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BPT Written > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Gastrin secretion inhibitors

A

VIP, glucagon, somatostatin, Calcitonin

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2
Q

Gastrin secretion stimulator

A

epinephrine, calcium, gastric distension, vagal stimulation, acetylcholine, L-amino acids

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3
Q

cell that secretes gastrin? cell upon which gastrin acts?

A

Secreted by G cells in stomach/duodenum, acts on parietal cell of stomach

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4
Q

Earliest phenotypic manifestation of haemochromatosis

A

Transferrin saturation Increase

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5
Q

Findings of following in SIBO (high or low): MCV, folate, B12

A

high, high, low (Luminal bacteria consume cobalamin but produce folate)

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6
Q

Commonest worldwide cause of non-cirrhotic portal hypertension?

A

Schistosomiasis

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7
Q

Drug causes of non-cirrhotic portal hypertension

A

Azathioprine, chemos

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8
Q

Vascular causes of non-cirrhotic portal hypertension

A

Budd Chiari, sinusoidal osbtructive syndrome

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9
Q

Infiltrative causes of non-cirrhotic portal HTN

A

sarcoid, mastocytosis

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10
Q

What factors are assoc. w. rapid progression of Hep B?

A

longer duration of infection, Hep B genotype C, core promoter mutation, co-infection with Hep C, Male

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11
Q

Drug with highest resistance in Hep B

A

Lamivudine

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12
Q

ETOH time frame for withdrawal seizures

A

12-48 hours

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13
Q

ETOH time frame for DTs

A

48-96 hours

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14
Q

Toxic effect of ETOH is due to

A

acetaldehyde

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15
Q

ETOH hepatitis histopath hallmark

A

neutrophilic infiltrate

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16
Q

When to use acamprosate?

A

withdrawal sx >1/52

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17
Q

4 causes of AST:ALT >2

A

ETOH, NAFLD, Wilson’s, Hep C

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18
Q

Abnormally low ALP with other elevated liver eynzymes

A

Wilson’s

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19
Q

Who progresses to chronic Hep B

A

babies/ kids

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20
Q

Define chronic Hep B

A

sAg +ve for >6/12

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21
Q

When to Rx Hep B

A

eAg+, HBV VL>20K and ALT >2x ULN

eAg-, HBL VL >2K and ALT >2x ULN

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22
Q

MOA entecavir and tenofovir

A

HBV DNA Pol inhibitors

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23
Q

Which Hep B drug is safe in pregnancy

A

Tenofovir DF

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24
Q

Demographics at highest risk of HCC from Hep B

A

Africans >20, Asians >40

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25
Q

How to manage pregnancy with elevated HBV VL

A

Tenofovir 3rd trimester, baby get IgG and vax

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26
Q

Mgmt of Hep D

A

Peg-IFN

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27
Q

Hep C genotype in Australia

A

3

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28
Q

Hep C assoc. GN

A

MPGN

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29
Q

What % of Hep C infections progress to chronic

A

75%

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30
Q

Why are Egyptian’s at higher risk of Hep C

A

Schistosomiasis vaccine

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31
Q

Side effects of Ribavarin

A

Rash and haemolytic anaemia

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32
Q

SVR in Hep C

A

-ve PCR at 3/12

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33
Q

Mutation assoc. w. Hep C resistance

A

Y93H

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34
Q

Diagnostic criteria for eosinophilic oesophagitis

A

> 15eo/HPF on biopsy (not just distal as GORD could cause that distally) and symptoms of oesophageal dysfunction

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35
Q

6 foods in elimination diet for eosino eo

A

egg, milk, wheat, soy, nuts, seafood

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36
Q

most sensitive test for achalasia

A

manometry

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37
Q

Most important type of metaplasia in Barrett’s

A

Intestinal

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38
Q

Barrett’s increases risk of adeno ca by how much?

