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MRCP - Part 1 > Gastro > Flashcards

Gastro Flashcards

1
Q

Peripheral stigmata of chronic liver disease

A

Palmar erythema
Spider naevi
Dupytrens contracture
Gynaecomastia
Caput medusae
Splenomegaly

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2
Q

Why do you get splenomegaly in ALD?

A

Portal HTN

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3
Q

What is a fibroscan for

A

To quantify liver fibrosis

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4
Q

What are the majority of gastric cancers

A

Adenocarcinomas
Arising from the glandular epithelium

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5
Q

RFs for gastric cancers

A

Japanese
H pylori
Hypochlorodyia
- pernicious anaemia
- chronic atrophic gastritis
- partial gastrectomy
FH
Male
Age
High salt / nitrates ./ processed foods
Gastric polyps

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6
Q

What is virchows node

A

A palpable lymph node in the left supraclavicular fosssa, which indicates the spread of an Upper GI malignancy

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7
Q

What is PSC

A

Progressive bile duct inflammation, stricturing and cholestasis which is autoimmune medicated
Results in scarring of the bile ducts and accumulation of toxins

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8
Q

60-70% of people with PSC have what?

A

UC

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9
Q

How is PSC diagnosed?

A

MRCP

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10
Q

Presentation of PSC

A

Asymptomatic
Fatigue
Pruritis
Obstructive jaundice
Cirrhosis/hepatic failure

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11
Q

Which blood test is raised in PSC?

A

ALP

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12
Q

What antibodies may be present in PSC?

A

Anti smooth muscle
Anti-nuclear antibodies

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13
Q

What relieves itching in PSC?

A

Cholestyramine

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14
Q

Tumour marker for CRC

A

CEA

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15
Q

Tumour marker for pancreatic ca

A

CA19-9

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16
Q

The combination of liver disease, resp disease and a FH of resp disease indicates what?

A

a-1 anti trypsin defieincy

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17
Q

Liver biopsy findings of a1 anti trypsin defiiency

A

PAS positive, diastase resistant globulesin periportal hepatocytes

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18
Q

What antibodies are seen in PBC

A

Anti-mitochondrial Abs (AMA)
Raised IgM

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19
Q

Rash assosciated with coaeliac

A

Dermatitis herpetiformis

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20
Q

Antibodies used in the detection of coeliac disease

A

Anti-endomysial IgA
Anti-gliadin IgG
Anti-reticulin IgM or IgG
Anti-TTG

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21
Q

Definitive test of coeliac disease

A

Duodenal biopsy

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22
Q

When drugs have a high rate of first pass metabolism, what does this mean?

A

High liver extraction

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23
Q

Drugs that have a high rate of first pass metabolism

A

Propranolol
Verapramil
Morphine

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24
Q

Pathophysiology of haemachromatosis

A

Decreased plasma hepcidin
C282Y mutation (Genetic code for HFE protein)

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25
Q

What can give rise to BOTH intra and extra hepatic bile duct dilatation

A

PSC
Cholangiocarcinoma

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26
Q

What organism is responsible for > 50% of SBP

A

E coli

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27
Q

Features of haemachromatosis

A

Hepatic dysfunction
Diabetes
Joint pains
increased skin pigmentation

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28
Q

Gene change in haemachromatosis

A

HFE gene

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29
Q

What is in excess of haemachromatosis

A

Iron

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30
Q

What is in excess of wilsons disease

A

Copper

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31
Q

What is the most common complication of H pylori

A

DU

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32
Q

Histology of CD

A

Transmural (full thickness)
Patchy skip lesions
Non caesating granulomas

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33
Q

Histology of UC

A

Inflammation confined to mucosa and submucosa
Histological changes to crypts are common, including crypt distortion, neutrophilic crypt distraction and crypt abscesses

