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GI Flashcards

1
Q

antibodies associated with primary billiary cholangitis

A

AMA

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2
Q

Pathophysiology of PBC

A

Interlobular bile ducts damaged, colestasis

portal hypertension

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3
Q

mx for pruritus in PBC

A

Colestyramine

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4
Q

PSC genes associated

A

HLA-A1 and B8

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5
Q

Patient with known IBD presents with pruritus and fatigue

1) Diagnosis
2) Genes associated
3) Abd associated
4) Abd negative for
5) Blood test results

A

1) PSC
2) HLA-A1, B3, DR3
3) ANA, ANCA +
4) AMA -
5)
Raised ALP
Normal/slightly raised ALT
AMA -ve
ANCA can be +ve

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6
Q

Causes of chronic hepatitis

A 
Viruses B and C
EBV
cytomegalovirus 
autoimmune 
wilsons disease
IBD
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7
Q

LFT results in hepatitis

A

Dependant on specific cause but
ALT and AST normally raised
ALP normal

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8
Q

How is Hep A spread

A

POO
Shellfish
Occurs in epidemics

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9
Q

Which two hepatitis virus commonly co-infect patients

A

B and D

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10
Q

Symptoms of alcoholic hepatitis

A

Fatigue + malaise
Jaundice
Ascites
Tender hepatomegaly

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11
Q

Management of acute alcoholic hepatitis

A

admit
fluid, catheter may be needed
management of withdrawal symptoms.
Chlordiazepoxide PO (ideally) or Lorazepam IM
Pabrinex (thiamine)
Predinisolone 40mg 5 days (taper over 3 weeks)

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12
Q

What would be an indication to more readily treat abx associated diarrhoea without stool sample results back?

A

Severe diarrhoea. Loose stools taking the shape of the pan
Severely unwell
Suspected outbreak of C. Diff

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13
Q

Investigation results that would indicate treating for C. Diff

A

Stool Toxin positive and antigen positive

Antigen positive alone is not enough

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14
Q

Other aspects of the management of abx associated diarrhoea

A

Fluid balance
Hydrate
Don’t give anti-motility agents (loperamide)

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15
Q

Mx for abx associated diarrhoea

A

1 - PO Vancomycin
2- PO Fidaxomicin
Life threatening - PO Vanc + IV metronidazole

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16
Q

Most common form of pancreatic cancer

A

Ductal adenocarcinoma

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17
Q

Two presentation of pancreatic cancer (depending on location)

A

Head - painless jaundice

Tail - epigastric pain, radiating to back, relieved sitting forwards.

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18
Q

referral criteria for pancreatic cancer

A

40 yrs + jaundice

60 yrs + weight loss, any other abdominal symptoms/new diabetes

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19
Q

Condition associated with pancreatitis, involving inflammation of blood vessels

A

migratory thrombophlebitis

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20
Q

What it marantic endocarditis

A

Non-infective endocarditis

Thrombotic disorder with growths on heart valves, no associated bacteraemia

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21
Q

investigations for pancreatic cancer

A

CT-TAP (look for mets)
CA 19-9 - pancreatic tumour marker
Biopsy + histology

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22
Q

What would be seen on the blood tests of someone with alcoholic liver disease

A 
Macrocytic anaemia 
raised ALT and AST
Normal ALP
Low albumin 
Increase PT
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23
Q 
Patient presents to A&E: 
Malaise, anorexia, confused. 
Examination shows tender hepatomegaly 
Bloods show increase PT, low albumin, raised ALT and ASP. 
give 3 stages to the management
A

Pabrinex - IV 50mL in 0.9% saline over 1/2 hour. (thiamine infusion)
Chlordiazepoxide PO or lorazepam IM
5 days of oral pred, 40mg. Then taper for 3 weeks
Also:
Infection screen + ascitic tap
monitor weight, blood, fluid output and renal function

