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Y4 Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Inducing remission in Crohns disease

A
  1. Steroids (e.g Oral pred/IV hydrocortisone) - or budoneside if mild disease
  2. Aminosalicylates e.g Mesalazine
  3. Azathioprine / Mercaptopurine / Methotrexate
  4. Infliximab
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2
Q

What must be checked prior to commencing treatment with Azathioprine or Mercaptopurine

A

TPMT - thiopurine methyltransferase.
If a pt is deficient in this then they cannot take azathioprine or Mercaptopurine. Consider methotrexate management instead.

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3
Q

Maintenance of remission in Crohn disease

A
  1. Azathioprine / Mercaptopurine
  2. Methotrexate (if TPMT deficient)
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4
Q

Inducing remission in Ulcerative colitis

A
  1. Rectal mesalazine +/- oral too if required (before adding a steroid)
  2. Oral prednisolone

If severe disease (i.e >6 stools per day + blood. or Systemic upset Temp >37.8, HR >100bpm, Hb <105, ESR >30) = INPATIENT
1. IV hydrocortisone
2. IV cyclosporin (if steroid can’t be tolerated or if no improvement in 72hrs with just steroids)

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5
Q

Maintenance of remission in Ulcerative Colitis

A
  1. Mesalazine (Rectal/Oral if L side or extensive)

If severe disease (or 2+ relapses in 1yr) = Azathioprine/Mercaptopruine

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6
Q

Histological findings in Crohn’s disease

A

Non-caseating granuloma formation
Lymphoid hyperplasia
Goblet cell hyperplasia

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7
Q

Histological findings in Ulcerative Colitis

A

Crypt abscesses
Goblet cell depletion
Crypt disorganisation

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8
Q

Radiological findings in Crohn’s disease

A

Small bowel enema shows;
- Kantor’s string sign (due to strictures)
- Rose thorn ulcers
- Proximal bowel dilation
- Fistulas

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9
Q

Radiological findings in Ulcerative Colitis

A

Barium enema shows;
- Loss of haustra
- Pseudopolyps
- Drainpipe colon: narrow and short colon in chronic disease
- Leadpipe sign: loss of haustra
- Thumb-printing sign: Thickened haustra folds

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10
Q

Endoscopic findings in Crohn’s disease

A

Deep ulcers with cobblestone appearance

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11
Q

Endoscopic findings in Ulcerative Colitis

A

Widespread ulceration, preservation of deep mucosa + pseudopolyps.

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12
Q

Distribution differences in IBD

A

Crohns = skip lesions
UC = continuous lesions

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13
Q

Is smoking protective or causative in UC

A

Protective

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14
Q

Extra-GI manifestations of IBD

A

Eyes = uveitis (more in UC) + episcleritis
Enteric arthritis
Skin = erythema nodosum + pyoderma gangrenosum
Clubbing
Osteoporosis
PSC (in UC only)

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15
Q

Age of onset in Chron’s disease

A

Bimodal - 15-40yrs and 60-80yrs

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16
Q

Age of onset in UC

A

20-40yrs

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17
Q

Indications for protocolectomy in UC

A

Protocolectomy = Colon + rectum removed. Ileostomy formed.
Indications = dysplastic transformation of the colon (long standing UC inc risk of colon cancer)

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18
Q

Indications for sub-total colectomy in UC

A

Sub-total colectomy = Portion of colon removed. Rectum remains in place. Temporary ileostomy formed.
Emergency/severe UC which has failed to respond to medical therapy

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19
Q

Restorative/Curative surgery in UC

A

Panprotocolectomy with Ileo-anal J pouch

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20
Q

Indications for surgery in Crohn’s disease

A

Fistulae, Abscess formation + Strictures

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21
Q

What is the main complication of a small bowel resection?

