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Gastro Flashcards

1
Q

Ulcerative colitis is associated with which biliary disease

A

Primary sclerosing cholangitis

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2
Q

Crohn’s disease usually has non-bloody diarrhoea vs bloody (in Ulcerative colitis).
Ulcerative colitis tends to have abdo pain in the LLQ, what does Crohn’s disease have in the RIF?

A

Abdominal mass palpable in the right iliac fossa - Crohn’s disease

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3
Q

Which type of inflammatory bowel disease has:
Lesions may be seen anywhere from the mouth to anus
Skip lesions may be present

A

Crohn’s disease

Endoscopy = deep ulcers, skip lesions with cobblestone appearance

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4
Q

Where is inflammation in Crohn’s disease versus Ulcerative colitis

A

Crohn’s disease - there is inflammation in all layers from mucosa to serosa - increased goblet cells, granulomas
Ulcerative colitis - no inflammation beyond submucosa (unless fulminant disease) - inflammatory cell infiltrate in lamina propria

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5
Q

Kantor’s string sign shows?

A

Strictures on small bowel enema
Crohn’s disease

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6
Q

Rose thorn ulcers indicates…

A

Crohn disease - on small bowel enema imaging

Also may see fistulae + strictures (Kantor’s string sign)

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7
Q

Loss of haustrations, psueodpolyps and narrowed/short colon (drainpipe colon) is seen in…

A

ulcerative colitis

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8
Q

Smoking worsens which inflammatory bowel disease

A

Crohn’s disease

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9
Q

Severity of ulcerative colitis flares
Mild, Moderate, Severe

A

Mild - <4 stools daily, no blood
Moderate - 4-6 stools daily
Severe - >6 stools daily, blood, systemic disturbance i.e. fever, tachycardia, anaemia, raised CRP/ESR

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10
Q

Peutz-Jeghers syndrome mode of inheritance

A

autosomal dominant

  • hamartomatous polyps in the gastrointestinal tract, pigmented lesions on lips, oral mucosa, face, palms and soles.
  • GI bleeds, small bowel obstruction
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11
Q

Hereditary non-polyposis colorectal carcinoma (HNPCC i.e. Lynch syndrome) is the most common form of genetic colon cancer. what is the mode of inheritance and common genes involved

A

automsal dominant

MSH2 (60% of cases)
MLH1 (30%)

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12
Q

familial adenomatous polyposis (FAP) has what mode of inheritance and what gene is mutated

A

Autosomal dominant

Adenomatous polyposis coli gene (APC) located on chromosome 5 is mutated. This is a tumour suppressor gene

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13
Q

The Amsterdam criteria are sometimes used to aid diagnosis of hereditary non-polyposis colorectal carcinoma (HNPCC) i.e. Lynch syndrome.
What are the 3 criteria

A
  1. at least 3 family members with colon cancer
  2. cases span at least two generations
  3. at least one case diagnosed before the age of 50 years
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14
Q

A variant of familial adenomatous polyposis (FAP) called Gardner’s syndrome can also feature…

A
  • Osteomas of skull and mandible
  • Retinal pigmentation
  • Thyroid carcinoma
  • Epidermoid cysts on the skin
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15
Q

Urgent 2ww criteria for upper GI referrals

A
  • Dysphagia
  • Upper abdominal mass
  • Over 55 years, weight loss and one of the following: dyspepsia, reflux, upper abdominal pain
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16
Q

Patients who have reflux/dyspepsia who do not meet criteria for referral, what is the management

A
  1. Lifestyle
  2. PPI for 1 month
  3. or test and treat for H.pylori
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17
Q

What is the test for H.pylori

A

Carbon-13 urea breath test

Or stool Ag test
Or lab based serology

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18
Q

There is no need to check for H.pylori eradication if symptoms have resolved. However, if repeat testing is required, what test is used

A

Carbon-13 urea breath test

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19
Q

What is the treatment for H.pylori eradication

A

PPI + amoxicillin (or metronidazole) + clarithromycin

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20
Q

Which peptic ulcer is more common

A

DUODENAL ulcers

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21
Q

Child Pugh score for liver cirrhosis uses which 5 elements

A
  1. Bilirubin
  2. Albumin
  3. PT time
  4. Encephalopathy
  5. Ascites
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22
Q

