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AKT > Gastroenterology 2 > Flashcards

Gastroenterology 2 Flashcards

1
Q

Amsterdam criteria is used in which condition?
Name the three criteria
Associated with which other cancer?

A

Hereditary non polyposis colorectal carcinoma
1. At least three family members
2. At least two generations
3. At least one case <50yo
Endometrial cancer

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2
Q

Crohn’s or UC
Bloody diarrhoea
Skip lesions
All layers
Goblet cells
Crypt abscesses
PSC
AP
Perianal fistulae
Smoking

A

Bloody diarrhoea UC
Skip lesions Crohn’s
All layers Crohn’s
Goblet cells Crohn’s
Crypt abscesses UC
PSC UC
AP Crohn’s
Perianal fistula Crohn’s
Makes Crohn’s worse but UC better

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3
Q

Name three features associated with UC and Crohn’s

A

Pyoderma gangrenosum
Arthritis
Erythema nodosum

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4
Q

Ix Crohn’s (3)

A

Faecal calprotectin
Low B12
Low vitamin D

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5
Q

Inducing remission Crohn’s (2)
Name three add on drugs

A
  1. Steroids (PO/topical/IV)
  2. Mesalazine (5-ASA)

1.AZT
2. Mercaptopurine
3. MTX

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6
Q

Crohn’s: what can be used for isolated peri-anal disease?

A

Metronidazole

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7
Q

Maintaining remission Crohn’s
1st line (2)
2nd line (1)
What should be assessed prior to starting remission treatment?

A
  1. AZT or mercaptopurine
  2. MTX
    TPMT activity
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8
Q

Investigation of choice for perianal fistula seen in Crohn’s?

Mx (2)

A

MRI
Metronidazole
Anti-TNF

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9
Q

UC features (3)

A

Bloody diarrhoea
Urgency
Tenesmus (feeling that you need to pass stools)

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9
Q

UC versus Crohn’s layers

A

Crohn’s through all the layers
UC not beyond submucosa

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10
Q

Barium enema findings for UC (3)

A
  1. Loss of haustrations
  2. Superficial ulceration/ pseudopolyps
  3. Drainpipe colon
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11
Q

UC flare classification
Mild
Mod
Severe
Hint: stool numbers and systemic disturbance

A

Mild <4 stools with or without blood, normal ESR and CRP
Moderate four-six stools with minimal systemic disturbance
Severe systemic sx, hypoalbuminaemia, >6 bloody stools

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12
Q

UC mx inducing remission:
Proctitis (3)

A
  1. Topical 5-ASA/ mesalazine
  2. If remission not achieved within 4 weeks add PO 5-ASA
  3. If still not achieved add topical/ PO steroid
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13
Q

UC mx inducing remission:
Proctosigmoiditis and left sided UC (3)

A
  1. Topical/ rectal 5-ASA
  2. If not resolved within 4 weeks then add a PO 5-ASA high dose OR PO 5ASA +/- topical steroid
  3. PO 5-ASA and PO steroid
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14
Q

UC mx inducing remission:
Extensive disease (2)

A
  1. Topical 5ASA + high dose PO 5-ASA
  2. If remission not achieved within 4 weeks then PO 5ASA and PO steroid
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15
Q

Severe colitis Mx inducing remission (4)

A
  1. Admit to hospital
  2. IV steroids
    If no improvement after 72 hours
  3. add IV ciclosporin
  4. surgery
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16
Q

Remission mx UC
Proctitis + proctosigmoiditis (3)

A
  1. Topical 5ASA OR
  2. PO 5ASA + topical OR
  3. PO 5ASA
17
Q

Remission mx UC
Left sided and extensive UC (1)

A

Low maintenance dose of a PO 5ASA

18
Q

UC maintenance mx of a severe relapse/ >=2 exacerbations in 1 year mx (2)

A

PO AZT or mercaptopurine

19
Q

UC mx of a severe relapse/ >=2 exacerbations in 1 year mx (2)