A

Short bowel syndrome

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22
Q

Severe peri-anal / Rectal Crohn’s disease surgical management

A

Proctectomy - with ileostomy

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23
Q

Why can ileo-anal J pouches not be used in Crohn’s disease

A

It carries a high risk of fistula formation + pouch failure

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24
Q

Terminal ileum Crohn’s disease surgical management

A

limited ileocaecal resection

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25
Q

What is the main risk/complication following limited ileocaecal resection in Crohn’s disease

A

Gallstone formation- due to Impairment of hepatic bile salt recycling

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26
Q

Most appropriate investigation to assess disease severity and therapeutic response in a Severe UC flare up

A

Flexible sigmoidoscopy
- less risk of perforation and can be done in emergencies without bowel preparation.

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27
Q

Investigation of choice for peri-anal fistula in patients with Crohn’s disease

A

MRI Pelvis - allows tract to be identified and any other abscesses

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28
Q

Hartmann’s procedure

A

Removal of sigmoid colon with end colostomy as emergency procedure.

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29
Q

Clinical Presentation of achalasia

A

Dysphagia of Solids AND liquids
Heartburn / regurgitation

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30
Q

1st line investigation + finding for achalasia

A

Manometry - demonstrates increased LOS tone which does not relax on swallowing

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31
Q

A bird-beak appearance on barium swallow is indicative of what disease?

A

Achalasia

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32
Q

What is the 1st line management of achalasia

A

Pneumatic balloon

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33
Q

Where does a pharyngeal pouch typically develop?

A

In the pharynx between the thyroid cartilage and Cricoid cartilage - Killian’s dehiscence

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34
Q

Sx of Pharyngeal pouch

A

Dysphagia
Halitosis
Neck swelling + gurgles on palpation

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35
Q

What is boerhaave’s syndrome?

A

Spontaneous rupture of the oesophagus resulting from repetitive vomitting

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36
Q

Sudden onset chest pain + Repetitive vomitting + Subcutaneous emphysema is indicative of what condition?

A

Boerhaave’s syndrome

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37
Q

Red flag Sx (2ww referral) in a pt presenting with dyspepsia

A

Dysphagia
Age > 55yrs
Weight loss
Treatment resistant dyspepsia
low Hb
Raised platelets

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38
Q

1st line Invx for GORD

A

Endoscopy

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39
Q

Gold standard Invx for GORD / further invx when endoscopy is inconclusive

A

24hr oesophageal pH monitoring

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40
Q

Medical treatment for GORD

A

PPI for 1-2 months (continue on lower dose prn if useful. If no response X2 the dose for 1 month and if still no response try a H2RA or prokinetic)

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41
Q

1st line investigation in any presentation of dyspepsia

A

H.pylori - Urea breath test or Stool antigen test
Note - must discontinue PPIs 2 weeks before and Abx 4 weeks before

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42
Q

Triple eradication therapy for H.pylori

A

PPI + Amoxicillin + Clarithromycin/metronidazole for 7 days

If pen allergic = PPI + Clarithromycin + Metronidazole

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43
Q

What is Barrett’s oesophagus?

A

Premalignant metaplasia or the lower oesophagus due to chronic reflux
Stratified squamous –> Columnar

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44
Q

What is the cancer risk in a pt with Barrett’s oesophagus

A

2-5 % inc risk of developing adenocarcinoma of oesophagus

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45
Q

Main complications of H.pylori infection

A

GORD
Gastritis
Peptic ulcers
Gastric cancer
Gastric MALT (b-cell lymphoma - eradication of h.pylori usually induces remission)

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46
Q

Pathophysiology of peptic ulcer formation

A

1) Loss of protective layer (due to meds e.g NSAIDs which inhibit COX-1 therefore inhibit prostaglandin synthesis)
2) Increased acid secreation

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47
Q

Differentiation in symptoms between Gastric and Duodenal ulcers

A

Gastric ulcers = pain worse after eating
Duodenal ulcers = pain relieved by eating

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48
Q

Diagnostic investigation for Peptic ulcer disease

A

H.pylori should be ruled out 1st line, then do an
Endoscopy = diagnostic +/- Rapid urease test/biopsy

