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Gastro Flashcards

1
Q

What is achalasia?

A

Disorder of motility of lower oesophageal sphincter - impaired peristalsis and failure to relax

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2
Q

What are the symptoms of achalasia?

A

Dysphagia of both solids and liquids
Regurgitation
Heartburn

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3
Q

How is achalasia diagnosed?

A

Gold standard - oesophageal manometry –> XL LOS tone

Bird’s beak on barium swallow

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4
Q

What is the treatment of achalasia?

A

Pneumatic dilation
Nifedipine
Heller myotomy

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5
Q

What are the risk factors for oesophageal cancer?

A

Barrett’s oesophagus
GORD
Excessive smoking or alcohol

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6
Q

What is a pharyngeal pouch?

A

AKA Zenker’s diverticulum

Posteromedial herniation between hyropharyngeus and cricopharyngeus muscles through Killian’s dehiscience

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7
Q

What are the risk factors for eosinophilic oesophagitis?

A 
Asthma/atopy
Males
FH
Caucasian
Autoimmune disease
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8
Q

How is eosinophilic oesophagitis diagnosed?

A

Endoscopy and biopsy

Doesn’t respond to PPI

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9
Q

What is the treatment of eosinophilic oesophagitis?

A

Elemental diet
Fluticasone/budesonide
Dilation

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10
Q

What is the triad of Plummer-Vinson syndrome?

A

Dysphagia secondary to oesophageal webs
Glossitis
IDA

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11
Q

Where is the most common location for oesophageal varices?

A

Distal oesophagus and proximal stomach

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12
Q

What is the management of UGIB?

A 
Terlipressin
Balloon tamponade
Prophylactic antibiotics
Band ligation
TIPS
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13
Q

What is the mechanism of action of terlipressin?

A

Constriction of splanchnic vessels

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14
Q

What is TIPS procedure?

A

Connection created between hepatic and portal vein, therefore reducing portal pressure

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15
Q

Why does TIPS procedure cause an exacerbation of hepatic encephalopathy?

A

Blood now bypasses the liver so toxins are delivered in greater quantity to the cerebral circulation

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16
Q

When should prothrombin complex concentrate be given?

A

If actively bleeding and on warfarin

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17
Q

When should FFP be given?

A

Fibrinogen<1g/L OR

PT/APTT>1.5x normal

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18
Q

What is prophylaxis for variceal bleeding?

A

Propanolol

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19
Q

What are the risk scores for UGIB?

A

Blatchford

Rockall after endoscopy

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20
Q

What is the histology of gastric cancer?

A

Signet ring cells - large vacuole of mucin which displaces nucleus to one side

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21
Q

What are the risk factors for gastric cancer?

A 
H. pylori
Blood group A
Gastric polyps
Pernicious anaemia
Smoking
Diet high in salt/spice/nitrates
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22
Q

What is the best method of staging gastric cancer?

A

Endoscopic ultrasound - assessment of mural invasion

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23
Q

What is the management of gastric cancer?

A

Proximal >5-10cm from OG junction: subtotal gastrectomy
<5cm from OG junction: total gastrectomy
Type 2 junctional tumours: oesophagogastrectomy

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24
Q

What are 4 associations of h.pylori?

A

Peptic ulcer disease
Gastric cancer
B cell lymphoma of MALT tissue
Atrophic gastritis