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34
Q

Treatment of aspirin overdose

A

Activated charcoal

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35
Q

Causes of drug induced hepatitis

A

Fenofibrate
Methyldopa
Carbamazepine
Nitrofurantoin
Isoniazid

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36
Q

When are black pigment gallstones often seen

A

Haemolysis
Cirrhosis

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37
Q

When are brown pigment gallstones seen

A

Very rarely seen in UK
Stasis and infection in the biliary system
Prescence of E coli or Klebsiella

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38
Q

WHat makes up 80% of gallstones in the UK

A

Cholesterol

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39
Q

Assosiations of cholesterol gallstones

A

Hypertriglyceridaemia

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40
Q

What is the appearance of a bird beak on barium swallow indicatative of ?

A

Achalasia

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41
Q

Treatment of wilsons disease

A

Penicillaemine

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42
Q

Blood and urine findings in wilsons disease

A

Decreased serum copper and caeroplasmin
Increased urinary copper excretion

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43
Q

What is boerhave syndrome

A

Oesophageal rupture following repeated and severe vomiting

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44
Q

What is a diuefloys lesion

A

Bleeding from a totorous dilated artery in the mucosa of the GI tract, usually the stomach

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45
Q

Blood features of pernicious anaemia

A

Increased bilirubin
Megaloblastic anaemia

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46
Q

Antibodies of pernicious anaemia

A

Anti parietal cell Abs (90%)
Anti-thyroid Abs (50%)

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47
Q

Treatment of pernicious anaemia

A

VitB12 injections

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48
Q

What is there an increased incidence of in the elderly with pernicious anaemia

A

Gastric carcinoma

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49
Q

Imaging modality if suspecting appendicitis

A

CT

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50
Q

Histology of CD

A

Transmural inflammation
Skip lesions
Fissuring ulcers
Mucosal ulcers
Lymhpoid aggregates
Neutrophil infiltrates
Non ceseating granulomas

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51
Q

Histology of UC

A

Mucosa and submucosa only
Inflammatory cell infiltrate
Crypt abscesses

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52
Q

ALT to AST ratio in NAFLD rather than ALD

A

ALT : AST > 2 suggests NAFLD rather than ALD

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53
Q

Haematological S/Es of ribavirin (Hep C Tx)

A

Haemolytic anaemia
Nausea / vomiting
Dry mouth
Stomatitis
`

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54
Q

Test to assess pancreatic exocrine function

A

Faecal elastase

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55
Q

Inheirtance of gardener syndrome

A

AD

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56
Q

Features of gardener syndrome

A

Multiple adenomatous intestinal polyps
Colonic carcinoma
Osteomas
Soft tissue tumours including lipomas, fibromas and epidermal cysts
Congenital hypertrophy of retinal pigment epithelium

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57
Q

Genetics of gardener syndrome

A

Mutation on APC gene on chromosome 5q21

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58
Q

What kind of polyps are most concerning for the development of CRC

A

Serrated polyps

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59
Q

What kind of anaemia does vit B12 malabsorption give

A

Macrocytic

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60
Q

Treatment of tropical spruae

A

Tetracycline
Folic acid

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61
Q

S/Es azathioprine

A

Pancreatitis
Hypersensitivity reactions
Intestinal nephritis (rare)
Bone marrow suppression
Liver disease

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62
Q

What part of a feed in an alcoholic patient can increase the risk of encephalopathy and why

A

Protein rich feeds
Adds to the total ammonia burden

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63
Q

Features of Menetriers disease

A

Rare condition
Giant gastric folds, predominantly in the fundus and body of the stomach
Histology
- gastric pits
- gland atrophy
- increase in mucosal thickness

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64
Q

Presentation of menetriers disease

A

Epigastric pain
Mild hypoalbuminuaemia
No gastric acid production in advanced cases