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24
Q

Common causes of liver cirrhosis

A

Hep B and C
NAFLD
Alcoholic liver disease

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25
Uncommon causes of liver cirrhosis
``` Haemachromatosis Wilsons Disease A1AD Cystic fibrosis Amiodarone, methotrexate Valproate ```
26
Score for measuring cirrhosis
Child-Pugh score
27
Complications of liver cirrhosis
Increased hepatic portal pressure causing varices Hepato-renal syndrome Ascites and spontaneous bacterial peritonitis Hepatic encephalopathy (ammonia)
28
Cause and management of hepatic encephalopathy
Ammonia produced by gut bacteria to broken down by liver Managed with laxatives to clear gut before ammonia reabsorbed Rifampicin to reduce number of gut bacteria
29
Blood results in autoimmune hepatitis
``` Raised LFTs (esp AST and ALT) WWC down PLTs down ```
30
Antibodies in autoimmune hepatitis
anti-smooth-muscle ASMA anti-nuclear ANA anti-liver/kidney-microsomal-antibodies (ALKMA) - these are more common in america.
31
Mx of autoimmune hepatitis
Prednisolone for up to 2 years to achieve remission | Azathioprine to maintain remission
32
Chromosome and gene mutation in Wilsons disease
Autosomal recessive C' 13 Gene - wilsons gene
33
presentations of wilsons disease
children - liver problems | Adults - neurological (co-ordination, dysarthria and dystonia, symmetrical parkinsonism (Parkinson's is asymmetrical)
34
Sign of wilsons disease seen in eyes
Keyser-fleischer rings around the iris
35
Blood test in wilsons disease
Caeruloplasmin - binds to free copper in blood. Can also be raised by inflammation , so not specific
36
Management of Wilsons disease
Penicillamine or Trientine
37
Extra-GI diseases associated with UC
Uveititis Ankylosing spondylitis Primary sclerosing cholangitis
38
Genes associated with IBD
HLA genes
39
Colonoscopy results (macro and micro) for 1) UC 2) chromes 3) Grading score used in UC
1) Psuodopolyps. Large bowel only, continuous. Goblet cell depletion. Crypt abscesses. Superficial mucosa 2) Skip lesions. Whole GI tract. Cobble stone appearance. Granulomas 3) Truelove-Whitts
40
Most affected area in chrones disease
Terminal ileus
41
Management of IBD (both) 1) Induce remission 1st and second line. 2) Maintain remission. 2 options each
1) UC - Mesalazine/Olsalazine. Hydrocortisone Chrones - Prednisolone. Azathioprine. 2) UC - Mesalazine. Azathioprine Chrones - Azathioprine. Methotrexate. Adalimumab. Infliximab
42
Patient being managed for a LRTI on clindamycin develops diarrhoea. 1) Likely infective cause. 2) Investigation 3) Initial management - 1st and second line The patient has an abdominal x ray - which shows large bowel diameter of 6.5cm. 4) How do you now manage this patient
1) C. Diff. 2) C diff toxin in stool 3) PO Vancamycin. Then PO Fidaxomicin. Then Oral Metronidazole 4) Life threatening c. diff = Oral Vanc and IV metronidazole.
43
Causes of bile acid malabsorption
Coeliac | Cholecystectomy
44
Management fon bile acid malabsorption
Cholestyramine.
45
Which two lymph nodes does gastric cancer commonly metastasis
Virchows Lymphnode - left clavicle area | Mary-Joseph - periumbilical
46
Most and second most common bacteria in spontaneous bacterial peritonitis
E coli | Klebsiella
47
Causes of drug induces cholesistasis
COCP Fluclox, co-amox, erythromycin Steroids Sulphonylureas
48
Drugs that cause liver cirrhosis
Methotrexate Mehtyldopa Amiodarone
49
Drugs that cause hepatocullular damage
``` Paracetamol Valproate, phenytoin Anti-TB medication Statins Nitrofurantoin ```
