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MSRA > Gastro/ Nutrition > Flashcards

Gastro/ Nutrition Flashcards

1
Q

Carcinoid Tumours
What is it?
Sx (6)

A

Tumour of neuroendocrine cells usually from bowel or lung

Sx

  1. SOB/ bronchospasm
  2. Diarrhoea
  3. Flushing
  4. Itching
  5. Pellagra
  6. Right heart valvular stenosis
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2
Q

Carcinoid Tumours
Ix (3)
Mx (2)
Metastases to _____

A

Ix

  1. 24h urinary 5HIAA
  2. Bloods to test for niacin levels
  3. Octreotide scan

Mx
1. Somatostatin anologues (octreotide)
2. Diarrhoea: cyproheptadine
Metastases to liver

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3
Q

What is Budd-Chiari syndrome?
Triad features (3)
Ix (1)

A 
Hepatic vein thrombosis
Features 
1. Sudden onset severe abdominal pain 
2. Tense ascites 
3. Hepatomegaly

Ix
1. USS with doppler

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4
Q

Budd-Chiari causes (4)

A

Anything haematological

  1. Thrombophillia
  2. Polycythaemia rubra vera
  3. Pregnancy
  4. COCP
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5
Q 
Gilbert's syndrome 
AD or AR 
What is it? 
Features (1) 
Ix (1)
A

AR unconjugated hyperbilirubinaemia

Features
1. Jaundice when has illness/ fasting/ exercise

Ix
1. rise in bilirubin following prolonged fasting or IV nicotinic acid

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6
Q 
Haemachromatosis 
AD or AR 
What is it?
Triad
Features (6) 
(Hint: skin, cardio, endo, bones)
A

AR, genetic mutation of HFE gene on chrm 6 (HaEmachromatoSIX), leading to the build up excess iron

Triad: cirrhosis, DM, bronze skin pigmentation

Features 
Reversible
Skin
1. Bronze skin pigmentation 
Heart
2. Cardiomyopathy/ cardiac failure 
Non reversible 
Bones
3. Arthralgia  
Endo
4. Liver disease 
5. DM 
6. Hypogonadotrophic hypogonadism
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7
Q 
Wilson's disease 
AD or AR 
What is it? 
Common in which three organs
Features
A

AR, genetic mutation ATP7B gene on chrm leading to build up of copper

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8
Q

Wilson’s disease
Common in which three organs
Features (8)
Mx (1)

A 
Features prevalent in brain, liver, eyes
Eyes
1. Keiser-Fleishcer rings 
Brain
2. Speech disturbance
3. Behavioural changes
Liver
4. Liver cirrhosis 
5. Hepatitis 
Other
6. Acute tubular necrosis (Fanconi)
7. Blue nails 
8. Haemolysis
Tx
1. Pencilliamine
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9
Q

Pellagra
What is it?
Features triad

A

Vitamin B3 (niacin) deficiency
Features 3Ds
Diarrhoea, dementia, dermatitis
Inflamed skin areas of sunlight/ friction first

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10
Q

Ix for Wilson’s (3)

A
  1. Slit lamp for KF rings
  2. Reduced caeruloplasmin
  3. Reduced total serum copper
  4. 24hr urinary copper excretion
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11
Q 
Whipple's disease 
Caused by (1)
M/F?
Age 
Features (4)
A
  1. caused by Tropheryma whippelii
    More common in middle aged men with HLA B27
    Features
  2. Malabsorption - steatorrhea/ diarrhoea
  3. Large joint arthralgia
  4. Pericarditis
  5. Pleurisy
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12
Q

Whipple’s disease
Ix
Mx

A

Ix
jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules

Mx co-trimoxazole

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13
Q

Crohn’s

Features (6)

A
  1. Mouth to anus
  2. All layers so skip lesions
  3. Episcleritis
  4. Non bloody diarrhoea
  5. Weight loss
  6. AP
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14
Q 
Ulcerative Colitis 
Where does it start?
Which layers? 
Stool 
Associated with which three conditions?
A 
Where does it start?
Which layers? 
Stool 
Associated with which three conditions? 
1. From ileocaecal valve only 
2. Submucosal layer only, crypt abscesses 
3. Bloody diarrhoea
4. PSC
5. Uveitis 
6. Colorectal CA
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15
Q

