Exam Flashcards
Cholangiocarcinoma vs IgG4
Cholangiocarcinoma
- Obstructive jaundice more likely
- Enlarged pancreas
- Lymphadenopathy
- Higher bilirubin
- Ca19.9
- Complete obstruction of the hilar/bile ducts as demonstrated by ERCP
Helicobacter Pylori infection is a risk factor for all of the following except: A. Gastric MALT lymphoma B. Gastro-oesophageal reflux disease C. Gastric intestinal metaplasia D. Duodenal ulcers
B. Gastro-oesophageal reflux disease
Which statement is true regarding thiopurines in IBD?
A. FBC and LFT monitoring are required until a stable dose of thiopurine is attained
B. Thiopurines are effective in maintaining remission in CD but not UC
C. 6 thioguanine levels predict risk of pancreatitis
D. 6 methylmercaptopurine levels predict risk of dose related hepatotoxicity
D. 6 methylmercaptopurine levels predict risk of dose related hepatotoxicity
Which one of the following is true of fructose?
A. Intake worldwide is reducing
B. It is less prone to promote hypertension than glucose
C. Fructose intolerance can present as a metabolic disorder in infancy
D. It is not malabsorbed
E. It is not as sweet tasting as glucose
C. Fructose intolerance can present as a metabolic disorder in infancy
Fructose is a simple sugar, a monosaccharide that is present primarily in added dietary sugars, honey and fruit. Fructose is absorbed by facilitated diffusion utilising
the sodium-independent insulin-independent transporter (GLUT-5). Worldwide, dietary fructose intake is increasing. It is obtained primarily from added sugars,
including sucrose and high fructose corn syrup, and this correlates epidemiologically with the rising prevalence of metabolic syndrome and hypertension world wide (Madero et al., 2011). The administration of fructose to animals and humans increases blood pressure and the development of metabolic syndrome. These
changes occur independently of caloric intake because of the effect of fructose on adenosine triphosphate (ATP) depletion and uric acid generation. Fructose
ingestion may also be a risk factor for kidney disease with glomerular hypertension, renal inflammation and tubulointerstitial injury seen in animals. Fructose
intolerance is due to fructose-1-phosphate aldolase deficiency and can present in infancy with hypoglycaemia and vomiting. Fructose malabsorption may play a role in the symptoms of coeliac disease and, potentially, irritable bowel syndrome.
What are the stimulators and inhibitors of gastrin secretion
The major stimuli for gastrin secretion are:
• L-Amino acids (i.e. phenylalanine, tryptophan, cysteine, tyrosine)
• Vagal stimulation
• Gastric distension
• Epinephrine (adrenaline)
• Calcium
• Acetylcholine.
The major inhibitors of gastrin secretion are: • Gastric pH <2 • Somatostatin • Calcitonin • Gastric inhibitory polypeptide (GIP) • Glucagon • Vasoactive inhibitory peptide (VIP).
Which one of the following best describes the faecal immunochemical
test (FIT)?
A. The antibodies in this test bind to the haem portion of human haemoglobin
B. FIT has a higher clinical sensitivity in detecting occult blood at lower concentrations compared to the guaiac-based faecal occult blood test (gFOBT)
C. Digested blood from the upper gastrointestinal tract is often detected by FITD. Patients have to observe dietary restrictions before collecting a stool sample
E. FIT has a higher false-positive rate than gFOBT
B. FIT has a higher clinical sensitivity in detecting occult blood at lower concentrations compared to the guaiac-based faecal occult blood test (gFOBT)
Liver biopsy of autoimmune hepatitis
dense portal and periportal predominance of plasma cell infiltrate with some lymphocytes.
Histopath of primary biliary cirrhosis (cholangiitis)
Histopathologically, primary biliary cirrhosis (PBC) is characterised by portal inflammation and immune-mediated destruction of the intrahepatic bile ducts
Conditions associated with primary biliary cholangitis
- Other common findings in PBC include hyperlipidaemia,
hypothyroidism, osteopenia and coexisting autoimmune diseases, including Sjögren syndrome and scleroderma. - PBC is characterised serologically by the presence of anti-mitochondrial antibodies, which are present in 90–95% of patients and are often detectable years before clinical signs appear.
Thiamine deficiency
Thiamine, or vitamin B1, is a coenzyme for the essential enzymes transketolase, pyruvate dehydrogenase and pyruvate carboxylase in the early stages of the tricarboxylic acid cycle and in the pentose phosphate pathway. Thiamine deficiency after Roux-en-Y gastric bypass surgery (RYGB) is quite common. Manifestations
of thiamine deficiency include:
• Neuropsychiatric: aggression, hallucinations, confusion, ataxia, nystagmus, paralysis of the motor nerves of the eye
• Neurological or ‘dry’ beriberi: convulsions, numbness, muscle weakness and/or pain in the lower and upper extremities, brisk tendon reflexes
• High-output cardiac or ‘wet’ beriberi: tachycardia or bradycardia, lactic acidosis, dyspnoea, leg oedema, right ventricular dilatation
• Gastrointestinal: slow gastric emptying, nausea, vomiting, jejunal dilatation or megacolon, constipation.
Vitamin A deficiency
Vitamin A deficiency can result in decreased vision, poor night vision (nyctalopia), xerosis, corneal ulceration and keratomalacia, retinopathy, itching (pruritus) and dry hair
A 38-year-old woman has had a 10-year history of heartburn but has not received any treatment. Over the past 4 months, she has had progressive difficulty
swallowing large bits of solid food. She has no difficulty with soft foods or liquids, and she has not lost weight. Which one of the following is the most likely explanation
for her symptoms?
A. Adenocarcinoma in the lower third of the oesophagus
B. Barrett oesophagus in the distal oesophagus
C. Stricture of the distal oesophagus
D. Schatzki ring of the distal oesophagus
E. Squamous carcinoma in the mid-third of the oesophagus
C. Stricture of the distal oesophagus
Mechanical dysphagia may follow many years of reflux and is often indicative of a peptic stricture that has developed as a result of fibrosis after a long period of chronic inflammation due to gastro-oesophageal reflux disease (GORD)
NAC infusion and paracetamol overdose
Ingestion < 8 hours = activated charcoal
> 8 hours = NAC
Kings hospital criteria for liver transplantation in acute liver failure
Paracetamol induced disease
- Arterial pH < 7.3 irrespective of the grade of encephalopathy OR
- Grade III or IV encephalopathy AND
- Prothrombin time > 100s AND
- Cr > 301
All other causes of acute liver failure
- Prothrombin time > 100s irrespective of the grade of encephalopathy OR
Any 3 of the following variables (irrespective of grade of encephalopathy)
- Age < 10 or >40yo
- Etiology: non A, Non B hepatitis,
- Duration of jaundice before onset of encephalopathy > 7 days
- Prothrombin time > 50s
- Bili > 18
Alcoholic hepatitis - maddreys discriminatory function
If >32 - commence prednisone