A

40-100x

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39
Q

MELD score for liver Tx in chronic cirrhosis

A

> 15

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40
Q

SAAG consistent w. portal HTn

A

> 11

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41
Q

HVPG consistent with cirrhosis

A

> 10

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42
Q

HVPG assoc. w. varices

A

> 12

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43
Q

When to start rifaxamin and what is the benefit?

A

after 1st epi encephalopathy, reduce recurrence of further

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44
Q

Which varices are best Mx with glue?

A

gastric

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45
Q

What is the R factor in LFTs?

A

(ALT/ULN) / (ALP/ULN)

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46
Q

Top causes of R factor >5

A

Paracetamol, sulfonamides, statins, tetracyclines

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47
Q

Drugs causing R factor <2

A

Penicillins, cephalosporins, terbinafine, OCP

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48
Q

How do non-selective BBs reduce risk of variceal bleed?

A

Reduced CO, and splanchnic vasoconstriction via alpha receptors

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49
Q

What factors make varices high risk?

A

Size, red wale sign, CP stage

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50
Q

Surveillance scope frequency

A

No varices = 2 years

Small or worse = annual

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51
Q

Definition of HRS-AKI

A

Creat 2-3x with bland UA and no other cause, diuretics withheld and 48h albumin given

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52
Q

Management of HRS-AKI

A

Terli and albumin 1g/kg/d

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53
Q

Define HRS-CKD

A

eGFR <60 for 3/12, no other cause

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54
Q

HCC - Barcelona liver clinic stage 0 definition and Rx

A

Single lesion <2cm

Resect or ablate

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55
Q

HCC - Barcelona liver clinic stage A definition and Rx

A

Single lesion or 3 lesions <3cm

Transplant

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56
Q

HCC - Barcelona liver clinic stage B definition and Rx

A

Multi-nodular

TACE

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57
Q

HCC - Barcelona liver clinic stage C definition and Rx

A

Portal invasion/distant mets

TKIs (sorafenib, lenvatinib)

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58
Q

HCC - Barcelona liver clinic stage D definition and Rx

A

CPC cirrhosis, ECOG >/=2

Palliate

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59
Q

Two most common mutations on haemachromatosis

A

1 - C282Y

2 - H63D

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60
Q

Penetrance for homozygotes of haemachromatosis mutations

A

10-30%

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61
Q

Ferritin level predictive of end-organ damage in haemachromatosis

A

> 1000

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62
Q

Indications for venesection haemachromatosis

A

Ferritin 100-400, organ dysfuncion (EF, ALT/AST), evidence of excess iron on MRI/biopsy

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63
Q

Why does fluid overload occur in re-feeding?

A

Insulin acts on DCT along with ADH

Some effect of low albumin

64
Q

What is fatal complication of hypophosphataemia?

A

Respiratory arrest

65
Q

Mechanism of haemolysis in re-feeding?

A

Hypophos –> reduced 2,3DPG

66
Q

Best form of calories in critical illness/re-feeding high risk patients?

A

Lipid calories

67
Q

Main organ affected by vit A deficiency

68
Q

Minimum amount of bowel needed to prevent short gut?

A

> 150cm small bowel

>60cm small bowel with ileum colon

69
Q

Why do those with short gut get gallstones?

A

Excess bile salts secretes

70
Q

Why do those with short gut get reflux?

A

Acid hyper-secretion

71
Q

Best form of Mg2+ to prevent diarrhoea

72
Q

Mechanism of oxalosis in short gut

A

Calcium bound by excess fatty acids, excess oxalate re-absorted in colon leading to renal impairment

73
Q

Management of bile salt diarrhoea

A

Cholestyramine or sucralfate

74
Q

Mechanism of teduglutide

A

GLP-2 agonist, increases proximal bowel absorption, risk of cancer

75
Q

Diagnosis of protein-losing enteropathy

A

Faecal alpha 1 anti-trypsin

76
Q

What treatment reduces Crohn’s recurrence post-op?

A

Metronidazole 3 months, 5-ASA and TNFa inhibitors

77
Q

Which medications increase risk of IBD?

