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MRCP 1 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Name Charcot’s triad and what is the disease

A

Fever
RUQ pain
Jaundice

Ascending Cholangitis

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2
Q

Indications for Acetylecysteine in paracetamol OD

A

Staggered OD (spread over >1hour)
Unsure time of ingestion
Over or above treatment line on plasma PCM vs time graph

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3
Q

Management of ascending cholangitis

A

IV Abx

ERCP after 24-48 hours to relieve any obstruction

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4
Q

Gastrin - stimulated by, inhibited by, secreted from, effect

A

St: Proteins, stomach distension, vagal stimulation
In: somatostatin, stomach acid (neg fb)
G cells in Antrum of stomach duodenum and pancreas
Increase histamine -> acid production

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5
Q

Define Zollinger-Ellison syndrome

features

A

Increased gastrin secretion (increases gastric acid secretion) usually from a gastrin secreting tumour
Usually 30% have MEN-1 (parathyroid (95%), pituitary (70%), pancreas (50%), also adrenal and thyroid)
gastric ulcers, diarrhoea, malabsorption

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6
Q

Dyspepsia red flags

A 
Unintentional weight loss
Iron deficiency anaemia
Malaena
Persistent vomiting
Epigastric mass
Progressive dysphagia
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7
Q

Mx of dyspepsia in community

A
  1. Review medications for possible causes of dyspepsia
  2. Lifestyle advice
  3. Trial of full-dose PPI for one month
  4. ‘Test and treat’ using carbon-13 urea breath test

If >55 and symptoms persistent/recent onset/unexplained -> OGD

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8
Q

Complications of coeliacs disease

A

Hyposplenism
Anaemia: iron, b12 and folate def
osteoporosis
lactose intolerance
enteropathy-associated T-cell lymphoma of small intestine
subfertility, unfavourable pregnancy outcomes
rare: oesophageal cancer, other malignancies

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9
Q

Criteria for liver transplant in paracetamol OD

A 
Arterial pH < 7.3, 24 hours after ingestion (MOST IMPORTANT FACTOR)
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

systolic BP <80 also poor prognostic marker.

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10
Q

Conditions associated with coeliac disease

A 
Dermatitis herpetiformis (vesicular pruritic rash)
Type 1 DM
Autoimmune hepatitis
HLA - DQ2/DQ8 (95%)
HLA - B8 (80%)
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11
Q

Indications for coeliac screening

A

Other conditions: T1DM, autoimmune thyroid, dermatitis herpetiformis, 1st degree relative of coeliac

Sx: anaemia, persistent/intermittent diarrhoea/vomiting/abdo pain/ abdo distension/ weight loss/ TATT/ FTT`

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12
Q

what is a gastric MALT lymphoma

Rx?

A

mucosa-associated lymphoid tissue lymphoma due to chronic inflammation
80-90% due to H.pylori infection, eradicate HP and resolution occurs in the majority

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13
Q

what are the features of the Child-Pugh classification for liver cirrhosis?

A 
bilirubin
albumin
PT
ascites
encephalopathy

severity graded A-C

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14
Q

typical causes of watery diarrhoea

A

E.coli - travellers, watery diarrhoea, abdo cramps and nausea.
Cholera - profuse watery diarrhoea, leading to dehydration and weight loss

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15
Q

typical causes of bloody diarrhoea

A

amoebiasis - gradual onset bloody diarrhoea, abdo pain lasting several weeks.
shigella - bloody diarrhoea, vomiting and abdo pain

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16
Q

treatment of hepatitis C

A

interferon-alpha and ribavirin

treatment is successful if serum HCV RNA is negative 6/12 after end of treatment (successful ~55% of pts)

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17
Q

smooth muscle antibody association

A

autoimmune hepatitis

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18
Q

causes of villous atrophy

A 
coeliacs
tropical sprue
hypogammaglobulinaema
GI lymphoma
Whipples disease (chronic bact. infection)
lactose intolerance
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19
Q

acute management of oesophageal variceal bleed

A

ABCDE
terlipressin - C/I in pregnancy (vasopressor)
prophylactic Abx
endoscopic band ligation

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20
Q

prophylaxis of oesophageal varices

A

propanolol - reduced rebleeding

endoscopic band ligation and PPI

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21
Q

features in the Rockall score

A

pre-gastroscopy:
age - 60-80/>80
shock - no shock/tachycardia/hypotension
comorbidities - HF or IHD/RF or LF, metastases
post gastroscopy:
Dx - mallory weiss or none seen/all other Dx/malignancy
major stigmata of recent GI bleed - blood or clot or active bleed

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22
Q

Mx of C.dif

A

oral metronidazole for 10-14 days
if severe/non responding then oral vancomycin
if life threatening then oral vanc and IV met

23
Q

most common site of inflammation in UC, and in Crohns

A

UC - rectum

CD - terminal ileum

24
Q

most common extra-intestinal feature of IBD

A

arthritis

25
Q

pathology of primary biliary cirrhosis

classic presentation

A

autoimmune chronic inflammation causing progressive cholestasis leading to cirrhosis.
classically: itching in middle aged woman

26
Q

Associations of primary biliary cirrhosis

A

Sjogren’s syndrome (seen in 80%) (both DR3)
RA
Systemic sclerosis
thyroid disease

27
Q

Ix of primary biliary cirrhosis

Mx

A

anti-mitochondrial antibodies - M2 subtype
raised serum IgM and ALP
Xanthelesma present
Mx: cholestyramine for pruritis
fat sol vitamins (DAKE) supplements
ursodeoxycholic acid (a bile salt replacement)
liver transplant if bilirubin >100

28
Q

complications of PBC

A

malabsorption
sicca syndrome (70%)
portal hypertension
HCC (20 fold increase risk)

