Gastro Flashcards
1
Q
What is a marker of Wilson’s disease?
A
Low ceruloplasmin. Also low ALP and raised copper in CSF.
2
Q
What is the primary chelator therapy in Wilson’s disease?
A
Penicillamine
COPPER NEEDS THE BEST ANTIBIOTIC
3
Q
How does zinc prevent copper buildup in Wilson’s?
A
Induction of intestinal cell metallothionein (Mt), which blocks copper absorption from the intestinal tract
4
Q
How does phototherapy work?
A
Structural isomeration into lumirubin which can be more easily excreted in bile.
Bilirubin LUMINATES like light
5
Q
Which duct joins pancrectic duct to form ampulla of vater
A
Common bile duct
6
Q
Which cells line the epithelium?
A
Stratified squamous
7
Q
What is the normal oesophageal epithelium changed to in Barrett’s oesephagus?
A
Coloumnar cells
8
Q
What nerve supplies the upper 2/3 of the oesophagus?
A
vagus nerve
9
Q
What nerve supplies the lower 1/3 of oesophagus?
A
Splanchnic
Oesophagus supplied overall by vagus, but with sympathetic input from thoracic chain
10
Q
Difference between gastrochisis and omphalocele? Which one is worse?
A
Gastrochesis: abdominal contacts get through the abdominal wall and into the uterine cavity. GOOD PROGNOSUS.
Omphalocele: abdominal contents remain in umbilicial viscera- 25% mortality because failure of reintegration.
11
Q
What other abnormalities is an omphalocele associated with>
A
cardiac anomalies and neural tube defects
Which is why it has worse prognosis than Gastrochesis
12
Q
What is the process of conversion from unconjugated bilirubin to conjugated bili?
A
Glucoronidation
13
Q
What do chief cells in the gut produce?
A
Pepsin.
Chief Pepsi
14
Q
What do paritetal cells produce
A
Gastric acid and intrinsic factor
15
Q
What stimulates gastric acid production? (3 things)
A
Vagus (senses stretch of the stomach), gastrin and histamine (H2 receptors on parietal cells)
16
Q
What inhibits gastric acid secretion?
A
High acid, nausea and sympathetics
17
Q
Where is B12 absorbed in the gut?
A
Ileum. But MUST be combined with intrinsic factor
18
Q
What are 3 monosaccharides?
A
Glucose, fructose and galactose
19
Q
What are 3 dissacharides
A
Lactose, sucrose, isomaltose
20
Q
Which monosachharides are absorbed via active transprot in the gut
A
Glucose and galactose
21
Q
What has more breakdown action? Oral lipase or pancreatic enzymes?
A
Pancreatic enzymes. Minimal breakdown from oral lipase
22
Q
How does ascorbic acid improve iron absorption?
A
Reduces Fe3+ to Fe2+ which is the more absorbable form
23
Q
What transporter is incharge of glucose and galactose absorption? What is the co-transporter?
A
GLUT1 and 2. Na is the co-transporter
24
Q
How is fructose transported in gut
A
Facilitated difficusion via GLUT but WITHOUT na, not as efficient
25
What antibiotic reduces folate abs
Trimethoprim (and hence also Bactrim)
26
What does zinc deficiency present with
Periorofacial dermatitis, reduced immunity, diarrhoea.
Also rash around anus with alopecia
27
How many calories in 1g of fat/carb/protein?
FAT= 9
CARB = 4
PROTEIN = 4
28
What B vitamin is Thiamine?
B1
29
What B vitamin in Riboflavin?
B2
30
What B vitamin is pyroxidine?
B6
Remember deficiency can cause intractable seizures in neonates
31
What B vitamin is folate?
B9
32
What B vitamin is folate?
B9
33
What does Vit E defieicny present with?
Ataxia, peripheral neuropathy, retinitis pigmentosa
34
What are 3 absolute contraindications for BF
HIV/HTLV1 , Maternal TB (until 2 weeks of therapy completed) and SCID in child
35
How many calories per 100ml of breast milk vs formula?
