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Year 3 ICSM > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is achalasia?

A

Absent or uncoordinated oesophageal muscular action with a failure of relaxation of the lower oesophageal sphincter

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2
Q

Recall the pathophysiology of achalasia

A

Breakdown of ganglion cells in mesenteric plexus

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3
Q

Recall the symptoms of achalasia

A

Intermittent dysphagia
Regurgitation at night
CP and heart burn

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4
Q

What is a common complication of achalasia to be wary of?

A

Aspiration pneumonia

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5
Q

What specialist investigation should be done for achalasia?

A

Barium swallow

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6
Q

Recall 3 causes of acute cholangitis

A

Biliary colic
Biliary stenosis
Cholangiocarcinoma

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7
Q

What is Charcot’s triad?

A

The triad used to describe symptoms of acute cholangitis

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8
Q

Recall Charcot’s triad and Reynold’s pentad

A

Triad: RUQ pain, jaundice, fever with rigors

Pentad = + confusion + septic shock

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9
Q

Describe the blood results of someone with acute cholangitis

A

High WCC
Raised CRP and ESR
LFTs similar to those you would expect in jaundice

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10
Q

If biliary stones are non-calcified, which investigation should be done?

A

MRCP

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11
Q

What is the first-line in management of acute cholangitis?

A

Broad-spectrum ABx

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12
Q

Why is the mortality of acute cholangitis high?

A

Can cause liver failure

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13
Q

Recall the names of each state of liver damage

A

Steatosis (fatty liver)
Hepatitis
Cirrhosis

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14
Q

Describe the liver in hepatitis

A

Necrotic with regions of fatty inflammation

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15
Q

Recall the mnemonic for and the signs of alcoholic hepatitis

A 
Particularly Excessive Gin Drinking Can Make Hepatic Fatty Tissue Start Necrotising
Palmar Eryhtema
Gynaecomastia
Dupuytren's Contracture
Malnutrition
Hepatomegaly
Facial Telangiectasia
Spider Naevi
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16
Q

Recall the mnemonic for and the symptoms of severe acute alcoholic hepatitis

A 
BEAST
Bruising
Encephalopathy
Ascites
Splenomegaly
Tachycardia
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17
Q

Recall 2 things of note in the FBC of someone with alcoholic hepatitis

A

High WCC

Macrocytic anaemia

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18
Q

What will be low in the LFTs of someone with alcoholic hepatitis?

A

Albumin

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19
Q

What is the most common cause of anal fissure?

A

Hard faeces

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20
Q

What is an anal fissure?

A

Tear in SQUAMOUS lining of lower anal canal

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21
Q

Recall some symptoms of anal fissure

A

Pain
Blood in stool
Pruritis ani

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22
Q

Recall the management of anal fissure

A

Conservative: high fibre diet, laxatives and hydration
Mecial: lidocaine, GTN (relaxes internal sphincter)
Surgical: lateral sphincterectomy (caution: often causes incontinence)

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23
Q

Summarise the pathophysiology of appendicitis

A
  1. Gut lumen obstruction
  2. Bacteria have opportunity to invade appendix
  3. Results in oedema, ischaemic necrosis and perforation
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24
Q

Recall one peculiar sign of appendicitis

A

Tongue-furring

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25
Q

Recall the 3 special signs that can be elicited in appendicitis

A

Rovsing’s: pushing down on LIF increases pain in RIF
Psoas: pain on hip extension
Cope: plain on flexion and internal rotation of hip

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26
Q

What is the test performed to confirm a diagnosis of appendicitis?

A

US/CT

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27
Q

What is the aetiology of autoimmune hepatitis?

