the most common organism found on ascitic fluid culture is E. coli Tx= IV cefotaxime
73
when to give abx prophylaxis regarding spontaneous bacterial peritonitis and which abcx to give
give ciproflox IF: -prev episode SBP - high fitz pugh score (9) or hepatorenal syndrome - fluid protein LOW (<15)
74
what is the iron study profile in pt with haemochromatosis
Typical iron study profile in patient with haemochromatosis transferrin saturation > 55% in men or > 50% in women raised ferritin (e.g. > 500 ug/l) and iron low TIBC
75
how to Ix microscopic colitis as a result of PPI use
colonoscopy and biopsy
76
gold standard Ix for achalasia (difficult to pass scope down)
oesophageal manometry
77
acute fatty liver of pregnancy what stage of preg does it occur cfs tx
occurs third trimester or the period immediately following delivery. Features abdominal pain nausea & vomiting headache jaundice hypoglycaemia severe disease may result in pre-eclampsia Investigations ALT is typically elevated e.g. 500 u/l Management support care once stabilised delivery is the definitive management
78
antibodies (LKM1) positive in?
autoimmune hep type 2 high titres of igg
79
dubin johnson syndrome inheritance cfs
Dubin-Johnson syndrome is a benign autosomal recessive disorder CONJUGATED hyperbilirubinaemia
80
Ongoing diarrhoea in Crohn's patient post-resection with normal CRP →
cholestyramine to manage symptoms
81
refeeding syndrome electrolytes
hypophosphataemia hypokalaemia hypomagnesaemia: may predispose to torsades de pointes abnormal fluid balance LOW EVERYTHING
82
Child-Pugh A cirrhosis B C management
Child-Pugh A cirrhosis: without signs of portal hypertension who have single lesions <2cm in size should be treated with surgical resection Child-Pugh A and B cirrhosis and 2-3 tumours <= 3 cm or 1 tumour <=5 cm without vascular invasion or extrahepatic spread should be considered for liver transplantation. As a bridge to liver transplantation these patients can be treated with TACE or RFA. Child-Pugh A or B cirrhosis , good performance status, and evidence of vascular, lymphatic or extrahepatic spread the multiple tyrosine kinase inhibitor, Sorafenib, has been shown to prolong survival. Those with Child-Pugh C cirrhosis have end-stage liver disease and are poor candidates for therapy as they lack any hepatic functional reserve to tolerate either resection, TACE or RFA. These patients are best treated symptomatically
83
peutz jeughers inheritance cf tx cause
autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract. freckles on lips pigmented freckles on the lips, face, palms and soles LKB1 or STK11 Features hamartomatous polyps in the gastronintestinal tract (mainly small bowel) small bowel obstruction is a common presenting complaint, often due to intussusception gastrointestinal bleeding pigmented lesions on lips, oral mucosa, face, palms and soles IDA Tx = conservative unless problems
84
Metabolic ketoacidosis with normal or low glucose: CAUSE LIKELY?
ALCOHOL EXCESS
85
hypokalemia eg 3 polyps in colon ==?
vilous ademona causes hypo kalemia
86
secondary prophylaxis of hepatic encephalopathy
lactulose rifiximin
87
severe alcoholic hepatitis mx
prednisolone
88
when to screen for hep carcinoma HCC : which groups
patients liver cirrhosis secondary to hepatitis B & C or haemochromatosis MEN (not females) with liver cirrhosis secondary to alcohol
89
. A sigmoidoscopy is performed which shows multiple white plaques adhered to the gastrointestinal mucosa ==?
psudomembranous colitis assd with c diff
90
marker of severity acute pancreatitis
CRp
91
signet ring cells associated with?
gastric adenocarcinoma
92
investigation of choice for bile acid malabsorption
SeHCAT scan
93
investigation carcinoid syndrome
urinary 5-HIAA plasma chromogranin A y
94
primary sclerosing cholangitis Ix
MRCP= definitive pANCA may be positiv e
95
when is urea breath test inaccurate
should not be performed within 4 weeks of treatment with an antibacterial or within 2 weeks of PPI (e.g. a proton pump inhibitor)
96
NICE bariatric referral cut-offs
NICE bariatric referral cut-offs with risk factors (T2DM, BP etc): > 35 kg/m^2 no risk factors: > 40 kg/m^2
97
which genetic conditions is the most prevalent in a Caucasian population?
haemochromatosis
98
must eat gluten for how many weeks before coeliac testing
6 weeks
99
. What is the most likely vessel to be responsible? in variceal bleed
gastroduodenal artery
100
negative HVC RNA but positive anti HCV==?
previous hep c infection
101
increase risk of HCC
Aflatoxin
102
achalasia CFs Ix tx
food and drink, regurg, heart burn Ix= oesophageal manometry barium swallow= birds beak RETROCARDIAL air fluid level Tx ballon dilation first line severe and sx needed= hellers myotomy
103
angiodysplasia Ix
capsule endoscopy
104
unsafe drugs in acute intermittent porphyria
Drugs unsafe in acute intermittent porphyria: If you go to a BAR on a BENZ,say HALO to a guy,take a SULFi,have some ALCOHOL n dont forget the OCP.(barbiturates;Benzodiazepines,HAloperidol,Sulfonamides;alcohol and OCP.
105
obeticholic acid
FXR agonist it is used in PBC

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