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49
Q

Management for Peptic ulcer (-ve H.pylori)

A

PPIs until the ulcer is healed

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50
Q

Causes of Upper GI bleed

A

Mallory-weiss tears
Oesophageal cancer
Esophagitis
Oesophageal varices
Gastric ulcer
Gastric cancer
Dieluafoy lesion
Diffuse erosive gastritis
Duodenal ulcer
Aortic-enteric fistula
Diverticular disease

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51
Q

Scoring systems in upper GI bleed

A

1) Glasgow-blatchford score: based on clinical findings to determine risk of GI bleed. Points for Rise in urea, drop in Hb/SBP/Pulse. Melena, syncope, hepatic disease, cardiac failure
2) Rockall score = based on endoscopic findings and determines risk of re-bleed.

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52
Q

Acute management of GI bleed caused by Oesophageal varices

A

IV terlipressin + Abx

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53
Q

Definitive treatment of oesophageal varices

A

Band ligation or TPSS

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54
Q

Acute management of upper GI bleed caused by a bleeding ulcer?

A

Adrenaline +/- Endoscopic clipping

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55
Q

Causes of Lower GI bleeding

A

Colitis
Diverticular disease
Cancer
Haemorrhoids
Angiodysplasia

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56
Q

Indications for surgery in acute lower GI bleed

A

Age >60yrs
Continued bleeding despite endoscopic intervention
Recurrent bleeding
Known CVD / Hypotension

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57
Q

Most common type of oesophageal cancer in UK

A

Adenocarcinoma

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58
Q

RF for oesophageal adenocarcinoma

A

GORD
Barrett’s
Smoking
Achalasia
Obesity

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59
Q

2ww referral for suspected oeseophageal cancer

A

New or changed dysphagia (any age)
Age >55 with weight loss + abdominal pain/reflux/dyspepsia

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60
Q

Diagnostic imvx for oesophageal cancer

A

Endoscopy + biopsy

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61
Q

Best imvx for TNM staging in oeseophageal cancer

A

CT TAP

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62
Q

Management of oesophageal cancer

A

Ivor-lewis type oesophagectomy + adjuvant chemo

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63
Q

Histology of gastric cancer

A

Signet ring cells - large vacuole of mucin displacing nucleus

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64
Q

Which lymph nodes are typically involved in gastric cancer

A

Virchow’s nodes - supraclavicular
sometimes sister may Jospeh nodes = periumbilical nodes

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65
Q

Surgical management choices in gastric cancer

A

Subtotal gastrectomy if cancer 5-10cm away from OGJ
Total gastrectomy if cancer <5cm from OGJ

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66
Q

Skin changes associated with coeliac disease

A

Dermatitis herpatiformis

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67
Q

Genetic associations to Coeliac disease

A

HLA-DQ2 & HLA-DQ8

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68
Q

Investigations for Coeliac disease

A

1) Total IgA - as if deficient can cause false -ve’s in the next two tests
2) Anti-TTG
3) Anti-endomysial antibodies

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69
Q

Why are coeliac patients considered immunocompromised

A

Functional Hyposplenism

70
Q

Which cancer is associated with coeliac disease

A

Enteropathy-associated T cell lymphoma of intestines (EATL)

71
Q

NICE diagnostic criteria for IBS

A

Abdominal pain
Bloating
Change in bowel habit (>6 months)

+ 2 of;
> abnormal stool passage (loose/constipated)
> Bloating
> Worsening sx after eating
> PR mucus

72
Q

Medical management in IBS

A

Loperamide (if diarrhoea)
Laxatives (if constipation - avoid lactulose)
Hyoscine butyl bromide (for pain)

73
Q

Risk Factors for Colorectal carcinoma

A

Fhx
FAP
HNPCC
IBD
Old age
Diet high in red meat / low in fibre
Obesity
Smoking
Alcohol

74
Q

Familial adenomatous polyposis

A

Autosomal dominant mutation to the APC gene
results in 100’s of polyps in colon
Typically leads to cancer <40 yrs
pts require prophylactic panprotocolectomy

