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MRCP Part 1 > MRCP Gastro > Flashcards

MRCP Gastro Flashcards

1
Q

What is pernicious anaemia

A

anti parietal and anti IF antibodies

B12 deficiency (absorbed in terminal ileum)

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2
Q

Autoimmune hepatitis 2 types and autoantibodies

A

type 1: anti smooth muscle

type 2: anti-LKM

IgG

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3
Q

Treatment for CLD encephalopathy

A

Encephalopathy:
lactulose,
rifaximin (modify gut microbiome)

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4
Q

Treatment for CLD ascites

A

Ascites: drain, diuretics- spiro first line to prevent reaccumulation (second line furosemide), albumin (HAS), TIPS (in refractory ascites)

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5
Q

What is whipple’s disease?

A

Tropheryma whippelii infection

Present:
abdo pain,
arthritis,
steathorrhoea

Mx: co trimox

jejunal biopsy: deposition of macrophages containing Periodic acid-Schi

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6
Q

Cirrhosis surveillance for varices and HCC

A

3 monthly OGD
6 monthly USS (+AFP if hepB)

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7
Q

What is Haemochromatosis?

AKA bronze diabetes

A

IRON deposit in pancreas

tanned, diabetes, cirrhosis
loss of hair, hypogonadism

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8
Q

Investigation for hepatic encephalopathy

A

Serum Ammonia Level

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9
Q

What tests suggest haemochromatosis?

A

Transferrin saturation >60%

Ferritin >500
TIBC <20
Iron >30
HFE gene mutation (C282Y mutation)

decreased plasma hepcidin

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10
Q

What is hepcidin

A

regulatory of iron in body
- inhibitrs intestinal absorption and drives into cells

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11
Q

What is a common bowel symptoms following Giardia infection?

A

Lactose intolerance for few week

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12
Q

What is giardiasis?

A

Traveller’s diarrhoea
Protozoon Giardia lamblia
Faeco-oral

Mx: single dose tinidazole OR one week metronidazole

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13
Q

Differentiate between acute and chronic bowel ischaemia

A

Acute- acute abdominal pain, guarding

Chronic- pain only after meals, may not have acute abdomen due to adequate collateral circulations

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14
Q

What other conditions are associated with rise in amylase (apart from pancreatitis)

A

acute mesenteric ischaemia

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15
Q

Differentiate between right sided and left sided colorectal cancer

A

Right- NO altered bowel habit/rectal bleed
- less likely to present with bowel obstruction as food is still liquid chyme

Left- altered bowel habit/rectal bleed
- solid faeces

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16
Q

What is the investigation of choice for iron deficiency microcytic anaemia?

A

Colonoscopy +/- OGD

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17
Q

What is the abx choice for SBP?

A

IV ceftriaxone

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18
Q

What is SBP and related pathogen?

A

Infected ascites

E.coli/Enterococcus/Streptococcus

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19
Q

What is glascow score for pancreatitis?

A

pO2 <8 (hypoxic)
Age >55
Neutrophil >15
Calcium <2
Renal urea >16
Enzyme ALT >200, LDH >600
Albumin <32
Sugar >10 (hypergly)

Significant hypocalcaemia=severe

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20
Q

What type of bilirubin confirms Gilbert’s?

A

Unconjugated bilirubin (high)

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21
Q

What is Gilbert’s syndrome?

A

Reduced UDP-glucoronyltransferase activity
- enzyme that conjugates in liver

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22
Q

Outline the most sensitive investigation test and confirming eradication for H.pyelori?

A

13C urea breath test is most sensitive

should have 2 week wash out of PPI before test

drink 13C urea->h.pyelori urease will convert 13c urea to ammonia and 13c- CO2

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23
Q

What is the treatment for h.pyelori

A

2 abx for 2 weeks
+ PPI for 1 week

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24
Q

When should you consider OGD 2WW?

A

> 50 years
anaemia/weight loss/anorexia
melaena/haematemesis/dysphagia

ALARM sx

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25
Q

Why does cirrhosis cause gynacomastia?

A

XS oestrogen

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26
Q

What is pseudomembranous colitis?

A

C.diff colitis

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27
Q

What is first line treatment for C.diff colitis?

A

Vancomycin

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28
Q

How does pharyngeal pouch present?

A

Intermittent swallowing difficulty
Regurgitation
Halitosis

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29
Q

What causes gastrin secretion and what inhibits?

A

amino acid secretes

pH <3 inhibits

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30
Q

What extraintestinal features are seen in UC?

A

Episcleritis (Red painful eye)
Pyoderma gangrenosum
Erythema nodosum

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31
Q

What is UC and where does it affect?

A

Starts from rectum -> ileocaecal valve

(terminal ileitis)

Continuous

Crypt abscess on biopsy

pseudocyst

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32
Q

What is the treatment of choise in UC that is not controlled with sulfasalazine (mesalazine) or steroids?

A

Thiopurine: azathioprine or 6mercaptopurine

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33
Q

What is characteristic symptom of IBS?

