Gastroenterology Flashcards
(155 cards)
1
Q
Gastrin secretion inhibitors
A
VIP, glucagon, somatostatin, Calcitonin
2
Q
Gastrin secretion stimulator
A
epinephrine, calcium, gastric distension, vagal stimulation, acetylcholine, L-amino acids
3
Q
cell that secretes gastrin? cell upon which gastrin acts?
A
Secreted by G cells in stomach/duodenum, acts on parietal cell of stomach
4
Q
Earliest phenotypic manifestation of haemochromatosis
A
Transferrin saturation Increase
5
Q
Findings of following in SIBO (high or low): MCV, folate, B12
A
high, high, low (Luminal bacteria consume cobalamin but produce folate)
6
Q
Commonest worldwide cause of non-cirrhotic portal hypertension?
A
Schistosomiasis
7
Q
Drug causes of non-cirrhotic portal hypertension
A
Azathioprine, chemos
8
Q
Vascular causes of non-cirrhotic portal hypertension
A
Budd Chiari, sinusoidal osbtructive syndrome
9
Q
Infiltrative causes of non-cirrhotic portal HTN
A
sarcoid, mastocytosis
10
Q
What factors are assoc. w. rapid progression of Hep B?
A
longer duration of infection, Hep B genotype C, core promoter mutation, co-infection with Hep C, Male
11
Q
Drug with highest resistance in Hep B
A
Lamivudine
12
Q
ETOH time frame for withdrawal seizures
A
12-48 hours
13
Q
ETOH time frame for DTs
A
48-96 hours
14
Q
Toxic effect of ETOH is due to
A
acetaldehyde
15
Q
ETOH hepatitis histopath hallmark
A
neutrophilic infiltrate
16
Q
When to use acamprosate?
A
withdrawal sx >1/52
17
Q
4 causes of AST:ALT >2
A
ETOH, NAFLD, Wilson’s, Hep C
18
Q
Abnormally low ALP with other elevated liver eynzymes
A
Wilson’s
19
Q
Who progresses to chronic Hep B
A
babies/ kids
20
Q
Define chronic Hep B
A
sAg +ve for >6/12
21
Q
When to Rx Hep B
A
eAg+, HBV VL>20K and ALT >2x ULN
eAg-, HBL VL >2K and ALT >2x ULN
22
Q
MOA entecavir and tenofovir
A
HBV DNA Pol inhibitors
23
Q
Which Hep B drug is safe in pregnancy
A
Tenofovir DF
24
Q
Demographics at highest risk of HCC from Hep B
A
Africans >20, Asians >40
25
How to manage pregnancy with elevated HBV VL
Tenofovir 3rd trimester, baby get IgG and vax
26
Mgmt of Hep D
Peg-IFN
27
Hep C genotype in Australia
3
28
Hep C assoc. GN
MPGN
29
What % of Hep C infections progress to chronic
75%
30
Why are Egyptian's at higher risk of Hep C
Schistosomiasis vaccine
31
Side effects of Ribavarin
Rash and haemolytic anaemia
32
SVR in Hep C
-ve PCR at 3/12
33
Mutation assoc. w. Hep C resistance
Y93H
34
Diagnostic criteria for eosinophilic oesophagitis
>15eo/HPF on biopsy (not just distal as GORD could cause that distally) and symptoms of oesophageal dysfunction
35
6 foods in elimination diet for eosino eo
egg, milk, wheat, soy, nuts, seafood
36
most sensitive test for achalasia
manometry
37
Most important type of metaplasia in Barrett's
Intestinal
38
Barrett's increases risk of adeno ca by how much?
40-100x
39
MELD score for liver Tx in chronic cirrhosis
>15
40
SAAG consistent w. portal HTn
>11
41
HVPG consistent with cirrhosis
>10
42
HVPG assoc. w. varices
>12
43
When to start rifaxamin and what is the benefit?
after 1st epi encephalopathy, reduce recurrence of further
44
Which varices are best Mx with glue?
gastric
45
What is the R factor in LFTs?
(ALT/ULN) / (ALP/ULN)
46
Top causes of R factor >5
Paracetamol, sulfonamides, statins, tetracyclines
47
Drugs causing R factor <2
Penicillins, cephalosporins, terbinafine, OCP
48
How do non-selective BBs reduce risk of variceal bleed?
Reduced CO, and splanchnic vasoconstriction via alpha receptors
49
What factors make varices high risk?