The model for end stage liver disease (MELD) scoring system is used with Child Pugh score for liver disease now. What are the 3 elements of MELD

A
  1. Bilirubin
  2. Creatinine
  3. INR
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23
Q

What is management for C.diff

A
  1. Oral vancomycin for 10 days
  2. Oral fidaxomicin
  3. Oral vancomycin +/- IV metronidazole (for life-threatening)
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24
Q

What is the treatment of recurrent C.diff
(a) within 12 weeks
(b) after 12 weeks

A

(a) within 12 weeks - oral fidaxomicin
(b) after 12 weeks - oral vancomycin OR fidaxomicin

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25
Q

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

what condition

A

Primary biliary cholangitis

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26
Q

What is the treatment for primary biliary cholangitis

A
  1. ursodeoxycholic acid - slows progression and improves symptoms
  2. pruritus: cholestyramine
  3. fat-soluble vitamin supplementation
  4. liver transplantation
    - if BR > 100
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27
Q

what antibody is seen in primary biliary cholangitis (cirrhosis)

A

anti-mitochondrial antibodies (AMA) M2 subtype

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28
Q

what scoring system is used for malnutrition

A

MUST score

giving a score out of 5:
BMI, unintentional weight loss, acute disease

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29
Q

What is the effect of insoluble fibre on people with IBS

A

Insoluble fibre (e.g. cereals, grains, brown rice) is bad and can cause diarrhoea and bloating

REDUCE it in IBS patients

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30
Q

IBS treatment for:
(a) pain
(b) constipation
(c) diarrhoea

A

(a) pain - antispasmodics
(b) constipation - laxatives, or if not working linaclotide
(c) diarrhoea - loperamide

Also consider TCAs (amitriptyline), CBT

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31
Q

Triad of cholangitis

A

Jaundice
Right upper quadrant pain
Fever, unwell

(n.b. there is no jaundice in acute cholecystitis)

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32
Q

Murphys sign (inspiration stops on palpation of the RUQ) on examination indicates which illness

A

Acute cholecystitis

(RUQ pain, fever)

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33
Q

4 risks of ERCP

A

Bleeding
Duodenal perforation
Cholangitis
Pancreatitis

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34
Q

What diabetic medication can cause cholestasis

A

Sulphonylureas

e.g. gliclazide

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35
Q

Non-urgent (not 2ww) referral for upper GI endoscopy criteria

A
  1. Haematemesis
  2. Patients over 55yo with any of:
    - treatment-resistant dypsepsia
    - upper abdo pain with low Hb
    - high plts with: N+V, weight loss, reflux, dyspepsia, or upper abdo pain
    - N+V with: weight loss, reflux, dyspepsia, or upper abdo pain
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36
Q

A palpable mass in the right upper quadrant (in cholangiocarcinoma) is called what sign

A

Courvoisier sign

seen in Cholangiocarcinoma

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37
Q

periumbilical lymphadenopathy - is called what sign

A

Sister Mary Joseph nodes

seen in Cholangiocarcinoma

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38
Q

Periumbilical bruising - is what sign

A

Cullen’s sign

seen in acute pancreatitis

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39
Q

flank bruising - is what sign

A

Grey-Turner’s sign

seen in acute pancreatitis

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40
Q

Painless jaundice is the classical presentation of…

A

pancreatic cancer

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41
Q

how to calculate units of alcohol

A

Volume (mls) x Alcohol by Volume ABV (%)] / 1000

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42
Q

Patients who have incidental finding of NAFLD on liver USS, in these patients, NICE recommends the use of the enhanced liver fibrosis (ELF) blood test to check for advanced fibrosis

What is the ELF blood test

A

Hyaluronic acid
Procollagen III
Tissue inhibitor of metalloproteinase 1

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43
Q

If ELF blood test is unavailable to assess for advanced fibrosis in NAFLD after liver USS, what should be done