A

Abdominal discomfort eased by bowel opening

Mx: soluble fibre

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34
Q

What is first line endoscopic thearpy for oesphageal varice?

A

Band ligation

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35
Q

Which chemotherapy is orally administered for advanced colorectal cancer?

A

Capecitabine

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36
Q

Which chemotherapy is intravenously (central line) administered for advanced colorectal cancer?

A

5 FU

fluorouracil

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37
Q

What is Gardner syndrome?

A

AD-

APC gene
Chromosome 5q21

multiple polyps (adenoma)
soft tissue tumours (lipoma)

Mx: total colectomy

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38
Q

What is peutz-jeghers syndrome?

A

Autosomal dominant
mutation in STK11 gene
Chr 19

polyposis
peri-oral pigment

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39
Q

Why is lactulose given in decompesanted liver disease and hepatic encephalopathy?

A

reduces systemic absorption of ammonia

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40
Q

Symptoms of carcinoid syndrome?

A

diarrhoea
flushing
wheeze

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41
Q

Mangement of Whipple’s

A

2 weeks ceftriaxone/penicillin

then 1 year of co-trimoxazole

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42
Q

Which cancer is chronic hep B associated with?

A

HCC

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43
Q

What is UC associated with?

A

PSC

inflammation and fibrosis of bile duce

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44
Q

Which auto-antibody is PBC associated with?

A

anti-mitochondrial antibody

Note:
IgM
Middle aged men
AMA

middle aged women, associated with autoimmune disease

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45
Q

Which condition presents with auto-immune features, macrocytic anaemia?

A

Pernicious anaemia

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46
Q

SAAG equation

A

SAAG = Serum Albumin Concentration - Ascites Albumin Concentration

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47
Q

Transudative ascites

A

11 g/L or More

Generally transudative causes

Cirrhosis

Heart Failure

Renal Failure

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48
Q

Exudative ascites

A

11 g/L or more (extra)

Generally exudative causes (because inflammation leads to an increase in vascular permeability which, in turn, causes more protein leakage into the ascitic fluid)

Peritonitis

Malignancy

Tuberculosis

Nephrotic Syndrome
- This is an anomaly as it is NOT exudative.
- It causes a low SAAG because the patients lose albumin through their urine resulting in a low serum albumin concentration.

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49
Q

Outline severity of UC

A

Mild <4
Moderate 4-6
Severe >6 + sepsis

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50
Q

Hepatitis management A-E

A

Management
Cholestyramine for pruritus
Avoid alcohol

Hepatitis A and E
Self-limiting
Resolves with supportive care

Hepatitis B
Antiviral Therapy (e.g. tenofovir, peginterferon alfa)

Hepatitis C
Antiviral Therapy (e.g. sofosbuvir/velpatasvir)

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51
Q

Outline management for UC to induce remission

A

Proctitis
- rectal mesalazine +/- oral mesalazine +/- oral prednisolone

Proctosigmoiditis
- rectal mesalazine + oral mesalazine
- rectal steroid + oral mesalazine

Extensive
- rectal mesalazine + oral mesalazine

Severe
- IV hydrocortisone +/- IV ciclosporin/surgery

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52
Q

Which type of oesophageal cancer are Barrett’s at risk of?

A

Adenocarcinoma of oesophagus

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53
Q

Ouline Barretts’s frequencey of OGD and management

A

No dysplasia
- every 2-5 years

Low grade
- every 6 months
- repeat OGD with biosy

High grade
- every 3 months
- endoscopy ablation with resection/radiofrequency ablation

High dose ppi

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54
Q

Which gastric cancer is associated with peptic ulcer history and pancreatic mass?

A

Gastrinoma
- 60% malignant
- 40% MEN1

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55
Q

What is zollinger ellison syndrome and associated with?

A

Gastrin producing tumours
Severe peptic ulcer disease

check serum gastrin

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56
Q

Drugs that cause cholestatic liver injury
(raised GGT, ALP, BR)

A

penicillin
erythromycin
COCP

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57
Q

Drugs that cause hepatic liver injury
(Transaminitis (AST/ALT)

A

Paracetamol
pheytoin
alcohol
TB drugs
Allopurinol

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58
Q

Drugs that cause mixed cholestatic/hepatic liver injury

A

Co-amox
Carbamazepine
Sulfasalazine
Sulphonamide

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59
Q

What is the management for haemochromatosis?

A

phlebectomy to reduce haematocrit to <40%

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60
Q

What is wilson’s disease?

A

CLD and early onset dementia from copper deposits

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61
Q

What is abetalipoproteinaemia?

A

failure to make chylomicrons in villi

DAKE malabsorption

D- ricket
K- prolonged INR/PT

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62
Q

What genetic mutations is seen in coeliac disease?

A

HLA DQ2 or HLADQ8

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63
Q

What should be checked in coeliac?

A

Screening:
- IgG- TTG
- IgA immunoglobulin
- Anti-Endomysial

Gold standard:
- OGD + duodenal biopsy

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64
Q

What do you see in coeliac but not in pernicious anaemia?