75
Q

Lynch syndrome

A

-> Hereditary non-polyposis colorectal cancer
Autosomal dominant mutation to DNA mismatch repair genes / MHS2 gene /MLH1
Causes multiple undifferentiated tumours in proximal colon
also inc risk of endometrial/ovarian/prostate cancer

76
Q

Gold standard investigation for colon canceer

A

Colonoscopy + biopsy

77
Q

2ww referral criteria for colon cancer

A

+ve Faecal occult blood test
Age <50yrs with rectal bleeding + abdominal pain/change in bowel habit/weight loss/anemia
Age > 40yrs + unexplained weight loss + abdominal pain
Age > 50yrs + unexplained rectal bleeding
Age >60 yrs + iron deficiency anaemia/change in bowel habit
Anal fissures NOT in midline/posterior

78
Q

What is the tumour marker in Colon cancer

A

CEA - Carcinoembryonic antigen

79
Q

Ileostomy

A

opening of the small intestine. Usually located in the RIF.
Has a sprouted appearance
Output will be liquid

80
Q

Colostomy

A

Opening of the colon
Location varies - more likely to be on L side of abdomen
Flushed appearance
Output will be solid

81
Q

Risk factors for ischemic bowel disease

A

AF
Endocarditis
malignancy
Old age
Smoking
IBS
HTN
Cocaine use

82
Q

Clinical Presentation of Acute mesenteric ischemia

A

Sudden severe abode pain which is out of keeping with physical examination findings.
Pt typically has AF

83
Q

Thumb-printing sign on Abdo X-ray is indicative of what?

A

Ischemic colitis

84
Q

Causes of Acute pancreatitis

A

idiopathic
Gallstones
Ethanol
Trauma
Scorpion sting
Mumps / malignancy
Autoimmune - SLE / Sjogrens
Steroids
Hyperlipidemia / Hypercalcemia / Hypothermia
ERCP
Drugs - azathioprine, furosemide + thiazide diuretics + Mesalazine

85
Q

Indications of Severe disease in pancreatitis

A

Pa02 <8 kPa
Age > 55yrs
Neutrophils (wbc>15)
Calcium <2
Urea > 16
Enzymes (LDH >600 or AST/ALT >2000)
Albumin <32
Sugar (hyperglycaemia)

86
Q

Cullens sign

A

Periumbilical discolouration
- can be seen in trauma (bleeding) or in pancreatitis

87
Q

Turner’s sign

A

Flank discolouration
- can be seen in trauma or pancreatitis

88
Q

Investigations for Acute pancreatitis

A

Bloods - FBC, U&E, LFT, calcium - for assessing severity
ABG
Amylase - will be 3x the norm. must be done <24hrs
Lipase - better test. Will be raised. Should be done >24hrs
Liver USS - to assess for presence of gallstones
CT abdomen - if you suspect any complications.

89
Q

Complications of Acute Pancreatitis

A

Pancreatic fluid collection
Pseudocysts - 4 weeks after
Pancreatic abscess
Pancreatic necrosis
Haemorrhage
ARDS

90
Q

1st line invx for chronic pancreatitis

A

Imaging (USS / CT/ Xray) = calcification
2nd line = Faecal elastase (if low it indicates exocrine insufficiency) can be done if imaging is inconclusive

91
Q

Pancreatic enzyme replacement

A

Creon

92
Q

Clinical presentation of Pancreatic cancer

A

Painless obstructive jaundice!!!!
-> yellow skin/sclera + dark urine + pale stools + pruritus
Palpable gallbladder
Rapid onset diabetes / worsening glycemic control
change in bowel habit
back pain

93
Q

Courvoisiers law

A

Painless palpable gallbladder + jaundice = unlikely to be gall stones (pancreatic or cholangiocarcinoma more likely)

94
Q

Trousseau’s sign

A

Migratory thrombophlebitis is indicated of pancreatic carcinoma

95
Q

Diagnostic investigation for Pancreatic cancer

A

High-resolution CT TAP - may show a double-duct sign

96
Q

Tumour marker in pancreatic cancer

A

CA19-9

97
Q

Whipple’s procedure

A

radical pancreaticoduodenectomy = removal of head of pancreas + pylorus of stomach + duodenum + gallbladder + bile duct + lymph nodes

98
Q

Which antibiotics cause C.Diff?

