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Yr 4 - CCC > Corrections - GI pt. 2 > Flashcards

Corrections - GI pt. 2 Flashcards

1
Q

What are the 2 most common triggers for autonomic dysreflexia?

A

1) faecal impaction
2) urinary retention

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2
Q

Who is autonomic dysreflexia seen in?

A

patients who have had a spinal cord injury at, or above T6 spinal level

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3
Q

Notching of the inferior border of the ribs (due to collateral vessels) is seen in what condition?

A

Coarctation of the aorta (due to collateral vessels)

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4
Q

What 3 categories can drug induced liver injury (DILI) be divided into?

A

1) hepatocellular
2) cholestatic
3) mixed

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5
Q

What drugs tend to cause a hepatocellular picture?

A
  • paracetamol
  • sodium valproate, phenytoin
  • MAOIs
  • anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
  • statins
  • alcohol
  • amiodarone
  • methyldopa
  • nitrofurantoin
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6
Q

What is hepatocellular liver injury characterised by?

A

Elevations in ALT and AST

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7
Q

What is the pattern of liver injury seen in cholestasis?

A

Elevated ALP

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8
Q

What drugs tend to cause a cholestatic picture (+/- hepatitis)?

A
  • COCP
  • Abx e.g. flucloxacillin, co-amoxiclav, erythromycin
  • anabolic steroids, testosterones
  • sulphonylureas
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9
Q

What drugs can cause cirrhosis?

A

1) methotrexate
2) amiodarone
3) methyldopa

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10
Q

What is the first serum marker to appear in Hep B?

A

surface antigen (HBsAg)

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11
Q

What does HBsAg tend to imply in Hep B infection?

A

Acute disease (present 1-6 monhts)

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12
Q

What type of liver injury does paracetamol overdose cause?

A

hepatocellular picture

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13
Q

What is best to assess the synthetic function of the liver?

A

Albumin & prothrombin time.

Prothrombin time has a shorter half-life than albumin, making it a better measure of acute liver failure

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14
Q

90% of women develop a benign liver cell adenoma in their 30s to 50s.

What is it linked to?

A

COCP

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15
Q

What are widespread convulsions without conscious impairment likely to represent?

A

Pseudoseizure

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16
Q

Which 3 Abx are associated with cholestasis?

A

1) flucloxacillin

2) co-amoxiclav

3) erythromycin

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17
Q

What type of anaemia can alcohol cause?

A

Normoblastic macrocytic

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18
Q

What would an isolated rise in GGT in the context of a macrocytic anaemia suggest?

A

Alcohol excess causing liver problems

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19
Q

What is the best 1st line management of NAFLD?

A

Weight loss

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20
Q

What would indicate an empyema over a malignancy with an exudative pleural fluid?

A

1) A very low pleural glucose concentration (<1.6 mmol/L) is indicative of empyema

2) as is a pleural fluid pH <7.3

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21
Q

Management of an empyema?

A

prompt drainage alongside antibiotic therapy

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22
Q

Who is autoimmune hepatitis most commonly seen in?

A

Young females

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23
Q

What are the 3 types of autoimmune hepatitis? How are they characterised?

A

Type I
Type II
Type III

Characterised according to the types of circulating antibodies present.

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24
Q

What Abs are present in type I autoimmune hepatitis?

Who does it affect?

A

Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)

Affects both adults & children

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25
Q

What Abs are present in type II autoimmune hepatitis?

Who does it affect?

A

Anti-liver/kidney microsomal type 1 antibodies (LKM1)

Affects children only

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26
Q

What Abs are present in type III autoimmune hepatitis?

Who does it affect?

A

Soluble liver-kidney antigen

Affects adults in middle age

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27
Q

What malignancies can dermatomyositis be associated with?

A

typically ovarian, breast and lung cancer, found in 20-25% - more if patient older

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28
Q

What is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease?

A

Thrombocytopenia

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29
Q

Via what mechanism does alcohol cause polyuria?

A

Ethanol inhibits ADH secretion

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30
Q

What does SAAG stand for?

A

Serum-ascites albumin gradient (SAAG).

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31
Q

The cause of ascites can be be grouped into those with a SAAG <11 g/L or a gradient >11g/L.

What SAAG indicates portal HTN?

A

> 11 g/l

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32
Q

What are the most common causes of ascites with SAAG >11 g/l?

A

Liver disorders:
- cirrhosis/alcoholic liver disease
- acute liver failure
- liver mets

33
Q

How can pregnancy affect LFTs?

A

can cause raised ALP (due to production by placental tissue)

34
Q

Surgical options in alpha-1 antitrypsin deficiency affecting the lungs?

A

lung reduction surgery

35
Q

Can Alpha1-antitrypsin deficiency be diagnosed prenatally?

A

Yes - by chorionic villus sampling (CVS) or amniocentesis

36
Q

What is the most common cause of hypopituitarism?

A

Non-secretory pituitary macroadenomas

37
Q

Perinuclear antineutrophil cytoplasmic antibodies (pANCA) are most strongly associated with which condition?

A

eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

38
Q

What is the characteristic iron study profile in haemochromatosis?

A

Raised ferritin
Raised transferrin saturation
Low TIBC

39
Q

What are 3 early signs of haemochromatosis in males?

A

1) ED
2) Fatigue
3) Arthralgia

40
Q

What is primary biliary cholangitis?

A

A chronic liver disorder typically seen in middle aged females.

Interlobular bile ducts become damaged by a chronic inflammatory process causing progressive cholestasis which may eventually progress to cirrhosis.

41
Q

Who primary biliary cholangitis primarily seen in?