A

Iron deficiency anaemia

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65
Q

What is seen in OGD biopsy for coeliac?

A

villous atrophy of small bowel
lymphocytic duodenosis

Crypt hyperplasia

Increased intraepithelial lymphocytes

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66
Q

What deficiency causes angioedema without urticaria?
What is it associated with?

A

C1 esterase inhibitor deficiency

Lymphoproliferative disease

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67
Q

Differentiating factor between Dubin Johnson syndrome and Rotor syndrome?

A

Dubin=liver biopsy dark pigmented
Rotor= normal biopsy

both isolated conjugated hyperbilirubinaemia (indirect BR)

Dubin Dark

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68
Q

What skin manifestation do you see in coeliac?

A

Dermatitis herpetiformis

itchy bullous rash

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69
Q

What is HUS (haemolytic uraemic syndrome) caused by?

A

E.coli0157

haemolytic anaemia
AKI
thrombocytopenia

SCHISTOCYTES on blood film due to shearing of RBC- > microthrombi

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70
Q

What are the causes of bloody diarrhoea?

A

CHESS

campylobacter = uncooked/unpasteurise
Haemorrhagic E.coli0157 = = meat
E.hitolytica
Salmonella = egg/pork/poultry
Shigella

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71
Q

What is the mortality rate from variceal haemorrhage?

A

30%

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72
Q

What is the most sensitive test for detecting hep c infection?

A

HCV RNA (from 1-2 wks)

Anti-HCV only from 6 weeks

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73
Q

Down’s syndrome patient presenting with symptoms of bowel obstruction

A

Meckel’s diverticulum

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74
Q

What do you see in ultrasound of PSC?

A

intra and extra hepatic duct dilatation

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75
Q

What causes encephalopathy?

A

Ammonia
Uraemia

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76
Q

What is crigler najjar syndrome?

A

another form of glucuronosyltransferase deficiency

Type 1: AR = early death in childhood
Type 2: AD/AR = milder illness (unconjugated hyperbili)

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77
Q

What non gynae cause of CA125 rise?

A

Cirrhosis
Ascites
Breast cancer

Note: ovarian cancer

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78
Q

How can a mass cause AKI?

A

compression of ureters

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79
Q

What causes c.diff, investigation and management?

A

Recent abx (disrupt gut flora)
- clindamycin
- cefalexine

Toxin (infx) and antigen (exposure)

Mx:
First ep:
1) Vanc
2) fidoxamicin
3) van +/- metro IV

Recurrent:
1) fidoxamicin
2) faecal transplant

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80
Q

What imaging should you do with biliary obstruction secondary to pancreatic cancer?

A

CTAP

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81
Q

What are the risk factors for gallstone?

A

Fat
Female
Fertile
Forty
Fair

Crohn
Colestyramine
Cirrhosis
Clofibrate
Cholesterol
COCP

Ileal resection

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82
Q

Which endocarditis is associated with colorectal cancer?

A

Step bovis

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83
Q

What is small intenstianal bacterial over growth?

A

Scleroderma => Chronic stricture/dilatation/diverticulum in small bowel => dysmotility => intestinal overgrowth (E.coli) => chronic diarrhoea

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84
Q

What extrahepatic manifestations is HCV associated with?

A

mixed cryoglobinemia
= immune complex deposition causing vascular inflammation

transient rash and arthritis

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85
Q

Hepatitis transmission route?

A

A
B
C
D
E

A+E = eat ass (faecal oral)
B= bodily fluid, blood, birth
(ds DNA as second letter, everything else is RNA)
C= Chronic, IV (c)
D= best buds (need B for infection)

Vaccine exist for A+B (Anti-Body)

B+C => cirrhosis and HCC

A+E = acute
E= pregnancy

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86
Q

Causes of pyogenic liver abscess

A

S.aureus
E.coli

amoebic abscess present later i.e entamoeba histolytica

Hyatid liver abscess SHOULD NOT BE ASPIRATED (risk of seeding)

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87
Q

How does crohn’s manifest?

A

mouth to anus with skip lesions
Mouth ulcers

whole thickness in all layers

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88
Q

Causes of pancreatitis?

A

GET SMASHED

Gallstone
Ethanol
Trauma

Steroid
Mumps
Autoimmune
Scorpion bite
Hypothermia/hypercalcaemia/hyperlipidaemia
ERCP
Drugs

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89
Q

Which UC medication is associated with pancreatitis?

A

Azathioprine

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90
Q

Which cancer is UC associated with?

A

Cholangiocarcinoma

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91
Q

What is pyoderma gangrenosum?

A

purple coloured ulcerated lesion on skin

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92
Q

What prophylactic medication should be given for oesophageal varice?

A

Beta blocker

reduce portal pressure

carvedilol

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93
Q

How does intrahepatic cholestasis of pregnancy present and when?

A

Pruritis

2nd or 3rd trimester

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94
Q

How does hyperemesis cause deranged LFT?

A

ALT and bili mildly raised

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95
Q

What condition must be ruled out in IBS?

