Gastro Flashcards
Mode of inheritance of Haemochromatosis?
Autosomal recessive.( He-man in his small cart)
K/c/o - peptic ulcer - hematemesis,melena - bp is unstable,repeat endoscopy shows persistent bleeding. Mx?
Surgical intervention.
It’s a non variceal bled with persistent bleeding and unstable vitals.
Patient on Dabigatran- develops melena.
RX?
Idarizumab.
Secretin- Location & function?
S cells in pancreas.
Function-Increase in bicarbonate rich fluid from pancreas.
Gastrin - Location & function
G cells in stomach.
Increases HCL production from gastric parietal cells- increases GI motility.
somato(do)statin
D cells from pancreas.
Reduces secretion from pancreas.
Reduces secretion of Serotonin
C.Diff risk factor ?
PPIs
Clindamycin.
C.Diff Management.
- Oral vancomycin
- Oral Fidaxomycin.
- Oral vancomycin+ IV metronidazole
Bezlotoxumab(Monoclonal antibody)
Targets C.diff toxin
Life threatening- 3rd option.
C.diff 2nd line?
oral fidaxomycin.
C.diff monoclonal antibody ?
Bezlotoxumab.
C.diff 3rd line
Oral vancomycin + IV metronidazole .
72 year old admitted for diarrahoea.on antibiotics. now - multiple white plaque.
Pseudomebranous colitis.
SAAG > 11g/L indicates
Portal Hypertension.
SAAG > 11g/L causes :-
liver : Cirrhosis,ALD
Cardiac: Rt heart Failure, constrictive pericaditis.
Other- Budd chiari , hepatic vein thrombosis.
Bud chiari leads to SAAG > or < 11
SAAG > 11.
Cancer ass with HNPCC
colorectal cancer( coal grill)
Endometrial cancer( endometrium shaped water bag on hen)
In HNPCC(Lynch Syndrome), mutation in which gene?
MSH2 gene.
H/o of copd
+ on salbutamol/beclomethason
+ odynophagia
Oesophageal Candidiasis
K/c/o cirrhosis- ascites+abd pain+ fever + neutrophil count >250 cells/ul. Dx-
spontaneous bacterial peritonitis.
spontaneous bacterial peritonitis.
K/c/o cirrhosis- ascites+abd pain+ fever + neutrophil count >250 cells/ul. Dx-
In spontaneous bacterial peritonitis, most common organism:-
Ecoli.
Rex of spontaneous bacterial peritonitis.
IV Cefotaxime.
Prophylaxis- oral ciprofloxacin or
Oral Norfloxacin.
Strongest ass with H.pylori:
duodenal ulceration.
H Pylori eradication therapy :
CLAMP down on H pylori :
Clarithromycin, Amoxicillin/Metronidazole , + PPI.
Autoimmune hepatitis is ass with which immunoglobulins ?
IgG.
Young Female+ other autoimmune diseases+ Amenorhea + Deranged LFTs+ Raised IgG
Autoimmune hepatitis.
Bariatric surgery which leads to max malabsorption :
Biliopancreatic division with duodenal switch.
Duodenum: absorption of iron and calcium.
Alcoholic liver failure , which clotting factor is increased?
factor 8.
Young female+ weight loss + diarrhoea + pigment laden macrophages + dark brown discoloration in in proximal colon.
Laxative abuse
Laxative abuse microscopic feature
pigment laden macrophages.
Colonoscopy- Dark brown discolouration of proximal colon.
Wilson disease Rx:
pencillamine,.
Investigation in Wilson’s
Reduced Ceruloplasmin.
Flushing + Diarrhoea + abd cramp + bronchospasm
Carcinoid Syndrome.
Carcinoid Syndrome Investigation:
urinary 5HIAA
Carcinoid Syndrome Management :
Somatostatin Analogue.(Octreotide)
C.diff transmission
Faeco Oral route via ingestion of spores.
Charcoat’s triad and where it is seen ?
Fever, RUQ pain, Jaundice.
Seen in Ascending chloangitis
First line Investigation in suspected Ascending Cholangitis:
Ultrasound.
Gastric bypass leads to what deficiency ?
Iron.
what gets absorbed in duodenum ?
Iron and calcium
What not to eat in IBS ?
Insoluble Fibres such as bran.
Whole meal Bread.
K/c/o of HIV/ulcerative colitis - RUQ pain+ deranged LFTs +cholestasis ( Jaundice,pruritis,Raised Bilirubin)+
Sclerosing Cholangitis.
