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Nephrology > Gastro > Flashcards

Gastro Flashcards

1
Q

Plummer vinson syndrome

A

Triad of:
dysphagia (secondary to oesophageal webs)
glossitis
IDA

Treatment includes iron supplementation and dilation of the webs

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2
Q

D2 Antagonist

A 
Metoclopramide - prokinetic
Domperidone - prokinetic
Prochlorperazine - Vestibular/GI causes
Haloperidol - drug causes
>> dystonias and oculogyric crisis in young
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3
Q

H2 antagonist

A

cyclizine - GI

cinnarizine - vestibular

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4
Q

5HT3 antagonist

A

Ondansetron - chemo

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5
Q

Zollinger Ellison Syndrome

A

gastroma > gastrin > gastroduodenal ulcres > abdo pain, diarrhoea,
PPI
Dx fasting gastrin
MEN1

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6
Q

Duodenal ulcer

A 
Blood O-
more common
before meals
milk helps
night
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7
Q

Gastric ulcer

A

elderly, lesser curve
after meals
better with antacids
biopsy (cancer)

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8
Q

Dx HH

A

Liver biopsy - Perls stain – iron loading

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9
Q

Complications HH

A 
hypogonadism
cardiomyopathy
skin changes - bronze
diabetes
cirrhosis
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10
Q

PBC

A 
Autoimmune
AMA, raised IgM, middle aged women
Cholestasis > fibrosis
> HCC (check AFP bi yearly), cirrhosis
Tx - ursodeoxycholic acid
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11
Q

Primary sclerosing cholangitis

A 
Ulcerative colitis
ANA
liver biopsy - fibrous obliterative cholangitis
beading ERCP/ MRCP -- dx
men
high risk ca - yearly colonoscopy and US
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12
Q

Autoimmune hep

A

young middle age women
T1 - AMA, SMA -kids, middle age
T2: kids, Anti liver anti kidney microsomal - LKM1
T3: Anti soluble liver antigen
Signs chronic liver disease, 25% acute, amenorrhea
associations - autoimmune disorders, hypergammaglobulinaemia and HLA B8, DR3
liver biopsy: inflammation extending beyond limiting plate ‘piecemeal necrosis’, bridging necrosis
Mx: steroids, azathioprine, liver transplantation

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13
Q

Wilsons

A 
Copper > liver, basal ganglia
AR
low serum copper and caeruloplasmin
high urinary copper 24hr
Tx penicillamine
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14
Q

Cholangiocarcinoma

A

flukes
slow growing
ERCP, surgery
75% cant have surgery, 75% re occur

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15
Q

Ulcerative colitis

A 
PSC > UC
Uveitis > UC
no inflammation beyond submucosa
ulceration  ('pseudopolyps')
 lamina propria
 crypt abscesses
loss of haustrations
'drainpipe colon'
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16
Q

Tx UC

A

topical (rectal) aminosalicylate (mesalazine) - mild mod

severe - IV steroids then IV ciclosporins

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17
Q

Crohns tx

A

Inducing remission:
glucocorticoids , budesonide
ASA - mesalazine

Maintaining remission
azathioprine or mercaptopurine
methotrexate

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18
Q

Investigations Crohns

A

increased faecal calprotectin

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19
Q

Complications Crohns

A

small bowel cancer
colorectal cancer
osteoporosis

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20
Q

Explosive diarrhoea

A

cholera; giardia; yersinia; rotavirus.

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21
Q

White cells: absent

A

in amoebiasis, cholera, E. coli and viruses

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22
Q

Clostridium difficile

A

Gram positive rod
exotoxin > intestinal damage > pseudomembranous colitis.
broad-spectrum antibiotics, 2nd/3rd gen cephalosporins, PPIs
diarrhoea, abdo pain, raised WCC
> toxic megacolon
Diagnosis -CDT stool
Clostridium difficile antigen -exposure
oral metronidazole 10-14 days
severe / not responding -oral vancomycin / fidaxomicin
life-threatening - oral vancomycin and IV metronidazole

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23
Q

Cryptosporidiosis

A

protozoa

Ziehl-Neelsen stain (acid-fast stain) of the stool - red cysts of Cryptosporidium

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24
Q

Travellers’ diarrhoea

A

Escherichia coli.

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25
Q

acute food poisoning

A

Staph aureus, Bacillus cereus or Clostridium perfringens.

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26
Q

Giardiasis

A

flagellate protozoan
chronic diarrhoea, malabsorption and lactose intolerance
metronidazole

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27
Q

Cholera

A

Profuse, watery diarrhoea

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28
Q

Shigella

A

Bloody diarrhoea

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29
Q

Campylobacter complications

A

GBS, Reiter’s syndrome, septicaemia, endocarditis, arthritis

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30
Q

Campylobacter

A

Gram-negative bacillus Campylobacter jejuni

bloody diarrhoea, may mimic appendicitis

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31
Q

rice

A

Bacillus cereus

32
Q

Salmonella - bacteria type

A

aerobic, Gram-negative rods

Typhoid and paratyphoid

33
Q

Salmonella symptoms

A

systemic upset
relative bradycardia
abdominal pain, distension
constipation: although Salmonella is a recognised cause of diarrhoea, constipation is more common in typhoid
rose spots: present on the trunk in 40% of patients, and are more common in paratyphoid

34
Q

Salmonella complications

A

osteomyelitis (especially in sickle cell disease)
GI bleed/perforation
meningitis
cholecystitis
chronic carriage (1%, more likely if adult females

