Gastroenterology Flashcards

Question

Signs and symptoms of alpha 1 antitrypsin deficiency?

Answer 1

COPD in young individuals Neonatal jaundice Deranged LFTs in those with no identifiable cause for cirrhosis

Answer 2

COPD Hepatitis Alcoholic liver disease NAFLD Viral hepatitis

Answer 3

Spirometry; obstructive picture Alpha 1 antitrypsin levels Genotyping Imaging; CXR, CT thorax (panacinar emphysema) Liver fibroscan Liver biopsy

Answer 4

Smoking cessation IV alpha 1 antitrypsin Liver transplantation

Answer 5

H1 receptor antagonists (cyclizine), indicated in vestibular disturbance D2 receptor antagonists (domperidone, metoclopramide), indicated in post operative nausea, motion sickness 5HT3 receptor antagonist (ondansetron), indicated in acute gastroenteritis, post operative nausea, radiotherapy/ chemotherapy induced Anti-muscarinic (hyoscine hydrobromide), indicated in vestibular disturbance, palliative care

Answer 6

Prochlorperazine, clorpromazine, haloperidol

Answer 7

Intrinsic factor

Answer 8

Anti-tissue transglutaminase IgA Anti- endomysial IgA Anti- deaminated gliadin peptide IgG

Answer 9

Antimitochondrial antibodies IgM

Answer 10

Anti smooth muscle antibodies IgG

Answer 11

Abnormal accumulation of fluid within peritoneal cavity

Answer 12

Liver disease; cirrhosis, acute liver failure, liver metastases Cardiac disease; right heart failure Budd- Chiari, Portal vein thrombosis Nephrotic syndrome, kwashiorkor, peritoneal carcinomatosis, peritoneal metastases, infection

Answer 13

Abdominal distension Abdominal discomfort or pain Dyspnea Reduced mobility Anorexia and early satiety due to pressure on the stomach Tense abdomen Shifting dullness Stigmata of the underlying cause (see below)

Answer 14

Ascitic tap Bloods; FBC, U+E, LFT, CRP Imaging; CT abdomen, CXR Serum ascites albumin gradient SAAG; serum albumin concentration - ascites albumin concentration

Answer 15

Cirrhosis Heart failure Budd Chiari syndrome Constrictive pericarditis Hepatic failure

Answer 16

Cancer of the peritoneum, metastatic disease Tuberculosis, peritonitis and other infections Pancreatitis Hypoalbuminaemia - nephrotic syndrome, Kwashiokor

Answer 17

High SAAG; salt and fluid restriction Spironolactone Therapeutic paracentesis If ascitic tap shows neutrophils >250mm3 treat with IV piperacillin- tazobactam Refractory ascites in portal hypertension consider TIPS

Answer 18

Chronic inflammatory disease of liver as a result of immune attack to hepatic cells

Answer 19

More common in young middle aged women Associated with other autoimmune conditions such as pernicious anaemia, ulcerative collitis, hashimotos/ graves, autoimmune haemolytic anaemia, primary sclerosing cholangitis

Answer 20

Acute hepatits; Fever, Jaundice, Malaise, Abdominal pain, Utricarial rash, Polyarthritis, Pulmonary infiltration, Glomerulonephritis Chronic liver disease; ascites, jaundice, leuconychia, spider naevi

Answer 21

Fatigue Anorexia Hepatomegaly Splenomegaly

Answer 22

Acute; Hepatitis A/ E/ B, paracetamol poisoning, ischaemia Chronic; alcohol, NAFLD, hepatitis B/ C

Answer 23

Bloods; raised ALT, bilirubin, normal ALP

Answer 24

Prednisolone induction therapy Maintenance therapy with azathioprine Liver transplantation

Answer 25

When any part of the distal squamous epithelium has undergone dysplasia and replaced with metaplastic columnar epithelium

Answer 26

Most commonly affecting males over 50 with longstanding GORD Higher risk in obese people

Answer 27

GORD- main risk factor Obesity Smoking Hiatus hernia Increasing age

Answer 28

Pain in the upper abdomen and chest Heartburn Acid taste in the mouth Bloating Belching Anaemia Weight loss Anoerxia Melaena

Answer 29

OGD- gold standard

Answer 30

Dysphagia >55 years with either weightloss, upper abdominal pain, reflux or dyspepsia Non urgent direct access for upper GI endoscopy

Answer 31

If short segment (<3cm) without intestinal metaplasia no further surveillance If longer segment (>3cm) repeat OGD every 2-3 years Short segment with intestinal metaplasia OGD every 3-5 years Indefinite dysplasia every 6 months Visible high grade dysplasia; endoscopic ablation

Answer 32

Oesophageal adenocarcinoma

Answer 33

Obstruction of hepatic venous outflow which impedes drainage of blood from liver leading to hepatomegaly, ascites and liver dysfunction

Answer 34

Primary; Thrombosis Polycythaemia Essential thrombocytosis Paroxysmal nocturnal haemoglobinuria Antiphospholipid syndrome Factor V leiden mutation Protein C, protein S or antithrombin deficiency Secondary; Compression of hepatic veins Inflammatory conditions Infections

Answer 35

Obstruction of hepatic venous outflow leads to increased hepatic sinusoidal pressure causing congestion and ischaemia Results in hepatocyte injury, fibrosis, cirrhosis

Answer 36

Abdominal pain (RUQ) Hepatomegaly Jaundice Ascites Peripheral oedema Splenomegaly Variceal bleeding

Answer 37

Cirrhosis Right heart failure Constrictive pericarditis Portal vein thrombosis Hepatic veno-occlusive disease

Answer 38

LFT, FBC, coagulation, serum albumin USS with doppler CT/ MRI angiography Hepatic venography Liver biopsy

Answer 39

Ascites; diuretics, sodium restriction Nutritional support to avoid hepatotoxic substances Anticoagulation Thrombolytic therapy Angioplasty and stenting TIPS Liver transplantation

Answer 40

Chronic liver disease and cirrhosis Portal hypertension -> variceal bleeding Liver failure Hepatocellular carcinoma

Answer 41

Neuroendocrine tumour that secretes serotonin often originating from appendix or small intestine

Answer 42

Neuroendocine cells most commonly found in GI tract and lungs

Answer 43

Abdominal pain Diarrhoea Flushing Wheezing Pulmonary stenosis

Answer 44

IBS IBD Mastocytosis

Answer 45

Hormone levels; 5-HIAA which is a breakdown of serotonin CT/MRI Octreotide scans Tissue biopsy

Answer 46

Octreotide Surgery Embolisation Radiofrequency ablation

Answer 47

Vibrio cholerae O1 and O139 gram negative comma shaped bacteria with single polar flagellum