50
Management of vatical bleeds | Management if rebreeding occurs
Endoscopic banding/ligation | Rebleeds - Transjugular intrahepatic portosystemic shunt
51
Causes of pancreatitis
``` G - gall stones E - Alcohol T - Trauma S - steroids M - mumps A - Autoimmune S - scorpions H - Hyperlipidaemia E - ERCP D - Drugs, furosemide, thiazides, azathioprine ```
52
Local complications of pancreatitis
Necrosis Fluid build up and abscesses pseudocysts
53
Systemic complications of Pancreatitis
``` VTE Thrombophlebitis migrans Renal Failure ARDS Shock ```
54
Where does pancreatic cancer commonly metastasis to (4)
Liver Peritoneum Lung Bone
55
1) 2 inx for H. Pylori | 2) Tripple threat
1) Urea breath test. Stool antigen | 2) Omeprazole. Amoxicillin. Clari or Metronidazole
56
1) What would you see on an ABG in a patient with mesenteric ischaema 2) Most common part of the bowel to be affected by mesenteric ischaemia
1) Acidosis. Low bicarb | 2) Splenic flexure
57
Patient presents with abdominal pain. N/V. Urine dip shows increased ketones. Blood glucose is 3.9. ABG shows acidosis and low O2. 1) Likely cause ? 2) Pathology
1) Alcoholic ketoacidosis | 2) Seen in alcoholics who don't consume any food. Or vomit it all out.
58
Skin sign in patients with haematomachrosis
Grey skin pigmentation
59
1) Blood results to be expected in referring syndrome 2) Cause of reseeding syndrome 3) Who is most at risk of referring syndrome 4) Management of referring syndrome
1) Raised Na. Low K, Low Phosph, Low Mg 2) Sudden increase in food. Increased insulin. Causes cells to take in K+, phosph and Mg. Increases Na reabsorption in distal tubule. 3) Those not eaten for 5-10 days. BMI < 16. >15% weight loss in 6 months. Alcoholics. Anorexia Nervosa. 4) Fluid and electrolyte replacement
60
Pathophysiology of A1 antitripsin deficiency
AAT unable to be released form hepatocytes Doesn't go to lungs to inhibit neutrophil elastase - causes COPD Accumulates in hepatocytes causes Cirrhosis
61
Complication of haematomachrosis
Liver cirrhosis T2DM Bronze/grey skin pigmentation Pituitary dysfunction - hypogonadism, hypothyroidism Joint deposition - pseudogout type picture Cardiomyopathy
62
Immunoglobulin associated with autoimmune hepatitis | Which disease overlaps with AIH
IgG | Primary biliary cholangitis
63
Management of primary biliary cholangitis
ursodeoxycholic acid
64
1) Which disease (PBC or PSC) is associated with inflammatory bowel disease 2) How does this disease typically present 3) How is this disease investigated (invasive and non-invasive options
1) PSC - predominately effects males 2) Cholestasis. Raised ALP and GGT 3) MRCP, ERCP (which is invasive)
65
Signs of cirrhosis
``` Rough hepatomegaly Spider naivae Clubbing Asterixes Palmer erythema Ascites Caput medusa Dupuytrons Splenomegaly Leukonechia ```
66
Investigation in cirrhosis
``` FBC - thrombocytopenia Clotting - raised INR, Raised PT u/e - renal damage if hepato-renal syndrome Liver - raised AST and ALT. Liver biopsy Liver USS ```
67
Most common cause of spontaneous bacterial peritonitis | Acute and long term management
``` E. Coli Cephalosporin IV (eg cefotaxime). Rituximab long term prophylaxis ```
68
Marker for hepatocellular carcinoma | Marker for cholangiocarcinoma
Alpha-fetoprotein | CA19-9
69
What is seen on biopsy of coeliac patient
Crypt hyperplasia | Villi atrophy
70
Diseases associated with coeliac disease
T cell Lymphoma | Dermatitis Herpatiformis
71
Scoring system used in UC
Truelove-Whitts

3B + Finals (15 decks)

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