Gastroenterology Flashcards
(314 cards)
1
Q
What is Achalasia?
A
Neuromuscualr disorder of failed peristalsis and inability to relax LOS
2
Q
Symptoms of achalasia?
A
Dysphagia to liquids and solids
Variability
Regurgitation
3
Q
Investigation of achalsia?
A
- Oesophageal mamometry
- Barium swallow
- CXR widened mediastinum
4
Q
Barium swallow in achalsia?
A
Birds beak
5
Q
Management of achalasia?
A
- Oesophageal dilatation endoscopically
- Heller myotomy- recurrence or persistent
- If can’t have surgical intervention: botulinum toxin injections, then CCB/nitrates
6
Q
What is Plummer-Vinson syndrome?
A
Dysphagia with IDA due to upper oesophageal web
7
Q
What is a pharyngeal pouch?
A
Herniation of pharyngeal mucosa
8
Q
Presentation of pharyngeal pouch?
A
Regurgitation
Bulging neck with gurgling
Halitosis
9
Q
Investigation of pharyngeal pouch?
A
Barium swallow with dynamic video fluoroscopy
10
Q
Management of pharyngeal pouch?
A
Observation
Surgery
11
Q
What is Barretts oesophagus?
A
Metaplasia of the lower oesophagus with epithelium changing from squamous cell to columnar
12
Q
What can Barretts oesophagus progress to?
A
Adenocarcinoma
13
Q
Management of Barretts oesophagus?
A
Metaplasia- OGD 3-5 years, high dose PPI
Dysplasia- radio frequency ablation
14
Q
Diffuse oesophageal spasm of barium swallow?
A
Corkscrew appearance
15
Q
What is eosinophillic oesophagitis?
A
Allergic inflammatory infiltration of the oeophagus causing dysphgia and dyspepsia on background of atopy
16
Q
Diagnosis of eosinophillic oesophagitis?
A
OGD with eosinophils >5 per high powered field
17
Q
Management of eosinophilic oesophagitis?
A
Stop food triggers
Topical steroids
Oesophageal dilation
18
Q
Management of pyloric stenosis?
A
Ramstedt pyloromyotomy
19
Q
Most common oesophageal cancer?
A
Adenocarcinoma
20
Q
Adenocarcinoma of the oesophagus risk factors and location?
A
GORD
Barrett’s
Smoking
Obesity
Lower 1.3rd by GOJ
21
Q
Squamous cell carcinoma of oesophagus risk factors and lcoation?
A
Alcohol
Smoking
Achalasia
Plummer-Vinson syndrome
Upper 2/3rd oesophagus
22
Q
Associations of H. pylori?
A
PUD
Gastric cancer
MALT lymphoma
Atrophic gastritis
23
Q
Management of H. pylori?
A
7 days
PPI + amoxicillin + clarithromycin
2nd line- PPI + amoxicillin + metronidazole
Pen allergy PPI + clarithromcyin + metronidazole
24
Q
What is Boerhaaves syndrome?
A
oesophgeal perforation after significant vomiting
25
Investigation of Boerhaaves syndrome?
Oesophagogram with gastrograffin
CT thorax
26
Risk factors for PUD?
Smoking
NSAIDs
H. pylori
Steroids
SSRIs
27
Most common PUD?
Duodenal
28
What is Zollinger-Ellison syndrome?
Gastrin secreting tumour seen with multiple ulcers
29
Association with Zollinger-ellison syndrome?
MEN-1
30
Screening for zollinger ellison syndrome?
fasting gastrin levels
31
Diagnosis of zollinger-ellison syndrome?
Secretin stimulation test
32
Management of zollinger-ellison syndrome?
High dose PPI + resection of tumour
33
Location of zollinger-ellison syndrome?
Duodenum
Pancreas
34
Gastric cancer biopsy?
Signet ring cells- more the worse the prognosis
35
What is early dumping syndrome?
Complication post gastrectomy with fluid shifts causing bloating, abdominal pain, diarrhoea
36
What is late dumping syndrome?
Complication post gastrectomy with rebound hypoglycaemia secondary to large insulin load
37
Management of Gastric MALT lymphoma?
H pylori eradication
If refractory- chemotherapy
38
Management of Salmonella/ shigella?
Sal and Ella sip wine
Ciprofloxacin
39
Management of Campylobacter?
Clarithromycin
Camping gives you clarity
40
What type of bacteria is C diff?