Answer 48

Sudden onset of watery diarrhoea Abdominal cramps Nausea Vomiting Excessive thirst Dry mouth Dry skin Oliguria Drowsiness or lethargy Irritability

Answer 49

Acute gastritis Rotavirus Traveler's diarrhoea

Answer 50

Stool culture Rapid diagnostic test FBC, U+E

Answer 51

A-E Aggressive fluid replacement Antibiotics; doxycycline Notifiable disease

Answer 52

Primary chronic disease with genetic, psychological and environmental factors influencing its development and manifestation

Answer 53

AUDIT questionnaire SADQ questionnaire

Answer 54

Patients drinking >30 units per day Scoring over 30 on the SADQ score High risk of alcohol withdrawal seizures (previous alcohol withdrawal seizures or delirium tremens, or history of epilepsy) Concurrent withdrawal from benzodiazepines Significant medical or psychiatric comorbidity Vulnerable patients Patients under 18

Answer 55

If drinking more than 15 units per day If scoring over 20 points in AUDIT questionnaire

Answer 56

Chlordiazepoxide Acamprosate Naltrexone/ disulfiram Psychological intervention; CBT

Answer 57

Persistent inflammation and fibrosis of exocrine and endocrine components of the pancreas

Answer 58

80% of cases are due to chronic alcohol use

Answer 59

Alcohol excess Genetics; cystic fibrosis Obstructive causes; pancreatic cancer Metabolic

Answer 60

Progressive inflammation and development of fibrotic tissue in pancreas results in loss of exocrine and endocrine function function

Answer 61

Epigastric pain exacerbated after eating fatty foods and relieved by leaning forward Bloating Weight loss Exocrine dysfunction; Malabsorption and steatorrhoea, reduced absorption of fat soluble vitamins A/D/E/K Diabetes

Answer 62

Acute pancreatitis Pancreatic cancer Peptic ulcer disease Abdominal aortic aneurysm

Answer 63

Blood glucose Faecal elastase Abdominal Xray CT scan- more sensitive to detect calcification

Answer 64

Abstinence from alcohol Endocrine dysfunction; insulin Exocrine dysfunction; creon containing mixture of amylase, lipase and protease Coeliac plexus block, pancreatectomy

Answer 65

Pseudocyst Pancreatic cancer Diabetes mellitus Steatorrhoea

Answer 66

Gram positive anaerobic bacteria which produces spores which release exotoxin causing intestinal damage

Answer 67

Non severe; WWC<15 Rise in creatinine <50% of baseline Temperature <38.5 Severe; WWC>15 Rise in creatinine >50% of baseline Temperature >38.5 Fulminant; Systemic; hypotension, septic shock, rapid deterioration in condition Local; ileus, toxic megacolon or bowel perforation

Answer 68

Recent treatment with broad-spectrum antibiotics – nearly all antibiotics can cause C. difficile infection, with common culprits being: Clindamycin Ciprofloxacin Third-generation cephalosporins (eg. Ceftriaxone) Penicillins including Piperacillin-tazobactam (Tazocin) Carbapenems (eg. Meropenem) Increased length of stay in hospital Age over 65 years Predisposing conditions including inflammatory bowel disease (IBD), cancer or kidney disease, and immunosuppression (diabetes or HIV infection, or as side effect of chemotherapy or steroids) Prolonged proton pump inhibitor (PPI) usage

Answer 69

Watery diarrhoea, which can be bloody Painful abdominal cramps Nausea Signs of dehydration, such as dry mucous membranes, tachycardia and oliguria Fever Loss of appetite and weight loss Confusion

Answer 70

Stool culture Bloods; FBC, U+E, CRP Abdominal Xray

Answer 71

A-E/ sepsis six Evaluate antibiotics and stop unnecessary medications Move to a side room and barrier nursing Rehydration Oral vancomycin Second line fidaxomicin Third line vancomycin and metronidazole Surgical resection in life threatening toxic megacolon; subtotal colectomy

Answer 72

Pseudomembranous colitis Toxic megacolon Systemic toxicity

Answer 73

T cell mediated autoimmune disorder affecting the small intestine

Answer 74

Affects females more More prevalent in Irish descent

Answer 75

Positive family history HLA-DQ2 History of other autoimmune disease

Answer 76

Gastrointestinal symptoms; abdominal pain, distension, nausea and vomiting, diarrhoea, steatorrhoea Systemic symptoms; fatigue, weight loss, failure to thrive

Answer 77

Pallor Short stature Signs of malabsorption such as bruising Dermatitis herpetiformis Abdominal distention

Answer 78

IBS IBD Food intolerance Gastroenteritis Malabsorption

Answer 79

Stool culture Bloods; FBC, U+E, Bone profile, LFT, Iron, B12, Folate anti-TTG, anti- endomysial, anti-gliadin OGD; villous atrophy, crypt hyperplasia intraepithelial lymphovytes

Answer 80

Lifelong gluten free diet Dermatitis herpetiformis managed with dapsone

Answer 81

Mixed anaemia Hyposplenism Osteoporosis Enteropathy associated T cell lymphoma

Answer 82

Fewer than three bowel movements per week Hard stool in more than 25% of bowel movements Tenesmus (sense of incomplete evacuation) in more than 25% of bowel movements Excessive straining in more than 25% of bowel movements A need for manual evacuation of bowel movements

Answer 83

Primary; no organic cause due to dysregulation of the function of colon Secondary; diet, medication, metabolic, endocrine or neurological

Answer 84

Advanced age Inactivity Low calorie intake Low fibre diet Certain medications Female sex

Answer 85

Dietary factors Behavioral; inactivity, avoid defecation Electrolyte disturbance; hypercalcaemia Medications; opiates, CCB, antipsychotics Neurological disorder; spinal cord lesion, parkinsons disease, diabetic neuropathy Endocrine; hypothyroidism Colon; malignancy, strictures Anal fissures, proctitis

Answer 86

Infrequent bowel movements (less than 3 per week) Difficulty passing bowel motions Tenesmus Excessive straining Abdominal distension Abdominal mass felt at the left or right lower quadrants (stool) Rectal bleeding Anal fissures Haemorrhoids Presence of hard stool or impaction on digital rectal examination

Answer 87

Anaemia Weight loss Anorexia Recent onset Melaena Haematemesis PR bleeding Swallowing difficulties

Answer 88

2WW; constipation with weight loss in anyone over 60 PR exam Stool culture; MC&S FIT test FBC, U+E, TFT, calcium Abdominal Xray Barium enema Colonoscopy

Answer 89

Lifestyle intervention Bulking agents; ispaghula husk Stimulant; senna Stool softeners; sodium docusate, macrogol Osmotic laxative; lactulose Phosphate enema

Answer 90

Increases faecal mass and stimulate peristalsis

Answer 91

Increases intestinal motility Used for short term relief

Answer 92

Softens stool to make passage of bowel movement easier Used in anal fissures with anticipatory withholding