Ass of scleroing Cholangitis
HIV, Ulcerative colitis(most common:
investigation of choice in Sclerosing Cholangitis
ERCP,MRCP
Which one of the following drugs used in the management of diabetes mellitus is most likely to cause cholestasis?
Sulphonylureas(Gliclazide)
H/o crohns/cholecystectomy/ileocaecal resection - watery diarrhoea.
Bile acid malabsorption
Bile acid malabsorption. Ix?
SeHCAT
Bile acid Malabsorption.Mx
Cholestyramine.
Sulphasalazine(Mesalazine) side effects :-
infertility
In men.
Whiples jejunal biopsy :
deposition of macrophages containing PAS positive granules.
Diarrhoea+Steatorhea +Jt pain + Photosensitive Rash + HLA b27
Whipples.
Pancreatic Cancer Investigation of choice :
CT scan of Panceas
Elderly + 3month H/o diarrhoea+ Wt loss
+steatorhea+ painless Lump in RUQ + painless jaundice + new onset Diabetes.( Raised glucose level)
Pancreatic Cancer.
CT scan of pancreatic cancer
Doubel Duct sign
Refeeding syndrome leads to
Hypophosphataemia - causes muscle weakness.
Most common cause of hepatocellular cancer
hepatits c
Tool used to screen malnutrition
MUST score.
Mx of PBC
ursodeoxycholic acid
Gastrinoma arises from :
G cells in gastric parietal cells- produces acid HCL- which increases gastric motility.
H/o Blood transfusion+ new onset Diabetes+bronze skin + anaemia
Secondary Haemochromatosis.
H/o Asthma/Allergies + Dysphagia to solids+ Heart Burn + Lack of response to PPI+ scope= Increase in Oesonophils/ Thick mucosa.
Eosinophilia Oesophagitis.
Eosinophilic oesophagitis Rx?
Rx- 1st line= Dietery Modification
2nd line= dietery modification + Fluticasone.
H/o non bloody/watery diarrhoea + since weeks/months .
H/o PPI/Smoking + mildly elevated ESR & Fecal calprotectin.
Microscopic Colitis.
Microscopic Colitis Infestation of choice=.
Colonscopy and biopsy.
Microscopic Colitis. Risk Factors?
PPI & Smoking.
Microscopic Colitis.What is elevated ?
Mildly elevated ESR & Fecal Calprotectin.
Which gene defect in Haemochromatosis ?
HFE
Fatigue+ Erectile Dysfunction+New onset Diabetes+Bronze skin+ Hepatomegaly+ Raised JVP(Cardiomyopathy0
Haemochromatosis.
Most sensitive and specific marker in pancreatitis ?
serum lipase.
Serum Amylase in pancreatitis diagnostic or prognostic ?
Diagnostic.
Most likely spot afffected in Ischaemic Colitis?
Splenic flexure.
X-ray sign in Ischaemic Colitis
Thumbprinting Sign
Appropriate Investigation for Hpylori:
Carbon 13 urea breath test.
MEN 1
Hyperparathyroidism + pancreas-gastrinoma- duodenal ulceration +
Epigastric pain + Diarrhoea + Duodenal ulceration + Hyperparathyroidism
Dx- MEN 1
SBOS Ix?
Hydrogen Breath test.
Imp intervention to reduces episodes of crohns ?
Stop smoking
Majority of gastrinomas are found in ?
First part of Duodenum.
what is elevated in Gilberts?
isolated rise in bilirubin.
Barrets microscopy ?
squamous coverts to coloumnar.
(Coloums are coming)
Barrets Rx?
High dose PPI and Follow Up.
Screening test for Haemochromatosis ?
Transferrin Saturation.
Variceal bleeding. Resuscitation done. What to give in meantime ?
Terlipresin.
Stimulation test in Zollinger Elision Syndrome ?
Secretin
K/c/o colorectal cancer. Mets in liver. Rx?
Metastatic lesion Resection.
Clinical features of PBC. First line Ix?
Biliary USG
characteristic antibody positive in PBC ?
Anti Mitochondrial Antibdies.
Organism Positive in Whipples ?
Tropheryma Whippeli.
Diarrhoea + weight loss+ Jt pain + Blurry Vision
Whipples disease.
CCK
I cells from Upper Small Intestine.
CCK function:
Hunger suppression.
Released in response to fatty meal—causes Biliary contraction.
Diarrhoe
+ Mucus like stools + Hypokalemia.
Villous Adenoma.
Villous Adenoma.
Diarrhoe
+ Mucus like stools + Hypokalemia.
Budd chiari is Hepatic ——-
Hepatic vein thrombosis.
GI bleed + Aortic Stenosis ( Ejection Systolic Murmur )
Angiodysplasia.