Gram +ve rod
41
Abx predisposing to c diff?
Clindamycin
Ciprofloxacin
Ceftriaxone
42
Bloods in C. diff?
Raised WCC
Normal CRP
43
Treatment of first episode of C. diff?
1- Oral vancomycin
2- Oral Fidaxomicin
3- Vancomycin +/- IV metronidazole
44
Management of life threatening C. diff infection?
Oral vancomycin and IV metronidazole
45
Management of recurrent C.diff?
<12 weeks: oral fidamoxicin
>12 weeks: vancomycin or fidamoxicin
46
What is Enterobiasis?
Threadworm infection with enterobius vermicularis common in children
47
Management of enterobiasis (threadworms)?
Mebendazole
48
What is Whipple's Disease?
Infection of tropheryma whipplei bacteria
49
Presentation of Whipples disease?
Diarrhoea
Weight loss
Arthralgia
Skin hyperpigmentation and photosensitivity
50
Diagnosis of Whipple disease?
Small bowel biopsy with acid Schiff (PAS) +ve macrophages
51
Management of Whipple's disease?
12 months co-trimoxazole
52
What is coeliac disease?
T cell mediated autoimmune condition triggered by gluten
53
HLA's of coeliac disease?
HLA-DQ2
HLA-DQ8
54
Skin rash associated with coeliac disease?
Dermatitis herpetiformis with itchy lesions over buttocks and extensor surfaces of the arms
55
Management of dermatitis herpetiformis?
Dapsone
Stop gluten
56
Investigation of Coeliac disease?
Anti TTG
Anti EMA
In IgA deficiency anti TTG IgG
OGD with biopsy
57
How can IgA deficiency be seen?
Previous packed red cell transfusion reactions
58
Complications of coeliac disease?
Malabsorption- IDA
Hyposplenism- infections with capsulated organisms
Osteoporosis/ Osteomalacia
Lactose intolerance
Subfertility
Enteropathy-associated T cell lymphoma
59
How long should someone be on gluten containing diet prior to testing?
6 weeks
60
What is small bowel bacterial overgrowth syndrome?
Excessive bacteria in the bowel causing diarrhoea, bloating and abdominal pain
61
Diagnosis of SBBOS?
Hydrogen breath test
62
Management of SBBOS?
Rifaximin
63
Location of UC?
Rectum up to the ileocecal valve in continuous manner
64
UC typcially presents with?
Bloody diarrhoea
65
Extra-intestinal features of UC?
Pyoderma gangrenousum
Erythema nodosum
Primary sclerosing cholangitis (PSC)
Anterior uveitis
Episcleritis
66
Smoking in UC?
Protective
67
Severity classification of UC?
Truelove and Witt's criteria
Mild: <4
Moderate: 4-6
Severe: 6+, bloody, fever, tachy, abdo tenderness
68
Biopsy findings in UC?
Continuous inflammation
Loss of haustra markings
Pseudo polyps
Goblet cells
Crypt abscesses
Lymphocytes
69
Inducing remission in UC in proctitis, proctosigmoiditis, extensive, severe?
Proctitis:
- Rectal mesalazine
- No remission 4w + oral
- No remission + corticosteroid
Proctosigmoiditis:
- Rectal mesalazine
- No remission 4w + high dose oral
- No remission + corticosteroid
Extensive:
- Rectal mesalazine + high dose oral ASA
- No remission 4w: stop rectal, high dose ASA + corticosteroid
Severe:
IV steroid
If no improvement in 72h ? IV ciclosporin, inflixamab, surgery
70
How to maintain remission in UC: proctitis, extensive and severe/ 2+ relapses in a year?
Proctitis- rectal ASA +/- oral ASA
Extensive- low dose oral ASA
Severe/ 2+ relapses in year- Azathioprine/ mercaptopurine
71
Indications for emergency surgery in UC?
- Acute fulminant UC
- Toxic megacolon with little improvement after 48-72h IV steroids
- Worsening symptoms despite IV steroids
72
Long term complications of UC?
Colorectal Ca- colonoscopy surveillance
PSC- yearly LFTs
73
Where is most commonly affected in Crohn's disease?
Terminal ileum
74
How is pyoderma granenosum seen?
Ulcer with purple overhanging edge
75
Peri-anal disease seen in Crohn's?
Skin tags
Fistula
Abscess
Pyoderma gangrenosum
Anterior uveitis
76
Biopsy of Crohn's?