Answer 93

Retains fluid in bowel and discourage ammonia producing microorganisms First line for hepatic encephalopathy

Answer 94

Used for rapid bowel evacuation before medical procedures

Answer 95

Chronic relapsing inflammatory bowel disease characterised by transmural granulomatous inflammation affecting any part of the GI tract

Answer 96

Family history Smoking Diet high in refined carbohydrates and fats

Answer 97

More common in northern climates Increased incidence in Europe in Northern America More common in 15-40 year olds and 60-80 year olds

Answer 98

Crampy abdominal pain Non bloody diarrhoea Systemic symptoms; weight loss, fever Aphthous ulcers in mouth Right lower quadrant tenderness Right iliac fossa mass Perianal tags Fistulae Perianal abscess Erythema nodosum; painful erythematous nodules/ plaques Pyoderma gangrenosum; well defined ulcer with a purple overhanging edge Anterior uveitis Episcleritis Enteropathic arthropathy Axial spondyloarthropathy Gallstones AA amyloidosis

Answer 99

Stool culture Faecal calprotectin Bloods; raised WCC, raised ESR/ CRP, thrombocytosis, anaemia, low albumin, haematinics Endoscopy MRI- upper GI series shows string of Kantour Colonoscopy + biopsy; intermittent inflammation, cobblestone appearance, rose thorn ulcers, non caseating granuloma

Answer 100

Induce remission; Glucocorticoids; oral prednisolone or IV hydrocortisone Maintaining remission; Azathioprine or mercaptopurine Methotrexate Biological; infliximab, adalimumab Surgical; If severe disease consider surgery to control fistulae, resection of strictures, rest/ defunctioning of bowel Management of peri-anal fistulae; Drainage seton Fistulotomy Sphincter saving Management of peri-anal abscess; Ceftriaxone + Metronidazole Examination under anaesthesia, incision and drainage

Answer 101

Assess for thiopurine methyltransferase activity, underactivity increases risk of bone marrow suppression

Answer 102

Fistulas Strictures Abscesses Malabsorption Perforation Nutritional deficiency Increased risk of colon cancer Osteoporosis Intestinal obstruction Toxic megacolon

Answer 103

Carbemazepines Rifampicin Alcohol Phenytoin Griseofulvin Phenobarbitone Sulphonylureas

Answer 104

Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol & Grapefruit juice Chloramphenicol Erythromycin Sulfonamides Ciprofloxacin Omeprazole Metronidazole

Answer 105

COCP and POP are hepatically metabolised so inducers will reduce their effectiveness

Answer 106

Group of gastrointestinal symptoms such as epigastric pain, bloating, early satiety and nausea

Answer 107

Multifactorial Dietary habits Lifestyle choices Psychological stressors Helicobacter pylori infection GORD Medication uses Underlying gastrointestinal disorders

Answer 108

Epigastric pain or discomfort Bloating Belching Nausea and early satiety Patients may also report heartburn, regurgitation, or sour taste in the mouth if associated with GORD.

Answer 109

GORD Peptic ulcer disease Gastritis Gallbladder disease Pancreatic disorders Inferior MI

Answer 110

FBC H.pylori; urea breath test, stool helicobacter antigen test OGD 2WW; if dysphagia over 55 years with weight loss and any of the following; upper abdominal pain, reflux, dyspepsia

Answer 111

Lifestyle; stop smoking, weight loss, avoid trigger foods, eat smaller meals, reduce alcohol Medication review; exacerbating medications include aspirin, alpha blockers, anticholinergic, benzodiazepines, calcium channel blockers, corticosteroids, nitrates, NSAIDs, TCA Medical management; PPI Treat H.pylori infection

Answer 112

Swallowing difficulty which involves problems in oral, pharyngeal or oesophageal stages of swallowing

Answer 113

Neurological: Conditions like cerebrovascular disease, Parkinson's disease, motor neurone disease, myasthenia gravis, and bulbar palsy. Motility disorders: Including achalasia, diffuse oesophageal spasm, and systemic sclerosis. Mechanical/obstructive causes: Such as benign strictures, malignancy, pharyngeal pouch, and extrinsic pressure from lung cancer, mediastinal lymph nodes, or retrosternal goitre. Other: Causes such as oesophagitis, globus (psychological causes), and Plummer-Vinson syndrome.

Answer 114

Motility disorders; liquids and solids equally affected from the start Benign or malignant stricture; progressive dysphagia of solids and then liquids Neurological; Difficulty in swallowing motion Candida; painful dysphagia Pharyngeal pouch; bulging neck on swallowing, gurgling or halitosis Plummer- Vinson syndrome; upper oesophageal web, post cricoid dysphagia, Diffuse oesophageal spasm; intermittent dysphagia

Answer 115

2WW; dysphagia over 55 years with weight loss and any of upper abdominal pain/ reflux or dyspepsia FBC Iron studies Barium swallow Manometry 24 hour pH

Answer 116

SALT assessment PPI Iron supplementation Dilation in achalasia, removal of malignancy

Answer 117

Typhoid or paratyphoid Infection caused by salmonella typhi and salmonella paratyphi

Answer 118

Paratyphoid A,B and C are prevalent in inadequate sanitation and poor water supply Paratyphoid fever is less common Highest incidence in south asia, southeast asia, sub saharan africa Primarily affect children and young adults

Answer 119

Poor sanitation Poor hygiene

Answer 120

Ingestion of food or water contaminated with faeces of infected infividual

Answer 121

Generally well 6-30 days post exposure Gradual onset with high fever developing over several days Paratyphoid is a milder illness with shorter incubation period Weakness & myalgia Relative bradycardia Abdominal pain Constipation (more common than diarrhoea) Headaches Vomiting (not usually severe) Skin rash with rose-colored spots (uncommon, but common in exams!) Confusion (if severe) without treatment symptoms persist for weeks

Answer 122

Measure urine output ECG FBC, U+E, CRP, ABG, VBG (lactate), LFT, Group and Save, clotting Blood culture, stool culture Bone marrow aspirate- gold standard MRI if ?osteomyelitis

Answer 123

Sepsis 6 Azithromycin/ ceftriaxone, some are sensitive to ciprofloxacin Notifiable disease

Answer 124

Osteomyelitis GI bleed/ perforation Meningitis

Answer 125

Reflux of gastric contents into oesophagus due to defective lower oesophageal sphincter leading to dyspepsia

Answer 126

10% of UK adults experience GORD More common in over 50

Answer 127

Defective LOS enabling reflux of gastric contents into oesophagus

Answer 128

Obesity Alcohol use Smoking Intake of coffee, citrus foods, spicy food, fat

Answer 129

Typical symptoms; dyspepsia, sensation of acid regurgitation Atypical symptoms; epigastric/ chest pain, nausea, bloating, belching, blobus, laryngitis, tooth erosion Alarm symptoms; weight loss, anaemia, dysphagia, haematemesis, melaena, persistent vomiting

