Gastro Flashcards
1
Q
Most common site H Pylori ulcers
A
Duodenum
2
Q
Most common cause gastric ulcers
A
H Pylori
3
Q
Most common manifestation NSAID induced ulcers
A
Gastric
4
Q
Indications for gastric biopsy
A
Gastric ulcer
Irregular
> 2cm
5
Q
Which medication can cause mid oesophageal ulcers
A
Doxycycline
6
Q
NASH histology feature
A
Hepatocyte ballooning
7
Q
Workup of Crohn’s
- Imaging
- Procedures
A
Imaging - MRE for all patients
Scopes - C scope if suspected colonic or terminal ileal disease
8
Q
CI to capsule endoscopy in Crohn’s workup
A
Stricturing disease
9
Q
F/U scopes for peptic ulcer disease
- Duodenal
- Gastric
A
Duodenal - not needed unless symptoms persist
Gastric - Indications:
- Persistent symptoms
- Big ulcer >3cm
- Unclear aetiology
- Suspicious - malignancy, ulcer, bleeding etc
10
Q
Methane breath test for?
A
SIBO
11
Q
Treatment of SIBO
A
rifaxamin
12
Q
Cause of platypnoea and orthodexia in hepatopulmonary syndrome
A
Pulmonary arterial dilatation
13
Q
Refeeding - what do you need to replace PRIOR to starting feeding
A
Thiamine - avoid precipitating acute thiamine deficiency (Wernicke’s)
14
Q
How long can CDT remain positive for after treatment?
A
6 weeks
15
Q
Pancreatitis - intervention with mortality benefit first 24 hrs
A
IV fluids
16
Q
Pancreatitis scoring
A
Glasgow Imrie
PaO2 < 60
Age > 55
Neus > 15
Ca < 2
Renal - urea > 16
Albumin < 32
Sugar > 10
17
Q
Condition causing increases risk squamous cell carcinoma oesophagus
A
Achalasia
18
Q
Achalasia treatment for patient who is surgical candidate?
A
POEM (peroral endoscopic myotomy)
Heller myotomy
Oesophagectomy (last line)
19
Q
Achalasia treatment for patient not surgical candidate
A
1st line - botulinum injection if able
CCB’s
Long acting nitrates
20
Q
OGD features EoE
A
Longtiduinal furrows
White exudates
Concentric rings
21
Q
Initial treatment for EoE
A
8 week PPI course
OR
Swallowed steroid.
22
Q
2nd line treatments for EoE
A
Elemental/elimination diet
Dupilumab
23
Q
Barrett’s -no dysplasia f/u
A
5 yearly surveillance scopes, sooner in symptoms
24
Q
Barett’s low grade dysplasia
A
Repeat scope 6 months, if changes confirmed radiofrequency ablation
25
Barrett's high grade dysplasia
Endoscopic mucosal resection/oesophagectomy
RFA to remaining Barrett's
26
Significance of CagA protein in H Pylori
CagA positive
- higher rate of duodenal ulcers
- Higher rate of GI malignancy
27
Gene associated with diffuse type gastric adenocarcinoma
CDH1 (can be somatic, germline, imbalance)
28
Lobular breast cancer
Signet ring cell gastric cancer
Syndrome?
genetic defect?
