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MRCP Part 1 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What are used in the management of severe alcoholic hepatitis?

A

Corticosteriods

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2
Q

What is a common diabetic drug which can cause cholestasis?

A

Gliclazide

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3
Q

What drugs can cause a liver injury?

A

Paracetomal
Sodium valproate, phenytoin
MAIOs
Anti-TB drugs (isonizaid, rifampicin, pyrazinamide)
Statins
Alcohol
Amiodarone
Methyldopa
Nitrofurantoin

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4
Q

Drugs that can cause liver cirrhosis

A

Methotrexate
Methyldopa
Amiodarone

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5
Q

Diagnostic test of choice for pancreatic ca

A

CT

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6
Q

Risk factors for pancreatic cancer

A

Older age
Smoking
Diabetes
Chronic pancreatitis
HNPCRC
Multiple endocrine neoplasia
BRCA2 gene
KRAS gene mutation

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7
Q

Presentation of pancreatic cancer

A

Painless jaundice
- Pale stools
- Dark urine
- itchy
Cholestatic LFTs
Anorexia
Epigastric pain
Loss of exocrine function (steatorrhoea)
Loss of endocrine function (DM)
Possible atypical back pain

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8
Q

What is courvoisiers law?

A

The prescence of painless obstructive jaundice and a palpable gallbladder is unlikely to be due to gallstones

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9
Q

Investigations of pancreatic cancer

A

USS
CT

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10
Q

What may imaging show classically in pancreatic cancer?

A

The “double duct” sign -> the presence of similtaneous dilatation of the common bile and pancreatic ducts

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11
Q

Treatment of pancreatic cancer

A

Whipples resection
Adjuvant chemotherapy
ERCP + stenting usually used for palliation

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12
Q

What is a whipples resection?

A

Pancreaticoduodenectomy

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13
Q

What genes are most strongly associated with coeliac disease?

A

HLA-DQ2 + HLA-DQ8

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14
Q

What is coeliac disease?

A

Autoimmune disease which causes a sensitivity to the protein gluten

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15
Q

Conditions that are associated with coeliac disease

A

Dermatitis herpatiformis (vesicular puritic skin eruption)
T1DM
Autoimmune hepatitis
IBS
Autoimmune thyroid disease

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16
Q

Signs/symptoms of coeliac disease

A

Chronic or intermittent diarrhoea
Failure to thrive or faltering growth in children
Persistent or unexplained GI symptoms including N+V
Prolonged fatigue
Recurrent abdo pain / cramping / distension
Sudden / unexpected weight loss
Unexplained IDA or other anaemia

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17
Q

Complications of coeliac disease

A

Anaemia
Hyposplenism
Osteoporosis
Osteomalacia
Lactose intolerance
Enteropathy-assosiated T cell lymphoma of the small intestine
Subfertility
Rarely oesophageal cancer or other malignancies

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18
Q

What electrolyte abnormalities are most commonly seen in refeeding syndrome

A

Hypophosphataemia
Hypomagnesia
Hypokalaemia

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19
Q

Where is the mutation if you have familial adenomatous polyposis?

A

A tumour supressor gene called adenomatous polyposis coli gene (APC)

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20
Q

What are the 3 types of colon cancers?

A

Sporadic (95%)
HNPCC (5%)
FAP (<1%)

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21
Q

Inheritance of HNPCC

A

Autosomal dominant

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22
Q

Another name for HNPCC

A

Lynch syndrome

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23
Q

Most common genes in HNPCC

A

MSH2
MLH1

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24
Q

What other cancer except CRC are patients with HNPCC at risk of?

A

Endometrial

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25
Q

What criteria is used to aid diagnosis of HNPCC?

A

Amsterdam criteria

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26
Q

Amsterdam criteria of HNPCC

A

At least 3 family members with colon cancer
The cases span at least 2 generations
At least one case diagnosed before 50 y/o

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27
Q

Patients with FAP, alongside CRC are also at risk of what?

A

Duodenal tumours

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28
Q

What test is recommended for post eradication H pylori treatment?

A

Urea breath test

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29
Q

HbsAg implies what?

A

Acute Hep B disease (1-6months)
Surface antigen first marker to be produced in infection

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30
Q

If HbsAg present > 6 months, what does this imply?