Answer 130

Gastric ulcers Oesophageal cancers Functional dyspepsia Hiatus hernia

Answer 131

H.pylori; Urea breath test, stool antigen test OGD Oesophageal manometry

Answer 132

2WW; over 55 years with weight loss and dyspepsia/ reflux Non urgent; 55 and above with treatment resistant dyspepsia Raised platelet count Nausea and vomiting

Answer 133

Lifestyle; weight loss, dietary changes, elevation of head at night, avoid late night eating PPI therapy H.pylori eradication therapy

Answer 134

Oesophageal ulcer Oesophageal stricture Barrett's oesophagus Adenocarcinoma of the oesophagus

Answer 135

Enteric infection causing acute-onset diarrhoea +/- associated symptoms

Answer 136

Is acute infectious diarrhoea with blood & mucus, often with associated symptoms

Answer 137

Norovirus Rotavirus Adenovirus Campylobacter E.coli Salmonella Shigella Bacillus cereus Staphylococcus aureus Cryptosporidium Entamoeba histolytica Giardia

Answer 138

Sudden-onset diarrhoea, with or without blood Faecal urgency Nausea & vomiting Fever, malaise Abdominal pain Associated symptoms specific to the cause

Answer 139

Stool culture Bloods; FBC, U+E, CRP, LFT, TFT VBG Monitor urine output

Answer 140

A-E Sepsis 6 Fluids Anti-emetic Anti-biotics; Campylobacter; clarithromycin Amoeba, giardia; metronidazole Cholera; tetracycline Notifiable disease

Answer 141

Dehydration, electrolyte disturbance, acute kidney injury Haemorrhagic colitis, haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura Reactive arthritis Toxic megacolon Sepsis Faltering growth IBS Lactose intolerance

Answer 142

Chronic medical condition characterised by delayed gastric emptying without mechanical obstruction due to impaired activity of stomach muscles which delays gastric emptying

Answer 143

Commonly associated with diabetes mellitus

Answer 144

Autonomic neuropathy More likely in diabetes, parkinsons, certain medications, multiple sclerosis

Answer 145

Nausea Vomiting Early satiety (feeling of fullness after a few bites) Abdominal pain Bloating Diabetics; poor glucose level

Answer 146

Peptic ulcer disease Gastric outlet obstruction GORD

Answer 147

Solid meal gastric scintigraphy allowing visualisation of rate of gastric emptying

Answer 148

Dietary modifications; low fibre, smaller frequent meals, pureed or mashed food Pharmacological; metoclopramide

Answer 149

Infectious gastroenteritis cause by protozoan parasite giardia lamblia

Answer 150

Exposure to contaminated water Spread via faecal- oral route Consumption of uncooked fruit or vegetables Poor hand hygiene

Answer 151

Explosive, watery, non-bloody diarrhoea Bloating Flatulence Nausea Weight loss Anorexia

Answer 152

Parasitic infections; cryptosporidium, entamoeba histolytica Bacterial gastroenteritis Viral gastroenteritis

Answer 153

Stool microscopy; repeat 3 times on separate days Stool antigen test, stool PCR Duodenal aspirates ad biopsy

Answer 154

Metronidazole

Answer 155

Inherited autosomal recessive disorder where liver does not process bilirubin due to mutation in UGT1A1 gene resulting in reduced activity of UGT enzyme which conjugates bilirubin with glucuronic acid

Answer 156

Asymptomatic Intermittent mild jaundice triggered by stress, fasting, infection, exercise

Answer 157

Hepatitis Haemolytic anaemia Cholestasis

Answer 158

Elevated bilirubin LFT- otherwise normal FBC

Answer 159

No treatment Monitor condition

Answer 160

Gram negative spiral shaped bacterium

Answer 161

Dyspepsia symptoms Abdominal discomfort or pain, typically in the upper abdomen Bloating Nausea Loss of appetite Weight loss

Answer 162

Gastritis GORD Gastric cancer

Answer 163

Stool antigen test Carbon 13 urea breath test OGD

Answer 164

First line; amoxicillin + clarithromycin + PPI Metronidazole if penicillin allergy After 4-8 weeks retest for H.pylori if still present commence another course of triple therapy with Metronidazole/ clarithromycin + amoxicillin +PPI If after 2nd course consider PPI+ amoxicillin + tetracycline/ quinolone If after 2 courses refer to gastroenterologist

Answer 165

Duodenal ulcer, gastric ulcer Gastric cancer B cell MALT lymphoma Atrophic gastritis

Answer 166

Hepatitis A, B, C, D, E EBV CMV Leptospirosis Malaria Alcohol Drugs Toxins Autoimmune

Answer 167

Acute liver failure; Hepatitis A and E Fever, malaise, anorexia, Nausea and vomiting Acute hepatitis; RUQ pain, jaundice, tender hepatosplenomegaly Chronic liver failure; Hepatic encephalopathy, jaundice, ascites, coagulopathy

Answer 168

RNA picornavirus transmitted by faecal oral route

Answer 169

High in developing countries Greatest mortality and morbidity in over 50 years

Answer 170

Flu like symptoms Jaundice Pale stools Dark urine Abdominal pain

Answer 171

LFT; raised ALT/ AST Serology

Answer 172

Supportive management Fluid intake Electrolyte replacement

Answer 173

Pregnancy, upto 20% mortality

Answer 174

dsDNA virus of hepadenaviridae family 60-90 day incubation period

Answer 175

Most common cause of hepatitis globally High prevalence in sub saharan africa, asia and pacific islands Decline in incidence due to vaccination

Answer 176

Vaginal/ anal intercourse Transfusion Vertical transmission Needle stick injury

Answer 177

HBsAg (Hepatitis B Surface Antigen); Indicates current infection; persists >6 months Anti-HBs (Hepatitis B Surface Antibody); Indicates immunity from past infection or vaccination HBeAg (Hepatitis B e Antigen); Indicates active viral replication; higher infectivity Anti-HBe (Hepatitis B e Antibody); Indicates lower infectivity; seroconversion is associated with reduced viral replication HBcAb (Hepatitis B Core Antibody); IgM indicates acute infection; IgG indicates past infection or vaccination HBV DNA (Hepatitis B Virus DNA); Quantifies viral load; used to monitor response to treatment

Answer 178

Pegylated interferon can prevent liver disease Antiviral therapy in adults over 30 years with HBV DNA greater than 2000 and abnormal ALT on 2 consecutive tests 3 months apart If sudden deterioration in hepatitis B patients consider co-infection with hepatitis D