A

Coeliac

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96
Q

Mangement of acute UC?

A

AXR
- toxic megacolon
- bowel wall >6cm, loss of haustra, thumb print (oed)

Stool MCS (infx)
IV hydrocortisone
Flexifig
VTE

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97
Q

What is anti-LKM associated with?

A

Autoimmune hepatitis
Drug induced hepatitis

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98
Q

Which autoantibody is PSC associated with?

A

pANCA

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99
Q

Which drugs can cause DILI?

A

MINK

Methydopa
Isoniazid
Nitrofurantoin
Ketoconazole

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100
Q

Outline management for maintaining remission for UC

A

Proctitis and proctosigmoiditis:
- rectal mesalazine (daily/intermittent)
- oral mesalazine + rectal mesalazine (daily/intermittent)
- oral mesalazine

Extensive/left sided UC:
- low maintenance oral mesalazine

Severe relapse OR >=2 exacerbations/year
- oral azathioprine
- mercaptopurine

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101
Q

Outline management for inducing remission in Crohns

A
  1. steroid OR budesonide OR mesalazine
  2. ADD ON azathioprine/mercaptopurine/methotrexate
    - 2 or more exacerbations in 12 months
    - Glucocorticoid dose cannot be tapered
    - WARNING: assess thiopurine methyltransferase (TPMT) levels before starting azathioprine or mercaptopurine
  3. infliximab + metho/azathio (refractory/fistulating/severe)
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102
Q

Outline management fo maintaining remission for Crohns

A

STOP SMOKING
First: Azathioprine/mercaptopurine as monotherapy
Second: methotrexate if above not tolerated.

Do NOT offer glucocorticoids to maintain remission

low TPMT activity are at increased risk of myelosuppression and toxicity

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103
Q

How do you treat intestinal pseudo-obstruction in advanced PD?

A

Domperidone

Note: metoclopramide worsen movement disorder

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104
Q

What is Budd Chiari syndrome

A

Occlusion of hepatic vein

ascites and splenomegaly and hepatomegaly

associated with COCP/Polycythaemia

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105
Q

What does elevated SAAG in ascitic tap indicate?

A

PORTAL HYPERTENSION

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106
Q

What are ALARM symptoms for OGD referral ?

>55 plus ALARM symptoms

A

Anaemia
Loss of weight
Anorexia
Recent onset of pregressive sx
Melaena/haematemesis/dysphagia

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107
Q

What is the treatment for bile acid diarrhoea post cholecystectomy?

A

First line: Cholestyramine
Second line: codeine

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108
Q

When is variceal banding used?

A

Grade 2 or 3 varice
Bleeding varice

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109
Q

What tumour marker strongly indicates metastatic colorectal cancer/recurrence?

A

CEA

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110
Q

How do you diagnose small intestinal bacterial overgrowth?

A

small bowel aspirate and cultures

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111
Q

What is HELLP syndrome?

A

Haemolysis elevated liver enzyme low platelet

risk of eclampsia- need Magsulf

Mx: deliver of baby

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112
Q

Risk of ischaemic colitis

A

AF
vascular disease
thrombophilia
COCP

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113
Q

What is watershed areas?

A

regions in the colon between 2 major arteries that supplying colon.

Splenic flexure is the area between SMA and IMA

rectosigmoid junction is the region between the IMA and the superior rectal artery

prone to ischaemia due to fewer collateral

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114
Q

What blood tests are abnormal in haemolytic anaemia?

A

unconjugated BR
abnormal haptoglobulin

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115
Q

How do you diagnose and manage PBC?

A

anti-AMA (usually no need for biopsy)

Mx: ursodeoxycholic acid and cholestyramine

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116
Q

Which organs make direct contact with left kidney retroperitoneally?

A

pancreas and adrenal gland

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117
Q

What should you check in chronic pancreatitis and how do you supplement that?

A

Faecal elastase (insufficiency)
Pancreatic enzyme (malabsorption)

Note: amylase may be normal

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118
Q

What do you see on ultrasound of PBC?

A

intrahepatic duct destruction

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119
Q

Charcot triad of ascending cholangitis?

A

Jaundice
RUQ pain
Fever

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120
Q

Common causes of ascending cholangitis?

A

Gallstone
ERCP

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121
Q

What investigations should be done for young person with recurrent peptic ulcer?

A

Screen for gastrinoma
octreotide scan- for neuroendocrine

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122
Q

4 causes of chronic hepatitis

A

Hep B
Hep C
autoimmune
drugs (MINK)

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123
Q

Which antibody is autoimmune hepatitis associated with?

A

anti-smooth muscle

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124
Q

What is the incubation period of Hep A?

A

2-4 weeks

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125
Q

What artery supplied distal 1/3 transverse colon, splenic flexture, descening colon, sigmoid colon, rectum?

A

Inferior mesentaric artery

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126
Q

Wilson disease chromosome

127
Q

Which vitamin is deficient in zollinger ellison syndrome?

