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Plab > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What are the invasive and non invasive H pylori tests

A

Non invasive

  • urea breath test C13
  • stool antigen test
  • Serology

Invasive
Endoscopy- Culture, giemsa stain + microscopy,

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2
Q

How do you diagnose acute pancreatitis?

A

Serum amylase, lipase
CRP
CT scan to show necrosis

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3
Q

Features of chronic pancreatitis?

A 
Background alcoholism or history of gall stones with:
Long standing abdominal pain
Calcifications 
Raised GGT
DM
Malabsorption
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4
Q

Pathophysiology of Chronic pancreatitis

A

Prolonged irritation of the yract leads to formation of calcifications on the tract causing blockage

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5
Q

How do you screen for the presence of Hy Pylori after starting therapy?

A

Urea breath test

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6
Q

What medications comprise the triple and quadruple therapy?

A

Triple- clarithromycin, amoxicillin and PPI

Quadruple- metro, tetra, bismuth citrate, ranitidine

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7
Q

Two most important aetiologies of acute pancreatitis in the west?

A

Alcohol and gallstones

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8
Q

What is absorbed in the
Duodenum
Jejunum
Ileum?

A

Duodenum- iron
Jejunum- most nutrients
Ileum- B12 and bile salts

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9
Q

Gold standard for diagnosis of Achalasia?

Whats an alternative?

A

Manometry test is the good standard

Alternative is barium swallow

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10
Q

Whats the initial investigation for achalasia?

A

Endoscopy

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11
Q

Treatment options for achalasia?

A

Hellers myotomy- gold standard
Pneumatic dilation
Endoscopic injection of botulinum toxin

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12
Q

Gold standard for diagnosis of GORD?

A

24 hr pH test

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13
Q

Tretment options for GERD?

A

PPI
Lifestyle changes
Weight loss
Elevation of head in bed

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14
Q

Bisphosphonates and NSAIDS worsen oesophagitis. How?

A

Because they aggravate GERD and irritation of the esophagus

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15
Q

Occassional rectal pain that occurs in the absence of any organic disease?

A

Proctalgia fugax

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16
Q

Barretts oesophagus is related to epithelial change from what to what?

A

Squamous to columnar

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17
Q

Barrett’s is a risk factor for which kind of cancer?

A

Adenocarcinoma

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18
Q

Whats the appearance of the oesophagus in achalasia on barium swallow called?

A

Bird’s beak appearance

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19
Q

Differentials of dyspepsia/reflux?

A

Achalasia
GORD
PUD
Hiatus hernia

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20
Q

Oesophageal pattern of DES on barium swallow?

A

Corkscrew

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21
Q

Gold standard for disgnosis of DES?

A

Oesophageal Manometry

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22
Q

Treatment of DES

A

Avoid triggering foods

Calcium channel blockers

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23
Q

Plummer vinson syndrome triad?

A

Oesophageal webs
IDA
Dysphagia

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24
Q

Treatment of plummer vinson?

A

Give iron supplements

Endoscopic dilation for persistent dysphagia

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25
Q

Differentials of dysphagia?

A 
Achalasia 
Pharyngeal pouch 
DES
Esophageal strictures 
Plummer Vinson 
Oesophageal cancer
Barrett’s oesophagus
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26
Q

When do you do a barium swallow first instead of endoscopy?

A

When there’s a pharyngeal pouch and you don’t want to rupture

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27
Q

Which imaging do you do for acute cholecystitis. Why?

A

USS- because gall stones are radio lucent

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28
Q

Features of zenker’s diverticulum?

A

Halitosis
Dysphagia
Reflux on lying down
Cough

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29
Q

Whet kind of esophageal cancer does smoking cause?

A

SCC

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30
Q

What kind of dyphagias affect both solid and liquids vs just solids?

A

Structural- solids

Motility related- solids and liquids

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31
Q

Causes of internittent structural and intermittent functional/motility related

A

Intermittent structural- Oesophageal ring

Intermittent motility- DES, Achalasia

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32
Q

Whats the order of investigations to do for dysphagia?

A

Endoscopy first

Barium swallow next

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33
Q

Most commonly affected site in CD?

A

The terminal ileum

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34
Q

Most commonly affected site in UC?

A

Rectum

35
Q

Mackler’s triad refers to which condition?

A

Esophageal rupture
Chest pain
Vomiting
Subcutaneous emphysema

36
Q

Wgat organs does copper deposot in Wilson’s disease?

A

Basal ganglia
Eyes
Liver

37
Q

What is the Kayser Fleischer ring?

A

The deposition of copper ions in the des cement membrane of the cornea in Wilson’s disease

38
Q

How is wilson’s dosease treated?

A

Penicillamine, which cheltes copper

39
Q

Features of pernicious anaemia

A 
Other autoimmune diseases
Features of anemia 
Megaloblastic anemia
Paraesthesia
Numbness 
Subacute combined degeneration
40
Q

How do you treat Giardiasis?

A

Metronidazole

41
Q

How do you treat cryptosporidiosis diarrhea?

A

Oral anti fungal- nitazoxanide + HAART

42
Q

What are the result expectations in CD for FBC, LFT, ESR, CRP?

