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MSRA Revision > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Wilson’s Disease:

  1. Pathophysiology?
  2. Signs / symptoms?
  3. Diagnosis?
  4. Treatment?
A

Wilson’s Disease

  1. Excessive copper deposition
  2. Liver (cirrhosis, hepatitis), Neuro (dementia, chorea, Parkinsonism, speech/behavioural abnormalities), Keyser-Fleischer rings, Renal tubular acidosis, Blue nails
  3. Raised serum caeruloplasmin, high 24h urinary copper excretion
  4. Penicillamine
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2
Q

Budd-Chiairi Syndrome

  1. Pathophysiology?
  2. Signs / symptoms?
  3. Diagnosis?
A

Budd-Chiairi Syndrome

  1. Hepatic vein thrombosis secondary to thombophilia
  2. Triad of abdo pain, ascites and tender hepatomegaly
  3. USS w Doppler
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3
Q

Haemochromatosis

  1. Pathophysiology?
  2. Signs / symptoms?
  3. Which features are reversible?
  4. Diagnosis?
  5. Treatment?
A
  1. Autosomal recessive disorder, iron accumulation
  2. Bronze skin, Arthritis, Fatigue, Liver disease, Diabetes, Cardiac disease
  3. Cardiomyopathy, bronze skin
  4. Iron studies: raised transferrin, ferritin, low TIBC
  5. Venesection (desferrioxamine second-line)
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4
Q

Prophylaxis of Variceal Haemorrhage?

A
  1. Propranolol

2. Endoscopic band ligation

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5
Q

Causes of Malabsorption?

A

Intestinal: coeliac, Crohn’s
Pancreatic: chronic pancreatitis, CF, pancreatic CA
Biliary: obstruction, PBC
Other: systemic sclerosis, diverticulae, short bowel syndrome

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6
Q

Crohn’s Disease Management- Inducing Remission

  1. First line
  2. Second line
  3. Third line
  4. Add-ons?
A
  1. Steroids / Budesonide
  2. 5-ASA drugs (Mesalazine)
  3. Infliximab
  4. AZA, MTX
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7
Q

Crohn’s Disease Management- Maintenence Therapy

  1. Advice?
  2. 1st line drugs?
  3. 2nd line drug?
A
  1. Stop smoking
  2. AZA / Mercaptopurine
  3. MTX
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8
Q
  1. Risk factors for HCC?
  2. Diagnosing HCC - marker?
  3. Diagnosing HCC - imaging?
A
  1. Cirrhosis, HCV, EtOH, PBC
  2. AFP
  3. USS
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9
Q

Autoimmune Hepatitis

  1. Epidemiology?
  2. Antibodies?
  3. Presentation?
  4. Treatment?
A
  1. Young F
  2. ANA, anti-SMA, anti-LKM1
  3. Acute/chronic liver failure, amenorrhoea
  4. Steroids / AZA; transplant
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10
Q

Pancreatic CA

  1. Presentation?
  2. What sign is this?
  3. Other features?
A

Pancreatic CA

  1. Painless enlarged gallbladder + jaundice
  2. Courvoisier’s sign
  3. Steatorrhoea, T2DM, weight loss, anorexia
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11
Q

Pernicious Anaemia

  1. Main abnormality it causes / pathophysiology?
  2. Diagnostic test?
  3. Features?
  4. Treatment?
A
  1. Vit B12 deficiency secondary to autoimmune attack on intrinsic factor & gastric parietal cells
  2. Macrocytic anaemia, anti-intrinsic factor Ab
  3. Anaemia + neuro features (peripheral and psych)
  4. Vit B12 replacement
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12
Q

Age >55 + dysphagia + Wt loss + anorexia
Diagnosis?
What to do?

A
  1. Oesophageal CA

2. Urgent endoscopy

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13
Q

HIV + swallowing difficulties?

A

Oesophageal candida

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14
Q

Dysphagia of solids + liquids from the start, plus regurgitation of food?

A

Achalasia

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15
Q

Bird-beak appearance on Barium swallow?

A

Achalasia

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16
Q

Older male, dysphagia + halitosis + cough + regurgitation?

A

Pharyngeal pouch

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17
Q

Features of systemic sclerosis?

A

Calcinosis, Raynaud’s, Oesophageal dysmotility, Sclerodactyly, Telangiectasia

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18
Q

Best imaging modality for pancreatic CA?

A

High resolution CT

19
Q

Vitamin that is teratogenic?

What is its role in the body?