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65
Q

What is the most sensitive test for Hep C infection

A

HCV RNA

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66
Q

What does the spleenic artery supply

A

The spleen

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67
Q

What does the gastroepiploic artery predominantely supply

A

The stomach

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68
Q

What does the anterior superior pancreaticoduodenal artery supply

A

Anterior duodenum
Pancreas

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69
Q

What does the proximal gastroduodenal artery supply

A

Pylorus
Proximal duodenum
Then gives rise to several branches including
- posteior superior pancreaticoduodenal artery

70
Q

What does the posterior superior pancreaticoduodenal artery supply

A

Posterior aspect of the duodenum

71
Q

Overall mortality rate from vairceal bleeds

A

30%

72
Q

Assosiations of anti-LKM positive antibodies

A

Autoimmune hepatitis
Drug induced hepatitis

73
Q

Drugs that are known to cause chronic hepatitis

A

Methyldopa
Ketonazole
Isoniazid
Nitrofurantoin

74
Q

WHat are the most common areas for ischamemic colitis and why

A

Splenic flexure
Sigmoid colon
The two blood circulations meet here and have limited collateral networks making ischaemic damage more common (watershed areas)

75
Q

Features of achalasia

A

Abrupt onset dysphagia - fluids then liquids
Often without weight loss
Regurgitation
Night time cough
Sore throat in the morning

76
Q

Investigation of achalasia

A

OGD to rule out carcinoma
Barium swallow (rats tail appearance at lower sphincter)
Pull through manometry (most specific)

77
Q

What is Gilberts syndrome

A

Mild loss of glucuronosyltransferase activity
AR inheritance
Failure of conjugation results in an uncongjugated hyperbiliruaemia
Episodes of jaundice induced by fasting and are self limiting

78
Q

Where are amino acids absorbed

A

Jejunum

79
Q

What is suggestive of wernickes in a patient who seems likely to have ALD

A

Opthalmoplegia
Ataxia
Confusion
Lacks specific neurological signs
Visual and hearing disturbance
Changes in cognition
Seizures

80
Q

Important and dangerous complication of E coli 0157

A

HUS

81
Q

Features of HUS

A

Haemolytic anaemia
AKI
Thrombocytopenia

82
Q

What can C diff cause on proctoscopy

A

Inflammed rectum

83
Q

Treatment of C diff

A

Vancomycin

84
Q

Tests for Hep A

A

HAV - IgM (Hep A immunoglobulin) and HAV - IgG (Hep A immunoglobulin G)

85
Q

Positive HAV-IGM and HAV-IGG means what

A

Acute Hep A is likely

86
Q

Positive HAV-IGG and negative HAV-IGM means what

A

Past Hep A or previous immunisation

87
Q

What rises in acute hep B infection

A

Hepatitis surface antigen (HBsAg)

88
Q

When the Hep B surface antigen is detectable, what is detectable roughly at the same time

A

Hepbatitis B e antigen
Hepatitis B virus DNA

89
Q

What does the prescence of Hep B surface antigen, Hep B e antigen and Hep B virus DNA indicate?

A

Progression to chronic Hep B

90
Q

What does IgM anti-HepBc indicate

A

Presence of infection last 6 months

91
Q

What does IgG anti-hepBC indicate

A

Past infection
Persists for life

92
Q

WHat does anti-HBs without anti-HepBc mean

A

A marker of immunisation

93
Q

What confirms exposure to Hep C

A

anti-HCV antibodies

94
Q

What confirms ongoing infection in Hep C

A

HCV-PCR

95
Q

What is whipples disease

A

Infectious condition by bacterium trophyerma whippleli

96
Q

Investigation of whipples disease

A

Biopsy of small intestina lamina propria
- infiltration by PAS positive macrophages containing gram positive bacilli