Size, red wale sign, CP stage
50
Surveillance scope frequency
No varices = 2 years
| Small or worse = annual
51
Definition of HRS-AKI
Creat 2-3x with bland UA and no other cause, diuretics withheld and 48h albumin given
52
Management of HRS-AKI
Terli and albumin 1g/kg/d
53
Define HRS-CKD
eGFR <60 for 3/12, no other cause
54
HCC - Barcelona liver clinic stage 0 definition and Rx
Single lesion <2cm
| Resect or ablate
55
HCC - Barcelona liver clinic stage A definition and Rx
Single lesion or 3 lesions <3cm
| Transplant
56
HCC - Barcelona liver clinic stage B definition and Rx
Multi-nodular
| TACE
57
HCC - Barcelona liver clinic stage C definition and Rx
Portal invasion/distant mets
| TKIs (sorafenib, lenvatinib)
58
HCC - Barcelona liver clinic stage D definition and Rx
CPC cirrhosis, ECOG >/=2
| Palliate
59
Two most common mutations on haemachromatosis
1 - C282Y
| 2 - H63D
60
Penetrance for homozygotes of haemachromatosis mutations
10-30%
61
Ferritin level predictive of end-organ damage in haemachromatosis
>1000
62
Indications for venesection haemachromatosis
Ferritin 100-400, organ dysfuncion (EF, ALT/AST), evidence of excess iron on MRI/biopsy
63
Why does fluid overload occur in re-feeding?
Insulin acts on DCT along with ADH
| Some effect of low albumin
64
What is fatal complication of hypophosphataemia?
Respiratory arrest
65
Mechanism of haemolysis in re-feeding?
Hypophos --> reduced 2,3DPG
66
Best form of calories in critical illness/re-feeding high risk patients?
Lipid calories
67
Main organ affected by vit A deficiency
Eyes
68
Minimum amount of bowel needed to prevent short gut?
>150cm small bowel
| >60cm small bowel with ileum colon
69
Why do those with short gut get gallstones?
Excess bile salts secretes
70
Why do those with short gut get reflux?
Acid hyper-secretion
71
Best form of Mg2+ to prevent diarrhoea
Aspartate
72
Mechanism of oxalosis in short gut
Calcium bound by excess fatty acids, excess oxalate re-absorted in colon leading to renal impairment
73
Management of bile salt diarrhoea
Cholestyramine or sucralfate
74
Mechanism of teduglutide
GLP-2 agonist, increases proximal bowel absorption, risk of cancer
75
Diagnosis of protein-losing enteropathy
Faecal alpha 1 anti-trypsin
76
What treatment reduces Crohn's recurrence post-op?
Metronidazole 3 months, 5-ASA and TNFa inhibitors
77
Which medications increase risk of IBD?
Aspirin, NSAIDs, OCP
78
Extra-intestinal manifestations that follow disease activity?
Episcleritis, large joint arthritis, erythema nodosum, oral ulcers
79
Extra-intestinal manifestations that DON'T follow disease activity?
PSC, Ank spon, uveitis, pyoderma, stones (renal, gall)
80
Diagnosis of acute severe colitis?
Truelove and Whitt
>6 bloody stools AND 1 of:
T>37.8, HR>90, Hb<100, ESR>35
81
Definition of failed treatment of acute severe colitis after 3 days of Rx
CRP >45, >8 stools/d
82
2 susceptibility genes for Crohn's
NOD2/CARD15
83
Phenotype of those with NOD2/CARD15 Crohn's
Younger, more aggressive, more surgery, stricturing
84
Antibody pattern for Crohn's
ASCA+
| pANCA-
85
Antibody pattern for UC
ASCA-
| pANCA+
86
In UC, who is more likely to get pouchitis?
pANCA+, non-smoker, PSC
87
Treatment of pouchitis
Metro or cipro
88
Proportion of PSC that have UC
50-90%
89
IBD drugs safe in pregnancy
Steroids, 5-ASA, AZA, TNFa inhibs until T3
90
Thiopurines increase risk of what malignancies
Lymphoma, non-melanoma skin cancer
91
Which aggressive malignancy is associated with treatment with thiopurines + anti-TNF
Hepatosplenic T-cell lymphoma
92
If TPMT increase, which product is increased?
6-MMP (hepatotoxic)
93
If TPMT decreased, which product is increased?
6-TGN (myelosuppression)
94
Effect of allopurinol on thiopurines
XO metabolises 6-PM to 6-TA, so allopurinol shunts 6-TGN (myelosuppression)
95
What form of TPMT are poor metabolisers?
homozygote 2/2, 3/3, or compount heterozygote 2/3
96
What 6-TGN level is associated with remission?
>235
97
If 6-MMP is elevated but 6-TGN reduced, how do you manage?
Add allopurinol
98
MTX used in Crohn's or UC?
Crohn's only
99
TNFa inhibitors may flare which skin condition?
Psoriasis
100
Cancers associated with TNFa inhibs?
