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finals > GI inc liver > Flashcards

GI inc liver Flashcards

1
Q

what is acute cholangitis?

A

infection of the biliary tree caused by biliary outflow obstruction

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2
Q

how does acute cholangitis present?

A

RUQ pain
fever
jaundice

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3
Q

what is biliary colic?

A

RUQ pain caused by impacted gallstone at the neck of the gallbladder

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4
Q

what is the trigger for biliary colic?

A

consumption of fatty foods

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5
Q

how does biliary colic present?

A

RUQ pain
no fever no jaundice

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6
Q

how does cholecystitis present?

A

RUQ pain
fever
no jaundice

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7
Q

what is the pathophysiology of acute pancreatitis?

A

inflammation caused by hypersecretion or back flow of exocrine enzymes which result in auto digestion of the pancreas

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8
Q

what are the causes of pancreatitis?

A

I - idiopathic
G - gallstones
E - ethanol
T - trauma
S - steroids
M - malignancy / mumps
A - autoimmumne disease
S - scorpion sting
H - hypercalcaemia
E - ERCP
D - drugs

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9
Q

how does acute pancreatitis present?

A

epigastric pain that radiates to back, is worse after meals and is better leaning forward

nausea and vomiting

decreased appetite

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10
Q

what is the diagnostic criteria for acute pancreatitis?

A

2 of 3 of:

abdo pain and history suggestive of acute pancreatitis

serum amylase / lipase over 3x the upper lim of normal

imaging findings suggestive

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11
Q

what are the 2 most common causes of acute pancreatitis?

A

gallstones and alcohol

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12
Q

what is the management of gallstone pancreatitis?

A

ERCP

cholecystectomy on all pts in the same hospital admission

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13
Q

what is the management of alcohol induced pancreatitis?

A

benzos for withdrawal
thiamine, folate and B12

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14
Q

how does the pain in appendicitis migrate?

A

initially it produces umbilical pain

as it progresses it produces localised pain in the right iliac fossa

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15
Q

what is Murphys triad in appendicitis?

A

low grade fever
nausea and vomiting
right iliac fossa pain

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16
Q

what is the first line imaging in appendicitis?

A

ultrasound

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17
Q

what is the management of appendicitis?

A

appendectomy

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18
Q

what is cholecystitis?

A

inflammation of the gallbladder usually secondary to gallstones

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19
Q

what is the most common type of colorectal cancer?

A

adenocarcinoma

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20
Q

what do most colorectal cancers arise from?

A

pre cancerous polyps

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21
Q

what is reccomended for pts who have red flag symptoms for colorectal cancer?

A

faecal immunoglobulin testing (FIT)

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22
Q

what happens if the FIT is positive?

A

the pt should be referred on an urgent suspected cancer pathway (2 wk wait)

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23
Q

what is the gold standard diagnostic test for colorectal cancer?

A

colonoscopy

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24
Q

almost all coeliac pts are positive for what?

A

HLA DQ2

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25
Q

which antibody is diagnostic of coeliac if strongly positive?

A

anti tTG

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26
Q

how often do pts w/ coeliac disease need the pneumococcal vaccine?

A

every 5 yrs

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27
Q

what are diverticula?

A

mucosal out-pouches in the colonic musculature

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28
Q

what its diverticulosis?

A

the presence of diverticula w/out symptoms

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29
Q

what antibiotic is most commonly used for the treatment of a diverticulitis flare?

A

co amoxiclav

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30
Q

what is the management of a pt w/ dysphagia (difficulty swallowing)?

A

urgent 2 wk referral for endoscopy

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31
Q

how long do you need to stop a PPI before a h. pylori test?

A

2 wks

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32
Q

what is Barretts oesophagus?

A

when the lower oesophageal epithelium changes from squamous to columnar epithelium (metaplasia) due to chronic acid reflux

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33
Q

what is the risk of Barretts oesophagus?

A

it is a pre malignant condition and a significant risk factor for developing oesophageal adenocarcinoma

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34
Q

what is Zollinger-Ellison syndrome?

A

a rare condition where a duodenal or pancreatic tumour secretes excess quantities of gastrin (hormone that stimulates acid secretion)

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35
Q

what is the likely diagnosis when there is a metabolic acidosis and hypokalaemia?