Skip lesions
Cobblestone mucosa
Rose thorn ulcers
Non caseating granulomas
Kantors string sign
77
Inducing remission in crohn's?
Prednisolone or IV hydrocortisone
+ Azathioprine/ Mercaptopurine in 2+ exacerbations in a year
Biologics
78
What to assess prior to Azathioprine or mercaptopurine?
TMPT activity
79
Maintaining remission in Crohn's?
Stop smoking
Azathioprine or mercaptopurine
80
Management of peri-anal abscess?
IV ceftriaxone and metronidazole
81
Treatment of IBS?
Mebeverine
Laxatives/ Loperamide
2nd line- amitriptyline
82
Genetic risk factors for colorectal cancer?
Lynch syndrome
FAP
Peutz-Jeghers syndrome
APC gene
p53/ DCC deletion
83
2ww for colorectal cancer?
* Age >40 + unexplained weight loss and abdominal pain
* Age >50 with unexplained rectal bleeding
* Age >60 with IDA or change in bowel habit
* Mass
* Under <50 with rectal bleeding and one of abdominal pain, change in bowel habit, weight loss, IDA
84
What is the dukes classification of colorectal cancer?
A- Limited to bowel wall (not beyond the muscularis)
B- Extending through the bowel wall (beyond muscularis)
C- Regional lymph node involvement
D- Distant metastasis
85
Tumour marker for colorectal ca?
CEA
86
Investigations for colorectal cancer?
FIT
CEA, FBC
Colonoscopy, or Ct colonoscopy
CTAP
MRI pelvis
87
What is Familial adenomatous polyposis (FAP)?
Autosomal dominant mutation in APC gene causing 100's polyps by 20's
88
Risks of FAP?
Colorectal cancer
Duodenal cancer- OGD
89
Management of FAP?
Prophylactic proctocolectomy
90
What is Gardener's syndrome?
variant of FAP with:
- Supernumerary teeth
- Osteomas
- Retinal pigmentation
- Thyroid tumours
- Epidermal cysts
91
What is Hereditary non-polyposis colorecal cancer HNPCC (lynch syndrome)?
Autosomal dominant mutation is mismatch repair genes:
- MLH1
- MSH2
92
Risks in HNPCC?
Colorectal ca in 30's, gastric, endometrial, breast and prostate cancer
93
HNPCC manangement?
Surveillance
94
What is Peutz-Jegher's syndrome?
Autosomal dominant mutation in:
- STK11
- LKB1
95
How is Peutz-Jegher's syndrome seen?
Harmatomatous polyps
Pigemented freckles on soles, face, lips
96
What is Hairy Leucoplakia?
Benign condition caused by EBV suggestive of HIV no treatment required
97
Gold standard for diagnosis of Hirshprungs?
Rectal biopsy
98
Sigmoid volvulus risk factors for large bowel obstruction?
Older age
Constipation
PD
Chagas disease
Duchennes
Psych patients
99
Sign for sigmoid volvulus?
Coffee bean sign showing large bowel obstruction
100
Caecal volvulus risk factors?
Adhesions
Pregnancy
101
Sign of caecal volvulus?
Fetal sign
102
Management of sigmoid volvulus?
R sigmoidoscopy
Rectal tube insertion
103
Management of caecal volvulus?
Laparotomy
104
What is Meckels diverticulum?
Congenital diverticulum of the small intestine
105
Ispaghula husk?
Bulk laxatives
106
Docusate sodium?
Stool softeners
107
Lactulose and macrogol?
Osmotic laxatives
108
Senna and bisacodyl?
Stimulant laxatives
109
Laxative for opioid induced constipation?
Sodium picosulfate
110
Management of gastroparesis?
Smaller more frequent meals
- Domperidone
- Metoclopramide
111
Causes of metabolic alkalosis?
- H+ loss- vomiting, diuretics, Bartter's syndrome
- RAAS system increasing aldosterone- primary hyperaldosteronism, Cushings syndrome
- Liquorice
- Carbenoxolone
112
What causes acute mesenteric ischaemia?
Thrombus in the superior mesenteric artery
113
Presentation of acute mesenteric ischaemia?
Sudden severe abdominal pain out of keeping with examination
Shock
Lactic acidosis
114
Diagnosis of acute mesenteric ischaemia?
CT angiography
115
Management of acute mesenteric ischaemia?
laparotomy
116
How does chronic mesenteric ischaemia present?
