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Gastroenterology Flashcards

1
Q

Define coeliac disease

A

An autoimmune enteropathy of the small bowel characterised by mucosal inflammation on gluten exposure leading to malabsorption

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2
Q

What autoantibodies are associated with coeliac disease?

A

Anti-TTG (anti-tissue transglutaminase)
Anti-EMA (anti-endomysial)

Need to test for IgA levels

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3
Q

What part of the small bowel is particularly affected in coeliac disease?

A

Jejunum

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4
Q

What are the genetic associations of coeliac disease?

A

HLA DQ2
HLA DQ8

(associated with T1DM, thyroid disease, autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis)

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5
Q

What are the symptoms of coeliac disease?

A 
Asymptomatic
Failure to thrive in young children
Diarrhoea, steatorrhoea, bloating 
Fatigue
Weight loss
Mouth ulcers, angular stomatitis 
Anaemia - secondary due to iron, B12 and folate deficiency
Dermatitis herpetiformis
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6
Q

What skin condition is associated with coeliac disease?

A

Dermatitis herpetiformis (itchy blistering skin rash typically on the abdomen)

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7
Q

What are the Ddx of coeliac disease?

A

IBS
IBD
Chronic infective gastroenteritis
Lactose intolerance

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8
Q

What is the gold standard investigation to confirm the diagnosis of coeliac disease?

A

Jejunum biopsy when having a gluten containing diet

Shows - subtotal villous atrophy, crypt hyperplasia, intra-epithelial lymphocytosis

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9
Q

What criteria is used in the assessment of jejunum biopsies in the diagnosis of coeliac disease?

A

Modified Marsh Criteria

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10
Q

What additional investigation should be performed in patients with a diagnosis of coeliac disease?

A

DEXA scan - calcium and vitamin D malabsorption leading to osteopenia

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11
Q

How is coeliac disease managed?

A

Total adherence to a gluten free diet

Iron, calcium, folate and vitamin B12 supplementation

Dapsone to improve dermatitis herpetiformis rash (will improve with adherence to gluten free diet)

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12
Q

Why is a 5 yearly pneumococcal vaccine recommended in people with coeliac disease?

A

Hyposplenism

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13
Q

What are complications of untreated coeliac disease?

A

Enteropathy-associated T-cell lymphoma (EATL) of the intestines
Non-Hodgkin lymphoma
Small bowel adenocarcinoma (rare)

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14
Q

Define chronic liver failure

A

Progressive destruction of the liver parenchyma over a period greater than 6 months leading to fibrosis and cirrhosis

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15
Q

What is the most common cause of chronic liver disease?

A

Alcohol

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16
Q

What other conditions are commonly associated with NAFLD?

A

T2DM
HTN
Obesity
Hyperlipidaemia

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17
Q

What ratio of AST:ALT is commonly seen in NAFLD

A

<1

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18
Q

Define haemochromatosis

A

Excessive iron absorption leading to iron deposition in the liver and other organs

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19
Q

What gene causes haemochromatosis

A

HFE gene - on chromosome 6

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20
Q

What are the effects of haemochromatosis

A 
Liver cirrhosis
Diabetes
Skin discolouration
Hypogonadism
Arrhythmias
Heart failure
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21
Q

Define Wilson disease

A

Autosomal recessive disorder leading to copper accumulation

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22
Q

What are the effects of Wilson disease

A

Liver cirrhosis
Neuropsychiatric symptoms - parkinsonism
Cardiomyopathy
Arrhythmias

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23
Q

What biochemistry is typical of Wilson’s disease

A

Low serum caeruloplasmin

High urinary copper

24
Q

How is Wilson’s disease managed?

