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Gastro Flashcards

1
Q

Most common site H Pylori ulcers

A

Duodenum

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2
Q

Most common cause gastric ulcers

A

H Pylori

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3
Q

Most common manifestation NSAID induced ulcers

A

Gastric

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4
Q

Indications for gastric biopsy

A

Gastric ulcer
Irregular
> 2cm

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5
Q

Which medication can cause mid oesophageal ulcers

A

Doxycycline

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6
Q

NASH histology feature

A

Hepatocyte ballooning

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7
Q

Workup of Crohn’s
- Imaging
- Procedures

A

Imaging - MRE for all patients

Scopes - C scope if suspected colonic or terminal ileal disease

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8
Q

CI to capsule endoscopy in Crohn’s workup

A

Stricturing disease

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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

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10
Q

Methane breath test for?

A

SIBO

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11
Q

Treatment of SIBO

A

rifaxamin

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12
Q

Cause of platypnoea and orthodexia in hepatopulmonary syndrome

A

Pulmonary arterial dilatation

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13
Q

Refeeding - what do you need to replace PRIOR to starting feeding

A

Thiamine - avoid precipitating acute thiamine deficiency (Wernicke’s)

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14
Q

How long can CDT remain positive for after treatment?

A

6 weeks

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15
Q

Pancreatitis - intervention with mortality benefit first 24 hrs

A

IV fluids

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16
Q

Pancreatitis scoring

A

Glasgow Imrie
PaO2 < 60
Age > 55
Neus > 15
Ca < 2
Renal - urea > 16
Albumin < 32
Sugar > 10

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17
Q

Condition causing increases risk squamous cell carcinoma oesophagus

A

Achalasia

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18
Q

Achalasia treatment for patient who is surgical candidate?

A

POEM (peroral endoscopic myotomy)

Heller myotomy

Oesophagectomy (last line)

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19
Q

Achalasia treatment for patient not surgical candidate

A

1st line - botulinum injection if able

CCB’s
Long acting nitrates

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20
Q

OGD features EoE

A

Longtiduinal furrows
White exudates
Concentric rings

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21
Q

Initial treatment for EoE

A

8 week PPI course

OR

Swallowed steroid.

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22
Q

2nd line treatments for EoE

A

Elemental/elimination diet

Dupilumab

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23
Q

Barrett’s -no dysplasia f/u

A

5 yearly surveillance scopes, sooner in symptoms

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24
Q

Barett’s low grade dysplasia

A

Repeat scope 6 months, if changes confirmed radiofrequency ablation

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25
Q

Barrett’s high grade dysplasia

A

Endoscopic mucosal resection/oesophagectomy

RFA to remaining Barrett’s

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26
Q

Significance of CagA protein in H Pylori

A

CagA positive
- higher rate of duodenal ulcers
- Higher rate of GI malignancy

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27
Q

Gene associated with diffuse type gastric adenocarcinoma

A

CDH1 (can be somatic, germline, imbalance)

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28
Q

Lobular breast cancer
Signet ring cell gastric cancer

Syndrome?
genetic defect?

A

Hereditary diffuse gastric cancer

Germline mutation in CDH1

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29
Q

Periodic acid schiff positive
Gram positive rod

A

Trophyrema whipplei - whipple’s disease

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30
Q

Chronic diarrhoea
Arthralgias
Cognitive dysfunction

A

Whipple’s disease

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31
Q

DDx for RF -ve migratory arthritis that doesn’t respond to immunosuppresson

A

Whipple’s disease

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32
Q

Coeliac disease testing

A

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

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33
Q

PPI therapy UGIB pre-scope- eveidence

A

Reduces high risk stigmata - no mortality/morbidity benefit

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34
Q

PPI 72 hours after UGIB ulcer. evidence

A

Improves re-bleeding, hospital LoS, mortality

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35
Q

High risk stigmata on scope (Forest classification) that need IP PPI

A

Bleeding or oozing (Forest 1a and 1b)
Visible vessel or large clot (2a and 2b)