Lymphoma, melanoma
101
Mechanism of vedolizumab
Integrin alpha4beta7 inhib, prevents leucocytes binding to MADCAM on intestinal wall --> prevents trafficking
102
MEchanism of ustekinumab
IL12/23 inhibt (anti-p40 subunit)
103
Gene associated with NAFLD in Hispanics
PNPLA3
104
2 main alternative causes for steatosis (aside from NAFLD)
Alcohol, meds (tamoxifen)
105
#1 cause of death in NAFLD
CVD
106
Best treatment for NAFLD
Weight loss
107
Role of statins in NALFD
Not indicated on own, no RCT
108
Does metformin help in NAFLD?
No - no significant effect on biochem or histopathology
109
What is PPAR alpha/delta agonist therapy in NAFLD?
Elafibrinor - reduces steatosis by increasing lipid oxidation, reduced inflamm/fibrosis through macrophage inhibition, but lots of AEs
110
Effect of vitamin E in NAFLD
Has demonstrated benefit in NASH resolution in non-diabetics but increases risk of haemorrhagic CVA and prostate Ca
111
How does obeticholic acid work?
For NAFLD. FXR agonist, improves lipids and insulin sensitivity. But increases LDL and causes pruritis
112
Benefit of PPI pre-scope
Reduce need for intervention
113
Benefit of PPI post scope for high risk
Reduces mortality, LOS, re-bleed
114
Dual treatment for GI ulcer bleed = ?
Adrenaline + either cautery or clips
115
Role of endoscopic spray
Salvage, falls off in 24h
116
What is Forrest 1a?
Active arterial bleeding
117
What is Forrest 1b?
Ooze, no visible vessel
118
What is Forrest IIa?
Non-bleeding visible vessel
119
What is Forrest IIb?
Adherent clot
120
What is Forrest IIc?
Flat spot
121
What is Forrest III?
Clean ulcer base
122
Implications of Forrest stage 2c and 3?
D/C on PO PPI
123
What is immunogenic part of gluten?
Gliadin. GLuten is 50/50 gliadin and glutenin
124
2 syndromal associations with coeliacs
Downs, Turners
125
Best serological test for coeliac
tTG-IgA and total IgA
126
2nd option for coeliac screen
tTG-IgA and DGP-IgG
127
Biopsy findings in coeliac
Villous atrophy, crypt hyperplasia, intra-epithelial lymphocytes
128
Drugs that can mimic coeliac
Olmesartan, NSAIDs, MMF
129
Autoimmune mimics of coeliac
Autoimmune enteropathy, Crohn's CVID
130
Infecitous mimics of coeliac
Giardia, H. pylori, tropical sprue
131
Best NPV test for coeliac?
HLA DQ2/8
132
Role of tTG?
Deamidates gluten peptides -> more immunogenic gliadin exposed
133
What vaccine reduces risk of coeliac?
Rotavirus
134
Role of repeat serology in coeliac
Usually normalises on GFD but is poor marker of adherence
135
Refractory coeliac type 1:
Normal lymphocytes --> immunosuppress
136
Refractory coeliac type 2:
Monoclonal lymphocytes: 50% lymphoma treat with chemo/ASCT
137
What is mechanism of non-coeliac gluten/wheat intolerance?
FODMAPS
138
Best test for carcinoid?
Urinary 5-HIAA
139
Other tests for carcinoid aside from urinary 5-HIAA, and what can cause this to be false positive?
Serum chromogranin A
| PPIs
140
Criteria for IBS
Pain for >/=1d per week
For >/=3 months
With at least 2/3: Change in stool appearance, change in frequency, pain associated with defecation
141
Cause of IBS
FODMAPS
142
Typical haematinics pattern of SIBO
High MCV, low B12, high folate
143
WHich meds associated with SIBO:
PPIs, antibiotics
144
Main antomical/surgical risk factors for SIBO
Absent ileocaecal valve
145
How does breath test work for SIBO
Give lactulose or glucose
| Positive is hydrogen increase >20ppm in <90min
146
Gold standard diagnosis SIBO
Jejunal aspirate
| Positive if >10^3 CFU/mL
147
Antibiotic of choice for SIBO
Rifaximin
148
Treatment of PBC
Urso
| Transplant
149
PBC associations
Sjogrens, thyroid disease
150
Most common part of stomach affected by H. pylori
Antrum
151
First line Rx H. pylori
Amox + clarith + esomep 7/7
152
Most common reason for H. pylori 1st line rx failure
Clarithromycin resistance
153
Why is metro not used for H. pylori
High resistance rate
154
Salvage Rx H. pylori
Levofloxacin, amox and PPI BD for 10/7
155
First line treatment for HCV
Glecaprevir (ns3/4a) + pibrentAsvir (ns5A)
OR
SofosBuvir (ns5B) + velpAtAsvir (ns5A)