Shared features IBD (4)

A
  1. Diarrhoea
  2. Pyoderma gangrenosum
  3. Erythema nodosum
  4. Arthritis
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16
Q

Features of UC on barium enema (3)

A
  1. Loss of haustrations
  2. Drain pipe colon
  3. Pseudopolyps
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17
Q

UC
Triggers for flares (4)
Management of acute flare (2)

A
  1. Abx
  2. Stopping smoking
  3. NSAIDs
  4. Stress
    Mx
  5. IV steroids
  6. IV ciclosporin
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18
Q

Flares Classification

A

Mild <4 stools /day, nil systemic sx
Mod 4-6 stools/day, minimal systemic sx
Severe >6 stools/ day, systemic sx, ESR >30

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19
Q 
UC Management 
Inducing remission (2)
Maintaining remission (1)
If severe (2)
A

Inducing

  1. 5-ASA, topical, then add PO
  2. Corticosteroids

Maintaining
1. Topical 5-ASA or combined PO + topical

Following severe, or if has had 2 or more exacerbations in one year
1. AZT or mercaptopurine

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20
Q 
Crohn's Mx 
Inducing remission (3) 
Maintaining remission (2)
A 
Inducing 
1. Steroids 
2. 5-ASA
3. AZT or mercaptopurine as add ons 
(assess thiopurine methyltransferase (TPMT) activity before AZT or mercaptopurine)

Maintaining

  1. AZT or mercaptopurine
  2. 5-ASA if has had surgery
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21
Q

Vitamin B1 deficiency
What is it?
What can it cause?

A

Thiamine deficiency
Wernickes
Beriberi

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22
Q

Coeliac disease
What is it?
Associations (3)

A

Autoimmune, sensitivity to gluten –> constant exposure can lead to villous atrophy which can cause malabsorption

Associations with:

  1. HLA-DQ2 + DQ8
  2. Dermatitis herpetiformis
  3. Autoimmune conditions e.g hepatitis, DM1
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23
Q

Coeliac

Features (7)

A
  1. AP
  2. Failure to thrive
  3. Anaemia (secondary to malabsorption)
  4. N&V
  5. Weight loss
  6. Fatigue
  7. Diarrhoea
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24
Q

Coeliac

Investigations (3)

A

Needs to have gluten in diet for 6 weeks
1st line
1. TTG (tissue transglutaminase) antibodies (IgA)
2nd line
2. Endomyseal antibody (IgA)
3. Duodenal/ jejunal biopsy

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25
Q

Vitamin A aka

Deficiency causes

A

Retinol

Night blindness

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26
Q

Variceal haemorrhage
Mx
Acute (3)
Chronic (2)

A

Acute
1. Terlipressin
(+ prophylactic abx in pts with liver cirrhossis)
2. Band ligation
3. Sengstaken-Blakemore tube if uncontrolled haemorrhage

Chronic

  1. Propranolol
  2. Band ligation every 2 weeks until resolved, PPI coverage
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27
Q

Spontaneous bacterial peritonitis is seen in patients with what condition?
Triad
Commonly caused by which organism?

A

Seen in pts with ascites secondary to liver cirrhosis

Triad

  1. Fever
  2. Ascites
  3. AP

Ecoli

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28
Q

Spontaneous bacterial peritonitis
Ix
Mx

A

Ix
1. Paracentesis >25 neutrophils
Mx
1. IV cefotaxime

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29
Q

Spontaneous bacterial peritonitis
Criteria for prophylactic abx
Choice of prophylactic abx

A
  1. SBP
    OR
  2. Patients with fluid protein <15 AND
    Child Pugh >9 OR hepatorenal syndrome

Prophylactic abx PO ciprofloxacin or norfloxacin

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30
Q

Primary sclerosing cholangitis
Associations (1)
Features (3)
Complications (2)

A
  1. UC (also Crohn’s and HIV)

Features

  1. AP pain (location: RUQ)
  2. Jaundice
  3. Itching
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31
Q

Primary sclerosing cholangitis
Ix
What will you seen on bloods?
What automimmune bloods will you see?