70 in breast milk and 65 in term formula
(Note 80 in preterm formula)
36
When does infant reflux peak?
4 months
37
What are investigations for suspected GORD in an infant/child with GORD?
Barium swallow- shows achalasia, strictures, hiatus hernia, gastric outlet, SI obstruction
Oesophageal pH probe
LTB- assess reflux damage of airways
PPI trial
38
What is achalasia
Achalasia results from damage to nerves in the food tube (oesophagus), preventing the oesophagus from squeezing food into the stomach.
Beak sign in oesophagus because part before that is acahalsed is dilated ++
39
Why cant you use iodine therapy in kids with Graves who have exopthalmos?
Makes eye disease worse
Need to use ablation or removal
40
Difference between MEN 2A and 2B?
2B does NOT have PTH effects
(2B or NOT 2B)
41
What is the indication for fundoplication in kids?
in strictures or airway disease
42
What is a known complication of chronic GORD
Barrets oeseophagus
Conversion from squamous to coloumnar epithelium.
Also laryngospasm in babies- due to reflux and can cause apnoeas
43
What is the classic presentation for EOE in kids?
Solid food dysphagia
Babies will have vomiting, feed issues, poor weight gain
44
Physiology behind EoE?
TH2 helper cells type 2 cytokine pathway
Produce eotaxin which is a potent eosinophil chemoattractant
45
What will show on bloods AND histology for EOE
Bloods: high IgE and eosinophils
Histology: >15 eosinophils per hi power field
46
Treatment for EOE
Budesonide- inhaled steroids
If resistant, can go to Omaluzimab
47
What TYPE of TOF is the most common? (tracheo-oesophageal fistula)
Type C
Essentially blind ended oesophagus from the top. Then connection from trachea halfway down.
48
Common cause of tracheooesophageal fistula? 2 associated syndromes?
Abnormal budding from the foregut
50% idiopathic and others syndromic-VACTERYL. Also charge
49
Investigation findings for Tracheooesophagel fistula?
cannot pass NG, no gastric bubble on CXR or gastroscopy findings.
50
Treatment for tracheooesophageal fistula
Maintain airway and decompress oesophageal pouch.
Usually primary repair but if unable then PEG
51
What is a vascular ring and what is the key finding on barium swallow
Abnormal origin of aorta/pulm vessels that can compress oesophagus or trachea.
Visible on barium swallow- can see indentation
52
What cancer is commonly associated with H Pylori
MALT LYMPHOMA
individuals infected with H. pylori have an increased risk of gastric adenocarcinoma. Studies have also shown that individuals infected with H. pylori have an increased risk of gastric mucosa-associated lymphoid tissue (MALT) lymphoma, a rare cancer of the stomach. Gastric MALT lymphoma is frequently associated (72-98%) with chronic inflammation as a result of the presence of H.pylori.
53
What are some associations with Coeliac disease or features suggestive of Coeliac?
(NAPHSGAN something...)
Dermatitis herpetiformis
Dental enamel hypoplasia of permanent teeth
Oesteopenia/osteoporosis
Short stature
Delayed puberty
Iron deficiency anaemia not responding to oral iron.
NOT hepatitis
54
What is seen on the microscope for H.Pylori?
Gram negative shaped rod
55
Treatment for peptic ulcer disease?
High dose PPI
Octreotide- inhibits gastrin!
56
What is the mechanism of Octreotide?
Name the 5 hormones it inhibits
Somatostatin analouge, leads to inhibition of gastrin. ALso inhibits CCK, GH, TSH and Prolactin
Also periportal smooth vessel constrictor
57
What is the first line triple therapy for H.Pylori
Amox, clarithromycin, PPI
58
What is Zollinger Ellison syndrome
What are 3 syndromes that increase the risk of this?
rare syndrome. Excess gastrin gastrin secretion by a gastrinoma.