A

Unknown

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28
Q

Recall 3 features of a blood test that are abnormal in autoimmune hepatitis

A

Hyperglobulinaemia (ANA, ASMA, Anti-LKM)
Same LFTs as alcoholic hepatitis (low albumin, high everything else)
WCC is LOW (unlike alcoholic hepatitis)

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29
Q

Recall the immunoglobulins present in type 1 and type 2 autoimmune hepatitis

A

Type 1: ANA, ASMA, Anti-SLA, AAA

Type 2: ALKM-1, ALC-1

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30
Q

Recall the aetiology of Barrett’s oesophagus

A
  1. Prolonged exposure of squamous epithelium to acid from GORD
  2. Mucosal inflammation and erosion
  3. Transformation into columnar epithelium (METAPLASTIC CHANGE)
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31
Q

What is the main sinister consequence of Barrett’s oesophagus?

A

Can lead to adenocarcinoma

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32
Q

What is water-brash and what is it a common symptom of?

A

Sour taste when swallowing: GORD, barrett’s oesophagus

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33
Q

What investigations need to be done to confirm a diagnosis of Barrett’s oesophagus?

A

OGD and biopsy

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34
Q

Recall the management of low-grade dysplasia in Barrett’s oesophagus

A

Endoscopic surveillance

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35
Q

Recall the management of high-grade dysplasia in Barrett’s oesophagus

A

For fit and well pt: mucosal resection

Otherwise: mucosal ablation

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36
Q

What causes the waves of pain in biliary colic?

A

Contraction of biliary tree around stone

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37
Q

Where may biliary colic pain radiate to and why?

A

Right scapula: due to diaphragmatic irritation

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38
Q

Recall 2 findings on ultrasound that indicate biliary colic

A
  1. Dilation of common bile duct

2. Hypertrophy of gallbladder wall

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39
Q

Recall 2 uses of ERCP in biliary colic

A
  1. Diagnostic

2. Therapeutic - can be sued to remove small stones

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40
Q

Recall the surgical management of biliary colic

A

Laparoscopic cholecystectomy

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41
Q

What is cholecystitis

A

The INFLAMMATION of the gallbladder that is caused by biliary stones

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42
Q

What is the composition of most gallbladder stones?

A

Mixed: cholesterol, calcium bilirubinate, protein and phosphate

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43
Q

What is Murphy’s sign used to diagnose?

A

Cholecystitis?

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44
Q

What is Murphy’s sign?

A

Ask patient to exhale then inhale deeply as you push your hand up under their rib cage on the RHS - causes lots of pain and they catch their breath

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45
Q

Recall the expected LFT abnormalities in cholecystitis

A

High ALP and GGT

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46
Q

Describe the histopathology of the liver in cirrhosis

A

Normal liver architecture replaced by diffuse fibrosis, nodules of regenerating hepatocytes present

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47
Q

Which types of hepatitis can lead to cirrhosis?

A

B and C

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48
Q

Define decompensated cirrhosis

A

Cirrhosis that is complicated by jaundice, encephalopathy, GI bleeding and ascites

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49
Q

Systematically recall the symptoms of liver cirrhosis

A

Systemic effects: anorexia, fatigue
Due to loss of synthetic function: easy bruising, ankle oedema
Due to loss of detox function: jaundice. amenorrhoea, personality change
Due to portal hypertension: haematemesis, melaena, abdominal swelling

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50
Q

Recall ALL the signs of liver cirrhosis

A 
Easy bruising
Gynaecomastia
Dupuytren's contracture
Spider Naevi
Leukoonychia
Asterixis
Ascites
Jaundice
Clubbing
Facial telangiectasia 
Caput medusae
Scratch marks
Palmar erythema
Splenomegaly
Hepatomegaly
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51
Q

What does an FBC show in liver cirrhosis and why?

A

Low platelets and haemaglobin
This is due to hypersplenism
Hypersplenism is a result of portal hypertension

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52
Q

What conditions can an elevated serum AFP be used to diganose?

A

Elevated: liver cirrhosis

Super-high: hepatocellular carcinoma

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53
Q

What is the use of an ascitic tap in liver cirrhosis?

