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FCRAP > Gastroenterology > Flashcards

Gastroenterology Flashcards

(64 cards)

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1
Q

Haemochromatosis - inheritance, what gene

A

Autosomal recessive
HFE gene - C282Y - most common
H63D mutation

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2
Q

Haemochromatosis - what features

A 
Arthritis
Diabetes
Cardiomyopathy
Bronzed skin
Liver failure
Hypogonadism
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3
Q

Haemochromatosis - reversible organ damage

A

Pigmented skin

Cardiomyopathy

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4
Q

Haemochromatosis - irreversible organ damage

A

Arthritis, Diabetes, Liver disease, Hypogonadism

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5
Q

You suspect a patient has haemochromatosis - what test would you do

A

Screening: Transferrin saturation >50%

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6
Q

A man has haemochromatosis - what test would you do

A

Known mutations: HFE (or other) gene testing = C282Y gene test

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7
Q

What test would you order on liver histology to look for iron accumulation?

A

Perl’s stain

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8
Q

What is the greatest risk factor for isoniazid induced hepatitis?

A

Increasing age (suggest not treating for latent TB unless reactivation risk is high)

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9
Q

UC bowel surveillance

A 
high risk: annual
stricture in past 5 years
extensive mod /evere colitis
dysplasia in past 5 years
PSC or transplant for same
FHx CRC < 50yo
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10
Q

Primary biliary cirrhosis

A 
cholestatic liver disease
raised ALP
ALT / AST > 5 times ULN
AMA +ve 95% pts
ANA +ve
elevated IgG
normal USS
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11
Q

What are the contraindications to liver biopsy

A 
anaemia < 100
INR > 1.4
plts < 100
hydatid cyst with ecchinococcus granulosus (anaphylaxis if punctured)
bile duct obstruction
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12
Q

SE of Boceprevir

A

Anaemia
Direct antiviral against Hep C (esp Genotype 1)
Altered taste

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13
Q

SE of Telaprevir

A

Rash - bad, could be hospitalised

Direct antiviral against Hep C (esp Genotype 1)

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14
Q

Extra intestinal manifestations of IBD in ACTIVE disease

A

Erythema nodosum
Oral ulcers
Arthritis
Episcleritis

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15
Q

Extra intestinal manifestation of IBD independent of active disease (in INACTIVE disease)

A 
PSC
Ank spond
Uveitis
Pyoderma gangrenousum
Kidney stones, gall stones
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16
Q

Rx of eosinophilic oesophagitis

A

Topical steroids
Elimination - 6 foods - milk, egg, wheat, soy, peanuts/treenuts, seafood
Consider dilation (may get mucosal tearing)

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17
Q

Components of blatchford score for GI bleeding

A

BUN
Hb
BP
Others: Cardiac failure, hepatic failure, syncope, malaena

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18
Q

Dx of pernicious anaemia

A

intrinsic factor antibodies 100% specific; 50-70% sensitive

elevated fasting serum gastrin level is sensitive but not specific

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19
Q

Hepatic vein pressure gradient HVPG

A

> 12 indicates cirrhosis, ascites devt

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20
Q

H Pylori

A

a/w ulcers, MALT, gastric cancer

not a/w GORD

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21
Q

Drug induced liver disease - hepatocellular

A 
paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin
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22
Q