A

Cephalosporins e.g cefotaxime / cefaclor (most common)
Clindamycin
Ciprofloxacin / quinolones
Co-amoxiclav + penicillins

99
Q

Treatment of C.diff

A

1st line = oral vancomycin
2nd line = oral Findoxomicin

100
Q

Treatment of C.diff reinfection (recurrence)

A

If within 12 weeks of first = Findaxomicin
If > 12 weeks after first = Vancomycin

101
Q

Treatment of life-threatening C.diff infection

A

high-dose vancomycin + IV metronidazole

102
Q

Risk factors for small bowel overgrowth syndrome

A

Scleroderma
Structural abnormalities of GI tract e.g stricutes/diverticular
Altered motility e.g gastroporesis, surgery, radiation, pancreatitis etc
Medications - PPIs / antibiotics

103
Q

Characteristic presentation of small bowel overgrowth syndrome

A

Intermittent loose stools + bloating, unrelated to type of food. Symptoms relieved by antibiotics

104
Q

Diagnosis of small bowel overgrowth syndrome

A

hydrogen breath testing

105
Q

Globus phyangis

A

Sensation of having a ‘lump in throat’ at all times. typically pain is worse when swallowing saliva and often relieved by food.

106
Q

Gastric cancer and colorectal cancer can often present in a similar way (i.e abdominal discomfort and anaemia due to bleeding) but what simple blood test can differentiate the two.

A

Urea - if this is raised then gastric cancer is more likely.

  • also - the blood is more likely to be melena as its coming from higher up whereas colorectal cancer is more often fresher blood
107
Q

which area is most likely to be affected in ischemic colitis

A

Splenic flexure

108
Q

Management of severe alcoholic hepatitis

A

Steroidss

109
Q

Best investigation for pharyngeal pouch

A

Barium swallow + fluoroscopy

110
Q

Prehepatic jaundice: Causes and Features

A

Haemolytic anemia
Sickle-cell anemia
Spherocytosis
Drugs - antibiotics + antiepileptics
Gilbert’s syndrome

Features = Unconjugated hyperbilirubinemia. Normal LFTs. Normal urine + Stool

111
Q

Intra-hepatic jaundice: causes + features

A

Causes = Hepatocyte dysfunction, liver cirrhosis + most liver diseases e.g hep B, alcoholism, Wilson’s disease.
Features = mixed bilirubinema. Dark urine, normal stools.
Hepatic LFT picture = V high ALT/AST + mildly raised ALP

112
Q

Post hepatic jaundice causes + features

A

Causes = Gallstones / Pancreatic cancer / Cholangiocarcinoma / Pancreatitis / Parasitic infection

Features = Conjugated bilirubinemia.
Obstructive LFTs = V high ALP, mildly raised ALT/AST. Dark urine & Pale stools

113
Q

1st line investigation in pt presenting with jaundice

A

USS liver + Biliary tree

114
Q

Cholestasis

A

Blockage to the flow of bile
Can be triggered by the COCP or Co-amoxiclav

115
Q

Typical presentation of gallstones induced cholestasis

A

Severe biliary colic (RUQ) typically triggered by fatty meals.
Pt is often female + Fat + Fair + Forty + Fertile

116
Q

Which type of IBD is a risk factor for gallstones

A

Crohn’s disease

117
Q

Best investigations to find gallstones

A

USS + MRCP

118
Q

Management of gallstones

A

no management if asymptomatic
Stones <5mm can be left
ERCP if stones are located in the bile duct

119
Q

Acute Cholecystitis Clinical Features

A

= Inflammation of the gall bladder due to impaired drainage.