A

Do MCS

If neutrophils are >250, is spontaneous bacterial peritonitis

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54
Q

Using what system is liver cirrhosis graded?

A

Child-pugh

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55
Q

Recall the histopathological appearance of the gut in coeliac disease

A

Subtotal villous atrophy

Crypt hyperplasia

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56
Q

What is the major cause of signs in coeliac disease?

A

Malnutrition

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57
Q

What sort of anaemia presents in coeliac disease?

A

Iron-deficiency

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58
Q

What is the key serological finding in coeliac disease?

A

Anti-gliadin

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59
Q

Summarise the defining characteristics of Crohn’s disease

A
  1. Granulomatous inflammation (so involves neutrophils)
  2. Can be anywhere in length of gut
  3. May cause erosion into the deep mucosa
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60
Q

What stool symptoms are common in Crohn’s disease?

A

Diarrhoea and steatorrhoea

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61
Q

What external signs of crohn’s disease may be seen upon examination of the anus?

A

Perineal skin tags

Fistulae

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62
Q

Recall some extra-articular manifestations of Crohn’s diease

A

Finger clubbing
Mouth ulcers
Uveitis
Erythema nodosum

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63
Q

Which elements of the FBC are elevated in Crohn’s disease?

A

WCC

Platelets

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64
Q

Describe the ESR and CRP in Crohn’s disease

A

ESR high

CRP may be normal or high

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65
Q

How can you distinguish infective colitis from Crohn’s disease?

A

Stool MC&S

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66
Q

Describe the management of an acute flair up of Crohn’s disease

A

Corticosteroids
5-ASA analogues (mesalazine)
Analgesia

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67
Q

Describe the long-term management of chronic Crohn’s disease

A

Mesalazine/olsalazine

Anti-TNF/immunosuppression

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68
Q

Recall some common complications of Crohn’s disease

A 
Strictures
Perforation of bowel
Fistulae
Haemorrhage
GI cancers
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69
Q

What are diverticulae?

A

Outpoachings of colonic mucosae/submucosae

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70
Q

Define diverticular disease

A

Diverticulitis PLUS COMPLICATIONS (haemorrhage, infection, fistulae)

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71
Q

Recall the aetiology of diverticulae formation

A

Low fibre diet –> higher intraluminal pressure required to expel stool
Higher pressure –> herniation of mucosa

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72
Q

Where do diverticulae most commonly appear?

A

At sites of nutritional artery penetration

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73
Q

What is the main complication of diverticulae?

A

They get obstructed with faeces leading to bacterial overgrowth and peritonitis

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74
Q

What are the Hinchley criteria used for?

Recall them

A

Staging of diverticular disease

1a: Phlegmon
1b: Localised abscesses
3: Purulent peritonitis
4: Faecal peritonitis

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75
Q

Where is right-sided diverticulitis most common?

A

Asia

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76
Q

What symptoms can be caused by fistulae?

A

Pneumaturia

Faecaluria

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77
Q

What is the diagnostic test used for diverticulae?

A

Barium enema

Do not use in acute setting in case of perforation

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78
Q

What is the management for diverticulitis?

A

Bowel rest
IV antibiotics
Rehydration

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79
Q

What does time of onset in gastroenteritis indicate about aetiology?

A

Toxins = early onset (1-24 hours)

Bacteria/viruses/protozoa have a later onset (12+ hours)

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80
Q

Recall and justify the blood tests that should be done for gastroenteritis

A

FBC
Blood culture (bactaraemia?)
U&Es (dehydrated?)

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81
Q

Where are the most common sites of gastrointestinal perforation?

A

Colon

Gastroduodenal

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82
Q

What are the most likely causes of colon perforation?

A

Cancer
Diverticulitis
Appendicitis

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83
Q

What is the most likely cause of gastroduodenal perforation?

A

Perforated ulcer

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84
Q

Describe the signs of GI perforation

A

Quite non-specific but they will be very unwell

Signs of shock, dehydration and pyrexia

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85
Q

What would a CXR show in GI perforation?