A
  1. Raised ALP and bili

2. p-ANCA +ve (and anticardiolipin?)

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32
Q

Primary biliary cirrhosis
Associatations (2)
Features (4)

A

Associations

  1. Sjogren’s
  2. RA

Features

  1. Jaundice
  2. Hyperpigmentation
  3. Xanthelasma
  4. pruritus
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33
Q

Primary biliary cirrhosis
What will you seen on bloods?
What autoimmune bloods will you see?

A
  1. Raised ALP and bili

2. anti-mitochondrial antibodies

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34
Q

Primary sclerosing cholangitis
Complications (3)

Primary biliary cirrhosis
Complications (3)

A

Complications

  1. Cholangiocarcinoma
  2. Colorectal cancer
  3. Cirrhosis
  4. Hepatocellular carcinoma
  5. Osteomalacia
  6. Cirrhosis
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35
Q

PBC

Mx

A
  1. Urso
  2. colestyramine (for pruritus)
  3. Fat soluble vitamins
  4. Liver transplant
36
Q

What is Child Pugh scoring system used for?

A

Used to assess liver cirrhosis severity

37
Q

Causes of liver cirrhosis

A

Vascular
1. Budd Chiari

Liver

  1. Hepatitis B/C
  2. NASH

Drugs

  1. ETOH
  2. MTX
  3. Amiodorone

Autoimmune

  1. PBC
  2. PSC

Genetic

  1. Wilson’s
  2. Haemachromatosis
  3. Alpha-1 antitrypsin deficiency
38
Q 
Hep B serology
HBsAg means 
anti-HbsAg +ve means 
anti- HbcAg -ve means 
anti-HBcAg +ve means
A

HBsAg means +ve –> current infection, -ve –> not currently infected
anti-HbsAg +ve means –> either immunised or cured
WITH
anti- HbcAg -ve means –> immunised
anti-HBcAg +ve means –> cured

39
Q

Hepatitis D
DNA or RNA, single or double
How is it spread?

A

Single stranded RNA
Needs HBsAg to replicate
Bodily fluids

40
Q

Hepatitis B
How is it spread?
Triad
Complications (2)

A

It is spread through bodily fluids/ vertical transmission mother to child

Triad fever, jaundice, elevated transaminases

Complications

  1. HCC
  2. Chronic hepatitis - ground glass hepatocytes
41
Q

Vitamin D deficiency
Child
Adults

A

Child - rickets

Adults - osteomalacia

42
Q

IBS

Diagnostic criteria

A 
AP related to defecation OR altered form/ frequency of stool 
AND at least x2 of
1. Bloating 
2. Altered stool passage 
3. Mucous PR 
4. Worse after eating
43
Q

x4 Ix needed prior to dx of IBS

A
  1. FBC
  2. Coeliac enzyme - transglutaminase antibodies
  3. CRP
  4. ESR
44
Q

Alcohol
Recommended units
How to calculate

A

14 M and W

Total in mls x ABV / 1000

45
Q

Name three screening tools for ETOH excess

A
  1. CAGE
  2. FAST
  3. AUDIT
    8M, 7W –> hazardous consumption
    15 M, 13W –> dependence
46
Q

Plummer Vinson syndrome

A

Triad

  1. Dysphagia (secondary to oesophageal webs)
  2. Glossitis
  3. Iron deficiency anaemia
47
Q

Achalsia
What is it?
Features (4)

A

Loss of oesophageal peristalsis secondary to loss of inhibitory cells in the ganglion from Auerbach’s plexus. Leads to contraction and nil relaxation

Features

  1. Dysphagia to solids and liquids
  2. Weight loss
  3. Regurgitation
  4. Heartburn
48
Q

Achalsia
Ix (3)
Mx (4)

A
  1. Oesophageal manometry - increased LOS tone which does not relax on swallowing
  2. Barium swallow - beaks appearance
  3. CXR - wide mediastinum

