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MRCP Part 1 > Gastroenterology > Flashcards

Gastroenterology Flashcards

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1
Q

How would you characterise the causes of dysphagia

A

Extrinsic
Intrinsic
Oesophageal wall
Neurological

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2
Q

Extrinsic causes of dysphagia

A

Mediastinal mass
Cervical spondylosis

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3
Q

Intrinsic causes of dysphagia

A

Tumours
Strictures

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4
Q

Oesophageal wall causes of dysphagia

A

Achalasia
Hypertensive LOS

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5
Q

Neurological causes of dysphagia

A

Stroke
Parkinsons
Myasthenia gravis
CVA

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6
Q

Achalasia - characteristics

A

Difficulty swallowing both solids and liquids

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7
Q

Pathgnomenomic sign of achalasia

A

Barium study - Bird beak appearance of the oesophagus - Dilated proximally and tapers distablly

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8
Q

How to differentiate achalasia and pseudoachalasia (Oesophageal cancr)

A

red flag symptoms of cancer - specifically rapid weight loss, Anorexia, Vomitting

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9
Q

What is the mechanism of action of achalasia

A

Impaired relaxation of the lower oesophageal sphincter

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10
Q

What scoring system is used to triage the severity of Acute pancreatitis

A

Modified Glasgow score

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11
Q

What is the threshold of the Modified Glasgow score to assess the severity of developing a complication in a patient diagnosed with acute pancreatitis

A

MGS >3 - At risk of a severe complication

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12
Q

What are the components of the Modified glasgow score to deleniate risk of developing severe pancreatitis

A

Age > 55 - 1
wcc >15
Glucose >10
LDH >600
AST >200
Serum calcium <2
Albumin <32

(Score of >3 - High risk of developing a severe complication)

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13
Q

How would you characterise the complications of Acute pancreatitis

A

Local vs systemic

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14
Q

Local complications of acute pancreatitis

A

1) fluid collection arouns the pancreas
2) Pseudocyst - Conservative management
3) Abscess (Infected pseudocyst)
4) Pancreatic necrosis:
- Sterile necrosis - conservative management
- Infected necrosis - Necrosectomy (hight mortality)
5) Haemorrhage - Sign - Grey turner sign due to retroperitoneal haemorrhage

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15
Q

Systemic complications of Acute pancreatitis

A

ARDS
- Sudden onset central cyanosis, tachypnoea and SOB

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16
Q

How to Diagnose C.DIFF

A

Stool sample - +ve for C.Diff Toxin (A/B)

NB - C.Diff antigen +ve means previous exposure (Important in Abx mgt)

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17
Q

What is the classification of Mild C.diff

A

Normal WCC

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18
Q

What is the classification of Moderate C.DIFF

A

WC >15X10^9

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19
Q

What is the classification of severe C.Diff

A

WCC >15 + Fever >38.5

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20
Q

What is the classification of Life trheatening C.DIFF

A

1) Haemodynamic compromise
2) CT Findings of Severe C.DIFF
3) Toxic Megacolon
4) Complete Ileus

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21
Q

What is the most common cause of C.diff

A

2nd/3rd gen cephalosporins

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22
Q

What are the causes of C.diff

A

1) 2nd/3rd gen cephalosporins
2) Clindamycin
3) PPI’s

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23
Q

1st line management of C.diff (Mild - Severe)

A

Oral Vancomycin

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24
Q

Management of C.diff

A

1st line - Oral Vancomycin
2nd line - Oral fidoxamicin
3rd line Oral van +/- IV Metronidazole

