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Gastroenterology Flashcards

1
Q

Histology changes in coeliac

A

Vilnius atrophy
Mononuclear infiltrate lamina propria
Crypt hyperplasia

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2
Q

90-95% coeliac HLA what

A

DQ2

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3
Q

Advice re coeliac and starting solids

A

Weaning onto a gluten containing diet 5-7 months with bf delays onset but doesn’t alter incidence

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4
Q

Risk factors for coeliac and percent

A

First degree relative 4-11% (normal risk 1-2%)
Downs (7-19%)
Turners
Williams
IgA def, DM1 10% and highest risk apart from relative and downs, JIA, thyroid

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5
Q

Metabolic causes of pancreatitis

A 
Hyperlipid
Increased calcium
Glycogen storage
Organic acidaemia 
Burn
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6
Q

Failure to inhibit activation in which enzyme most commonly leads to familial pancreatitis

A

Trypsinogen (75%)

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7
Q

How much gut req to live

A

15cm with ileocaecal valve and 40 without

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8
Q

Stool osmolality

A

(Na + k) x 2

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9
Q

Osmotic diarrhoea (gap >50) and secretory diarrhoea (gap <50) causes

A

Osmotic: infectious, disaccharide def, laxative abuse, impaired absorption
Secretory: toxic E. coli, cholera, tumour, enteropathy

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10
Q

Low alk phos causes

A

Wilson and zinc def

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11
Q

ALT and AST also raised in

A

Muscle necrosis (check CK)

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12
Q

Treatment for wilsons

A

Copper chelation (penicillamine and pyridoxine)

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13
Q

Absorption of Fe and amino acids

A

Duodenum

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14
Q

Folate absorbed in

A

Jejunum

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15
Q

Galactose and fructose transporters

A

Galactose SLGT1

Fructose GLUT 5

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16
Q

Sucrose if from

A

Fructose and glucose

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17
Q

Most sensitive and specific coeliac test

A

Anti TTG IgA

(hLADQ2/8 99% of CD)

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18
Q

Eosinophilia oesophagitis presentation

A

Impacted food (obstructive dysphagia)