97
Q

Treatment of whipples

A

Prolonged treatment with co-trimoxazole
Ceftriazxone
Penicillin

98
Q

Criteria for liver transplant secondary to paracetomal OD

A

ph <7.3
INR > 6.5 and creatinine > 230 and grade 3/4 HE

99
Q

Extraintestinal manifestation assosiated with HCV

A

Mixed cryoglobuninuria

100
Q

Presentation of mixed cryoglobuniuria

A

Arthralgia
Palpable purpura
Signs of organ involvement sudch as nephropathy

101
Q

Presentation of villous adenomas

A

Hypokalaemia, hypochloroic metabolic acidosis
Copious diarrhoea
IDA

102
Q

Indications for referral to fundoplication

A

Young age
Persistent reflux symptoms despite maximal PPI therapy
Ongoing resp symptoms

103
Q

What does protein C deficiency make you have

A

A hypercoagulable state

104
Q

Causes of bacterial overgrowth syndrome

A

Upper GI surgeyr
Immunosuppresion
Chronic illlness e..g ESRF / liver cirrhosis
Use of PPIs
Conditions that affect gut motility e.g. diabetes
Scleroderma
CD

105
Q

Investigations for bacterial overgrowth syndrome

A

Hydrogen breath test

106
Q

What is Budd Chairi syndrome

A

Obstruction to the venous outflow system of the liver due to the obstruction of the hepatic vein

107
Q

Who is at risk of getting Bud Chairi syndrome

A

Hypercoagulable states
- leukaemia
- polycythaemia
- COCP

108
Q

Presentation of budd chairi syndrome

A

Abdominal pain
Nausea
Vomiting
Tender hepatomegaly
Ascites

109
Q

Investigations for pernicious anaemia

A

Anti parietal and anti intrinsic cell antibodies

110
Q

Pathological cause of wernickes

A

thiamine (vit B1) deficiency

111
Q

What is melanis coli secondary to

A

Laxative use

112
Q

What at baseline is the best marker for prognosticating treatment for Hep C

A

Viral genotyping

113
Q

Characteristic sign on AXR for sigmoid volvulus

A

Coffee bean sign (ennourmously dilated bowel loop)

114
Q

8 criteria of the glasgow severity score for acute pancreatitis

A

age > 55
PO2 < 8
WCC > 15
corrected ca < 2
ALT > 200
LDH > 600
Glucose > 10
Urea > 16
Albumin < 32

115
Q

What is a well known recognised feature of active small bowel crohns disease

A

Finger clubbing

116
Q

What should be offered to patients with suspected variceal bleeding

A

IV terlipressin

117
Q

Features of dublin Johnson syndrome

A

Defective hepatic secretion of conjugated bilirubin
Results in mild conjugated hyperbiliuranaemia (high direct bilirubin)
AR inheritance
Liver biopsy - dark granular pigments
No Tx required

118
Q

What does pseudomembranous colitis occur secondary to?

A

C diff infection

119
Q

Investigation for bile acid malabsorption

A

SeHCAT test

120
Q

Investigation for haemachromatosis

A

Transferrin saturation

121
Q

What does the prescence of multiple ulcers and hyperparathyroidism indicate

A

Zollinger ellison syndrome

122
Q

What is zollinger ellison syndrome

A

Pancreatic tumour that secretes gastrin

123
Q

Investigation of zollinger ellison syndrome

A

Serum gastrin level

124
Q

Genetic tests for coaeliac

A

HLA DQ2 and HLA DQ8

125
Q

Does smoking make UC better or worse

A

Better

126
Q

Does smoking make CD better or worse

A

Worse

127
Q

What is the classic histological finding of Hep E infection

A

Marked chloestasis

128
Q

What stimulates gastrin release

A

Gastrointestinal luminal peptides
Stomach distension
Vagal stimulation
Hypercalcaemia

129
Q

Blood tests in coaelic disease

A

Howel jolley bodies (due to functional hyposplenism)
anaemia (microcytic/ IDA)

130
Q

What organism are you concerned if an HIV positivie patient with poor complicance with meds presents with diarrhoea