A

prolonged vomiting

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36
Q

what is involved in a trans jugular intrahepatic portosystemic shunt (TIPS)?

A

connecting the hepatic vein into the portal vein

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37
Q

what is the management of pharyngeal pouch?

A

surgical repar

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38
Q

how does a pharyngeal pouch present?

A

dysphagia
halitosis
regurgitation

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39
Q

coeliac disease increases the risk of developing which cancer?

A

T cell lymphoma

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40
Q

a recurrent episode of c diff w/in 12 wks of symptom resolution should be treated w/ what?

A

fidaxomicin

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41
Q

what is the first line treatment for c diff?

A

10 days of vancomycin

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42
Q

what is the likely diagnosis of a pt w/ T2DM and abnormal LFTs?

A

non alcoholic fatty liver disease

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43
Q

what does positive anti-HBc IgG indicate?

A

chronic hepatitis B

think C and G are kinda similar

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44
Q

what does positive anti-HBc indicate?

A

acute hepatitis B infection

think A and B are close together in alphabet

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45
Q

which medications are a risk factor for c dif?

A

PPIs

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46
Q

what is the investigation of choice for a suspected pharyngeal pouch?

A

barium swallow w/ fluoroscopy

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47
Q

what is primary biliary cholangitis?

A

a chronic liver disorder commonly seen in females - thought to be autoimmune

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48
Q

what is the M rule for primary biliary cholangitis?

A

IgM - raised serum IgM

anti Mitochondrial antibodies, M2 subtype

Middle aged women

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49
Q

what its life threatening c dif treated w/?

A

oral vancomycin and IV metronidazole

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50
Q

what is GORD caused by?

A

stomach acid flowing through the lower oesophageal sphincter and into the oesophagus

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51
Q

what is a hiatus hernia?

A

when the stomach herniates up through the diaphragm

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52
Q

what are the 3 key complications of hernias?

A

incarcerations
obstruction
strangulation

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53
Q

what is incarceration (hernia complication)?

A

when the hernia cannot be reduced back into its proper place

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54
Q

what is obstruction (hernia complication)?

A

when the hernia causes an obstruction in the passage of faeces through the bowel

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55
Q

what is strangulation (hernia complication)?

A

when the hernia is non reducible and the base of the hernia twists cutting off the blood supply

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56
Q

what is an indirect inguinal hernia?

A

when the bowel herniates through the inguinal canal

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57
Q

where does the inguinal canal run between?

A

the deep inguinal ring and the superficial inguinal ring

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58
Q

what does a direct inguinal hernia occur due to?

A

a weakness in hesselbachs triangle

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59
Q

how can you differentiate a direct inguinal hernia from an indirect inguinal hernia?

A

when pressure is applied over the deep inguinal ring an indirect hernia will remain reduced whereas it will not stop herniation for a direct inguinal hernia

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60
Q

what is a femoral hernia?

A

when there is herniation of abdominal contents through the femoral canal

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61
Q

what is a sliding hiatus hernia?

A

when the stomach slides up through the diaphragm w/ the gastro-oesophageal junction passing up into the thorax

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62
Q

what is a rolling hiatus hernia?

A

when a separate part of the stomach folds around and enters through the diaphragm opening along w/ the oesophagus

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63
Q

what is autoimmune hepatitis?

A

a rare cause of chronic hepatitis (inflammation in the liver)

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64
Q

who does type 1 autoimmune hepatitis usually affect?

A

women in their 40s-50s

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65
Q

what is a hepatitis picture on bloods?

A

raised ALT and AST
no change to ALP

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66
Q

what immunoglobulin is raised in autoimmune hepatitis?

A

IgG

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67
Q

what are the liver biopsy findings of autoimmune hepatitis?

A

interface hepatitis
plasma cell infiltration

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68
Q

what is the management of autoimmune hepatitis?

A

high dose steroids (prednisolone)

immunosuppressants (azothioprine)

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69
Q

what is the most common viral hepatitis in the world?

A

hepatitis A

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70
Q

how is hepatitis A diagnosed?

A

IgM antibodies

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71
Q

what is the management of hepatitis A?

A

usually self limiting

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72
Q

how is hepatitis A transmitted?

A

faecal oral route

usually through contaminated foods

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73
Q

what type of virus is hepatitis A?

