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MRCP 2 > Gastroenterology > Flashcards

Gastroenterology Flashcards

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1
Q

Fabry disease

A

X-linked recessive lipid storage disorder in which there a deficiency in the fat enzyme alpha-galactosidase

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2
Q

Clinical features of Fabry disease include:

A

Acroparaesthesia: tingling, burning pain in the hands and feet triggered by stress such as emotion, extreme temperatures, or exercise

Angiokeratoma corporis diffusum: lightly verrucous, deep-red to blue-black papules on the trunk (in the bathing trunk distribution)

Cardiac: mitral valve prolapse or regurgitation usually, but any valvular heart defect can occur

Strokes: including young strokes/TIAs

Chronic Kidney Disease: proteinuria usually, can present late in fulminant renal failure

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3
Q

Gaucher’s disease

A

Autosomal recessive disorder characterised by a deficiency of glucocerebrosidase

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4
Q

Primary biliary cholangitis - diagnosis

A

anti-mitochondrial antibodies (AMA) M2

raised serum IgM

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5
Q

First-line in PBC

A

Ursodeoxycholic acid

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6
Q

How to diagnose Small Bowel Bacterial Overgrowth Syndrome

A

Hydrogen breath test

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7
Q

What is useful for diagnosing and monitoring the severity of liver cirrhosis

A

Transient elastography (FibroScan)

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8
Q

Main causes of Liver Cirrhosis

A

Alcohol

Non-alcoholic fatty liver disease (NAFLD)

Viral hepatitis (B and C)

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9
Q

Screening for haemochromatosis

A

General population: transferrin saturation > ferritin

Family members: HFE genetic testing

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10
Q

Treatment of small bowel bacterial overgrowth syndrome.

A

Rifaximin

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11
Q

Wilson’s disease

A

Autosomal recessive disorder characterised by excessive copper deposition in the tissues.

Defect in the ATP7B gene located on chromosome 13

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12
Q

Management of Wilson’s Disease

A

Penicillamine (chelates copper)

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13
Q

SAAG > 11g/L

A

(Indicates portal hypertension)

Liver disorders:
Cirrhosis/alcoholic liver disease
Acute liver failure
Liver metastases

Cardiac:
Right heart failure
Constrictive pericarditis

Other causes:
Budd-Chiari syndrome
Portal vein thrombosis
Veno-occlusive disease
Myxoedema

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14
Q

SAAG <11g/L

A

Hypoalbuminaemia:
Nephrotic syndrome
Severe malnutrition (e.g. Kwashiorkor)

Malignancy:
Peritoneal carcinomatosis

Infections:
Tuberculous peritonitis

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15
Q

Histology of Crohn’s Disease

A

Inflammation in all layers from mucosa to serosa
Goblet cells
Granulomas

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16
Q

Vitamin A - functions

A

Retinol

Converted into retinal, an important visual pigment

Important in epithelial cell differentiation

Antioxidant

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17
Q

HELLP

A

Haemolysis

Elevated Liver enzymes

Low Platelets

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18
Q

Dubin-Johnson syndrome

A

Autosomal recessive disorder

Raised Conjugated Bilirubin

(conjugated, therefore present in urine)

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19
Q

Zollinger-Ellison syndrome

A

Excessive levels of gastrin secondary to a gastrin-secreting tumour.

  1. Duodenum
  2. Pancreas
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20
Q

Diagnosis of Zollinger-Ellison syndrome

A

Fasting gastrin levels

Secretin stimulation test

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21
Q

Treatment of Pyogenic liver abscess

A

Drainage (typically percutaneous)

+

Amoxicillin + ciprofloxacin + metronidazole

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22
Q

Most common organisms found in pyogenic liver abscesses are:

A

Staphylococcus aureus in children

E-coli in adults.