*NEUROENDOCRINE TUMOUR*
Predisposition common in MEN1, mild increase in neurofibromatosis and TS
59
What happens to the villi in coeliac?
Inflammation leading to absorption of nutrients. Villous blunting.
60
What HLA mutation causes coeliac?
HLA DQ2 and 8
If both tests negative, very unlikely.
61
What is the pathophysiology of coeliac disease?
Incomplete degradation of gliadin--> immunostimulation--> activation of innate immunity --> T cell activation.
62
What are 3 grains that contain gluten?
wheat, rye and barley
OATS dont have gluten but a simialr protein
63
What is dermatitis hepatiformis? What is the common disease assocaited with that?
itchy papular vesicualr rash on extensor surfaces.
FROM CIRCULATING IGA
Associated with coelaic
64
What is the diagnostic test for coeliac?
anti-tissue transglutaminase (anti-TTG). Inaccurate if low IgA level, or if off gluten. If low IgA, test IgG
Anti-gliadin useless.
EMA= testing AFTER anti-TTG positive and very good but $$.
Biopsy only if anti-TTG <10x normal.
65
What is the most sensitive test for coeliac?
Endomysial antibodies (EMA) but variable specificity and expensive
Anti-TTG most specific, RULE IN
66
What are the three SYNDROMES associated with coeliac? (ie that increase the risk of coeliac)
Downs (10%)
Turners (5%)
Williams (5%)
67
What do you do if HLA DQ2 or 8 positive but no symptoms of coeliac?
Yearly serology
68
In neonates, what does malrotation with volvulus cause?
Acute billious vomiting, abdominal distenion with bloody diarrhoea
Duodenum in RLQ
69
What is a Meckel's diverticulum? What does it present with?
gastric mucosa outside of the stomach, embryological remnant.
Painless occult PR bleeding
70
What is the rule of 2s with meckels
2% of ppn
By age 2
2x more common in males
2inches long
2feet of ileocaecal valve
71
What is juvenile polyposis syndrome
Multiple haemartomas in GI tract. Ulcerated polyps ==> GI bleed
ALSO increase cancer risk
72
What is the mutation assocaited with juvenile polyposis syndrome
SMAD4
JuvenileS are MAD 4 each other
73
Why is the rotavirus vaccine given <3mo kids?
To reduce risk of intussuception
74
How long can a rotavirus illness last for>
2 weeks
75
Name 3 bacteria that cause gastroenteritis
Campylobacter, Ecoli (STEC, ETEC), Shigella, Salmonella, Cholera, Yersinia (Iron related)
76
What is encoparesis?
Soiling
77
What is the risk of IBD if first degree relative has it?
10-20%
78
What percentage of kids with IBD have extraintestinal manifestations?
25%
79
Which condition is associated with sclerosing cholangitis
Ulceratvie colitis
80
What two liver infections are associated with IBD?
Pyogenic liver abscess and hepatitis reactivation.
All due to immunosuppression.
81
What is toxic megacolon and which IBD is it more common with?
Non obstructive colonic dilation plus systemic toxicity due to severe inflammation of smooth muscle layer
MORE WITH UC than CHROHNS
82
What are the symptoms or presentation of toxic megacolon
Fever >38, HR >120, hypotension, anaemia, dilatation >6cm
83
Which IBD has pyoderma gangrenosum
UC
-GangrenosUm = UC
ULCERS on mouth and skin
84
Which IBD has erythema nordosum
Crohn's disease.
Painful red lesions on the shinsW
85
When is faecal calprotectin not useful
Used to differentiate inflamamtory and non-inflammatory cause.
Not accurate if loose stools/bloody stools/gastro
86
Which IBD causes thrombosis
UC
87
Which IBD is more likely to have strictures, fistulas, fissues
Chrons
88
Where is the most common site for chrohns
ileocolic
-CROHNs- COLIC
89
Which IBD is more commonly associated with extra intestinal manfestations?
