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MRCP > Gastro > Flashcards

Gastro Flashcards

1
Q

Pancreatic secretions - exocrine

A

Trypsinogen
Chymotrypsinogen
Pancreatic amylase
Lipase

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2
Q

Pancreatic secretions - endocrine

A

Glucagon - from alpha cells
Insuln from beta cells
Somatostatin from delta cells
Pancreatic polypeptide by PP cells

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3
Q

Gastrin source

A

G cells in antrum

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4
Q

Gastrin stimulated by

A

Gastric distension and amino acid in antrum

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5
Q

Gastrin action

A

Secretion of pepsin, gastric acid and intrinsic factor

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6
Q

Cholecystokinin-pancreozymin (CCK-PK) source

A

duodenum and jejunum

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7
Q

Cholecystokinin-pancreozymin (CCK-PK) stimulated by

A

fats, and amino acids in SI

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8
Q

Cholecystokinin-pancreozymin (CCK-PK) action

A

Pancreatic secretion
gallbladder contraction
delayed gastric emptying

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9
Q

Secretin source

A

Duodenum and jejunum

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10
Q

Secretin stimulated by

A

ACID in the small bowel

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11
Q

Secretin action

A

pancreatic bicarbonate secretion

delays gastric emptying

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12
Q

Motilin source

A

Duodenum and jejunum

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13
Q

Motilin stimulated by

A

acid in the small bowerl

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14
Q

Motilin action

A

increased motility

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15
Q

Vasoactive intestinal peptide (VIP) source

A

SI

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16
Q

Vasoactive intestinal peptide (VIP) stimulated by

A

neural stimulation

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17
Q

Vasoactive intestinal peptide (VIP) action

A

inhibits gastric acid/peptin secretion - stimulates secretion by intestine and pancreas

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18
Q

Gastric Inhibitory peptide (GIP) source

A

duodenum and jejunum

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19
Q

Gastric Inhibitory peptide (GIP) stimulated by

A

glucose ,fats and amino acids

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20
Q

Gastric Inhibitory peptide (GIP) action

A

inbihits gastric secretion

stimulates insulin secretion

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21
Q

Somatostatin source

A

D cells in pancreas

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22
Q

Somatostatin stimulated by

A

Vagal and adrenergic stimulation

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23
Q

Somatostatin action

A

Inhibits gastric and pancreatic secretion

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24
Q

Pancreatic POlypeptide source

A

PP cells

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25
Q

Pancreatic Polypeptide PP stimulated by

A

Protein rich meal

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26
Q

Pancreatic Polypeptide action

A

inhibition of pancreatic and billiary secretion

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27
Q

factors increasing Fe absorption

A

increased erethropoesis (ie pregnancy)
GI blood loss
Vitamin C/Gastric acid

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28
Q

Factors decreasing Fe absorption

A

Gasrtrectomy
Achlorydria
SI disease
Drugs such as desferrioxamine

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29
Q

Folate deficiency caused by

A

body demand increase such as prengnacy and haemolysis

methotrexate

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30
Q

B12 defiecincy caused by

A 
Dietary deficiency
post-gastrectomy (lack of IF)
Atrophic gastritis (pernicious anaemia)
terminal ileal disease
blind loops
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31
Q

Causes of mouth ulcers

A 
IBD
HIV
Drugs
Ca
Nutritional deficiency
Bechets
celiac
sweet syndrome
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32
Q

Achalasia

A
  • -lack of peristalsis and lack of relaxation of lower oesophageal sphincter
  • -1/100,000 per year
  • -any age but rarely children
  • -CXR may show air/fluid behind the heart
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33
Q

GORD/GERD predisposing factors

A 
Hiatus hernia
Obesity
Smoking
Etoh
Caffiene 
Large meals late at night
Drugs - theophyllines, nitrates, antibholinergics
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34
Q

Causes of oesophagitis

A

Candidal - immunosuppressed - on abx on steroids particularly inhaled
Chemical - nsaids
eosinophillic
HSV