A

B12

gastric acid inhibits formiation of vit 12

128
Q

What feature indicates UC flare needs surgery (colectomy)

A

> 8 bowel motions per day

Pyrexia

Tachycardia

Abdominal X-ray showing colonic dilatation (toxic megacolon)

Low albumin, low haemoglobin, high platelet count, CRP above 45 mg/L

129
Q

What is the kings criteria for liver transplant?

A

pH <7.3 or INR >6.5
and Creatinine >300
and Grade 3 hepatic encephalopathy

Symptoms

Grade 1: altered mood/behaviour, minimal change GCS
Grade 2: asterixis, drowsy
Grade 3: confused, incoherent
Grade 4: comatose, unresponsive to pain GCS 3

130
Q

What dose AST:ALT >2 suggest?

A

alcoholic hepatitis

Make ASS of themself

131
Q

Tumour markers:

A

HCC: AFP
Pancreatic: CA199
Trophoblastic: beta HCG
Ovarian: CA125
Colorectal: CEA

132
Q

Management of wilson’s

A

Medical
Penicillamine (copper chelator)

Zinc Therapy (blocks copper absorption in the intestines)

Trientine

Surgical
Liver Transplantation

133
Q

Which hepatitis is associated with shellfish?

134
Q

Outline UGIB managment

A

Fluid resus

OGD in 24 hrs
- direct adrenaline/clips
- variceal banding for varice
- embolisation IR

IV PPI if non variceal bleed pre OGD

Terlipressin and abx pre OGD (better than octreotide)
- this must be given before OGD!!!!

135
Q

Difference between NASH and NAFLD

A

NASH is severe form of NAFLD with fatty liver, and liver fibrosis

AST:ALT <1 is NAFLD

136
Q

What gastric proton pump does omeprazole irreversibly bind to?

A

K+/H+ ATPase in parietal cells

137
Q

What drug can cause transient ischaemic colitis in watershed areas?

A

cocaine (just like coronary spasm)

138
Q

What does anti HBsurfarce antibody imply?

Anti-sick antibody

A

Immune (prev vaccine)
Natural infection

vaccine has surface antigen

139
Q

HbSAg indicates

A

SICK

incubation
acute illness

140
Q

HbeAg indicates

A

EASILY spread (infective)

only Escapes in acute infection

141
Q

HbCAg indicates?

A

C through the window period

142
Q

Anti-HbC antibody

A

Came across Hep B
(NOT VACCINATED)

previous infection/ongoing
IgM= acute
IgG= chronic

143
Q

Anti-Hbe antibody

A

Anti-easily spread

low transmissbility

144
Q

How does pancreatic cancer present?

A

abdo pain radiating to back
painless jaundice

145
Q

Where is the gallstone likely to have blocked to cause pancreatitis?

A

Ampulla of vater

146
Q

How does acute pancreatitis cause ARDS?

A

protein risk oedema fluid due to alveolar permeability

147
Q

What is typhoid fever?

A

salmonella typhi
diarrhoea/constipation settles
later fever, headache, cough, rose spots blanching
transaminitis and neutropenia
cef/cipro

148
Q

What is the most sensitive index of viral replication for Hep B?

A

Hep B virus DNA

149
Q

What is the hallmark of hep E virus infection?

A

marked cholestasis

150
Q

What barium swallow findings suggest Achalasia?

A

Bird beak

oesophgeal motility disorder

dysphagia to both liquid and solid

151
Q

What is the abx of choice for cholera?

A

PO doxycycline single dose

OR PO Cipro

152
Q

which bacterial food poisoning present with vomiting 2-4hrs post ingestion?

A

s.aureus

enterotoxin contaminant

diarrhoea watery and profuse after vomiting

153
Q

How does Yersinia present?

A

uncooked meat
1 day after ingestion

154
Q

What is Mirizzi syndrome?

A

Gallstone in cystic duct

155
Q

How does Hep A present?

A

Flu like illness
then jaundice

156
Q

What is the management for pyogenic liver abscess?

A

amoxicillin + ciprofloxacin + metronidazole

157
Q

What cancer is barrett’s oesophagus associated with?

A

Oesophageal adenocarcinoma

158
Q

Outline different types of hepatitis and steatosis

A

Alcoholic hepatitis (cholestatic)
Alcoholic hepatic steatosis (transaminitis)
Autoimmune hepatitis (ASM, cholestatic)
Non alcoholic hepatic steatosis (fatty liver no ETOH)
Non alcoholic steatohepatitis (transaminitis, no ETOH)

159
Q

What laboratory findings do you see in Wilson’s?

A

Low caeruloplasmin

Low serum copper (bound to above)
High urinary copper
Low serum uric acid (urinary excretion)
High AST

160
Q

What imaging should be ordered for bowel obstruction (tinkling bowel sound)

161
Q

What does HBV DNA viral load tell you?

A

Risk of progression of Hep B to cirrhosis

162
Q

What is the triad of Wernicke’s encephalopathy?

A

Opthalmoplegia
Ataxia
Confusion

163
Q

What is deficient in wernicke?

A

vitamin B (thiamine)

164
Q

What is korsakoff syndrome?