A

Air under diaphragm

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86
Q

Recall the surgical management of GI perforation

A

Peritoneal lavage
For large bowel perforation: resection
For small bowel perforation: close with omental patch

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87
Q

Recall 3 things that aggravate heartburn in GORD

A

Lying supine
Large meals
Alcohol

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88
Q

If someone has GORD and begins to experience dysphagia, what does this indicate?

A

Stricture has formed

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89
Q

Differentiate internal and external haemorrhoids

A

Internal: above dentate line, arising from superior haemorrhoidal plexus
External: below dentate line

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90
Q

Recall and define each degree of haemorrhoid classification

A

1st degree: no prolapse
2nd degree: prolapses on defaecation and resolves spontaneously
3rd degree: prolapses on defaecation and needs to be resolved manually
4th degree: Prolapse which cannot be reduced

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91
Q

Describe how haemorrhoidal blood appears in stool

A

Does not mix with stool

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92
Q

Which investigations must be done when haemorrhoids are suspected and why?

A

DRE
Flexible sigmoidoscopy
Need to exclude any other causes of blood in stool that are more sinister

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93
Q

Recall the management of haemorrhoids

A

Conservative: high fibre diet. laxatives, topical analgesic
Minor surgery: injection scleropathy (induces fibrosis of dilated veins) and banding (causes haemorrhoid to fall off in a few days)
Surgical: reserved for symptomatic 3rd/4th degree haemorrhoids

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94
Q

Which abdominal contents are protuding into the inguinal region in an inguinal hernia?

A

Peritoneum

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95
Q

Recall which type of inguinal hernia arises medial and lateral to the key blood vessel, and what that vessel is

A

Vessel = inferior epigastric vessels
Direct: medial
Indirect: lateral

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96
Q

Where is the weakness in direct inguinal hernias?

A

Transversalis fascia

97
Q

Where do direct inguinal hernias protrude?

A

Hasselbach’s triangle

98
Q

Recall the borders of Hasselbach’s triangle

A

Inferior epigastric artery
Lateral border of rectus
Inguinal ligament

99
Q

Where do indirect inguinal hernias protrude?

A

Deep inguinal ring

100
Q

Which type of hernias can be reduced on cough impulse?

A

Indirect

101
Q

What would make an inguinal hernia and emergency?

A

If it were obstructed or strangulated

102
Q

What symptoms are produced by a hiatus hernia?

A

Symptoms of GORD (but usually asymptomatic)

103
Q

What may be seen on CXR in hiatus hernia?

A

Gastric air bubble above diaphragm

104
Q

What is the surgical management of hiatus hernia?

A

Nissen fundoplication

105
Q

Recall the symptoms of infectious colitis

A

Diarrhoea
Blood in stools
Lower abdominal pain

106
Q

Define intestinal ischaemia

A

Obstruction of a mesenteric vessel

107
Q

In what ways might a mesenteric vessel be obstructed?

A

Thrombus or embolus

108
Q

Recall 3 symptoms of intestinal ischaemia

A
  1. Severe colicky pain
  2. Vomiting
  3. Rectal bleeding
109
Q

Recall 3 signs of intestinal ischaemia

A
  1. Abdominal tenderness
  2. Abdominal distention
  3. Palpable mass which is ischaemic bowel
110
Q

What would an ABG show in intestinal ischaemia?

A

Lactic acidosis

111
Q

Where is the bowel most susceptible to ischaemia?

A

Watershed zone - this is near the splenic flexure, between the SMA and IMA supplies

112
Q

How is intestinal obstruction classified?

