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MSRA 2023 > Gastro > Flashcards

Gastro Flashcards

1
Q

Ulcerative Colitis extraintestinal ass

A

Primary sclerosing cholagitis

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2
Q

endoscopy findings in UC

A

ulceration with preservation of adj mucosa-> pseudopolyps

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3
Q

UC Mx- Mild to Mod

A

Mild: <4stool day, only small amount of blood
Mod: 4-6 stool/day, varying amountof blood, no systemic upset

topical/ rectal aminosalicylate -> add po aminosalicylate -> po or topical corticosteroid

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4
Q

UC Mx- severe

A

> 6 blood stool/day + systemic upset

admit in hospital
iv steroid!! 1st line
iv ciclosporin if steroid CI OR add if no improvement after 72hrs

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5
Q

Maintenance Mx for UC

A

mild-mod:
proctitis topical aminosalicylate OR po aminosalicylate + rectal aminosalicylate

extensive UC: low maintenance dose po aminosalicylate

severe relap or >2 exacerbation: po azithioprine OR po mercaptopurine

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6
Q

LFT for AFLD & US findings

A

ALT> AST
increased echogenicity on US

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7
Q

Coeliac Disease associated disease + strongly ass with which immuno

A

dermatitis herpetiformis, DM1, autoimmune hepatitis

HLA-DQ2, HLA- DQ8

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8
Q

Dx Coeliac disease: serology + gold standard

A

need to take gluten for at lest 6 weeks

Serology: TTG-Ab IGA 1st line, Eendmyseal Ab IgA, Anti-gliadin, anti-casein Ab

Endoscopic intestinal biopsy=> GOLD STD traditionally taken from duodenum
Histo: villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes, laminia propria infiltration with lymphocytes

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9
Q

How to calculate alcohol units

A

Volume ml x ABV (in decimal) divided by 1000

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10
Q

Haemochromatosis definition and genetic inheritance

A

AR disorder of iron absorption and metabolism

HFE gene on chromosome 6

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11
Q

Iron studies in haemochormatosis

A

Decreased TIBC, increased transferrin saturation M >55%, >50% F
Ferritin high later on

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12
Q

Mx haemochromatosis

A

1st line: gene section weekly monitor adequacy of venesection transferring saturation aim <50%, serum ferritin concentration <50yg/L

2nd line: deferrioxamine

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13
Q

LFT and mx alcoholic liver disease

A

High GGT
AST:ALT >2 , ratio >3 strongly suggests acute alcoholic hepatitis

Mx: glucocorticoids (prednisolone) often used in acute episodes of alcoholic hepatitis

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14
Q

Autoimmune hepatitis classification

A

Type I: ANA and SMA adult and children

Type II: LKM1 Ab children only

Type III: soluble liver kidney Ag adults middle age

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15
Q

Lab findings in Autoimmune hepatitis and other Ix

Mx

A

ANA/ SMA/ LKM1 Ab/ increased IgG

Liver biopsy: piecemeal necrosis, bridging necrosis

Steroid other immunosuppressants

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16
Q

Non-alcoholic fatty liver disease progression and LFT findings

A

Steatosis, stratohepatitis fat with inflammation, progressive disease- fibrosis and liver cirrhosis

LFT: ALT>AST

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17
Q

Inheritance of Wilson’s disease

A

Increased copper absorption and decreased copper excretion

AR, defect ATP7B gene on chromosome 13

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18
Q

Ix esp lab findings in `wilsons disease

A

Keyer -fleischer Ring

Decreased serum ceruloplasmin- carries cupper
Decreased total serum copper, free non-ceruloplasmin bound serum copper increased

Increased 24 hour Cu excretion

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19
Q

Mx Wilson’s disease

A

Penicillamine chelates Copper 1st line

Trentine hydrochloride alternate chelating agent may become 1st line in future. Tetrathiomolybolate newer agent

20
Q

Ass disease with primary biliary cholangitis

A

Sjogren 80%

RA, systemic sclerosis, thyroid disease

21
Q

Ix os primary biliary cholangitis

A

High ALP, aMA Ab- anti mitochondrial M2 Ab, high IgM
US and MRCP

22
Q

Mx of primary biliary cholangitis

A

1st line: ursodeoxycholic acid
Pruritus: chilestyramine
Liver transplant if Bb >100

