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MRCP > Gastro > Flashcards

Gastro Flashcards

1
Q

What is achalasia

A

Impaired oesophageal peristalsis due to degen of myenteric neurones (Auerbach’s plexus)

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2
Q

Symptoms of achalasia

A

gradual dysphasia
weight loss
heart burn
chest pain
regurgitation (cough, aspiration)

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3
Q

Gold standard diagnosis of achalasia

A

oesophageal manometry
high tone of LOS when swallowing, no peristalsis lower oesophagus

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4
Q

Management achalasia

A

1) pneumatic dilation
2) Hellers cardiomyotomy
Botox injections, meds (CCB, nitrates)

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5
Q

Appendicitis common ages

A

10-20

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6
Q

Appendicitis symptoms

A

pain central -> RIF (24h)
N&V
anorexia
low grade fever

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7
Q

appendicitis signs

A

Tender over McBurneys Point
Rovsings sign (RIF tenderness when palpating LIF)
Guarding and rebound tenderness (suggests rupture and perionitis)

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8
Q

Appendicitis Diagnosis

A

Clinical + high inflam markers
US pelvis in women/kids
CT if unsure
serum/blood HCG to rule out ectopic
diagnostic laparoscopy if sypmtomatic but investigations normal

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9
Q

Causes of acute pancreatitis

A

Gallstones, Alcohol, post ERCP

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10
Q

How do gallstones cause acute pancreatitis?

A

Block ampulla of Vater causing build up of bile/pancreatic juice causing inflamation

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11
Q

How does alcohol cause pancreatitis?

A

acute - directly toxic to pancreatic cells
chronic- causes fibrosis which leads to loss of function of pancreatic cells

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12
Q

How does acute pancreatitis present?

A

epigastric pain
N&V
Systemically unwell

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13
Q

Acute pancreatitis signs

A

abdo pain
Cullens
Grey Turners

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14
Q

How do you diagnose acute pancreatitis?

A

Clinically + amylase 3x normal upper limit
US to show cause - gallstones
CT abdo - look for complications

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15
Q

How do you assess severity of acute pancreatits?

A

Glasgow Score

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16
Q

How do you manage acute pancreatitis?

A

Supportive
Fluid resus, analgesia, treat gallstones
?IV Abx if complications

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17
Q

Complications of pancreatitis

A

Peripancreatic fluid collections
pseudocysts
pancreatic necrosis
abscess
haemorrhage

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18
Q

Causes of chronic pancreatitis

A

80% alcohol
cystic fibrosis, ductal obstruction

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19
Q

Sypmtoms of chronic pancreatitis

A

pain (15-20mins after eating)
steatorrhoea
diabetes (loss of endocrine function)

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20
Q

Investigations in chronic pancreatitis

A

Abdo XR, abdo CT show pancreatic calcification
faecal elastase to assess exocrine function

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21
Q

Management of chronic pancreatitis

A

lifestyle
analgesia
pancreatic enzyme replacement

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22
Q

What is alcoholic ketoacidosis

A

large alcohol intake, small food intake (or vomit foot which has been consumed) become malnourished. Following alcohol binge body breaks down fat producing ketones -> ketoacidosis

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23
Q

How do you treat alcoholic ketoacidosis

A

IV saline and thiamine

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24
Q

Acute and chronic management of anal fissure

A

Acute <6/52: stool softener, lubricant, topical analgesia
Chronic >6/52: topical GTN, refer for surgery (sphincterotomy) or botulinum toxin

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25
Q

What is angiodysplasia

A

vascular deformity of the gastrointestinal tract which predisposes to bleeding and iron deficiency anaemia

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26
Q

How do you diagnose and manage angiodysplasia?

A

Diagnosis
colonoscopy
mesenteric angiography if acutely bleeding

Management
endoscopic cautery or argon plasma coagulation
antifibrinolytics e.g. Tranexamic acid
oestrogens may also be used

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27
Q

what is liver cirrhosis and what are the main causes?