A

Chronic disease i.e. infective

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31
Q

What does anti-Hbs imply?

A

Immunity (exposure or immunisation)
It is negative in chronic disease

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32
Q

What does anti-HbC imply?

A

Previous or current infection

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33
Q

What is HbeAg a marker of?

A

HBV replication and infectivity

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34
Q

What may trigger an UC flare?

A

Stopping smoking
Stress
NSAIDs
Abx

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35
Q

What is classed as mild UC?

A

<4 stools per day +/- blood
Nil systemic disturbance
Normal ESR + CRP

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36
Q

What is classed as moderate UC?

A

4-6 stools per day
Minimal systemic disturbance

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37
Q

What is classed as severe UC?

A

> 6 Stools / day -> containing blood
Evidence of systemic disturbance e.g.
- fever
- tachycardia
- abdo pain / distension / reduced bowel sounds
- anaemia
- hypoalbuminaemia

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38
Q

What is the most common cause of HCC worldwide?

A

Chronic hep B

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39
Q

What is the most common cause of HCC in europe?

A

Chronic hep C

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40
Q

Main risk factor for HCC

A

Liver cirrhosis

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41
Q

Risk factors for HCC

A

Liver cirrhosis
- hepatitis
- alcohol
- haemachromatosis
- PBC
alpha-1-antitrypsin defieicny
hereditary tyrosinosis
glycogen storage disease
aflatoxin
OCP
Anabolic steriods
Male
Diabetes
Metabolic syndromes

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42
Q

When does HCC tend to present?

A

Late

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43
Q

Presentation of liver disease

A

Jaundice
Ascites
RUQ pain
Hepatomegaly
Itchy
Splenomegaly

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44
Q

What tumour marker is looked at in HCC?

A

AFP

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45
Q

What is the screening is used for HCC?

A

USS

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46
Q

Who often gets screening for HCC?

A

Patients with liver cirrhosis 2ndry to hep B, C or haemachromatosis
Men with liver cirrhosis secondary to alcohol

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47
Q

Treatment of HCC

A

Early disease; surgical resection
Liver transplant
Radiofrequency ablation
Transaterial chemoembolisation
Sorafenib

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48
Q

What is whipples disease caused by?

A

Tropheryma whippelii infection

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49
Q

Who is whipples disease more common in?

A

HLA-B27 positive
Middle aged men

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50
Q

Presentation of whipples disease

A

Malabsorption; diarrhoea, weight loss
Large joint arthralgia
Lymphadenopathy
Hyperpigmentation and photosensitvity
Pleurisy
Pericarditis
Neurological sx; rare

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51
Q

Investigatin of whipples disease

A

Jejunal biopsy

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52
Q

Finding of biopsy in whipples disease

A

Deposition of macrophages containing PAS granules

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53
Q

Treatment of whipples disease

A

Oral co-trimox for a year
Sometimes followed by a course of IV penicillin

54
Q

What is the strongest risk factor for anal cancer?

A

HPV infection

55
Q

Increasing risk factors for HPV infection

A

Anal intercourse
High lifetime number of sexual partners

56
Q

Risk factors for anal cancer

A

HPV
MSM
HIV
Immunosuppressive medications
Cervical cancer / CIN
Smoking

57
Q

Presentation of anal cancer

A

Perianal pain
Perianal bleeding
Palpable lesion
Faecal incontinence
Fistulas

58
Q

Investigations of anal cancer

A

CT/MRI/PET
Biopsy

59
Q

What is Budd-Chiari syndrome?

A

Hepatic vein thrombosis

60
Q

Causes of budd chiari syndrome

A

Polycythaemia rubra vera
Thrombophilia
Pregnancy
COCP

61
Q

Triad of budd chairi syndrome

A

Abdominal pain, severe, sudden onset
Ascites
Tender hepatomegaly

62
Q

Initial Ix for budd chairi syndrome

A

USS with doppler flow studies

63
Q

What is the main risk factor for cholangiocarcinoma?

A

PSC

64
Q

Presentation of cholangiocarcinoma

A

Persistent biliary colic symptoms
Anorexia
Jaundice
Weight loss
Palpable mass RUQ
Periumbilical lymphadenopathy and left supraclavicular adenopathy

65
Q

What tumour marker may be raised in cholangiocarcinoma?

