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Gastro Flashcards

1
Q

What is autoimmune hepatitis?

A

A chronic liver disease with autoantibodies and raised IgG

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2
Q

Who is mostly affected by autoimmune hepatitis

A

Young women

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3
Q

Features of autoimmune hepatitis

A 
Signs of chronic liver disease
Acute hepatitis
Jaundice
Hepatomegaly
Amenorrhoea
Nausea
Fatigue, pruritis
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4
Q

Which immunoglobulin is involved in autoimmune hepatitis?

A

IgG

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5
Q

Management of autoimmune hepatitis

A

Steroids
Immunosuppression with azathioprine
Liver transplant

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6
Q

How to calculate number of units of alcohol

A

number of ml x ABV and divide by 1000

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7
Q

Recommended number of alcoholic units per week

A

14

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8
Q

How many units in 25ml of pure spirit?

A

1

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9
Q

How many units in a pint of beer?

A

3

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10
Q

How many units in half a 175ml standard glass of wine?

A

1

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11
Q

What type of drug is sulphasalazine?

A

5-aminosalicyclic acid

Combined with a sulphonamide called sulphapyridine

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12
Q

Side effects of sulphasalazine

A 
Rashes
Oligospermia
Headache
Heinz body anaemia
Megaloblastic anaemia
Lung fibrosis
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13
Q

What type of drug is mesalazine?

A

delayed release 5-aminosalicyclic acid

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14
Q

Side effects of 5-aminosalicyclic acid medications

A 
GI upset
Headache
Agranulocytosis
Pancreatitis
Interstitial nephritis
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15
Q

Which 5-aminosalicyclic acid is typically associated with pancreatitis?

A

Mesalazine

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16
Q

Examples of 5-aminosalicyclic acid drugs

A

Sulphasalazine
Mesalazine
Olsalazine

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17
Q

Which medical condition is associated with cyclical vomiting syndrome?

A

Migraine

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18
Q

Cyclical vomiting syndrome - acute management

A

Ondansetron
Prochlorperazine
Triptans

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19
Q

Cyclical vomiting syndrome - prophylaxis

A

Amitryptilline
Propranolol
Topiramate

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20
Q

Inheritance of Gilbert’s syndrome

A

Autosomal recessive

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21
Q

What is Gilbert’s syndrome?

A

Defective conjugation of bilirubin

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22
Q

Features of Gilbert’s syndrome

A

Unconjugated hyperbilirubinaemia

Jaundice during illness, fasting, exercise

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23
Q

Investigations for Gilbert’s syndrome

A

Rise in bilirubin after fasting or IV nicotinic acid

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24
Q

Mechanism of action of metoclopramide

A

D2 receptor antagonist

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25
Q

Side effects of metoclopramide

A

Extrapyramidal effects - oculogyric crisis
Hyperprolactinaemia
Tardive dyskinesia
Parkinsonism

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26
Q

Referral method for a patient with dysphagia

A

Urgent

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27
Q

Referral method for a patient with upper abdominal mass consistent with gastric cancer

A

Urgent

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28
Q

Referral method for patients 55 years+ who have weight loss AND upper abdo pain

A

Urgent

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29
Q

Referral method for patient over 55 with treatment resistant dyspepsia

A

Routine

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30
Q

Referral method for patient with haematemesis

A

Routine

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31
Q

Referral method for patient over 55 with weight loss and reflux

A

Urgent

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32
Q

Referral method for patient over 55 with weight loss and dyspepsia

A

Urgent

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33
Q

Referral for patients over 55 with upper abdo pain and low haemoglobin

A

Routine

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34
Q

Referral for patients over 55 with raised PLT count plus: nausea, vomiting, reflux, dyspepsia, upper abdo pain

A

Routine

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35
Q

Testing for H pylori

A

Carbon-13 urea breath test
Stool antigen test
“Test and treat”