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36
Q

1st line H Pylori

A

7-14 days ACE
Amoxi
Claritho
PPI

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37
Q

1st ine H Pylori pencillin immediate hypersensitivity

A

ACE but replace amox with Metro

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38
Q

2nd line therapy if failed eradication

A

Remove clarithromycin - 10% success rates

Triple - ACE but use levofloxacin instead of clarithro

Quadruple - PPI, bismuth, metro, doxycycline

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39
Q

Chronic watery diarrhoea 65 year old female

A

Microscopic colitis

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40
Q

Risk factors Collagenous colitis

A

NSAID use
Smoking

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41
Q

Treatment of collagenous colitis

A

Budenoside

Cholestyramine if budenoside fails

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42
Q

Zollinger Ellison Dx approach

A

Fasting gastrin and gastric pH
- Gastrin high, pH < 2 to be diagnostic

Equivocal - secretin stimulation test

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43
Q

Oesophageal cancer location comparison

A

Squamous - mid

Adeno - lower

44
Q

RIsk factors for squamous cell oesophageal cancer

A

Smoking
ETOH
Achalasia
Nutritional deficiency

44
Q

RIsk factors for squamous cell oesophageal cancer

A

Smoking
ETOH
Achalasia
Nutritional deficiency

45
Q

Recent course doxycycline, acut onset odynophagia

A

Pill oesophagitis

46
Q

Immunocompromised, odynophagia, white plauqes

A

Oesophageal candida

47
Q

Immunocompromised, odynophagia, small discrete ulcers

48
Q

Immunocompromised, odynophagia, giant ulcers

49
Q

Kit-117 staining positive - next step for lesion in stomach?

A

Suggestive of GIST

Tissue and staging –> EUS and CT

50
Q

Ascetic tap indicating SBP
WCC
Neuts

A

WCC > 500
Neuts > 250

Treat as SBP

51
Q

Cancer associated with PSC

A

Cholangiocarcinoma

52
Q

Genetic defect of Gilber’ts syndrome

A

UDP deficiency, so unable to glucorinodate bilirubin

53
Q

Hepatitis A pre-exposure PPx

A

Travellers - 1st dose up to time of departure

54
Q

Hepatitis A post-exposure PPx

A

Single dose of vaccine < 2 weeks, if age 10-40

Add Hep A Ig if immunocompromised or high risk

55
Q

Supporive Management of valproate overdose

A

Elevated ammonia - L carnitine

Respiratory depression - consider naloxone

HDx - readily dialysable as protein binding saturable

56
Q

Gene forWilson’s

57
Q

Inheritance wilsons

A

Autosomal recessive

58
Q

Pathophys of Wilson’s

A

Defective incorporation of Copper into protein to form caeruloplasmin

More free copper, causes extrahepatic injury

Intrahepatic injury also

59
Q

Manifestations of Wilson’s

A

Liver failure
Neuro - dysarthria, movement disorders
Behavioural
Kaiser Fleischer rings
Coombe’s negative haemolytic anaemia

60
Q

Diagnosis of Wilson’s

A

Elevated urine Cu, low caeroplasmin, kaise fleischer rings –> diagnosis

Equivocal - get liver biopsy

61
Q

> 100 polyps
Strong FHx of CRC

Diagnosis?

62
Q

Which chromosome is APC gene on?

A

Chromosome 5

63
Q

> 10 colonic polyps
Gastric, duodenal poylps

Disease?
Inheritance

A

MUTHy - base excision repair deficiency

Autosomal recessive

64
Q

HNPCC associated cancers and screening

A

Colon - 2 yearly from 25
Endometrial - 1 yearly from 25
Renal and ureteric
Gastric - 2 yearly

65
Q

3:2:1 rule

A

3 relatives with HNPCC cancer (one must be FDR)