A

Extramural, intramural and intraluminal

113
Q

Recall a cause of extramural intestinal obstruction

A

Hernia/ volvulus

114
Q

Recall a cause of intramural intestinal obstruction

A

Tumours/ Inflammatory strictures

115
Q

Recall a cause of intraluminal intestinal obstruction

A

Foreign body

116
Q

Recall the 3 key symptoms of intestinal obstruction

A

Severe colic
Frequent vomiting
Absolute constipation

117
Q

Recall the 3 necessary investigations for intestinal obstruction

A

AXR
Water-soluble enema
Barium swallow

118
Q

How is vomiting managed in intestinal obstruction?

A

Gastric aspiration

119
Q

What is the surgical management option for intestinal obstruction?

A

Emergency laparotomy

120
Q

Define IBS

A

Recurrent abdominal pain and discomfort for >6 months, associated with 2 or more out of:

  • altered stool passage
  • bloating
  • passage of mucous
  • symptoms being worse post-prandially
121
Q

Recall one important thing to exclude in a IBS diagnosis and how you would exclude it

A

H Pylori

Urease breath test

122
Q

Define liver abscess

A

Liver infection resulting in a walled-off collection of pus

123
Q

Define liver cyst

A

Liver infection resulting in a walled-off collection of cyst fluid

124
Q

What is a pyogenic liver abscess?

A

A liver cyst that produces pus caused by bacterial infection

125
Q

What is the most common cause of pyogenic liver abscess?

A

Biliary tract disease

126
Q

What is the most common cause of liver abscess in the Western world vs worldwide?

A

Western world: bacterial

Worldwide: Entamoeba histolytica

127
Q

Recall the management of both pyogenic and amoebic liver abscesses

A

Pyogenic: needle aspiration
Amoebic: metronidazole + amoebacide

128
Q

What symptoms do liver abscesses produce?

A

Systemic: fever, night sweats, anorexia

Liver symptoms: RUQ pain, jaundice, diarrhoea

129
Q

What lung sign may be present alongside a liver abscess?

A

Right-sided reactive pleural effusion

130
Q

What is the main complication of liver abscess to be aware of?

A

Rupture and dissemination causing septic shock/ acute cholangitis/ peritonitis

131
Q

How is liver failure classified?

A

Based on time interval between onset of jaundice and hepatic encephalopathy
Hyperacute: <7 days
Acute: 1-4 weeks
Subacute: 4-12 weeks

132
Q

What is the main cause of acute liver failure in the UK?

A

Paracetamol OD

133
Q

What is the pathophysiology of jaundice in liver failure?

A

Decrease secretion of conjugated bilirubin

134
Q

What is the pathophysiology of encephalopathy in liver failure?

A

Decresed clrnce of nitrogenous products such as ammonia –> brain

135
Q

What would the LFTs show in liver failure?

A

Low albumin, high everything else

136
Q

What is the main use of an ascitic tap in liver failure?

A

To identify spontaneous bacterial peritonitis - indicated by neutrophil count of >250mm^3

137
Q

Recall the medical management of liver failure if it is caused by paracetamol overdose

A

N-acetylcysteine

138
Q

What is the medical management of hepatic encephalopathy?

A

Lactulose enema to reduce blood ammonia

139
Q

How is coagulopathy treated in liver failure?

A

IV Vitamin K

FFP

140
Q

What are the 2 main complications of liver failure to be aware of?

A

Cerebral oedema

Renal failure

141
Q

What is the cause of a mallory-weiss tear?

A

Straining to vomit

142
Q

Recall a sign of mallory weis tear

A

melaena

143
Q

What is the main investigation that needs to be done in suspected mallory-weis tear?

A

OGD

144
Q

Recall the management of mallory weiss tear

A

80% self-resolve

20% may need surgical repair if bleeding does not stop

145
Q

Differentiate fatty liver from NASH

A

Fatty liver = fat accumulation in the liver

Non-alcoholic steatohepatitis = fat plus inflammation and scarring

146
Q

What are the symptoms of NASH?

A

Nearly always asymptomtic

147
Q

In what way would liver tests be deranged in NASH?