Mx

  1. Balloon dilatation
  2. Heller myotomy
  3. Botulinim injection
  4. CCB or nitrates
49
Q 
Pharyngeal pouch 
What is it? 
M or F?
Age 
Features (5) 
Mx (1)
A 
Herniation due to pressure/ weakness of pharnygeal muscle leading to a pouch at UOS. 
Old men (70yo)

Features

  1. Dysphagia
  2. Halitosis
  3. Neck swelling which gurgles on palpation (Boyce sign)
  4. Regurgitation of food
  5. Aspiration

Mx
1. Surgery

50
Q

Systemic sclerosis
F or M?
Name three types (3)

A

Hardened sclerotic skin
F>M

Types

  1. Limited cutaneous SS
  2. Diffuse cutaneous SS
  3. Scleroderma
51
Q

Sulphasalazine SE (3)

A
  1. Heinz body anaemia + Megaloblastic anaemia
  2. Lung fibrosis
  3. Oligospermia
52
Q

Mesalazine SE (2)

A
  1. Pancreatitis

2. Agranulocytosis

53
Q 
Automimmune hepatitis 
F or M?
Features (3) 
(Hint: think A's) 
Mx (2)
A

More common in females

ANA, amenorrhea, acute hepatitis

Mx:

  1. Steroids + AZT
  2. Liver transplant
54
Q

Barrett’s oesophagus
What is it?
Risk of which ca

RF (4)

Mx (2)

A

lower oesophageal squamous epithelium being replaced by columnar epithelium
1. Oesophageal ADENOcarcinoma

RF 
Obestiy
Smoking 
GORD 
Male

Mx

  1. Endoscopic surveillance every 3-5 yrs +/- resection
  2. Ablation
55
Q

C diff
Gram +ve or -ve
Shape

Causes (2)
Mx (3)

A

Gram +ve rod

Causes

  1. Clindamycin
  2. PPI
Mx 
1. Metronidazole
If more severe
2. Vanc 
If not responding 
3. Fidaxomicin
56
Q 
Bowel screening explain
age group 
how often 
test of choice 
results of test 
results of colonoscopy
A 
Age 60-74 
Every 2 years 
Faecal immunochemical testing
x3 stool samples, x2 samples from each 
= 6 samples total

0 positive - routine recall
1-4 positive - repeat test
5-6 positive - offered colonoscopy

Colonoscopy
Low risk - routine recall
Intermediate to high - colonoscopy surveillance
Cancer - specialist

57
Q

Criteria for lower GI ca 2ww

A
    • FOB/ FIB
      OR
  2. > =40 yo with unexplained weight loss and AP
    OR
  3. > =50yo with rectal bleeding
    OR
  4. > = 60yo with IDA or change in bowel habit
58
Q

Non urgent criteria for upper GI cancer referral

A

Anyone with haematemesis
OR

> = 55yo with:

  1. Treatment resistant dyspepsia
  2. Low Hb + upper abdominal pain
  3. Raised platelets + one other sx
59
Q 
Upper GI cancer and Ix of choice for suspected ca in GP 
Stomach 
Liver
Gall bladder 
Pancreas
Gall bladder 
Oesophagus
A 
Stomach - endoscopy 
Liver - US 
Gall bladder - US  
Pancreas - CT
Gall bladder - US 
Oesophagus - endoscopy
60
Q

Dyspepsia Mx (nil ca) (3)

A
  1. Lifestyle advice + review medications AND
  2. PPI for 1 month OR
  3. Test and treat for H pylori
    (If 2 doesn’t work, trial 3 and vice versa)
61
Q

Testing for H pylori (3)

Treatment for H pylori (3)

A
  1. Carbon-13 urea breath test OR
  2. Stool antigen test OR
  3. Laboratory-based serology
    No PPI or abx for the 2 weeks prior

Tx - triple therapy

  1. PPI BD
  2. Amoxicillin
  3. Clarithro OR metro
62
Q

Signet cells are associated with which ca

A

gastric

63
Q

H pylori
Gram positive or negative

Associations (4)

A

Gram negative

Associations

  1. Peptic ulcer disease
  2. Gastric cancer
  3. B cell lymphoma of MALT tissue
  4. Atrophic gastritis
64
Q

Ascending cholangitis triad

A
  1. Fever
  2. RUQ pain
  3. Jaundice
65
Q

Cholangiocarcinoma features (3)

A
  1. Palpable mass (Courvoisier sign)
  2. Periumbilical nodes (Sister Mary Joseph nodes)
  3. Supraclavicular adenopathy (Virchow’s)
66
Q

What is Grey Turners and Cullens signs

Which disease?