Crohns
90
What is the induction therapy for Crohns disease
1. EXCLUSIVE enteral nutrition- only polymeric diet. Has greater mucosal healing.
2. Steroids- taper over 6-8 weeks. Poor mucosal healing.
91
What is the maintenance therapy for Chrohns disease
1. Azathiprine or MTX
2. Biologics- adalumimab, infliximab
92
What is the most significant risk factor when commencing Infliximab
TB reactivation
93
What are the drugs of choice for UC?
5-ASA.
MEsalamine or Sulfasalazine.
Metabolised by liver
94
Which two syndromes have increased risk of IBD?
Turners
GLycogen storage type 1B- this one has abnormal fat pads!
95
Is there any role of EEN or Methotrexate in UC?
NO
96
When does pyloric stenosis present?
What is the classic presentations
3-4 weeks.
Vomiting post each feed and HUNGRY after each feed
97
Examination finding for pyloric stenosis
olive shaped mass mid epigastrium.
OLIVES cause STENOSIS
98
What is the name of the operation to fix pyloric stenosis
Polymyotomy
99
How does antral webbing or pyloric atresia present
Non billious vomiting from day1
Kids usually polyhydramnios
100
How does duodenal atresia present
Billious vomiting from day 1 of life.
Can have green inutero fluid.
101
Which genetic mutation is assocaited with familial pancreatitis?
PRSS1 mutations are present in 80% of patients with autosomal dominant hereditary pancreatiti
102
In terms of LKM, ANA and SMA- which is more common in Type 1 bs Type 2 autoimmune hepatitis
LKM positivity is suggestive of Type 2 AIH, whereas ANA and SMA is suggestive of Type 1.
103
Which has lower rates of relapse? Type 1 or tpe 2 Autommune hepatitis?
Type 1
104
What type of foods should be stopped in patients wth chylothorax?
Long chain trigliceride
105
What mutation is associated with Alagaila syndrome?
JAG1
A for Anna, JAG
106
How does infliximab work
anti-TNFalpha- BINDS To TNF alpha so it cant cause autoimmune probs
107
What is Diencephalic syndrome and what is the most striking feature on presentation?
a rare cause of failure to thrive in infants and young children. It is associated with neoplastic lesions of the hypothalamic-optic chiasmatic region.
striking absence of subcutaneous adipose tissue.
108
Which disease will have biopsy significant for paucity of interlobular bile ducts.
Alagile
109
Which will show moderate steatosis with mild inflammation but without ballooning injury or fibrosis
NAFLD
110
Which disease shows peribiliary fibrosis, ductular proliferation, bile duct plugs
Bilitary atresia
111
Which anti-epileptic causes pancreatitis
Sodium valproate
112
Main pathophys behind malrotation volvulus?
Essentially in the name.
Caecum fails to rotate so you have SI on the right and LI on the left--> greater mobilty of the bowel and increased risk of twisting.
113
What are three things a malrotation is assocaited with?
Diaphragmatic hernia
gastrochesis
Omphalocele
114
Presentation of malrotation volvulus
Billious vomiting
115
Scan for Meckels?
Technitium-99
116
What is the most common cause of lower intestinal obstruction in neonates?
Hirschsprungs disease
117
What is Joubert syndrome? What is the classical radiological sign?
rare brain malformation characterized by the absence or underdevelopment of the cerebellar vermis
MOLAR tooth on the CT.
Jou-BEAR syndrome, bears have big teeth
118
Pathophys of hirschsprungs disease
Bowel hypertonicity due to absence of ganglionic cells in submucosa and mesenteric plexus.
119
Where is the most common location to be affected by Hirshsprungs
Rectosigmoid in 80%
120
Presentation of Hirchsprungs
Delayed passage of mec, not for 48 hours. PR may cause explosion of foul smelling gas and faeces.
Delayed diagnosis leads to enterocolitis.
ALso will have billios vomiting and feed intolerace
121
Diagnosis of Hirschsprungs?
