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Mrcp > Gastro > Flashcards

Gastro Flashcards

1
Q

What do you need to test for before starting azathioprine or mercaptopurine in Crohn’s?

A

thiopurine methyltransferase (TPMT) activity, the enzyme that metabolises Aza

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2
Q

Diagnosis of hep c active on bloods

A

HCV RNA

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3
Q

Hep b serology of ongoing infection

A

HBsAg either acute or chronic if present for> 6 months

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4
Q

what does Anti HBc serology indicate?

A

Caught -negative if immunised

Implies previous or current infection

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5
Q

How do you diagnose spontaneous bacterial peritonitis

A

Paracentesis with neutrophil count above 250

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6
Q

What calls release gastrin

A

G cells in antrum of stomach

Increases gastric motili

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7
Q

What cells release CCK

A

I cells in upper small intestine

Increases pancreatic enzymes, gallbladder contraction, decreased gastric emptying

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8
Q

What cells release secretion

A

S cells in upper small intestine

Increases bicarb rich foods from pancreas

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9
Q

What cells release somatostatin

A

D cells in pancreas and stomach…

They decrease acid gastrin pancreatic enzymes insulin

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10
Q

Red flags of IBS diagnosis

A

Onset over 60
Family history of bowel or ovarian cancer
Unexplained weight loss
Rectal bleeding

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11
Q

hereditary non-polyposis colorectal cancer (HNPCC) due to a defect in the MSH2 gene. What is the function of this gene?

A

DNA mismatch repair,

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12
Q

Criteria for liver transplant after paracetamol

A 
pH <7.3 12 hours after ingestion
Or 
Prothrombin >100
Creatanine >300
Grade 3 or 4 encephalopathy
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13
Q

Xray features of chronic pancreatitis

A

30% show pancreatic calcification, but CT is more sensitive

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14
Q

investigations for chronic pancreatitis

A

XR may show calcification (30%)
CT has sens/spec of 85% or so
faecal elastase may be used to assess exocrine function if imaging inconclusive

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15
Q

What is Courvoisier’s sign

A
  • a palpable gallbladder in the presence of painless jaundice is unlikely to be gallstones.

Only present in 15% of pancreatic cancers

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16
Q

What is the management of severe alcoholic hepatitis?

A

prednisolone 40mg/day for 28 days

determine severity by a Maddrey discriminant function value >32

Steroids reduced mortality by 39% at 28 days in STOPAH trial

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17
Q

Most common cause of HCC worldwide and in europe?

A

Worldwide Hep b

Europe hep c

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18
Q

Travellers diarrhoea differentials

A

Long incubation period- amoebiosis
Long duration of illness- giardiasis
Acute- E.coli - most common

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19
Q

Symptoms of ascending cholangitis

A

Charcot’s cholangitis triad: fever, jaundice and right upper quadrant pain

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20
Q

65 yr old man with BG of ischemic heart disease and hypertension presents with pr bleeding and abdo pain. Worse after eating. Diagnosis and location?

A

Ischaemic colitis… Most likely splenic flexure, where it is border of two different arteries (sup/inf mesenteric)

Thumbprinting on AXR

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21
Q

Barium swallow of a patient who can’t eat solids+liquid, mild weight loss, regurgitation…

A

Achalasia - Dilated tapering oesophagus

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22
Q

Barium swallow of patient with significant risk factors, can’t swallow solids and liquids and significant weight loss…

A

Cancer. Oesophageal structure with Apple core

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23
Q

Immunoglobulin related to alcoholic liver disease ,autoimmune hepatitis and primary biliary cirrhosis

A

IgA
IgG
IgM

Alphabetical

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24
Q

Why should patient with Coeliac disease have pneumoncoccal vaccine and booster every five years?

A

functional hyposplenism

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25
Q

Ulcer… Pain relieved by eating.

A

Duodenal ulcer

Gastroduodenal artery

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26
Q

Troublesome dyspepsia, not settled with PPI. 6 watery stools a day. Ogd showed erosions and ulcers
What is diagnosis and test to perform?