A
  • FIB4 score
  • NALFD fibrosis score
  • Fibroscan of liver
  • Liver specialist referral if advanced fibrosis
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44
Q

What is an important blood test for somebody with inflammatory bowel disease on aminosalicylate (e.g. mesalazine) feeling unwell

A

Full blood count - check for agranulocytosis

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45
Q

Type I Autoimmune hepatitis antibodies

A

Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)

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46
Q

Type II Autoimmune hepatitis antibodies

A

Anti-liver/kidney microsomal type 1 antibodies (LKM1)

Affects children only

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47
Q

Type III Autoimmune hepatitis antibodies

A

Soluble liver-kidney antigen

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48
Q

3 investigations for achalsia

A
  1. Oesophageal manometry - excessive LOS tone which doesn’t relax on swallowing
  2. Barium swallow
    - expanded oesophagus, fluid level
    ‘bird’s beak’
  3. CXR - wide mediastinum, fluid level
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49
Q

Treatment of achalsia

A
  1. Pneumatic balloon dilation
  2. Heller cardiomyotomy if recurrent/persistent
  3. Intra-sphincter botox injection if high surgical risk
  4. Meds e.g. nitrates, CCBs
50
Q

Screening for haemochromatosis:
(a) general population
(b) family members

A

(a) transferrin sats > ferritin
(b) HFE genetic testing

51
Q

what mode of inheritance is haemochromatosis

A

autosomal recessive

HFE gene on Chr 6 mutations

52
Q

treatment of haemochromatosis

A
  1. venesection
    - aim for transferrin sats <50%, and serum ferritin <50
  2. desferrioxamine
53
Q

The risk of Crohn’s disease increases early after what operation

A

an appendicectomy

54
Q

What is the strongest risk factor for the development of Barrett’s oesophagus

A

GORD

55
Q

Barrett’s oesophagus refers to the metaplasia of the lower oesophageal mucosa. What cells are replaced here in the metaplasia?

A

Squamous epithelium is replaced by columnar epithelium

56
Q

4 risk factors for Barrett’s oesophagus

A
  1. GORD - strongest risk factor
  2. Male gender (7:1)
  3. Smoking
  4. Obesity
57
Q

Treatment of Barrett’s oesophagus

A
  1. High dose PPI
  2. Endoscopy surveillance with biopsies - metaplasia but not dysplasia has endoscopy every 3-5 years
  3. Dysplasia of any grade - endoscopic intervention e.g. radiofrequency ablation, or mucosal resection is offered
58
Q

Haemochromatosis can lead to cirrhosis and pituitary dysfunction. What condition can this lead to

A

hypogonadotrophic hypogonadism

59
Q

What are 2 reversible complications of haemachromatosis

A
  1. Cardiomyopathy
  2. Skin pigmentation

Other issues e.g. cirrhosis, T2DM, hypogonadotrophic hypogonadism, arthritis, are irreversible.

60
Q

Systemic sclerosis CREST - what does this stand for

A

Calcinosis
Raynaud’s phenomenon
oEsophageal dysmotility
Sclerodactyly
Telangiectasia

61
Q

Oesophagitis may also have a history of what symptom …

A

Heartburn

62
Q

Alcohol can cause what type of anaemia

A

Macrocytic

63
Q

Achalsia has dysphagia of which substances and at what onset

A

Dysphagia of both liquids and solids from the start

64
Q

Dysphagia
History of anxiety
Symptoms are often intermittent and relieved by swallowing
Usually painless

What is the likely diagnosis

A

Globus hystericus

65
Q

If laxatives don’t work in IBS, you can use Linaclotide. What is its mechanism of action

A

It is a GCC receptor agonist

Increases fluid in the intestinal lumen

66
Q

Positive anti-HBc IgG
Positive HBsAg
Negative anti-HBc IgM Negative anti-HBc

What does this imply

A

Chronic HBV infection

67
Q

Pernicious anaemia antibodies

A

antibodies to intrinsic factor +/- gastric parietal cells

68
Q

Management of pernicious anaemia

A

Vit B12 replacement
IM hydroxycobalamin

3 injections per week for 2 weeks
Then 3 monthly

+/- folic acid

69
Q

What is the most common cause of hepatocellular carcinoma
(a) worldwide
(b) Europe