A

RNA

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74
Q

what type of virus is hepatitis B?

A

double stranded DNA

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75
Q

how is hepatitis B transmitted?

A

through blood or bodily fluids

mother to baby (vertical transmission)

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76
Q

what does HBsAg indicate in hepatitis B?

A

active infection

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77
Q

what does HBeAg indicate in hepatitis B?

A

high infectivity

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78
Q

what does HBcAb indicate in hepatitis B?

A

current or past infection

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79
Q

what does HBsAb indicate?

A

vaccination, past or current infection

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80
Q

what is HBV DNA in hepatitis B?

A

a direct count of the viral load

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81
Q

what type of virus is hepatitis C?

A

an RNA virus

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82
Q

how is hepatitis C transmitted?

A

blood and bodily fluids

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83
Q

what is the management of hepatitis C?

A

it is curable w/ direct acting antiviral medications

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84
Q

what is the duration of treatment for hepatitis C?

A

8-12 wks

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85
Q

what type of virus is hepatitis D?

A

RNA virus

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86
Q

hepatitis D pts can only survive in pts w/ what?

A

hepatitis B

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87
Q

what is the impact of hepatitis D on hepatitis B?

A

increases the severity and complications of hepatitis B

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88
Q

what type of virus is hepatitis E?

A

RNA virus

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89
Q

how is hepatitis E transmitted?

A

faecal oral route

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90
Q

what is the management of hepatitis E?

A

nothing it is usually self limiting

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91
Q

what are haemorrhoids?

A

enlarged anal vascular cushions

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92
Q

what are haemorrhoids assoc w/?

A

constipation / straining

increased abdo pressure from weight lifting and coughing

pregnancy

obesity

increased age

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93
Q

what are the anal cushions?

A

specialised submucosal tissue that contain connections between the arteries and the veins

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94
Q

what is a first degree haemorrhoid?

A

no prolapse

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95
Q

what is a second degree haemorrhoid?

A

prolapse on straining and return inside the anus when relaxing

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96
Q

what is a third degree haemorrhoid?

A

prolapses on straining and does not return on relaxing but can be pushed back inside

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97
Q

what is a fourth degree haemorrhoid?

A

permanently prolapsed

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98
Q

how do haemorrhoids present?

A

fresh bright red blood on wiping that is not mixed in w/ the stool

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99
Q

what are the features of Crohns disease?

A

N - no blood or mucus

E - entire GI tract affected (mouth to anus)

S - skip lesions on endoscopy

T - terminal ilium most affected and transmural thickness

S - smoking is a risk factor (don’t set the nest on fire)

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100
Q

what are the features of ulcerative colitis?

A

C - continuous inflammation

L - limited to the colon and rectum

O - only superficial mucosa affected

S - smoking may be protective

E - excrete blood and mucus

U - use aminosalicylates

P - primary sclerosising cholangitis

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101
Q

what is the initial test for inflammatory bowel disease?

A

faecal calceprotein

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102
Q

what is the investigation of choice for inflammatory bowel disease?

A

colonoscopy w/ multiple intestinal biopsies

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103
Q

explain the management of mild to moderate ulcerative colitis?

A

aminosalicylate (e.g. mesalazine) first line

corticosteroids (e.g. prednisolone) second line

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104
Q

what is the management of severe ulcerative colitis?

A

iv steroids

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105
Q

what is the most definitive management for ulcerative colitis and why

A

removal of the entire large bowel and rectum (panproctocolectomy)

because ulcerative colitis only affects the large bowel and rectum

106
Q

how is remission induced in crohns disease?

A

steroids (oral prednisone or IV hydrocortisone) first line

107
Q

what is used first line for maintaining remission in crohns disease?

A

aziothioprine

108
Q

how long does a pt need to have had symptoms for before a diagnosis of IBS can be made?

A

6 months

109
Q

in patients w/ suspected variceal haemorrhage what should be given before endoscopy?

A

ABs ans terlipressin

110
Q

what is the first line treatment for diarrhoea in IBS?

A

loperamide

111
Q

what is the best marker for acute liver dysfunction and why?

