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MRCP > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Abx for spontaneous bacterial peritonitis

A

Cefotaxime

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2
Q

SBP is complication of …

Causative organisms are …

A

Ascites secondary to cirrhosis (normally alcoholic)

E coli, Klebsiella, S pneumoniae, Enterococci

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3
Q

Salmonella ABx

A

Ciprofloxacin

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4
Q

Define chronic diarrhoea

A

3+ stools/day for >4 weeks

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5
Q

Shigella ABx

A

Ampicillin or ciprofloxacin

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6
Q

Campylobacter ABx

A

Erythromycin

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7
Q

C diff Rx

A

Metronidazole, vancomycin

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8
Q

Yersinia ABx

A

Tetracycline

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9
Q

RFs for Small Bowel overgrowth (where CRP NORMAL)

A

Bowel surgery
Crohn’s
Motility disorders e.g. Scleroderma

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10
Q

% mortality in severe acute pancreatitis

A

20%

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11
Q

Ix for gastrinoma

A

Gastrin >1000
Then do secretin test (rise >200 = gastrinoma)
Then do pancreatic imaging

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12
Q

Abdominal bloating, intermittent diarrhoea, strong farts

A

Giardiasis

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13
Q

Whipples disease: demographic, causative organism

A

Middle aged male
Tropheryma whippelii
Often affects small bowel -> malabsorption

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14
Q

Fatigue, weight loss, fever, arthralgia, diarrhoea, middle aged male

A

Whipple’s disease

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15
Q

Whipples disease SB histology

A

Abnormal macrophages stain magenta with PAS

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16
Q

What is transferrin

A

glycoprotein produced in the liver
transports iron to cells
regulated by body iron stores

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17
Q

Transferrin levels in Fe deficiency and iron overload

A

transferrin production increases in Fe deficiency

iron overload decreases.

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18
Q

What is ferritin?

Levels of ferritin in Fe deficiency and Fe overload

A

present in all cells, iron storage
reduced in states of iron deficiency
raised in states of iron overload.

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19
Q

MOA hereditary haemochromatosis

A

increased iron absorption in the duodenum and proximal small intestine

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20
Q

Inheritance hereditary haemochromatosis and gene mutation

A

AR

C282Y HFE mutation

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21
Q

Organs affected in hereditary haemochromatosis

A

cirrhosis, restrictive cardiomyopathy, diabetes mellitus, arthropathy, skin hyperpigmentation, and gonadal failure.

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22
Q

Ix hereditary haemochromatosis

A

transferrin saturation >45% = initial screening test
then genetic screening (C282Y HFE mutation)
NB if ferritin >1000 do liver biopsy

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23
Q

% Down’s with ASD

A

40%

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24
Q

GI manifestations in Down’s

A

Duodenal atresia - DOUBLE BUBBLE sign

Hirschprung’s disease

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25
Q

Perioral dermatitis + acral (hand and foot) erythema. Which deficiency post bowel resection?

A

Zinc deficiency

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26
Q

What is Mackler’s triad? Indicates?

A

vomiting, chest pain and surgical emphysema
oesophageal rupture
but absent in almost half the cases

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27
Q

Ix for oesophageal rupture

A

gastrograffin swallow

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28
Q

Melanosis coli due to

A

Chronic laxative abuse (containing anthraquinones)

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29
Q

LFTs for alcoholic hepatitis

A

AST >ALT 2:1

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30
Q

UC associated with which liver pathologies

A

PSC

Cholangiocarcinoma

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31
Q

Lethargy + itching + BG UC

A

PSC

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32
Q

Ix for PSC

A

ERCP/ MRCP

multiple intrahepatic and extrahepatic bile duct strictures and dilatations

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33
Q

Refeeding syndrome comprises:

A

Low K, Phos, Mg
Deficiencies in vitamins, for example, thiamine
Fluid overload with oedema

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34
Q

Ix after excision colon adenocarcinoma

A

colonoscopy annually for at least two years

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35
Q

Carcinoid syndrome Sx

A

Flushing and diarrhoea
Release serotonin and other vasoactive peptides
Neuroendocrine tumour (gut, lungs)

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36
Q

Ix carcinoid syndrome

A

high urinary 5-hydroxyindoleacetic acid

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37
Q

Rx carcinoid syndrome

A

Rx = somatostatin analogue, surgical resection

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38
Q

Why use lactulose in cirrhosis/hepatic encephalopathy

A

Osmotic laxatives
Stops proliferation of ammonia-forming gut organisms
Increases protein clearance from gut

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39
Q

What is portal hypertensive gastropathy? Risks of it?

A

Vascular disorder
Complication of chronic liver disease
Causes UGI bleed in patients with cirrhosis + portal HTN

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40
Q

Rx UGI bleed

A

Somatostatin or terlipressin
If bleeding stops then start on BB
Consider shunt if rebleed despite BB

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41
Q

Genotype associated w/ lowest levels a1at

A

PiZZ

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42
Q

Return from tanzania, acute watery diarrhoea with some blood. Likely cause? Rx?