Angiodysplasia.
GI bleed + Aortic Stenosis ( Ejection Systolic Murmur )
Bicarbonate rich Fluid is released by ?
secretin.
High Urea indicates
Upper GI bleed
Upper GI bleed Ix?
Upper GI endoscopy.
Ruptured Hyadatid cyst , Rx?
Surgery.
Strongest RF for anal cancer ?
HPV
Inflammation confined to mucosa and submucosa. feature of Crohns or Ulcerative colitis ?
Ulcerative colitis.
Triad of bud chiari
Abd pain+ Ascites+ Tender /non tender Hepatomegaly.
Bud chiari common association:
Polycythemia Rudra Vera.
Bud chiari Ix?
Abd USG.
SBOS Rx?
Rifaximin
Travel to Mediterranean + Abd pain/tenderness in RUQ + Ascites + Jaundice + USG scan - cystic lesion with Multiple cysts in liver.
Dx and Rx?
Dx= Hyadatid Cyst.
Rx= Surgery.
Which epileptic drug causes pancreatitis ?
Sodium valproate.
Poor prognosis for cirrhosis ?
Ascites.
Alcohol Induced Hepatitis Rx
Prednisolone.
Reefeeding syndrome can lead which arrhythmia ?
Torsades Pointes secondary to hypomagnesemia.
what to avoid In IBS ?
Lactulose.
Prophylaxis for variceal bleeding ?
Propranolol.
What is not a feature of achlasia ?
weight loss
Hyperchyloicronaemia leads to ?
Acute Pancreatitis.
Which laxative is carcinogenic ?
co danthamer.
What type of cells in gastric adenocarcinoma ?
Signet Ring cells.
Perianal itching in children at night , affecting other family members . Causative organism ?
Enterobius Vermicularis.
Which HLA in coeliacs ?
HLA DQ2
Coeliacs microscopy ?
Villous atrophy in intestinal mucosa
In mid flare of Distal Ulcerative Colitis, Rx ?
Topical/RectalAminosalicylate.
Pathophysiology of hepatorenal syndrome?
Splanchnic Vasodilation.
K/C/o ALD, now raised urea/creat(kidney)
Dx?
Hepatorenal Syndrome.
H/O dysphagia+ difficulty passing through lower oesophageal sphincter. Dx?
Achlasia
Achlasia. Ix?
oesophageal manometry.
3rd trimester + pruritis + Chloestatic picture ( high ALP, GGT) + High Bilirubin. Dx
Intrahepatic Cholstasis of pregnancy.
3rd trimester + abdomen pain + nausea+ vomitting+ Headchae + Jaundice + High ALT
Acute Fatty liver of pregnancy.
Angiodysplasia , Ix to make Dx?
Colonoscopy.
What is measured to monitor Rx in Haemochromatosis ?
Transferrin Saturtoin + Serum Ferittin.
Diarrhoea + Rectal Bleed + Brown pigmentation on lips and palms. Dx
Peutz Jeghers Syndrome.
Rx of flare of Ulcerative colitis ?
Iv steroids.
C.diff infection—Got treated—recurrent episode within 12 weeks. Rx?
Oral Fidaxomicin..
Sudden onset cramping abd pain+ H/o Dm+smoking
Ischaemic colitis.
IBS patient, on Laxative, Anti spasmodic, Laxative. No improvement in 6 months. Next Rx?
Tricyclic Antidepressants.
Mx of IBS:
1st: Anti Spasmodic, Laxativs.
2nd: Tricyclic Antideressant
3rd: If no Improvement in 12 months -Hypnotherapy.
Upper GI Bleed cause :
Duodenal ulcer perforation.
Malory weis tear.
Oesophagitis.
Angiodysplasia.
Terlipressin MOA
Splanchnic Vasoconstriction.
Prophylaxis of Hepatic Encephalopathy:
Rifaxmin + Lactulose.
most appropriate infection control plan, for C.diff?
Side Room + hand washing + disposable gloves/apron.
(No mask)
Initial Investigaion for trauma in abdomen and thorax ?
FAST scan.
inadequate response with her initial H. pylori eradication regime. Next step ?
Retest with C 13 urea breath test, before starting on 2nd line antibiotic.
Which HLA in Coeliacs ?
HLA DQ2
IBS symp + Wt loss + Anaemia + Decreased Ferittin level. Dx
Coeliacs.
Coeliacs Ix?
1st - Tissue transglutaminase Antibody(IgA)
2nd. Endoscopic Intestinal Biopsy.(Jejunal biopsy )
Which Ig in coealiacs ?
IgA.
which vaccine in coeliacs?
