Gastroenterology Flashcards
Which bacteria causes vomiting and diarrhea after eating rice?
Bacillus cereus
Which poisoning is associated with eating tuna?
Scombroid poisoning
What is the treatment of alcoholic hepatitis?
Prednisolone
What is the PPV of FOB?
5-15%
What are the pathological features of liver cirrhosis?
Excess collagen and extracellular matrix deposition in periportal and pericentral zones
What do chief cells in the stomach secrete?
enzymes such as pepsin and gastric lipase
Which cells secrete gastric acid?
Parietal cells
What is the most common organism in pyogenic liver abscesses in adults?
E. coli
What is the most common organism in pyogenic liver abscesses in children?
Staph aureus
What causes multiple duodenal ulcers?
Zollinger-Ellinson syndrome
Which anti-retroviral causes pancreatitis?
Didanosine
What causes arthralgia and chondrocalcinosis?
Haemochromatosis
What causes 95% of duodenal ulcers?
H. Pylori
What condition causes PAS granules to be seen on jejunal biopsy?
Whipple’s disease
Where do VIPomas arise from?
The pancreas
What are the most common type of antibodies seen in pernicious anaemia?
Gastric parietal cell Abs
Which hormone increases HCO3 secretion in the GI tract?
Secretin
Which liver disease is amenorrhoea associated with?
Autoimmune hepatitis
What is the primary management of autoimmune hepatitis?
Steroids
Name the 6 types of drug that tend to cause cholestasis
COCP, antibiotics (flucloxacillin, co-amoxiclav, erythromycin), steroids, chlorpromazine, sulphonylureas, fibrates
Which 3 drugs cause liver cirrhosis
Methotrexate, methyldopa, amiodarone
What is the best initial investigation of Budd Chiari syndrome
Ultrasound with dopplers
What is the most common site affected in UC
The rectum
What is the most likely sign on imaging of pancreatic cancer
Common bile and pancreatic duct dilation (double duct sign)
What test is recommended for H. pylori post-eradication therapy
Urea breath test
What is the main risk factor for anal cancer
HPV16 and HPV18
What benign condition caused by a defect in the cMOAT protein causes conjugated hyperbilirubinaemia
Dubin-Johnson syndrome
What is the most common organism in SBP
E. coli
What neutrophil count on ascitic tap suggests SBP
Neutrophils >250
Where is CCK secreted
I cells in upper small intestines
Where is secretin secreted
S cells in upper small intestine
What do A cells produce in the pancreas
Glucagon
What secretory tumour causes hypokalaemia, acidosis, low HCl and diarrhoea
VIPoma
What cell changes occur in Barrett’s oesophagus
Squamous to columnar
Which cancer is most likely to occur in the lower third of the oesophagus
Oesophageal adenocarcinoma
What is the treatment of Achalasia
Heller cardiomyotomy
Which arteries supply the greater curvature of the stomach
Right and left gastroepiploic
What blood results are typical in alcoholic hepatitis
AST > ALT, raised IgA
What immune markers are raised in type 1 autoimmune hepatitis
ANA, smooth muscle Abs, IgG
What percentage of HCV go on to develop chronic infection
80-85%
What are the side effects of interferon alpha
Flu, depression, leukopenia, low platelets
Which antivirals are used to treat HBV
Entecavir, tenofovir
Which vasculitis is commonly associated with HCV infection
Cryoglobulinaemia
What pattern does alcohol/biliary disease show on liver biopsy
Micronodular
What is the treatment for hepatorenal syndrome
Terlipressin, volume expansion with 20% albumin, ABx, TIPSS
What condition in liver disease causes SOB on standing or being upright
Hepatopulmonary syndrome
Which condition causes blistering skin lesion a on the back of hands due to deficiency of hepatic UROD
Porphyria Cutanea Tarda
What condition shows onion skin pattern on liver biopsy
PSC
What blood result suggests haemochromatosis
Transferrin sats >45%
What does haemochromatosis show on liver biopsy
Perl’s stain
How is Wilson’s disease diagnosed
24 hour urinary copper excretion
What two conditions cause ALT > 10,000
Paracetamol overdose, ischaemic hepatitis