A

Chronic wernicke with memory loss

165
Q

How do you differentiate between IBS and alternative diagnosis?

A

Pain not relieved by defecation

166
Q

What is systemic mastocytosis?

A

XS mast cell producing blood disorder

increased histamine production thus increased gastric acid

hypened allergic reaction

167
Q

What is transudate ascitic fluid and causes

A

protein <30 (assuming normal alb)

cirrhosis
HF
Nephritis
Nephrotic (low alb)
Budd Chiari

168
Q

What is exudate ascitic fluid and causes

A

protein >30

infection (SBP/TB)
inflamm (pancreatitis)
malignancy

169
Q

What does deficiency in vitamin C cause?

A

scurvy

vit c hydroxylate procollagen proline and lysine

170
Q

What is lynch syndrome and management?

A

hereditary non polyposis colon cancer syndrome

ASPIRIN may reduce risk of cancer

171
Q

If liver enzymes and amylase are elevated where is the obstruction ?

A

after pancreatic duct joins the common bild duct therefore DISTAL CBD

172
Q

What is the biochemical hallmark of refeeding syndrome?

A

HYPOPHOSPHATAEMIA

Insulin released from carb intake drives phos into cells

173
Q

Which gastric cancer is h.pyelori associated with?

A

gastric MALT lymphoma

174
Q

Which endocrine abnormality is zollinger ellison associated with?

A

Hyperparathyroidism

175
Q

What can affect 5HIAA levels

A

dietary (vegetarians)

remove dietary factors and retest

176
Q

Which traveller diarrhoea cause skin rash?

A

Yersinia

Mx: cipro

uncooked meat

177
Q

What is the side effect of metformin?

A

Bile acid malabsorption
diarrhoea

178
Q

What is the triad of symptomatic pancreatic pseudocyst?

A

epigastric pain
fever
mass in epigastrium

179
Q

What is menetiers disease?

A

Rare giant gastric folds

180
Q

What diseases cause HCC?

A

Chronic Alcoholism
Chronic viral hepatitis
Haemochromatosis
alpha 1 antitrypsin

181
Q

What is a common side effect of bisphosphonate?

A

Oesophagitis
(reflux without red flags)

182
Q

Melanosis coli

A

brown pigmentation in chronic laxative use (senna)

183
Q

What severity liver disease do you see clotting abnormality?

184
Q

What oesophageal abnormality is seen in systemic sclerosis (CREST)

A

oesophageal stricture

185
Q

What is truelove and witts criteria for acute severe colitis?

A

fever>37.8
BO >6 times with blood
ESR >30
HR >90
Anaemia

186
Q

What are the causes of toxic megacolon?

A

IBD
C.diff
Dysentry (CHESS)

187
Q

Why should you not perform flexi sig in severe colitis?

A

risk of perforation

188
Q

What is mallory weiss tear caused by?

A

alcohol binge
recurrent vomiting

189
Q

What immune complication do you see in Whipples?

A

immune reconstitution inflammatory syndrome

return of diarrhoea, arthalgia, fever

need steroids

190
Q

What are the features of drug induced lupus?

A

pleuritis
pericarditis
arthritis
photosensitive rash (SLE)

191
Q

What is the managmenet for diverticulosis and diverticulitis?

A

Diverticulosis: increase fibre
Acute diverticulitis: IV abx
Perforation: surgery

192
Q

What bed side investigation should be done in low GCS patient initially?

193
Q

How is smoking associated with Crohns and UC?

A

Crohns: risk
UC: reduced risk

194
Q

What is tropical Spru

A

Vietnam
Months of diarrhoea and malabsorption of vitamins
infection

Mx: 4-6 wk of ampicillin/tetracyclin

195
Q

What medication induces remission rapidly in UC?

A

infliximab/ciclosporin

hence saved for severe UC

196
Q

What is the diagnosis of seronegative arthritis, diarrhoea and malabsorption?

A

Whipple’s

197
Q

What are e antigen positive people at risk of?

A

Higher risk of HCC than those negative

198
Q

How does chronic pancreatitis present?

A

chronic epigastric pain
steatorrhoea
weight loss
pancreatic calcification
pseudocyst

199
Q

What is NAC?

A

N-acetylcysteine for pcm overdose

200
Q

Which ulcer is h.pyelori most associated with

A

duodenal ulcer (90%)

peptic-80%

201
Q

How often should patients with Duke’s A tumour monitored?

202
Q

Which part of bowel does the reabsorption of bile acid?

A

terminal ileum

therefore bile reach colon
increasing gastric transit time
deconjugated by gut microbiome
stimulating water and electrolye secretion
thus bile acid diarrhoea

Mx: cholestyramine

203
Q

What is the treatment for diabetic gastroparesis (autoimmune neuropathy)

A

domperidone

204
Q

What is painless jaundice, weight loss, no abdo pain

A

pancreatic adenocarcinoma

205
Q

How would you manage patients who have persistent reflux despite maximal PPI, ongoing respiratory symptoms and young

A

fundoplication

206
Q

What is the investigation for whipple’s

A

small bowel barium follow through and biopsy of small intestine- PAS macrophage

207
Q

Which food has highest folic acid?

