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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

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70
Q

What does the posterior superior pancreaticoduodenal artery supply

A

Posterior aspect of the duodenum

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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

How long post EBV virus do you need to avoid contact sports

A

4 weeks

171
Q

Worst prognostic factors of child pugh scoring

A

Moderate ascites
Bilirubin > 51.3
Albumin < 28
PT >6
INR > 2.3
Encephalopathy Grade 3-4

172
Q

What should be given to patients who have an acute exacerbation of their UC with little or no improvement within 72 hours of starting their IV steriods or whose symptoms worsen at any time despite steriod treatment

A

Ciclosporin or infliximab
(surgery thereafter)

173
Q

Where is gastrin produced

A

G cells in the pyloric antrum and duodenum

174
Q

What causative organism would you think of for symptoms of diarrhoea only when travelling

A

E Coli

175
Q

Most common site for gastrinomas

A

First part of the duodenum

176
Q

One third of patients with achalasia have co-existing what

A

Malignancy

177
Q
A

MRCP - Part 1 (20 decks)

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