Answer 179

RNA virus of flaviviridae family

Answer 180

15-25% clear virus 70% go on to develop chronic hepatitis 1-4% develop hepatocellular carcinoma 2-5% develop liver failure Arthralgia/ arthritis Sjorgen's syndrome Cryoglobulinaemia Porphyria cutanea tarda Membranoproliferative glomerulonephritis

Answer 181

Nucleoside analogues; sofobuvir, daclatsavir

Answer 182

Primary malignancy of liver predominantly in patients with underlying chronic liver disease and cirrhosis

Answer 183

6th most common cancer Leading cause is chronic hepatitis B infection

Answer 184

Chronic viral hepatitis (Hepatitis B or C) Cirrhosis Non-alcoholic fatty liver disease Primary biliary cirrhosis Inherited metabolic diseases Alcohol misuse Obesity Type 2 Diabetes Rare diseases: Wilson's disease, porphyria cutanea tarda, alpha-1-antitrypsin deficiency

Answer 185

Can present with decompensated liver disease or liver failure Abdominal pain Weight loss Jaundice Ascites Hepatomegaly, with a 'craggy' liver edge on examination Encephalopathy

Answer 186

Metastatic liver disease Cirrhosis Hemangioma Pancreatic cancer Cholangiocarcinoma

Answer 187

Bloods; FBC, U+E, CRP, LFT, coagulation, viral serology, AFP Abdominal USS Liver biopsy with CT of chest, abdomen and pelvis

Answer 188

6 monthly liver ultrasound and AFP measurement

Answer 189

Surgical resection of early stage tumour Liver transplant Radiotherapy Chemotherapy Biologicals Palliative care

Answer 190

Autosomal recessive disorder of iron metabolism characterised by accumulation of iron in body

Answer 191

Common in northern european descent Affects 1 in 200 people C282Y homozygous mutation is more common in celtic heritage

Answer 192

Most common genotype is homozygosity for HFE C282Y on chromosome 6 This disrupts control of iron absorption leading to excessive accumulation in the body

Answer 193

Bronze skin Type 2 diabetes mellitus Fatigue Joint pain Sequalae of chronic liver disease/cirrhosis Adrenal insufficiency Testicular Atrophy

Answer 194

Wilson's disease Alpha- 1 antitrypsin deficiency Porphyria cutanea tarda Addisons disease

Answer 195

Transferrin saturation >55% Raised iron Low TIBC Genetic testing for HFE gene mutation MRI brain to identify higher iron deposition Liver biopsy to confirm iron stores

Answer 196

Venesection Desferrioxamine; iron chelating agents Avoid undercooked seafood, high risk of listeria which thrive on iron

Answer 197

Dilated cardiomyopathy Bronze skin Cirrhosis Diabetes mellitus Hypogonadotropic hypogonadism Arthropathy

Answer 198

Abdominal contents protrude through enlarged oesophageal hiatus in diaphragm

Answer 199

Obesity Prior hiatal surgery Increased intra-abdominal pressure, such as from chronic cough, multiparity, or ascites Increasing age

Answer 200

Sliding hiatal hernia; GOJ slides up into chest resulting in less competent sphincter and consequent acid reflux Rolling hiatal hernia; GOJ stays in abdomen but part of stomach protrudes into chest alongside oeshphagus

Answer 201

Sliding hiatal hernia, 80%

Answer 202

Rolling due to risk of volvulus

Answer 203

Heartburn Dysphagia Regurgitation Odynophagia Shortness of breath Chronic cough Chest pain

Answer 204

GORD Gastritis Peptic ulcer Gallstones

Answer 205

Barium swallows Endoscopy Oesophageal manometry

Answer 206

Conservative; Weight loss Elevating head of bed Avoid large meals 3-4 hours before bedtime Avoid alcohol and spicy food Smoking cessation Caffeine, fatty foods , chocolate, peppermint, CCB, nitrates and beta blockers should be avoided Medical; PPI trial for 4-8 weeks Surgical; Nissen's fundoplication

Answer 207

Haemorrhage Volvulus Ischaemia Necrosis Obstruction

Answer 208

Magnesium Antibiotics, specifically penicillins Chemotherapy agents Proton pump inhibitors such as omeprazole H2 blockers like cimetidine and ranitidine Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Metformin

Answer 209

Anti-depressants Anti-psychotics Levodopa Aluminium-based antacids Iron supplements Opiates

Answer 210

Review and adjust dosage of offending drugs Consider alternate medications Anti-diarrhoeal/ laxative for short term use Encourage hydration and dietary modification

Answer 211

Chronic GI disorder of abdominal pain/ discomfort associated with altered bowel habits without identifiable structural or biochemical abnormalities

Answer 212

10-20% of adults affected worldwide

Answer 213

Genetic predisposition, altered gut microbiota, low grade inflammation and abnormalities in gut-brain axis

Answer 214

Abdominal pain or discomfort relieved by defecation or associated with altered bowel frequency or stool form Altered stool passage Abdominal bloating Symptoms worsened by eating Passage of mucus Lethargy, nausea, backache

Answer 215

IBD Coeliac disease Colorectal cancer

Answer 216

Diagnosis of exclusion, investigations to rule out other causes Faecal calprotectin FBC ESR CRP Coeliac serology Consider abdominal USS, sigmoidoscopy, colonoscopy, TFT, FIT test, faecal ova and parasite test, hydrogen breath test

Answer 217

Regular exercise, stress management Low FODMAP diet Low dose TCA Psychotherapy, CBT, hypnotherapy

Answer 218

Pre-hepatic; gilberts disease, crigler-naajjar, haemolysis, rifampicin Hepatic; Viruses (hepatitis, CMV, EBV) Drugs, including paracetamol overdose, nitrofurantoin, halothane, valproate, statins, tuberculosis antibiotics Alcohol Cirrhosis Liver mass (abscess or malignancy) Haemochromatosis Autoimmune hepatitis Alpha-1 antitrypsin deficiency Budd-Chiari Wilson's disease Failure to excrete conjugated bilirubin (Rotor and Dubin-Johnson syndromes) Post hepatic; Primary biliary cirrhosis Primary sclerosing cholangitis Common bile duct gallstones or Mirrizi's syndrome (CBD compression from a gallstone in the cystic duct) Drugs, including coamoxiclav, flucloxacillin, steroids, sulfonylureas Malignancy, such as head of the pancreas adenocarcinoma, cholangiocarcinoma Caroli's disease Biliary atresia

Answer 219

Pre-hepatic: haemolysis, anaemia (fatigue, chest pain, palpitations, lightheadedness) Hepatic: RUQ pain, fever, viral illness, risk factors include: IVDU/tattoo, UPSI Post-hepatic: dark urine, pale stools, itch

