Gastroenterology 2 Flashcards
Pegylated IFN use when?
HBV + HDV
No portal HTN/thrombosis
Alcohol - toxicity to nerve - what type and manifestation?
In brain where alcohol attack?
Axonal degeneration
Common peroneal nerve neuropathy
Brain - Purkinje cells
Type 1 Autoimmune hepatitis
Type 2 Autoimmune hepatitis
Type 1 = SMA - smooth muscle antibodies/IgG - Adulthood - female
Type 2 = LKM - drug induced, younger age
-more difficult to treat
SLA/LP is most specific for AIH!
Maddrey score used for?
Alcoholic hepatitis
Score > 30 = systemic oral corticosteroids
Continue IV NAC till when?
ALT improves
INR < 2
Panadol < 10 mg/L
Th response in Ulcerative colitis?
Th2 ( remember autoimmune)
Monoclonal antibodies for maintenance phase of UC?
Vedolizumab/ Ustekinumab
Allopurinol cannot be use with?
Aza/mercaptopurine - increases their levels and causes myelosuppression
Microsopic colitis has 2 types?
Treatment of it?
Collagenous
Lymphocytic
SNRI/SSRI withdrawal
give Oral budesonide
Only proven surgery for GORD?
Nissen fundoplication
H.pylori is what organism?
Gram negative flagellated
How pantoprazole work?
Blocks CCK2/gastrin receptor
Zollinger ellison syndrome diagnosis?
MEN1 gene
Fasting gastrin level > 1000
Gastric ulcer!
Surveillance of
1-FAP
2-Lynch syndrome
What age FAP and lynch usually occurs?
FAP
Colonoscopy from 10 years old
Endoscopy from 20 years old
HNPCC
Colonoscopy from 20 years old
Everything else from 30 years old - TVS/pelvic US/endoscopy/Urinalysis
40 years old
What is lamivudine?
Nucleotide Reverse Transcriptase Inhibitor
Bilirubin broken down in liver via what process?
Glucoronidation
What diet causes IBS and why?
FODMAP ( short chain Carbohydrates) - not absorbed in gut, too short = so ferment
Refractory coeliac disease type and treatment?
Gluten free diet for 12 months
Type 1 = Normal IEL = immunosuppressant
Type 2 Monoclonal IEL = Chemotherapy + ASCT
Non-responsive Coeliac disease treatment?
Gluten free diet 6 months and re-biopsy
NASH histology shows?
NAFLD histology shows?
Autoimmune hepatitis histology shows?
Alcoholic hepatitis histology shows?
NASH = Hepatocyte ballooning
NAFLD = macrovesicular steatosis
AIH = Lymphoplasmacytic infiltrate and necrosis, hepatocyte rossette
Alcoholic hepatitis = Mallory hyaline changes
Wilson’s copper like to deposit where?
basal ganglia
Treatment of Wilson disease?
Acute
Maintenance
Acute - Penicillamine = copper chelation and increase urinary copper
Maintenance - Zinc = stimulates metallothiorein - increase urinary copper
Type of achalasia has best prognosis?
Type II compression
How amiodarone causes liver injury?
inhibit Phospholipase A - lots of lipids in liver
Triad of hemachromatosis? (HFE mutation)
Skin bronze
DM
Liver cirrhosis
Myenteric (auerbach) plexus innervates what and found where?
Smooth muscles within Muscularis layer
What hormones trigger parietal cell acid?
Gastrin
Acetylcholine
Histamine
what glands found only in duoedenum?
Brunner’s gland - secrete alkaline HCO3, mucus
Muscles of stomach does what?
Inner oblique
middle circular
outer longitudinal
inner oblique = churns stomach
middle circular = pyloric sphincter
outer longitudinal = peristaltic wave
Sudak point
importance?
prone to?
watershed region - rectosigmoid junction
prone to ischemic colitis
What HLA strongly a/w AIH?
HLA DRB1-301
In liver cirrhosis/failure - threshold to transfuse prior to procedure/paracentesis?
What is elevated in liver cirrhosis?
PLT > 50
Fibrinogen > 1.2
vWF ( so Desmopressin no use)
Statins in liver cirrhosis?
Prevent hepatic decompensation/ reduce risk of HCC
Improve survival in those with variceal bleeding