A

prothrombin time

because liver enzymes are misleading in the context of acute liver failure and so coagulation factors and albumin are more indicative of the organs current state

prothrombin time has a shorter half life than albumin making it a better measure of acute liver failure

112
Q

what are pts on long term PPIs at risk of getting?

A

c diff

113
Q

what electrolyte imbalance can PPIs cause and how?

A

hyponatraemia through SIADH

114
Q

what can be used to stop an uncontrolled variceal haemorrhage?

A

insertion of a sengstaken - Blakemore tube

115
Q

what is the screening tool used to screen for malnutrition?

A

MUST

116
Q

what is the first line antibiotic used to treat c diff?

A

vancomycin

117
Q

what is the technique to stop variceal bleeding if it is oesophageal?

A

endoscopic band liigaton

118
Q

what is the double duct finding on MRCP indicative of?

A

pancreatic cancer

119
Q

what is the double duct sign on MRCP?

A

dilation of the common bile ducts and the pancreatic duct

120
Q

pts w/ haemocrhomatosis are at increased risk of what?

A

hepatocellualr carcinoma

121
Q

what is the most common cause of hepatocellualr carcinoma worldwide?

A

chronic hepatitis B

122
Q

what is the inheritance pattern of Wilsons disease?

A

autosomal recessive

123
Q

what is Wilsons disease?

A

autosomal recessive disorder that results in excess copper deposition in the tissues (esp brain liver and cornea)

124
Q

what age is the typical onset of symptoms of Wilsons disease?

A

10-25 y/o

125
Q

how do children w/ Wilsons typically present?

A

liver disease

126
Q

how do young adults w/ Wilsons typically present?

A

neurological symptoms

127
Q

what are the ALT, urinary copper and serum caeruloplasmin findings in Wilsons disease?

A

ALT raised
urinary copper raised
serum caeruloplasmin reduced

128
Q

what blood test can be used to differentiate an upper GI bleed from a lower GI bleed?

A

high urea levels indicate an upper GI bleed

129
Q

what is the hallmark symptom of refeeding syndrome?

A

hypophosphataemia

130
Q

which 2 electrolyte imbalances can cause torsades de points in refeeding syndrome?

A

hypokalaemia
hypomagnesaemia

131
Q

which cereals contain gluten?

A

wheat
barley
rye
oats

132
Q

what is used in the management of crohns patents who develop perinanal fistulas?

A

oral metronidazole

133
Q

what is hepatorenal syndrome?

A

AKI in pts w/ advanced liver disease

134
Q

what is type 1 hepatorenal syndrome?

A

rapid onset (less than 2 wks)

135
Q

what is type 2 hepatorenal failure?

A

more gradual decline in renal function typically associated w/ refractory ascites

136
Q

what is the first line management for small bowel bacterial overgrowth syndrome?

A

rifaximin

137
Q

what should be used to treat pts w/ ascites secondary to alcoholic cirrhosis?

A

spironolactone

138
Q

what is pernicious anaemia?

A

an autoimmune condition that results in reduced absorption of vitamin B12 due to antibodies targeting intrinsic factor

139
Q

when is endoscopic intervention required for Barretts oesophagus?

A

when there is dysplasia of any grade identified

140
Q

what is the diagnostic investigation of choice for pancreatic cancer?

A

high resolution CT scan

141
Q

what is the likely diagnosis when there is dysphagia to both solids and liquids?

A

achalasia

142
Q

what is seen on a barium enema of a pt w/ ulcerative colitis?

A

loss of haustral markings giving a lead pipe colon appearance

143
Q

are the majority of pancreatic cancers endocrine cancers or exocrine cancer?

A

95% exocrine

144
Q

painless obstructive jaundice is what until proven otherwise?

A

pancreatic cancer

145
Q

what are the majority of pancreatic cancers?

A

adenocarcinomas

146
Q

where in the pancreas do most pancreatic cancers occur?

A

the head of the pancreas

147
Q

what are the 4 sites that pancreatic cancers usually metastasise to?

A

the liver
the peritoneum
the bones
the lungs

148
Q

give 4 features of the presentation of pancreatic cancer?

A

jaundice
pale stools
dark urine
generalised itching

149
Q

what is an important consideration if a pt has worsening glycemic control despite good compliance and good lifestyle modificaitons?

A

pancreatic cancer

150
Q

what is the likely diagnosis when there is jaundice and a palpable gallbladder?