A

Elevated AST and ALT

148
Q

Recall the mnemonic for and the causes of acute pancreatitis

A

GET SMASHED
Gallstones
Ethanol
Trauma

Steroids
Mumps
Autoimmune
Scorpion venom
Hypercalcaemia
ERCP
Drugs
149
Q

Recall 3 drugs that may cause acute pancreatitis

A

Thiazides
Valporate
Azothioprine

150
Q

Where does the epigastric pain resulting from acute pancreatitis radiate to?

A

The back

151
Q

What can relieve the pain of acute pancreatitis?

A

Sitting forward

152
Q

Recall 2 signs that are specific to acute pancreatitis

A

Grey-Turner’s (flank bruising)

Cullen’s (periumbiliCal bruising)

153
Q

Recall 4 things that would be elevated on a blood test in acute pancreatitis

A

WCC
CRP
Amylase
Glucose

154
Q

What happens to serum calcium in acute pancreatitis and why?

A

Hypocalcaemia

Calcium binds to digested lipids from pancreas

155
Q

What are the 2 main scoring systems used to assess the severity of acute pancreatitis?

A
  1. Modified Glasgow scale combined with CRP

2. APACHE-II score

156
Q

What is the main cause of acute pancreatitis for men and women in the UK?

A

Men: alcohol
Women: gallstones

157
Q

Define chronic pancreatitis

A

Irreversible parenchymal atrophy and fibrosis

158
Q

What is the primary cause of chronic pancreatitis?

A

Alochol

159
Q

Describe the amylase level in chronic pancreatitis

A

Usually normal

160
Q

What is the first line of management in chronic pancretitis?

A

A good dose of conservative management with lots of lifestyle advice and support to make changes

161
Q

What treatment for chronic pancreatitis can be offered endoscopically?

A

Extraction of stones
Dilation of strictures
Sphincterectomy

162
Q

As well as gastric acid, what must the gastric lining be exposed to in order for a peptic ulcer to form?

A

Pepsin

163
Q

What are the 2 strongest correlated risk factors for peptic ulcer disease?

A

H pylori

NSAID use

164
Q

How can the history differentiate between gastric and duodenal ulcers?

A

Gastric: pain worst post-prandially
Duodenal: pain worst several hours post-prandially

165
Q

What may be seen on an FBC that is abnormal in peptic ulcer disease?

A

Anaemia

166
Q

What is the medical management of H pylori?

A

Triple therapy for 1-2 weeks:
PPI
Clarithromycin
Amoxicillin OR metronidazole

167
Q

Define perineal abscess

A

Pus collection in perineal region

168
Q

Define perineal fistula

A

Chronically infected tract connecting between perineal skin and anal canal

169
Q

What is the cause of a perineal abscess or fistula?

A

Bacterial infection

170
Q

Recall the symptoms of perineal abscess/fistula

A

Throbbing pain

Intermittent discharge

171
Q

What is Goodsall’s law?

A

Law used to locate internal opening of a fistula based on where the external opening is:
If anterior to anal canal it runs radially and directly into the anal canal
If posterior to the anal canal, or >3cm away from rectum, it takes a curved path

172
Q

What is the most useful form of imaging to investigate a perineal fistula?

A

MRI

173
Q

What is the first line management of a perineal abscess?

A

Open drainage

174
Q

Differentiate the management of high and low perineal fistulae

A

High: SETON inserted to allow drainage (as fistulotomy would cause incontinence)
Low: fistulotomy

175
Q

What are the 3 different types of peritonitis?

A

Localised
Primary generalised
Secondary generalised

176
Q

Recall 4 types of localised peritonitis

A

Appendicitis
Cholecystitis
Diverticulitis
Salpingitis

177
Q

Differentiate between primary and secondary generalised peritonitis

A

Primary: rare, usually seen in adolescent females = bacterial infection without obvious cause
Secondary: bacterial translocation from localised focus for example a peptic ulcer rupture causing spillage of bowel contents

178
Q

What is the standard medical treatment for SBP

A

Quinolone antibiotics (eg ciprofloxacin)

179
Q

What is the surgical management of generalised peritonitis?