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36
Q

Inherited causes of unconjugated hyperbilirubinaemia

A

Gilbert’s syndrome

Crigler-Najjar syndrome

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37
Q

Crigler-Najjar syndrome basic facts

A

Autosomal recessive
Type 1 will not survive to adulthood
Type 2 may improve with phenobarbital

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38
Q

Inherited causes of conjugated hyperbilirubinaemia

A

Dubin-Johnson syndrome

Rotor syndrome

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39
Q

Dubin-Johnson syndrome

A 
Autosomal recessive
Common in Iranian Jews
Defective hepatic excretion of bilirubin
Grossly black liver
Benign
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40
Q

Rotor syndrome

A

Autosomal recessive
Defect in the hepatic uptake and storage of bilirubin
Benign

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41
Q

Drug causes of liver cirrhosis

A

Methotrexate
Methyldopa
Amiodarone

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42
Q

Drug causes of cholestasis

A

Combined oral contraception
Flucloxacillin, co-amoxiclav, erythromycin
Anabolic steroids

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43
Q

What is the MELD scoring system for?

A

Liver cirrhosis

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44
Q

PPI mechanism of action

A

Irreversible blockade of H+/K+ ATPase of gastric parietal cell

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45
Q

Side effects of PPIs

A 
Hyponatraemia
Hypomagnesaemia
Osteoporosis
Microscopic colitis
Increased risk of c. diff
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46
Q

Plummer-Vision syndrome

A

Dysphagia
Glossitis
Iron deficiency anaemia

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47
Q

Treatment of Plummer-Vision syndrome

A

Dilation of webs

Iron supplements

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48
Q

Booerhaave syndrome

A

Oesophageal rupture due to severe vomiting

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49
Q

Melanosis coli

A

Pigmentation of the bowel wall

Pigment laded macrophages

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50
Q

Cause of melanosis coli

A

Laxative abuse

particularly senna

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51
Q

What is ferritin?

A

Intracellular protein that binds to iron and stores it to be released in a controlled fashion at sites where iron is required

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52
Q

Causes of raised ferritin without iron overload

A 
Inflammation
Alcohol excess
Liver disease
CKD
Malignancy
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53
Q

Causes of raised ferritin with iron overload

A

Hereditary haemochromatosis

Following repeated transfusions

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54
Q

How do you assess whether there is iron overload?

A

Transferrin saturation

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55
Q

What is a normal transferrin saturation?

A

<45% in women

<50% in men

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56
Q

Causes of reduced ferritin

A

Iron deficiency anaemia

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57
Q

What is cholestyramine?

A

Bile acid sequestrant

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58
Q

How does cholestyramine work?

A

Reduces bile acid reabsorption in the small intestine

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59
Q

Who is cholestyramine used for?

A

Hyperlipidaemia
Increases amount of cholesterol coverted to bile acids

Reduces LDL

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60
Q

Side effects of cholestyramine

A 
Abdominal pain
Constipation
Cholesterol gallstones
May raise Triglyceride levels
Decreased absorption of fat soluble vitamins
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61
Q

What is pellegra?

A

Disease due to lack of vitamin B3, niacin

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62
Q

What is niacin

A

Vitamin B3

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63
Q

Features of pellegra

A 
Inflamed skin
Diarrhoea
Dementia
Sores in the mouth
Skin becomes darker
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64
Q

Management of alcoholic hepatitis

A

Prednisolone

Pentoxyphylline

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65
Q

Crohn’s disease - pathology

A 
Mouth to anus
Inflammation of all layers down to serosa
Skip lesions
Goblet cells, granulomas
Strictures, fissures, adhesions
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66
Q

Crohn’s disease - features

A 
Weight loss, lethargy
Diarrhoea which may be bloody
Abdominal pain
Anal skin tags
Anal ulcers
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67
Q

Crohn’s disease and UC - extra intestinal disease which is related to disease activity

A

Arthritis (asymmetrical)
Erythema nodosum
Episcleritis
Osteoporosis

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68
Q

Crohn’s disease and UC - extra intestinal disease which is not related to disease activity