A

cholangiocarcinoma or pancreatic cancer

the diagnosis is unlikely to be gallstones

151
Q

what is migratory thrombophlebitis and what is it indicative of?

A

blood clot in inflamed blood vessels that recurs at dif times and dif locations

indicative of pancreatic cancer

152
Q

how is pancreatic cancer diagnosed?

A

imaging (CT scan)

and biopsy of lesion

153
Q

which tumour marker may be raised in pancreatic cancer?

A

Ca 19 - 9

154
Q

which type of oesophageal cancer develops as a result of GORD?

A

adenocaricinoma

155
Q

what is used for the prophylaxis of bleeding in stable oesophageal varices?

A

propanolol first line

variceal band ligation if beta blockers are contraindicated

156
Q

what is spontaneous bacterial peritonitis?

A

an infection developing in the ascitic fluid and peritoneal lining w/out a clear source of infection

157
Q

what are the 2 most common causative organisms in spontaneous bacterial peritonitis?

A

e coli
klebsiella

158
Q

what is hepatorenal syndrome?

A

impaired kidney function caused by changes to the blood flow to the kidneys relating to liver cirrhosis and portal hypertension

159
Q

what is the most common cause of ascites?

A

portal hypertension which is usually due to liver cirrhosis

160
Q

what is haemochromatosis?

A

an iron storage disorder that results in excess total body iron and the deposition of iron in body tissues

161
Q

what is the inheritance pattern of the mutation on the HFE gene seen in haemochromatosis?

A

autosomal recessive

162
Q

when does haemochromatosis typically present and why?

A

after the age of 40 as it takes time for enough iron to build up in the body to cause symptom

after menopause in women as menstruation actively gets rid of iron

163
Q

how does haemochromatosis present?

A

hair loss
cognitive issues
chronic fatigue
bronzed skin
sexual dysfunction and amenorrhoea
joint pain

164
Q

what are the blood tests findings that indicate iron overload and so haemochromatosis?

A

high ferritin
high transferrin saturation
low total iron binding capacity

165
Q

what is the management of haemochromatosis?

A

venesection

166
Q

what is the likely diagnosis of green watery diarrhoea following choecystectomy?

A

bile acid malabsorption

167
Q

what is the treatment of bile acid malabsorption?

A

cholestyramine

168
Q

what is the most common cause of gastrointestinal varices?

A

portal hypertension

169
Q

what is the main complication that pts w/ primary sclerosing cholangitis are at risk of?

A

cholangiocarcinoma

170
Q

what is the most common cause of pseudomembranous colitis?

A

c diff

171
Q

how does Budd chiari syndrome present?

A

triad of:

sudden onset abdo pain
ascites
tender hepatomegaly

172
Q

what is Budd chiari syndrome?

A

hepatic vein thrombosis

173
Q

what is Gilberts syndrome?

A

a hereditary condition in which pts have transient raises in bilirubin esp during times of stress

174
Q

what is the best marker used to monitor treatment in haemochromatosis?

A

transferrin saturation

175
Q

what is melanosis coli and what is it most commonly assoc w/?

A

a disorder of pigmentation of the bowel wall

most commonly assoc w/ laxative abuse

176
Q

what are the 2 electrolyte imbalances that PPIs can cause?

A

hyponatraemia
hypomagnasaemia

177
Q

why is osteomalacia seen in untreated coeliac disease and how does this present?

A

osteomalacia seen in untreated coeliac disease due to reduced absorption of vitamin D

indicated by low levels of Ca, phosphate and vitamin D

178
Q

what is the most prominent symptom of crohns disease in children?

A

abdominal pain

179
Q

what is Plummer Vinson syndrome?

A

triad of:

dysphagia
iron deficiency anaemia
glottitis

180
Q

what is mailer Weiss syndrome?

A

severe vomiting leads to mucosal lacerations at the gastroesoohageal junction leading to haematemesis

common in alcoholics

181
Q

what is boerhaave syndrome?

A

severe vomiting leads to oesophageal rupture

182
Q

what is the AST:ALT ratio in alcoholic hepatitis?

A

> 2

183
Q

what is hepatorenal syndrome?

A

a functional kidney impairment seen in pts w/ liver disease

184
Q

what are the 3 key features of hepatorenal syndrome?