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35
Q

two types of hiatus hernia

A

sliding - 80% may cause aspiration./acid reflux

rolling - 20% may obstruct or strangulate

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36
Q

Oesophogeal Ca risk factors

A 
Smoking
Etoh
Plummer-Vinson syndrome
Achalasia
Barrets
Chinese/Russian ethnicity
Obesity
Tylosis
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37
Q

Osophogeal Ca clinical features

A

Pain and dyspepsia
Progressive dysphagia for liquids then solids
Weight loss
Vomiting

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38
Q

Clinical symptoms of peptic ulcer disease

A 
Epigastric pain (can radiate to back if posterior duodenal ) 
vomiting
relapsing and remitting course
weight loss
fe deficiency 
acute haemorrage
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39
Q

causes of upper GI bleeds

A 
Common 
Duodenal - 35%
Gasrtic 20%
Gastric erosions 18%
Mallory Weiss tear - 10%

5% or less
Duo or osophagitis
upper GI ca
varices

Rare 1% or less
Angiodysplasia 
Hereditary Talengiectasia
POrtal hypertension
Aorto-duodenal fistula
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40
Q

Risk assessment tool for upper Gi bleed

A

Glasgow-Blatchford

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41
Q

Clinical signs of Zollinger-Ellinson

A

pain and dyspepsia from multiple ulcers
steatorrhoea/diarrhoea

diagnosis - high serum fasting gastrin levels - CT/MR scanning

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42
Q

Treatment of zollinger ellinson

A

HIgh dose PPI (80-120mg od)
Surgery
Chemotherapy
Somatostatin analogues

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43
Q

Gastric Ca risk factors

A 
Japanese
Hypo/achlorhydria (ie pernicious anemmia partial gastrectomy)
male
high salt/nitrates
gastric polyps
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44
Q

Gastric Ca clinical presentation

A 
Dyspepsia 
weight loss
Epigastric pain
anorexia
early satiety
Fe deficiency anemia
maelena
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45
Q

Scoring systems for acute pancreatitis

A

APCHE
Ransom
Glasgow criteria

most unreliable in first 48 hours

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46
Q

Causes of acute pancreatitis

A 
Gallstones
Etoh
Viral (mumps)
Trauma
Drugs (azothioprine, coocp furusomide, steroids)
Hypercalcemia
Hypertriglyceridemia
Post surgery/ERCP
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47
Q

Early complications of pancreatitis

A

ARDS
renal failure
DIC
pleaural effusions

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48
Q

Late complications of pancreatitis

A

splennic/portal vein thrombosis
pseudocyst
abscess

49
Q

Pancreatitis clnical features

A

secere epigastric pain - radiating to the back - vomiting.
Amylase raised above circa 300
Plain Xray may show sentinal loop

50
Q

Chronic pancreatitis features

A

Malaborption and steatorrhea
Abdo pain
T2DM

51
Q

Coeliac Disease clinical features

A 
Diarrhoea
mouth ulcers
Weight loss
Malaise
weakness - ataxia
abdo pain
amenorrhoea
52
Q

Coeliac complications

A 
Nutriotional deficiency 
increased Gi malargnany but this returns to normal with treatment
dermatitis herpetiformis
osteomalacia
abnormal LFTs
53
Q

Refeeding syndrome pathophysiology

A

Overenthusiastic feeding
surge in insulin
intracellulur shift in potassum phosphate and magnesium

Can cause cardiac problems, seizures, delerium, parasthesia

54
Q

refeeding monitoring and treatment

A

U&E daily including Mg Ca and Po4

Thiamine

55
Q

Transmural inflamation (Chrohns or UC)?

56
Q

Mucosa and submcusoa only (Chrohns or UC)?

57
Q

Crypt abcesses (Chrohns or UC)?

58
Q

smoking? (Chrohns or UC)?