29
Q

Mx of hepatorenal syn

A

terlipressin (vasoconstrict)
albumin solution to increase vol
transjugular intrahepatic portosystemic shunt

30
Q

Features of Diptheria

A 
Eastern European/Russia
Grey tonsils
Cervical lymphadenopathy
Heart block
Neuritis (cranial nerves)
31
Q

Mx of UC - inducing remission

A

If mild/moderate: 1st line: oral mesalazine
2nd: add oral prednisolone to induce remission (after 4 week trial)
If severe: IV steroids first line

32
Q

Classify severity of UC

A

mild <4 stools/day
mod 4-6, variable blood
severe: 6 bloody stools/day, systemic upset

33
Q

Mx of UC - maintaining remission

A

oral mesalazine
azathioprine and mercaptopurine
probiotics for mild/moderate

note MTX not indicated for UC (unlike Crohns)

34
Q

What is the rate of transmission of Hep C
from mother to child
during sex
needle stick injury

A

mother to child - 6%
breastfeeding is not contraindicated
sex 5%
needle stick 2%

35
Q

how deep is the inflammation in UC

A

mucosa and submucosa

36
Q

Mx of Crohns flare

A

stop smoking
steroids to induce remission and elemental diet
2nd line: mesalazine
3rd: add azathioprine or methotrexate
infliximab for refractory Crohns or fistulating
metronidazole for peri-anal disease

37
Q

Causes of hepatosplenomegaly

A 
chronic liver disease with portal HTN
infections:malaria, hepatitis, glandular fever
lymphoproliferative
myeloproliferative
amyloidosis
38
Q

what is the increased risk of colorectal ca in pts with UC

factors increasing risk

A 
10-20x general pop
disease >10 yrs
pancolitis
unremitting disease
onset before 15 yrs
poor compliance with treatment
39
Q

What is Peutz-Jegher’s syndrome?
inheritance?
features?

A

Auto dom
benign hamartomatous polyps in GI tract and hyperpigmented macules on lips and oral mucosa.
increased risk of GI cancer ~50% will have cancer by 60s

40
Q

What is the function of the gene defect in FAP and in HNPCC

A

FAP - tumour suppressor gene defect

HNPCC (most common cause of familial CR ca) - DNA mismatch repair

41
Q

What percentage of UC patients have primary sclerosing cholangitis?

A

4% of UC pts have PSC

80% of PSC pts have UC

42
Q

Primary sclerosing cholangitis pathology
features
Ix of choice
complications

A

unknown cause
inflammation of intra and extra hepatic bile ducts
RUQ pain, cholestasis (jaundice and pruritis), fatigue
ERCP - multiple biliary strictures
complications: cholangiocarcinoma in 10%, increased risk of colorectal ca

43
Q

Spontaneous bacterial peritonitis:
Dx
Mx

A

Dx: paracentesis neutrophils >250cells/ul
Mx: IV cefotaxime

44
Q

Chance of having colorectal cancer with a positive faecal occult blood test

A

5-15%

colonoscopy post +FOB: 50% normal exam, 30-40% have polyps, 5-15% have colorectal cancer

45
Q

features of the Glasgow-Blatchford score?

what is it used for?

A

urea, Hb, HR, malaena, syncope, liver disease, HF

Assess the likelihood of needing intervention as inpatient.

46
Q

What is a significant serum ascites albumin gradient?

What does it signify?

A

SAAG >1.1 g/dL - portal hypertension

low SAAG - TB peritonitis, pancreatic or biliary ascites, nephritic syndrome

47
Q

What is the significance of melanosis coli findings on colonoscopy?

A

Benign finding, secondary to senna or dantron abuse

48
Q

Features of Wilson’s disease
Ix
Mx

A

Copper aggregation - autosomal recessive
abnormal LFTs and basal ganglia signs (dysarthria, ataxia)
neuro/psychiatric symptoms presenting feature in 40%
kayser-fleischer rings
Ix: 24 hour urinary copper excretion, liver biopsy is diagnostic
Mx: penicillamine or trientine to chelate the copper

49
Q

Serological markers in UC and Crohns

A

UC - pANCA
Crohns - ASCA (anti-saccharomyces cerevisiae antibodies)

Useful in patients with indeterminate colitis (?Crohns ?UC)

50
Q

features of a VIPoma

A

watery diarrhoea
hypokalaemia
achlorhydria (absent gastric acid production)

raised serum chromogranin A in all neuroendocrine tumours except insulinoma.

51
Q

Mx of a VIPoma

A

octreotide (somatostatin) blocks action of VIP

surgical removal of tumour

52
Q

Pathology and features of Whipple’s disease

A

abnormal immune response to intracellular organism tropheryma whippeli
seronegative arthropathy, weight loss, diarrhoea
cardiac complications in 30% (pericarditis, valvular disease)
CNS signs in 15% - occulomasticatory morphyria pathopneumonic
hypoalbuminaemia secondary to malabsorption due to flattening of intestinal villi
SIRS response, anaemia.
lipid deposition in the lamina propria of intestinal villi and lipid containing macrophages with sickle-like inclusion bodies and PAS positive staining.

53
Q

what is the triad of features in microscopic colitis

Mx

A

watery diarrhoea
normal colonoscopy
inflammation of the lamina propria of the colon.
due to NSAIDs, PPI, ticlopidine and cimetidine
Mx - stop offending medication.

54
Q

Dx and Rx of hepatitis C

A

hep C antibody and PCR positive
raised ALT and fibrosis score (US and liver biopsy)

pegylated interferon - SE flu-like illness, depression
ribavirin - SE anaemia

type 1+4 - 1yr Rx
type 2+3 - 6/12

MRCP 1 (15 decks)

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