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BPT Sadness 😔 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is the triad of Budd-Chiari syndrome?

A

Ascites, abdominal pain, and hepatomegaly

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2
Q

Key features in Wernicke’s encephalopathy?

A

Triad
1. Ataxia
2. Ocuomotor dysfunction
i. Nystagmus
ii. Opthalmoplegia
3. Encephalopathy
i. Confusion, disorientation, inattentiveness
(Also sensory neuropathy)

Korsakoff syndrome
- Antero- and retrograde amnesia with confabulation

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3
Q

Positive anti-mitochondrial antibodies (AMA), raised IgM, and cholestatic LFTs (esp. raised ALP) suggests what diagnoses? And what treatment delays progression?

A

Primary biliary cholangitis
- Ursodeoxycholic acid

Middle aged, itchy lady with autoimmune condition (Sjogren, CREST, RA etc.)

Increased cholesterol but nil IHD due to increased HDL

Imaging: ultrasound or magnetic resonance cholangiopancreatography to exclude extrahepatic obstruction

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4
Q

What gene is associated with higher rates of NASH, and which ethnic group is implicated?

A

rs738409 in PNPLA3
- in Hispanic groups

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5
Q

What are key SE of long term PPI?

A

• Hyponatraemia,hypomagnasaemia
• Osteoporosis → increased risk of fractures
• Microscopic colitis
• Increased risk ofC. difficileinfections

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6
Q

What scoring system is used to alcoholic hepatitis, and what is the cut off for administration of prednisolone?

A

Maddrey’s Discriminant Function
- Score >/= 32

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7
Q

What are endoscopy findings which are high risk of bleeding?

A

• Actively bleeding peptic ulcers
• Ulcers with nonbleeding visible vessels
• Ulcers with adherent clots

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8
Q

Which dermatological condition is associated with coeliac disease, and what is its treatment?

A

Dermatitis herpetiformis
- Treatment with dapsone

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9
Q

Which HLA markers are associated with coeliac disease?

A

HLA-DQ2 and HLA-DQ8

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10
Q

Which autoimmune conditions are associated with coeliac disease?

A
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11
Q

What are the SEROLOGICAL screening tests for coeliac disease?

A
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12
Q

What are the most common causes of portal HTN in
a) Western world
b) Africa

A

Cirrhosis and schistosomiasis respectively

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13
Q

What is antimicrobial treatment for life-threatening toxic megacolon?

A

ORAL vancomycin and IV metronidazole

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14
Q

What are factors that may indicate severe pancreatitis?

A

Factors:
• Age > 55 years
• Hypocalcaemia
• Hyperglycaemia
• Hypoxia
• Neutrophilia
• Elevated LDH and AST

Only thing low are the UMMs (calcium, oxygumm)

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15
Q

What are the genetics of Wilson’s disease? What is the treatment

A

Autosomal recessive - characterised by excessive copper deposition in the tissues
- Defect in theATP7Bgene located onchromosome 13

Treatment: penicillamine, chelates copper

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16
Q

What is the most common site affected in ischaemic colitis, and what is seen on AXR

A

The splenic flexure with ‘thumbprinting’ on AXR due to mucosal oedema/haemorrhage

Watershed area (minimal collateral supply)

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17
Q

What is the genetic inheritance of HNPCC/Lynch syndrome?

A

Autosomal dominant

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18
Q

What causes defective bilirubin conjugation in Gilbert’s syndrome?

A

Deficiency of UDP glucuronosyltransferase (UGT1A1)

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19
Q

Classic histological finding in hepatocytes in patients with alcoholism?

A

Mallory bodies

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20
Q

What are implications of TPMT gene when treating IBD?

A

Genetic variants alter drug metabolism
- Low enzyme activity = risk of toxicity due to slow metabolism

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21
Q

Treatment of CMV colitis?

A

Ganciclovir
- Tx valganciclovir in renal transplant

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22
Q

Dysphagia with solids alone suggests which of the following?
- Mechanical obstruction, or
- Motility disorder?

A

Mechanical
- Benign or malignant
- Masses, strictures, eosophageal ring e.g. Schatzki ring, webs, hiatus hernia

Causes of strictures
- Chronic reflux oesophagitis
- Eosinophilic oesophagitis
- Radiation
- Caustic injury

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23
Q

Dysphagia that progresses from occuring only with solids to both solids and liquids is concerning for what?

A

Most importantly - malignancy
- DDx: benign stricture that has become high grade obstruction

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24
Q

Where are Schatzki rings located?

A

A Schatzki ring is a circular membrane of mucosa and submucosa that forms at the squamocolumnar junction of the distal esophagus
- Do not contain any muscularis propria
- Always associated with hiatal hernias

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25
Q

Does achalasia present as dysphagia to liquids or solids first?