Chronic intestinal angina commonly after eating associated with weight loss, diarrhoea
117
In colonic ischaemia where is most likely to be affected?
Watershed areas- splenic flexure
118
Risk factors of microscopic colitis?
NSAIDs
PPIs
SSRIs
Smoking
119
How is microscopic colitis seen?
Watery diarrhoea
Urgency
Abdo pain
Weight loss
Arthralgia
120
What is angiodysplasia?
Vascular abnormality with thin walled vessels prone to bleeding seen with GI bleeding and anaemia
121
Risk factors for angiodyplasia?
Older age
AS (Heyde syndrome)
CKD
122
Diagnosis of angiodysplasia?
Endoscopy
Mesenteric angiography
123
Treatment of angiodysplasia?
Actively bleeding:
- Endoscopy with APC
- Mesenteric angiography with embolisation
- surgery
Recurrent or less severe bleeding: TXA
124
What is pseudomyxoma peritonei?
Mucinous tumour commonly from the appendix causing large amounts of mucin in the abdominal cavity
125
Alcohol on bloods?
AST:ALT ratio >1.5
Macrocytic anaemia
126
What is hepatic encephalopathy?
Accumulation of ammonia in the brain which when detoxified forms glutamine that causes cerebral oedema
127
How is hepatic encephalopathy seen?
Confusion
Apraxia
Asterixis
128
What can precipitate hepatic encephalopathy?
Infection
Decompensation
TIPS
129
What are the 4 stages of hepatic encephalopathy?
1- irritability
2- confusion, inappropriate behaviour
3- Incoherency, restlessness
4- coma
130
Management of hepatic encephalopathy?
Lactulose
Rifaximin
131
Criteria for non paracetamol induced liver transplant?
PT >100s
OR any 3 of:
- Drug induced liver failure
- Age <10 or >40
- 1 week from jaundice to encephalopathy
- Bili 300+
132
Criteria for paracetamol induced need for liver transplant?
pH <7.3 24h after ingestion
OR
PT >100 + creatinine >300 + Grade 3-4 encephalopathy
133
Why is paracetamol overdose dangerous?
Build up of toxic NAPQI which cant be deactivated to glutathione
134
Best prognostic indicator for paracetamol overdose?
INR
135
How to treat paracetamol overdose?
<1h + dose >150mg/kg = charcoal
<4h = 4h level and treat based on level
8-24h + dose >150mg/kg = NAC
>24h = NAC immediately if jaundiced/ RUQ pain, elevated ALT, INR >1.3 or paracetamol concentration detectable
136
Who gets autoimmune hepatitis?
Young to middle aged women with co-exisiting autoimmunity
137
Investigations of autoimmune hepatitis?
ANA
Anti-SMA
Anti-LKM1
IgG (raised)
138
What are the 3 types of autoimmune hepatitis?
1- ANA (most common) or SMA- Adults and kids
2- Anti LKM1- kids
3- Soluble liver kidney antigen- adults
139
Diagnosis of autoimmune hepatitis?
Liver biopsy with inflammation extending beyond the limiting plate/ piecemeal necrosis/ bridging necrosis
140
Management of autoimmune hepatitis?
Prednisolone
Azathioprine
141
Describe hepatitis A?
RNA Piconavirus
Faecal oral route
142
Hepatitis virus most common in developing world?
Hep A
143
Treatment of Hep A?
Supportive
144
Describe Hepatitis B infection?
dsDNA virus
Bodily fluids and vertical transmission
145
Most common hepatitis globally?
Hep B
146
IgM if Hepatitis B?
+ve in acute infection
-ve in chronic infection
147
IgG in Hepatitis B?
+ve current or previous infection
148
HBeAg in Hep B?
Infectivity
149
HBsAg and antibodies to HBsAg, anti-HBc?
HBsAg +ve 3-5 weeks after acute infection, if positive after 6 months carrier
Antibodies to HBsAg previous vaccination
Anti-HBc (core antigen)- past infection
150
When to treat hepatitis B?
HBsAg +ve have liver disease, pregnant or young
- peginterferon alfa-2
- Tenofovir + entecavir
151
Describe hepatitis C?
RNA virus in flavivaridae family
Bodily fluid transmission
152
Risks of hepatitis C?
75% chronic infection
HCC
Cirrhosis
153
Management of Hep C?