A

(a) worldwide - Hep B
(b) Europe - Hep C

70
Q

Four management options for hepatocellular carcinoma

A
  1. Surgical resection/liver transplant
  2. Radiofrequency ablation
  3. Transarterial chemoembolisation
  4. Sorafenib - multikinase inhibitor
71
Q

What is the most common type of oesophageal cancer in:
(a) UK/US
(b) developing world

A

(a) UK/US - adenocarcinoma
(b) developing world - squamous cell carcinoma

72
Q

What area of the oesophagus does adenocarcinoma affect (most common type in UK/US)

RFs: GORD, Barrett’s, smoking, obesity

A

Lower third

Near gastroesphageal junction

73
Q

What area of the oesophagus does squamous cell carcinoma affect (most common type in developing world)

RFs: smoking, alcohol, achalasia, Pulmmer-Vinson syndrome, diets rich in nitrosamines

A

Upper two-thirds of oesophagus

74
Q

Treatment of oesophageal cancers

A

Surgical resection (Ivor-Lewis)
+ chemotherapy

Big risk of anastomotic leak with mediastinitis

75
Q

NICE recommend avoiding which laxative in the management of IBS

A

Lactulose

76
Q

Colonoscopy biopsy:
Pigment laden macrophages suggestive of melanosis coli

What does this suggest

A

Laxative abuse

77
Q

What daily supplement does the NHS advise may be beneficial for women who eat a vegan diet whilst breastfeeding?

A

Vitamin B12

also daily supplement of vit D 10mcg

78
Q

Which five extra-intestinal manifestations of IBD are related to disease activity?

A
  1. Arthritis
  2. Erythema nodosum
  3. Episcleritis
  4. Osteoporosis
  5. apthous ulcers
79
Q

Prophylaxis of variceal haemorrhage

A
  1. Propranlol
  2. Endoscopic variceal band ligation (EVL) with PPI cover
  3. TIPPSS
80
Q

Acute treatment of variceal haemorrhage

A

ABC approach
1. Blood transfusion
2. Correct the clotting - FFP, vitamin K, platelet transfusions as required
3. Terlipressin - vasoactive agent
4. Or octreotide
5. IV antibiotics
6. Then to endoscopy for endoscopic variceal band ligation > endoscopic sclerotherapy
7. If uncontrolled bleed, for Sengstaken-Blakemore tube
8. TIPPS if above fails

81
Q

A period of how long is typically used to assess response to treatment in patients with mild-moderate flares of ulcerative colitis

A

4 weeks

(if no remission after 4 weeks of topical ASA, add in oral or steroids!)

82
Q

iron study profile in haemochromatosis for:
ferritin
transferrin saturation
transferrin levels/TIBC

A

high ferritin
high transferrin sats
low TIBC

83
Q

For a patient with jaundice and a bilirubin greater than 100, when should they be seen by a specialist

A

SAME DAY admission

84
Q

Urea breath test requires what prep beforehand

A

No antibiotics in past 4 weeks
No PPIs in past 2 weeks

85
Q

what is the most common extra-intestinal feature in both Crohn’s and UC

A

arthritis

86
Q

All male patients drinking more than 50 units per week, and female patients > 35 units, should be referred for what liver investigations (even if LFTs are normal)…

A

ELF test or fibroscan

87
Q

Ratio of AST:ALT >3 suggests…

A

alcoholic hepatitis

88
Q

2 medications that can be used for alcoholic hepatitis

A

Glucocorticoids e.g. prednisolone
Pentoxyphylline

89
Q

What age does ulcerative colitis usually present?

A

BIMODAL

15-25
55-65

90
Q

what two factors are used to monitor effectiveness of treatment in haemochromatosis

A

ferritin
transferrin sats

91
Q

If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year, what should they be given to MAINTAIN remission?