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25
What is the eradication regime for h.pylori?
7 days PPI + amoxicillin + clari/metro OR 7 days PPI + clari + metro
26
What is the most common electrolyte in refeeding syndrome?
Low phosphate
27
What factors are high risk for refeeding syndrome?
BMI<16 Unintentional weight loss >15% over 3-6 months Little intake 10 days Low K, Phosphate, magnesium prior to feeding
28
What is the mechanism of PPIs?
Irreversible blockade of H/K/ATPase of gastric parietal cell
29
What are the side effects of PPIs?
Low Na/Mg Osteoporosis Microscopic colitis Increased risk of c diff
30
What is Zollinger-Ellinson syndrome?
Gastrin secreting tumour - gastrinoma
31
Which cells produce gastrin?
G cells
32
What is the function of gastrin?
Increases H+ secretion by parietal cells | Increases gastric motility
33
Whic/h cells secrete CCK
I cells in upper small intestine
34
What is the function of CCK?
Contraction of gallbladder Relaxation of sphincter of Oddi Decreases gastric emptying Secretion of pancreatic fluid
35
D cells produce what?
Somatostatin
36
What is the function of somatostatin?
Decreases acid and pepsin secretion Insulin and glucagon secretion Pancreatic enzyme secretion
37
What is the most common cause of diarrhoea after ileocaecal resection, and the diagnosis and treatment?
Bile acid malabsorption SeHCAT test Cholestyramine
38
Name 5 complications of coeliac disease
``` Hyposplenism Osteoporosis Subfertility Oesophageal Ca Enteropathy-associated T cell lymphoma of small intestine ```
39
What are the symptoms of small bowel overgrowth syndrome?
Chronic diarrhoea Bloating and flatulence Abdo pain
40
How is small bowel overgrowth syndrome diagnosed and managed?
Hydrogen breath test Rifaximin
41
What are the symptoms of VIPomas?
Large volume diarrhoea Weight loss Diarrhoea Hypokalaemia, hypochlorhydia
42
What is Heyde's syndrome?
Angiodysplasia, IDA, aortic stenosis
43
How is angiodysplasia diagnosed?
Colonoscopy/endoscopy Capsule endoscopy
44
What is Whipple's disease?
Multisystem disorder caused by tropheryma whippelii infection
45
What are the symptoms of Whipple's disease?
``` Malabsorption Large joint arthralgia Lymphadenopathy Hyperpigmentation and photosensitivity Pleurisy/pericarditis ```
46
How is Whipple's disease diagnosed?
Jejunal biopsy - deposition of macrophages containing Periodic-acid Schiff (PAS) granules
47
What is the treatment of Whipple's disease?
PO co-trimoxazole for one year
48
Where is the most common location for ischaemic colitis?
Splenic flexure Watershed area between IMA and SMA
49
What is seen on AXR in ischaemic colitis?
Thumbprinting
50
What is a RF for ischaemic colitis?
AF
51
What are the genetics of sporadic colorectal Ca?
50% show allelic loss of APC gene Other- activation of K-ras oncogene, deletion of DCC tumour suppressor genes
52
What is the inheritance of HNPCC?
Autosomal dominant MSH2 (60%) and MLH1 (30%) 90% develop cancers
53
What other cancer are patients with HNPCC at risk of?
Endometrial
54
What is the genetics of FAP?
Autosomal dominant | Mutation of Adenomatosis polyposis coli gene (APC) on chromosome 5
55
What is Gardner's syndrome?
Variant of FAP | Features skull and mandible osteomas, retinal pigmentation, thyroid carcinoma
56
What is the most common cause of HCC?
Chronic hep C
57
What is the management of HCC?
Resection (Child-Pugh A, no portal HTN, single lesion<2cm) Radiofrequency ablation and Tx (Child-Pugh A and B, 2-3 tumours<3cm or 1 tumour 2-5cm, no spread) Sorafenib (Child-Pugh A and B, vascular invasion/spread) Best supportive care (Child-Pugh C)
58
What is the syndrome of hepatic vein thrombosis?
Budd-Chiari syndrome
59
What is the triad of Budd-Chiari syndrome?
Sudden onset severe abdo pain Ascites Tender hepatomegaly
60
What is the gold standard diagnosis of Budd-Chiari syndrome?
USS doppler
61
What LFT derangement is seen in a cholestatic/hepatitic picture?
ALP>ALT
62
Which drugs cause cholestasis or hepatitis?
COCP Penicillins/erythromycin Anabolic steroids Sulphonylureas