What condition causes low HCO3 on secretin stimulation test
Chronic pancreatitis
Which blood panel is used to assess fibrosis in an asymptomatic finding of NAFLD
ELF (hyaluronic acid + procollagen III + tissue inhibition of metalloproteinase 1)
Which monoclonal antibody can be used to prevent recurrence of C.diff
Bezlotuxumab
What test is used to assess small bowel bacterial overgrowth syndrome
Hydrogen breath test
What is the treatment of bile acid malabsorption after ileal resection
Cholestyramine
What causes Howel-Jolly bodies in coeliac disease
Hyposplenism
Which condition might present after a holiday to Thailand with coliforms on jejunal biopsy
Tropical sprue
What test is used to detect bile acid malabsorption
14C glycolate test
What test is diagnostic for Whipple’s disease
PAS staining
What are the common symptoms of carcinoid syndrome
Flushing, hypotension, right heart valvular stenosis, pellagra
What is cowden’s syndrome
Multiple hamartomatous polyps in GIT
Which condition causes hamartomatous polyps in GI tract and pigmented lesions on lips
Peutz-Jeghers syndrome
What is seen on GI biopsy in laxative abuse
Pigment-laden macrophages
Why does hypocalcaemia occur in pancreatitis
Saponification of fats
What is the increased risk of developing HCC in PBC patients
20-fold increase
What is the earliest symptom of carcinoid syndrome
Facial flushing
What is the diagnostic test for pancreatic cancer
High-resolution CT
What BMI is cutoff for referral to bariatric surgery if patient has risk factors
BMI > 35
Where does mesenteric ischaemia typically affect
Small bowel
What is the treatment of C.diff that doesn’t respond to oral vancomycin
Oral fidaxomicin
What criteria determines moderate c.diff
Raised WCC <15, 3-5 loose stools per day
What criteria determines life-threatening c.diff
Hypotension, partial/complete ileus, toxic megacolon, CT evidence of severe disease
What is the action of VIP
Stimulates secretion by pancreas and intestines, inhibits acid secretion
What is the treatment of recurrent c.diff within 12 weeks
Oral fidaxomicin
Which aminosalicylate drug has the highest risk of causing pancreatitis
Mesalazine
Which aminosalicylate is associated with oligospermia
Sulphasalazine
What is the management of eosinophilic oesophagitis
Dietary modification and topical steroids (e.g. fluticasone)
Which clotting factor is paradoxically increased in coagulopathy of liver disease
Factor VIII
Which laxative should not be given in IBS
Lactulose
What eye condition is a rare complication of acute pancreatitis
Ischaemic (Purtscher) retinopathy
What is included in the child-Pugh classification for liver cirrhosis
Bilirubin, albumin, PT, encephalopathy, ascites
What is used to calculate the MELD score to predict survival in liver cirrhosis patients
Creatinine, bilirubin, INR
Which condition is associated with aortic stenosis and predisposes to bleeding in the GI tract
Angiodysplasia
What is the most common cause of biliary disease in HIV
PSC due to infections such as CMV, cryptosporidium, microsporidia
What are the risk factors for squamous cell oesophageal cancer
Alcohol, smoking, achalasia, Plummer Vinson
What are the risk factors for oesophageal adenocarcinoma
Alcohol, smoking, Barrett’s oesophagus
A retrocardiac air-fluid level is sometimes seen in which GI condition
Achalasia
Which drug can be used to reverse the bleeding effect of dabigatran
Idarucizumab
Which features of haemochromatosis are reversible with treatment
Cardiomyopathy, skin pigmentation
What test can be used to diagnose Gilbert’s syndrome
Nicotinic acid test
What are the causes of villous atrophy
Coeliac, tropical sprue, Whipple’s, lymphoma, hypogammaglobulinaemia
Which brush border enzyme results in the formation of glucose and galactose
Lactase
Which brush border enzyme results in the formation of glucose and fructose
Sucrase
Which brush border enzyme results in the formation of glucose and glucose
Maltase
What percentage of patients with Peutz-Jeghers syndrome will die from a related cancer by the age of 60
