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Phase 2A (HV) > Miscellaneous- Gi + Liver > Flashcards

Miscellaneous- Gi + Liver Flashcards

1
Q

What antibodies are associated with autoimmune hepatitis

A 
ANA 
Anti Smooth Muscle (anti-actin)
Anti soluble liver antigen (anti SLA/LP)
Anti Liver Kidney Microsome 1 
Anti Liver Cytosol
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2
Q

Tumour marker for hepatocellular carcinoma

A

Alpha fetoprotein

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3
Q

Tumour marker for chalangiocarcinima

A

CA19-9

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4
Q

What diseases is cholangiocarcinoma associated with

A

PSC
UC
Chronic cholecystitis

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5
Q

Where does cancer of liver metastasise to

A

Lung bones

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6
Q

What enzyme conjugates bilirubin

A

UDP Glucosonyl transferase

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7
Q

What is the classical LFT findings in alcoholic liver disease

A

AST;ALT ratio is 2;1

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8
Q

1st line treatment for hepatic encephalopathy

A

1st line- Lactulose

Additionally add
Abx- rifaximin
Nutritional support- e.g. nasogastric feeding

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9
Q

What antibodies is PBC associated with

A

Anti mitochondrial antibody (AMA M2)

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10
Q

Key signs and Sx of PBC

A 
Hyperpigmentation of pressure points 
Xanthasmos 
Clubbing 
RUQ pain 
Jaundice (cholestatic)
Joint pain
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11
Q

What is PBC

A

Autoimmune disease characterised by the destruction of intra-hepatic ducts

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12
Q

Tx for PBC

A

Ursodeoxycholic acid

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13
Q

What is PSC

A

Chronic inflammation of the intra and extra-hepatic ducts of the liver

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14
Q

Sx of PSC

A 
Nights sweats 
Fever
RUQ pain 
Jaundice 
Fatigue
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15
Q

Gold standard Ix for PSC

A

ERCP/MRCP- beaded string

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16
Q

Tx for PSC

A

Lifestyle changes- avoid alcohol
Antihistamines for pruritus
Strictures dilated via ERCP

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17
Q

Sx of pellagra

A

B3 niacin deficiency
Dementia
Dermatitis
Diarrhoea

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18
Q

Mode of inheritance of haemochromotosis

A

Autosomal recessive (mutation in HFE gene)

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19
Q

What is the role of hepcidin

A

Protein responsible for controlling iron absorption (low in haemochromotosis)

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20
Q

Sx of haemochromotosis

A

Hyperpigmentation- bronze look
Organomegaly
Joint pain

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21
Q

Initial treatment and pharmacological treatment of haemochromotosis

A

CX- avoid alcohol
1st line- venesection
Rx- deferoxamine

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22
Q

List 4 pathophysiological causes for ascites

A

Local inflammation- peritonitis
Leaky blood vessels
Low flow- cardiac failure, cirrhosis, thrombosis
Low protein- hupoalbuminaemia

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23
Q

What causes wernickes encephalopathy

A

Deficiency in vit b1- thiamine

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24
Q

Triad associated with wernickes encephalopathy

A

Ophthamaloplegia
Ataxia
Confusion

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25
Q

Name a pharmacological tx for diarrhoea

A

Loperamide- opioid receptor agonist

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26
Q

What condition is strongly associated with autoimmune hepatitis

A

Graves’ disease

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27
Q

Treatment for cdiff

A

Oral vancomycin and metronidazole/fidoxamin

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28
Q

4 causes of peritonitis

A

Bacterial infection
Perforation of organ- SBP
bile leak
Blood from ruptured ectopic pregnancy

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29
Q

Causes of portal hypertension

A

Pre- portal vein thrombosis

Intra- cirrhosis, schistosomiasis, sarcoidosis

Post- budd chiari, CHF, constrictive pericarditis

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30
Q

Risk factors for gallstone

A

Fat
Female
Forty
Fertile

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31
Q

What is Charcot triad and what disease is it associated with

A

Ascending chilangitis

Fever
RUQ pain
Jaundice

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32
Q

1st line and gold standard investigation for ascending cholanangitis

A

1st line- Abdominal uss

Gs- MRCP

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33
Q

Tx for ascending cholangitis

A 
IV antibiotics (cefotaxime and metronidiazole)
ERCP- relieve obstruction
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34
Q