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23
Q

Gastrectomy: complications

A

Dumping syndrome

Food of high osmotic potential moves into small intestine causing fluid shift

Iron-deficiency anaemia

Osteoporosis/osteomalacia

Vitamin B12 deficiency

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24
Q

Smoking and IBD

A

Smoking makes Crohn’s worse

But may help ulcerative colitis

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25
Adverse effects - Metoclopramide
D2 receptor antagonist Extrapyramidal effects Diarrhoea Hyperprolactinaemia
26
Fresh Frozen Plasma - when to give in UGIB
fibrinogen <1 g/L or PT/APTT/INR over 1.5 times the normal value.
27
Carcinoid tumours - Investigations + management
Urinary 5-HIAA Somatostatin analogues e.g. octreotide Diarrhoea: cyproheptadine may help
28
Haemochromatosis
Autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation
29
Reversible complications of Haemochromatosis
Cardiomyopathy Skin pigmentation
30
Irreversible complications of Haemochromatosis
Liver cirrhosis Diabetes mellitus Hypogonadotrophic hypogonadism Arthropathy
31
Cholestyramine
Bile acid sequestrant - used mainly in the managemenyt of hyperlipidaemia Decreases bile acid reabsorption in the small intestine Can be used in Crohn's disease for treatment diarrhoea following bowel resection.
32
Best marker for determining the risk of developing cirrhosis in Hepatitis B infection
Hepatitis B DNA level
33
ECG: Hyperkalaemia
Peaked or 'tall-tented' T waves (occurs first) Loss of P waves Broad QRS complexes Sinusoidal wave pattern Ventricular fibrillation
34
Beriberi
Thiamine deficiency Peripheral neuropathy High-output cardiac failure Weight loss.
35
Pellagra
Niacin Deficiency Dementia Dermatitis Diarrhoea
36
Hydatid cysts
Tapeworm parasite Echinococcus granulosus These cysts are allergens which precipitate a type 1 hypersensitivity reaction.
37
Volvulus - define
Torsion of the colon around it's mesenteric axis resulting in compromised blood flow and closed loop obstruction
38
Management Sigmoid volvulus
Rigid sigmoidoscopy with rectal tube insertion
39
Management Caecal Volvulus
Likely operative - Right hemicolectomy
40
Management of Hepatorenal syndrome
Terlipressin 20% HAS TIPS Liver transplant
41
Medical treatment for Achalasia
CCB (Nifedipine) / Nitrates
42
Triad of Budd Chiari Syndrome
Ascites Tender Hepatomegaly Abdominal pain (Hepatic Vein Thrombosis)
43
Initial investigation in patients with possible chronic pancreatitis to determine exocrine pancreatic insufficiency
Faecal Elastase
44
Common drugs causing cholestasis
Flucloxacillin Erythromycin Chlorpromazine Oral contraceptives Anabolic steroids
45
Features of Refeeding Syndrome
Hypophosphataemia This is the hallmark symptom of refeeding syndrome may result in significant muscle weakness, including myocardial muscle (→ cardiac failure) and the diaphragm (→ respiratory failure) Hypokalaemia Hypomagnesaemia: may predispose to torsades de pointes
46
Triple therapy in H Pylori eradication
Amox + Clari + PPI Metro + Clari + PPI (Pen Allergic)
47
Jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules
Whipple's disease
48
Treatment for Whipple's
Co-Trimoxazole (+ IV Penicillin)
49
Management of eosinophilic oesophagitis
Dietary modification and topical steroids (fluticasone and budesonide)
50
Management of SBP - acute
Intravenous cefotaxime
51
Lille score > 0.45 - what does it mean?
Used to evaluate response to corticosteroid treatment after 7 days (Prognosis in alcoholic hepatitis) Poor response to steroids and a poor prognosis.
52
Autoimmune Hepatitis - Antibodies Type 1
Anti-nuclear antibodies (ANA) Anti-smooth muscle antibodies (ASMA)
53
Autoimmune Hepatitis - Antibodies Type 2
Anti-liver/kidney microsomal type 1 antibodies (LKM1)
54
? is a highly sensitive and specific test for inflammatory bowel disease
Faecal calprotectin
55
Vitamin B1
Thiamine
56
Dry beriberi
Peripheral neuropathy Thiamine deficiency
57
Wet beriberi
Dilated cardiomyopathy Thiamine deficiency
58
What investigation to diagnose bile acid malabsorption
SeHCAT
59
What is used to assess pancreatic exocrine function in pancreatic insufficiency
Faecal elastase
60
Vitamin C
Ascorbic acid
61
Wernicke's encephalopathy - triad
Nystagmus Ophthalmoplegia Ataxia
62
Prophylaxis of variceal haemorrhage
Propranolol
63
Triad of: Dysphagia (secondary to oesophageal webs) Glossitis Iron-deficiency anaemia
Plummer-Vinson syndrome
64
Alcoholic liver disease - LFT pattern
AST:ALT is normally > 2 Gamma-GT is elevated
65
First-line to maintain remission in Crohn's Disease
Azathioprine or mercaptopurine
66
First-line anti-motility agent in IBS
Loperamide
67
Management of Whipple's Disease
Oral co-trimoxazole
68
Vitamin D deficiency Calcium Phosphate ALP
Calcium - low Phosphate - low ALP - high
69
Gastric MALT lymphoma - treatment
Eradicate H. pylori Omeprazole, clarithromycin, and amoxicillin
70
Acute mesenteric ischaemia - treatment
Immediate laparotomy
71
If a severe flare of UC has not responded to IV steroids after 72 hours - what next?
IV ciclosporin or surgery

MRCP 2 (13 decks)

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