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RACP Written Exam > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Primary cause of pill oesophagitis

A

doxycycline

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2
Q

What causes zolliger ellison syndrome?

A

Secretion of gastrin from neuroendocrine tumours (gastrinoma)

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3
Q

Barrett;s eosphagus histo

A

metaplastic columnar epithelium

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4
Q

how long is barretts when it has higher risk of malignancy?

A

> 3cm

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5
Q

Characetistic findings of oesinophilic eosophagitis

A

stacked circular rings
strictures
linear furrows

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6
Q

Microscopy which is diagnostic of eosinophilic oedeophagitis

A

> 15 eosinophils on high power field

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7
Q

eosinophilic oesophagitis mangement

A

PPI for 8 weeks, if no improvement fluticasone or budesonide slurry

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8
Q

pathology of achalasia

A

progressive degeneration of ganglion cells in myenteric plexus -> failure of relaxation of lower oesophageal sphincter and loss of peristalsis in distal oesophagitis

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9
Q

secondary causes of achalasia

A

chagas disease
amyloidosis
sarcoidosis

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10
Q

investigation findings in achalasia

A

barium - oesophageal dilatation, bird beak oesophageal junction
manometry - failure of relation of LOS

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11
Q

Achalasia management

A

pneumatic dilatation of LOS
surgical myotomy
botox (elderly)
nitrates, CCB
POEM

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12
Q

risk of dilation of LOS

A

3% perforation

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13
Q

What pressure do varices occur and when do they bleed

A

Seen when presure gradient between portal and hepatic veins >12mmHg
Bleeding when >18
gastric varices bleed more than oesophageal varices

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14
Q

What causes risk of AKI and Na and fluid retention in liver disease

A

shunting of blood flow from cardiac circulation to splanchnic leads to relative renal hypoperfusion

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15
Q

Therapies in acute variceal bleeds

A

AIm Hb >80
antibiotic prophylaxis (oral norflox or IV cipro)
somatostatin or octreotide for 3-5 days
TIPS when not controlled bleeding or recurrent
can use balloon tamponade

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16
Q

Prevention of varicies

A

non-selective beta blockers (propranolol, carvedilol) and maximal tolerated dose
ligation (same outcomes)

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17
Q

Most common reason for inadequate treatment of H pylori

A

clarithromycin resistance

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18
Q

Virulence factor of H pylori

A

CagA
VacA

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19
Q

H pylori resistance in australia

A

clarithromycin resistance 10%
Metronidazole 30%
amox 10%

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20
Q

How to test for H pylori eradication

A

breath test 8 weeks after treatment

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21
Q

Which type of ulcer do you repeat endocopy after 8 weeks of PPI therapy?

A

Gastric not duodenal (higher risk of malignancy)

