Gastroenterology Flashcards
Which of the following is first line treatment for Hepatitis C in Australia?
A. Sofosbuvir + velpatasvir + voxilaprevir
B. Grazoprevir + elbasvir
C. Glecapravir + pibrentasvir
D. Ledipasvir + sofsbuvir
C. Glecapravir + pibrentasvir for 8-12 weeks
Which class of HCV drug is glecapravir?
NS3/4A protease inhibitor
What class of drug is sofosbuvir?
Nucleoside (NS5B) polymerase inhibitor
What class of drug is voxilaprevir? When is it indicated?
NS3/4A protease inhibitor
Add to velpatasvir + sofosbuvir for refractory HCV
What class of drug is Velpatasvir?
NS5a inhibitor
What class of drug is dasabuvir?
Non-nucleoside NS5B polymerase inhibitor
Lanafibranor may be useful in which condition?
peroxisome proliferator–activated receptor agonist that reduces ballooning and lobular inflammation in NASH
Which of the following biologics is not helpful in UC? A. Vedolizumab B. Tofacitnib C. Secukinumab D. Ozanimod
C. Secukinumab - anti IL-17a, used in ank spond and psoriatic arthritis
Vedolizumab = anti-integrin a4B7, Tofacitnib =JAK inhibitor, Ozanimod = S1P receptor modulator
Where is iron absorbed?
Duodenum
Where is calcium absorbed?
Duodenum
Where is B12 absorbed?
Terminal ileum
Where are bile salts absorbed?
Terminal ileum
Where is folate absorbed?
Duodenum
Which class of HCV drugs should not be used in decompensated liver disease?
NS3/4a protease inhibitors, due to raised drug levels in setting of hepatic failure
Drug classes ending with -evir (i.e. glecaprevir, voxilaprevir, grasoprevir)
Which coagulation factors are not made in the liver?
FVIII (endothelial cell production), FXIIIa (megakaryocytes)
Biopsy findings of primary sclerosing cholangitis
Associated lab and disorder?
Degeneration of small bile ducts with periductal Sclerosis/fibrosis
Onion skin pattern
p-ANCA, IBD (UC++)
Biopsy findings of primary biliary cholangitis (same as primary biliary cirrhosis)
Antibody?
Bile duct degeneration with periductular GRANULOMATOUS inflammation
“Florid” bile duct lesions
Anti-Mitochondrial antibody (sMall bile ducts)
Inhibitors of gastrin release
- Gastric pH <2
- Somatostatin
- Calcitonin
- Gastric inhibitory polypeptide (GIP)
- Glucagon
- Vasoactive inhibitory peptide (VIP).
Stimulators of gastrin release
L-Amino acids (i.e. phenylalanine, tryptophan, cysteine, tyrosine) • Vagal stimulation • Gastric distension • Epinephrine (adrenaline) • Calcium • Acetylcholine
Biopsy findings of autoimmune hepatitis
lymphocytic piecemeal necrosis
Anti-integrins with a role in IBD
Vedolizumab (a4B7)
Abrilumab (a4B7)
Etrolizumab (anti-B7)
Ontamalimab (MADCAM)
Jak inhibitors with a role in IBD
Filgotinib (JAK1)
Tofacitinib (in UC)
Upadacitnib
Treatment of primary biliary cholangitis
Ursodeoxycholic acid).
What is Gilbert Syndrome
Treatment?
Autosomal recessive disorder of unconjugated hyperbilirubinemia due to mutation in UGT1A1
Causes episodes of jaundice
Generally no treatment needed - avoid irinotecan
Disorders associated with PBC
Sjogrens (most common)
Autoimmune thyroiditis
CREST
RA
Treatment of eosinophilic colitis
Dietary modification (elimination) Steroids
Main antibodies associated with T2 AIH
Anti-liver/kidney microsomal-1 (anti-LKM-1) antibodies
Anti-liver cytosol-1 (anti-LC1) antibodies
Main antibodies associated with T1 AIH
Anti-smooth muscle antibody (ASMA)
ANA
Micronutrient deficiency causing high output cardiac failure
B1 - “wet beri beri”
Dry beri beri = neurologic complications (i.e. convulsions, weakness, numbness, hyperreflexia)
PAS-positive macrophages on small bowel biopsy is representative of what?
Whipple’s disease (Tropheryma whipplei)
Main deficiencies in SIBO
A, B12 (cobalamin consumption), K
Folate is elevated due to increased bacterial production
What does a raised HPVG represent?
Raised HVPG (>5mmhg) = hepatic cause of portal HTN >10 = varices, >12 = variceal bleeding
Which hepatitis c genotype is elbasvir plus grazoprevir recommended for?
G1 and 4
Which hepatitis c genotype is sofusbavir plus ledapasvir recommended fro?
G1
Most specific antibody for AIH
Anti-SLA/LP
First line therapy for unresectable stage C HCC
Atezolizumab (anti-PL1) + bevacizuman
Transplant criteria in HCC
2-3 nodules all <3cm OR single lesion <5cm
ECOG 0
No macrovascular invasion, regional nodal spread or distal mets
S/E of JAK inhibitors
VTE and herpes zoster - increased compareed with other biologics
Best described for tofacitinib