Sofosbuvir
154
Hepatitis E risk?
Highest in pregnancy
155
Previous immunisation of Hep B seen as?
Anti-HBs +ve only
156
Previous hepatitis B >6 months ago, not a carrier bloods?
anti-HBc +ve, HBsAg -ve
157
Previous Hepatitis B now a carrier bloods?
anti-HBc positive, HBsAg positive
158
Classification of Cirrhosis and what does it do?
Child-Pugh Score
Predicts mortality and need for transplant
159
Who should receive a fibroscan (transient elastography)?
Hep C, >50 units of alcohol per week if male and >35 units a week if female, ALD diagnosis
160
Monitoring of HCC in cirrhosis?
USS every 6 months +/- AFP
161
When does delirium tremens occur?
72 hours post drink
162
Management of alcohol withdrawal?
Reducing regimen of chlordiazepoxide or BZ
Pabrinex 1 pair OD or high risk 2 pairs TDS
163
Thiamine is vitamin?
Vitamin B1
164
Bloods in ALD?
GGT high
AST : ALT ration >2 (>3 in acute alcoholic hepatitis)
165
Management of acute alcoholic hepatitis?
Maddrey score ? prednisolone
166
Plt transfusion if UGI haemorrhage?
<50 and actively bleeding
167
When to give FFP in UGIB?
Fibrinogen <1g or PT >1.5x normal
168
When to give Prothrombin complex concentrate in UGIB?
If taking warfarin and actively bleeding
169
When to give IV PPI in endoscopy?
After endoscopy if non variceal bleeding
170
If variceal bleed if suspected do what prior to endoscopy?
IV abx
Terlipressin (not in PVD or ischaemic stroke)
171
What scoring system is used prior to endoscopy?
GBS
172
What score if used following endoscopy?
Rockall score
173
Management of acute UGIB?
A-E approach
2 large bore cannula's
IVF resuscitation
Bloods: VBG for Hb, routines, crossmatch, coagulation profile including fibrinogen and PT
Bloods products:
- Packed Red Cells
- Plts <50
- FFP if fibrinogen <1 or PT >1.5X normal
- Prothrombin complex- in warfarin
If variceal:
- BS IV abx and terlipressin
NBM
Glasgow Blatchford score
Urgent OGD
174
What is the action of terlipressin?
Splanchnic vasoconstriction
175
What is prophylactic for varcies?
Propranolol if Grade 1 with red signs or 2-3
Variceal band ligation if medium to large
If fails TIPPS
176
What is TIPSS?
Trans jugular intrahepatic portosystemic shunt
Creating an artificial channel bypassing the liver from the inflow portal vein and the outflow hepatic vein to reduce portal HTN
177
Complication of TIPSS?
Hepatic encephalopathy
178
Indications for TIPSS?
- Secondary prophylaxis of oesophageal varices
- Refractory ascites
- Portal HTN in Budd-Chiari syndrome
179
Investigation for ascites?
Ascitic tap
- Albumin, WBC, neutrophils, protein, culture
SAAG
180
How do you calculate SAAG?
Serum albumin - ascitic albumin
181
High SAAG >11 caused by?
Portal HTN
- Cirrhosis
- Liver mets
- R sided HF/ constrictive pericarditis
- Budd-Chiari syndrome
182
Low SAAG <11 causes?
- Malignancy
- Hypoalbuminaemia (nephrotic syndrome, severe malnutrition)
- TB
- Pancreatitis
- Bowel obstruction
183
Management of ascites?
Correct cause
Spironolactone +/- furosemide
Abdominal paracentesis
Oral cipro if cirrhosis and ascites protein 15 or less for SBP
TIPSS if refractory
184
Why do you cover abdominal paracentesis with 100ml 20% albumin for every 2.5L drained?
Prevent circulatory dysfunction
185
What is Budd-Chiari Syndrome?
Hepatic vein thrombosis often seen with procoagulant condition
186
What are the causes of Budd-chiari syndrome?
Polycythaemia rubra vera
Thrombophilia
Pregnancy
COCP
187
Symptoms of Budd-Chiari Syndrome?
Abdo pain
Ascites
Tender hepatomegaly
188
Investigation for Budd-Chiari syndrome?
USS doppler
189
Drugs that can cause DILI?
Nitrofurantoin (AST/ALT)
Flucloxacillin
Co-amoxiclav
Erythromycin
COCP
Methotrexate
190
What causes hepatorenal syndrome?