Hereditary diffuse gastric cancer
Germline mutation in CDH1
29
Periodic acid schiff positive
Gram positive rod
Trophyrema whipplei - whipple's disease
30
Chronic diarrhoea
Arthralgias
Cognitive dysfunction
Whipple's disease
31
DDx for RF -ve migratory arthritis that doesn't respond to immunosuppresson
Whipple's disease
32
Coeliac disease testing
1st - Anti TTG IgA
If Anti-TTG IgA weakly positive, and do anti endomysial IgA (specific, but technically difficult)
In IgA deficiency:
- TTG - IgG
- Anti-DPG IgG
33
PPI therapy UGIB pre-scope- eveidence
Reduces high risk stigmata - no mortality/morbidity benefit
34
PPI 72 hours after UGIB ulcer. evidence
Improves re-bleeding, hospital LoS, mortality
35
High risk stigmata on scope (Forest classification) that need IP PPI
Bleeding or oozing (Forest 1a and 1b)
Visible vessel or large clot (2a and 2b)
36
1st line H Pylori
7-14 days ACE
Amoxi
Claritho
PPI
37
1st ine H Pylori pencillin immediate hypersensitivity
ACE but replace amox with Metro
38
2nd line therapy if failed eradication
Remove clarithromycin - 10% success rates
Triple - ACE but use levofloxacin instead of clarithro
Quadruple - PPI, bismuth, metro, doxycycline
39
Chronic watery diarrhoea 65 year old female
Microscopic colitis
40
Risk factors Collagenous colitis
NSAID use
Smoking
41
Treatment of collagenous colitis
Budenoside
Cholestyramine if budenoside fails
42
Zollinger Ellison Dx approach
Fasting gastrin and gastric pH
- Gastrin high, pH < 2 to be diagnostic
Equivocal - secretin stimulation test
43
Oesophageal cancer location comparison
Squamous - mid
Adeno - lower
44
RIsk factors for squamous cell oesophageal cancer
Smoking
ETOH
Achalasia
Nutritional deficiency
44
RIsk factors for squamous cell oesophageal cancer
Smoking
ETOH
Achalasia
Nutritional deficiency
45
Recent course doxycycline, acut onset odynophagia
Pill oesophagitis
46
Immunocompromised, odynophagia, white plauqes
Oesophageal candida
47
Immunocompromised, odynophagia, small discrete ulcers
HSV
48
Immunocompromised, odynophagia, giant ulcers
CMV
49
Kit-117 staining positive - next step for lesion in stomach?
Suggestive of GIST
Tissue and staging --> EUS and CT
50
Ascetic tap indicating SBP
WCC
Neuts
WCC > 500
Neuts > 250
Treat as SBP
51
Cancer associated with PSC
Cholangiocarcinoma
52
Genetic defect of Gilber'ts syndrome
UDP deficiency, so unable to glucorinodate bilirubin
53
Hepatitis A pre-exposure PPx
Travellers - 1st dose up to time of departure
54
Hepatitis A post-exposure PPx
Single dose of vaccine < 2 weeks, if age 10-40
Add Hep A Ig if immunocompromised or high risk
55
Supporive Management of valproate overdose
Elevated ammonia - L carnitine
Respiratory depression - consider naloxone
HDx - readily dialysable as protein binding saturable
56
Gene forWilson's
ATP7B
57
Inheritance wilsons
Autosomal recessive
58
Pathophys of Wilson's
Defective incorporation of Copper into protein to form caeruloplasmin
More free copper, causes extrahepatic injury
Intrahepatic injury also
59
Manifestations of Wilson's
Liver failure
Neuro - dysarthria, movement disorders
Behavioural
Kaiser Fleischer rings
Coombe's negative haemolytic anaemia
60
Diagnosis of Wilson's
Elevated urine Cu, low caeroplasmin, kaise fleischer rings --> diagnosis
Equivocal - get liver biopsy
61
>100 polyps
Strong FHx of CRC
Diagnosis?
FAP
62
Which chromosome is APC gene on?
Chromosome 5
63
>10 colonic polyps
Gastric, duodenal poylps
Disease?