A

chronic scarring/damage to liver which leads to non reversible changes (fibrosis)
alcohol, NAFLD, viral hep B/C

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28
Q

Pathophysiology of liver cirrhosis

A

hepatocyte damage, stellate cells produce collagen, fibrosis/scar tissue formation

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29
Q

Main complications of liver cirrhosis

A

Portal hypertension -> ascites, splenomegaly, hepatorenal failure
Reduced liver function
Increased ammonia (hepatic encephalopathy)
Increased oestrogen (gynaecomastia, palmar erythema)
Increased uncong. bili (jaundice)
Decreased albumin
Decreased clotting factors

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30
Q

Symptoms of early liver cirrhosis

A

asymptomatic, general (fatigue, weight gain, weakness)

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31
Q

Symptoms of late stage liver cirrhosis

A

Jaundice, itch, ascites, confusion, bruising

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32
Q

Diagnosis of liver cirrhosis

A

biopsy (regenerative nodules, fibrosis)
Fibroscan (transient elastography)

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33
Q

Management of liver cirrhosis

A

stop drinking
antivirals (if hep +ve)
transplant

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34
Q

Screening for liver cirrhosis

A

fibroscan
Hep C +ve
men who drink >50 units/week
women who drink >35 units/week
alcohol related liver disease

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35
Q

Causes of acute liver failure

A

PCM OD
hep A/B
alcohol
fatty liver of pregnancy

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36
Q

In liver failure, which clotting factor is not low and why

A

factor VIII
Synthesised in endothelial cells throughout body not just liver
Requires good hepatic function to clear from blood stream

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37
Q

Scoring system for liver cirrhosis

A

Model for End-Stage Liver Disease (MELD)
Child-Pugh classification

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38
Q

Pathophysiology of alcoholic liver disease

A

alcohol converted to acetaldehyde in liver
this essentially causes neutrophils to invade liver
biproduct of conversion is NADH which causes more fatty acid production

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39
Q

Bloods which would indicate alcohol related liver disease

A

AST ++ ALT + GGT + ALP +
thrombocytopenia

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40
Q

Management of alcoholic liver disease

A

Stop drinking
steroids to suppress immune system

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41
Q

c. diff pathophysiology

A

anaerobic gram-positive, spore-forming, toxin-producing bacillus
transmission: via the faecal-oral route by ingestion of spores

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42
Q

c diff symptoms

A

diarrhoea
abdominal pain
a raised white blood cell count (WCC) is characteristic
if severe toxic megacolon may develop

43
Q

Crohns colonscopy/biopsy findings

A

deep ulcers, skip lesions
transmural inflammation, goblet cells, granulomas cobblestone appearance

44
Q

Crohns SB enema findings

A

Kantors String sign, rose thorn ulcers

45
Q

Crohns management for inducing remission

A

1st line - glucocorticoids
2nd line - 5ASA e.g mesalazine

46
Q

Crohns management for maintaining remission

A

1st line - azathioprine or mercaptopurine
2nd line - methotrexate

47
Q

Extra intestinal features of inflam bowel disease related to disease activity

A

asymmetric arthritis
erythema nodosum
episcleritis

48
Q

Extra intestinal features of inflam bowel disease not related to disease activity

A

symmetric arthritis
uveitis
pyoderma gangremosum
clubbing
primary sclerosing cholangitis

49
Q

Colonoscopy/biopsy findings in UC

A

No inflam beyond submucosa
reduced goblet cells
crypt abscssess
ulceration and pseudopolyps

50
Q

Barium enema findings in UC

A

reduced haustrations
pseudopolyps
drain pipe colon

51
Q

Management for inducing remission in mild/mod UC

A

topical aminosalicylate -> PO aminosalicylate-> PO corticosteroids

52
Q

Management for inducing remission in severe UC

A

admit
IV steroids +/- IV ciclosporin

53
Q

Associations with autoimmune hepatitis

A

HLA DR3
autoimmune disorders
hypergammaglobulinaemia

54
Q

Types of autoimmune hepatits

A

1: ANA and /or SMA (adults and kids)
2: LKM1 (kids)
3: Soluble liver-kidney antigen (adults)

55
Q

Presentation of autoimmune hepatitis

A

chronic liver disease
acute hepatitis
amenorrhoea

56
Q

Ix and Mx autoimmune hepatitis

A

ANA, SMA, LKM1
biopsy: piecemeal necrosis
Mx: steroids, transplant

57
Q

Management of UGIB caused by varices

A

teripressin and Abx before endoscopy
band ligation
TIPS if above fails

58
Q

symptoms of ascending colangitis

A

charcots triad
1) fever
2) RUQ pain
3) jaundice

+hypotension and confusion

59
Q

Ix and mx ascending colangitis

A

US
IV Abx
ERCP after 24-48hrs

60
Q

How is ascites categorised

A

serum ascites albumin gradient more or less than 11

60
Q

Causes of ascites SAAG <11

A

low albumin
malignancy
TB
pancreatitis
obstruction

60
Q

Causes of ascites SAAG >11

A

liver: cirrhosis, ALF, mets
RHF, C pericarditis
Budd-Chiari

61
Q

Management of ascites

A

spiro
drainage
prophylactic Abx ( SBP cipro) if ascitic protein <15

62
Q

Presentation of SBP

A

abdo pain, ascites, fever

63
Q

Ix, cause and Mx SBP

A

E. coli
paracentesis neutrophils >250
IV cefotax

64
Q

What is Barretts and what are the risk factors

A

squamous cell -> columnar (goblet cells, brush border)
GORD, male, smoking

65
Q

Management Barretts

A

high dose PPI
metaplasia: endoscopy 3-5 years
dysplasia: radio-frequency ablation