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25
Management of recurrent C.diff
Within 12 weeks - Oral Fidoxamicin Afer 12 weeks - Oral Vanc or Oral Fidoxamicin
26
Management of Life threatening C.diff
Oral Vancomycin + IV Metronidazole
27
What is the mainstay management of Coeliac disease
Gluten free diet
28
What grains include gluten
Wheat Barley Oats Rye
29
What grains are gluten free
Rice Potatoes Corn
30
How do you diagnose coleiac Disease
1st line - Anti-Tissue tranglutaminase Ab - aTTG-IGA If patients have liver disease, or have an IgA deficiency then TTG-IGA will be false -ve hence need to sue: - TTG-IgG
31
How is aTTG-IgA used in coeliacs disease
Diagnosis and to ensure compliance with a gluten free diet
32
Why are patients with Coeliac disease at higher risk of developing infections caused by encapsulated bacteria
Functional Hyposplenism
33
Four examples of encapsulated bacteria
Nisseria Meningitidis Haemophilus Influenza Type B Strep Pneumonia E.coli
34
Vaccinations recommended for coeliac patients
Pneumococcal vaccine one off and booster every 5 years
35
What are the causes of ischaemic hepatitis
Ischaemic event - I.e cardiac arrest
36
How does Ischaemic hepatitis present
Post hypoperfusion event resulting in ACUTE rise in Liver function tests (ALT) -Usually seen in conjunction with acute kidney injury (Tubular necrosis) and other end-organ failure
37
What causes carcinoid syndrome
Neuroendocrine tumour which is either the primary or metastasized to the liver
38
Pathophysiology of carcinoid syndrome
NET's secrete horomones - Serotonin, Bradykinin and Histamines These result in the manifestation of the signs seen in Carcinoid syndrome
39
What are the characteristics of cacinoid syndrome
Bradykinin/Histamine: - Hypotension - Vasodilation - Facial Flushing -Bronchoconstriction, Wheeze Serotonin - Fibrosis - Heart - Right side - Tricuspid regurgitation/Pulmonary stenosis - Reduces tryptophan levels - resulting in Vitd D3 deficiency - Phallegra - Diarrhoea, Dermatitis and dementia
40
What can exacerbate carcinoid syndrome
Exercise Alcohol intake Emotional distressH
41
How do you diagnose Carcinoid syndrome
24 hour - Urinary 5-Hydroxyindolacetic acid (5-HIAA) which is a byproduct of metabolised serotonin (Raised)
42
How to treat carcinoid syndrome (Symptom control VS Curative)
Symptom control - Somatostatin analogue - Ocreotide Curative - Surgical removal of the neuroendocrine tumour (Increased somatostatin receptors)
43
What is spontaneous bacterial peritonitis
It is a form of infective peritonitis seen in patients who have ascites secondary to cirrhosis
44
How would you categorise the different causes of ascites
By quantifying the Serum-Ascites Albumin Gradient. Cut off is 11g/L
45
Causes of ascites in patients with a SAAG of >11G/L
Ascites due to portal hypertension: - Liver: a) Acute liver failure b) Decompensated liver cirrhosis -Cardiac a) Right heart failure Other: a) Portal venous thrombosis b) Budd chiari malformation
46
Causes of ascites in patients ith a SAAG of <11g/L
Nephrotic syndrome Severe malnutrition Malignancy Pancreaititis Bowel obstruction
47
How does SBP present
Ascites + Abdominal pain + Fever
48
What is the most common bacteria causing SBP
E.COLI
49
How to Diagnose SBP
Paracentesis which shows Neutrophil count of >250units/L
50
How to treat SBP
IV Cefotaxime
51
Antibiotic prophylaxis of SBP indications
Previous SBP Ascites with: - Fluid Protein <15g/l - Child-Pugh score >9 (Class B/C) - Hepatorenal syndrome
52
What is the antibiotic of choice for prophylaxis against SBP
Oral ciprofloxacin
53
What is hepatorenal syndrome
It is classified as acute renal failure secondary to Hepatic impairmentP
54
Pathophysiology of Hepatorenal syndrome
Splanchnic vasodilation results in activation of the RAAS sysytem resulting in renal vasoconstriction and subsequent renal hypoperfusion
55
Categorise hepatorenal syndrome
T1HRS - Acute within 2 weeks the CrCL drops to <20 or the Cr Doubles T2HRS - Chronic
56
Characteristics
Signs of hepatic impairment along with rising creatinine levels and oligouria
57
Treatment of hepatorenal syndrome
1) Volume expansion - HAS 2) Splanchnic vasoconstriction - Terlipressin (1mg IV over 4-6hours) 3) Definitive - Liver transplant
58
What are anal fissures
Eliptical tears of the anoderm
59
Where are anal fissures usually found
90% - Posterior Midline of the anus 10% -Else where -Think IBD if else where
60
Aeitiology of Anal fissures
Main - Idiopathic RF's - Contipation/Trauma Secondary: -IBD - Crohn's >>> UC - Malignancy - Infectious - Syphylli, HIV, HSV
61
Symptoms of anal fissures
Pain - Pain on defacation is the main debillitating symptom PR BLeeding - Scanty, Fresh red blood, usually on wipin or in the bowl Discharge - Pus Pruritus Ani Constipation - Pain can result in avoidance of defecation
62
DDX of anal fissures
Haemerrhoids - Painless unless thrombosed Anal fistula?
63
Management of acute (<6weeks) of anal fissure
Diet - High fibre diet Laxatives: -1sT Line - Bulk forming laxative (Isphagula Husk - Fybogel) 2nd line - Lactulose Petroleum jelly prior to defacation as lubricant
64
Management of chronci (>6weeks) anal fissure
1st line - Topic GTN ointment (Minimum 8 weeks trial) 2nd line - Botulinum toxin vs surgical spyncterectomy

MRCP Part 1 (19 decks)

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