Rectal suction biopsy: 2cm from dentate line to look for ganglionic cells.
Also contrast enema which shows small rectum and dilation sigmoid
122
Treatment for hirshsprungs
surgery.
Long term complications are consitpatin, recurrent enterocolitis, stricture, prolapse
123
What is a cloacae?
Common outlet for faeces and urine. Part of anorectal malformations.
124
What is the pathophys in refeeding syndrome?
Body is used to running on catabolic state (Low insulin but gluconeogenesis). So when you increase glucose, there will be DROP in glucagon leading to cell glucose uptake and shift of phosphate, K and Mg to make ATP
125
What are the electrolyte abnormalities in refeeding syndrome
Low PO4
Low Mg, K
Plus/minus hyperglycemia
126
What are ABSOLUTE indications to commence TPN
NEC
Extensive burns and/or severe trauma
Short gut --> malabs of all nutrients
127
What is a complications of long term TPN and what condition is it most commonly associated with?
Liver disease, due to high lipid or dextrose in PN.
Commonly seen in short gut because they need the longest time for TPN
128
What are 3 polyposis syndromes?
FAP- 100% cancer risk. AD
Lynch syndrome
Gardner syndrome- polyps but in the small bowel. Also 100% cancer risk
129
What are 3 polyposis syndromes?
FAP- 100% cancer risk. AD
Lynch syndrome
Gardner syndrome- polyps but in the small bowel. Also 100% cancer risk
130
What is the difference between juvenile polyposis syndrome and peutz jegher syndrome
Both have hamartomous polyps but Peutz Jegher has ococcutaneous melanin spots
131
Which syndrome has orocutaneous melanin spots
Petuz Jegher
132
What does Peutz Jegher commonly present with and what is the associated gene
Intussuception and LKB1
Luc Ky Bean 1 causes intussceotion in Peutz Jegher
133
What is Cowden's syndrome
Also harmatomatous polyps with PTEN mutation. Not associated with colon cancer but macrocephaly
breast/thyroid and endometrial cancers
Cow has 10 haemartomas which can cause cancer
134
What is inheritance for congenital chloride diarrhoea?
Autosomal recessive
135
What is present in the stool in osmotic diarrhoea?
Reducing substances (because cant absorb the glucose), low pH, low Cl and sodium in OSMOTIC
Think water has been sucked into the gut
136
What is intestinal lymphandiectasia
Abnormal lymph vessels/blockage
137
What does intestinal lymphagiectasia present with
Protein losing enteropathy so reduced lymphocytes, protein and gammaglobulin. Also loss of calcium and magnesium.
138
What will be present in the stools for intestinal lymphangiectasia
fat globules
139
What is acrodermatiti enropathica
Problem with zinc transporter so presents with zinc deficiency and all the related issues
140
What two syndromes present with hypochloremic, hypokalemic metabolic acidosis
(Think gut pathology, not vomiting)
Barter and congenital chloride diarrhoea.
141
Which two markers in LFTs are indicative of hepatcellualr damange
AST and ALT
142
In kids, what does a high AST:ALT ration mean?
Marker of muscle injury
143
In the setting of liver disease, what is low ALP a marker of
Wilson dsiease
144
What is the single most common paediatric disease laeding to liver transplant?
Biliary atresia
145
What is the pathophys for biliary atresia?
Progressice, INFLAMMATORY cholangiopathy leading to obliteration of extrahepatic bile ducts.
Good pic in notes.
146
Presentation of biliary atresia?
Usually okay until 4-6 weeks of age and then present with hyper bilirubinaemia, pale stools and dark urine.
147
Treatment for Biliary atresia? Surgical and medcial
Kasai procedure (within 60 days) and then transplant.
Medical: optimise nutrition, fat soluble vitamin supplement, treat cholangitis etc.
148
What do biliary cysts present with?
jaundice, abdominal pain, mass and vomiting. can present outside the neonatal period
149
Inheritance for alagile syndrome
Autosomal dominant
150
Mutation for Alagile
JAG1 or NOTCH 2
ALAGILE IS a JAGGED NOTCH
151
Common cardiac anomaly associated with Alagile?