A

70-97% will have both upon initial presentation

Classic achalasia
- Hypertonic lower oesophageal sphincter + aperistalsis

Longstanding achalasia associated with SCC

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26
Q

Goblet cells make what?

A

Mucous
- Goblets are gross and make mucous

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27
Q

Chief cells secrete what?

A

Pepsinogen
- Pepsi is king
- Pepsinogen is the inactive form of pepsin, which digests protein into polypeptides

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28
Q

Parietal cells secrete what?

A
  1. Gastric acid e.g. HCl
    - Keep it PG, Ga
    - Primary cell
  2. Intrinsic factor - required for B12 absorption in terminal ileum
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29
Q

D cells secrete what?

A

Somatostatin; inhibits acid secretion
- Don’t Secrete

Suppresses gastrin

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30
Q

G cells (a neuroendocrine cell) secrete what?

A

Gastrin; stimulates acid secretion
- Good to go on a acid trip on the gasTRaIN

MOA
- Stimulates parietal cells directly, and
- Stimulates ECL cells to release histamine > works on parietal cells

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31
Q

In Barrett oesophagus, which cells are replaced with what?

A

Squamous epithelial cells as replaced with metaplastic columnar epithelium
- Precursor to oesophageal Ca
- EtOH itself is not a RF for Barrett (although EtOH is a RF for sqamous cell carcinoma)

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32
Q

What are the 2 types of oesophageal cancer, and which is most common?

A

Squamous cell and adenocarcinoma
- SCC is ~90% and found in PROXIMAL oesophagus; assoc. EtOH
- Adenocarcinoma usually found in DISTAL oesophagus; assoc. with GORD or Barrett’s

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33
Q

Most common causes of PUD?

A

NSAIDS and H. pylori

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34
Q

First line regime for H. pylori eradication in Australia?

A

ACE
- Amoxicillin 1 g orally, twice daily for 7 to 14 days
- Clarithromycin 500 mg orally, twice daily for 7 to 14 days
- Esomeprazole 20 mg orally, twice daily for 7 to 14 days

If allergic to penicillin, use metronidazole

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35
Q

What are standard follow up post H. pylori eradication treatment?

A

C13- or C14-urea breath test
- Antibiotic therapy and bismuth should not be taken for at least 4 weeks
- PPI therapy should be withheld for at least 1 week (and preferably 2 weeks)

OK to have H2-receptor antagonists (ranitidine, famotidine etc.)

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36
Q

What is second line H. pylori eradication?

A
  • PPI BD for 10/7
  • Amoxicillin 1 g BD 10/7
  • Levofloxacin BD OR moxifloxacin BD for 10/7

NB: secondary Helicobacter pylori resistance to clarithromycin is common after failure of first-line therapy

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37
Q

What is MOA of azathioprine? Which metabolite causes immunosuppression?

A

Azathioprineinhibits purine synthesis (purines are needed to produce DNA and RNA)
- Inhibit purine synthesis > less DNA and RNA are produced for synthesis of WBC > immunosuppression

6TGN

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38
Q

Which type of hepatorenal syndrome has the best prognosis?

A

Type 2

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39
Q

Anti-smooth muscle Ab is suggestive of which condition?

A

Autoimmune hepatitis

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40
Q

What MHC gene promotes spontaneous HCV clearance?

A

MHC IL28B

Other factors: young, female

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41
Q

Which skin condition is associated with hepatitis C?

A

Porphyria cutanea tarda
- blistering disease on sun-exposed skin esp. hands

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42
Q

What is a normal FibroScan result?

A

<7 kPA

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43
Q

How and when do you check for cure of HCV post treatment?

A

Negative HCV RNA 12 weeks post completion of treatment

Sustained virological response = cure

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44
Q

What are pangenotypic treatment options for HCV?

A

Pangenotypic and treatment naïve
§ Sofosbuvir + velpatasvir for 12 weeks (cirrhosis and non-cirrhosis)
§ Glecaprevir + pibrentasvir for 8 weeks (cirrhosis and non-cirrhosis)
Pangenotypic and treatment failure
§ Sofosbuvir + velpatasvir PLUS voxilaprevir for 12 weeks (cirrhosis and non-cirrhosis)

45
Q

What is the Child Pugh score

A
46
Q

Pseudomembranous colitis is associated with which pathogen?

A

C. difficile

47
Q

Which mutations are most common causes leading to hereditary haemochromatosis?

A

Mutations in HFE gene
* **C282Y ** (85%)
* H63D

Heterozyogosity for HFE mutation carries similar risk iron overload as general population

48
Q

IBD has a bimodal peak - which decades of life?

