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3B + Finals > GI > Flashcards

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
Q

Uncommon causes of liver cirrhosis

A 
Haemachromatosis   
Wilsons Disease
A1AD
Cystic fibrosis 
Amiodarone, methotrexate 
Valproate
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26
Q

Score for measuring cirrhosis

A

Child-Pugh score

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27
Q

Complications of liver cirrhosis

A

Increased hepatic portal pressure causing varices
Hepato-renal syndrome
Ascites and spontaneous bacterial peritonitis
Hepatic encephalopathy (ammonia)

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28
Q

Cause and management of hepatic encephalopathy

A

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

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29
Q

Blood results in autoimmune hepatitis

A 
Raised LFTs (esp AST and ALT)
WWC down PLTs down
30
Q

Antibodies in autoimmune hepatitis

A

anti-smooth-muscle ASMA
anti-nuclear ANA
anti-liver/kidney-microsomal-antibodies (ALKMA) - these are more common in america.

31
Q

Mx of autoimmune hepatitis

A

Prednisolone for up to 2 years to achieve remission

Azathioprine to maintain remission

32
Q

Chromosome and gene mutation in Wilsons disease

A

Autosomal recessive
C’ 13
Gene - wilsons gene

33
Q

presentations of wilsons disease

A

children - liver problems

Adults - neurological (co-ordination, dysarthria and dystonia, symmetrical parkinsonism (Parkinson’s is asymmetrical)

34
Q

Sign of wilsons disease seen in eyes

A

Keyser-fleischer rings around the iris

35
Q

Blood test in wilsons disease

A

Caeruloplasmin - binds to free copper in blood. Can also be raised by inflammation , so not specific

36
Q

Management of Wilsons disease

A

Penicillamine or Trientine

37
Q

Extra-GI diseases associated with UC

A

Uveititis
Ankylosing spondylitis
Primary sclerosing cholangitis

38
Q

Genes associated with IBD

A

HLA genes

39
Q

Colonoscopy results (macro and micro) for

1) UC
2) chromes
3) Grading score used in UC

A

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
Q

Most affected area in chrones disease

A

Terminal ileus

41
Q

Management of IBD (both)

1) Induce remission 1st and second line.
2) Maintain remission. 2 options each

A

1)
UC - Mesalazine/Olsalazine. Hydrocortisone
Chrones - Prednisolone. Azathioprine.
2)
UC - Mesalazine. Azathioprine
Chrones - Azathioprine. Methotrexate. Adalimumab. Infliximab

42
Q

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

A

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
Q

Causes of bile acid malabsorption

A

Coeliac

Cholecystectomy

44
Q

Management fon bile acid malabsorption

A

Cholestyramine.

45
Q

Which two lymph nodes does gastric cancer commonly metastasis

A

Virchows Lymphnode - left clavicle area

Mary-Joseph - periumbilical

46
Q

Most and second most common bacteria in spontaneous bacterial peritonitis

A

E coli

Klebsiella

47
Q

Causes of drug induces cholesistasis

A

COCP
Fluclox, co-amox, erythromycin
Steroids
Sulphonylureas

48
Q

Drugs that cause liver cirrhosis

A

Methotrexate
Mehtyldopa
Amiodarone

49
Q

Drugs that cause hepatocullular damage

A 
Paracetamol 
Valproate, phenytoin 
Anti-TB medication 
Statins 
Nitrofurantoin
50
Q

Management of vatical bleeds

Management if rebreeding occurs

A

Endoscopic banding/ligation

Rebleeds - Transjugular intrahepatic portosystemic shunt

51
Q

Causes of pancreatitis

A 
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
Q

Local complications of pancreatitis

A

Necrosis
Fluid build up and abscesses
pseudocysts

53
Q

Systemic complications of Pancreatitis

A 
VTE
Thrombophlebitis migrans 
Renal Failure 
ARDS
Shock
54
Q

Where does pancreatic cancer commonly metastasis to (4)

A

Liver
Peritoneum
Lung
Bone

55
Q

1) 2 inx for H. Pylori

2) Tripple threat

A

1) Urea breath test. Stool antigen

2) Omeprazole. Amoxicillin. Clari or Metronidazole

56
Q

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

A

1) Acidosis. Low bicarb

2) Splenic flexure

57
Q

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

A

1) Alcoholic ketoacidosis

2) Seen in alcoholics who don’t consume any food. Or vomit it all out.

58
Q

Skin sign in patients with haematomachrosis

A

Grey skin pigmentation

59
Q

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

A

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
Q

Pathophysiology of A1 antitripsin deficiency

A

AAT unable to be released form hepatocytes
Doesn’t go to lungs to inhibit neutrophil elastase - causes COPD
Accumulates in hepatocytes causes Cirrhosis

61
Q

Complication of haematomachrosis

A

Liver cirrhosis
T2DM
Bronze/grey skin pigmentation
Pituitary dysfunction - hypogonadism, hypothyroidism
Joint deposition - pseudogout type picture
Cardiomyopathy

62
Q

Immunoglobulin associated with autoimmune hepatitis

Which disease overlaps with AIH

A

IgG

Primary biliary cholangitis

63
Q

Management of primary biliary cholangitis

A

ursodeoxycholic acid

64
Q

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

A

1) PSC - predominately effects males
2) Cholestasis. Raised ALP and GGT
3) MRCP, ERCP (which is invasive)

65
Q

Signs of cirrhosis

A 
Rough hepatomegaly 
Spider naivae 
Clubbing
Asterixes
Palmer erythema
Ascites
Caput medusa
Dupuytrons 
Splenomegaly 
Leukonechia
66
Q

Investigation in cirrhosis

A 
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
Q

Most common cause of spontaneous bacterial peritonitis

Acute and long term management

A 
E. Coli
Cephalosporin IV (eg cefotaxime). Rituximab long term prophylaxis
68
Q

Marker for hepatocellular carcinoma

Marker for cholangiocarcinoma

A

Alpha-fetoprotein

CA19-9

69
Q

What is seen on biopsy of coeliac patient

A

Crypt hyperplasia

Villi atrophy

70
Q

Diseases associated with coeliac disease

A

T cell Lymphoma

Dermatitis Herpatiformis

71
Q

Scoring system used in UC

A

Truelove-Whitts

3B + Finals (15 decks)

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