Vasoactive mediators cause splanchnic vasodilation reducing systemic vascular resistance causing hypoperfusion of the kidneys
191
2 types of hepatorenal syndrome?
Type 1: rapidly progressive, creat rise X2 to > 221 in <2 weeks
Type 2: slowly progressive
192
Treatment of hepatorenal syndrome?
Terlipressin
20% albumin
TIPSS
Liver transplant
193
Most common organism in SBP?
E. coli
194
Diagnosis of SBP?
Ascitic neutrophils >250
195
Management of SBP?
IV cefotaxime
196
Presentation of SBP?
Ascites
Abdominal pain
Fever
197
Investigations for NAFLD?
ELF blood test
NAFLD fibrosis score
Fibroscan
198
What are the 4 inherited causes of jaundice?
Unconjugated
Gilberts syndrome
Crigler-Najjar syndrome
Conjugated
Dubin-Johnson syndrome
Rotor syndrome
199
What is Gilberts syndrome?
AR mild deficiency of UPD-glucuornyl-transferase due to mutation in UGT1A1
200
Presentation of Gilberts syndrome?
Asymptomatic till triggers of stress/infection/fasting with unconjugated jaundice and mild pain
201
Treatment of Gilberts syndrome?
Nil required
202
What is crigler-Naajjar syndrome?
AR absolute deficiency of UDP glucuronosyl transferase seen in neonates with uncongugated hyperbilirubinaemia
203
2 Types of Crigler-Naajar syndrome?
Type 1- life threatening
Type 2- less severe
204
Treatment of crigler-najjar syndrome?
Liver transplant
205
What is Dubin-Johnson syndrome?
AR disorder with mutation to MRP2 causing a black liver and defective hepatic excretion
seen with conjugated jaundice
206
What is Rotor Syndrome?
AR defect in hepatic uptake and storage of bilirubin causing conjugated jaundice
207
What is Wilsons disease?
AR defect in copper metabolism due to ATP7B gene mutation
208
When is the onset of Wilsons disease?
10-25 with liver and neurological symptoms
209
Features of wilsons disease?
Hepatitis
Cirrhosis
Parkinsonism due to basal ganglia degeneration
Asterixis
Chorea
Dementia
Kaiser-fletcher rings
Sunflower cataracts
RTA
Haemolysis
Blue nails
210
Nails in wilsons disease?
Blue
211
Where is the copper in Kayser-fletcher rings?
Descements membrane
212
Investigations for wilsons disease?
1- serum caeruloplasmin (low)
2- Total serum copper (low)
3- Free copper (high)
4- 24h urinary copper high
213
Diagnosis of Wilsons?
Genetics for ATP7B gene
214
Management of Wilsons disease?
D-penicillamine
Trientine hydrochloride
215
What is haemochromatosis?
AR excess of iron in pancreas, liver, heart, joints etc.
216
Mutation in haemochromatosis?
HFE gene
H63D
C282Y
217
Features of haemochromatosis?
Fatigue
Erectile dysfunction
Arthralgia
Bronze skin
DM
Cirrhosis
Dilated cardiomyopathy
218
What kind of cardiomyopathy does haemochromatosis cause?
Dilated cardiomyopathy
219
What can you reverse with treatment in haemachromatosis?
Cardiomyopathy (dilated)
Skin pigmentation
220
Investigation for haemochromatosis?
Transferrin saturation >50 women, >55 men
Ferritin >500
Low TIBC
Genetic testing
221
Management of haemochromatosis?
Venesection with T sat <50% and ferritin <50
Second line- deferoxamine
222
What is primary biliary cirrhosis?
Autoimmune inflammation and scarring of bile ducts
223
Who is PBC seen?
Middle aged women
224
Associations with PBC?
Sjogrens syndrome
RA
Systemic sclerosis
Thyroid disease
225
Presentation of PBC?
Cholestasis
Cirrhosis
Itch
226
Rule for PBC?
Rule of M
IgM
AMA +ve M2 subtype
Smooth muscle antibodies
227
Investigation for PBC?
AMA M2 subtype
Smooth muscle antibodies
IgM raised
USS/MRCP to rule out other causes
228
Management of PBC?
Ursodeoxycholic acid
Itch: cholestyramine
Fat soluble vitamins
Liver transplant
229
Complications of PBC?
HCC
Cirrhosis
Osteomalacia
230
What is PSC?