A

Copper chelators eg penicillamine

25
What antibody is associated with autoimmune hepatitis?
Anti-smooth muscle Abs | IgG usually also up
26
How is autoimmune hepatitis managed?
Prednisolone | AND/OR azathioprine
27
How can chronic liver disease manifest?
Fatigue Encephalopathy Hands - Dupuytren's contracture, palmar erythema, leuconychia Asterixis Face - jaundice sclera, fetor hepaticus Chest - spider naevi, gynaecomastia Abdo - hepatomegaly, splenomegaly; ascites, caput medusa Polyneuropathy
28
What are three scoring systems used in assessing chronic liver disease?
MELD (model of end-stage liver disease) UKELD (UK model of end-stage liver disease) Childs-Pugh
29
What parameters are considered in the MELD score for assessing chronic liver disease?
Bilirubin Creatinine INR
30
What parameters are considered in the UKMELD score for assessing chronic liver disease?
Bilirubin Creatinine INR Sodium
31
What parameters are considered in the Child-Pugh score for assessing chronic liver disease?
``` Ascites Bilirubin Albumin PT Encephalopathy ```
32
What bloods are required in the initial management of chronic liver disease?
FBC LFTs (can be normal in advanced disease) Coag U&Es
33
What tests of synthetic liver function?
PT Albumin Platelets
34
What tests are included in a liver screen?
``` Viral screen: Hep B, C, D and HIV Autoantibodies for PBC, PSC Serum immunoglobulins Iron studies and ferritin Copper and ceruloplasmin Anti-1 antitrypsin level ```
35
What imaging is useful in assessing a patient with chronic liver disease?
USS (+fibroscan) | CT
36
What investigation should all patients with chronic liver disease have?
Endoscopy - assess for oesophageal varices
37
What medication can be commenced for patients with oesophageal varices?
Non-selective beta blockers eg propanolol
38
What are the complications of chronic liver disease?
``` Variceal bleeding Ascites - SBP Encephalopathy Hepatorenal syndrome Hepatocellular carcinoma ```
39
What tumour marker is used in HCC?
Alpha-fetoprotein
40
What is the pathophysiology of Primary Biliary Cirrhosis?
Immune system attacks the small bile ducts --> cholestasis --> back pressure into the liver causing fibrosis, cirrhosis and liver failure
41
How does PBC present?
``` Fatigue Puritis GI disturbance and abdo pain Jaundice Pale, greasy stool Xanthoma and xanthelasma Signs of cirrhosis and liver failure ```
42
What are the associations of PBC?
Middle aged women Other autoimmune disease Rheumatoid conditions
43
What is the first liver enzyme to raise in PBC?
Alkaline phosphatase
44
What autoantibody is associated with PBC?
Anti-mitochondrial antibody
45
Other than raised alk phos and raised anti-mitochondrial antibody, what other blood tests might be raised in PBC?
Raised ESR | Raised IgM
46
What is used to diagnose and stage PBC?
Liver biopsy
47
How can PBC be treated?
Ursodeoxycholic acid - reduces intestinal absorption of cholesterol Colestyramine Liver transplant Immunosuppression
48
How can PBC progress?
Advanced liver cirrhosis and portal hypertension
49
What are some complications associated with PBC?
Distal renal tubular acidosis | Hepatocellular carcinoma
50
What is primary sclerosing cholangitis?
Intrahepatic or extra hepatic ducts become strictured and fibrotic --> obstruction of flow of bile out of the liver and into the intestines
51
What condition is highly associated with PSC?
UC
52
What are the risk factors for PSC?
Male 30-40 UC FHx
53
How can PSC present?
``` Jaundice Chronic RUQ pain Puritis fatigue Hepatomegaly ```
54
How is PSC diagnosed?
MRCP - bile duct lesions and strictures
55
What are the complications of PSC
``` Acute bacterial cholangitis Cholangiocarcinoma Colorectal cancer Cirrhosis and liver failure Biliary strictures Fat soluble vitamin deficiencies ```
56
How can PSC be managed?
``` Liver transplant ERCP - dilate and stent strictures Ursodeoxycholic acid Cholestyramine Monitoring for complications such as cholangiocarcinoma, cirrhosis and oesophageal varices ```

Medicine finals (12 decks)

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