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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

25
pathology of primary biliary cirrhosis | classic presentation
autoimmune chronic inflammation causing progressive cholestasis leading to cirrhosis. classically: itching in middle aged woman
26
Associations of primary biliary cirrhosis
Sjogren's syndrome (seen in 80%) (both DR3) RA Systemic sclerosis thyroid disease
27
Ix of primary biliary cirrhosis | Mx
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
complications of PBC
malabsorption sicca syndrome (70%) portal hypertension HCC (20 fold increase risk)
29
Mx of hepatorenal syn
terlipressin (vasoconstrict) albumin solution to increase vol transjugular intrahepatic portosystemic shunt
30
Features of Diptheria
``` Eastern European/Russia Grey tonsils Cervical lymphadenopathy Heart block Neuritis (cranial nerves) ```
31
Mx of UC - inducing remission
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
Classify severity of UC
mild <4 stools/day mod 4-6, variable blood severe: 6 bloody stools/day, systemic upset
33
Mx of UC - maintaining remission
oral mesalazine azathioprine and mercaptopurine probiotics for mild/moderate note MTX not indicated for UC (unlike Crohns)
34
What is the rate of transmission of Hep C from mother to child during sex needle stick injury
mother to child - 6% breastfeeding is not contraindicated sex 5% needle stick 2%
35
how deep is the inflammation in UC
mucosa and submucosa
36
Mx of Crohns flare
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
Causes of hepatosplenomegaly
``` chronic liver disease with portal HTN infections:malaria, hepatitis, glandular fever lymphoproliferative myeloproliferative amyloidosis ```
38
what is the increased risk of colorectal ca in pts with UC | factors increasing risk
``` 10-20x general pop disease >10 yrs pancolitis unremitting disease onset before 15 yrs poor compliance with treatment ```
39
What is Peutz-Jegher's syndrome? inheritance? features?
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
What is the function of the gene defect in FAP and in HNPCC
FAP - tumour suppressor gene defect | HNPCC (most common cause of familial CR ca) - DNA mismatch repair
41
What percentage of UC patients have primary sclerosing cholangitis?
4% of UC pts have PSC | 80% of PSC pts have UC
42
Primary sclerosing cholangitis pathology features Ix of choice complications
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
Spontaneous bacterial peritonitis: Dx Mx
Dx: paracentesis neutrophils >250cells/ul Mx: IV cefotaxime
44
Chance of having colorectal cancer with a positive faecal occult blood test
5-15% | colonoscopy post +FOB: 50% normal exam, 30-40% have polyps, 5-15% have colorectal cancer
45
features of the Glasgow-Blatchford score? | what is it used for?
urea, Hb, HR, malaena, syncope, liver disease, HF | Assess the likelihood of needing intervention as inpatient.
46
What is a significant serum ascites albumin gradient? | What does it signify?
SAAG >1.1 g/dL - portal hypertension low SAAG - TB peritonitis, pancreatic or biliary ascites, nephritic syndrome
47
What is the significance of melanosis coli findings on colonoscopy?
Benign finding, secondary to senna or dantron abuse
48
Features of Wilson's disease Ix Mx
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
Serological markers in UC and Crohns
UC - pANCA Crohns - ASCA (anti-saccharomyces cerevisiae antibodies) Useful in patients with indeterminate colitis (?Crohns ?UC)
50
features of a VIPoma
watery diarrhoea hypokalaemia achlorhydria (absent gastric acid production) raised serum chromogranin A in all neuroendocrine tumours except insulinoma.
51
Mx of a VIPoma
octreotide (somatostatin) blocks action of VIP | surgical removal of tumour
52
Pathology and features of Whipple's disease
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
what is the triad of features in microscopic colitis | Mx
watery diarrhoea normal colonoscopy inflammation of the lamina propria of the colon. due to NSAIDs, PPI, ticlopidine and cimetidine Mx - stop offending medication.
54
Dx and Rx of hepatitis C
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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