A

Arthritis (symmetrical)
Uveitis
Pyoderma gangrenosum
Clubbing

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69
Q

Crohn’s disease - investigations

A

Raised ESR and CRP
Raised faecal calprotectin
Low B12, low Vit D
Anaemia

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70
Q

Crohn’s disease - inducing remission

A 
Steroids
5-aminosalicylate drugs
Elemental diet
Azathioprine or mecaptopurine
Methotrexate
Infliximab in refractory cases
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71
Q

Crohn’s disease - maintaining remission

A

Azathioprine or mercaptopurine

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72
Q

Bile acid malabsorption - primary causes

A

Excessive production of bile acid

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73
Q

Bile acid malabsorption - secondary causes

A

GI disorder preventing bile acid absorption, e.g.

Crohn’s
Cholecystectomy
Coeliac disease
Small intestinal bacteria overgrowth

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74
Q

Bile acid malabsorption - investigations

A

Nuclear medicine SeHCAT

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75
Q

Bile acid malabsorption - management

A

Bile acid sequestrants - cholestyramine

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76
Q

Bile acid malabsorption - features

A

Chronic diarrhoea
Steatorrhoea
Vitamin A, D, E, K malabsorption

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77
Q

What is angiodysplasia?

A

Vascular deformity in the GI tract which predisposes to bleeding and IDA

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78
Q

Who is affected by angiodysplasia?

A

Elderly

Possible link to aortic stenosis

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79
Q

Angiodysplasia - diagnosis

A

Colonoscopy

Mesenteric angiography if acutely bleeding

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80
Q

Angiodysplasia - management

A

Endoscopic cautery or coagulation
Antifibrinolytics - tranexamic acid
Oestrogens

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81
Q

What is achalasia?

A

Failure of oesphageal peristalsis

Failure of relaxation of LOS

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82
Q

Achalasia - who is affected?

A

Middle age

Men and women

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83
Q

Achalasia - presentation

A

Dysphagia to liquids AND solids
Variation in symptom severity
Heartburn
Regurgitation of food (may cause cough, pneumonia)
Malignant change in small number of patients

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84
Q

Achalasia - investigations

A

Oesophageal manometry
Barium swallow
CXR

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85
Q

Achalasia - what does oesophageal manometry show?

A

Excessive LOS which doesn’t relax on swallowing

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86
Q

Achalasia - what does barium swallow show?

A

Grossly expanded oesophagus with fluid level

‘birds beak’ appearance

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87
Q

Achalasia - what does chest xray show?

A

Wide mediastinum

Fluid level

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88
Q

Achalasia - management

A

Pneumatic balloon dilation
Surgery if persistent symptoms
Botox if unfit for surgery

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89
Q

What is Budd chiari syndrome?

A

Hepatic vein thrombosis

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90
Q

Budd chiari syndrome - features

A

Sudden severe abdominal pain
Ascites causing abdominal distension
tender hepatomegaly

91
Q

Budd chiari syndrome - investigations

A

Doppler ultrasound

92
Q

Budd chiari syndrome - causes

A

Polycythaemia vera
Thrombophilia
Pregnancy
Combined oral contraceptive pill

93
Q

What is carcinoid syndrome?

A

When carcinoid tumours release serotonin into systemic circulation

94
Q

Where are the tumours that normally cause carcinoid syndrome?

A

Liver metastasis

Sometimes lung carcinoid

95
Q

Carcinoid tumours - features

A 
Flushing
Diarrhoea
Bronchospasm
Hypotension
Pellegra
96
Q

Carcinoid tumours - investigations

A

Urinary 5-HIAA

Plasma chromoranin A y

97
Q

Carcinoid tumours - management

A

Somatostatin analogues - octreotide

Cyproheptadine for diarrhoea

98
Q

What percentage of colorectal cancers are caused by HNPCC?

99
Q

Inheritance of HNPCC

A

Autosomal dominant

100
Q

What cancers are HNPCC at risk of?

A

Colorectal in 90% patients

Endometrial

101
Q

What percentage of colorectal cancers are caused by FAP?

