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MRCP - Passmed > Gastro > Flashcards

Gastro Flashcards

1
Q

What’s the rule for PBC?

A

The M rule:

IgM
anti-Mitochondrial ab M2
Middle aged females

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2
Q

Early signs - asymptomatic eg raised ALP on routine LFTs, fatigue pruritis

Suggestive of?

A

PBC

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3
Q

What other conditions is PBC associated with?

A

Sjogren’s syndrome (seen in up to 80% of patients)
rheumatoid arthritis
systemic sclerosis
thyroid disease

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4
Q

When for liver transplant in PBC?

A

Bilirubin >100

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5
Q

Histology showing:
inflammation in all layers from mucosa to serosa
goblet cells
granulomas

Suggestive of?

A

Crohns

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6
Q

Diarrhoea, weight loss, arthralgia, lymphadenopathy, ophthalmoplegia - what condition? cause? more common in who?

A

Whipples disease - Infection by tropheryma whipplei

More common in HLA B27 +ve and middle aged MEN

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7
Q

jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules - which disease?

A

Whipples disease

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8
Q

Severity of UC flare ups?

A

mild: < 4 stools/day, only a small amount of blood

moderate: 4-6 stools/day, varying amounts of blood, no systemic upset

severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)

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9
Q

Mx of severe UC colitis?

A

Admission + IV steroids
(IV ciclosporin if CI)

If no improvement in 72h consider adding IV ciclosporin / surgery

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10
Q

Flushing, diarrhoea, bronchospasm, tricuspid stenosis, pellagra

Diagnosis? ix? mx?

A

Carcinoid syndrome

Ix - Urinary 5-HIAA + plasma chromogranin A y

Mx - Somatostatin analogue (octretride)
- Cyproheptadine may help with diarrhoea

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11
Q

biospy shows pigment laden macrophages in someone having diarrhoea is suggestive of? Colonscopy findings?

A

Laxative abuse (esp Senna)

Colonoscopy - dark-brown discolouration in the proximal colon (Melanosis coli)

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12
Q

What needs to be offered to everyone with Coeliac, how often and why?

A

Pneumococcal vaccination 5 yearly due to functional hyposplenism

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13
Q

Grading of hepatic encephalpathy?

A

Grade I: Irritability
Grade II: Confusion, inappropriate behaviour
Grade III: Incoherent, restless
Grade IV: Coma

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14
Q

Prophylaxis of hepatic encephalopathy?

A

Lactulose (increased excretion and metabolism of ammonia)

Can also add Rifaximin (Modulates gut flora -> decreased ammonia production)

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15
Q

Suspected pathophysiology of hepatorenal syndrome?

A

Sphlanchnic vasodilation -> underfilling of kidneys

Noticed by juxtaglomerular apparatus -> RAAS activation -> Renal vasoconstriction (doesn’t counterbalance enough)

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16
Q

Difference between Type 1 and 2 Hepatorenal syndrome?

A

Type 1 - rapidly progressive - v. poor prognosis

Type 2 - slowly progressive - poor prognosis but better than type 1

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17
Q

Electrolyte abnormalities in refeeding syndrome?

A

Hypophosphataemia (HALLMARK)
-> muscle weakness inc cardiac (-> cardiac failure) and diaphragm (-> resp failure)

Hypokalaemia

Hypomagnesaemia (can lead to trosades de pointes)

Abnormal fluid balance

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18
Q

Mode of transmission - C Diff

A

Faecoral via ingestion of spores

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19
Q

Markers of pancreatitis severity?

A

age > 55 years
hypocalcaemia
hyperglycaemia
hypoxia
neutrophilia
elevated LDH and AST

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20
Q

mx of eosinophilic oesophagitis?

A

Dietary modification + topical steroids

Oesophageal dilatation - reduces sx associated with strictures

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21
Q

Signs of life threatening C Diff? Mx?

A

Hypotension
Partial or complete ileus
Toxic megacolon, or CT evidence of severe disease

Mx: Oral Vanc + IV Metro

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22
Q

What bloods in Coeliac?

A

TTG ab

IgA - if IgA deficiency gives false +ve

(Can also look at anti-fliadin and anti-casein ab)

23
Q

Histology:
villous atrophy
crypt hyperplasia
increase in intraepithelial lymphocytes
lamina propria infiltration with lymphocytes

A

Coeliac

24
Q

Drug causes of cirrhosis?

A

Methotrexate
Methyldopa
Amiodarone

25
Q

Drug causes of cholestasis +- hepatitis?