A

Laparotomy to remove necrotised tissue

180
Q

Define pilonidal sinus

A

Abnormal epithelium-lined track, filled with hair, that opens onto skin surface, most commonly at the natal cleft

181
Q

What is the pathophysiology of pilonidal sinus?

A

Shed hair penetrates the skin causing an inflammatory reaction

182
Q

What is the management of pilonidal sinus

A

Incision and drainage

183
Q

Define portal hypertension

A

High pressure within the hepatic portal vein

184
Q

What pressure in the hepatic portal vein is clinically significant?

A

> 10mmHg

185
Q

Recall 2 possible pre-hepatic causes of portal hypertension

A

Thrombosis of splenic/ portal vein

Extrinsic compression

186
Q

Recall 3 possible hepatic causes of portal hypertension

A

Cirrhosis
Chronic hepatitis
Schistosomiasis

187
Q

Recall 3 possible post-hepatic causes of portal hypertension

A

Blockage of hepatic vasculature
Right heart failure
Constrictive pericarditis

188
Q

Give some examples of complications of portal hypertension

A

Ascites
Maleana
Haematemesis
Hepatic encephalopathy

189
Q

Recall 2 signs that specifically indicate portal hypertension

A

Splenomegaly

Caput medusae

190
Q

Why might a doppler ultrasound be helpful in portal hypertension

A

Can assess direction of blood flow

191
Q

Where might a shunt be positioned to treat portal hypertension?

A

Between HPV and hepatic vein

192
Q

Name the 2 autoimmune cholestatic liver diseases

A

Primary biliary cirrhosis

Primary sclerosing cholangitis

193
Q

Differentiate which elements of the liver are damaged by PBC and PSC

A

PBC: small interlobular ducts
PSC: intralobular and extrahepatic ducts

194
Q

Differentiate the immunoglobulins implicated in PBC and PSC

A

PBC: AMA, IgM
PSC: pANCA, AMSA, ANA

195
Q

Recall a complication of both PBC and PSC

A

PBC: hypercholesterolaemia
PSC: stricture formation

196
Q

Describe the symptoms of primary biliary cirrhosis

A

Insidious onset: fatigue, weight loss and fat-soluble vitamin deficiencies

197
Q

Describe the symptoms of primary sclerosing cholangitis

A

Often those of IBD, as it often follows UC/Crohn’s

198
Q

What is the key LFT result that indicates PBC/PSC?

A

High ALP and GGT

199
Q

In which type of autoimmune cholestatic liver disease may anti-mitochondrial antibodies be present?

A

Primary biliary cirrhosis

200
Q

How is a diagnosis of PBC/PSC confirmed?

A

Liver biopsy

201
Q

What is the aetiology of rectal prolapse?

A

Straining

202
Q

What might make a rectal prolapse an emergency?

A

If it is irreducible or strangulated

203
Q

What is the main investigation to do for rectal prolapse?

A

Protosigmoidoscopy

204
Q

Recall an immunoglobulin that is associated with ulcerative colitis?

A

pANCA

205
Q

Which 2 ethnic groups are most likely to have ulcerative colitis?

A

Ashkenazi jews

Caucasians

206
Q

Recall 4 extra-articular manifestations of IBD

A

Uveitis
Erythema nodosum
Scleritis
Aphthous ulcers

207
Q

How may stool appear in IBD?

A

Bloody or mucousy

208
Q

As well as signs of IBD and its extra-articular manifestations, what signs may be present in UC patients?

A

Signs of IDA as they aren’t absorbing iron

209
Q

Describe the blood results in IBD

A

High CRP, ESR and WCC

Low FBC as anaemia

210
Q

What blood test is done to differentiate IBS and IBD?