A

middle-aged females

42
Q

Classic presentation of primary biliary cholangitis?

A

Itching in a middle aged female

43
Q

Clinical features of primary biliary cholangitis?

A
  • early: may be asymptomatic (e.g. raised ALP on routine LFTs) or fatigue, pruritus
  • cholestatic jaundice
  • hyperpigmentation, especially over pressure points
  • around 10% of patients have right upper quadrant pain
  • xanthelasmas, xanthomata
  • also: clubbing, hepatosplenomegaly
  • late: may progress to liver failure
44
Q

What are 2 measurements used to monitor treatment in haemochromatosis?

A

1) ferritin
2) transferrin saturation

45
Q

is haemochromatosis a risk factor for gout?

A

yes

46
Q

How does hep A present?

A
  • flu like symptoms
  • RUQ pain
  • tender hepatomegaly
  • deranged LFTs: raised bilirubin, raised ALT/AST, normal or slightly raised ALP
47
Q

What is acute intermittent porphyria (AIP)?

A

A rare autosomal dominant condition caused by a defect in porphobilinogen deaminase, an enzyme involved in the biosynthesis of haem.

The results in the toxic accumulation of delta aminolaevulinic acid and porphobilinogen.

48
Q

How does AIP classically present?

A

Combo of abdo, neuro & psych symptoms in 20-40 year olds:

  • abdo: pain & vomiting
  • neuro: motor neuropathy
  • psych: depression
  • HTN & tachycardia common
49
Q

What can cause obstructive jaundice post cholecystectomy?

A

Common bile duct gallstones –> Around 15% of patients are found to have gallstones in the common bile duct (choledocholithiasis) at the time of cholecystectomy

50
Q

Investigation of choice for suspected perianal fistulae in patients with Crohn’s?

A

MRI

51
Q

Are pseudopolyps more commonly seen in UC or Crohn’s disease?

A

UC

52
Q

1st line in maintain remission in ulcerative colitis patients with proctitis and proctosigmoiditis?

A

A topical (rectal) aminosalicylate +/- an oral aminosalicylate

53
Q

1st line in a a mild-moderate flare of ulcerative colitis extending past the left-sided colon?

A

oral aminosalicylates should be added to rectal aminosalicylates

54
Q

What condition does diarrhoea + fatigue + osteomalacia indicate?

A

Coeliac disease

55
Q

Blood results in osteomalacia?

A

Low calcium, low phosphate, low vit D, high PTH

56
Q

What is carcinoid syndrome?

A

Usually occurs when metastases are present in the liver and release serotonin into the systemic circulation.

57
Q

What hormone is released in carcinoid syndrome?

A

Serotonin

58
Q

What is often the earliest symptom of carcinoid syndrome?

A

Flushing

59
Q

1st line investigation in carcinoid syndrome?

A

urinary 5-HIAA

60
Q

What is 5-HIAA?

A

A breakdown product of serotonin

61
Q

What is the AST/ALT ratio in alcoholic hepatitis?

A

normally > 2, a ratio of > 3 is strongly suggestive of acute alcoholic hepatitis

62
Q

What is the most common symptom of Crohn’s disease in children?

A

Abdo pain

63
Q

How does Coeliac disease cause osteomalacia?

A

Due to decreased absorption of Vitamin D that occurs, in turn, because of improper functionality of the small intestine.

64
Q

What are the top 3 genetic diseases that cause liver cirrhosis?

A

1) A1AT deficiency

2) Wilson’s disease

3) Haemochromatosis

65
Q

What scoring system is used at the initial presentation in suspected upper GI bleeding?

A

Glasgow Blatchford

66
Q

What is the diagnostic imaging investigation for primary sclerosing cholangitis?

A

Magnetic resonance cholangiopancreatography (MRCP)

67
Q

What antibodies are most specific to primary biliary cholangitis and form part of the diagnostic criteria?

A

Anti-mitochondrial antibodies (AMA)

68
Q

What is seen on a liver biopsy in alpha-1 antitrypsin deficiency?

A

Periodic acid-Schiff positive staining globules in hepatocytes

69
Q

What scoring system is used to assess the severity of liver cirrhosis and the prognosis?

A

Child-Pugh score

70
Q

What 2 scoring systems are available to estimate the degree of liver fibrosis in patients with non-alcoholic fatty liver disease?

A

1) NAFLD fibrosis score (NFS)

2) Fibrosis 4 (FIB-4) score

71
Q

What is the inheritance pattern of Wilson’s disease?

What gene is affected?

A

Autosomal recessive

Wilson disease protein gene on chromosome 13 (ATP7B copper-binding protein)

72
Q

What hormone may contribute to the development of focal nodular hyperplasia in the liver?

A

Oestrogen

73
Q

How long should the symptoms of irritable bowel syndrome be present before establishing the diagnosis?

A

At least 6 months

74
Q

What is seen on examination of jejunal biopsies in coeliac disease? (2)

A

1) crypt hyperplasia

2) villous atrophy

75
Q

What 4 features indicate decompensated liver disease (as opposed to compensated)?

A

1) ascites
2) hepatic encephalopathy
3) bleeding oesophageal varices
4) jaundice

76
Q

What type of laxative is the first line for constipation in irritable bowel syndrome?

A

Bulk forming e.g. ispaghula husk

77
Q

What condition involves duodenal or pancreatic tumour secretes excessive quantities of gastrin, resulting in excessive acid production in the stomach?

A

Zollinger Ellison syndrome

78
Q

What genetic condition is associated with developing gastrin-secreting tumours?

A

Multiple endocrine neoplasia type 1 (MEN1)

79
Q
A

Yr 4 - CCC (54 decks)

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