A

Fasting gastrin for Zollinger Ellison syndrome

… Not h pylori because of loose stools, erosions

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27
Q

Causes of rise in ALT and AST vs rise in ALP and GGT

A

Hepatocellular picture caused by paracetamol, valproate, phenytoin alcohol
Cholestatic eg caused by fluclox, cocp

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28
Q

Test to diagnose h pylori

A

13c urea breath test -very sensitive and specific, noninvasive

Can’t have had PPI for 2/52 or Abx for 4/52
(remember Rapid urease CLO test is from biopsy)

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29
Q

Triggers for liver decompensation in patient with chronic liver disease

A

Infection
Constipation
Electrolyte imbalance

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30
Q

Management of Gastric MALT lymphoma

A

H pylori eradication

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31
Q

Diagnosis of cirrhosis liver

A

Fibroscan -transient elastography

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32
Q

Severe hepatitis in a pregnant woman who’s been travelling to North Africa - what is likely cause?

A

Hepatitis E
pregnant women are at particular risk
20% Mortality in third trimester

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33
Q

Severe hepatitis in a pregnant woman who’s been travelling to North Africa - what is likely cause?

A

Hepatitis E
pregnant women are at particular risk
20% Mortality in third trimester

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34
Q

abdominal distension, hepatosplenomegaly and rose spots on her abdomen… Organism?

A

Salmonella typhi infections –Typhoid/paratyphoid.

They also appear in C.psittaci infections although it is more associated with typhoid than psittacosis.

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35
Q

Plummer-Vinson syndrome triad

A

glositis, iron def anaemia, dysphagia (secondary to oesophageal webs)

Great prog with iron and widening esophagus

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36
Q

biggest risk factor for developing Barrett’s Oesophagus

A

GORD is strongest
7:1 male:female too

interestingly, alcohol isn’t independent RF, but if a RF for GORD and Oesoph Ca

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37
Q

What is gold standard investigation for ?Gastro-oesophageal reflux disease

A

24hr oesophogeal pH monitoring, but only done if endoscopy negative

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38
Q

differentials of loss of distal oesophageal peristalsis

A

Achalasia - with increased LOS pressure on manometry

Scleroderma - with decreased LOS pressure on manometry

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39
Q

What are the restrictions to Urea breath test for H Pylori

A

should not be done within 4 weeks of Abx or 2 weeks of PPI

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40
Q

Patient presents with dyspepsia, no alarm symptoms, what is the management?

A

Trial one month PPI and lifestyle changes, then test

Test first (or in parallel with PPI trial) patients who are high risk - older people, individuals of North African ethnicity, and from a known high risk area

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41
Q

When do you do H Pylori test?

A

dyspepsia following trial of PPI (or if older or north african before trial)
If symptoms persist
Prior to NSAIDs if history of peptic ulcers / bleeds
Unexplained IDA following normal endoscopy

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42
Q

prognosis of Peutz-Jeghers syndrome

A

50% die by 60yr of a GI cancer (although their polyps don’t have malignant potential)

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43
Q

what blood group is associated with Gastric Cancer?

A

blood group A: gAstric cAncer

44
Q

what is current guidance for Colorectal cancer screening in England?

A

Faecal Immunochemical Test (FIT) screening every two years for all 60-74yr old, can request after that

ALSO one-off flexisig at 55yr

45
Q

What are the statistics re colonoscopy following abnormal faecal immunochemical test?

A

1/10 cancer
4/10 polyp, which may be removed
5/10 normal exam so bleeding could haev been peptic ulcer, angiodysplasia etc

46
Q

which is more common -hereditary non-polyposis colorectal carcinoma or familial adenomatous polyposis

A

hereditary non-polyposis colorectal carcinoma (HNPCC, 5%)

familial adenomatous polyposis (<1%)

47
Q

diagnostic test for Zollinger Ellison Syndrome

A

Serum gastrin levels followed by radiological or nuclear localisation
Secretin stimulation test - Gastrin should be suppressed but if it increases by >200 fifteen mins after secretin IV then 100% specific

48
Q

management and prognosis of Gastric MALT lymphoma?

A

80% respond to H Pylori erradication so very good prognosis

49
Q

What blood marker is important for Acute Pancreatitis prognosis?

A

CRP (>150), but isn’t in Glasgow, APACHE II or Ranson

50
Q

what is double duct sign and in what condition is it seen?

A

Pancreatic cancer can cause CBD and pancreatic duct obstruction +jaundice + dilatation

51
Q

blood marker for PAncreatic cancer prognosis

A

Ca 19-9 at presentation and post-op

52
Q

what is the most common Extra-intestinal feature of inflammatory bowel disease?

A

Arthritis

Usually asymmetrical, pauciarticular (less than 4joints) is related to disease activity

53
Q

Associations between inflammatory bowel disease and eye disease

A 
Episcleritis (predominantly Crohn's) 
and Uveitis (predominantly Ulcerative Collitis)
54
Q

Marker of Ulcerative collitis severity?