102
Q

Inheritance of FAP

A

Autosomal dominant

103
Q

Management of FAP

A

Total colectomy by mid 20’s

104
Q

Gardner’s syndrome

A 
Variation of FAP
Osteomas of skull and mandible
Retinal pigmentation
Thyroid ca
Epidermoid cysts on the skin
105
Q

What is haemochromatosis?

A

Disorder of iron absorption and metabolism resulting in iron accumulation

106
Q

Haemochromatosis - genetics

A

Majority due to HFE gene on chromosome 6
Autosomal recessive
1 in 10 carry gene, 1 in 200 have disease

107
Q

Haemochromatosis - screening

A

General population: transferrin saturation, ferritin

Family members: HFE mutation

108
Q

Haemochromatosis - features

A 
Fatigue
Erectile dysfunction
Arthralgia
Bronze skin pigmentation
Diabetes
Chronic liver disease 
Cardiac failure secondary to dilated cardiomyopathy
109
Q

Haemochromatosis - reversible features

A

Cardiomyopathy

Skin pigmentation

110
Q

Haemochromatosis - irreversible features

A

Liver cirrhosis
Diabetes
Hypogonadotrophic hypogonadism
Arthropathy

111
Q

Haemochromatosis - investigations

A 
Raised transferrin, ferritin and iron
Low TIBC
Gene mutation - HFE
Liver biopsy shows Perl's stain
Joint xrays - chondrocalcinosis
112
Q

Haemochromatosis - management

A

Venesection

Desferrioxamine

113
Q

NAFLD - features

A

Usually asymptomatic
Hepatomegaly
ALT > AST
Increased echogenecity on ultrasound

114
Q

NAFLD - how to assess for fibrosis

A

ELF - enhanced liver fibrosis blood test
NAFLD fibrosis score
Fibroscan

115
Q

NAFLD - spectrum of disease

A

1) Steatosis
2) Steatohepatitis - fat with inflammation (NASH)
3) progressive disease leading to fibrosis and liver cirrhosis

116
Q

NAFLD - management

A

Weight loss
Monitoring
Possible future management with insulin sensitising drugs e.g. metformin

117
Q

Pancreatic cancer - pathology

A

80% adenocarcinomas found at pancreatic head

118
Q

Pancreatic cancer - features

A

Painless jaundice
Epigastric pain
Weight loss
Loss of exocrine function causes steatorrhoea
Loss of endocrine function causes diabetes
Atypical back pain
Migratory thrombophlebitis

119
Q

Pancreatic cancer - investigations

A

Ultrasound

High resolution CT

120
Q

Pancreatic cancer - associations

A 
Age
Smoking
Diabetes
Chronic pancreatitis
HNPCC
BRCA2
MEN
121
Q

Pancreatic cancer - management

A

Majority not suitable for surgery by time of presentation - Whipple’s resection
Stenting for palliation

122
Q

Ulcerative colitis - disease location

A

Rectum
Never spreads beyond ileocaecal valve
Continuous disease

123
Q

Ulcerative colitis - pathology

A

No inflammation beyond submucosa
Widespread ulceration leads to “pseudopolyps”
Crypt abscesses
Inflammatory cell infiltrate in lamina propria

124
Q

Ulcerative colitis - features

A

Bloody diarrhoea
Urgency
Tenesmus
Abdo pain

125
Q

Ulcerative colitis - findings on barium enema

A

Loss of haustrations
Superficial ulcerations “pseudopolyps”
Long standing disease causes short and narrow colon called drainpipe colon

126
Q

Ulcerative colitis - symptoms of mild flare

A

less than 4 per day
With or without blood
Normal ESR/CRP

127
Q

Ulcerative colitis - moderate flare

A

4-6 per day

Minimal systemic disturbance

128
Q

Ulcerative colitis - severe flare

A

> 6 per day
With blood
Systemic disturbance

129
Q

Ulcerative colitis - triggers for flares

A

Stress
NSAIDS
Antibiotics
Smoking cessation

130
Q

Ulcerative colitis - inducing remission

A

Topical or oral mesalazine
Topical or oral steroids
IV steroids
IV ciclosporin

131
Q

Ulcerative colitis - maintaining remission

A

Topical or oral mesalazine
Oral azathioprine if multiple relapses
Probiotics can help prevent relapse

132
Q

What is Peutz-Jegher’s syndrome?