A

FBC- Raised platelets, raised WBC, if malabsorption- anemia
LFT- hypoalbuminemia
ESR- raised
CRP- raised

43
Q

The role of NSAIDS and stress in IBD?

A

They worsen it and trigger relapses

44
Q

Medications for induction of remission in CD?

A

Steroids - oral prednisone

45
Q

Medications for maintenance of remission in CD?

A

Mercaptopurine, azathioprine, methotrexate

46
Q

What substance in stool can be used to differentiate IBD from IBS?

A

Fecal calprotectin

47
Q

How does proctitis in UC present?

A

Tenesmus, hematochezia, urgency

48
Q

Can patients with UC have aphthous ulcers?

A

Yep!

49
Q

Presentations of UC and respective symptoms?

A

UC rectal- proctitis
UC sigmoid/ left sided- left sided pain, hematochezia, severe diarrhea
UC extensive - same as above
Toxic mega colon- acutely ill, fever, distension, tenderness,

50
Q

Features of toxic megacolon on xray?

A

Lead pipe appearance- loss of haustrations

Dilated colon

51
Q

Treatment of the different forms of UC?

A 
Proctitis- rectal mesalazine
Left sided- topical mesalazine enema 
Extensive- oral mesalazine plus enema
All of them plus/minus oral prednisone me 
Severe colitis- IV hydrocort
52
Q

Is PANCA positive in UC?

A

Yep!

53
Q

Where are the locations of ulcers in ZES?

A

Distal Duodenum and proximal jejunum

54
Q

Treatment of ZES?

A

PPIs

Surgical resection of tumor

55
Q

What gene is implicated in Hereditary haemochromatosis?

A

HFE

56
Q

What is responsible for the bronze skin nature in haemochromatosis?

A

Melanin deposition in the skin

57
Q

Investigations in haemochromatosis?

A

Transferrin- saturation increased
Increased ferritin
LFT- increased ALT and AST
HFE gene

58
Q

How is hemochromatosis treated?

A

Phlebotomy

Liver transplant

59
Q

A condition with decresed UDPGT causing jaundice in the face of stressors?

A

Gilbert syndrome

60
Q

Whst 2 things are lost in villous adenoma?

A

Protein and potassium

61
Q

First line for pseudomembrabous colitis?

A

Vancomycin

62
Q

Bloody diarrhea organism acronym?

Clue- symptom in iron def anaemia

A

PECAS

63
Q

Demographics for primary biliary cirrhosis?

A

Middle aged female with another autoimmune disease

64
Q

Primary biliary cirrhosis/primary sclerosing cholangitis, which one is associated with IBD?
(Remember- inflammation begets inflammation)

A

PBC- Coeliac

PSC- IBS

65
Q

What antibody is associated with PBC?

A

Anti mitochondrial antibody

66
Q

Treatment of PBC?

A

Ursodeoxycholic acid

Cholestyramine

67
Q

Demographic for PSC?

A

Middle aged male

Background IBD

68
Q

Which immunoglobulin is deficient in coeliac’s disease?

A

IgA

69
Q

Histological changes in coeliac disease?

A

Villous atrophy
Crypt hyperplasia
Lymphoid infiltration

70
Q

The characteristic rash in coeliac dosease

A

Dermatitis herpetiformes

71
Q

Diagnostic test of coeliac dosease?

A

Duodenal/jejunal biopsy

72
Q

What are the antibodies involved in coeliac dosease?

Which is tested first?

A

Tissue transglutaminase antibody

Anti endomysial antibody

73
Q

Whats the duration of time between eating and endoscopy permitted?

A

6 hours

74
Q

Whats the relationship between GGT abd Alcoholic liver dx?

Also, AST/ALT ratio?

A

Alcohol raises GGT levels

AST/ALT ratio = 2:1

75
Q

Cancers associated with coeliac?

A

Lymphoma, small bowel adenocarcinoma, esophageal cancer

76
Q

What differentiates HELLP syndrome from AFLP?

A

Hypoglycemia, ammonia

77
Q

Criteria for liver transplantation after paracetamol overdose?

A

Arterial pH <7.3 24 hrs after ingestion
PT > 100 secs
Creatinine > 300micromol/L
Grade III or IV encephalopathy

78
Q

Charcot’s triad for acute cholangitis?

A

RUQ pain
Fever
Murphy’s sign

79
Q

Whats the difference between hemosiderosis and hemochromatosis?

A

Hemosiderosis usually occurs with Iron deposition, usually doesn’t cause tissue injury. Deposits are more centrally placed and are found in kupffer cells.
Hemochromatosis is a genetic disorder which occurs when there is excessive iron absorption.
Deposits focus more peripherally and do not involve Kupffer cells

80
Q

Kantor string and Rose thorn ulcers are seen in?

A

Chrons disease

81
Q

Dark purple lump under the skin at the anal margin is called?

A

Anal hematoma

82
Q

Where will a gallstone need to be found for urgent action to be taken? (With or without symptoms)

A

The common bile duct

83
Q

How do the neutrophils look in b12 deficiency?

A

Hypersegmented

Plab (5 decks)

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