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MRCP 2 > Gastro > Flashcards

Gastro Flashcards

1
Q

Councilman bodies on liver post mortem

A

Yellow fever

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2
Q

The three classical causes of ALT in the 1000s

A

Acute hepatitis
Ischaemia
Drug tox ( paracetamol, anaesthetic agents, alcohol, labetalol)

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3
Q

right upper quadrant pain, evidence of upper GI bleeding and jaundice after liver biopsy

A

Haemobilia
- bleeding into the biliary tree following connection between splanchnic circulation and either the intrahepatic or extrahepatic biliary system

Endoscopy only diagnostic in 12%
MRI with cholangiopancreatographic may help
Angiography is diagnostic and then embolisation of the lesion

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4
Q

Patient presents with drop in Hb. Colonoscopy and OGD normal two years ago. What investigation is more likely to contribute to diagnosis

A

Capsule endoscopy
?angiodysplasia - second leading cause of lower GI bleeding in >60yr

Treated with sclerotherapy,angioembolisatiob or selective resection

Capsule endoscopy used to identify the source of occult GIB when an OGD/colonoscopy N

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5
Q

How many bloody stools in a day is severe in UC

A

More than 6

<4 and 4-6 are mild and moderate

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6
Q

Patient with Crohn’s or coeliac disease, started on sertraline…what may develop?

A

Lymphocytic colitis

Lymphocytic infiltrates on biopsy

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7
Q

Patient presents with two years of Abdo pain and loose stool.

They then develop cognitive decline , and eye exam reveals upgaze palsy, and pendular oscillations of both eyes. With each eye movement there is concurrent movement of the jaw

Diagnosis

A

Whipple’s
Eye involvement is only in 20% but pathognomonic

Diagnose with jejunal biopsy

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8
Q

Eye features of Whipple’s disease occur in 20% but are thought to be pathognomonic. What are they?

A

upgaze palsy, and pendular oscillations of both eyes. With each eye movement there is concurrent movement of the jaw

Diagnose with jejunal biopsy

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9
Q

Patient with diabetes presents with chronic diarrhoea

Found to have low vitamin B 12 and high folate levels

A

Small bowel bacterial overgrowth syndrome

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10
Q

Investigation for suspected Bile acid malabsorption

A

SeHCAT test - a form of nuclear imaging test

Mx: bile acid sequestrants e.g. cholestyramine

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11
Q

Combined oral contraceptive pill use + acute abdominal pain/distension
ascites and deranged liver function tests
Diagnosis

A

?Budd-Chiari syndrome
Aka hepatic being thrombosis

Triad of sudden onset abdominal pain, ascites, and tender hepatomegaly

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12
Q

What is budd chiari

A

Hepatic vein thrombosis

…sudden onset abdominal pain, ascites, and tender hepatomegaly

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13
Q

Spontaneous bacterial peritonitis is diagnosed with….

A

neutrophil count > 250 cells / mm^3

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14
Q

Variceal uncontrolled haemorrhage, not resolved by banding in endoscopy

A

Sengstaken-Blakemore tube

If that fails then TIPSS (connects hepatic vein to portal vein, can exacerbate hep enceph)

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15
Q

UC flare marker of need for surgery

A

At day three CRP >45 mg/l or a stool freq of >8/day predicts the need for surgery in 85% of cases.

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16
Q

Jejunal biopsy shows deposition of macrophages containing PAS-positive granules

A

Whipple’s

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17
Q

Patient with Barrett’s management

A

Endoscopic surveillance w biopsy and high dose PPI

If metaplasia then Endoscopy 3-5y
If dysplasia then Endoscopic mucosal resection , radiofreq ablation

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18
Q

Risk of cancer for Crohn’s

A

Small bowel standard incidence ratio 40

Colorectal standard incidence ratio 2 (less than in UC)

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19
Q

Pt has varices so has TIPS. 2 months later develops breathless and reduced ET. No other symptoms.

A

Pulmonary hypertension is known complication

Causes an increased cardiac preload by diverting blood past cirrhotic liver, increasing peripheral resistance

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20
Q

Colonic Adenoma surveillance

A

Low risk:
1or 2 adenomas, less than 10mm….. 5y colonoscopy

Intermediate
3 or 4 small, or 1-2 w one >10mn……3y colonoscopy

High
5 or more smaller, or 3 / more but larger…….1y colo

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21
Q

What topical disease has mega-oesophagus? -dilated on barium

A

Chronic phase of Chagas disease
Trypanosoma cruzi

Can also have mega colon,CHF and Arrhythmia

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22
Q

Management of primary biliary cirrhosis

A

Ursodeoxycholine acid

AMA antibodies

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23
Q

Management for achalasia

A

pneumatic (balloon) dilation first line

Nifedipine , lowers oesoph pressure

24
Q

Absolute contraindications for transjugular intrahepatic portosystemic shunt TIPPS

A

Severe and progressive liver failure (Child-Pugh score >12)
Uncontrolled hepatic enceph (commonly makes it worse)
R HF
Uncontrolled sepsis
Unrelieved biliary obstruction

25
Q

What is TIPPS procedure

A

transjugular intrahepatic portosystemic shunt

percutaneous creation of a tract between the intrahepatic portal vein and the hepatic vein.