A

Numerous hamartomatous polyps in the GI tract

133
Q

Peutz-Jegher’s syndrome - inheritance

A

Autosomal dominant

134
Q

Peutz-Jegher’s syndrome - features

A

Hamartomatous polyps in GI tract
Pigmented lesions on lips, oral mucosa, face, palms, soles
Intestinal obstruction
GI bleeding

135
Q

Peutz-Jegher’s syndrome - malignancy risk

A

Polyps don’t have malignant potential but 50% die by age 60 of cancer

136
Q

Peutz-Jegher’s syndrome - management

A

Screen family members

Colorectal surveillance every 2 years from age 25

137
Q

Functions of vitamin A

A

Converted to retinal
Important for epithelial cell differentiation
Antioxidant

138
Q

Consequences of vitamin A deficiency

A

Night blindness

139
Q

What causes Whipple’s disease?

A

Tropheryma whippelii

140
Q

Whipple’s disease - features

A

Malabsorption causing weight loss and diarrhoea
Large joint athralgia
Lymphadenopathy
Hyperpigmentation, photosensitivity
Pleurisy, pericarditis
Neuro symptoms = dementia, seizures, ataxia

141
Q

Whipple’s disease - investigations

A

Jejunal biopsy - macrophages contain periodic acid-shiff (PAS) granules

142
Q

Whipple’s disease - management

A

Oral co-trimoxazole for 1 year

Sometimes IV penicillin prior to orals

143
Q

Wilson’s disease - inheritance

A

Autosomal recessive

144
Q

Wilson’s disease - pathology

A

Excessive copper deposition in tissues

145
Q

Wilson’s disease - when does it present?

A

Age 10-25

liver symptoms in children
neuro symptoms in adults

146
Q

Wilson’s disease - features

A 
Hepatitis, cirrhosis
Speech and psychiatric problems
Chorea, Parkinsonism, dementia
Kayser-Fleischer rings
Renal tubular acidosis
Haemolysis
Blue nails
147
Q

Wilson’s disease - investigations

A

Raised free serum copper
Raised 24 hour urinary copper excretion
Low serum caeruloplasmin
Low total serum copper

148
Q

Wilson’s disease - management

A

Penicillamine

149
Q

What is primary sclerosing cholangitis?

A

inflammation and fibrosis of the intra and extra hepatic bile ducts

150
Q

Primary sclerosing cholangitis - associations

A

Ulcerative colitis
Crohn’s
HIV

151
Q

Primary sclerosing cholangitis - features

A

Cholestasis causing jaundice, pruritis, increased bilirubin, increased ALP

RUQ pain
Fatigue

152
Q

Primary sclerosing cholangitis - Investigations

A

MRCP - biliary strictures giving beaded appearance
pANCA
liver biopsy - fibrous obliterative colangitis ‘onion skin’
Raised bilirubin, raised ALP

153
Q

Primary sclerosing cholangitis - complications

A

Cholangiocarcinoma in 10%

154
Q

Primary sclerosing cholangitis - management

A

Symptomatic

liver transplant

155
Q

Management of pruritis from liver disease

A

Colestyramine

156
Q

What is clostridium difficile?