Answer 220

Jaundice and palpable painless gallbladder not due to gallstones. Painless jaundice – red flag for pancreatic cancer or cholangiocarcinoma

Answer 221

Irreversible scarring of the liver with loss of normal hepatic architecture

Answer 222

Commonest causes: Alcohol Hepatitis B and C Non-alcoholic fatty liver disease (NAFLD) Less common causes: Autoimmune: Autoimmune hepatitis, Primary biliary cirrhosis, Primary sclerosis cholangitis, Sarcoid Genetic: Haemochromatosis, Wilson's disease, Alpha-1-antitrypsin deficiency Drugs: Methotrexate, Amiodarone, Isoniazid Others: Budd-Chiari Syndrome, Heart failure, Tertiary syphilis

Answer 223

Compensated; Fatigue and anergia Anorexia and cachexia Nausea or abdominal pain Spider naevi Gynaecomastia Finger clubbing Leuconychia Dupuytren's contracture Caput medusae Splenomegaly Decompensated; Ascites and oedema Jaundice Pruritus Palmar erythema Gynaecomastia and testicular atrophy Easy bruising Encephalopathy/confusion Liver 'flap'

Answer 224

Hepatic steatosis Chronic hepatitis Congestive heart failure

Answer 225

LFT; AST, ALT, ALP, GGT, albumin, bilirubin FBC; leukocytosis, thrombocytopenia, anaemia U+E INR Hepatitis serology Peritoneal tap Doppler USS Fibroscan Liver biopsy

Answer 226

Assess severity of liver cirrhosis Takes into account bilirubin, albumin, PT, encephalopathy, ascites A; <7 points B; 7-9 points c; >9 points

Answer 227

6-9; Low risk of mortality; Class I (less than 10%) 10-19; Intermediate risk of mortality; Class II (19%) 20-29; High risk of mortality; Class III (52%) 30-39; Severe risk of mortality; Class IV (71%) ≥40; Very severe risk of mortality; Class V (95%)

Answer 228

Nutrition and no alcohol Avoid NSAIDs, sedatives and opiates 6 month scans and serum AFP Upper GI endoscopy Cholestyramine for pruritus Ascites; fluid restriction, low salt diet, spironolactone, furosemide, therapeutic paracentesis, albumin infusion Liver transplant

Answer 229

Ascites Spontaneous bacterial peritonitis Liver failure Hepatocellular carcinoma Oesophageal varices +/- haemorrhage Renal failure

Answer 230

Loss of liver function and development of complications including coagulopathy, jaundice, encephalopathy

Answer 231

Acute liver failure; viral hepatitis, drug induced liver injury (paracetamol halothane, isoniazid), toxic exposure, vascular disorder (budd- chiari syndrome, hepatic vein obstruction) Chronic liver failure; alcohol misuse, chronic viral hepatitis, non alcoholic fatty liver disease, autoimmune liver disease (autoimmune hepatitis, primary biliary cholangitis), wilson's disease, alpha-1 antitrypsin deficiency

Answer 232

Hepatic encephalopathy Abnormal bleeding Jaundice

Answer 233

Ammonia accumulates in blood and crosses blood brain barrier and is metabolised by astrocytes to form glutamine. Glutamine disrupts osmotic balance and astrocytes begin to swell resulting in cerebral oedema

Answer 234

Altered mood and behaviour, disturbance of sleep pattern and dyspraxia Drowsiness, confusion, slurring of speech and personality change Incoherency, restlessness, asterixis Coma

Answer 235

INR, coagulation studies LFT, albumin FBC, U+E, haematinics Viral serology Ascitic drain Abdominal ultrasound scan Doppler ultrasound scan OGD

Answer 236

Hepatic encephalopathy; lactulose, rifaximin, mannitol Coagulopathy; vitamin K, FFP Spontaneous bacterial peritonitis; IV piperacillin- tazobactam TIPSS Liver transplant

Answer 237

Cirrhosis Ascites Renal failure

Answer 238

Arterial pH <7.3 24h after ingestion OR Pro-thrombin time >100s AND creatinine >300µmol/L AND grade III or IV encephalopathy.

Answer 239

Prothrombin time >100s OR Any three of: Drug-induced liver failure Age under 10 or over 40 years 1 week from 1st jaundice to encephalopathy Prothrombin time >50s Bilirubin ≥300µmol/L.

Answer 240

Clinical syndrome characterised by impaired absorption of nutrients, vitamins or minerals from diet resulting in nutritional deficiencies

Answer 241

Gastric causes; post gastrectomy Small bowel causes; coeliac, crohns, small bowel resection Pancreatic causes; chronic pancreatitis, pancreatic cancer, cystic fibrosis Hepatobiliary causes; primary biliary cirrhosis, ileal resection, post cholecystectomy Infective; giardasis, whipple's disease, bacterial overgrowth

Answer 242

Diarrhoea Steatorrhoea Weight loss Nutritional deficiency leading to anaemia, osteoporosis, peripheral neuropathy

Answer 243

A body mass index (BMI) of less than 18.5 kg/m2. Unintentional weight loss greater than 10% within the last 3–6 months. A BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3–6 months.

Answer 244

Histological condition due to laxative abuse characterised by presence of dark brown pigmentation of the macrophages in the lamina propria of the colon

Answer 245

Prolonged laxative use Higher in elderly and young females

Answer 246

Laxative use, especially senns

Answer 247

Chronic constipation Abdominal discomfort Anorexia nervosa/Bulimia - patients may be young and underweight with a history of purging. Nausea

Answer 248

IBD Colorectal cancer Ishcaemic colitis

Answer 249

Colonoscopy Histology; presence of pigmented macrophages in lamina propria

Answer 250

Cessation of laxatives

Answer 251

Low grade non hodgkins lymphoma that originates from B lymphocytes in the marginal zone

Answer 252

H.pylori infection Chronic inflammation

Answer 253

Abdominal pain Nausea and vomiting Symptoms of anaemia Weight loss

Answer 254

Gastric adenocarcinoma Gastritis Peptic ulcer disease

Answer 255

Endoscopy and biopsy Immunohistochemistry CT/ PET scan

Answer 256

H. pylori eradication therapy Chemotherapy/ radiotherapy

Answer 257

Excessive fat accumulation in the liver in the absence of significant alcohol consumption

Answer 258

Affects 23-30%

Answer 259

Obesity Type 2 diabetes mellitus Hyperlipidaemia (high triglycerides and low HDL) Hypertension Jejunal bypass surgery Rapid weight loss or prolonged starvation Polycystic ovary syndrome (PCOS) Hypothyroidism Obstructive sleep apnoea

Answer 260

Steatosis; fat accumulates in the hepatocytes Non alcoholic steatohepatitis; inflammation and hepatocellular injury in addition to fat accumulation leading to fibrosis Fibrosis and cirrhosis; progressive scarring of the liver tissue leading to liver failure and increased risk of hepatocellular carcinoma