208
Q

How does achalasia present?

A

sudden onset dysphagia TO BOTH solid and liquid
no weight loss
regurgitation

failure to relax lower spincter

209
Q

What is the diagnostic investigation of choice for achalasia?

A

Ix: oesophageal manomatry

210
Q

Differentiate between pyogenic and amoebic liver abscess

A

pyogenic- following recent biliary/GI infection

Pyogenic- multiple abscess

Amoebic- single mass

211
Q

What is entamoeba histolytica?

A

Amoebiasis is caused by Entamoeba histolytica (an amoeboid protozoan) and spread by the faecal-oral route

mild diarrhoea or severe amoebic dysentery.

high leukocyte in stool- inflamm

Mx: Metronidazole

212
Q

Outline pregnancy associated liver disease:

A

Intrahepatic cholestasis of pregnancy:
- pruritus
- raised bilirubin

Acute fatty liver of pregnancy:
- liver failure
- transaminitis and higher BR

HELLP
- hemolysis, Elevated Liver enzymes, and a Low Platelet
- RUQ pain
- nausea & vomiting

213
Q

What is the most common cause of UGIB?

A

Chronic peptic ulcer

214
Q

Outline the timescale for symptoms with food poisoning by different organisms post ingestion

A

s.aureus - 2-4 hrs, vomit,

yersinia- bloody diarrhoea, 4-10 days

salmonella- diarrhoea, 8-48hrs

campylobacter- incubation 3-7 days (flulike, diarrhoea, abdo pain)

bacillus cereus - reheated rice (5-18hrs D+V)

215
Q

What additional medication should be taken with pancreatic supplements to increase efficacy of latter ?

A

PPI (reduced acid breakdown)

216
Q

What is eruptive xanthomas and what is it associated with?

A

Yellow papules in extensors

Lipoprotein lipase deficiency
- chylomicron acquire apoC2 which activate lipoprotein lipase on vascular endothelium
- this releases TG->fatty acid from chylo into tissues
- chylo become smaller and become cholesterol rich
- remnant taken up by liver and metabolised

217
Q

What deficiency is seen in familial hypercholesterolaemia

A

LDL receptor
Apolipoprotein B (part of LDL for receptor binding)

218
Q

What can cause false negative amylase in acute pancreatitis?

A

hypertriglyceridaemia - chylomicron specifically

most common lipidaemia a/w pancreatitis

219
Q

What condition is splenic atrophy associated with?

A

coeliac disease

Howell jolly bodies in blood film for hyposplenism

220
Q

Mechanism of lansoprazole

A

H/K ATP pump inhibitor

221
Q

Mechanism of ranitidine

A

H2 receptor inhibitor

222
Q

Outline the site of absorption of essential nutrients in GI tract

A

Duodenum- release protease
Jejunum - absorb amino acid
Caecum - water absorption

223
Q

Which cell produces gastrin and where?

A

G cell in antrum and duodenum

gastrin stimulate parietal cell to secrete gastric acid

224
Q

What is the investigation for chronic enteric fever carrier (salmonella typhi)

A

culture of intestinal secreation/faeces/urine

225
Q

Differentiate between haemochromatosis and wilsons presentation

A

Haemo: joint pain, loss of libido, low testosterone

Wilson: liver, basal ganglia, eyes

226
Q

What vitamin B is thiamine

227
Q

What neurological symptoms can B12 deficiency cause?

A

peripheral neuropathy

subacute cord degeneration

228
Q

What is the role of HDL ?

A

transport cholesterol from foam cell to liver -> bile excretion

anti-inflammatory

HDL cholesterol go to organs for steroid synthesis

229
Q

Outline metabolism of VLDL to LDL and IDL

A

Liver makes VLDL transporting endogenous cholesterol and TG to peripheral tissue -> further hydrolysed in blood -> form IDL and LDL

LDL cleared by liver by LDL receptors and macrophage

XS LDL not taken up -> udergo oxidation and form foam cell -> atherosclerotic plaque

230
Q

How do you investigate diabetes induced gastroparesis?

A

gamma scintigraphy, gastric emptying study

231
Q

How do you investigate for small bowel bacterial overgrowth?

A

lactose hydrogen breath test

232
Q

Which medication is useful in controlling diarrhoea associated with carcinoid syndrome

A

octreotide

233
Q

What is the most sensitive imaging for PSC intra and extra hepatic duct stricture/dilatation?

234
Q

What is the mode of action of laxatives with examples

A

Osmotic: lactulose
Sofener: docusate
Motility: Senna
Bulk forming: movicol

235
Q

Top 3 drugs for hepatic encephalopathy

A

lactulose
enemas
rifaximin

236
Q

How does terlipressin work?

A

reduce splanchnic circulation hence reduce portal HTN

237
Q

What are polyposis syndromes?