A

Faecal calprotectin

211
Q

What investigations may be done to assess IBD severity?

A

Flexible sigmoidoscopy

212
Q

What is the most useful medical management option for mild ulcerative colitis?

A

5-ASA analogues like mesalazine/olsalazine

213
Q

What drugs may be added to 5-ASA analogues in more severe ulcerative colitis?

A

Immunosuppressants such as azothioprine/ steroids

Anti-TNF (infliximab)

214
Q

In general, what class of immunoglobulin is produced in acute and chronic manifestations of hepatitis virus infection?

A

Acute: IgM
Chronic: IgG

215
Q

Which types of viral hepatitis always follow an acute course?

A

A and E

216
Q

Recall the route of transmission of each type of hepatitis

A

A&E - faeco-oral
B&D - sexual contact, bodily fluids, vertical
C - parenteral (sexual/vertical)

217
Q

Describe the symptoms of viral hepatitis A/E infection

A

Often subclinical
May have prodromal malaise/ fever
May have dark urine with pale stool (as is liver infection)
NO STIGMATA of chronic liver disease

218
Q

Recall the antibodies detectable on viral serology in the presence of viral hepatitis A/E infection?

A

Anti-HAV

Anti-HEV

219
Q

Describe the course of viral hepatitis B/D infection

A

1-2 weeks of prodromal illness: malaise, anorexia, diarrhoea, nausea and vomiting, RUQ pain
Jaundice develops
Recovery period of 4-8 weeks

220
Q

What immunoglobulin is detectable by viral serology in infection of viral hepatitis B/D?

A

HBcAg

221
Q

Does hepatitis C tend to follow an acute or chronic course?

A

Chronic in 80%

222
Q

Describe the pathophysiology of viral hepatitis infection?

A

The virus itself is not directly hepatotoxic - it is the immune response that lads to inflammatory damage

223
Q

What are the symptoms of Hep C infection?

A

90% are asymptomatic

224
Q

In what way are LFTs likely to be deranged in viral hepatitis?

A

Elevated AST and ALT

225
Q

What are the 2 drugs of choice for treating chronic Hep C infection?

A

Interferon alpha

Ribavarin (anti-viral)

226
Q

Define volvulus

A

Rotation of a loop of small bowel around the axis of its mesentery

227
Q

Recall the relative proportion of cases of volvulus that affect each part of the large bowel

A

65% = sigmoid colon
30% = caecum
In neonates affects MIDGUT = volvulus neonatorum

228
Q

Recall the 2 key symptoms of volvulus

A

Severe colicky pain

Absolute constipation

229
Q

Describe the signs that may be seen in a case of volvulus

A

Signs of bowel obstruction with abdominal distention and tenderness
Tachycardia and pyrexia
Signs of dehydration

230
Q

Which 2 investigations are most useful in suspected volvulus?

A

XR

Water-soluble contrast enema

231
Q

What is the inheritance pattern of Wilson’s disease?

A

Autosomal recessive

232
Q

Define Wilson’s disease

A

Reduced biliary excretion of copper

233
Q

Where does copper tend to accumulate in Wilson’s disease?

A

In liver and brain, especially in the basal ganglia

234
Q

Which gene is mutated in Wilson’s disease?

A

Copper-transporting ATPase

235
Q

How does excess copper cause damage to the liver in Wilson’s disease?

A

Build-up of copper –> mitochondrial damage –> cell death –> copper released into plasma –> tissue deposition

236
Q

Recall the symptoms of Wilson’s disease

A

Liver: jaundice, encephalopathy, easy bruising
Neurological: dysphagia, dyskinesia, dysphasia, dystonia

237
Q

What is a specific sign that indicates Wilson’s disease?

A

“Sunflower cateract” due to copper deposition in eye

238
Q

Recall the management of Wilson’s disease

A

Treat with copper chelators and oral zinc

Liver transplantation may be necessary

Year 3 ICSM (17 decks)

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