A

Cryptosporidium (voluminous diarrhoea ++)
CMV (slightly lower stool frequency, abdo pain and fever)
Microsporidium (VERY low CD4 counts < 50)
Isospora (when travel hx)
Mycobacterium avium intracellulare (assosiated with severe immunodeficiency and other organ systems involved e.g. resp)

131
Q

Antibodies of autoimmune hepatitis

A

Smooth muscle antibodies (70%)
Anti-nuclear factor antibodies (70%)
anti-mitochondrial antibodies

132
Q

Treatment of chlorea

A

Single dose of PO doxycycline 300mgg

133
Q

What does thrumbprinting at the splenic flexure on a AXR indiciate

A

Ischaemic colitis

134
Q

What happens to uric acid levels in the serum in wilsons disease

A

Low

135
Q

Inheritance of peutz jeger syndrome

A

AD

136
Q

What deficiency are hair loss and dermatitis classic of

A

zinc deficiency

137
Q

Vitamin C role in collagen synthesis

A

Hyroxylation of procollagen proline and lysine

138
Q

Presentation of vit b12 deficiency

A

Peripheral neuropathy
Angular stomatitis

139
Q

Presentation of chronium deficiency

A

Impaired glucose metabolism and tolerance

140
Q

Presentation of copper deficiency

A

Neurological sx - peripheral neuropathy or optic neuropathy
Anaemia and neutropenia

141
Q

Presentation of selenium deficiency

A

Dilated cardiomyopathy

142
Q

Disease assosiated with vitamin C deficiency

A

Scurvery

143
Q

What causes enteric fever

A

Salmonella

144
Q

Test for chronic enteric fever

A

Culture from intestinal secretions, faeces or urine

145
Q

who gets hydatid disease

A

Sheep farming work

146
Q

WHat causes hydatid disease

A

Propagating cysts formed by echinococcus granulosis
Cysts form in the liver and rarely in the lungs

147
Q

Investigation and treatment of hydatid disease

A

USS
Potential surgery +/- albendazole

148
Q

Blood film of HUS secondary to E coli 0157

A

Schisocytes

149
Q

Daily potassium replacement

A

1mmol/kg/day

150
Q

Example of a prokinetic drug used in gastroporesis

A

Domperidone

151
Q

Investigation of a patient who you suspect is having a protein leaking enteropathy

A

stool sample for a1 antitrypsin

152
Q

Treatment of giardia

A

Tinidazole

153
Q

Common complication of giardia infection

A

Lactose intolerance

154
Q

What is the most potent gastrin stimulator

A

amino acids

155
Q

WHat does gastrin do?

A

Increased gastric motor activity
Acid secretion
Mucosal growth
Smooth muscle contraction

156
Q

Quick way of inducing remission in severe IBD flare

A

Infliximab

157
Q

Mutation of haemachromatosis

A

C282Y

158
Q

What is GAVE also known as

A

Watermelon stomach

159
Q

What are common in severe malnutrition

A

Steatohepatitis
Hypercholesteraemia

160
Q

What is the most sensitive test for Hep B viral duplication

A

HBV DNA

161
Q

Blood film for hyposplenism

A

Howell Jolley bodies

162
Q

Calorie requirements to maintain weight

A

25-35kcal/kg

163
Q

Genetic mutation of HNPCC

A

MSH2 mutation

164
Q

Genetic mutation of FAP

A

APC mutation

165
Q

Treatment of Hep B

A

Infection resolves in > 90% of adults who have acute Hep B without intervention
Observe and repeat measurement of Hep B PCR test

In younger age (infancy) and underlying immunosuppression - need treatment

166
Q

Correct pH if a NG tube is placed in the stomach

A

1.5 - 3.5

167
Q

What is the deficiency seen in roux-en-Y bypass surgery

A

Iron

168
Q

Features of bechets disease

A

Anterior uveritis
Orogenital ulceration
Erythema nodosum
Prev DVT

169
Q

Leukocyte antigen assosiation of Bechets disease

A

B-51

170
Q
A

MRCP - Part 1 (19 decks)

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