A

E coli travellers diarrhoea

Ciprofloxacin

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43
Q

Causes bloody/mucus stool

A

E coli, Shigella, Yersinia

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44
Q

Offensive smelling diarrhoea insidious onset (3 days - 3 weeks). Cause?

A

Giardia

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45
Q

Ix Giardia

A

Cysts in stool

Trophozoites in SB mucosal biopsy

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46
Q

Rx Giardia diarrhoea (insidious onset compared to E coli)

A

Metronidazole

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47
Q

MOA cholestyramine for intolerable itching

A

Anion exchange resin

Interferes with absorption of fat soluble vitamins

48
Q

Which drugs less effective after starting cholestyramine

A

Vitamin D

As cholestyramine inhibits absorption of fat soluble vitamins

49
Q

Swinging pyrexia, neutrophilia, high infl markers, RUQ pain. DDx?

A

Pyogenic liver abscess

Amoebic liver abscess

50
Q

How to differentiate pyogenic and amoebic liver abscess

A

Pyogenic - pleural effusions, BC positive

Amoebic - no bowel Sx

51
Q

Coeliac prevalence

Pt with anti SM ABs: Autoimmune hepatitis is often seen in individuals with other autoimmune disorders such as ulcerative colitis.

A

1%

52
Q

Microscopic colitis Ix

A

colonoscopy and mucosal biopsy

because macroscopically colon appears normal.

53
Q

Microscopic colitis Rx

A

Budesonide

54
Q

What is Weil’s disease?

A

severe form of leptospirosis

bacteria - Leptospira

If the infection causes jaundice, kidney failure and bleeding, it is then known as Weil’s disease.

If it affects the lung and causes pulmonary haemorrhage, then it is known as severe pulmonary haemorrhage syndrome.

55
Q

pruritus
hypercholesterolaemia
jaundice
raised ALP and GGT

A

primary biliary cirrhosis

56
Q

Causes pigmentation + CLD

A

primary biliary cirrhosis (PBC) haemochromatosis

57
Q

What is PBC?

A

chronic cholestatic inflammatory liver disease

aetiology probably autoimmune

commonly affects middle-aged women

58
Q

What are cirrhosis patients hyponatraemic?

A

inability to excrete free water (increased ADH levels and systemic vasodilation contribute)

59
Q

Gastric carcinoma staging Ix

A

endoscopic ultrasonography

is superior to CT scanning for local tumour staging.

60
Q

Is incidence of proximal or distal stomach increasing?

A

proximal stomach is increasing

61
Q

Organism causing of pseudomembranous colitis

Gram stain?

ABx causing p.c.?

A

Clostridium difficile

Gram-positive anaerobic bacterium

broad-spectrum antibiotics - cephalosporins, broad-spectrum penicillins, quinolones, and clindamycin

62
Q

anti SM ABs

A

AI hepatitis

63
Q

AI hepatitis associated with

A

UC

64
Q

Common demographic for AI hepatitis

Sx onset

A

young and middle-aged women

1/4 acute hepatitis
but usually onset is insidious
some ASx for years and then have signs of chronic liver disease

65
Q

Coeliac disease

hypersensitivity type reaction

A

T cell mediated hypersensitivity reaction to gluten

(Type IV)

causes intestinal inflammation and atrophy

66
Q

diarrhoea/steatorrhoa

mild macrocytic anaemia

iron or folate deficiency

abnormal LFTs in 15%

A

Coeliac disease

67
Q

Coeliac disease Ix
1)
2)

A

1) IgA anti-endomysial Ab
anti-tissue transglutaminase Ab

2) duodenal biopsy - villous atrophy

68
Q

Type 2 diabetes increases risk of which gastro cancer?

A

40-60% increase in the risk CRC

69
Q

commonest sites for CRC

A

rectum and sigmoid colon

70
Q

Familial polyposis coli
Gardner’s syndrome
Peutz-Jegher’s syndrome

inheritance

A

autosomal dominant

71
Q

dominant inheritance

perioral/ skin pigmentation
numerous hamartomas in the stomach and larger intestine

polyps rarely malignant BUT 50% die of GI cancer

A

Peutz-Jegher’s syndrome

72
Q

Familial polyposis coli

Increased risk of cancer?

A

increased cancer risk is due to inheritance of a mutated tumour suppressor gene

73
Q

Give ABx in Campylobacter infection

A

No, only IVF and antiemetics

If do give, give erythromycin

74
Q

Peutz-Jegher’s syndrome

Increased risk of cancer?

A

Originally no

Rarely can be linked to malignancy

75
Q

High bilirubin
ALP high
2nd or 3rd trimester

A

Intrahepatic cholestasis of pregnancy

NB. Gilbert’s = (isolated high bilirubin)

76
Q

How is iron carried in blood/ role of transferrin?