A

Grey Turners - periumbilical discolouration
Cullens - flank discolouration
Pancreatitis

67
Q

Painless jaundice =

A

pancreatic ca

68
Q

Amoebic liver abscess

Features (3)

A

RUQ tenderness
No jaundice
Malaise

69
Q

HCC

RF

A

Anything causing liver cirrhosis

  1. Hep C - most common cause in Europe
  2. Hep B worldwide
  3. Haemachromatosis
  4. Cirrhosis secondary to ETOH
  5. PBC
70
Q

HCC screening investigations of choice (2)

A
  1. Screening with ultrasound

2. +/- alpha-fetoprotein

71
Q

Hepatorenal syndrome what is it?
Classification (2)
Mx (1)

A

Portal hypertension leads to sphlanchic vasodilation
This leads to reduced circulating volume
This leads to activation of renal vasoconstriction
= Worsening renal function

T1HRS rapidly progressive v.poor prognosis

T2HRS slower, pt lasts a bit longer

Mx terlipressin

72
Q

Differences between mesenteric ischaemia and ischaemic colitis

A

Mesenteric ischaemia

  1. Small bowel
  2. Emergency
  3. Sudden onset very severe pain
  4. Usually secondary to thrombus
  5. Surgery

Ischaemic colitis

  1. Transient
  2. Less severe
  3. Bloody diarrhoea
  4. Large bowel
  5. Thumbprinting seen
  6. Conservative management
73
Q

NAFLD/ NASH

Bloods (1)

A

ALT > AST

74
Q

Pancreatic ca
Features (3)
Mx (1)

A
  1. Painless jaundice
  2. Atypical back pain
  3. Weight loss
    Mx Whipples procedure (pancreaticoduodenectomy)
75
Q

Gastric ulcers versus duodenal

A

Gastric ulcer pain worse after eating

Duodenal relieved by eating

76
Q

Scoring system for acute GI bleed (2)

A
  1. Blatchford score at first assessment

2. Rockall score after endoscopy

77
Q 
Clotting factors and what to expect: 
DIC 
Haemophilia A 
Haemophilia B 
Liver failure 
Von Willebrand
A 
DIC - all factors depleted 
A low factor IX
B low factor VIII
Liver failure all low excepd FVIII
Von Willebrand all normal, factor VIII may be low or normal, VWF low
78
Q

Pernicious anaemia RF for which GI cancer

A

Stomach

79
Q

High risk groups that should be considered for HCC surveillance/ screening (2)

A
  1. pts with liver cirrhosis secondary to hepatitis B & C or haemochromatosis
  2. men with liver cirrhosis secondary to alcohol
80
Q

Ring and furrows on endoscopy =

RF

A

Eosinophilic esophagitis

Allergies/ asthma

81
Q

Gastric ca associations (3)

Negative association

A
  1. Pernicious anaemia
  2. Blood group A
  3. Diet - salty, spicy

Negative assoc duodenal ulcers

82
Q

Beaded appearance on ERCP =

A

PSC

83
Q

Alpha gliadin antibodies =

anti endomyseal + anti TTG=

A

Coeliacs

Coeliacs

84
Q

Pernicious anaemia aka
Signs (2)
Mx (1)

A 
B12 deficiency 
1. Beefy red sore tongue 
2. Yellow tinge to skin 
Mx 
1. Hydroxycobalamin
85
Q

Leptospiral infection =

A

Weil’s disease

86
Q 
Saint's triad:
Gall stones 
N&V
Diverticular disease 
which disease?
A

= sliding hiatus hernia

87
Q

Hiatus hernia diagnostic investigation

A

barium meal

MSRA (22 decks)

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