A

Smokers more prone to Chrohns but less likely in UC

59
Q

Primary SCLEROSING cholangitis (Chrohns or UC)?

60
Q

Primary BILIARY cirrhosis (Chrohns or UC)?

61
Q

Cobblestone mucosa (Chrohns or UC)?

62
Q

Rose thorn ulcers (Chrohns or UC)?

63
Q

Skip lesions (Chrohns or UC)?

64
Q

Fistulae? (Chrohns or UC)?

65
Q

Definition of acute severe colitis

A

True-love and witts criteria

> 6 bloody stools
plus any signs of systemic shock

66
Q

Psuudomembrinous colitis otherwise known as

67
Q

Campylobactor features

A

Gram negative rods
fecal oral
headache and malaise prior to diarrhoea
abdo pain may be severe

68
Q

Cholera features

A

Vibrio Cholerae - gram negative rods
spread is fecal oral
rice water stools

69
Q

Giardiasis features

A

flagellate protozoa
fecal oral spread
bloading and non bloody diarrhoea

70
Q

Salmonella features

A

Gram negative bacillus divided into enteric (tyhic/paratyhic) and those causing gastro-enteritis

71
Q

GI TB features

A

mimicks chrohns disease
occasionally spontaneous peritonitis
clinical features are non-specific
Diagnosis by biopsy

72
Q

Causes of jaundice types

A

Pre-hepatic
Hepatic
Post Hepatic

73
Q

Prehepatic causes of jaundice

A

Haemolysis

Gilberts syndrome etc

74
Q

hepatic causes of jaundice

A 
Etoh hepatitis
Viral hepatitis
Drugs - augmentin etc
Wilsons disease
Chirrosis 
Hepatic Metastases
Hepatic congestion in cardiac failure
75
Q

Post-Hepatic causes of jaundice

A 
Gallstones
carcinom of pancreas
lymphadenopathy
PBC
PSC
Biliary artresia
76
Q

Synthetic measurs of liver function

A

Albumin and PT

77
Q

Obstructive jaundice

A

ALP raised

78
Q

hepatocellular jaundice

A

ALT raised

79
Q

Chronic livery disease LFTs

A

May be “normal” but poor synthetic function

80
Q

Investigations for Jaundice

A

LFT
Viral serology
autoantibodies

Liver USS - single most useful test
CT scan
MRCP

81
Q

Congenital Hyperbilirubinaemia types

A

Gilbert
Crigler Najjar
Dubin-Johnson
Rotor

82
Q

Congenital Hyperbilirubinaemia benign except

A

Crigler Najjar

83
Q

Congenital Hyperbilirubinaemia fatal no treatment

A

Crigler Najjar type 1

84
Q

Congenital Hyperbilirubinaemia survive to adulthood

A

Crigler Najjar type 2

85
Q

Gilbert syndrome genetics

A

Autosomal dominant

86
Q

Crigler Najarr genetics

A

Type 1 autosomal recesive

Type 2 autosomal dominant

87
Q

Dumin Johnson/Rotor genetics

A

Autosomal recessive

88
Q

Gilbert Syndrome clinical features

A

increased unconjigated bilirubin
asymptomatic jaundice
increases with fasting

89
Q

Dubin-Johnson clinical features

A

jaundice, right upper quadrant pain and malaise

90
Q

Rotor clinical features

A

increase in CONJUGATED bilirubin

91
Q

Ascitis types

A

Transudates and exudative

92
Q

Causes of transudative ascities

A

portal hypertension
nephrotic syndrome
malnutrition
myxoedema

93
Q

Causes of exudative ascititis

A

Ca
Intra-abdominal TB
Pancreatitis

94
Q

Hepato-renal syndrome

A

Acute kidney injury can complicate chronic liver disease

Type 1 rapidly progressive renal failure - high mortality rate
Type 2 mortality again high but onset and progression slower