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22
Q

What does forrest classification predict

A

risk of rebleeding
and which lesions need therapy

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23
Q

Why PPI 72 hours post bleeding

A

helps prevent re-bleeding

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24
Q

Genetic associations with coeliac

A

HLA-DQ2 DQ8

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25
Skin manifestations of coaelic
Dermatitis hepatiformis (itchy symmetrical blistering rash over scalp shoulders buttocks elbow and knees) atrophic glossitis
26
Associated conditions with coeliac
Selective IgA deficiency (false negatives of EMA and TTG) T1DM, thyroid disease GORD, eosinophilic eosophagitis IBD (UC more than CD) Glomerular IgA deposition Autoimmune myocarditis and idiopathic dilated cardiomyopathy
27
Diagnosis of coeliac
TTG is preferred endomysial (EMA) -ve result has high negative predictive value Both serology and small bowel bx is required If positive serology but -ve endoscopy do HLA testing, if positive then high gluten diet for 6-12 weeks then repeat scope
28
Histo findings for coeliac disease
atrophic mucosa, loss of folds on endoscopy complete loss of villi, crypt hyperplasia, enhanced epithelial apoptosis
29
Malignancy associated with coeliac disease
enteropathy associated T cell lymphoma (EATL) - <5% of all GI lymphomas, gluten free prevents Small bowel adenocarcinoma HR 3.05
30
Specific finding in Igg4 related disease
retroperitoneal fibrosis
31
Treatment of IGG4
corticosteriods additional immunosuppressant (AZA, MMF) or biologic
32
Impaired synthetic function
INR >1.5
33
King's college criteria
ABG pH <7.25 after fluid resus and NAC >24 hours or all 3: PT >100/INR>6.5n Creat >300 or anuric, grade 3/4 encephalopathy
34
LFT pattern in alcohol hepatitis
AST:ALT>2
35
hallmark of alcoholic induced liver injury
neutrophil infiltration
36
NAFLD progression % to cirrhosis and then to decompensation
25% 7-8 years then 25% to 8-10%
37
Therapies for NASH
Only in those with fibrosis >2 If no DM vitamin E If DM pioglitazone or GLP1
38
Type 1 vs T2 autoimmune hepatitis
T1: ANA, anti-smooth muscle, antiactin, antimitochondrial, anti-SLP, p-ANCA T2: ALKM1 or ALC1 ab
39
primary biliary cholangitis ab
antimitochondrial ab
40
Condition associated with primary sclerosising cholangitis
UC
41
Liver Bx for autoimmune hepatitis
hepatitis with lymphoplasmacytic infiltrate
42
Autoimmune hepatitis treatment
Glococorticoids - most improve in 4 weeks Alt AZA
43
Histology findings in primary biliary cirrhosis
non-suoourative, granulomatous, lymphocytic small bile duct cholangitis
44
clinical manifestations of primary biliary cirrhosis
most asymptomatic pruritis hyperpigmentation sjogrens 65% scleroderma
45
Diagnosis of Primary biliary cirrhosis
adults with cholstasis, no systemic disease, elevated ALP and AMA >1:40 is diagnostic
46
Treatment of primary biliary cirrhosis
Ursodeoxycholic acid 2nd line obeticholic acid Assess response with serial bx if AIH overlap
47
Characteristics of Primary sclerosing cholangitis
chronic progressive disorder inflammation, fibrosis and stricturing of medium and large bile ducts
48
Conditions associated with primary sclerosing cholangitis
cholangiocarcinoma (10-20%) 70% with IBD (UC >CD)
49
Diagnosis of primary sclerosising cholangitis
cholstatic pattern LFTs p-ANCA MRCP >ERCP showing abnormalities in biliary tree liver bx only if dx uncertain
50
Treatment for primary sclerosing cholangitis
UDCA can be beneficial Liver tx
51
Primary scleorising cholangitis survival
median 1 year
52
Signficant fibrosis on fibroscan in cirrhosis
Low range has good negative predictive value >7.5 signfiicant cirrhosis >11 cirrhosis
53
SAAG
SAAG > 11 suggests portal HTN
54
Tap findings in SBP
Leuks >500 PMN >250
55
Mangement of SBP
Ceftriaxone for 5 days IV albumin then daily for 3 days
56
Hish risk features for varicies
size red wale marks advanced liver disease
57
difference between T1 and T2 hepatorenal
T1 more rapid, x2 increase in creatinine in < 2 weeks T2 less severe than type 1, major clinical feature is ascities which is resistant to diuretics
58
Difference between hepatopulmonary syndrome and portopulmonary syndrome