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19
Q

Meckles scan

A

tc99 scan

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20
Q

Hirsprungs incidence

A

1/5000

More boys

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21
Q

Percent of UC With primary sclerosing cholangitis

A

5%

Pyoderma gangreosum also assoc

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22
Q

Gilbert’s percentage

A

5-10%

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23
Q

Sucrose isomaltase def

A

Presents at 6m when sucrose added

Mx: sucrose free diet, enzyme replacement

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24
Q

Melanesia coli occurs with

A

Laxative abuse

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25
100ml breast milk contains ?kcal
67 (280kj)
26
Caloric value of glucose
3.4kcal/g
27
Fat and CHO and protein kcal
Cat 10kcal/g | CHO and protein 4kcal/g
28
Triangular cord sign on USS
Biliary atresia
29
Crohns treatment
``` Enteral therapy (Crohn’s) 5 asa’s Prednisone Azathioprine Methotrexate TNF monocloncal antibodies ```
30
Two familial issues with what in familial pancreatitis
SPINK1 Trypsinogen activation within the pancreas is inhibited by pancreatic secretory inhibitor (PSTI or SPINK1) PRSS1 Multiple isoforms of trypsinogen – missense mutation lead to premature activation within pancreas
31
Short gut causes renal stones by
Calcium binds to malabsorbed fat, allows an increased absorption of oxalate
32
Pill induced oesophagitis commonly from...
Tetracycline, Doxycycline NSAIDs, aspirin | Potassium
33
AST:ALT ratio >4 highly suggestive And low ALP
Wilson's disease Confirmed by keiser flesher ring ATP7B (multiple mutations though) ALP low because raised copper displaces zinc in the ALP enzyme and reduces its concentration
34
Total protein raised in what??
Autoimmune disease
35
Assoc with autoimmune hepatitis
UC > C
36
Beading on cholangiogram suggests
Sclerosing cholangitis (cryptosporidium most common cause in immunosuppressive)
37
AST and ALT also raised in
Muscle damage | ALT up for longer and longer half life but more delayed and more liver specific
38
Antibiotics for campylobacter, shigella, salmonella, yersinia
Campylobacter- erythromycin Salmonella - cotrimox Shigella - Yersinia - doxy or cotrimox
39
Baby with jaundice, panniculitis (hard skin with painful lumps) or SOB exertion and lung affected
Signs and symptoms of alpha one antitrypsin def
40
Furrowing and white specs on gastroscopy indicate | (or ringed occasionally)
Eosinophilic oesophagitis
41
Folate absorbed in
Jejunum
42
Fat globules vs fat crystals causes
Globules fat not split by lipase | Crystals not absorbed
43
Leg swelling and diarrhoea (protein losing enteropathy) Nausea, vomiting, fatty stools, and abdominal pain may also develop. Children have delayed growth.
Intestinal Lymphangiectasia Leaky lymph into small intestines Need lymph to transport long chain Fa in micelles therefore have fat globules in stool
44
Acidic stool and reducing substances present indicate what?
Carbohydrate malabsorption (c.diff or cryptosporidium)
45
Three monosaccharides
Glucose, galactose, fructose
46
Sucrose =
Glucose and fructose
47
Lactose =
Galactose and glucose
48
Starch is long chains of...
Maltose (Glucose and glucose)
49
Glucose galactose malabsorption from
SGLT1 transporter
50
Sequelae of cleft
Recurrent otitis media and hearing loss are frequent with cleft palate. Malposition of the teeth. Speech development
51
Coeliac incidence
1% T cell response to gliadin Oats may be contaminated Related also to Williams and tuners
52
Severe fat malabsorption from birth in
Abetalipoproteinemia
53
Low elastase in stool indicates
Exocrine pancreas insufficiency (most common CF) Pearson syndrome (ePancreas-marrow failure) Schwachman-diamond
54
Recurrent pancreatitis or chronic in child think
Genetic: cationic trypsinogen gene (PRSS1), chymotrypsin C gene (CTRC), CF gene (CFTR), trypsin inhibitor gene (SPINK1).
55
Differential of jaundice: 4 syndromes
Conjugated and asymptomatic: rotor and dubin-johnson Unconjugated and asymptomatic: 5-10% population Gilbert's Unconjugated and severe - type 1 Crigler-najjar (NO UGT1A1 activity) diagnosed by measuring glucuronyl transferase activity in liver from biopsy (liver normal)
56
Two types autoimmune hepatitis
Type 1: anti smooth muscle, ANA. Type 2: liver kidney microsomal antibodies. Tend to be more refractory to treatment and need long term immunosuppression.
57
Night blindness vitamin deficient
A
58
What can cause exacerbated SE azathioprine
Low or no TPMT | thiopurine methyltransferase catabolises 6MP to 6MMP, activity is genetically regulated
59
Three syndromes assoc with hirsprungs
Odines curse (autonomic dysfunction) Wardenburg Downs
60
Erythema nodosum is
Redness overlying panniculitis (inflame don't adipose under skin)
61
Jaundice | UPD deficient and low in?
Low in Gilbert's | Absent/low in crigler-najjar (can try phenobarb)
62
Gloss it is and chelosis related to
B12 and B2 (riboflavin)
63
Pellagra (dermatitis, diarrhoea) due to?
B3 niacin deficiency
64
Thiamine deficiency causes
Heart failure from B1 deficiency
65
Northern vs southern blow
Northern looks for RNA and southern DNA
66
Liver failure from tyrosinaemia type 1 or galactosemia how to differentiate
Reducing substances urine and RBC galactose 1 phosphate uridyl transferase in galactosemia Plasma a.a in tyrosinaemia and urine succinylacetone
67
B12 also called
Cobalamin
68
Pancreatic dysfunction from what in schwachman diamond syndrome
Acinar cell hypoppasia
69
Three common causes acute pancreatitis in children
Idiopathic Systemic disease such as HUS or vasculitis autoimmune Trauma (blunt or child abuse) Drugs (valproate L-Aapariginase and azathioprine)
70
Chronic pancreatitis cause in child
Hereditary from PRSS1 mutation (trypsin autoactivation) CTFR chymotrypsinC gene SPINK1 (trypsin activity inadequately controlled)
71
Focal biliary cirrhosis from
CF
72
Portal HTN value
> 10 mmHg
73
Spontaneous bacterial peritonitis organisms
E. coli Klebsiella Strep Enterococci
74
Drug induced pancreatitis causes
V. FAT SHEEP Valproate verapamil ``` Frusemide Azathiorone asparginase Tetracycline Statin sulfonamides Hydrochlorthiazide Estrogen Pentamidine ```
75
R side aortic arch and difficulty swallowing has
Vascular ring
76
Diabetic with bowel obstruction and H2 breath test positive caused by?
Bacterial overgrowth
77
Protein req per day per kg
0.75g/kg/day
78
Water absorbed intestines due to
Diffusion (coupled with glu and a.a.)
79
High volume secretory diarrhoea can be due to
Cholera or other toxins | cholera upregulating chloride channel
80
Most common s.i atresia
Ileal
81
Liver synthesises all factors except
8

Paediatrics (19 decks)

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