A

> 6 bloody stools a day and signs of systemic illness is severe

55
Q

management of Crohn’s vs Ulcerative Colitis to induce remission?

A

Crohn’s is managed by glucocorticosteroids first line, aminosalicylate (ASA)second line

UC is ASA first line, topical if possible. Except in severe - IV steroids +/- ciclosporin or surgery

56
Q

What is the diagnosis with a jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules?

A

Whipple’s Disease - symptoms diarrhoea/weight loss

W: worn out joints, weight loss
H: hyperpigmentation
I: intestinal malabsorption
P: pleurisy, photosensitivity
P: pericarditis, PAS nodules
L: lymphadenopathy
E: elevated macrophages
57
Q

patient with Irritable bowel syndrome hasn’t responded to antispasmodics, laxatives and amitriptyline for 12 months. what is next step?

A

psychological interventions like CBT

58
Q

causeS of villous atrophy

A 
Coeliac dsease
Tropical Sprue 
Hypogammaglobulinaemia 
GI lymphoma 
Whipple's disease 
Cow's milk intolerance
59
Q

Numerous Howell-Jolly bodies and pencil cells seen……diagnosis

A

Howell-Jolly bodies are seen in hyposplenism and pencil cells are a feature of iron-deficiency. Both of these are seen in coeliac disease.

60
Q

symptoms of whipple’s disease

A 
W: worn out joints, weight loss
H: hyperpigmentation
I: intestinal malabsorption
P: pleurisy, photosensitivity
P: pericarditis, PAS nodules
L: lymphadenopathy
E: elevated macrophages
61
Q

most common bacteria in spontaneous bacterial peritonitis

A

E coli

62
Q

Diagnosis of spontaneous bacterial peritonitis

A

pericentesis: neutrophils >250cells/ul

63
Q

how do you diagnosis portal venous hypertension?

A

serum ascites albumin gradient (SAAG) above 11g/L

SAAG = (serum albumin) − (albumin level of ascitic fluid)

the high pressure in the liver leaves the albumin in serum…

64
Q

features of portal venous hypertension, mneumonic

A 
Ascites
Bleeding (varices, haemorrhoids)
Caput medusa
Diminished liver function
Enlarged spleen
65
Q

is albumin a good measure of hepatic function?

A

yes, but has 20d half-life so not usefully in acute setting

66
Q

which comes first Wernicke’s or Korsakoff’s?

A

if Wernicke’s encephalopathy is not treated with thiamine, then it progresses to Korsakoff’s Syndrome

67
Q

what is xerostomia?

A

dry mouth

68
Q

middle aged female presents with xerostomia and fatigue with ALP 292. what is diagnosis?

A

primary biliary cirrhosis

69
Q

what is the diagnosis in patient with beaded appearance on MRCP, showing multiple billiary strictures?

A

primary sclerosising cholangitis

70
Q

what is most common cause of bilary disease in patients with HIV?

A

sclerosing cholangitis due to infections like CMV , Cryptosporidium

71
Q

what gene is defective in Wilson’s disease?

A

ATP7B on chromosome 13

autorecessive

72
Q

diagnostic tests for Wilson’s disease?

A

increased 24hr urinary copper excretion
Counterintuitively LOW serum copper (as 95% of copper is carried by caruloplasmin, which is also degraded quickly in wilson’s)

73
Q

What disorder is most strongly associated with primary biliary cirrhosis?

A

Sicca AKA Sjogren’s syndrome in 80%

74
Q

What is increased risk of developing hepatocellular cancer in pt with primary biliary cirrhosis?

A

20x normal population

75
Q

How do you diagnose Gilbert

A

rise in bilirubin following prolonged fasting or IV nicotinic acid

76
Q

Describe Budd-Chiari syndrome

A

aka hepatic vein thrombosis
Usually seen in prothrombotic patients
Ruq pain, tender hepatomegaly and ascites

USS

77
Q

What is the BMI cut off for bariatric referral?

A

Obesity - NICE bariatric referral cut-offs

with risk factors (T2DM, BP etc): > 35

no risk factors: > 40

78
Q

Patient presents with diarrhoea and colonoscopy biospy shows pigment laden macrophages… Diagnosis?

A

laxative abuse

79
Q

What histology might you saw in gastric adenocarcinoma?

