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MRCP Revision > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What part of the GI tract is most commonly affected in Crohn’s?

A

Terminal Ileum + Colon

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2
Q

1st Line treatment for inducing remission in corhns?
2nd line?
add-on medication to 2nd line?
Tx for refractory cases?
Tx for isolated peri-anal disease?

A

1) Glucocorticoids
2) 5 ASA drugs (e.g. Mesalazine)
3) Azathioprine
refractory = Infliximab
Isolated peri-anal disease = metronidazole

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3
Q

Tx options for maintaining remission in Crohns?

A

1st line = Azathioprine/Mercaptopurine (Always check TPMT activity)
2nd line = methotrexate

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4
Q

Triad in Budd-Chiari syndrome?

A

Abdominal pain, hepatomegaly, ascites

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5
Q

Pathophysiology of Budd-Chiari syndrome?

A

Occlusion of the hepatic veins that drain the liver causes painful distension of the liver capsule and backflow portal hypertension resulting in ascites

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6
Q

1st line Ix for H Pylori?

A

13C-urea breath test

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7
Q

1st line Ix for small intestinal bacterial overgrowth/ carbohydrate malabsorption conditions such as lactose intolerance.

A

Hydrogen breath test

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8
Q

What is the triad for Heyde’s syndrome?

A

Aortic stenosis, GI Bleeding, Acquired Von Willebrand disease (type 2A)

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9
Q

Pathophysiology of carcinoid syndrome?

A

systemic release of vasoactive substances (mainly serotonin) from neuroendocrine tumors (NETs), typically arising from the gastrointestinal tract, bronchial tree,

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10
Q

5 clinical features of carcinoid syndrome?

A

1) Flushing
2) Diarrhoea
3) Bronchospasm
4) Right sided valvular heart disease
5) Pellagra symptoms
(Niacin deficiency (due to diversion of tryptophan for serotonin synthesis))

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11
Q

1st line investigation for suspected carcinoid syndrome?

A

Urinary 5-HIAA
(Serotonin is broken down into 5-hydroxyindoleacetic acid (5-HIAA))

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12
Q

MOA Terlipressin?

A

Results in vasoconstriction of the vasopressin V1 receptors located on vascular smooth muscle. Vasoconstriciton of splanic arteries reduced blood flow to the portal venous system

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13
Q

How does a transjugular intrahepetic portosystemic shunt (TIPS) procedure work in Variceal Haemorrhage?

A

Connects hepatic vein to portal vein reducing portal pressure
SE: exacerbates hepatic encephalopathy

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14
Q

Pathophysiology of wilsons disease?

A

Defective copper transport in hepatocytes
Reduced incorporation into ceruloplasmin
copper builds up in liver and spells into blood stream

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15
Q

Hepatic manifestations of wilsons disease?

A

Acute liver failure ( Coombs-negative hemolytic anemia)

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16
Q

Neurological manifestations of wilsons disease?

A

Parkinsonism symptoms (Primarily deposited in basal ganglia -> Putamen and Globus Pallidus

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17
Q

Ophthalmological signs of Wilsons Disease?

A

Kayser-Fleischer rings

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18
Q

Inheritance pattern of Wilsons disease?

A

Autosomal recessive (Mutations in the ATP7B gene)

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19
Q

1st line management of Wilsons disease (chelation)

A

D-penicillamine
Trientine

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20
Q

Aetiology of Zollinger-Ellison syndrome?

A

Gastrinomas are found in in the gastrinoma triangle:
Duodenum, Pancreas, Peripancreatic lymph nodes

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21
Q

Triad of Zollinger-Ellison syndrome?

A

Peptic ulcer disease, diarrhoea, reflux symptoms

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22
Q

Number 1 Ix for Zollinger-Ellison syndrome?

A

Serum Gastrin levels (have to be of PPI)

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23
Q

Medical Mx of Zollinger-Ellison syndrome?

A

1) High dose PPI
2) Somatostain Analogs (e.g. Octreotide)

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24
Q

Most common organism indicated in Ascites?

A

E. Coli

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25
Q

Cause of whipple disease?

A

Gram positive bacillus Tropheryma whipplei

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26
Q

Gold standard for diagnosing Whipple disease and finding?

A

Small Bowel Biopsy (Gold Standard):

Periodic acid–Schiff (PAS)-positive macrophages in the lamina propria

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27
Q

Triad for whiples disease?

A

Chronic diarrhoea, weight loss, arthralgia

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28
Q

Threadworms
-Most common cause?
-Symptoms?
-Tx?

A

-Enterobius vermicularis
-Perianal itching/Vulval symptoms
-mebendazole

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29
Q

Spot diagnosis:
Elevated ALP in a middle aged wormen, with fatigue and pruritis, AMA positive?

A

Primary Biliary Cholangitis

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30
Q

Pathophysiology of PBC?

A

Autoimmune destruction of small intrahepatic bile ducts by antimitochondrial antibodies (AMAs) and T lymphocytes.
Leads to cholestasis, bile acid accumulation, and progressive liver damage.

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31
Q

Tx for PBC?

A

Ursodeoxycholic acid (UDCA)

32
Q

Young female with fatigue, arthralgia, and jaundice. Raised ALT/AST. Positive immunoglbulin igM

A

Autoimmune hepatitis

33
Q

What autoantibodies are associated with:
-Type 1 AIH?
-Type 2 AIH?

A

ANA+SMA
Anti-LKM1

34
Q

1st line management for autoimmune hepatitis?