A

gram negative rod

produces exotoxin that causes pseudomembranous colitis

157
Q

C diff - risk factors

A

PPIs
Clindamycin
Cephalosporins - ceftriaxone, cefotaxime

158
Q

C diff - features

A

Diarrhoa
Abdo pain
Raised WCC
Toxic megacolon

159
Q

C diff - diagnosis

A

C diff toxin in the stool

160
Q

C diff - management

A

1) Oral metronidazole
2) Oral vancomycin
3) Oral vancomcyin + IV metronidazole

161
Q

Coeliac disease - associations

A 
Autoimmune thyroid disease
Dermatitis herpetiformis
IBS
T1DM
1st degree relative
162
Q

Coeliac disease - features

A 
Diarrhoea
FTT
Persistent GI symptoms - nausea, vomiting, abdo pain
Prolonged fatigue
Weight loss
163
Q

Coeliac disease - investigations

A

anaemia
tissue transglutaminase antibody
endomyseal antibody
biopsy

164
Q

Coeliac disease - why do you need to test for endomyseal antibody?

A

To check for selective IgA deficiency which would give a false negative

165
Q

Coeliac disease - biopsy findings

A

Villous atrophy
Crypt hyperplasia
Increased intraepithelial lymphocytes
Lamina propria infiltration with lymphocytes

166
Q

Coeliac disease - management

A

Gluten free diet

Pneumoccal vaccine

167
Q

Coeliac disease - complications

A 
Anaemia, low B12, low folate
Hyposplenism
Lactose intolerance
Enteropathy associated T cell lymphoma of small intestines
Subfertility
168
Q

IBS - management

A

1st line: Symptomatic

2nd line: linaclotide in constipation type, low dose tricyclic antidepressant (amitryptilline)

169
Q

IBS - dietary advice

A 
regular meals, 8 cups of fluid per day
Limit high fibre food
Oats and linseeds for bloating
Limit fruit to 3 portions
Limit tea/coffee to 3
170
Q

What is H pylori?

A

Gram negative bacteria associated with GI disease

171
Q

H pylori - associations

A

Peptic ulcers
Gastric cancer
B cell lymphoma of MALT tissue
Atrophic gastritis

172
Q

H pylori - management

A

7 days of
PPI + amoxicillin + clari OR met

If pen allergic: PPI + clari + met

173
Q

What is vitamin C needed for?

A

Collagen synthesis
Facilitates iron absorption
Cofactor for norepinephrine synthesis

174
Q

What does vitamin C deficiency cause?

A

Scurvy

Impaired collagen synthesis causes capillary fragility and poor wound healing

175
Q

Features of scurvy

A

Gingivitis, loose teeth
Poor wound healing
Bleeding from gums, haematuria, epistaxis
Malaise

176
Q

Risk factors for scurvey

A

Severe malnutrition
Drug abuse, alcohol abuse
Poverty

177
Q

What is vitamin C found in?

A 
Citrus fruits
Potatoes, tomatoes
Sprouts
Cauliflower, broccoli
Cabbage
Spinach
178
Q

Hepatocellular carcinoma - most common cause in Europe

A

Chronic hep C

179
Q

Hepatocellular carcinoma - most common cause worldwide

A

Chronic hep B

180
Q

Hepatocellular carcinoma - presentation

A

Features of liver cirrhosis or failure
Raised AFP
Acute decompensation in a patient with chronic liver disease

181
Q

Causes of cirrhosis

A 
Chronic hep B
Chronic hep C
Alcohol
Haemochromatosis
Primary biliary cholangitis
182
Q

Features of liver cirrhosis

A 
Jaundice
Ascites
RUQ pain
Hepatomegaly
Splenomegaly
Pruritis
183
Q

How do you screen for HCC?

A

Ultrasound +/- AFP

184
Q

Who gets screened for HCC?

A

Cirrhosis secondary to hep B, hep C or haemachromatosis

Men with cirrhosis secondary to alcohol

185
Q

Hepatocellular carcinoma - management

A

Surgical resection
liver transplant
Radiofrequency ablation
Transarterial chemoembolisation

186
Q

Primary biliary cholangitis - pathology

A

Intralobular bile ducts damaged by chronic inflammation
Causes progressive cholestasis
May progress to cirrhosis

187
Q

Primary biliary cholangitis - cause

A

Autoimmune

188
Q

Primary biliary cholangitis - who is affected?