23
Q

Relationship between primary sclerosing cholangitis and UC

A

UC 4% pts have PSC
PSC 80% pts have UC

24
Q

Ix of primary sclerosing cholangitis

A

WRCP/ MrCP std dx multiple biliary strictures beaded appearance

P-ANCA maybe +

25
Q

PBC vs PSC

A

PBC- intrahepatic bile duct inflammation, AMA, ursodeoxycholic acid improves survival

PSC- intra and extra hepatic bile duct inflammation
Ass with UC, ursodeoxycholic acid does not improve survival

26
Q

Mirrizi syndrome

A

Common hepatic duct obstruction caused by extrinsic compression from impacted stone in cystic duct/ infundibuoum of gall bladder

27
Q

Ix and mx of bile acid malabsorption

A

SeHCAT: nuclear medicine test using gamma emitting molecule scan done 7d apart to assess retention/ loss of radiolabelled SeHCAT

Mx: bile acid sequestration- cholestyramine

28
Q

Most common cause of HCC world and Europe

A

World help B, Europe help C

29
Q

Endoscopy findings of UC and CD

A

UC: widespread ulceration with preservation of adjacent mucosa which has appearance of polyps

CD: deep u,cert skip lesions cobble stone like appearance

30
Q

Classification of UC

A

Mild: <4 stools/day, small amount of blood

Mod: 4-6 stools/day, varying amount of blood, no systemic upset

Severe: >6 stools/day and feature of systemic upset.

31
Q

Maintenance of left sided/ extensive UC and following severe relapse/ >2 exacerbation in post year

A

Left sided + extensive UC: low maintenance dose of po aminosalicylate

Following severe relapse/ >2 exacerbation in past year:po azathioprine or po mercaptopurine.

32
Q

Associated sx in CD and uC

A

CD and UC: arthritis, erythema nodosum, osteoporosis

CD: episcleritis

UC: pSC, uveitis

33
Q

1st line for maintaining remission for CD

A

Azathioprine/ mercaptopurine

34
Q

Associated disease in coeliac disease

A

Dermatitis herpetiformis, autoimmune disorder: type 1 DM, autoimmune hepatitis,

HLA-DQ2 and HLA-DQ8

35
Q

How long to you have to take gluten before dx of coeliac disease

A

6 weeks

36
Q

H pylori dx

A

Urea breath test - may be used to check H pylori eradication

Rapid urease test CLO test

37
Q

Mx of Barrett’s oesophagus

A

High dose PPI
Endoscopic surveillance with biopsies for metaplasia

If dysplasia- 1st line radiofreq ablation esp for low grade dysplasia . Endoscopic mucosal resection

38
Q

Which score to use in UGIB

A

Glasgow blatchford score OP/IP mx
Rock all score

39
Q

Peru’s jeghers syndrome inheritance

A

AD numerous polyps in HI tract
Haemartomatous polyp in GI tract mainly SMALL bowel- SBO or intussusception and increased GI bleeding

40
Q

Ix pancreatic cancer

A

CT investigation of choice

41
Q

Ascites Ix

A

SAAG serum ascites albumin gradient >11g/L and <11g/L

> 11g/L: liver disorder are the most common cause- cirrhosis/ alcoholic liver disease, acute liver failure, liver metastases, cardiac rt heart failure, constrictive pericarditis, other causes- budd chairing syndrome, portal vein thrombosis, venom-occlusive disease, myxoedema]
<11g/L: hypoalbuminaemia- nephrotic sy, severe malnutrition, malignancy , infection tuberculous peritonitis, other causes- pancreatitis, vowel obstruction, biliary ascites, postoperative lymphatic leak, serositis in connective tissue disease

42
Q

Mx ascites

A

Fluid restrict is Na- <125mmol/l
Aldosterone ATG spironolactone, albumin cover HAS, decreased paracentesis-induced circulatory dysfunction & mortality, paracentesis induced circulatory dysfunction

Prophylactic abx

43
Q

Virchow’s node, sister Mary Joseph node

A

Virchows node left supraclacivular LN

Sister Mary Joseph’s Node

44
Q

Pernicious anaemia Ix and ass disease

A

Ab to intrinsic factor +/- gastric parietal cells

Ass disease: thyroid, DM1, addisons, RA, viltiligo

45
Q

Ix carcinoid tumour

A

Urinary 5-HIAA
Plasma choreographing A

46
Q

Mx of carcinoid tumour

A

Somatostatin analogue
Diarrhoea:cryproheptadine

MSRA 2023 (22 decks)

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