Answer 261

Fatigue Right upper quadrant discomfort Hepatomegaly Jaundice Ascites Peripheral oedema Hepatic encephalopathy

Answer 262

Alcoholic liver disease Chronic hepatitis B and C Autoimmune hepatitis Wilson's disease Haemochromatosis Drug induced liver injury

Answer 263

Bedside; History and examination ALT, AST, GGT, ALP, albumin, clotting, FBC, lipid profile, viral serology Ultrasound scan, fibroscan Liver biopsy

Answer 264

Lifestyle modification, abstain from alcohol, vaccination against hepatitis A and B, avoid hepatotoxic medications Control diabetes, hyperlipidaemia, hypertension Vitamin E, pioglitazone

Answer 265

Steatosis Progression to cirrhosis Liver failure Hepatocellular carinoma CVD due to metabolic syndrome

Answer 266

Dilated veins which are formed due to portal hypertension

Answer 267

Common in patients with advanced liver disease Occur in 50% of patients with cirrhosis Variceal bleeding is leading cause of mortality Gastric varices are less common than oesophageal

Answer 268

Result of portal hypertension which can be due to cirrhosis, portal vein thrombosis, schistosomiasis, hepatic fibrosis

Answer 269

Haematemesis (vomiting of blood) Melena (black, tarry stools) Palpitations Syncope (fainting) Hypotension (low blood pressure)

Answer 270

Gastric ulcers Duodenal ulcers Mallory- weiss tears

Answer 271

Endoscopy OGD

Answer 272

In acute bleed; correct clotting abnormalities, FFP and platelet transfusion Trelipressin Broad spectrum antibiotics to reduce risk of spontaneous bacterial peritonitis Variceal band ligation Sengstaken- Blakemore Thiamine Prevention; beta blocker, variceal band ligation, TIPSS

Answer 273

Inflammation of the oesophagus commonly due to reflux of gastric contents

Answer 274

Reflux of gastric contents, the most common cause Medications e.g. NSAIDs Infections Allergens, as seen in eosinophilic oesophagitis

Answer 275

'Heartburn' or retrosternal burning pain Nausea with or without vomiting Odynophagia, or painful swallowing

Answer 276

GORD Gastritis Peptic ulcer disease

Answer 277

Endoscopy Oesophageal pH monitoring

Answer 278

Lifestyle changes; weight loss, cessation of smoking, reduce alcohol intake Pharmacological treatment; PPI for 1 month

Answer 279

White patches in mouth due to fungal infection, patches can be scraped off with friable mucosa underneath satellite lesions

Answer 280

Old age Diabetes mellitus Immunosuppression Long term corticosteroids Malignancy Antibiotics

Answer 281

Nystatin Fluconazole

Answer 282

EBV and is a sign of underlying HIV

Answer 283

Candida can be scrapped of but hairy leukoplakia cannot

Answer 284

Painful sores/ ulcers in the lining of the stomach/ duodenum

Answer 285

Duodenal ulcers are 4 times as common as gastric ulcers H.pylori accounts for 90% of duodenal ulcers

Answer 286

H.pylori infection NSAIDs Chronic use of steroids SSRIs Increased secretion of gastric acid Smoking Blood group O Accelerated gastric emptying

Answer 287

NSAIDs H. Pylori infection Smoking Delayed gastric emptying Severe stress

Answer 288

Abdominal pain exacerbated by eating Nausea Vomiting Loss of appetite Unexplained weight loss Duodenal ulcer causes epigastric abdominal pain relieved by eating

Answer 289

Gastritis GORD Stomach cancer

Answer 290

Over 55 with dyspepsia and weight loss should ave 2WW C-13 urea breath test Endoscopy + biopsy

Answer 291

Smoking cessation Reducing alcohol intake Regular, small meals and avoiding eating 4 hours before bedtime Avoidance of acidic, fatty or spicy foods, and coffee Weight loss if overweight Stress management Avoidance of NSAIDs, steroids, bisphosphonates, potassium supplements, SSRIs, and crack cocaine Over-the-counter antacids H.pylori eradication; If associated with NSAID use; 8 week PPI then eradication therapy of amoxicillin + clarythromycin/ metronidazole if not associated with NSAID then start PPI with eradication therapy

Answer 292

Autoimmune destruction of parietal cells in the gastric mucosa resulting in an intrinsic factor deficiency and hence vitamin B12

Answer 293

Autoimmune attack Intrinsic factor deficiency Vitamin B12 deficiency Megaloblastic changes Haemolysis

Answer 294

More common in Northern European, Scandinavian and African descent affecting adults aged 60 More common in those with other autoimmune disease

Answer 295

Fatigue Pallor Glossitis - inflammation of the tongue, leading to a smooth, beefy-red appearance. Neurological Symptoms and subacute combined degeneration of the cord: Pernicious anaemia may cause neuropathy, affecting balance, sensation, and coordination. Jaundice - due to haemolysis Cognitive Impairment - memory problems, confusion, and mood changes may occur

Answer 296

Iron deficiency anaemia Folate deficiency anaemia Myelodysplastic syndromes

Answer 297

FBC; low Hb, high MCV, high MCH, normal MCHC, low reticulocyte count Blood smear; abnormally large oval shaped RBC Haematinics, B12 assay Parietal cell antibodies Bone marrow aspiration and biopsy

Answer 298

Lifelong hydroxycobalamin replacement Consider folate replacement

Answer 299

Gastric cancer Peripheral neuropathy Subacute combined degeneration of the cord Optic atrophy Dementia Hypothyroidism Vitiligo

Answer 300

Pharyngeal pouch characterised by herniation of the pharyngeal mucosa through a point of weakness between thyropharyngeus and cricopharyngeus muscle in the inferior constrictor of the pharynx

Answer 301

Affects older adults over the age of 70 years More common in males with ratio of 2:1

Answer 302

Dysphagia Regurgitation of undigested food, resulting in halitosis Aspiration Chronic cough Weight loss

Answer 303

If small and asymptomatic; watch and wait Surgical; resection of the diverticulum, incision of the circopharyngeus

Answer 304

Autoimmune disease of the bile ducts that leads to scarring and inflammation leading to eventual liver cirrhosis

Answer 305

More commonly affects women 25% of patients are under 40 years 10% of patients are male

Answer 306

Previous family history of PBC Female Smoking Predisposition to other autoimmune conditions (80% have Sjogren’s)

Answer 307

Extreme fatigue Pruritus (itching) Xerosis (dry skin) Sicca syndrome (dry eyes) RUQ pain Xanthelasma Clubbing Jaundice Late signs include sequalae of chronic liver disease Increased risk of HCC