A

Prednisolone + Azathioprine

35
Q

Role of gastrin hormone in the stomach?

A

Stimulates secretion of gastric acid by parietal cells
Promotes gastric motility

36
Q

Gastrin stimuli of release?

A

Distention of stomach, presences of peptide, vagal stimulation

37
Q

Site of release of Gastrin?

A

G-cells in antrum of stomach

38
Q

Mnemonic for gastrin role and function?

A

Gastrin for “Gas” in the stomach – It revs up acid production for digestion.

39
Q

Cholecystokinin (CCK)
Two key roles?

A

1) Gallbladder contraction to release bile
2) Stimulates pancreatic enzyme secretion

40
Q

Stimuli for release of CCK?

A

Fatty acids, monoglycerides, and amino acids in the duodenum

41
Q

Site of release CCK?

A

I cells (duodenum)

42
Q

Action of CCK?

A

CCK binds to receptors on the gallbladder and pancreas, promoting bile and enzyme release. It also reduces gastric motility

43
Q

Mnemonic for remembering function of CCK?

A

“Chewing up fats” – Think bile and pancreatic enzymes breaking down fat

44
Q

3 main functions of secretin?

A

1) Bicarbonate secretion from pancreas
2) Inhibits gastric acid secretion
3) Enhances bile flow

45
Q

Stimulus for release of secretin?

A

Acidic chyme (low pH) entering the duodenum

46
Q

Site of release of secretin?

A

S cells (duodenum)

47
Q

Mnemonic for remembering role and function of secretin?

A

Secretin “secretly neutralizes acid” – Think of it as the pH balancer

48
Q

Vasoactive Intestinal Peptide (VIP) role? (3)

A

1) Stimulates intestinal secretion of water and electrolytes
2) Relaxes smooth muscle in the GI tract
3) Inhibits gastric acid secretion

49
Q

Site of release of VIP?

A

Neurons in the enteric nervous system

50
Q

Mnemonic for function VIP?

A

VIP for “Very Important Pooping” – Focuses on water secretion and smooth muscle relaxation.

51
Q

Somatostatin role? (2)

A

Inhibits secretion of multiple hormones (gastrin, CCK, secretin, VIP, insulin, glucagon).
Reduces gastric acid and pancreatic secretion.

52
Q

Stimulus for release of somatostatin?

A

Increased acid levels (lower pH)

53
Q

Somatatostatin site of release?

A

D cells in stomach and pancreas

54
Q

Mnemonic for somatostatin?

A

Somatostatin “stops” everything – It’s the master inhibitor

55
Q

Where are Somatostatin analogs (e.g., octreotide) used? (two conditions)

A

Carcinoid syndrome
VIPomas

56
Q

pigment laden macrophages or pseudomelanosis coli is indicative of what?

A

Laxtative abuse

57
Q

Test for exocrine function of pancreas? (commonly used in chronic pancreatitis?

A

Faecal Elastase

58
Q

Causes of pancreatitis (GET SMASHED)

A

Gall Stones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion Venum
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
ERCP
Drugs (Azathioprine, Mesalazine, furosemide, steroids, valporate)

59
Q

Most common autoantibody associated with Ulcerative Colitis?

60
Q

Agent for reducing remission in mild/moderate UC proctitis?

A

topical (rectal) aminosalicylate

61
Q

Agent for reducing remission in mild/moderate UC proctosigmoiditis and left-sided ulcerative colitis?

A

topical (rectal) aminosalicylate

62
Q

Agent for reducing remission in mild/moderate UC extensive disease?

A

topical (rectal) aminosalicylate and a high-dose oral aminosalicylate:

63
Q

How to maintain remission in UC?

A

5-ASA (oral or rectal).
Azathioprine or mercaptopurine if frequent relapses or steroid dependence.

64
Q

what other hepatobiliary condition is UC closely associated with?

A

Primary sclerosing cholangitis

65
Q

1st line Tx for small intestinal bacterial overgrowth?

66
Q

1st Line management for Gastric MALT Lymphoma?

A

H. Pylori Eradication

67
Q

T/F patients with ascites and protein concentration < 15/g should be given oral ciprofloxacilin or norfloxacilin as prophylaxis?

68
Q

What is the Ix of choice for bile acid malabsorption?

A

SeHCAT (Selenium-75-labelled homocholic acid taurine)

69
Q

Alternative name for Lynch Syndrome?

A

Hereditary non-polyposis colorectal carcinoma

70
Q

Inheritance pattern of Lynch syndrome?

A

Autosomal dominant

71
Q

Pathophysiology of Lynch Syndrome?

A

Mutations in genes associated with DNA Mismatch repair

72
Q

Most common gene mutations associated with Lynch Syndrome?

A

MSH2 (60% of cases)
MLH1 (30%)

73
Q

Pathophysiology of Familial Adenomatous Polyposis?

A

Germline mutation in the APC gene on chromosome 5

74
Q

Tx options for FAP?

A

total proctocolectomy with ileal pouch anal anastomosis (IPAA) formation in their twenties

75
Q

Variant of FAP which result in osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on the skin

A

Gardners Syndrome

76
Q

When interpreting coeliac serology, what immunoglobulin level also needs to be checked?

77
Q

Wilsons disease: Summary
-Inheritance pattern?
-Absence in what gene ? means that Caeruloplasmin can not be synthesised properly

A

-Autosomal recessive
-ATP7B

MRCP Revision (17 decks)

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