A

combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin* (reduced w erythromycin stearate)
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine

26
Q

Iron studies:
transferrin saturation > 55% in men or > 50% in women
raised ferritin (e.g. > 500 ug/l) and iron
low TIBC

Suggestive of? Which marker is most sensitive and specific for the condition?

A

Haemochromatosis

Transferrin sat > ferritin
- in early disease ferritin is usually normal

27
Q

Liver and neurological disease -> diagnosis?

A

Wilsons

28
Q

Tx for Wilsons?

A

Currently - Pencillamine (chelates copper)

Future - Trientine HCl (also chelating agent)
Tetrathomolybdate also under ix for possible use

29
Q

What is angiodysplasia thought to be debatably associated with?

A

AS

30
Q

Adverse effects of PPIs?

A

hyponatraemia, hypomagnasaemia
osteoporosis → increased risk of fractures
microscopic colitis
increased risk of C. difficile infections

31
Q

Ix of small bowel bacterial overgrowth syndrome? similar to which other condition in presentation?

A

H breath test

Similar to IBS in presentation

32
Q

Dysphagia, aspiration pneumonia, halitosis

Suggestive of which disease?

A

Pharyngeal pouch

33
Q

How is SBP diagnosed?

A

Paracentesis with neutrophils >250 cells/ul

34
Q

raised ALP/GGT and associated hyperbilirubinemia suggests?

A

Cholestatic picture

35
Q

Which investigation is best for local staging of oesophageal / gastric ca?

A

Endoscopic USS

36
Q

What drug can be useful if someone has had multiple episodes of C. Diff in the past?

A

Bezlotoxumab - Mab targeting C Diff toxin

37
Q

H. pylori post-eradication therapy test?

A

Urea breath test

38
Q

Where is Gastrin secreted from?

What does it do?

A

G cells in antrum of the stomach

Increases acid secretion by gastric parietal cells, pepsinogen and IF secretion, increases gastric motility, stimulates parietal cell maturation

39
Q

Where is CCK released from?

What does it do?

A

I cells in upper small intestine

Increases secretion of enzyme-rich fluid from pancreas, contraction of gallbladder and relaxation of sphincter of Oddi, decreases gastric emptying, trophic effect on pancreatic acinar cells, induces satiety

40
Q

Where is Secretin released from?

What does it do?

A

S cells in upper small intestine

Increases secretion of bicarbonate-rich fluid from pancreas and hepatic duct cells, decreases gastric acid secretion, trophic effect on pancreatic acinar cells

41
Q

Where is VIP released from?

What does it do?

A

Small intestine, pancreas

Stimulates secretion by pancreas and intestines, inhibits acid secretion

42
Q

Where is somatostatin released from?

What does it do?

A

D cells in the pancreas & stomach

Decreases acid and pepsin secretion, decreases gastrin secretion, decreases pancreatic enzyme secretion, decreases insulin and glucagon secretion
inhibits trophic effects of gastrin, stimulates gastric mucous production

43
Q

What does a high SAAG tell us?

A

Indicates portal HTN

44
Q

Scoring system for likelihood of appendicitis?

A

Alvarado score

45
Q

What is the scoring system for prognosis in liver cirrhosis?

A

Child-Pugh

46
Q

What is the scoring system used in end-stage liver disease?

A

MELD score

47
Q

Which Mab can be used for C Diff? When to consider FMT?

A

Bezlotoxumab

FMT can be used if pts have had 2+ episodes

48
Q

Best bloods to monitor tx in haemochromatosis?

A

Transferrin saturation and ferritin

49
Q

What is angiodysplasia?

What is it associated with?

A

Vascular deformity of GI tract -> bleeding and IDA

Associated with AS and generally older patients

50
Q

Which drugs cause cholestasis?

A

Cholestasis Always Stops The Paediatrician From Saving the NHS

COCP
Antibiotics (fluclox, co-amox, erythromycin)
Steroids (anabolic)
Testosterone
Phenothiazines (chlorpromazine, prochlorperazine)
Fibrates
Sulfonylureas
Nifedipine

51
Q

What are some common triggers for liver decompensation in cirrhotic patients?

A

Constipation / Diarrhoea
Infection
Electrolyte imbalances
Dehydration
UGIB
Increased alcohol intake

52
Q

Medical prophylaxis against oesophageal variceal bleeding?

A

NSBB - Propanolol

53
Q

Mx of ascites?

A

Aldosterone antagonists eg Spironolactone

54
Q

1st line test for small bowel overgrowth syndrome? mx?

A

H breath testing

mx: Rifaximin

MRCP - Passmed (15 decks)

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