Primary sclerosing cholangitis in fibrosis of the intra and extrahepatic bile ducts
231
Associations with PSC?
UC
Crohn's
HIV
232
Diagnosis of PSC?
pANCA
ERCP/ MRCP/ histology
233
MRCP findings in PSC?
Beading
234
Histology of PSC?
Onion skin fibrosis
235
Complications of PSC?
Cholangiocarcinoma
Colorectal cancer
236
Gallstones made of calcium bilirubinate (pigmented stones) more common in?
Sickle cell disease
237
Acute cholecystitis presentation?
Murpheys +ve
RUQ pain
Fever
238
Ascending cholangitis presentation?
Charcot triad:
- RUQ pain
- Fever
- Jaundice
Reynolds pentad- hypotension and confusion
239
Most common organism in ascending cholangitis?
E. coli
240
Management of ascending cholangitis?
BS Abx
ERCP
241
Investigation for gallstones?
-USS
-MRCP/ ERCP
242
What is haemobilia?
Bleeding from splanchnic circulation into the biliary tree seen with RUQ pain and UGIB with jaundice
243
What are hydatid cysts?
Tapeworm infection of echinococcus granulosus precipitating a type 1 hypersensitivity reaction causing cysts in liver and lungs
244
Tumour marker for HCC?
AFP
245
Management of intrahepatic cholestasis of pregnancy?
Ursodeoxycholic acid for symptoms
Weekly LFTs
Delivery 37 weeks
246
Differentials for jaundice in third trimester?
HELLP
Acute fatty liver of pregnancy
Gilberts syndrome
Dubin-Johnson syndrome
247
What is courvisiers sign?
RUQ mass indicating cholangiocarcinoma
248
Risk factors for cholangiocarcinoma?
Smoking
Obesity
PSC
UC
Pesticides
Radiation
Heavy metals
249
Causes of acute pancreatitis?
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion stings
Hypothermia, hypercalcaemia, hypertriglycerideaemia
ERCP
Drugs
250
What drugs can cause acute pancreatitis?
Mesalazine
Furosemide
Azathioprine
Thiazides
Tretracyclines
Statins
Steroids
Sodium valproate
251
Diagnosis of acute pancreatitis?
Amylase X3 upper limit of normal
252
Investigations for pancreatitis?
Amylase
Lipase (more sensitive)
LDH
ABG for O2
Lipids
USS for gallstones
CT complications
253
Severity of pancreatitis?
Glasgow score
3+ ITU
254
Management of acute pancreatitis?
Aggressive IVF
UO aim >30ml/hr
Cathertisation
Analgesia
Anti emetic
255
Feeding in acute pancreatitis?
Encourage oral intake
If not achieving within 5 days NG tube
256
Causes of chronic pancreatitis?
Alcohol
CF
Malignancy
Obstruction
Metabolic causes
257
Presentation of chronic pancreatitis?
Epigastric pain after eating, better leaning forwards
Steatorrhoea
DM
258
Imaging of chronic pancreatitis?
Calcifications
259
Faecal test for chronic pancreatitis?
Faecal elastase
260
Management of chronic pancreatitis?
Analgesia
Creon
261
What is alpha-1-anti trypsin deficiency?
Lack of this enzyme allowing action of neutrophil elastase causing emphysema, cirrhosis and HCC
262
Liver biopsy of alpha-1-anti trypsin deficiency?
Periodic acid schiff positive globules
263
Management of alpha-1-antityrypsin deficiency?
IV A1AT at high cost
264
What are carcinoid tumours?
Slow growing neuroendocrine tumours often in the appendix of SI
265
Presentation of carcinoid tumours?
Abdo pain
Diarrhoea
Flushing
PS
266
Investigation of carcinoid tumours?
5-HIAA urine
CT
267
Management of carcinoid tumours?
Octreotide
Surgical resection
268
USS in pancreatic cancer?
Double duct sign
269
Management of pancreatic cancer?
Whipples resection
270
Causes of bile acid malabsorption?
Cholecystectomy
Coeliac disease
SBBO
271
Investigation for bile acid malabsoprtion?
SeHCAT 7 days apart
272
Management of bile acid malabsoprtion?
Cholestyramine
273
What is cholestyramine?
Bile acid sequestrant
274
When is cholestyramine used?
Hyperlipidaemia
Diarrhoea in Crohn's post resection
Bile acid malabsorption
275
What is pernicious anaemia?