2 successive generations

1 < age 50

66
Q

Pathogenesis of HNPCC

A

Mismatch repair deficiency

67
Q

Harmatomous GI polyps
Pigemented oral/peri-oral mucocutaneous lesions

A

Peutz Jegher

68
Q

Gene for peutz jeger

69
Q

Differentiate peutz jegher and juvenile polypsis syndrome

A

Juvenile polyposis
- Won’t have pigmented lesions
- GEne is MKD4

70
Q

MoA of cholestyramine

A

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
Q

A/E of thiopurines

A

6- TGN -Myelosuppression, Skin cancer, lymphoma

6-MMP - Pancreatitis, Hepatitis

72
Q

Excess A/E on thiopurines but normal TPMT

A

Check metabolites

If excess 6-MMP, then shuntin occuring

Can reverse by addin in xanithine oxidase inhibitor and reducing AZA dose

73
Q

MoA of vedolizumab

A

a4b7 intergrin inhibitor

74
Q

Toxic megacolon
- Definition
- Causes

A

Abdominal pain, systemic toxicity, colon > 6cm

IBD and infectious (C diff)

75
Q

Treatment of IBD toxic megacolon

A

1) 3 days IV steroids
2) 3 days infliximab

Failing this, colectomy

76
Q

Fluclox causes what pattern of LFT derangement?

A

Cholestatic

77
Q

Hook like osteophytes, 2nd and 3rd MCP OA

A

Haemachromatosis

78
Q

Histopathology of alcoholic hepatitis

A

Neutrophil infiltration

79
Q

Function of hepcidin

A

Inhibits ferroportin
- This inhibits transport of iron from cells/enterocytes into blood, traps in in cells (liver, enterocytes, splenic macrophages)

80
Q

Iron in diet - what form?

A

Ferric - Fe3+

81
Q

Ionic changes of Fe3+ after ingestion

A

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
Q

When should PPI’s be given during the day?

A

Before first meal of the day

83
Q

Recurrent abdo pain, post prandial, chronic

No clear cause found - consider?

A

Arcuate ligament syndrome

84
Q

Pancreatitis - which blood marker strongest indication for ERCP in presence of gallstones?

A

Elevated bilirubin - indicates obstruction

85
Q

Nutrition for severe acute pancreatitis

A

NJ feeding

86
Q

Acanthocytes

A

Spiculated RBC’s

Severe liver disease

87
Q

Reason for post-op/chemo CT’s and CEA’s?

A

Detect oligometastatic disease

88
Q

Spindle shaped cells

89
Q

Suggest alternative diagnosis to prophyria?

90
Q

Stricturing Crohn’s disease
- Signs it is fibrostenotic
- Management in this case?

A

No surroinding inflammation

Upstream dilatation

> 10cm

Any of these, manage:
- endoscopically - < 5cm
- >5cm - surgicall with resection or strictureplasty

91
Q

Chemo most likely to cause tissue damage if it extravasates

A

Anthracyclines

92
Q

How many LN need to be sampled for CRC staging?

A

12

If inadequate sampling, and no nodes found, sample enough nodes –> biggest predictor of severity is node involvement

93
Q

Highest risk of premature menopause with chemo?

A

Older females (less ovarian reserve)

94
Q

Oraopharyngeal squamous cell carcinoma
- good prognostic factor?
- poor prognostic factors

A

Good - HPV positive

Bad - HPV negative, low p16, smoking, ETOH, EBV positive

95
Q

Mantle radiotherapy, 5 years after presents with weight gain, fatigue, irregular periods

A

Thyroid

NOT menopause as would expect soon after chemo

96
Q

Most common A/E of VEGF inhibitors

A

Hypertension

97
Q

Ataxia, neuropathy
Hepatosplenomegaly
Recent foregut surgery

98
Q

Dental Caries

A

Flouride deficiency

99
Q

Welding/steeling industry

EPSE

A

Manganese toxicity

100
Q

Cardiomyopathy
Skeletal muscle disease
Whitened naibeds

Chinese female

A

Selenium deficiency

In Chinese people called Keshan disease

101
Q

Impaired wound healing
Altered taste
Impaired growth/growth velocity
Impotence/infertility

Which mineral?

A

Zinc deficiency

102
Q

IBD - extraintestinal manifestation associated with active GI inflammation

103
Q

Electrolytes causes precipiating Hepatic enceph

A

Hypokalaemia

104
Q

What allows Hep B to become chronic

A

Circular closed DNA - that NRTI’s can’t affect

105
Q

Most specific Ab for AIH

A

Anti SA/LPA

106
Q

Risk factor for microscopic colitis

BPT (18 decks)

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