Answer 308

Autoimmune hepatitis Chronic viral hepatitis Primary sclerosing cholangitis Alcoholic liver disease

Answer 309

Deranged LFTs Positive AMA Raised serum IgM Abdominal USS MRCP- Gold standard for visualising liver and bile duct Liver biopsy

Answer 310

Ursodeoxycholic acid to slow disease progression by promoting bile flow Cholestyramine for relief of pruritus Vitamin supplements to manage deficiencies Liver transplantation in advanced cases, often once bilirubin is >100 this is considered (Note: PBC may recur after transplantation)

Answer 311

Chronic liver disease Osteomalacia

Answer 312

Chronic cholestatic disorder characterised by inflammation and fibrosis of intrahepatic and extrahepatic bile ducts leading to multifocal biliary strictures

Answer 313

More common in those with IBD, especially UC, 80% of PSC patients have UC Associated with increased risk of colorectal and hepatobiliary cancers

Answer 314

Autoimmune disease associated with positive anti- smooth muscle, antinuclear and p-ANCA antibodies

Answer 315

Hepatomegaly Jaundice Right upper quadrant pain Fatigue, weight loss, fevers, and sweats Associated with ulcerative colitis

Answer 316

Autoimmune hepatitis Cholangiocarcinoma Primary biliary cholangitis

Answer 317

Deranged LFT Positive anti-smooth muscle , antinuclear and p-ANCA antibodies Hypergammaglobulinaemia MRCP/ ERCP Liver biopsy

Answer 318

Lifestyle changes such as alcohol avoidance Symptomatic management such as cholestyramine for pruritus Supplementation of fat soluble vitamins (A,D,E,K) Strictures may be dilated via ERCP Liver transplantation may be indicated in cases complicated by chronic liver disease and/or hepatobiliary malignancies.

Answer 319

Cholangiocarcinoma Colorectal cancer

Answer 320

Chronic relapsing-remitting inflammatory disease affecting large bowel typically starting at the rectum which spreads proximally upto the ileocaecal valve

Answer 321

More prevalent in those 15-25 years and 55-65 years

Answer 322

Diarrhoea often containing blood and/or mucus Tenesmus or urgency Generalised crampy abdominal pain in the left iliac fossa Weight loss Fever Malaise Anorexia Extra-intestinal manifestations; Dermatological; erythema nodosum, pyoderma gangrenosum Ocular; anterior uveitis, episcleritis, conjunctivitis Musculoskeletal; clubbing, non- deforming asymmetrical arthritis , sacroiliitis Hepatobiliary; jaundice AA amyloidosis

Answer 323

Crohns disease Infective collitis Ischaemic collitis

Answer 324

Stool microscopy Faecal calprotectin FBC CRP/ ESR LFT Abdominal xray to rule out to toxic megacolon/ perforation Endoscopy/ colonoscopy Biopsy Barium enema

Answer 325

Truelove and Witt's criteria

Answer 326

Mild to moderate disease; Proctitis/ proctosigmoiditis; aminosalicylate, oral prednisolone, consider tacrolimus Left sided/ extensive disease; high dose oral aminosalicylate, oral prednisolone Acute severe disease; IV corticosteroids If no improvement in 72 hours IV ciclosporin Surgery

Answer 327

Toxic megacolon Massive lower GI haemorrhage Colorectal cancer Cholangiocarcinoma Colonic strictures Primary sclerosing cholangitis Inflammatory pseudopolyps Increased risk of VTE

Answer 328

Rare systemic infectious disorder caused by bacterium tropheryma whipplei and affects GI system, joints and nervous system

Answer 329

Tropheryma whipplei

Answer 330

Chronic diarrhoea Abdominal pain Joint pain Weight loss Heart failure Neurological disturbance

Answer 331

IBD Rheumatoid arthritis Malabsorption syndrome

Answer 332

Small bowel biopsy; presence of acid- schiff positive macrophages Electron microscopy shows macrophages containing causative bacterium

Answer 333

Long term co- trimoxazole

Answer 334

Autosomal recessive hereditary disorder characterised by impaired copper metabolism

Answer 335

Mutation in ATP7B gene which encodes a protein vital for copper transportation and elimination in the body resulting in copper accumulation in the liver and brain

Answer 336

Hepatic manifestations: These range from asymptomatic disease with minor transaminase elevation, acute hepatitis, acute-on-chronic liver failure, to cirrhosis. Copper release into the bloodstream may cause Coomb's negative haemolytic anaemia, characterized by transient low-grade haemolysis and jaundice. Neurological manifestations: These include akinetic-rigid syndrome similar to Parkinson's disease, pseudosclerosis dominated by tremor, ataxia, and a dystonic syndrome leading to severe contractures. Additional neurological findings may include drooling, spasticity, chorea, athetosis, myoclonus, micrographia, dyslalia, hypomimia, and dysarthria. Psychiatric manifestations: These may precede hepatic or neurological signs in up to a third of patients and may include decreased academic performance, personality changes, sexual exhibitionism, impulsiveness, labile mood, inappropriate behaviour, depression, paranoia, schizophrenia, and, in rare cases, suicide. Ocular manifestations: Include the presence of Kayser-Fleischer rings and sunflower cataracts, which are attributed to copper deposition in the Descemet's membrane and the anterior and posterior capsule of the lens in the former and latter, respectively.

Answer 337

Hepatitis; viral, autoimmune Parkinsons disease Cirrhosis Psychiatric disorder; schizophrenia, paranoia, depression

Answer 338

The first line blood test is serum caeruloplasmin - <140mg/L i.e. low, is pathogonomic. Can also measure total serum copper (low). A 24-hour urine collection for measuring urinary copper excretion, which is typically high. Genetic analysis of the ATP7B gene to confirm the diagnosis. Imaging: MRI brain – may show basal ganglia degeneration Invasive: Liver biopsy – increased hepatic copper

Answer 339

Avoid chocolate, nuts, liver Chelators; D-penicillamine, trientine Zinc salts For severe disease liver transplantatin

Answer 340

Good prognosis with early diagnosis Untreated disease can lead to liver failure

Answer 341

Tumour that sits in the pancreas or duodenum. There is uncontrolled release of gastrin from gastrinoma resulting in development of ulcerations in the stomach and duodenum

Answer 342

0.5-2 per million

Answer 343

MEN type 1

Answer 344

Abdominal pain, particularly in the epigastric region Diarrhoea Ulceration of the duodenum, which can often lead to gastrointestinal bleeding Non-responsiveness to simple Proton Pump Inhibitors (PPIs)

Answer 345

Peptic ulcer disease Gastritis GORD

Answer 346

Gastrin levels Secretin stimulation test Somatostain receptor scintigraphy Endoscopy

Answer 347

Surgical resection PPI Chemotherapy, somatostatin analogues

Gastroenterology Flashcards

(375 cards)