Pneumococcal vaccine due to hyposplenism.
Why pneumococcal vaccine in coeliacs?
D/t Hyposplenism.
Ix which helps to stage the oesophageal cancer?
Endoscopic Ultrasound.
H/o Alcohol + severe abd pain + Sudden deterioration of vision+ cotton wool spots. Dx
Panecreatitis
Complication - Purtscher Retinopathy.
Ix to confirm Dx of Pancreatisis:
Serum Amylase.
Variceal bleeding. ABC done—Terlipressin—next ?
Endoscopic Band Ligation.
Barrets/GORD is a risk factor for which carcinoma ?
Adenocarcinoma
Most imp ethology in crohns ?
Genetic component.
Which facto suggest severe disease in pancreatitis ?
Hypocalcemia.
Which symptom occur first in carcinoid ?
Facial Fluhing.
What is high in alcoholic hepatitis. AST or ALT ?
AST»_space; ALT
have a toAST with alcohol.
Gold standard for GORD?
24 hr oesophageal PH monitoring.
A nurse undergoes primary immunisation against hepatitis B. Levels of which one of the following should be checked four months later to ensure an adequate response to immunisation?
Anti HBs.
Drug induced cholestasis ex?
OC pills.
Flucloxacin.
Co-amoiclav
Sulphonylureas- Gliclazide.
Oc pills.
Plummer Vinson syndrome Triad ?
Angluar Stomatitis + Iron deficiency anaemia + Glossitis( Inflamed red tongue) + Dysphagia ( D/T Oesophageal webs)
Angluar Stomatitis + Iron deficiency anaemia + Glossitis( Inflamed red tongue) + Dysphagia ( D/T Oesophageal webs)
Plummer Vinson Synfrome.
Ix for Gilberts Syndrome ?
Nicotinic acid test.
Liver plus Neuro
Wilsons.
Chronic Pancratitis Ix of choice ?
CT abdomen.
Indicator of Pancreatitis severity ?
Hypocalcemia.
Obesity + Abnormal LFTs
NAFLD.
H.pylori is protective against ?
GORD.
Dyspepsia + Watery stools + Gastric erosions & Ulcers. Dx?
Zollinger Elission Syndrome.
Zollinger Ellison Syndrome features?
Dyspepsia + Watery stools + Gastric erosions & Ulcers. Dx?
Zollinger Elission Syndrome. Ix of choice ?
Fasting Gastrin.
Secretin Stimulation test.
IOC in suspected Cholangitis ?
Ultrasound.
Goblet cell depletion occurs in Crohns or UC ?
Ulcerative colitis.
Angiodysplasia =
Upper GI bleed + Aortic Stenosis.
Which score in acute appendicitis ?
Alvarado score.
Underwent TIPS—now Hep Enchephalopathy. Rx ?
Phosphate Enema + Laxatives.
Dubin Johnson, Conjugated or Unconjugated ?
Conjugated Bilirubinaemia.
Reversible with Rx in Haemochromatosis?
Skin pigmentation & Cardiomyopathy.
Pyogenic liver abscess. Rx?
Drainage and Antibiotics.
Antibiotics :- Ciprofloaxcin + Amoxillin + Metronidazole.
You need CAMera to see abscess.
Test for H. Pylori post eradication therapy ?
Urea Breath Test.
Prophylaxis for Spontaneous Bacterial peritonitis ?
Oral Ciprofloxacin or oral Norfloxacin.
Ascites secondary to Liver cirrhosis. Rx?
Spironolactone.
Chronic pancreatitis. Ix?
CT pancreas.
Drug causing hepatitis picture ( ALT»»>
Sodium Valproate.
Obesity cut off for surgery in risk and no risk patients ?
Risk : 35
No Risk : 40
2 or more exacerbation of UC in past year .Rx ?
Oral Azathioprine.
Blood group O ass with which cancer?
Duodenal cancer.
Blood group A ass with which cancer ?
Gastric Cancer.
Chronic Anal fissure duration ?
> 7 weeks.
Acute Anal Fissure Duration ?
< 7 weeks.
Chronic anal fissure Rx?
Glyceryl Trinitrate.
Acute Anal Fissure Rx?
Stool softener.
Dietary advice.
Anaesthetics
Analgesia.
Dysphagia to both solid and liquid from the beginning + CXR- air fluid level behind normal sized heart. Dx?
Achlasia.
Which antibiotics causes cholestasis ?
Co-amoxiclav(Amoxicillin(penicillin/Clavulanic acid)
Flucloxacillin(Penicillin)
Flouroquinolones.
Vipoma arise from :
Pancreas.