RUQ pain
Boa’s sign = Hyperaesthesia of R shoulder
Murphy’s sign
N&V
Tachycardia

120
Q

Management of acute cholecystitis

A

NBM + IV fluids + Abs + NG tube (if vomitting)
Definitive management = cholecystectomy within 72hours.

121
Q

Acute Cholangitis presentation

A

Charcot’s triad;
RUQ pain
Fever
Obstructive jaundice

+/- Confusion + hypotension (Reynolds pentad)

122
Q

1st line investigation for Cholangitis

A

USS

123
Q

Definitive management of cholangitis

A

ERCP cholangiopancreatography after 24-48hrs
(during this can do sphincterectomy, balloon dilation, stunting etc to relieve the bile duct)

124
Q

If AST > ALT what does this indicate

A

Alcoholic liver disease
(ALT is normally higher than AST)

125
Q

What causes a rise in ALP?

A

ALP is found in liver, biliary system and bone.
Liver disease
Bone disease
Renal disease
Lymphoma
Myeloma
Pregnancy

***Isolated ALP rise often indicates bony mets or vit D deficiency

126
Q

Non hepatic causes of raised GGT

A

COPD
Renal failure
Post MI

127
Q

Non invasive liver screen

A

USS liver
Hep B & C serology
Immunoglobulins
Ceruloplasmin
A1AT
Ferritin
Transferrin
Autoantibodies

128
Q

Investigations to assess degree of liver fibrosis

A

Liver fibrosis blood test (HA + HIINP + TIMP1)
NAFLD fibrosis score
Fibroscan (transient elastography USS)

129
Q

Medical management of NAFLD

A

Vit E
Pioglitazone
transplant

130
Q

Gold standard investigation for alcoholic liver disease

A

Liver biopsy
*** this is required prior to steroid treatment

131
Q

Autoimmune hepatitis Type 1

A

Women aged 40-50yrs
Sx = Fatigue + Features of liver disease (less acute presentation than T2)
Imvx = ANA + anti-smooth muscle antibody

132
Q

Autoimmune hepatitis Type 2

A

Occurs in teens/early 20’s
Sx = acute hepatitis + jaundice
Invx = Anti-LKM1 antibodies

133
Q

Which hepatitis is commonly caused through eating poorly cooked seafood

A

Hep A

134
Q

Which hepatitis is common following a BBQ or eating pork

A

Hep E

135
Q

Viral markers of active Hep B infection

A

HBsAG
HBcAB IgM
HbeAg = raised during replication

136
Q

how to differentiate between acute or chronic hepatitis B

A

IgM high titre = acute, Low titre = chronic

137
Q

Marker of Hep B immunity

A

HbcAb = past infection
HBsSb = Vaccination/previous infection

138
Q

Complications of Hep B / Hep C

A

Liver cirrhosis
Hepatocellular carcinoma
Sjogren’s syndrome
Membranoproliferative GN

139
Q

Drugs causing chronic liver disease

A

Think SAM
Sodium valporate
Amiodarone
Methotrexate

140
Q

Tumor marker for hepatocellular carcinoma

A

Alpha fetoprotein

141
Q

Liver USS findings in chronic liver disease

A

Corkscrew appearance to hepatic arteries
Enlarged portal vein
Ascites
Splenomegaly

142
Q

Scoring systems for cirrhosis

A

Child-pugh score
MELD score

143
Q

Prophylactic Abx for ascitic patients

A

Ciprofloxacin

144
Q

What must you give to a patient undergoing ascitic tap/paracentesis

A

IV Human albumin

145
Q

Management of Spontaneous bacterial peritonitis

A

IV cefotaxime (cephalosporin)