66
Q

What is c. diff + risk factors + transmission

A

gram +Ve rod
clindamycin, cephlosporins, PPI
faeco-oral

67
Q

Management of 1st episode c.diff

A

vanc -> findax -> vanc ± IV met

68
Q

Management of 2nd episode c. diff

A

<12 weeks: PO findax
>12 weeks: PO findax or PO vanc

69
Q

Coeliac associations

A

Dermatitis herpetiformis
HLA DQ2 and HLA DQ3

70
Q

Complications coeliac

A

Anaemia
hyposplenism
OP
lactose intolerance
subfertility

71
Q

Investigations of coeliac

A

eat gluten 6/52 prior
bloods: TTG antibodies, endomyseal anitbody
Biospy: villous atrophy
crypt hyperplasia
increased intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

72
Q

Management of coeliac

A

stop eating gluten
pneumococcal vaccine

73
Q

What is haemochromatosis?

A

autosomal recessive
chromosome 6
accumlation of iron

74
Q

How does haemachromatosis present, which features are reversible and irreversible

A

Rev
- bronze skin
-HF (DCM)

Irreversible
-DM
- liver disease
- arteritis

75
Q

Investigations of haemachromatosis

A

transferrin saturation - >55% m >50% f
increased ferritin and iron
genetic testing

76
Q

Mangement haemachromatosis

A

1st venesection aim transfer <50% and ferr <50
2nd desferrioxamine

77
Q

What is Wilsons

A

autosomal recessive, chromosome 13
Increased copper
ATP7B gene

78
Q

presentation of wilsons

A

hepatitis, cirrhosis
speech, behavioural
Kayer fletcher rings
blue nails

79
Q

Diagnosis of Wilsons

A

Genetic analysis ATP7B gene

Slit lamp
Low serum caeruloplasmin

80
Q

Management Wilsons

A

penicillamine
trientine hydrochloride

81
Q

Management of hepatorenal syndrome

A

terlipressin
albumin
TIPS

82
Q

Features of IBS

A

abdo pain relieved when bowels opened or associated with altered bowel frequency +2
-altered stool passage
-abdo bloating
-worse when eating
-passage of mucus

82
Q

Red flags of abdo pain

A

Rectal bleeding
weight loss
Fhx
>60

83
Q

What does thumbprinting on abdo XR indicate

A

ishaemic colitis, most likely at splenic flexure

84
Q

What is Meckels Diverticulum

A

congenital remnant of vitellointestinal duct

85
Q

How does Meckels present

A

usually asympotmatic
massive painless GI haemorrhage in kids
obstruction

86
Q

Ix and Mx Meckels

A

Meckels scan or mesenteric arteriography
Surgical removal

87
Q

Presentation of PBC

A

middle aged woman with itch
jaundice
hyperpigmentation
clubbing
liver failure (late)
(raised ALP incidental finding)

88
Q

What conditions is PBC associated with?

A

Sjogrens
RA
systemic sclerosis
thyroid disease

89
Q

How do you diagnose PBC

A

AMA M2
SMA
Raised IgM
MRCP

90
Q

Mx PBC

A

ursodeoxycholic acid
Cholestyramine (itch)
liver transplant if bili >100

91
Q

Complications of PBC

A

OP
hepatocellular ca

92
Q

what is PSC

A

inflam and fibrosis of intra and extra hepatic bile ducts

93
Q

How does PSC present

A

cholestasis: jaundice, itch, increased bili and ALP
RUQ pain
fatigue

94
Q

What is PSC associated wtih

A

US
Crohns
HIV

95
Q

How do you investigate PSC

A

ERCP/MRCP (beaded)
pANCA +ve
Biopsy - onion skin

96
Q

Metabolic markers of refeeding syndrome

A

low Mg, K+ phosphate

97
Q

What is Whipples

A

Rare multi-system disorder caused by tropheryma whippelii

98
Q

Presentation of Whipples

A

middle aged man (HLA-B27)
diarrhoea, weight loss
lymphadenopathy
arthralgia
hyperpigment and photosensitivity
opthalmopegia

99
Q

Whipples investigation

A

jejunal biopsy: macrophages containing PAS granules

100
Q
A

MRCP (19 decks)

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