Rx for acute pancreatitis ?
IV fluids + Analgesia.
Familial Adenomatous Polyposis. Rx?
Protocolectomy.
A baby is born to a mother who is known to have chronic hepatitis B.
Hepatitis B vaccine + Hepatitis B immunoglobulin.
Severe life threatening Flare of UC ?
IV Hydrocortisone.
Biliary Colic by which cells ?
I cells from Duodenum.
Causes—contraction of Gall bladder—releases in response to fatty food.
Prophylaxis of variceal bleeding ?
Propranolol.
Antigen used to monitor colorectal cancer ?
Carcinoembryonic antigen.
Sulfasalazine S/E:
Male infertility.
Agranulocytosis.
Diarrhoea.
Skin Rashes.
Marker to assess severity of acute pancreatitis ?
CRP.
Gene in Familial adenomatous polyposis
Adenomatous polyposis tumour suppressor gene.
Posterior duodenal ulcer bleeds. It’s ass with which artery ?
Gastroduodenal Artery.
Least useful in assessing severity of ascites ?
ALT.
Lactose=
Glucose + Galactose
Maltase
Glucose + Glucose.
Sucrase
Glucose + Fructose.
Type 1 hepatorenal is <
< 2 weeks.
Diagnostic Ix for Pancreatic Cancer:
CT pancreas.( also for chronic pancreatitis, acute pancreatitis )
Gastric MALT lymphoma Rx:
H. Pylori eradication.
Test for exocrine function of chronic pancreatitis :
Fecal elastase.
In a mild-moderate flare of ulcerative colitis extending past the left-sided colon:
Rectal aminosalicylates.
Oral aminosalicylates.
Diarrhoea + White plaques.
Pseudomembranous colitis secondary to C. Difficile.
Crypts Abscess is a feature of UC or Crohns ?
Ulcerative colitis.
Pernicious anaemia is micro or macrocytic ?
Macrocytic ( >100)
pernicious anaemia is D/t:
Antiboides against intrinsic factor.
Is pellagara a feature of carcinoid syndrome ?
yes.
Does H.pylori cause oesophageal cancer ?
No.
Does ALD cause SAAG >11 ?
Yes. ALD—portal hypertension.
H.pylori is protective against ?
Gord.
Barrets.
Deranged LFTs+ Slow and stiff movements :
Wilsons.
Mode of inheritance in Familial Adenomatous Polyposis ?
Autosomal Dominant.
Can hepatitis B be transmitted via breastfeeding ?
No.
Safe to breastfeed if mother has hepatitis.
What stimulats release of Gastrin from G cells ?
Luminal peptides.
Which Food can a coeliac patient eat ?
Maize.
In patients with non-alcoholic fatty liver disease, recommended test to aid diagnosis of liver fibrosis
enhanced liver fibrosis (ELF) testing
What cardiac abnormalities are associated with Carcinoid?
Pulmonary Stenosis & Tricupid insufficiency.
What is the most appropriate course of action to avoid refeeding syndrome?
provide 50% of normal energy and protein requirements for the first 2 days.
What breaks starch down to sugars?
Amylase.
Which of the following should be assessed before commencing azathioprine in this patient?
Thiopurine methyltransferase (TPMT)
Urea breath test - no antibiotics in past ?
past 4 weeks
Urea breath test - no antisecretory drugs (e.g. PPI) in past ?
past 2 weeks
Which of the following anti-retroviral drugs is most characteristically associated with pancreatitis?
Didanosine.
Angiodysplasia is associated with Murmur ?
ejection systolic murmur heard loudest on expiration
useful test for diagnosing and monitoring the severity of liver cirrhosis
Transient elastography.
recognised complication of acute pancreatitis
Acute respiratory distress syndrome
chlorpromazine, prochlorperazine Causes Cholestasis ?
yes.
flare of ulcerative colitis extending past the left-sided colon,
Topical ASA + Oral ASA.
common complication of ERCP?
Acute pancreatitis is the most common complication of ERCP
false negative serology test in diagnosis of coeliac disease?
Selective IgA deficiency.
The majority of gastrinomas are found
first part of the duodenum
MSH2 gene In Lynch syndrome function :
DNA mismatch repair
Type 1 diabetes mellitus causes Non-alcoholic steatohepatitis (NASH
No
most common site affected in Ulcerative Colitis ?
Rectum.
The most common type of inherited colorectal cancer:
Hereditary non-polyposis colorectal carcinoma
oesophageal cancer finding :
Oesophageal stricture with apple core defect.
Primary sclerosing cholangitis is most associated with
Ulcerative colitis