146
Q

Management of hepatorenal syndrome

A

Desmopressin + IV albumin + TIPSS

147
Q

Features of cholangiocarcinoma

A

Cancer symptoms + Painless jaundice + Palpable gallbladder + hepatomegaly

Pt may have PSC or a history of liver flukes

148
Q

Cholangiocarcinoma tumor marker

A

CA 19-9

149
Q

Carcinoid tumour presentation

A

Flushing + Diarrhoea + Bronchospasm + Hypotension

150
Q

What is Wilson’ disease

A

An autosomal recessive condition resulting in copper accumulation in tissues due to inc absorption + decreased excretion

151
Q

What mutation causes Wilson’s disease

A

ATP7B mutation on chromosome 13

152
Q

Clinical Presentation of Wilson’s disease

A

Typically age 10-25yrs
Kayser-fleischer rings
Hepatic symptoms (hepatitis/cirrhosis)
Neurological symptoms - concentratio problems, dysarthria, dystonia, psychosis
Renal tubular acidosis

153
Q

Wilson’s disease investigations

A

Serum Ceruloplasmic + Total serum copper = low
Gold standard = Liver biopsy
24hr urine copper assay = elevated
MRI brain to look for copper deposits

154
Q

Management of Wilsons disease

A

Copper chelation - Penecilliamine 1st line
Trientene 2nd line

155
Q

What is Gilberts disease

A

Autosomal recessive condition causing an unconjugated hyperbilirubinemia (due to decreased UDP glucoronsyltransferase)

156
Q

Clinical Presentation of Gilberts syndrome

A

Jaundice typically following illness/hangover/exercise/fasting

Investigation = rise in bilirubin levels after a period of fasting or IV nicotinic acid

157
Q

What is hereditary haemochromatosis

A

Autosomal recessive condition due to a mutation of the human haemochromatosis gene on chromosome 6.
Resulting in increased iron levels and deposition in tissue

158
Q

Clinical Presentation of Hereditary haemochromatosis

A

Typical onset age 40
Bronze skin pigmentation, erectile dysfunction, fatigue
Chrondrocalcinosis
Mood/memory disturbance
Liver disease –> cirrhosis –> hepatocellular carcinoma
T1DM/Hypogonadism/Hypothyroidism
Dilated cardiomyopathy

159
Q

Investigation findings in hereditary haemochromatosis

A

High Ferritin
High Transferrin
Low TIBC
Biopsy reveals Perl’s stain due to iron deposition
CT abdo = inc attenuation of the liver

160
Q

Management of heriditary haemochromatosis

A

Weekly venesection.
Aim for transferrin/ferritin <50%

161
Q

What would a liver biopsy show in A1AT deficiency

A

Acid schiff +ve staining

162
Q

Primary Biliary Cholangitis

A

Chronic autoimmune destruction of the small bile ducts resulting in cholestasis + Fibrosis + Cirrhosis

163
Q

Risk Factors for PBC

A

Middle aged women
RA / Systemic sclerosis / Sjogren’s syndrome
Autoimmune disease e.g thyroid/coeliac disease

164
Q

Autoantibodies in PBC

A

Anti-mitochondrial antibodies
IgM

165
Q

Complications of PBC

A

20x increased risk of hepatocellular carcinoma
Cirrhosis + Osteomalacia + Osteoporosis +

166
Q

Primary sclerosing cholangitis

A

Stricture + fibrosis of bile ducts resulting in cholestasis + cholangitis.

167
Q

Risk Factors for PSC

A

Male
Aged 30-40
Ulcerative colitis

168
Q

Autoantibodies in PSC

A

P-ANCA
ANA
Anti-cardiolipin

169
Q

Gold standard investigation for PSC

A

MRCP

170
Q

Complications of PSC

A

Acute cholangitis
Cholangiocarcinoma
Colon cancer
Cirrhosis

171
Q

Budd Chiari syndrome

A

= Hepatic vein thrombosis
usually seen with underlying haematological condition (e.g polycythemia) other procoagulant conditions (like thrombophilias) or associated with the COCP use
Presents with;
* Sudden onset severe abdo pain
* Ascites (SAAG >11)
* Tender hepatomegaly

Y4 Medicine (22 decks)

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