A

Iron is carried in the blood bound to transferrin
Fe2+ (ferrous iron) is oxidised to Fe3+ (ferric iron) by caeruloplasmin

to bind to transferrin which is about one-third saturated with iron.

77
Q

What does transferrin saturation measure?

Level in iron deficiency?

A

measure of iron stores

16% is indicative of iron deficiency

78
Q

iron deficiency

A

both rise

79
Q

Pregnancy and the OCP

effects on transferrin level

A

increase transferrin level

80
Q

Haemochromatosis

transferrin level
TIBC

A

both fall

81
Q

microangiopathic haemolytic anaemia

thrombocytopenia

acute kidney injury

A

HUS

82
Q

low plt

bloody diarrhoea

AKI

A

HUS

haemolysis -> bloody diarrhoea

83
Q

Loss sensory myenteric plexus neurones

-> LOS dysfunction

failure to relax LOS in response to swallowing

A

Achalasia

84
Q

Commonest Sx in achalasia

A

Dysphagia to SOLIDS

85
Q

Rx to reduce Sx of achalasia

A

Nifedipine (relaxes LOS but effects short-lived)

Surgical cardiomyotomy

86
Q 
Chronic diarrhoea 
joint Sx
weight loss
LNs
abdominal pain
A

Whipple’s disease

No LNs with Coeliac and giardiasis

87
Q

Cause profuse BLOODY diarrhoea

A

Shigella

88
Q

Cause watery diarrhoea (2)

A

E coli

Giardia (Sx more insidious onset)

89
Q

Common SE of ciclosporin (e.g. for UC, psoriasis, eczema)

A

HTN

90
Q

Positive Hydrogen breath test

Causes (2)

A

Bacterial overgrowth syndrome

lactose intolerance

91
Q 
Chronic cholestasis
AMA
Liver biopsy
  -  non-suppurative destructive cholangitis + 
     interlobar BD dilatation
A

Primary biliary cirrhosis

92
Q

Rx primary biliary cirrhosis

A

Ursodeoxycholic acid (to reduce conc toxic bile acids)

93
Q

Confusion
Oculomotor signs
Ataxia

A

Wernicke’s encephalopathy

94
Q

Cause of Wernicke’s encephalopathy

A

Vitamin B deficiency

95
Q

Skin condition associated with gastric adenocarcinoma

A

Acanthosis nigricans

96
Q

Skin condition associated with lymphoma

A

Ichthyosis (scaly skin)

97
Q

Skin condition associated with oesophageal carcinoma

A

Tylosis (palmar and plantar keratosis)

98
Q

Virus that increases risk aplastic crisis in sickle cell anaemia or hereditary spherocytosis

A

Parvovirus B19

99
Q 
Diarrhoea 
no blood
patient post R hemicolectomy
BG of Crohn’s disease
Bloods normal

Cause?
Rx?

A

Loss terminal ileum -> bile salt malabsorption

Cholestyramine (stops bile acid absorption)

100
Q

What is VIPoma

A

Neuroendocrine tumour

Pancreas secretes vasoactive intestinal peptide

101
Q 
Watery diarrhoea
Low K and low Cl
Dehydration and flushing 
Achlorhydria (no HCL secretion) 
Hyperglycaemia (as gluconeogenesis)
A

VIPoma

102
Q

Gastrin secreting duodenal (or pancreatic) tumour

Diarrhoea + peptic ulcer

A

gastrinoma / Z-E syndrome

103
Q

Skin condition associated with glucagonoma

A

Migratory erythema

104
Q

Carcinoid syndrome associated with which deficiency

A

Niacin (-> pellagra)

105
Q

Wilson disease chromosome

A

Chromosome 13

106
Q

Rx large volume ascites that is symptomatic vs non-symptomatic

A

Symptomatic = Paracentesis

Not symptomatic = reduce dietary salt + spironolactone

107
Q

What stimulates and inhibits gastrin secretion from G cells of stomach

A

Stimulates gastrin = Amino acids (from food)

Inhibits = somatostatin

108
Q

Bug most associated with cryoglobulinaemia

A

Hepatitis C

109
Q

Conditions where see subtotal villous atrophy

A

Coeliac disease
Gastroenteritis
Whipple’s disease

110
Q

GI condition associated with functional hyposplenism

A

Coeliac disease

111
Q

How to differentiate PSC and PBC

A

PSC more common in men, with IBD

112
Q

Acute intermittent porphyria inheritance

A

AD

113
Q

Ascitic tap results for SBP

A

PMN >250

114
Q

Serum albumin ascites gradient >11g/L. Cause?

A 
Portal HTN 
Liver causes - cirrhosis, acute hepatitis, HCC, massive liver mets
CHF
Portal vein thrombosis 
Budd-chiari syndrome
115
Q

What is hepatorenal syndrome

A

Renal failure in patients with severe liver disease (acute or chronic), in absence of any other identifiable cause

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