Drug induced liver disease - cholestatic

A

oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine

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23
Q

Drug induced liver disease - cirrhosis

A

methotrexate
methyldopa
amiodarone

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24
Q

painful red eye

A

dilated pupil - glaucoma

small pupil - uveitis

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25
alpha 1 antitrypsin
``` alleles classified by their electrophoretic mobility - M for normal, S for slow, and Z for very slow normal = PiMM homozygous PiSS (50% normal A1AT levels) homozygous PiZZ (10% normal A1AT levels) ```
26
autoimmune hepatitis
Features may present with signs of chronic liver disease acute hepatitis: fever, jaundice etc (only 25% present in this way) amenorrhoea (common) type 1: ANA/Smooth muscle antibodies, raised IgG levels; respond well to steroids type 2: LKM (liver kidney microsomal) Abs severe course liver biopsy: inflammation extending beyond limiting plate 'piecemeal necrosis', bridging necrosis
27
coeliac diagnosis
anti endomysial IgA near 100% sens, spec anti gliadin IgG, IgA 70-90% sens, spec HLA DQ2 DQ8 universal
28
SAAG
> 11 indicates portal HT protein > 3g/dL is exudate - heart failure < 3g/dL is transudate - cirrhosis
29
cryoglobulins
type 1: monoclonal a/w lymphoma, hyperviscosity, normal complement levels type 2: mixed monoclonal; Ab to Fc of IgG (Rh F), HCV, lymphoproflierative disorders, rheumatic disease low complement type 3: mixed polyclonal HCV, Rh D, low complement 2 + 3: purpura, GN, peripheral neuropathy Rx; pred, cyclo
30
CAG PAI
Virulence factor for H. Pylori | PAI = pathogenicity island
31
H. Pylori
Rx: PPI, clarithromycin, amoxicillin (metro if allergy) 7/7 urease breath test 4/52 post treatment completion PPI may cause FN result clarithro resistance: levofloxacin, bismuth
32
amoxycillin DILI
cholestasis
33
methotrexate DILI
transaminitis
34
CRC kras mutation
40% CRC | predicts lack of response to EGFR inhibitors (cetuximab)
35
Lynch Syndrome
BRAF mutation - only in sporadic tumours
36
anti TNF agents in IBD indications
fisulising crohns active crohns: induction / maintenance salvage therapy in UC: fulminant and other treatments failed; not for UC maintenance (ciclo just as good)
37
paracetamol overdose
activated charcoal only in first 2 hours | cimetidine inhibits 2E1 (protective); chronic alcohol induces 2E1 (worse)
38
coeliac disease HLA type
HLA DQ2 or DQ8
39
Whipples disease
Tropheryma whipplei worm eye, CNS, lungs, heart, joints diarrhoea, LOW, fever, malaise, arthralgias, cognitive impairment, ataxia, eye signs
40
autoimmune enteropathy
looks like coeliac disease but does not respond to exclusion diet
41
UGI bleed
restart aspirin if for secondary prevention (use PPI cover)
42
HBV
treat if DNA load > 106IU/ml at any time during the pregnancy Precore mutant: HBeAg negative but high viral load HDV is lamivudine resistant
43
histamine - which cell
ECL (enterochromaffin like) cells | most important paracrine stimulator of acid release
44
gastrin
G cells | stimulates histamine secretion from ECL cells which stimulates acid secretion from parietal cells
45
somatostatin
D cells - inhibit gastric acid secretion (direct action on parietal cells and decreases histamine and gastrin release too) released in response to low pH
46
intrinsic factor
parietal cells
47
acetylcholine
directly stimulates parietal cells to secrete gastric acid
48
ALT: AST
AST > ALT - alcoholic liver disease, AI liver disease | ALT > AST - NAFLD
49
Maddreys discriminant function
BI (bili + PT above control) X 4.6 | > 32 indicates need for pred for 4/52
50
PBC
anti mitochondrial Abs 90%
51
HCC surveillance
``` 6 monthly USS, alpha fetoprotein cirrhotics HBsAg +ve Asian male > 40yo; female > 50yo African male > 20yo; female > 50yo FHx HCC ```
52
do not recur post liver transplant
wilsons disease | alpha 1 antitrypsin
53
abnormality in Wilsons disease
``` neuro / liver + haemolysis auto recessive ATP 7B mutation Rx: penicillamine, zinc, trientine tetrathiomolybdate for neuro sxs ```
54
crohns disease
NOD2 card variant predicts severe disease | ASCA anti saccharomyces ceresvisiae in 70%
55
azathioprine active metabolite
6TGN
56
neuroendocrine tumours
chromogranin A positive in 90% | octreoscan
57
PPI side effects
osteoporosis increased; incl hip # in women decreased iron absorption increased c diff increased CAP
58
Zollinger Ellison
gastrinoma in pancreas / duodenum Dx: secretin stimulation test octreoscan
59
nutrient absorption
mostly jejunum calcium - proximal duodenum B12, bile - terminal ileum Fe - duodenum
60
Bloody diarrhoea
E Coli 0157:H7, salmonella, shigella, campylobacter
61
diarrhoea < 6/24
staph aureus / bacillus cereus
62
HVPG
``` hepatic vein pressure gradient = WHVP - FHVP wedged hepativ vein pressure minus free hepatic vein pressure normal 1-5; clin sigt portal HT > 10 risk bleeds > 12 ```
63
Gilbert
defect in bilirubin conjugation due to defect in UGT1A1
64
Wilsons
cannot put copper into caeruloplasmin low caeruloplasmin, copper accumulates in bile auto rec ATP7B

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