B what bacteria can cause ascending cholangitis

A

Ecoli
Klebsiella
Enterococcus

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35
Q

Sign of acute cholecystitis

A

Murphys sign- inspiartory arrest on RUQ palpitation

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36
Q

What type of hernias have a female predominance

A

Femoral

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37
Q

3 broad catergories of bowel obstruction and 3 causes

A

Obstruction- tumour, diaphragmatic disease, gallstones in ileum

Contraction- hircshpprung disease, intramural tumour, inflammation

Pressure- intersucception, volvuous, adhesions

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38
Q

What is the most common cause of bowel obstruction in children under 2

A

Intersucception

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39
Q

1st line investigation for bowel obstruction

A

Abdominal X-ray- coffee bean sign (specific for volvulus)

40
Q

Tx for bowel obstruction

A

If fluids
Decompression
Analgesics and anti emetics
Abx

41
Q

Most common cause of SBO in adults

A

Adhesions

42
Q

Causes of oesophageal cancer

A 
Achlasia
Barrets oesophagus
Corrosive oeshagitis
Diverticulitis 
Eoshageal web
Gord
Alcohol smoking
Hiatal hernia
43
Q

Achlasia appearance on X-ray

A

Birds beak

44
Q

What can h-pylori cause

A

Gastritis
Peptic ulcers (90% causes in duodenal ulcer)
Gastric cancer

45
Q

1st line tx for Wilson’s

A

Pencillamide (copper chelater)

46
Q

Cause of Wilson’s disease

A

Autosomal recessive- mutation of ATPB7 gene

47
Q

Where are femoral hernias located

A

Inferior and lateral to pubic tubercle

48
Q

List 5 antibiotics that cause c-diff

A 
Carbapenams 
Cephalosporins
Clindamycin 
Co-amoxiclav
Ciprofloxacin
49
Q

What change is seen in barrets

A

Stratified squamous to simple columnar

50
Q

What is the treatment for ascites

A

Treat underlying cause
Slat and fluid restriction
Spiranolactone

51
Q

What is the 1st line tx for crohns

A

Corticosteroids- oral prednisalone

52
Q

1st line tx for UC

A

Topical or oral sulfalasalzine (5 ASA)

53
Q

What is the 1st line Ix for coeliacs

A

Total IgA and IgA tTG

54
Q

What histology changes are seen in coeliacs

A

Villous atrophy

Crypt hyperplasia

55
Q

List 3 complications of coeliacs

A

Anaemia
Osteoporosis
Hyposplenism

56
Q

What changes can be seen in colonoscopy in a patients diagnosed with crohns

A

Cobblestone appearance
Skip lesions
Deep ulcers

57
Q

What changes can be seen on colonoscopy in pts with UC

A

Psuedopooyps,

Continuation of inflammation form rectum

58
Q

What changes can be seen on histology in crohns

A

Transmurral inflammation
Granulomas non casesting
Increase in goblet cells
Skip lesions

59
Q

What changes can be seen on histology in UC

A

Continuous inflammation
Mucosa only
No/decreased goblet cellls
Crypt abscesses

60
Q

Name r extra manifestations of IBD

A

Pyoderma gangrenosum
Erythema nodusum
Uveitis
Arthralgia

61
Q

What are the types of oesophageal cancers and where are they mostly found

A

Adenicarcinoma- lower 1/3 of oesophagus

Squamous cell carcinoma- upper 2/3 of oesophagus

62
Q

List 5 risk factors for oesophageal adenocarcinoma

A 
Gord 
Achlasia 
Barrets 
Smoking
Obesity
63
Q

List 5 rf for oesophageal squamous cell carcinoma

A 
Achlasia 
Smoking 
Alcohol
HPV
diets risk in nitrosamines 
Hot fluids
64
Q

List 5 causes of gastric cancer

A 
H-pylori 
Obesity
Smoked foods 
Pernicious anaemia 
Mutations/fhx
65
Q

Where are most colorectal cancers found

A

Rectum

66
Q

List 5 causes of dyspepsia

A 
Large volume meals 
Obesity
Smoking
Pregnancy 
Excess acid 
H-pylori infection 
GORD
67
Q