A

Vitamin A

Vision, growth and development

20
Q 
HBV Serology
HBsAg            Neg
Anti-HBc Ab   Pos
IgG anti-HBc  Pos
Anti-HBs Ab   Pos
A

Prev infection, now immune

21
Q 
HBV Serology
HBsAg            Neg
Anti-HBc Ab   Neg
IgG Anti-HBc  Neg
Anti-HBs Ab   Pos
A

Vaccinated

22
Q 
HBV Serology
HBsAg            Pos
Anti-HBc Ab   Pos
IgM Anti-HBc Pos
IgG Anti-HBc Neg
Anti-HBs Ab   Neg
A

Acute infection

23
Q 
HBV Serology
HBsAg            Pos
Anti-HBc Ab   Pos
IgM Anti-HBc Neg
IgG Anti-HBc Pos
Anti-HBs Ab   Neg
A

Chronic infection

24
Q

Primary Biliary Cholangitis

3 features of the ‘M’ rule?

A

IgM
anti-Mitochrondrial Ab
Middle aged females

25
Q

Primary Biliary Cholangitis

Treatment?

A

Ursodeoxycholic acid
Colestyramine (for itching)
Liver transplant

26
Q

Primary Biliary Cholangitis

Distinguishing features?

A

Females > males
Chronic cholestasis -> cirrhosis
Early pruritis and cholestatic jaundice
IgM anti-mitochondrial Ab (AMA)

27
Q

HBV Serology

HBeAg +ve significance?

A

Indicates infectivity

28
Q

UC Flares - Classification
Mild vs mod vs severe?
Name of classification?

A

Mild: <4/day, minimal blood
Mod: 4-6/day, varying blood
Severe: >6/day, blood, systemically unwell
2. Truelove-Witt

29
Q

UC Flare - Management

  1. Mild-mod flare - proctitis / L-sided?
  2. Mild-mod flare - extensive?
  3. Mild-mod flare - not responsive to initial treatment?
A
  1. Rectal aminosalicylate (e.g. mesalazine)
  2. Rectal 5ASA + Oral 5ASA
  3. Add PO 5ASA / PO steroids
30
Q

UC Flare - Management
Severe flare
1. 1st line
2. 2nd line

A

Admit
IV steroids
2nd line: IV Ciclosporin

31
Q

UC - Maintenance Therapy
Mild-mod disease
1. Proctitis?
2. L-sided disease / extensive colitis?

A
  1. Topical 5ASA +/- PO 5ASA

2. PO 5ASA

32
Q

UC - Maintenance Therapy

Severe disease?

A

PO Azathioprine

PO Mercaptopurine

33
Q

Ascites - Diagnosing Cause

What does SAAG stand for?

A

Serum-Ascites Albumin Gradient

34
Q

Ascites - Diagnosing Cause
SAAG >11
1. What does it indicate?
2. Give 3 causes?

A
  1. Portal hypertension

2. Liver cirrhosis, cardiac failure, Budd-Chiairi syndrome

35
Q

Ascites - Diagnosing Cause
SAAG <11
1. Give 3 causes?

A

Low albumin (e.g. nephrotic syndrome), Malignancy, Pancreatitis, Bowel Obstruction

36
Q

Ascites - Management

  1. Simple steps?
  2. Pharmacological?
  3. Interventional?
  4. Anything else to consider?
A
  1. Salt restriction, fluid restriction (if Na low)
  2. Spironolactone (aldosterone antagonist) +/- loop diuretics.
  3. Paracentesis, TIPSS late stage
  4. If Alb <15, prophylactic Abx (Ciprofloxacin)
37
Q

C Diff

Main causative agents?

A

PPI

Broad-spectrum Abx, e.g. Clindamycin

38
Q

C Diff - Management
1st line?
2nd line?
3rd line / severe?

A

1st: PO Vancomycin 10d
2nd: PO Fidoxamicin
3rd / Severe: PO Vancomycin + IV Metronidazole

39
Q

Coeliac Disease

  1. Complications?
  2. Diagnostic test?
  3. Definitive test?
  4. Histological features?
A
  1. Anaemia, Hyposplenism, Lactose intolerance, subfertility
  2. TTG Ab (IgA)
  3. Endoscopic intestinal biopsy
  4. Villous atrophy, crypt hyperplasia
40
Q

Acute GI Bleed Management

Initial Steps

A 
A to E
Fluid and blood replacement
Correct clotting
Blatchford score
Endoscopy
41
Q

Acute GI Bleed Management

Acute variceal bleed management?

A

IV Terlipressin
IV Abx before endoscopy
Endoscopy and variceal band ligation

42
Q

Acute GI Bleed

Main features of Blatchford score?

A 
Urea
Hb
SBP
Presence of malaena
Presence of syncope
HR
Liver disease
Cardiac disease
43
Q

Acute GI Bleed

Management of non-variceal bleed?

A

IV PPI

44
Q 
Acute GI Bleed
When to use the following:
1. Platelets
2. FFP
3. Prothrombin complex concentrate
A

Plt: actively bleeding + PLT<50
FFP: fibrinogen<1 / PT/APTT>1.5
PCC: on Warfarin + actively bleeding

MSRA Revision (6 decks)

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