A

ascites

low urine output

significant increase in serum creatinine

185
Q

what is the first line treatment for hepatorenal syndrome?

A

terlipressin

186
Q

how does terlipressin help in hepatorenal syndrome?

A

causes splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow

187
Q

what is type 1 hepatorenal syndrome?

A

rapidly progressive

very poor prognosis

188
Q

what is type 2 hepatorenal syndrome?

A

slowly progressive

poor prognosis

189
Q

how can phaeochromocytoma be differentiated from carcinoid syndrome?

A

both present very similarly but phaeochromocytoma causes pale and meaty skin whereas carcinoid syndrome causes dry and flushed skin

190
Q

what are the characteristic findings of autoimmune hepatitis?

A

+ve anti ANA
+ve anti smooth muscle

raised IgG

191
Q

what is peutz jegher syndrome?

A

an autosomal dominant condition where pts develop polyps throughout the GI tract and melanotic macula’s on the mouth, lips, genitals, palms and soles

192
Q

what is the risk w/ peutz jegher syndrome?

A

that the polyps develop into cancer

193
Q

what is the management of any pt w/ Barretts oesophagus when high grade dysplasia is identified?

A

endoscopic mucosal therapy

194
Q

which area is most likely to be affected by ischaemic colitis?

A

the splenic flexure

195
Q

what are the blood test findings of small bowel ischaemia?

A

high WCC
metabolic acidosis

196
Q

what is used to induce remission in crohns disease?

A

steroids

197
Q

what is used to maintain remission in crohns disease?

A

azathioprine or mercaptourine

198
Q

how does boerhaave syndrome present?

A

an episode of vomiting followed by severe chest pain and shock

199
Q

how can hepatitis b immunity from natural infection be differentiated from immunity due to vaccination?

A

anti HBs +ve in both natural infection and vaccination

anti HBc only +ve in immunity from natural infection

200
Q

how does Wilsons disease present?

A

a combination of neurological symptoms and liver symptoms

201
Q

what do signet ring cells on biopsy indicate?

A

gastric adenocarcinoma

202
Q

what is the most commonly used diagnostic marker for carcinoid syndrome?

A

5 HIAA

203
Q

what is the first line test used to diagnose all bowel over growth syndrome?

A

hydrogen breath test

204
Q

what is the treatment for Wilsons disease?

A

penicillamine

205
Q

what is the only test recommended for H pylori erradication?

A

urea breath test

206
Q

in a pt w/ variceal haemorrhage, what should be given before they have an endoscopy?

A

terlipressin and IV ABs

207
Q

which antibody may be positive in primary sclerosing cholangitis?

A

pANCA

208
Q

what must you look at in order to be able to interpret TTG levels in coeliac disease?

A

IgA level

209
Q

what is the first line for inducing remission in crohns disease?

A

glucocorticoids (prednisolone)

210
Q

what is the first line for maintaining remission in crohns disease?

A

azathioprine

211
Q

what is used to treat bile acid malabsorption?

A

cholestyramine

212
Q

how should pts w/ severe colitis be investigated?

A

flexible sigmoidoscopy

because colonoscopy should not be done due to risk of perforation

213
Q

what is the nail change seen in crohns disease and why does it occur?

A

koilonychia

occurs due to iron deficiency anaemia

214
Q

what are the biopsy findings of coeliac disease?

A

villous atrophy
crypt hyperplasia
intraepithelial lymphocytes

215
Q

pts w/ coeliac disease are at an increased risk of developing which cancer?

A

enteropathy assoc T cell lymphoma

216
Q

what is the inheritance pattern of Peutz Jeghers syndrome?

A

autosomal dominant

217
Q

what is the surgical treatment of achalasia?

A

Heller cardiomyotomy

218
Q

what is the most significant lab finding in Wilsons disease?

A

reduced serum caeruloplasmin

219
Q

what is caeruloplasmin?

A

a copper carrying protein

220
Q

why is serum caeruloplasmin reduced in wilsons disease?

A

because its synthesis is impaired in wilsons disease due to intracellular copper overload

221
Q

in ascites what does a high serum ascitic albumin gradient (SAAG) >11g/l indicate?