A

Oral azathioprine or mercaptopurine

92
Q

treating ulcerative colitis can be separated into which two categories

A
  • inducing remission
  • maintaining remission
93
Q

What is the treatment for ulcerative colitis
- Inducing remission

A
  1. Topical rectal ASA
  2. If remission not achieved within 4 weeks, add high-dose oral ASA
  3. OR add topical/oral corticosteroid

Severe colitis will need hospitalisation and IV steroids (or cyclosporin after 72hrs or cannot take steroids, or consider surgery)

94
Q

What is the treatment for ulcerative colitis
- Maintaining remission

A
  1. Topical (rectal) ASA
  2. Or topical ASA + oral ASA
  3. Or oral ASA alone (usually in L-sided and extensive UC)
  4. Following severe relapse or more than 2 exacerbations in 1 year, give oral azathioprine or oral mercaptopurine
95
Q

what is the mode of inheritance of gilberts syndrome

A

autosomal recessive

96
Q

gilberts syndrome has an increase in what type of bilirubin

A

unconjugated bilirubin

increases in response to stress, fasting, exercise. no treatment needed.

97
Q

secondary amenorrhoea is common in which liver disorder

A

autoimmune hepatitis

98
Q

patients with ulcerative colitis taking mesalazine are at risk of gastric side effect

A

PANCREATITIS

99
Q

What medication prevents variceal bleeding

A

PROPRANOLOL

100
Q

What medication TREATS variceal bleeding

A

Terlipressin

101
Q

What drugs can increase the risk of Crohn’s disease relapse

A

NSAIDs

102
Q

Treatment for Crohn’s disease
- inducing remission

A
  1. Steroids -budeonside is an alternative
  2. 2nd line = 5-ASA
  3. Azathioprine, methotrexate or mercaptopurine can be used as add-on but not as monotherapy
  4. Consider infliximab for fistulating + refractory
  5. Metronidazole for peri-anal

Enteral feeding with an elemental diet can be used

103
Q

Treatment for Crohn’s disease
- maintaining remission

A

Azathioprine or mercaptopurine

Second line - methotrexate

104
Q

What needs to be assessed before starting methotrexate

A

TPMT activity

105
Q

For patients with Crohn’s disease who have symptomatic perianal fistulae, what medication are they usually given

A

Oral metronidazole

106
Q

Suspected perianal fistulae in crohn’s disease, what is the investigation of choice

A

MRI

107
Q

what is the BMI cut off score for diagnosing malnutrition

A

<18.5kg/m2

108
Q

HBsAg usually implies what

A

Acute Hep B infection

109
Q

If HBsAg is present for >6 months then what does this imply

A

Chronic disease i.e. infection Hep B infection

110
Q

What does anti-HBs imply?

A

Immunity
either exposure or immunisation

  • this is negative in chronic disease
111
Q

What does anti-HBc imply

A

Previous or current Hep B infection

(IgM is acute/recent, IgG persists)

112
Q

HbeAg is from the breakdown of core antigen from infected liver cells so what does it indicated

A

Infectivity and Hep B replication

113
Q

What virus serology would previous Hep B immunisation show

A

Anti-HBs positive
All others negative

114
Q

Anti-HBc positive
HBsAg negative

A

Previous Hep B (>6 months ago) infection
Not a carrier

115
Q

Anti-HBc positive
HBsAg positive

A

Previous Hep B
Now a carrier (i.e. chronic infection)

116
Q

what is prescribed to patients who drink alcohol excessively

A

oral thiamine

vitamin B co-strong is no longer recommended

117
Q

how long do coeliac disease patients have to eat gluten for before they are tested (blood test for anti-TTG)

A

at least 6 weeks

118
Q

what is a common cause of vitamin deficiencies in scleroderma

A

malabsorption syndrome

119
Q

laxatives recommended for IBS

A

bulk-forming laxative

e.g. isphagula husk

120
Q

what is tested for in blood to see appropriate response to Hep B vaccination

A

anti-HbS

121
Q

what antibiotic is a cause of cholestasis/jaundice

A

flucloxacillin

122
Q

patients with perianal disease in Crohn’s disease tend to have better or worse prognosis

A

worse

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