Gastroenterology and Hepatology Flashcards by Ailsa Morris

Where is the most common site of ulcers in H.pylori infection?

Lesser curvature of the stomach

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What syndrome is duodenal atresia highly associated with?

Down syndrome

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Which condition typically causes the “double bubble” sign on AXR?

Duodenal atresia

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Where is leptin produced?

Adipocytes

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What is produced by pancreatic acinar cells?

Amylase

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What conditions is coeliac associated with?

IgA deficiency
Dermatitis herpetiformis
AI disorders
Small bowel malignancy

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Which RNA virus can sometimes lead to pancreatitis?

Mumps

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What is produced by pancreatic alpha cells?

Glucagon

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What is a type A TOF?

Oesophageal atresia with no communication with the trachea

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What is produced by pancreatic beta cells?

Insulin

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What is the treatment of lymphangiectasia?

Low-fat, high-protein diet with medium chain triglycerides

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What is produced by pancreatic delta cells?

Somatostatin

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What is lymphangiectasia?

Protein-losing enteropathy

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What is the role of vasoactive intestinal polypeptide with regards to stomach acid secretion?

Acts to decrease acid production

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What is the role of secretin with regards to stomach acid secretion?

S-cells in duodenum detect excess acid and release secretin to reduce stomach acid

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How is lymphangiectasia diagnosed?

Increased stool alpha-1-antitrypsin levels

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What layers of the bowel are affected in UC?

Mucosal

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What is the role of acetylcholine with regards to stomach acid secretion?

Stimulates antral G-cells and partial cells to inhibit somatostatin release.

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What layers of the bowel are affected in Crohns?

All layers (transmural)

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What is the role of somatostatin with regards to stomach acid secretion?

D-cells release somatostatin in response to increased acidity - this inhibits gastrin release and decreases acid production

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What is the role of cholecystokinin with regards to stomach acid secretion?

When partially digested food enters duodenum, entero-endocrine cells release cholecystokinin to reduce acid production in the stomach

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What is an H-type TOF?

Continuous oesophagus with an anastomosis with the trachea

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What is a type C TOF?

Oesophageal atresia with distal TOF

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What is a type B TOF?

Oesophageal atresia with proximal TOF

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What is Rovsing's sign?

Increased pain in RLQ on palpation of LLQ in appendicitis

What is a type D TOF?

Oesophageal atresia with proximal and distal TOF

Which cells most directly protect the gastric mucosa from autodigestion and how?

Mucus neck cells - produce bicarbonate and mucus to form a protective barrier

What is McBurney's sign?

Site of maximal tenderness in appendicitis - typically 2/3 of the way along a line drawn from umbilicus to right anterior superior iliac spine

What is the Psoas sign?

Pain in RLQ on passive extension of right thigh with the patient in the left lateral position - common in retrocaecal or retrocolic appendicitis

What is the Obturator sign?

Pain in RLQ as a result of passive internal rotation of flexed right thigh in appendicitis

What is Dunphy's sign?

RLQ on coughing in appendicitis

What is the differentiating factor between a gram positive and gram negative bacteria?

Presence of a lipopolysaccharide layer - present in gram negative but not positive

What type of virus is rotavirus?

Non-enveloped dsDNA

How many serological groups of rotavirus are there?

Seven (A-G) - type A most common

What is Crigler Najjar syndrome?

Severe, persistent hyperbilirubinemia in first few days of life in the absence of haemolysis

What mutation is associated with Crigler Najjar syndrome?

UGT1A1 gene mutation

What is the treatment for Criger Najjar syndrome?

Phototherapy and plasmapheresis

What does the Ladd's procedure aim to fix?

Failure of the mid-gut to rotate through 270degrees at 5-10weeks gestation

Which factor involved in the homeostasis of the large intestine is most significantly impacted by a lack of dietary fibre?

Mucin 2 - protein produced by goblet cells which acts to organise the 2 mucous layers

Which type of antibiotic treatment can increase the risk of developing pyloric stenosis?

Macrolides e.g. azithromycin

What is the most common cause of pancreatitis in children?

Idiopathic

Deficiency of which enzyme typically causes dark urine, jaundice and hepatomegaly?

Glucose 6-phosphatase (or other glycogen storage disorder)

With a double bubble sign in duodenal atresia - which part of the duodenum is most likely to be affected?

What is the most common cause of perianal redness and soreness?

Streptococcal infection - area should be swabbed and PO penicillin started

If IgA tTG ab level is <10x upper limit of normal in suspected coeliac disease, what is the best next step?

Upper GI endoscopy for biopsy

What type of bacteria is H.pylori?

Gram negative bacilli

What occurs in the liver and kidneys in G6P deficiency?

Glycogen and fat accumulation

What is seen on microscopy in coeliac disease?

Crypt hyperplasia and lymphocytosis

How does giardiasis infection present?

Acute diarrhoeal illness which usually self resolves but may develop into chronic infection with steatorrhea, wasting and stunting as well as nutritional deficiencies.

Which vitamins are usually deficient in biliary atresia?

Fat soluble vitamins - A, D, E and K

Where is ghrelin mostly produced?

Fundus of the stomach

What are the typical signs seen on endoscopy in UC?

Friable mucosa Ulcers Areas of regeneration

What are the typical signs seen on endoscopy in Crohns?

Inflamed mucosa Aphthous ulcers Fissures Cobblestoning Strictures

What is measured doing a H.pylori breath test?

Carbon dioxide

Which HLA is associated with severe disease in UC?

HLA-DRB

What is the most common type of oesophageal atresia?

Distal tracheo-oesophageal fistula with OA.

How is choledochal cyst investigated?

AUSS

Can buckwheat be used as part of a gluten free diet?

Yes

How does a choledochal cyst typically present?

Conjugated hyperbilirubinaemia +/- palpable abdominal mass in RUQ Can present with severe liver dysfunction - ascites and coagulopathy

What is the most common type of Kasai classification in biliary atresia?

Kasai type III (90%) - obliteration of left and right hepatic ducts at level of porta hepatis

What is the initial eradication therapy for H.pylori?

Amoxicillin, Clarithromycin and omeprazole for 1 week