Gastroenterology Clinical Flashcards
Which HLA subtype is associated with autoimmune hepatitis?
HLA B8
What antibodies are associated with autoimmune hepatitis?
Anti nuclear
Anti smooth muscle
What immunoglobulin is high is autoimmune hepatitis?
IgG
What do you see on a liver biopsy of autoimmune hepatitis?
Piecemeal necrossi
What are the three subtypes of autoimmune hepatitis?
Type 1 - Affects adults and children. Anti nuclear and anti smooth muscle antibodies
Type 2 - Affects children online (LKM1 antibodies)
Type 3 - Adults in middle age. Soluble liver-kidney antigen
What is zollinger ellison syndrome?
Excessive production of gastrin usually from a gastrin secreting tumour of the duodenum or pancreas. Around 30% occur as part on MEN 1
What tests do you do if you suspect zollinger ellison syndrome?
Fasting gastrin levels (best test)
Secretin stimulation test
What HLA type in associated with coeliac disease?
HLA DQ2 (also HLA DQ8 but slightly less common!)
What does somatostatin do?
Decreases acid and pepsin secretion, decreases gastrin secretion, decreases pancreatic enzyme secretion, decreases insulin and glucagon secretion
What is the most common type of oesophageal cancer in the UK?
Adenocarcinoma
Where is the location of adenocarcinoma oesophageal cancer?
Lower third - near the gastrooesophageal junction
Where is the location of squamous cell carcinoma of the oesophagus?
Upper two thirds of the ooesophague
What are the risk factors for adenocarcinoma of the oesophagus?
GORD Barretts oesophagus Smoking Achalasia Obesity
What are the risk factors for squamous cell carcinoma of the oesophagus?
smoking alcohol achalasia plummer vinson syndrome diet rich in nitrosamines
What part of the colon is most often affected by ischaemic colitis?
Splenic flexure
What do you see on an abdominal X Ray of ischaemia colitis?
Thumbprinting oedema
What do you see on a duodenal biopsy of coeliac disease?
Villous atrophy
Crypt hyperplasia
What cells secrete somatostatin?
D cells in the pancreas and the stomach
What is the test for haemachromatosis?
General population: Transferrin saturation (over 55% in men or over 50% in women with haemachromatosis)
Family history: HFE gene
What is the inheritence pattern of wilsons disease?
Autosomal recessive - gene located on chromosome 13
How do you diagnose wilsons disease?
- Kayser Fleisher rings
- Reduced serum caeruloplasmin
- Reduced total serum copper
- Free serum copper in increased
- Increased 24 hour urinary copper excretion
What is the treatment for wilsons disease?
Penicillamine (chelates copper)
What is the best investigation for suspected budd chiari syndrome?
Ultrasound with doppler flow studies
What is the treatment for eosinophilic oesophagitis?
Dietary modifications (eg elemental diet)
Topical steroids
Oesophageal dilatation