A

Middle aged women

189
Q

Primary biliary cholangitis - features

A 
Asymptomatic
Pruritis
Cholestatic jaundice
Hyperpigmentation over pressure points
RUQ pain
Xanthelasma
Clubbing
Hepatosplenomegaly
190
Q

Primary biliary cholangitis - investigations

A

Antimitochondrial antibodies
Smooth muscle antibodies
Raised IgM
Ultrasound/MRCP to exclude extrahepatic biliary obstruction

191
Q

Primary biliary cholangitis - complications

A

Cirrhosis
HCC
Osteomalacia, osteoprosis

192
Q

Primary biliary cholangitis - management

A

Ursodeoxycholic acid
Cholestyramine for pruritis
Liver transplant

193
Q

Features of globus hystericus

A

Anxiety history
Painless
Intermittent symptoms relieved by swallowing

194
Q

Oesophageal cancer - features

A

Dysphagia
Weight loss
Vomiting

195
Q

Oesophageal cancer - investigations

A

Upper GI endoscopy
Staging CT
Staging ultrasound
Staging laparoscopy

196
Q

Oesophageal cancer - management

A

Surgical resection + chemo

197
Q

Oesophageal cancer - two types

A

Adenocarcinoma and squamous cell carcinoma

198
Q

Oesophageal cancer - adenocarcinoma location

199
Q

Oesophageal cancer - adenocarcinoma risk factors

A 
GORD
Barrett's 
Smoking
Achalasia
Obesity
200
Q

Oesophageal cancer - squamous cell location

A

Upper 2/3rds

201
Q

Oesophageal cancer - squamous cell risk factors

A

Smoking
Alcohol
Achalasia
Plummer-Vison syndrome

202
Q

Oesophageal cancer - which type is most common in the UK?

A

Adenocarcinoma

203
Q

What is Barrett’s oesophagus?

A

Metaplasia of the lower oesophageal mucosa from squamous epithelium to columnar

204
Q

Barrett’s oesophagus - risk factors

A

GORD
male
smoking
central obesity

205
Q

Barrett’s oesophagus - management

A

Endoscopic surveillance every 2-5 years

High dose PPI

206
Q

Barrett’s oesophagus - risk

A

50-100 fold increased risk of carcinoma

207
Q

Features of ascending cholangitis

A

Fever
RUQ pain
Jaundice

208
Q

What is ascending cholangitis?

A

infection of bile ducts

209
Q

Features of acute cholecystitis

A

Severe persistent RUQ pain
Radiates to back/shoulders
Pyrexia
Murphy’s sign positive

210
Q

Features of cholangiocarcinoma

A 
Persistent biliary colic
Jaundice, weight loss
Palpable mass RUQ
Left supraclavicular LN
Periumbilical LN
211
Q

Features of amoebic liver abscess

A

Malaise, anorexia, weight loss

Mild RUQ

212
Q

Features of gallstone ileus

A

Abdo pain and distension

Vomiting

213
Q

What is gallstone ileus?

A

Small bowel obstruction secondary to impacted gallstone

214
Q

What causes gallstone ileus?

A

May develop if fistula forms between gangrenous gallbladder and duodenum

215
Q

What is congestive hepatomegaly?

A

Liver pain due to capsular stretch

Normally due to congestive heart failure

216
Q

Features of viral hepatitis

A

Nausea, vomiting, mylagia
Lethargy
RUQ pain

217
Q

Risk factors for viral hepatitis

A

IVDU

Foreign travel

218
Q

What is the best way to screen for cirrhosis?

219
Q

What amount of alcohol would make you refer for fibroscan?

A

Men >50 units

Women >25 units

220
Q

Best questionnaire to assess for alcohol misuse?

221
Q

What is the most common extra-intestinal feature in both Crohn’s and UC?

222
Q

How many ml in one pint?

223
Q

Testing for H. pylori post-eradication therapy

A

Urea breath test

224
Q

What is the main mode of action of linaclotide?

A

Increases the amount of fluid in the intestinal lumen

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