35
Q

Osmotic laxatives

A

Lactulose, Movicol®, Magnesium salts, Phosphate enemas

36
Q

Stimulant laxatives

A

senna , Docusate sodium, Glycerol suppositories ( sodium picosulfate)

37
Q

Cullens sign

A

periumbilical

38
Q

Turners sign

A

flanks

39
Q

Courvoisiers sign

A

palpable gallbladder
jaundice
no pain

:> unlikely stone, think ca

40
Q

Carcinoid tumours - ix and tx

A

Investigation
urinary 5-HIAA (metabolite of serotonin)
plasma chromogranin A y

Management
somatostatin analogues e.g. octreotide
diarrhoea: cyproheptadine may help

41
Q

gastric cancer. histology

A

signet rings

42
Q

Complication deficiency selenium

A

cardiomyopathy

43
Q

Complication deficiency B6 (pyridoxine)

A

polyneuropathy

44
Q

Complication deficiency Zinc

A

Acrodermatitis enteropathica

poor wound healing

45
Q

Complication deficiency B 1 (thiamine)

A

Beriberi
wet - HF
dry - neuropathy
Wernicke’s encephalopathy

46
Q

pellagra

A

nicotinic acid
diarrhoea, dementia, dermatitis
nicotinamide

47
Q

xeropthalmia

A

vit a
blind
btots spots

48
Q

Unconjugated hyperbilirubinaemia

A

Gilbert’s syndrome - mild deficiency of UDP-glucuronyl transferase
Crigler-Najjar syndrome - absolute deficiency

49
Q

Conjugated hyperbilirubinaemia

A

Dubin-Johnson syndrome:
Iranian Jews
mutation in the canalicular multidrug resistance protein 2 (MRP2) results in defective hepatic excretion of bilirubin
grossly black liver

Rotor syndrome:
defect in the hepatic uptake and storage of bilirubin
benign

50
Q

Peutz-Jeghers syndrome

A

gene encodes serine threonine kinase LKB1 or STK11
hamartomatous polyps in GI tract (mainly small bowel)
pigmented lesions on lips, oral mucosa, face, palms and soles
intestinal obstruction e.g. intussusception
gastrointestinal bleeding
GIT cancers

51
Q

Melanosis coli

A

disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages

It is associated with laxative abuse, especially anthraquinone compounds such as senna

52
Q

Previous Hep B immunisation

A

Anti HBS only

53
Q

Hep B previously, now clear

A

anti HBsAg positive
anti HBcAg positive
All antigen negative

54
Q

Hep B, chronic

A

All antigens and all antibodies - IgG as chronic

55
Q

Hep A

A 
benign, self limiting
2-4 incubation
RNA picornavirus
cholestatic LFTs
At risk groups vaccinated
56
Q

Hep B

A 
DS hepadnavirus
incubation 6-20 weeks
ALT > AST
Peg interferon alpha, now some antivirals
Screen pregnant women
57
Q

Hep C

A

RNA flavavirus
No vaccine
High risk transmission
Majority (60%) chronic

58
Q

Chronic hep C treatment

A

Aim: sustained virological response
combination of protease inhibitors
+ / - ribavirin

59
Q

Ribavirin

A

Tx chronic Hep C

SE: Haemolytic anaemia, cough, teratogenic (no preg <6/12)

60
Q

Interferon alpha

A

Chronic hep c

Flu like symptoms, depression, fatigue, leukopenia, thrombocytopenia

61
Q

Hep D

A 
Single stranded RNA
Parenteral
Requires HBsAg
Interferon tx (poor evidence)
Coinfection/ superinfection
62
Q

Hep E

A 
RNA herpesvirus
faecal oral
3-8 weeks incubation
20% mortality pregnancy
vaccine in development
not chronic
63
Q

Autoimmune hepatitis T1

A

ANA/ SMA

adults, kids

64
Q

Autoimmune hepatitis T2

A

LKMI
Anti liver/ kidney microsomal type 1 antibodies
Kids

65
Q

Autoimmune hepatitis T3

A

Soluble liver kidney antigen

Middle aged adults

66
Q

Wilsons

A

autosomal recessive
ATP7B gene, chromosome 13
reduced serum caeruloplasmin with reduced serum copper
increased 24hr urinary copper excretion

67
Q

Wilsons treatment

A

penicillamine

trientine hydrochloride - chelating agent

68
Q

HCC screening

A

US + - AFP

cirrhosis secondary to Hep B/C/ haemochromatis or alcohol

69
Q

HH iron profile

A

transferrin saturation high
raised ferritin
low TIBC

70
Q

Tx HH

A

venesection

Desferrioxamine

71
Q

Who is at risk of liver cirrhosis?

A

Hep B/ C, BMI > 30, alcohol abuse, T2DM

72
Q

Who do you offer transient elastography to?

A

Hep C, alcohol M>55 units, F> 35 units, alcohol related liver disease, NAFLD with ELF test > 10.5
Retest every 2 years

73
Q

Cirrhosis risk screening

A

HCC - US and AFP 6 monthly

UGIE 3 yearly for varices

74
Q

IBS management

A

2nd line = low-dose TCA (e.g. amitriptyline 5-10 mg)

if no improvement 1 year - CBT/ hypnotherapy/

75
Q

Gastroparesis

A

Prokinetic agents:
Metoclopramide
Domperidone
Erythromycin

Nephrology (26 decks)

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