Pulmonary artery stenosis
152
What is the pathophys for alagile
paucity of interlobar bile ducts
153
Other abnormalities assocaited with Alagile (apart from cholestasis)
bony abnormalities, eye problems, cardiac (PULMONARY ARTERY STENOSIS), renal dysplasia, butterlfy vertebrae
THINK Midline- skull, eyes, heart, kidneys, spine
154
What is the most common GENETIC cause of neonatal liver siease
Alpha 1 antitripsin def
155
Inheritance for alpha 1 antitrypsin
aut recessive
156
What other system does alpha 1 antitrypsin affect
lung
157
WHICH type of gene mutation in Alpha one antitrypsin causes liver disease?
Name the gene and also the mutation subtype
SERPINA gene affected, and PiZZ type that causes misfolded proteins which get stuck in the liver and cause cirrhosis.
Good image and explanation in notes
158
What is on liver histology in Alpha 1 antitrupsin
PAS+
Alpha 1 antitrypsin must PAS off as a POSITIVE vibe
159
Specific mutation in Wilsons?
ATP7B - this is the transporter for copper
Wilson is a guy who needs lots of energy (ATP) and goes up 7 stairs
160
What is intestinal failure assocaited liver disease?
Essentially liver disease from long term TPN due to short gut. Worsened by excess dextrose of lipids in TPN
161
What is Gilbert's syndrome?
Genetic defect at UGT1A1 gene which encodes for glucorynyl transferase --> lower transcriptional rates and overall educed enzyme activity.
ONLY unconjugated bili rise.
162
What is Criggler Najjar syndrome? How does it present?
Mutation in MULTIPLE spots on UGT1A1 gene leading to mildly dysfunctional proteins. Severe unconjugated hyper ilirubinaemia >> kernicterus and bili deposition in the brain
163
What is the most important thing to rule out with conjugated hyperbili?
Biliary atresia
164
What are two METABOLIC causes of neonatal liver failure (common ones)
Galactossemia and tyrosinaemia
165
What is the most common cause of neonatal haemachromatosis
gestational alloimmune liver disease
166
Pathophys of gestational alloimmune liver disease?
Transplacental reactive IgG--> complement cascade--> MAC attack complex and fetal liver injury.
No clear trigger but it is the most common cause of neonatal haemachromatosis
167
Presentation of gestational alloimmune liver disease?
severe liver failure, coagulopathy, ascites and reduced albumin
168
When do majority of autoimmune hepatitis present?
During adolescence with chronic hepatitis
169
What are conditions associated with autoimmune hepatitis
other autoimmune conditions ie coeliac, thyroid, diabetes, addisons
170
What is Hep E antigen a marker of?
High rates of replication and infectivity. Used as a marker for treatment response.
171
What is Hep B core antibody a marker of
Prev infection, past or current
172
What is Hep B surface antibody a marker of
demonstrates immunity- through vaccination or infection
173
What is Hep B surface antigen a marker of
demonstrates active infection - acute or chronic
174
What condition is primary sclerosing cholangitis assocaited with
UC
175
What is the long term risk of primary sclerosing cholangitis
Cholangiocarcinoma
176
What is characteristic of the prothrombin time in acute liver failure
ELEVATED PT not corrected by Vitamin K
177
What dose/kg/day of paracetamol is TOXIC
>200mg/kg/day
178
When should a serum paracetamol level be obtained?
Depends on presentation.
If presents within 8 hours, then test at 4 hours post ingestion. Anyting after 8 hours test immediately
179
Is activated charcoal useful in paracetamol OD?
Only if patient is awake and willing to take it
Charcoal only really indicated in Clonidine OD
180
What should you do if a patient with paracetamol OD presents 8 hours post ingestion?