A

Aspirin, NSAIDs, OCP

78
Q

Extra-intestinal manifestations that follow disease activity?

A

Episcleritis, large joint arthritis, erythema nodosum, oral ulcers

79
Q

Extra-intestinal manifestations that DON’T follow disease activity?

A

PSC, Ank spon, uveitis, pyoderma, stones (renal, gall)

80
Q

Diagnosis of acute severe colitis?

A

Truelove and Whitt
>6 bloody stools AND 1 of:
T>37.8, HR>90, Hb<100, ESR>35

81
Q

Definition of failed treatment of acute severe colitis after 3 days of Rx

A

CRP >45, >8 stools/d

82
Q

2 susceptibility genes for Crohn’s

A

NOD2/CARD15

83
Q

Phenotype of those with NOD2/CARD15 Crohn’s

A

Younger, more aggressive, more surgery, stricturing

84
Q

Antibody pattern for Crohn’s

A

ASCA+

pANCA-

85
Q

Antibody pattern for UC

A

ASCA-

pANCA+

86
Q

In UC, who is more likely to get pouchitis?

A

pANCA+, non-smoker, PSC

87
Q

Treatment of pouchitis

A

Metro or cipro

88
Q

Proportion of PSC that have UC

89
Q

IBD drugs safe in pregnancy

A

Steroids, 5-ASA, AZA, TNFa inhibs until T3

90
Q

Thiopurines increase risk of what malignancies

A

Lymphoma, non-melanoma skin cancer

91
Q

Which aggressive malignancy is associated with treatment with thiopurines + anti-TNF

A

Hepatosplenic T-cell lymphoma

92
Q

If TPMT increase, which product is increased?

A

6-MMP (hepatotoxic)

93
Q

If TPMT decreased, which product is increased?

A

6-TGN (myelosuppression)

94
Q

Effect of allopurinol on thiopurines

A

XO metabolises 6-PM to 6-TA, so allopurinol shunts 6-TGN (myelosuppression)

95
Q

What form of TPMT are poor metabolisers?

A

homozygote 2/2, 3/3, or compount heterozygote 2/3

96
Q

What 6-TGN level is associated with remission?

97
Q

If 6-MMP is elevated but 6-TGN reduced, how do you manage?

A

Add allopurinol

98
Q

MTX used in Crohn’s or UC?

A

Crohn’s only

99
Q

TNFa inhibitors may flare which skin condition?

100
Q

Cancers associated with TNFa inhibs?

A

Lymphoma, melanoma

101
Q

Mechanism of vedolizumab

A

Integrin alpha4beta7 inhib, prevents leucocytes binding to MADCAM on intestinal wall –> prevents trafficking

102
Q

MEchanism of ustekinumab

A

IL12/23 inhibt (anti-p40 subunit)

103
Q

Gene associated with NAFLD in Hispanics

104
Q

2 main alternative causes for steatosis (aside from NAFLD)

A

Alcohol, meds (tamoxifen)

105
Q

1 cause of death in NAFLD

106
Q

Best treatment for NAFLD

A

Weight loss

107
Q

Role of statins in NALFD

A

Not indicated on own, no RCT

108
Q

Does metformin help in NAFLD?

A

No - no significant effect on biochem or histopathology

109
Q

What is PPAR alpha/delta agonist therapy in NAFLD?

A

Elafibrinor - reduces steatosis by increasing lipid oxidation, reduced inflamm/fibrosis through macrophage inhibition, but lots of AEs

110
Q

Effect of vitamin E in NAFLD

A

Has demonstrated benefit in NASH resolution in non-diabetics but increases risk of haemorrhagic CVA and prostate Ca

111
Q

How does obeticholic acid work?

A

For NAFLD. FXR agonist, improves lipids and insulin sensitivity. But increases LDL and causes pruritis

112
Q

Benefit of PPI pre-scope

A

Reduce need for intervention

113
Q

Benefit of PPI post scope for high risk

A

Reduces mortality, LOS, re-bleed

114
Q

Dual treatment for GI ulcer bleed = ?