A

portal hypertension and so likely liver cirrhosis

222
Q

what is the primary treatment of wilsons disease?

A

penicillamine (metal chelating agent used to remove the excess copper)

223
Q

where is the most common site affected in UC?

A

the rectum

224
Q

which medications should be stopped in c diff iinfectons?

A

oromorph

225
Q

what are the findings of someone who has hep B immunity only through vaccination?

A

anti HBs positive
all others negative

226
Q

which 2 things are used to monitor treatment in haemochromatosis?

A

ferritin and transferrin saturation

227
Q

what is used for h pylori eradication therapy?

A

PPI + clarithromycin + metronidazole

OR

PPI + clarithromycin + amoxicillin

228
Q

what is used to treat the symptoms of carcinoid syndrome?

A

octreotide (somatosatin analogue)

229
Q

a lemon tinge to the skin is assoc w/ what and why does it occur?

A

assoc w/ pernicious anaemia

occurs due to pallor due to anaemia and mild jaundice due to haemolysis

230
Q

what is the investigation of choice for perinea fistulae in pts w/ crohns?

A

MRI pelvis

231
Q

how are liver abscesses managed?

A

ABs and drainage

232
Q

what is used for the prophylaxis of variceal bleeding?

A

propanolol

233
Q

what can be used to differentiate IBD from IBS in primary care?

A

faecal calprotectin

234
Q

what is the likely diagnosis when the pt has jaundice, hepatomegaly an raised ANA and anti smooth muscle antibodies?

A

autoimmune hepatitis

235
Q

which is better for haemochromatosis screening, transferrin saturation or ferritin?

A

transferritin saturation

236
Q

how does hepatitis A present?

A

flu like symptoms
RUQ pain
tender hepatomeglay
deranged LFTs

237
Q

how can you differentiate ascending cholangitis from hepatitis A?

A

a flu like prodrome and tender hepatomegaly suggests hepatitis A

they will both present w/ fever, jaundice and RUQ pain

238
Q

which vitamin is teratogenic if taken in high doses?

A

vitamin A

239
Q

which inflammatory bowel disease is associated with gallstones and why?

A

crohns disease

because the terminal ileum is affected and this is the area that absorbs bile salts therefore gallstones can form

240
Q

what is used to maintain remission in a pt w/ UC who has had more than 2 exacerbations in the last year requiring steroids?

A

oral azathioprine

241
Q
A
242
Q

what is used for determining the severity of c diff infection?

A

white cell count

243
Q

what is the first line medication for primary biliary cholangitis?

A

ursodeoxycholic acid

244
Q

what is used for prophylaxis for patients who have had a previous episode of spontaneous bacterial peritonitis?

A

cirpfloxacin

245
Q

what is the likely diagnosis when there is liver failure following cardiac arrest?

A

ischaemic hepatitis

246
Q

how can you differentiate an upper GI bleed from a lower GI bleed?

A

urea levels are raised n an upper GI bleed

247
Q

what is the first line laxative used?

A

bulk forming laxative e.g. isphagula husk

248
Q

what is an upper GI bleed classified as?

A

a bleed w/ an origin above the ligament of Treitz

249
Q

what blood gas abnormality is seen w/ persistent vomiting?

A

metabolic alkalosis

250
Q

what is needed for large volume paracentesis and why?

A

albumin cover

to reduce postparacentesis circulatory dysfunction

251
Q

what are the xray findings of gallstone ileus?

A

small bowel obstruction

air in the biliary tree

252
Q

what are the xray finings of sigmoid volvulus?

A

coffee bean sign

253
Q

what is used for the secondary prophylaxis of hepatic encephalopathy?

A

lactulose and rifaximin

254
Q

barretts oesophagus increases the risk of having which cancer?

A

adenocarcinoma of the oesophagus

255
Q

achalasia increase the risk of having which cancer?

A

squamous cell carcinoma of the oesophagus

256
Q

when should PPIs be stopped before an upper GI endoscopy?

A

2 wks before

257
Q

what is used for prophylaxis of oesophageal bleeding?

A

propranolol

258
Q

what is the most common site affected by crohns disease?

A

ileum

259
Q

what is the classic triad of mesenteric ischaemia?

A

history of cardiovascular disease
high lactate
soft but tender abdo

260
Q
A

finals (25 decks)

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