A

PO AZT or mercaptopurine

20
Q

Prophylaxis of variceal haemorrhage mx (2)

A

Propranolol
Endoscopic variceal band ligation - should be performed at two weekly intervals until all varices are eradicated

21
Q

Vitamin A deficiency =
Vitamin A name

A

Retinal
Night blindness

21
Q

B1 name
B1 deficiency = (4)

A

Thiamine
Wernicke’s/ Korsakoff’s
Dry beriberi: peripheral neuropathy
Wet beriberi: dilated cardiomyopathy

22
Q

Vitamin C name
Deficiency = (5)

A

Ascorbic acid
Gingivitis, loose teeth, haematuria, epistaxis, poor wound healing

23
Q

Follicular hyperkeratosis and perifollicular haemorrhage
Ecchymosis, easy bruising
Poor wound healing
Gingivitis with bleeding and receding gums
Sjogren’s syndrome
Arthralgia
Oedema
Impaired wound healing
Generalised symptoms such as weakness, malaise, anorexia and depression
= which deficiency

A

Vitamin C/ scurvy

24
Q

steatorrhoea/ diarrhoea/ weight loss
large-joint arthralgia
hyperpigmentation and photosensitivity
cardiac + neurological symptoms
PAS (periodic acid Schiff) granules on jejunal biopsy
Middle Aged Man
= which condition?

Mx

A

Whipple’s
Co-trimoxazole for one year

25
Q

Excessive copper deposition =
Age of onset
Presentation in children versus adults

A

Wilson’s disease
10-25yo
Liver disease vs neurological disease

26
Q

Wilson’s disease impacts which three organs

A

Liver
Brain
Cornea

27
Q

Features of Wilson’s (6)

A

Liver - hepatitis
Brain - behavioural and psych problems
Eyes - Kayser-Fleischer rings
Blue nails
Haemolysis
Renal tubular acidosis (Fanconi syndrome)

28
Q

Wilson’s Ix (3)
Diagnostic test (1)

A

Reduced serum caeruloplasmin
Reduced serum copper
Increased 24 hour urinary copper excretion
Diagnostic - genetic anaylsis of ATP7B gene

29
Q

Wilson’s Mx (1)

A
  1. Penicillamine
30
Q

PSC associations (3)

A

UC
Crohn’s
HIV

31
Q

PSC diagnostic test:
Antibody
Complications/ increased risk of which cancers (2)

A

ERCP
p-ANCA
Cholangiocarcinoma and bowel ca

32
Q

PBC
Age group and gender

A

Middle aged women

33
Q

PBC associations (4)

A

Sjogren’s
RA
Systemic sclerosis
Thyroid disease

34
Q

PBC antibody

A

Anti-mitochondrial (AMA M2)

35
Q

PSC bloods (2)
Features (3)

A

Raised bilirubin and ALP
RUQ pain, jaundice, pruritus

36
Q

PBC
Bloods (2)
Features (2)
Increases risk of which cancer?

A

Raised ALP + bili
Hyperpigmentation on pressure points, xanthelasma
HCC

37
Q

PBC Dx (2)
Mx (1)
When is a liver transplant considered?
What is given for the pruritus

A

MRCP or US liver
Mx
1. ursodeoxycholic acid
2. Liver transplant if bili >100

  1. Cholestyramine
38
Q

dysphagia
regurgitation
aspiration
neck swelling which gurgles on palpation
halitosis
=

Ix (1)
Mx (1)

A

Pharyngeal pouch
Barium swallow with dynamic video
Surgery

39
Q

Cyclical vomiting syndrome is associated with which other condition?
Mx (3)
Acute (3)

A

Migraine
Prophylaxis Amitryptilline/ propranalol/ topiramate
Acute ondansetron, prochloperazine, triptans

40
Q

Child Pugh factors considered (5)

A

Albumin
Bili
Coag
Distension (ascites)
Encephalopathy

AKT (52 decks)

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