What is the treatment for eradication of h-pylori

A

Triple therapy

Omaeprazole + amoxicillin + clarithromycin for 7 days

68
Q

What is the most common cause of pseudommebranous colitis and it’s associated Sx

A

C-diff infections

Mucoid, green smell watery stools 
Abdominal cramps
Fever 
Nausea 
Abdominal pain
69
Q

What is Achlasia

A

The failure of oesophageal peristalsis and LOS relaxation due to loss of ganglia from Auerbach plexus (muscularis propria)

70
Q

Gs investigation for Achlasia

A

Oeshaphagel mammometry

71
Q

1st line ix for Achlasia

A

Barium swallow- birds beak appearance

72
Q

Tx for Achlasia in
A- a good surgical candidate
B- poor surgical candidate

A

A- balloon dilation (1st line)

B- nitrates (isosorbide nitrate) and calcium channel blockers (verapamil/nifedipine)
2nd line- botulinum toxin

73
Q

Gs ix for diverticulitis

A

Ct abdomen

74
Q

List 5 rf of Gord

A 
Smoking
Obesity 
Alcohol
Hiatal hernias
Scleroderma
75
Q

Tx for divertucular disease

A

Diet modification- high fibre diet and increase fluid intake (whole grain and fruit)
Bulkforming laxatives for constipation-
Antispasmodics for pain

76
Q

List 5 causes of dyspepsia

A 
Large volume meals
Smoking
Alcohol
Pregnancy 
Obesity 
Excess acid production 
Prolonged use of NSAIDs
77
Q

Red flags for dyspepsia

A

Vomiting
Anaemia/bleeding
Abdominal pain/weight loss
Dysphagia

78
Q

Tx for dyspepsia w/o red flag Sx

A

Review medication
Lifestyle and diet modifications
Full dose PPI for 4 weeks
Test and treat h-pylori

79
Q

Tx for dyspepsia w/ red flag Sx

A

Review medication and stop NSAIDs use
Endoscopy
Referral to malignancy specialist

80
Q

What clinical tool is used to classify faeces

A

Bristol stool chart

81
Q

Name three types of diarrhoea

A 
Inflammatory 
Exudative 
Osmotic 
Dysentery 
Secretory
82
Q

What are the abdominal radiograph findings in bowel obstruction

A

Dilated bowel proximal to obstruction

Absence of gas in bowel distal to obstruction

83
Q

What are haemorrhoids

A

Are swollen inflamed veins of the rectum and anus

84
Q

List symptoms of haemorrhoids

A 
Anal pruritus
Discomfort when sitting 
Painful 
Sore anus 
Fresh blood on wiping
85
Q

Name 2 non surgical and one surgical tx for haemorrhoids

A

Ns- topical analgesia, high fibre diet, bulk forming laxatives

Surgical- band ligation

86
Q

List 5 causes of acute infectious diarrhoea

A 
Viral infection- rotavirus, Norovirus 
Parasitic infection - giardia lambila 
Bacterial infection- salmonella
IBD
IBS
Anxiety 
Antibiotic associated diarrhoea
87
Q

List 5 rf of colorectal cancer

A 
UC/Crohns 
Low fibre diet
Obesity
Smoking 
Alcohol
High intake of red meat 
Increasing age 
FHx
88
Q

List 4 complications of diverticulitis

A

Perforation
Sepsis
Abscess formation
Obstruction

89
Q

What drug is used to treat ruptured oesophageal varicies

A

IV Terlipressin

90
Q

What drug would you use if iv terlipressin was contraindicated

A

IV somatostatin

91
Q

Gs ix for appendicitis

A

Ct scan abdo

92
Q

Name the 3 different type of gallstones

A

Cholesterol
Calcium billurubinate- chronic haemolytic anaemia
Brown pigment- stasis and infection

93
Q

1st line treatment for autoimmune hepatitis and tx for remission

A

1st line- prednisalone

Remission- azathioprine

94
Q

What is cirrhosis

A

Diffuse fibrosis and structural abnormality of the liver due to chronic inflammation

95
Q

Features of internal haemorrhoids

A

Painless rectal bleeding
Bright red blood in toilet after defacation
No abnormalities to external rectal anal canal

Phase 2A (HV) (13 decks)

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