95
Q

Hep A features

A 
Spread: fecal oral
Virus: RNA
Clinical: anorexia/jaundice/nausea/joint pain/fever
Treatment: supportive
Chronicity: none
Vaccine: Yes
96
Q

Hep B features

A 
Spread: blood born
Virus: DNA
Clinical: acute fever, arteritis, glomerulonephritis, arthorpathy
Treatment: supportive and ?antivirals
Chronicity: 5% chronic carriage
Vaccine: Yes
97
Q

Hep C features

A 
Spread: blood born/sti
Virus: RNA
Clinical: acute hepatitis
Treatment: peg interferon alpha
Chronicity: 60-80%
Vaccine: No
98
Q

Hep D features

A

Spread: blood born but depends on Hep B infection
Virus: incomplete
Clinical: exacerbates Hep B infection
Treatment: Interferon of limited benefit
Chronicity: increased incidence of chirosis
Vaccine: No

99
Q

Hep E features

A 
Spread: Blood born
Virus: RNA
Clinical: acute self limiting but 25% mortality in pregnancy
Treatment: supportive
Chronicity: none
Vaccine: No
100
Q

Hep B serology HBsAg

A

Acute infection -SiCK NOW

101
Q

Hep B sereology HBeAg

A

High infectivety - spreading it EVRYWHERE

102
Q

Hep B sereology Anti-HBs

A

immune from getting SICK

103
Q

Hep B sereology Anti-HBe

A

Declining infectivity - stopped spreading it EVERYWHERE

104
Q

Hep B serology anti-HBe IgM

A

recent infection <6 MONTHS

105
Q

Hep B sereology anti Hbc IgG

A

Lifelong marker of post infection - not immunity

GOT it - might GET it again.

106
Q

Drug induced hepatitis Cholestatis examples

A

cause bile duct inflammation
flucloxaccilin
anabolic steroids
oral contraceptives

107
Q

Drug induced hepatitis

A

direct hepatocellular damage from statins anti-TB drugs, ketoconoazole.Fulminant liver failure possible.

108
Q

Hepatic necrosis

A

where ability of liver to metabolise toxins fails - gluthathione levels fal and toxic metabolites accumulate = ie paracetamol OD

109
Q

Four stages of chirossis

A

liver cell necrosiss
inflammation
fibrosis
nodular regeneration

110
Q

chirosis definition

A

irreversible destruction and fibrosis of liver architecture with some nodular regeneration

111
Q

Causes of chirrhosis

A 
Etoh
Haemochromatosis
PBC
Wilsons
NASH
Auto-immune hepatitis
112
Q

Clinical features of Chirrhosis

A 
Confusion/encephalopathy
bruiding/bleeding
oedema  (hypo-abuminaemia)
ascites
jaundice
palmar erethema/dupetrons contacture/caput medusa/splenomegaly)
GI haemorrage.
113
Q

Portal Hypertension - Budd Chiari

A

thrombosis or obstruction of hepatic vein

114
Q

Portal hypertension - thrombotic causes

A

Portal thrombosis or Budd Chiari

115
Q

Primary Billiary Chirrosis features

A

Cholestatic jaundice
xanthelasma
hepatosplenomegaly

high ALP/IgM

Diagnosis is AM2 antibodies

116
Q

Pyogenic absesses

A

Hepatic absess following intra-abdominal sepsis or spontaneously - ecoli - proteus/ staph A

Patients have swingin pyrexia - weight loss - right upper quadrant pain and anorexia

117
Q

Acute Abdomen causes

A 
Appendicitis
Perforated viscus
IBD
Diverticular diseases
Obstruction
Ischaemia
Incaraterd hernia

torsion
PID
endometriosis

Pancreatitis

Cholycystitis/Cholangitis

Peritonitis

renal calculi

spenic infarcts

118
Q

Ix for Acute Abdomen

A 
Bloods - inc amylase and Ca, and VBG
CXR
AXR
ECG
CT abdo

MRCP (7 decks)

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