B12 deficiency due to anti intrinsic factor antibodies or anti gastric parietal cell antibodies
276
Presentation of pernicious anaemia?
Anaemia- megaloblastic
B12 deficiency
Neuropathy
Atrophic glossitis
277
Management of pernicious anaemia?
IM B12
278
Complication of pernicious anaemia?
Gastric Ca
Subacute degeneration of the cord
279
Drugs that are metabolised by P450 enzymes?
Clopidogrel
Statins
Warfarin
280
Inhibitors of P450 enzymes (therefore increasing the concentration of drugs)?
SSACAIE
Silly Sarah and Charlie always inspire energy
Sodium valproate
SSRIs
Amiodarone
Ciprofloxacin
Azoles
Isoniazid
Erythromycin
281
Inducers of P450 enzymes (decreasing drug concentration)?
Sarah Collis, Sarah Collis Really Pretty
* Smoking
* Carbamazepine
* St john wart
* Chronic alcohol
* Rifampicin
* Phenytoin
282
Name the 4 glycogen storage disorders?
1- Von Gierkes disease
2- Pompe disease
3- Cori disease
5- McArdle's disease
283
What is McArdles disease?
Glycogen storage disorder seen with myalgia, myoglobinuria with exercise
284
Presentation of Fabry disease?
Angiokeratomas
Peripheral neuropathy
Renal failure
285
What is alkaptouria?
AR disorder of HGD enzyme so cant metabolise phenylalanine and tyrosine with black urine, intervertebral calcification, renal stones
286
Management of alkaptonuria?
High dose Vit D
Restrict phenylalanine and tyrosine
287
Hallmark of refeeding syndrome?
Hypophosphataemia
288
Vitamin D deficiency can result in?
Low calcium and phosphate leading to rickets in children and Osteomalacia in adults
289
Vitamin D conversion to calcitriol needs what to activate?
the liver and kidneys to active it
290
What is Vitamin A?
Retinol
291
What happens in Vitamin A (Retinol) deficiency?
Night blindness
292
What is vitamin B1?
Thiamine
293
Consequences of thiamine deficiency?
Wernicke's encephalopathy (confusion ataxia and ocular abnormalities)
Korsakoff syndrome (amnesia, confabulation)
Wet beri beri- dilated cardiomyopathy
Dry beri beri- peripheral neuropathy
294
What is wet beri beri?
Dilated cardiomyopathy caused by thiamine (vitamin V1) deficiency
295
What is dry beri beri?
Peripheral neuropathy due to thiamine deficiency (vitamin B1)
296
What is pellegra?
Vitamin B3 deficiency
297
How does vitamin B3 deficiency (pellagra) present?
Diarrhoea
Dermatitis
Dementia
298
Treatment of vitamin B3 deficiency (pellegra)?
Vitamin B3 nicotinamide
299
What is scurvy?
Vitamin C deficiency
300
What is ascorbic acid?
Vitamin C
301
How does vitamin C deficiency (ascorbic acid deficiency causing scurvy) present?
Bleeding
Bruising
Gingival swelling
Teeth loss
302
Likely cause of UGIB following liver biopsy?
Haemobilia due to damage of splanchnic vein
303
Sand sign in liver abscess is?
Hydatid cyst
304
Absolute contraindications for TIPSS?
Severe and progressive liver failure (Child-Pugh score >12 is associated with a high risk of early death)
Uncontrolled hepatic encephalopathy
Right-sided heart failure
Uncontrolled sepsis
Unrelieved biliary obstruction
305
Tricuspid disease in carcinoid is due to?
Fibrous endocardial thickening
306
Gastric biopsy: Presence of dense diffuse infiltrate of marginal-zone cells in lamina propria with prominent lymphoepithelial lesions is?
MALT lymphoma
307
Liver abscess treatment?
Percutaneous drainage + amoxicillin + ciprofloxacin + metronidazole
308
Presentation of autoimmune pancreatitis?
Jaundice
Nausea
Enlarged pancreas
309
Blood test for autoimmune pancreatitis?
IgG
Amylase not necessarily raised
310
Cant take what with azathioprine?
Allopurinol
311
When to give prednisolone based on the Maddrey score?
>32
312
co-amoxiclav can cause what in LFTs?
Cholestasis
313
Hb aim for UGIB?
70-80
314
pANCA more likely to be seen in which IBD?
UC
