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Pass Med finals pack > Gastro 2 > Flashcards

Gastro 2 Flashcards

1
Q

25 y/o female concerned periods have stopped. not pregnant.

RUQ pain, reduced appetite .

OE: hepatomegaly and yellow sclera

Blood results:

  • ANCA neg
  • AMA neg
  • Anti nuclear antibodies raised
  • smooth muscle antibodies raised

what is likely diagnosis?

A

autoimmune hepatitis

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2
Q

first line treatment for autoimmune hepatitis

A

steroids are first line +/- immunosuppressant therapy

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3
Q

what is ribavirin ?

A

anti viral

can be used to treat hep C

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4
Q

what antibodies are found in type 1 auto immune hepatitis?

A

type 1
- Anti-nuclear antibodies and/or anti-smooth muscle antibodies

  • adults and children
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5
Q

describe type 2 autoimmune hepatitis

A

type 2
- anti-liver/kidney microsomal type 1 (LKM1) antibodies

  • affects children only
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6
Q

describe type 3 autoimmune hepatitis

A

type 3
- soluble liver-kidney antigen

  • affects adults in middle-age
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7
Q

long term proton pump inhibitor therapy can cause what?

A

hypomagnesaemia

can then cause muscle weakness

PPIs can also known to cause hyponatraemia

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8
Q

obesity with abnormal LFTs think

A

non-alcoholic fatty liver disease

  • linked to insulin resistance thus think of history of pre-diabetes
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9
Q

when treating dyspepsia, if PPI or ‘test and treat’ approach has failed, then what other approach should be tried next

A

test for helicobacter pylori infection in 2 weeks and treat if positive

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10
Q

patient

  • raised urea
  • marginal normocytic anaemia

patient likely suffered a…

A

Gastrointestinal bleed

  • raised urea
  • anaemia due to blood los
  • RBC –breakdown–> urea
  • UREA raised
  • digestion of blood in stomach
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11
Q

what intervention is required when dysplasia on biopsy in barrett’s oesophagus is seen?

A

endoscopic intervention.

  • endoscopic mucosal resection
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12
Q

barrett’s oesophagus refers to

A

metaplasia of lower oesophageal mucosa with usually squamous epithelium

being replaced by columnar epithelium

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13
Q

why is prothrombin a better measure of acute liver failure as opposed to albumin?

A

prothrombin has shorter half-life

thus better measure

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14
Q

79 y/o female

  • PMH AF
  • PC abdo pain + bloody diarrhoea + vomiting

OE

  • temp 37.8 degrees
  • 102 bpm
  • 30 / min
  • tender abdomen
  • generalised guarding
  • low bicarb
  • metabolic acidosis

indicative of:

A

mesenteric ischaemia

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15
Q

what is the double duct sign and when is it seen?

A
  • dilated common bile duct and dilated pancreatic duct

- may be seen in pancreatic cancer

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16
Q

patient who have had previous episode of spontaneous bacterial peritonitis will require…

A

antibiotics prophylaxis

e.g. long term medication of ciprofloxacin

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17
Q

patient

  • fatigued
  • raised ALP, yGT (cholestatic liver biochemistry)
  • positive mitochondrial antibodies
  • raised Igm

indicative of:

A

primary biliary cholangitis

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18
Q

first line medication of primary biliary cholangitis?

A
  • ursodeoxycholic acid

- secondary bile acid

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19
Q

what key factor would point you towards a diagnosis of oesophageal candidiasis in the following case

40 y/o male, pc pain on swallowing hpc 7 days. PMH HIV positive. generally unwell 3 months hx with diarrhoea and weight loss

A

oesophageal candidiasis

immunocompromised patients are prone to oesophgeal candidiasis

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20
Q

55 y/o pc dysphagia for past 5 weeks. Also noticed some double vision.

may be indicative of?

A
  • myasthenia gravis
  • dysphagia with liquids awa solids
  • may involve extra ocular muscle
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21
Q

describe how systemic sclerosis may lead to dysphagia?

A
  • multi system disease
  • causes oesophageal dysmotility , Lower oesophageal sphincter is decreased

Crest

  • calcinosis
  • Raynaud’s
  • oesophageal dysmotility
  • sclerodactyl
  • telangiectasia
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22
Q

first line screening test for coeliac disease?

A

tissue transglutaminase antibodies

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23
Q

49 y/o pt

  • 3 month hx epigastric pain and diarrhoea
  • endoscopy revealed multiple duodenal ulcerations
  • pmh hyperparathyroidism

indicative of:

A

Zollinger-Ellison syndrome

- patients usually present with multiple gasproduodenal ulcers causing abdominal pain and diarrhoea

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24
Q

the following clinical features point to a diagnosis of what:

  • jaundice
  • anorexia
  • fever
  • tender hepatomegaly
  • AST/ALT ratio of 2:1
A

alcoholic hepatitis

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25
which ulcers characteristically cause pain when hungry and are relieved by eating...
duodenal ulcers gastric ulcers are worse on eating due to release of HCl which worsen ulcer
26
38 y/o female pc fever, malaise, jaundice moderate hepatomegaly positive anti-smooth muscle antibody positive anti-nuclear antibody AMA antibodies negative indicative of:
autoimmune hepatitis
27
patients with ascites secondary to liver cirrhosis should be given what medication?
- aldosterone antagonist
28
how are ascites managed
- through sodium and fluid restriction
29
long segment of narrowed terminal ileum in a 'string like' configuration is known as 'kantors string sign' this is seen in:
Crohn's disease
30
the following histology is seen in what: - inflammation in all layers from mucosa to serosa - goblet cells - granulomas
Crohn's disease
31
describe the histology that will be seen in Crohn's disease?
- inflammation in all layers from mucosa to serosa - goblet cells - granulomas
32
46 y/o male presents with reduced libido and erectile dysfunction. has no energy and has 'permanent suntan' has pain in both hands. which investigation likely to reveal diagnosis? ferritin, testosterone, cortisol, blood glucose, prolactin
ferritin screening for haemochromatosis
33
37 y/o female with 2 month hx of progressive fatigue on background of T1DM. - low Hb - higher MCV likely diagnosis
megaloblastic anaemia - may be caused by B12 or folate deficiency Pernicious anaemia - autoimmune - caused B12 deficiency
34
what investigation is sued when investigating b12 deficiency?
- looking at intrinsic factor antibodies parietal cells ---release---> intrinsic factor intrinsic factor ---bind---> dietary b12 complex formed complex ---absorbed--> ileum
35
which antibodies are screened for in coeliac disease
anti-TTG antibodies
36
56 y/o male - worsening rash - ongoing diarrhoea - nausea - vomitting - harder to concentration - increasingly forgetful - vegan likely diagnosis?
pellagra - dermatitis - diarrhoea - dementia / delusions - leading to death
37
condition characterised by - numerous hamartomatous polyps in GI tract - pigmented lesions on lips, face, palm and soles - intestinal obstruction - GI bleeding
peutz-jegher syndrome | - autosomal dominant§
38
jaundice following abdominal pain and itching during pregnancy think:
acute fatty liver of pregnancy
39
gilberts syndrome caused
- benign condition | - caused mild rise in unconjugated bilirubin
40
what class of drugs are used in the management of severe alcoholic hepatitis
corticosteroids
41
abdominal mass palpable in right iliac fossa is more common in Crohn's of ulcerative colitis
Crohn's disease
42
triad of - dysphagia (secondary to oesophageal webs) - glossitis - iron deficiency anaemia is seen in:
Plummer-Vinson syndrome
43
a palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen is known as a
sister Mary Joseph node
44
what is a Virchow's node
enlarged left supraclavicular lymph node seen in various internal abdominal malignancies
45
causes of macrocytic anaemia
- vitamin b12 deficiency - folate deficiency - alcohol excess
46
What is TIBC and what does it measure?
- total iron binding capacity - measures number of binding sites on transferrin available for iron - raised in iron deficiency anaemia - raised in pregnancy and by oestrogen
47
Middle aged female history of lethargy and pruritus rise in ALP and yGT point to a diagnosis of:
primary biliary cirrhosis anti-mitochondrial antibodies are found in 98% of patients with PBC
48
isolated rise inbilirubin in response to physiological stress is typical of:
gilbert syndrome
49
35 y/o female with RUQ pain, slightly yellow skin, yellow tinge to sclera. itching of arms. PMH - ulcerative colitis likely diangosis?
primary sclerosing cholangitis
50
investigation of choice in a patient with suspected primary sclerosing cholangitis?
ERCP / MRCP
51
name three main caused of liver cirrhosis?
1. alcohol 2. non-alcoholic fatty liver disease 3. viral hep B and C
52
Budd-chiari syndrome is also known as
hepatic vein thrombosis
53
treatment for wilsons disease is currently?
penicillamine
54
most common organism found on ascitic fluid culture in spontaneous bacterial peritonitis is?
E-coli
55
three main features of spontaneous bacterial peritonitis
1. ascites 2. abdominal pain 3. fever
56
how are liver abscesses generally managed?
- combination of antibiotics | - and image guided percutaneous drainage
57
what is the first line treatment of diarrhoea in IB
Loperamide
58
plain abdominal film showing small bowel obstruction and air in the biliary tree indicative of:
gallstone ileus - gall stone enters small intestine, it lodges in ileocaecal valve
59
psuedopolyps seen on endoscopy likely to be:
ulcerative colitis
60
results which would indicate a diagnosis of haemochromatosis?
- transferrin HIGH - ferritin HIGH - total iron binding capacity LOW
61
surgical treatment of achalasia
heller cardiomyotomy - procedure involves the cutting of thick muscle around lower oesophagus and upper stomach to allow for passage of food and drink
62
24 y/o female - history of diarrhoea - passage of mucus - lethargy - abdominal discomfort relieved by defaecation - nomral blood tests likely clinical diagnosis?
irritable bowel syndrome
63
22 y/o male - three week hx diarrhoea - has to run to toilet - passing blood in stool - abdominal pain LLQ likely diagnosis of:
ulcerative colitis

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