A

CA 19-9

66
Q

Most appropriate treatment for variceal haemorrhage whilst waiting for endoscopy?

A

Terlipressin

67
Q

Prophylaxis of variceal haemorrhage

A

Propranolol
Endoscopic band ligation
TIPSS

68
Q

What can happen if H pylori is left untreated?

A

PUD
Gastric cancer
B cell lymphoma of malt tissue
Atrophic gastritis

69
Q

Treatment of H pylori

A

7 day eradication therapy of
- PPI + amoxicillin + (clarithromycin or metronidazole)
- PPI + Clari + metronidazole if pen allergic

70
Q

Most common causes of acute upper GI bleed

A

Oesophageal varices
Peptic ulcer disease

71
Q

Presentation of upper GI bleeding

A

Haematemesis
Melena
Raised urea

72
Q

What is the screening test for haemachromatosis?

A

Transferrrin saturation > ferritin

73
Q

What gene are family members tested for in haemachromatosis?

A

HFE genetic testing

74
Q

What is haemachromatosis?

A

Autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation

75
Q

What is the typical iron study in a patient with haemachromatosis?

A

Transferrin saturation > 55% in men or >50% in women
Raised ferritin and iron
Low TIBC

76
Q

Management of haemachromatosis

A
  1. Venesection
  2. Desferrioxamine
77
Q

If C diff does not respond to first line treatment, in the abscence of life threatning features, what should be used next?

A

Oral fidaxomicin

78
Q

Risk factors for C diff

A

C antibiotics
PPIs

79
Q

Presentation of C diff

A

Abdo pain
Diarrhoea
Raised WCC

80
Q

Complication of C diff

A

Toxic Megacolon

81
Q

Diagnostic testing of C diff

A

C diff toxin in stool

82
Q

1st line treatment of C diff

A

Oral vancomycin for 10 days

83
Q

Second line treatment of C diff

A

Oral fidaxomicin

84
Q

Third line treatment for C diff

A

Oral vanc +/- IV metronidazole

85
Q

What is seen on a CXR characteristically with achalasia?

A

Retro-cardiac air fluid level
Wide mediastinum

86
Q

What is achalasia?

A

Failure of oesophageal peristalsis and relaxation of the LOS due to generative loss of ganglia from Aucherbachs plexus i.e. LOS contracted, oesophagus above dilatated

87
Q

Presentation of achalasia

A

Dysphagia of both SOLIDS AND LIQUIDS
Variation in severity of symptoms
Heartburn
Regurgitation of food (may lead to cough, aspiration pneumonia etc)

88
Q

Definition of dysphagia

A

Difficulty swallowing

89
Q

Investigations of achalasia

A

Oesophageal mamometry
Barium swallow
CXR

90
Q

Treatment of achalasia

A

Pneumatic ballon dilatation
Surgical intervention with Heller cardiomyotomy if recurrent or persistent symptoms
Intra-sphincteric injection of botulinium toxin in patients high surgical risk

91
Q

What inheritance is haemachromatosis?

A

Autosomal recessive

92
Q

Presentation of haemachromatosis

A

Fatigue
Erectile dysfunction
Arthralgia (often in hands)
Bronze skin pigmentation
DM
Sigmata of chronic liver disease
Cardiac failure 2ndrly to dilated cardiomyopathy
Hypogonadism 2ndry to cirrhosis and pituitary dysfunction
Arthritis (particularly of hands)

93
Q

1st line test for coeliac disease

A

Tissue transglutaminase antibodies

94
Q

First line investigations for coeliac disease

A
  1. TTG antibodies
  2. Endoscopic intestinal biopsy
95
Q

Biopsy Findings supportive of coeliac disease

A

Villous atrophy
Crypt hyperplasia
Increase in intraepithelial lymphocytes
Lamina propria infiltration with lymphocytes

96
Q

Sulphazalazines such as mesalazine can cause what in men?

A

Oligospermia and infertility

97
Q

Complications of acute pancreatitis

A

Peripancreatic fluid collections
Pseudocysts
Pancreatic necrosis
Pancreatic abscess
Pancreatic haemorrhage
Acute respiratory distress syndrome

98
Q

What antibiotic is a well recognised cause of cholestasis?

A

co-amoxiclav

99
Q

How does gastrin work?