So blood can bypass the liver and lowers portal pressure

26
Q

Barrett’s w low grade dysplasia. Management

A

PPI, repeat colonoscopy in 6m

If there is still dysplasia, then enoscopic ablation

27
Q

Progression rate of low grade dysplasia in barrett’s oesoph

A

9%/yr to high grade or oesoph Ca

28
Q

Cancer surveillance for Crohn’s

A

1y scope in moderate/severe or PSC/fam hx in under 50/dysplasia/structure

3yr if mild, or fam hx over 50/postinflam polyps

29
Q

colorectal carcinoma w liver mets management

A

staged surgical resection of carcinoma and liver lesions - 5-year survival rate of up to 30%

biopsy is not an option as would seed the tumour

30
Q

when do you get acalculous cholecystitis ?

A

Typically occurs in the very ill patient on the intensive care unit, or after extensive burns

31
Q

what is a succussion splash?

A

AKA gastric splash

sloshing sound heard through a stethoscope during sudden movement of the pt on abdo auscultation

  • gas and fluid in an obstructed organ, as in gastric outlet obstruction or gastroparesis
32
Q

Pt w ulcerative proctitis on oral mesalazine 2g BD presents w flare:

inflamed distal 7 cm of rectum, with normal mucosa above…. Management

A

Topical treatment with mesalazine suppositories is the most appropriate first-line measure for a proctitis flare.

already on a high dose of oral 5-aminosalicylic acid

33
Q

regurge of undigested food and halotosis

A

zenker’s diverticulum

diagnosed w barium swallow

34
Q

pt presents with change in bowel habit, PR bleeding, and history of Osteomas of the skull and mandible

diagnosis

A

Gardner’s syndrome

variant of FAP

w osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on the skin

35
Q

features of Gardner’s syndrome

A

variant of FAP

w colorectal Ca, osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on the skin

36
Q

mx of hepatic encephalopathy

A

treat any underlying cause

Lactulose and Rifaximin

37
Q

MOA of Rifaximin and lactulose in hep encephalopathy

A

rifaxmin decreases ammonia production

Lactulose promotes excretion of ammonia and increasing the metabolism of ammonia by gut bacteria

38
Q

diagnosis of autoimmune pancreatitis

A

imaging and raised serum IgG4

39
Q

Classic presentation of graft Vs host disease post liver transplant

A

15 days post, abnormal LFTs jaundice hepatomegaly

Macpap rash on palms and soles
Diarrhoea

Urgent USS and Doppler

40
Q

Pt w UC

anorexia, jaundice, RUQ pain and weight loss over 6m

A

cholangiocarcinoma (in 10% of Primary sclerosing cholangitis)

41
Q

east africa, eosinophiilia, liver failure, varices

A

Schistosoma mansoni and Schistosoma japonicum

42
Q

most common autoimmune hepatitis

A

type 1

Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (ASMA)

43
Q

scoring system for autoimmune hepatitis

A

revised original AIH score

44
Q

tx of autoimmune hep

A

induce remission w pred,
then taper and add azathioprine

if IgG, ALT normalise then can stop treatment completely (40% req lifelong)

45
Q

Chronic Hepatitis C complication

A

Membranoproliferative glomerulonephritis
Hepatocellular Cancer
Cryoglobulinaemia: typically type II (mixed monoclonal and polyclonal)
sjogrens

46
Q

immunocompromised pt develops watery diarrhoea

Management

A

Cryptosporidium

Largely supportive
Nitazoxanide is licensed in the US for immunocompetent patients

47
Q

confused after transjugular intrahepatic portosystemic shunt TIPPS

A

Hepatic encephalopathy

TIPPS precipitates it in 25%
increased portosystemic passage of nitrogen from the gut

48
Q

in well-man check, patient has Ferritin 15, MCV 76, Hb 132

A

iron deficiency (without anaemia)

Endoscopy if postmenopausal women and men >50yr,

49
Q

which immunoglobulin is classically raised in autoimmune hepatitis?

A

IgG

50
Q

Single most important factor to indicate the need for a liver transplant post paracetamol overdose

A

pH < 7.3 , 24hr after ingestion

Or all of:
PT>100
Cr >300
Grade 3 or 4 enceph

(King’s College Hospital criteria for liver transplantation)

51
Q

Which autoimmune hepatitis has highest rate of cirrhosis?

A 
Type 2 (82%)
--Soluble liver-kidney antigen

T3 (75%)
T1 (45%)

52
Q

Which autoimmune hepatitis has best response to steroids

A

3

53
Q

indication of alcoholic liver disease rather than non-alcoholic fatty liver

A

AST : ALT ratio > 2

Normal GGT can exclude alcohol only

54
Q

Newly diagnoses coeliac disease , responded to gluten exclusion. Now asymptomatic. Abnormal transaminases, why?

A

Hepatic steatosis is common finding at diagnosis or within a yr of treatment
Usually returns to normal

Auto immune hep tends to be middle aged women, chronic fatigue & pruritis

55
Q

sudden onset bilat red eyes in history of IBD. Mx?

A

Episcleritis (more common in Crohn’s)

Topical corticosteroids

56
Q

what do you measure to determine cause of ascites?

A

serum-ascites albumin gradient (SAAG)
Serum albumin / ascitic albumin
>11g/L indicates portal hypertension

MRCP 2 (13 decks)

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