Hepatopulmonary -> pulmonary vascular dilatation -> hypoxia Portopulomary -> pulmonary vasocontriction -> RHF
59
What serology indicates acute HCV infection
HCV RNA +ve with antiHCV Ab -ve which becomes positive in 12 weeks or HCV RNA +ve and antiHCV positive with neagtive tests 6 motnsh prior
60
Most common HCV genotype in australia
type 3
61
Treatment duration of hep C
8 weeks for glecaprevir and pibrentasvir, 12 weeks for others plus if cirrhosis
62
side effects of glecaprevir
elevation in bilirubin due to inhibition of bilirubin transporters
63
Usual sustained virological response to HCV treatment
SVR >95%
64
HCV treatment CYP and drug interactions
CYP3A4 PPIs statins OCP amiodarone
65
When are protease inhibitors contraindicated
in decompensated cirrhosis (B and C)
66
What are the differences between genotypes of HBV
Genotype B - less active disease Gene C - higher risk of HCC Gene F - fulminant liver disease (rare)
67
aminotransferase indication of higher cirrhosis risk
ALT (not AST)
68
Extrahepatic manifestations of HBV
polyarteritis nodosa membranous or MPGN
69
Lynch syndrome and mutations
autosomal dominant MSH2 due to deletions in EPCAM gene MLH1 MSH2 MSH6 PMS2 most common increased right sided colorectal Ca, endometrial and prostate
70
Most common met site of HCC
Lungs Then abdominal LN
71
Serum marker for hcc
AFP
72
Transplantation criteria for HCC
single lesion <5m or max 3 lesions <3cm No vascular invasion organ allocation based on MELD
73
Treatment for advanced stage HCC
1st: Atezolizumab and bavacizumab 2nd: TKI
74
Side effects of TKI
hand foot skin reaction Fatal liver toxicity (rare)
75
Features of HCC on CT
arterial enchancement portal venous washout LIRADS 4-5
76
MRI characetistics of focal nocule hyperplasia
T2 hyperintense central scar
77
Mutation which causes early surgeries due to stricturing disease
Nod2/CARD15
78
Extraintestinal manifestations associated with active GI disease in IBD
oral ulcers erythema nodosa large joint arthritis episcleritis
79
Extraintestinal manifestations independent of active GI disease in IBD
primary scleorising cholangitis ank spond uveitis pyoderma gangrenosum renal stones gall stones
80
What secetes faecal calprotectin
Neutrophils in the bowel
81
Histology of UC
confined to mucosa and submucosa Goblet cell depletion crypt abscesses crypt branching
82
Endoscopy findings in crohns
apthous ulcers longitudinal snail trail ulcer cobblestoning
83
Crohns histology
transmural ulceration goblets preserved granulomas parietal metaplasia
84
Treatment for mild/mod UC
Mesalazine Corticosteriods If poor prognostic features: other maintence (thiopurines and then biologics)
85
Moderate/severe disease for UC
Iv corticosteriods, reasses day 3 if response -> steriods no response -< surgery or 2nd line, IV cephalosporin or infliximab if still no response -> surgery
86
Treatment differences based off location in mild/mod crohns
if colonic use 5ASA or pred If small bowel -> use pred
87
If persistant disease in mild/mod crohns despite initial therapy?
MTX or thiopurine (MTX not useful in UC)
88
Management of mod/severe crohns
induction: systemic corticosteriods, biologics
89
Treatment of stricturing crohns disease
if inflammatory may respond to medical therapy if fibrotic poor response to medical therapy, usually surgical options
90
Most common site of external fistula in fistulating crohns disease
perianal
91
Fistulating crohns disease medical treatment
Abx: cipro and metro minimal evidence in immunomodulators infliximab and adalimumab
92
Dose dependant thiopurine side effects
N+V Leucopenia Hepatotoxicity
93
Dose independant side effects of thiopurines
infection pancreatitis hepatosplenic T cell lymphoma non-melanoma skin cancers
94
rare side effect of thiopurines
nodular regenerative hyperplasia
95
Infliximab moa
Anti-TNF
96
Adalimumab moa
anti-tNF
97
Golimumab moa
anti-TNF
98
Vedolizumab moa
anti-integrin
99
ustekinumab moa
anti IL12/23
100
tafacitinib moa
jak inihibitor
101
upadacitinib moa
JAK inhibitor
102
Ozanimod moa
S1p modulators
103
Associations with hep C
insulin resistance essential mixed cryo lymphoma membranoproliferative thyroiditis porphyria cutanea tarda lichen planus

RACP Written Exam (14 decks)

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