63
What LFT derangement is seen in hepatocellular picture?
ALT>ALP
64
Which drugs cause hepatocellular injury?
V-PAN-AM ``` Valproate and phenytoin Paracetamol overdose Atorvastatin, amidarone Nitrofurantoin Alcohol, anti-tuberculous drugs MAOs, methyldopa ```
65
Which drugs cause cirrhosis?
Methotrexate Methyldopa Amiodarone
66
What is the pathophysiology of decompensated ALD?
Excess collagen and extracellular matrix deposition in peripheral and pericentral zone leading to formation of regenerative nodules
67
What criteria do Child-Pugh and MELD use?
Child-Pugh: bilirubin, albumin, PT, encephalopathy, ascites MELD: bilirubin, creatinine, INR
68
What causes ascites in ALD?
Hypoalbuminaemia (impairment of hepatic synthetic function) | Fluid overload due to hyperaldosteronism
69
How is ascites managed?
Spiro reverses hyperaldosteronism Furosemide used as an adjunct but less effective as monotherapy If hyponatraemic <125 - fluid restriction Abdominal paracentesis
70
What are the indications for HAS?
Volume replacement after LVP Hepatorenal syndrome SBP
71
What is the pathophysiology of hepatorenal syndrome?
Vasoactive mediators cause splanchnic vasodilation This reduces systemic vascular resistance --> underfilled kidneys Sensed by JG apparatus which activates RAAS causing renal vasoconstriction, which is not enough to counter balance the effects of splanchnic vasodilation
72
What are the types of HRS?
1: rapidly progressive, often occurs following an acute event 2: slower progression, associated with refractory ascites
73
What is the management of ascites?
Terlipressin HAS TIPS
74
What is diagnostic for SBP?
Paracentesis: neutrophils >250cells/ul
75
Which patients have SBP prophylaxis and what is it?
Prev episode of SBP Fluid protein <15g/l Child PUgh>8 HRS Oral cipro
76
What is the pathophysiology of NAFLD?
Insulin resistance
77
What are the features of NAFLD?
Asymptomatic ALT>AST, ratio >3 Increased echogenicity on US
78
What is the cause of hereditary haemochromatosis?
Autosomal recessive Defect of HFE gene on chromosome 6
79
What are the features of haemochromatosis?
``` Symptomatic 40-60s Fatigue, weakness Arthropathy ED Diabetes Bronzing of the skin Cirrhosis Arrhythmias Dilated cardiomopathy ```
80
How is haemochromatosis diagnosed?
High fasting transferrin sats >55% M >50% women High ferritin, low TIBC Liver biopsy with Perl's stain
81
Which features of haemochromatosis are reversible with treatment?
Cardiomyopathy | Skin pigmentation
82
What is the screening test for haemochromatosis?
General popu: transferrin sats Family members: HFE genetic testing
83
What are the associations of PBC?
Sjogrens in 80% RA Systemic sclerosis
84
What are the ?symptoms of PBC
``` Fatigue Pruritus Incidental raised ALP Hyperpigmentation over pressure points 10% RUQ pain ```
85
What is the immunology of PBC?
Anti-mitochondrial antibodies M2 subtype SM antibodies Raised serum IgM
86
What is the treatment of PBC?
Ursodeoxycholic acid Cholestyramine Liver tx
87
What is the increased risk of HCC in PBC?
20 x
88
What is the gene mutation in Wilson's disease?
ATP7B on chromosome 13
89
What are the symptoms of Wilson's disease?
``` Liver failure Psychiatric disorders Dysarthria and tremor Chorea Kayser-Fleischer ring/sunflower cataracts ```
90
How is wilson's disease diagnosed?
Low serum caeruloplasmin Low serum copper Elevated 24h urianry copper Liver biopsy
91
What is the treatment of Wilson's disease?
Penicillamine
92
What are the most common organisms causing liver abscesses?
Children: s.aureus Adults: e.coli
93
What is the most important risk factor for the progression of hepatitis B to cirrhosis?
HBV DNA titres
94
What is the frequency of endoscopy in Barrett's oesophagus monitoring?
No dysplasia: every 2-5 years Low grade dysplasia: every 6 months, and repeat endoscopy with biopsies every cm High grade dysplasia: every 3 months If a visible lesion is present - endoscopic ablation with mucosal resection

MRCP (17 decks)

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