A

Gastric adenocarcinoma - signet ring cells may be seen

80
Q

how many types of Hepatorenal syndrome are there?

A

HRS - AKI (formally type 1) is acute - less than 2w, usually due to acute bleed e.g. variceal
HRS-CKD (formally Type 2) is a gradual decline in renal function and is generally associated with refractory ascites

There is also sub-acute or AKD

81
Q

patient with AF presented with bloody diarrhoea and abdo pain. tender. Diagnosis?

Bicarb 18 (low)
WCC 25
A

The low bicarbonate points to a metabolic acidosis - highly suggestive of mesenteric ischaemia.

82
Q

what syndrome does C Diff cause?

A

Pseudomembranous colitis is caused by C Diff exotoxin causing intestinal damage

Multiple white plaques adhered to the gastrointestinal mucosa. on sigmoid

83
Q

test to diagnose small bowel overgrowth syndrome

A

hydrogen breath test

84
Q

Childs Pugh score

A 
Albumin
Bilirubin
Coagulopathy (PT)
Distension (ascites)
Encephalopathy

(Used to calculate severity of liver cirrhosis)

85
Q

Villous adenoma

A

Colonic polyp, potential malignant transformation

Diarrhoea
Classically large amount of mucus
Hypokal
Microcytic anaemia

86
Q

Pregnant lady, jaundice abdo pain, deranged LFTs, hypoglycemia, blood film shows no evidence of haemolysis

A

Acute fatty liver of pregnancy

There would be haemolysis w HELLP

87
Q

right upper quadrant pain, fever and jaundice

A

Charcot’s triad -ascending cholangitis

Typically e coli

88
Q

Most common bacterial cause of ascending cholangitis

A

E coli

Assx w gallstones

89
Q

Patient presents with erectile dysfunction, arthralgia, with evidence of chrondrocalcinosis

OE bronze skin, liver failure, dilated cardiomyopathy,

A

Haemochromatosis ,

Auto r

90
Q

Prevalent of haemochromatosis

A

1 in 10 people of European descent carry a mutation in the genes affecting iron metabolism, mainly HFE

Prevalence in European 1/200

91
Q

Childs Pugh score

A 
Albumin
Bilirubin
Coagulopathy (PT)
Distension (ascites
Encephalopathy
92
Q

Features of Post-cholecystectomy syndrome

A

Up to 40% of patients develop diarrhoea, dyspepsia, vomiting, pain…
Unclear pathology

93
Q

Management of post cholecystectomy syndrome

A

bile acid sequestrants, such as Cholestyramine

PPI might help

94
Q

Drug causes of acute pancreatitis

A

Mesalazine, sodium valproate, bendroflumethiazide, furosemide,

Alcohol ..

95
Q

Population screening for haemochromatosis

A

Serum transferrin saturation

HFE gene analysis for family

96
Q

Pernicious anaemia antibodies

A

anti gastric parietal cell antibodies (90%, but m specific)

Anti IF antibodies (50% but specific)

97
Q

Ulcerative colitis - most common site affected

A

the rectum

98
Q

Mx for Hepatic encephalopathy

A

Lactulose (increases ammonia excretion)

Then rifaximin (affects gut flora to decrease ammonia production)

99
Q

severe acute alcoholic hepatitis is made

Which clotting factor is characteristically increased?

A

Factor VIII

100
Q

Acute management of variceal bleeds

A

FFP vit k
Terlipressin
Prophylactic abx (reduce mortality)
endoscopic variceal band ligation

Prophylaxis with propranolol

101
Q

mnemonic for DRugs causing hepatocellular disease:

A 
Peter- Paracetamol
Had- Halothane
Epilepsy- sodium valproated and phenytoin
And- amiodrone
Alcoholic- Alcohol
TB- anti-tbs
he Met- Methyldopa
dr. Nitro in- Nitrofurantoin
STATes- Statins
102
Q

Diarrhoea, PR bleed, pigmented freckles on the lips, face, palms and sole….diagnosis

A

Peutz-Jeghers syndrome

LKB1 or STK11

103
Q

HBsAg meaning

A

Infected

Might be neg in window period with anti HBs also neg, but where anti HBc has developed… So is still infected.

104
Q

Anti HBs simplified

A

Immunity

If there is also anti HBc then means you’re had caught up. If this is neg then you were vaccinated

105
Q

Management of Whipple’s

A

oral Co-trimoxazole for a year (!)

Or IV Ceftriaxone

Mrcp (21 decks)

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