Start NAC
181
Post ingestion of paracetamol OD, what is the time frame in which a patient can progress to liver failure>
2-4 days
182
How does NAC work?
NAC repletes glutathione reserves by providing cysteine, which is an essential precursor in glutathione production. NAC by itself also binds to the toxic metabolites and scavenges free radicals. I
183
Once NAC infusion is started, when should repeat bloods be taken
2 hours before the end of the infusion
184
How is paracetamol normally metabolised in liver?
Multiple enzymes.
Mostly through glucorodination and sulfation but some goes through CYP450 pathway which produces toxic metabolites which are digested by glutathione.
SO WHEN +++ paracetamol, a lot more digested by CYP 450= glutathione used up so NAC makes more
185
Mode of inheritance for Gilbers
AR
186
What is faecal elastase a measure of
Pancreatic exocrine fn
187
Where is the majority of FAT breakdown? Which hormones are responsible?
Lipase. Minimal from oral lipase so most from pancreas
188
What enzyme involved in CARB breakdown?
Amylase. salivary and pancreatic. Salivary= decent function
189
What enzyme is involved in protein metabolism
Pepsin in stomach an then thrypsi/chemotrypsin (activated forms) in intestines
P for Pepsin, P for protein.
190
3 drugs that cause pancreatitis (hint they are alll chemo drugs)
Asparignase (A- PancreAtitis)
Mercaptopurine
Azathioprine
191
What do alpha, beta and delta cells make in pancreas?
Alpha- glucagon
beta- insulin
Delta-Somatostatin, 'Do Grow'
192
What is the difference between type 1 and type 2 autoimmune pancreatitis
Type 1- Elevated IgG and radiographic evidence of extrapancreatic invovlement. Ie Rhuematoid,PSC, IBD
Type2: no IgG but associated with IBD
193
What two factors determine what is filtered through the GM?
Charge and size
194
Which condition has the highest number of secondary infections?
Measles (18)
COVID is 5-8
195
What is NOD2 assocaited with?
Crohn's disease. Increased risk.
Give a 'Nod 2 crohn' as you walk past
196
What is the difference between Atomoxatine and methylphenidate?
Atomoxetine= SNRI only
Methylphenidate= Norad and dopamine re uptake inhibitor
197
What two factors cause a falsely LOW HbA1c?
Haemolytic anaemia (ie spherocytossi) and CF
Think that's why we only do OGTT for testing for diabetes in CF
198
What causes a falsely elevated HbA1c
IDA
199
What do gamma and epsilon cells in the pancreas produce?
Gamma= gastrin
Epislon= ghrelin
GAmma= GAstrin
200
What is B MODY treated with?
So IN GENERAL, all alpha can be treated with Sulfonylurea and beta can be treated with insulin
201
Where is the problem duirng development for 22q11
3 and 4 parayngeal pouches
YOU CAN CATCH 22q11 in 3 and 4 pouches
202
What is Mepolizimab
Monoclonal antibody for asthma, anti-IL5.
The other is Omalizumab which is IgE
203
What is the way to maximise urinary excretion of aspirin
Urinary alkalysation
204
Carrier rate for SMA
1/50
205
What is protein Filgrin associated with
Eczema
206
What is orofacial granulomatosis and what other disease is it associated with
clinical term describing orofacial swelling caused by non-caseating granulomatous inflammation in the absence of systemic disease
Associated with Crohn's disease
207
What is a cause for atypical HUS
Complement
208
Target antigen for ANCA
Catalase
ANC- Catalase - A
209
Syndrome that combines an impaired sense of smell with a hormonal disorder that delays or prevents puberty.
Kallmann syndrome
210
Most common cause of PR bleeding >2yo
Juvenile polyps, occur in first decade.
211
What age group do you see polyps from Cowden's syndrome?
second decade
(remember PTEN syndrome, 10 polyps on a cow)
212
Treatment of perianal crohns disease?
Metronidazole and then add in immunomodulators (MTX, Asathioprine) OR infliximab.