Inheritance
MUTHy - base excision repair deficiency
Autosomal recessive
64
HNPCC associated cancers and screening
Colon - 2 yearly from 25
Endometrial - 1 yearly from 25
Renal and ureteric
Gastric - 2 yearly
65
3:2:1 rule
3 relatives with HNPCC cancer (one must be FDR)
2 successive generations
1 < age 50
66
Pathogenesis of HNPCC
Mismatch repair deficiency
67
Harmatomous GI polyps
Pigemented oral/peri-oral mucocutaneous lesions
Peutz Jegher
68
Gene for peutz jeger
STK11
69
Differentiate peutz jegher and juvenile polypsis syndrome
Juvenile polyposis
- Won't have pigmented lesions
- GEne is MKD4
70
MoA of cholestyramine
Binds bile acids into non-absorbable complex, increases bile acid secretion in stool
Only use when colon still present(site of secretory diarrhoeaa)
If > 100cm ileum removed, can increase diarrhoea
71
A/E of thiopurines
6- TGN -Myelosuppression, Skin cancer, lymphoma
6-MMP - Pancreatitis, Hepatitis
72
Excess A/E on thiopurines but normal TPMT
Check metabolites
If excess 6-MMP, then shuntin occuring
Can reverse by addin in xanithine oxidase inhibitor and reducing AZA dose
73
MoA of vedolizumab
a4b7 intergrin inhibitor
74
Toxic megacolon
- Definition
- Causes
Abdominal pain, systemic toxicity, colon > 6cm
IBD and infectious (C diff)
75
Treatment of IBD toxic megacolon
1) 3 days IV steroids
2) 3 days infliximab
Failing this, colectomy
76
Fluclox causes what pattern of LFT derangement?
Cholestatic
77
Hook like osteophytes, 2nd and 3rd MCP OA
Haemachromatosis
78
Histopathology of alcoholic hepatitis
Neutrophil infiltration
79
Function of hepcidin
Inhibits ferroportin
- This inhibits transport of iron from cells/enterocytes into blood, traps in in cells (liver, enterocytes, splenic macrophages)
80
Iron in diet - what form?
Ferric - Fe3+
81
Ionic changes of Fe3+ after ingestion
Converted to Fe2+ by ferroreductase (mediated by vitamin C) at apical enterocytes
Fe2+ in cells transported to blood, binds transferrin
To store as ferritin, Fe2+ converted back to Fe3+ (liver and enterocytes)
82
When should PPI's be given during the day?
Before first meal of the day
83
Recurrent abdo pain, post prandial, chronic
No clear cause found - consider?
Arcuate ligament syndrome
84
Pancreatitis - which blood marker strongest indication for ERCP in presence of gallstones?
Elevated bilirubin - indicates obstruction
85
Nutrition for severe acute pancreatitis
NJ feeding
86
Acanthocytes
Spiculated RBC's
Severe liver disease
87
Reason for post-op/chemo CT's and CEA's?
Detect oligometastatic disease
88
Spindle shaped cells
GIST
89
Suggest alternative diagnosis to prophyria?
Fever
90
Stricturing Crohn's disease
- Signs it is fibrostenotic
- Management in this case?
No surroinding inflammation
Upstream dilatation
>10cm
Any of these, manage:
- endoscopically - < 5cm
- >5cm - surgicall with resection or strictureplasty
91
Chemo most likely to cause tissue damage if it extravasates
Anthracyclines
92
How many LN need to be sampled for CRC staging?
12
If inadequate sampling, and no nodes found, sample enough nodes --> biggest predictor of severity is node involvement
93
Highest risk of premature menopause with chemo?
Older females (less ovarian reserve)
94
Oraopharyngeal squamous cell carcinoma
- good prognostic factor?
- poor prognostic factors
Good - HPV positive
Bad - HPV negative, low p16, smoking, ETOH, EBV positive
95
Mantle radiotherapy, 5 years after presents with weight gain, fatigue, irregular periods
Thyroid
NOT menopause as would expect soon after chemo
96
Most common A/E of VEGF inhibitors
Hypertension
97
Ataxia, neuropathy
Hepatosplenomegaly
Recent foregut surgery
Copper
98
Dental Caries
Flouride deficiency
99
Welding/steeling industry
EPSE
Manganese toxicity
100
Cardiomyopathy
Skeletal muscle disease
Whitened naibeds
Chinese female
Selenium deficiency
In Chinese people called Keshan disease
101
Impaired wound healing
Altered taste
Impaired growth/growth velocity
Impotence/infertility
Which mineral?
Zinc deficiency
102
IBD - extraintestinal manifestation associated with active GI inflammation
arthritis
103
Electrolytes causes precipiating Hepatic enceph
Hypokalaemia
104
What allows Hep B to become chronic
Circular closed DNA - that NRTI's can't affect
105
Most specific Ab for AIH
Anti SA/LPA
106
Risk factor for microscopic colitis
NSAIDs
