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STEPH BPT 2021 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Treatment of Barrett’s with a reduction in adenocarcinoma

A

High dose PPI and aspirin

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2
Q

Barrett’s surveillance

A

No dysplasia - surveillance
Low grade at 2 endos 6 months apart- RFA
High grade dysplasia - oesophagectomy vs low endo resection followed by RFA
Post RFA - 5 years

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3
Q

Portal HTN pressure

A

> 5mmHg

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4
Q

Primary prophylaxis if nil bleed

A

Non selective b blocker or ligation

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5
Q

Prevention of hepatorenal syndrome in SBP

A

IV albumen at diagnosis and day 3

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6
Q

High ALP and GGT and antimitochondrial antibodies

A

PBC

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7
Q

PBC treatment

A

Ursodeoxycholic acid

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8
Q

Liver transplant referral

A

Kings college criteria (not paracetamol)

PT >100 OR 3 of

Age over 40

Jaundice for 7 days

PT over 50

Bili over 180

Non A or Non B hepatitis, Wilson’s or drugs

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9
Q

Type 1 AIH

A

Anti Smooth muscle antibodies and ANA

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10
Q

Type 2 AIH

A

Anti LKM1

Target antigen: Cyp450 2D6

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11
Q

Haemachromatosis gene mutation

A

HFE gene mutation (C282Y or H63D)

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12
Q

Test for Pancreatic insufficiency with chronic pancreatitis

A

Faecal elastase

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13
Q

FAP gene

A

APC gene chromosome 5

Tumour suppressor gene

Autosomal dominant

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14
Q

MYH associated polyposis

A

MutY gene

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15
Q

HNPCC gene mutations

A

MSH2 (60%) and MLH1 (30%)

Mismatch repair genes causing micro satellite instability

Right sided tumour

> 10 adenomas

3 cases, 2 generations, 1 age <50

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16
Q

5-AZA SE

A 
Hepatotoxicity
Myelosuppressions
Allergy/pancreatitis 
NHL 
Non melanomatous skin cancer

No effect in pregnancy

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17
Q

Risk of progression from high grade dysplasia to adenocarcinoma

A

10%

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18
Q

The benefit of IV PPI pre endoscopy

A

Reduces endoscopy therapy does not reduce mortality, rebleed or death

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19
Q

Treatment of acute bleeding UGIB

A

Adrenaline + diathermy/clip has mortality/rebleed benefit
Post endoscopy PPI IV for 72 hours (oral similarly efficacious)
Restart aspirin at 3 days
Restart warfarin/DOAC 2 weeks

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20
Q

High gradient ascites

A

Serum albumin: ascites alumen >11g/L

Portal HTN

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21
Q

Low gradient ascites

A

<11g/L ‘Leaky capillaries (infection) or cancer

22
Q

Treatment of SBP

A

WCC >250
Cefotaxime 2g TDS
Cease beta blockers (mortality risk)
Bactrim prophylaxis

23
Q

Histology of alcoholic liver disease

A

Mallory-Denk hyalines surrounded by neutrophils (termed Mallory-Denk bodies)
macrovesicular steatosis

24
Q

Histology of NASH

A

fat droplets in the hepatocytes in association with ballooning degeneration and lobular inflammation.

25
Q

DNA stool test for CRC

A 
KRAS mutation 
NDRG4
BMP3 methylation 
Beta actin
Haemoglobin immunoassay
26
Q

When to refer cirrhosis for transplant

A

Evidence of hepatic dysfunction (child’s Pugh 7 or meld >10) or first complication (ascites varicella bleed or hepatic encephalopathy)

27
Q

Child Pugh score

A 
Albumin 
Bilirubin
Coagulation (pt inr)
Drain the ascites 
Encephalopathy
28
Q

Ferroportin

A

Stimulates iron release from entericyte into blood stream at basolateral surface

29
Q

Hepcidin

A

Inhibits iron release from enterocyte ast basolateral membrane

30
Q

Genetic variant of crowns disease which could lead to early initial surgery due to structures

A

NOD2/CARD15

31
Q

Positive pANCA negative ASCA

A

UC

32
Q

Negative pANCA pos ASCA

A

Crohns

33
Q

Drug for Crohn’s with anti-IL12/23 action

A

Ustekinumab

34
Q

Hormones that stimulate appetite

A

Ghrelin
Neuropeptide
Agouty related peptide

35
Q

IBD drugs to avoid in pregnancy

A

MTX contraindicated

Infliximab (anti-TNF) should be avoided in third trimester

36
Q

Indication for elective total colectomy in UC patients

A

Risk of cancer
Unable to wean steroids
Steriod side effects

37
Q

UC/Crohn’s surveillance

A

Colonoscopy 8 years from disgnosis every 1-3 years

38
Q

Diarrhoea associated with resection of terminal ileum

A

Bile malabsorption related

39
Q

Serology coeliac

A

1) Tissue transglutaminase Ab (IgA-tTG)(most accurate) or Endomysial Ab (IgA-EMA).
2) Anti-gliadin Ab (less sensitive/specific)

HLA-DQ2 DQ8 - rule out test

40
Q

When to treat with Abx in acute pancreatitis

A

If necrosis is present

41
Q

Corckskrew oesophagus

A

Oesophageal spasm

Most commonly in seting of uncontrolled GERD

42
Q

Most common cause of viral gastro

A

norovirus

43
Q

therpaeutic effect of lactulose

A

lowers faeces pH

44
Q

Interferon treatment of HCV

A

Interferon alfa-2b (5 million U) of subcutaneously daily for 4 weeks and then three times per week for 20 weeks

45
Q

MELD score

A

Creatinine
Bilirubin
INR

46
Q

autoimmune pancreatitis serological test?

A

IgG4

47
Q

Diagnosis of wilsons disease

A

Low serum copper and ceruloplasmin levels
High 24 urine copper

Rx: trientine and zinc

48
Q

HCC finding on quad phase imaging

A

Enhance on arterial imaging rapidly

Wash out in arterial phase

49
Q

Serum albumin gradient > 1.1 and ascites protein <2.5

A

Cirrhosis
Budd Chiari
Liver mets

50
Q

Barrett’s oesophagus histology

A

Intestinal metaplasia characterized with goblet cells.

51
Q

Most specific autoimmune hepatitis

A

Anti-SLA/LP (Soluble Liver Antigen/Liver–Pancreas Antigen)

52
Q

Medication for post-ERCP pancreatitis

A

NSAIDS i.e. indomethacin pre ERCP

STEPH BPT 2021 (16 decks)

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