A

20s and 50-60s

49
Q

Perianal fistula - Crohn’s or UC?

A

PERIANAL FISTULA IS ALWAYS CROHN’s in exam

50
Q

Pathognomic pathology for Crohn’s?

A

Non-caseating granuloma

51
Q

Where is the most likely site to find Crohn’s?

A

Terminal ileum;
flexisig only goes to splenic flexure only (thus useful for UC but may not Dx Crohn’s)

52
Q

Intraepithelial lymphocytosis on histology likely to be?

A

Coeliac disease

53
Q

Crypt abscess is most common in which type of IBD?

A

UC

54
Q

Familial adenomatous polyposis (FAP) is associated with which mutation? And what is likelihood of developing CRC?

A

Adenomatous polyposis coli (APC) gene
- APC is a tumour suppressor gene

Chance of CRC is 100% if left untreated

55
Q

Non-polyposis colorectal carcinoma (HNPCC)/Lynch syndrome is associated with which gene mutations?

A

MSH2 (60%) and MLH1 (30%)

Colorectal, endometrial Ca

56
Q

What are the 3 types of colon cancers, and their prevalence?

A
  1. Sporadic - 95%
  2. HNPCC - 5%
  3. FAP - <1%
57
Q

What is the strongest risk factor for anal cancer development?

A

HPV infection, 80-85%
- 80% of these cancers are SCCs

58
Q

What is the risk of developing HCC in the setting of primary biliary cirrhosis?

A

20x increase

59
Q

What is the diagnostic investigation of choice for someone presenting with LOW, steatorrhoea , pruritis, painless obstructive jaundice and palpable gallbladder - Courvoisier’s sign?

A

CT pancreas to diagnose pancreatic cancer

60
Q

Perianal itching in children which possibly affects other family members is likely to be caused by?

A

Threadworm, Enterobius vermicularis
- Girls may have vulval symptoms
- Tx with mebendazole

61
Q

What is the best marker of severity for pancreatitis?

A

CRP

62
Q

Which 5ASA drug most raises the risk of pancreatitis?

A

Mesalazine - 7x more than sulfasalazine

63
Q

Diarrhoea + hypokalaemia with metabolic acidosis (+/- large adenoma)?

A

Villous adenoma
- McKittrick-Wheelock syndrome

64
Q

Which cardiac abnormalities are associated with carcinoid syndrome?

A

Right-sided valvular pathology
- Tricuspid insufficiency
- Pulmonary stenosis

65
Q

Primary sclerosing cholangitis is most associated with:
a. Primary biliary cirrhosis
b. Crohn’s disease
c. Hepatitis C infection
d. Ulcerative colitis
e. Coeliac disease

A

Ulcerative colitis; 4% of patients with UC have PSC, 80% of patients with PSC have UC
- Also associated with HIV
- p-ANCA

66
Q

What are possible CXR findings in achalasia?

A

Retrocardiac air-fluid level +/- wide mediastinum

67
Q

What is preferred radioimaging for malignant oesophageal stricture?

A

Endoscopic ultrasound
- Better than CT or MRI

68
Q

Reduction in which serum investigation is present in Wilson’s disease

A

Serum caeruloplasmin is decreased

Wilson’s disease: excessive copper deposition in tissues
- Autosomal recessive
- Defect in ATP7B gene on chromosome 13

69
Q

Hep B and Hep C are which type of viral illnesses?

A

Hep B = DNA
Hep C = RNA

70
Q

Which HBV treatment is approved for use in pregnancy?

A

Tenofovir fumarate
- F = FOETUS

Can also use in decompensated cirrhosis

71
Q

What are therapies which are at highest risk of hepatitis B reactivation?

A
  • Stem cell and solid organ transplantation (highest)
  • B-cell depleting agents incl. rituximab, ustekinumab, natalizumab
  • Steroids
  • Local therapy HCC
  • TNF-alpha inhibitors
  • Systematic chemo
  • Anti-metabolites; 5-ASA, MMP
72
Q

Hepcidin deficiency is implicated in… HH or IDA?

A

Too little hepcidin > iron overload in hereditary haemochromatosis

73
Q

Implication of increased hepcidin?

A

Inflammation, chronic disease > increased hepcidin > essentially inhibits function of ferroportin (because it binds ferroportin) > iron depletion

74
Q

Which is a useful first line test of exocrine function in chronic pancreatits

A

Faecal elastase

75
Q

The combination of neuropsychiatric symptoms with abnormal liver function tests (LFTs) in a young adult should make you think?

A

Wilson’s disease - copper accumulation
- Preferentially affects the basal ganglia > resulting in symptoms of Parkinsonism such as rigidity, tremor and bradykinesia
- Deposition in the liver results in hepatic impairment, which can range from asymptomatic LFT derangement to cirrhosis and liver failure

76
Q

What substance gives faeces it’s colour?