50%
What triad of symptoms is associated with Plummer-Vinson Syndrome
Dysphagia, glossitis, IDA
Which lipid disorders predispose a risk of acute pancreatitis
Hypertriglyceridaemia, Hyperchylomicronaemia
What is the MOA of azathioprine
Metabolised to mecaptopurine - a purine analogue that inhibits purine synthesis
What is the treatment of AIP
Haematin (haem arginate) + IV glucose
Which hepatitis is associated with transmission via blood transfusion prior to 1991
Hepatitis C
What is the management of Barrett’s oesophagus with high grade dysplasia
Endoscopic mucosal ablation
Which IBD has crypt abscesses
Ulcerative colitis
Which vitamin deficiency can carcinoid syndrome cause
Pellagra (niacin - B3)
What are the indications for FOB testing
> = 50 with unexplained abdo pain/weight loss
< 60 with CIBH or IDA
> = 60 with anaemia in absence of iron deficiency
Which subtype of AMA is specific for PBC
M2 subtype AMA
What causes inclusion bodies on colonic histology
CMV infection
What is the most suitable emergency diagnostic test for mesenteric ischaemia
Contrast CT angiography
What are the causes of chronic pancreatitis
Alcohol abuse, CF, haemochromatosis and PSC
What are the most effective agents in maintaining Crohn’s disease long term
Thiopurines (azathioprine and 6-mercaptopurine)
Which type of colitis is associated with coeliac disease
Collagenous colitis
Which colitis presents with chronic watery diarrhoea and looks normal on colonoscopy
Collagenous colitis
When should liver transplant be considered in cirrhosis + HCC
Cirrhosis and single small HCC (<5cm) or up to three lesions (<3cm)
When should hepatic resection be considered in HCC
Primary HCC in a non-cirrhotic liver
What is the management of acute fatty liver disease of pregnancy
Aggressive correction of hypoglycaemia and coagulopathy followed by expeditious delivery
What can be used to induce remission in severe colitis not responding to steroids after 72 hours
IV cyclosporin
What is the initial treatment for gastroparesis
Domperidone
Which disease is associated with Kantor’s string sign
Small bowel Crohn’s disease
What cause of ascites does a SAAG gradient >11g/L indicate
Transudate (portal HTN)
What is the vertical transmission rate of HCV
6%
What % of acute HCV leads to chronic infection
85%
What is first line treatment for HCV infection
Direct-acting antivirals (sofosbuvir, ledipasvir, ombitasvir etc)
What is the status of HBsAb in chronic disease
Negative
When should patients at risk of HNPCC be screened with colonoscopy
2-yearly between 20-40 years, then annually
Which deficiency is most common after a gastrectomy
Iron deficiency (absent acidic environment means Fe3+ can’t be reduced to the more absorbable Fe2+)
What is the the most common extra-intestinal feature in Crohn’s and UC
Arthritis
What criteria is used to determine severe colitis
Truelove-Witts
How often should patients with intermediate risk UC be screened for colorectal ca
3 yearly colonoscopy
How often should a patient with UC and PSC be screened for colorectal ca
Yearly (high risk)
Which type of lymphoma is most associated with coeliac disease
Enteropathy associated T-cell lymphoma
What should be considered in a young adult presenting with intermittent melaena despite normal OGD/colonoscopy
Meckel’s diverticulum
What are the causes of hamartomatous polyps in the GI tract
Cowden syndrome
Peutz-Jeghers syndrome
NF1
MEN2
Familial juvenile polyposis
What are the causes of adenomatous polyposis in the GI tract
HNPCC
FAP
What test is used to diagnose Meckel’s diverticulum
Tc-99m pertechnetate
What INR is transplant indicated according to King’s College criteria
> 6.5
OR
> 3.5 along with: age <11 or >40, bili >300, drug toxicity, >7 days to develop coma
What is the treatment of pyoderma gangrenosum around a stoma site that does not respond to steroids
Anti-TNF drugs e.g. infliximab
Which type of patients tend to develop acalculous cholecystitis
ICU patients, extensive burns patients
