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MRCP Part 2 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

How do you induce remission in crohns disease?

A
  1. Steroids
    (Enteral feeding may be used especially in children)
  2. 5ASA drugs (mesalazine(
  3. Azathioprine or mercaptopurine. Methotrexate is an alternative one.
  4. Infliximab
    Metronidazole for isolated perianal disease
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2
Q

How do you maintain remission in crohns disease?

A

Azathioprine or mercaptopurine.

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3
Q

What do you need to check before starting mercaptopurine or azathioprine?

A

TPMP

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4
Q

Treatment of carcinoid tumours

A

Octreotide

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5
Q

Test for haemachromatosis

A

Tranferrin saturaton

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6
Q

What is the treatment for a gastric MALT lymphoma?

A

Eradication of H Pylori (8-% respond to this)

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7
Q

What caused hydatid cysts?

A

Tapworm parasites echinococcus granulosus

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8
Q

What is the target haemaglobin pre scope for an upper GI bleed?

A

70 - 80

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9
Q

Whats the most common cause of liver abscess in adults?

A

E coli

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10
Q

What are the lab results in wilsons disease?

A

Reduced serum caerulopasmin
Reduced total serum copper
Increased free serum copper
Increased 24 hour urinary copper excretion

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11
Q

Whats the treatment for wilsons disease?

A

Penicillamine (chelates copper)

Trientine hydrochloride

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12
Q

Treatment of C Diff

A

1st line - Oral vancomycin
2nd line - Oral fidaxomicin
3rd line - Oral vancomycin and IV metronidazole

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13
Q

What does an SAAG of over 11 mean?

A

Portal hyprtension

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14
Q

What does an SAAG of less than 11 mean?

A

No portal hypertension

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15
Q

What causes ascities with a SAAG of over 11?

A

Liver disorders (cirrhosis, ALD, liver failure, liver mets)
Cardiac (right heart failure, pericarditis)
Budd chiari
Portal vein thrombosis
Veno occlusive disease
Myxodema

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16
Q

What causes ascites with a SAAG of less than 11?

A 
Hypoalbuminaemia  (nephrotic syndrome, severe malnutrition) 
Malignancy (peritoneal carcinoma) 
Infections (TB) 
Pancreatitis
Bowel obstrcution 
Biliary ascites 
Post op lymphatic leak 
Serositis in connective tissue diseases
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17
Q

Treatment of ascites

A

Aldosterone antagonist
Loop diuretics
Drainage if tense ascites
Prophylactic antibiotics if at risk of SBP (oral ciprofloxacin)

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18
Q

Diagnosis of small bowel overgrowth

A

Hydrogen breath test

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19
Q

Management of small bowel overgrowth

A

Rifaximin

Co amoxiclav and metronidazole can also be used.

20
Q

Antimitochondrial antibodies are associated with which condition?

A

Primary biliary cholangitis

21
Q

Management of primary biliary cholangitis

A

Ursodeoxycholic acid
Cholestyramine
Fatt soluble vitamin supplments
Liver transplant

22
Q

Treatment of hepatic encephalopathy

A

Treat precipitating cause
Lactulose
Rifaximin

23
Q

Treatment for achalasia?

A

Pneumatic balloon dilatation
Heller cardiomyotomy
Intraspinteric injection of botox injections
Drugs - nitrates, calcium channel blockers

24
Q

What is budd chiari syndrome?

A

Hepatic vein thrombosis

25
Q

What is the definition of type 1 hepatorenal syndrome?

A

Rapidly progressive with doubling of the serum creatanine to over 221 or a halving of creataning clearance to less than 20ml/min over a period of less than 2 weeks.

26
Q

Prophylactic antibiotic for SBP?

A

Ciprofloxacin

27
Q

Treatment of mild to moderate ulcerative colitis (proctitis)

A
  1. Topical aminosalicylate
  2. If remission not achieved in 4 weeks then add an oral aminosalicylate
  3. If remission still not achieved then add a topical or oral corticosteroid
28
Q

Treatment of mild to moderate ulcerative colitis (proctosigmoiditis and left sided UC)

A
  1. Topical aminosalicylate
  2. If remission not achieved in 4 weeks add a high dose oral aminosalicylate OR high dose oral aminosalicylate and a topical steroid.
  3. If still not achieved then stop topcal treatment and offer and aral aminosalicylate and an oral corticosteroid
29
Q

Treatment of mild to moderate ulcerative colitis (extensive disease)

A

Topical and high dose oral aminosalicylate

30
Q

Treatment for inducing remission in a severe flare of ulcerative colitis

A

IV hydrocortisone

IV ciclosporin if contraindicated or if no improvement after 72 hours.

31
Q

Contraindications to liver biopsy

A 
Deranged clotting (INR over 1.4) 
Low plateltes (less than 60) 
Anaemia 
Extrahepatic biliary obstruction 
Hydatid cysts 
HAemangioma 
Unccoperative patient 
Ascites
32
Q

Antibodies in autoimmune hepatitis

A

Anti smooth muscle antibodies

33
Q

Plummer vinson syndrome

A

Triad of dyphagia (secondary to oesophageal webs), glossitis, iron deficiency anaemia

34
Q

What anti emetic is useful in incomplete bowel obstruction?

A

Metoclopramide

35
Q

What treatment can be given for a metastatic bowel obstruction?

A

Dexamethasone

36
Q

Test for bile acid malabsorption

A

SeHCAT (nuclear medicine test)

37
Q

What is zollinger ellison syndrome?

A

Condition charactersed by excessive levels of gastrin usually from a gastrin secreting tumour of the duodenum or pancreas (can occur as part on MEN1)

38
Q

What does the jejunal biopsy show in whipples disease?

A

Periodic acid-schiff (PAS) granules

39
Q

What is the treatment for whipples disease?

A

Oral co-trimoxazole for 1 year. (sometimes IV penicillin is needed first)

40
Q

What is the genetic problem in heriditary non polyposis colorectal cancer?

A

Mutation in the DNA mismatch repar gene. (MSH2 or MLH1)

41
Q

What other cancer are people with hereditary non polyposis colorectal cancer at risk of?

A

Endometrial cancer

42
Q

What is barretts oesophagus?

A

Metaplasia of the lower oesophageal mucose with the squamous epithelium being replaced by columnar epithelium.

43
Q

How often do patients with barrets oesophagus get endoscopies?

A

Every 3 - 5 years if there is no dysplasia

44
Q

What is the treatment if there is dysplasia of the barretts oesophagus?

A

Endoscopic muscosal resection and then radifrequency ablation

45
Q

How often should adults with cirrhosis be screened for hepatocellular carcinoma?

A

Every 6 months - done with ultrasound with our withour AFP

46
Q

What is haemobilia?

A

A condition where there is bleeding into the biliary tree following connection between the splanchnic circulation and the inrahepatic or extrahepatic biliary system.
RUQ pain, GI bleeding and jaundice

47
Q

Criteria for an acute transplantation following a paracetamol overdose?

A
  1. Arterial pH less than 7.3
  2. INR greater than 6.5
  3. Creatanine over 300
  4. Grade 3 or Grade 4 hepatic encephalopathy

MRCP Part 2 (11 decks)

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