A

Stercobilin

77
Q

Important prognostic markers paracetamol OD?

A

pH <7.3 @ 24 hrs post ingestion

OR
1. PT >100
2. Creatinine >300
3. Grade 3 or 4 encephalopathy

78
Q

Cut off for portal HTN?

A

10mmHg
- HyperTENsion

79
Q

Dx of coeliac disease

A
80
Q

Histology of coeliac disease

A

• Atrophic mucosa with complete loss of villi
• Enhanced epithelial apoptosis
• Crypt hyperplasia

81
Q

Retroperitonal fibrosis makes you think?

A

IgG 4 related disease
- Histo: storiform fibrosis

82
Q

Wilson’s disease

A
83
Q

Criteria for liver Tx in EtOH liver

A

• EtOH abstinence >6/12
• MELD >15
• Recurrent HE, SBP
• Diuretic-resistant ascites
• UGIB
• Hepatopulmonary syndrome, portopulonary HTN

84
Q

Which HCV genotype is associated with hepatic steatosis?

A

HCV genotype 2
- Fat-ty (2 syllables)

85
Q

Types of auto-immune hepatitis?

A

• Type 1 - ANA, anti-Sm, AMA, p-ANCA
• Type 2 - anti-LKM1, liver cytosol Ag (ALC-1)

86
Q

Which stool test is useful for assessing GIT inflammation?

A

Faecal calprotectin

87
Q

Non-cirrhotic portal HTN makes you think?

A

NRH
- Nodular regenerative hyperplasia

88
Q

SAAG aetiology

A
89
Q

Most common GCV genotype?

A

Genotype 3

90
Q

Criteria for SVR (sustained virologists remission) in HCV (hepatis C)?

A

Undetectable RNA at least 12 weeks post treatment

91
Q

Hepatitis C/HCV treatment in renal failure?

A

Glecaprevir plus pibrentasvir
- G for GFR

92
Q

HCC advanced but good ECOG treatment?

A
  1. Atezolizumab + bevacizumab
  2. Sorafenib or lenvatinib
93
Q

What MELD score would you consider liver transplant?

A

MELD >15

94
Q

What chemo is used in TACE?

A

Cisplatin and/or doxorubicin

95
Q

MOA MMF

A

Blocking inosine monophosphate dehydrogenase (IMPDH)
- It’s mycophenolate dick head

96
Q

MOA vedolizumab

A

α4β7 integrin blocker

97
Q

Which is preferred if looking to preserve male fertility?

A

Aminosalicylate
- Sulfasalazine > infertility

98
Q

What is ammonia converted to in ESLD?

A

Ammonia produced by enterocytes during protein digestion
- Healthy liver converts to glutamine

99
Q

Which is the mechanism of paracetamol hepatotoxicity?

A

Glutathione depletion
- Excess paracetamol produces NAPQI > glutathione depletion
- NAC increases glutathione

100
Q

RF for increased risk HCC in chronic HBV (i.e. who to treat)

A

Cirrhosis
Viral load >20,000

1st degree relative
Asian men >40, women >50
ATSI >50
African M+W >20

101
Q

Serology in UC?

A

P-ANCA positive
ASCA negative

102
Q

High 6MMP and low 6TGN makes you think?

A

TPMT deficiency > decreased metabolism of TPMT > decreased inactivation of 6MMP > less 6TGN and more risk of hepatotoxicity

103
Q

Melanosis coli is associated with what?

A

Laxative abuse

104
Q

Which biologic in acute moderate to severe ulcerative colitis best for clinical remission at >1 year?

A

Infliximab > vedolizumab > adalimumab
* Vedolizumab is gut-selective integrin blocker

105
Q

Pathophys achalasia

A

Degeneration of ganglion cells in the myenteric plexus in the oesophageal wall > failure of relaxation of the lower oesophageal sphincter + loss of peristalsis in the distal oesophagus

Pathogen association: Trypanosoa cruzi (Chagas disease) > damage to neurons

106
Q

What hepatic venous gradient pressure AKA HVGP is suggestive of cirrhosis and what places you at risk of variceal bleed

A

HVPG >or= 10 mmHg (termed clinically significant portal hypertension)
- HVPG above 12 mmHg is the threshold pressure for variceal rupture

107
Q

What is the cut-off for cirrhosis using the APRI score and FIB4 score

A
  • APRI score >1.5 suggests fibrosis or cirhosis
  • FIB4 score: >3.4
108
Q

Watery secretory diarrhea, which can result in hypokalemia and metabolic acidosis and with flushes makes you think?

A

VIPoma

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