A

Increases H+ secretion by gastric parietal cells

100
Q

If a patient who had severe UC has had a severe relapse or >2 exacerbations in the past year, what should they be given?

A

Oral azathioprine or oral mercaptopurine

101
Q

Treatment for proctitis in UC

A

Topical rectal aminosalicylate
If remission is not achieved within 4 weeks, add oral aminosalicylate
If remission still not achieved, add topical or oral corticosteriod

102
Q

Treatment for proctosigmoiditis and left sided colitis

A

Topical rectal aminosalicylate
If remission not achieved within 4 weeks, add high dose oral aminosalicylate or switch to high dose oral aminosalicylate and a topic corticosteriod
If remission still not achieved stop topical treatments and offer oral aminosalicylate and oral corticosteriods

103
Q

Treatment for extensive UC disease

A

Topical rectal aminosalicylate and high dose oral aminosalicylate
If remission not achieved in 4 weeks, stop topical treatments and offer high dose aminosalicylates and oral corticosteriods

104
Q

Treatment of severe colitis

A

IV steriods
If no improvement by 72 hrs, consider adding IV ciclosporin or consider steriods

105
Q

What hormone is released in response to a fatty meal and what cells release this?

A

CCK
Released by I cells

106
Q

What is a recognised complication of cholecystectomies?

A

Post cholycystectomy syndrome

107
Q

Incidence of post cholycystectomy syndrome

A

up to 40%

108
Q

Presentation of post cholycystecotmy syndrome

A

Dyspepsia
Vomiting
Pain
Flatulence
Diarrhoea

109
Q

Management of post cholycystectomy syndrome

A

Low fat diet
Bile acid sequestrants e.g. cholystyramine
PPIs symptomatically

110
Q

Where is somastatin released from?

A

D cells in the pancreas and stomach

111
Q

Presentation of oesophageal cancer

A

Anorexia / weight loss
Dysphagia - progressive
Vomiting during eating

112
Q

Assosiations of oesophageal cancer

A

Barretts oesophagus
GORD
Smoking
Alcohol XS

113
Q

Risk factors for oesophageal candidiasis

A

HIV
Steriod inhaler use

114
Q

Who is a pharyngeal pouch common in?

A

Older men

115
Q

Presentation of pharyngeal pouch

A

Dysphagia
Regurgitation
Aspiration
Chronic cough
Halitosis

116
Q

What is a pharyngeal pouch?

A

A posteriomedial herniation between thyropharyngeus and cricopharyngeus muscles

117
Q

Presentation of myasthenia gravis

A

Progressive fatigue
Dysphagia with both liquids and solids
Extraocular muscle weakness / ptosis

118
Q

Extrinsic causes of dysphagia

A

Mediastinal masses
Cervical spondylosis

119
Q

Oesophageal wall causes of dysphagia

A

Achalasia
Diffuse oesophageal spasm
Hypertensive lower oesophageal spasm

120
Q

Intrinsic causes of dysphagia

A

Malignancy
Strictures
Oesophageal web
Schtazi webs

121
Q

Neurological causes of dysphagia

A

CVA
Parkinsons disease
MS
Brainstem pathology
Myasthenia gravis

122
Q

Treatment of wilsons disease

A

Penicillamine

123
Q

Inheritance of wilsons disease

A

Autosomal Recessive

124
Q

What is wilsons disease?

A

Autosomal recessive disorder characterised by exessive copper deposition in tissues

125
Q

What genetic abnormality causes wilson disease?

A

Defect in ATP7B gene located on chromosome 13

126
Q

Presentation of wilsons disease

A

Hepatitis
Liver cirrhosis
Basal ganglia degeneration
Speech, behavioural and psychiatric problems
Aterixis
Chorea
Dementia
Parkinsonism
Kayser FIscher rings
Renal tubular acidosis
Haemolysis
Blue nails

127
Q

What are katser fischer rings?

A

Green brown rings in the periphery of the iris

128
Q

Investigations for wilsons disease

A

Slit lamp examination
Low serum careoplasmin
Reduced total serum copper
Free serum coppler is increased
Increased 24hr urinary copper excretion

129
Q

How is the diagnosis of wilsons disease confirmed?

A

Genetic analysis of the ATP7B gene

130
Q

How does penicillamine work in wilsons disease?

A

Chellates copper

MRCP Part 1 (7 decks)

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