A

Adrenaline + either cautery or clips

115
Q

Role of endoscopic spray

A

Salvage, falls off in 24h

116
Q

What is Forrest 1a?

A

Active arterial bleeding

117
Q

What is Forrest 1b?

A

Ooze, no visible vessel

118
Q

What is Forrest IIa?

A

Non-bleeding visible vessel

119
Q

What is Forrest IIb?

A

Adherent clot

120
Q

What is Forrest IIc?

121
Q

What is Forrest III?

A

Clean ulcer base

122
Q

Implications of Forrest stage 2c and 3?

A

D/C on PO PPI

123
Q

What is immunogenic part of gluten?

A

Gliadin. GLuten is 50/50 gliadin and glutenin

124
Q

2 syndromal associations with coeliacs

A

Downs, Turners

125
Q

Best serological test for coeliac

A

tTG-IgA and total IgA

126
Q

2nd option for coeliac screen

A

tTG-IgA and DGP-IgG

127
Q

Biopsy findings in coeliac

A

Villous atrophy, crypt hyperplasia, intra-epithelial lymphocytes

128
Q

Drugs that can mimic coeliac

A

Olmesartan, NSAIDs, MMF

129
Q

Autoimmune mimics of coeliac

A

Autoimmune enteropathy, Crohn’s CVID

130
Q

Infecitous mimics of coeliac

A

Giardia, H. pylori, tropical sprue

131
Q

Best NPV test for coeliac?

132
Q

Role of tTG?

A

Deamidates gluten peptides -> more immunogenic gliadin exposed

133
Q

What vaccine reduces risk of coeliac?

134
Q

Role of repeat serology in coeliac

A

Usually normalises on GFD but is poor marker of adherence

135
Q

Refractory coeliac type 1:

A

Normal lymphocytes –> immunosuppress

136
Q

Refractory coeliac type 2:

A

Monoclonal lymphocytes: 50% lymphoma treat with chemo/ASCT

137
Q

What is mechanism of non-coeliac gluten/wheat intolerance?

138
Q

Best test for carcinoid?

A

Urinary 5-HIAA

139
Q

Other tests for carcinoid aside from urinary 5-HIAA, and what can cause this to be false positive?

A

Serum chromogranin A

PPIs

140
Q

Criteria for IBS

A

Pain for >/=1d per week
For >/=3 months
With at least 2/3: Change in stool appearance, change in frequency, pain associated with defecation

141
Q

Cause of IBS

142
Q

Typical haematinics pattern of SIBO

A

High MCV, low B12, high folate

143
Q

WHich meds associated with SIBO:

A

PPIs, antibiotics

144
Q

Main antomical/surgical risk factors for SIBO

A

Absent ileocaecal valve

145
Q

How does breath test work for SIBO

A

Give lactulose or glucose

Positive is hydrogen increase >20ppm in <90min

146
Q

Gold standard diagnosis SIBO

A

Jejunal aspirate

Positive if >10^3 CFU/mL

147
Q

Antibiotic of choice for SIBO

148
Q

Treatment of PBC

A

Urso

Transplant

149
Q

PBC associations

A

Sjogrens, thyroid disease

150
Q

Most common part of stomach affected by H. pylori

151
Q

First line Rx H. pylori

A

Amox + clarith + esomep 7/7

152
Q

Most common reason for H. pylori 1st line rx failure

A

Clarithromycin resistance

153
Q

Why is metro not used for H. pylori

A

High resistance rate

154
Q

Salvage Rx H. pylori

A

Levofloxacin, amox and PPI BD for 10/7

155
Q

First line treatment for HCV

A

Glecaprevir (ns3/4a) + pibrentAsvir (ns5A)
OR
SofosBuvir (ns5B) + velpAtAsvir (ns5A)

BPT Written (21 decks)

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