A

Familial adenomatous polyposis
- APC gene
- a/w medulloblastoma

Peutz -Jeghers syndrome
- STK11 (LKB1) on Ch 19
- harmatomas

HNPCC (Lynch syndrome)
- DNA mismatch repair gene mutation
- CEO (colorectalm, endometrial, ovarian)
- a/w glioblastoma

238
Q

Why does haemochromatosis present with hypogonadism?

A

iron deposit in pituitary

239
Q

What is imatinib and which 2 conditions is it used in?

A

CML
GI stromal tumour

Tyrosine kinase inhibitor

240
Q

What is SeHCAT test for?

A

bile acid malabsorption

note: metformin can increase bile acid excretion causing diarrhoea thus switch to IR.

241
Q

What cancer is coeliac associated with?

A

Intestinal lymphoma (T-cell)

242
Q

What is barrett’s

A

columnar metaplasia

need surveillance as meta->dysplasia->adenocarcinoma

243
Q

Why do you check TPMT deficiency prior to azathioprine

A

risk of myelosuppression

244
Q

Which artery is the posterior duodenum supplied by?

A

posterior superior pancreaticoduodenal artery

245
Q

What is an important complication of sulfasalazine therapy?

A

pancytopenia

246
Q

What is GAVE

gastric antral vascular ectasia

A

watermelon stomach

247
Q

Which age group does PSC affect?

A

men <50 years

248
Q

Which bug causes diarrhoea in HIV patients with low CD4 <100

A

Crytosporidium

249
Q

What is the recommended daily K replacement ?

A

1mmol /kg/day

note with GI loss- 90-120 per day is recommended

250
Q

What is child pugh grade for?

A

cirrhosis mortality

251
Q

What markers are used to grade in child pugh?

A

encephalophathy
bilirubin
ascites
albumin
INR and PT

252
Q

What GI side effect is mycophenolate mofetil MMF used in renal transplant associted with?

A

crohns like enterocolitis
- skip lesions

253
Q

What does ALT:AST >2 suggest?

254
Q

How does malnutrition cuase steatohepatitis and hypercholesterolaemia?

A

anabolic process in liver to maintain albumin levels

255
Q

Which bacteria is most likely cause of SBP?

256
Q

What is hepatorenal syndrome and what clinical sign do you see in all patient?

A

vasoactive mediators cause splanchnic vasodilation

which reduces the systemic vascular resistance.

Causing hypoperfusion of kidney

RAAS activation cause renal vasoconstriction which is not enough to counterbalance the effects of the splanchnic vasodilation.

JAUNDICE AND ASCITES

257
Q

What infections is an absolute contraindication to liver transplant?

A

HIV with AIDS

258
Q

Which gene is Wilson’s associated with?

A

ATP7B gene

259
Q

What is the function of gastrin released from antral G cells?

A

stimulates parietal cells to secrete H+

increases gastric motor activity

260
Q

What is the function of secretin?

A

stimulates pancreatic secretion in response to duodenal acid

261
Q

What is the role of somatostatin in gastro?

A

decreases gastrin secretion

262
Q

What is short bowel syndrome and who are at risk?

A

previous GI surgery

causing fast transit hence malabsorption and diarrhoea

263
Q

What is protein losing enteropathy?

A

leaking protein in gut

264
Q

Which blood test would be useful in protein losing enteropathy?

A

alpha 1 antitrypsin

not degraded by protease

265
Q

What is the treatment for bacterial overgrowth syndrome?

A

rotating antibiotic therapy (metronidazole and cipro)

266
Q

What is the investigation of choice for bacterial overgrowth syndrome?

A

Hydrogen breath test

267
Q

How does bacterial overgrowth present?

A

bloating
diarrhoea
constipation

268
Q

What does IgM anti-HBc indicate?

A

ACUTE HEP B infection (mother)

269
Q

When is HBV DNA useful?

A

Chronic hep B

270
Q

Which PPI is known to interact with clopidogrel (DAPT)

A

Omeprazole

271
Q

When is prothrombin complex used?

A

warfarin reversal

272
Q

When should terlipressin be given?

A

suspected variceal bleed at presentation

273
Q

What platelet level is a contraindication for liver biopsy?

A

Platelet <50
INR >1.5

274
Q

What is cryoglobinaemia?

A

Immunoglobulins undergo reversible precipitation at 4 deg
dissolve when 37 deg

275
Q

What are the 3 types of cryoglobinaemia?

A

1: monoclonal (25%)
2: mixed mono and polyclonal (25%)
3: polyclonal (50%)

276
Q

Which cryoglobinaemia is associated with severe pulmonary fibrosis?

A

Mixed (type 2)

277
Q

Which cryoglobinaemia do you see raynaud’s?

A

Type 1 (monoclonal - IgM or IgG)

278
Q

What histological findings do you see in Crohn’s biopsy?

A

Transmural
Skip lesion
Non caseating granuloma
Goblet cells
Cobblestone
Rosethorn

279
Q

What histological findings do you see in UC biopsy?

A

mucosal and submucosal
continuous
crypt abscess

280
Q

What is IgG4 related disease associated with?

A

chronic pancreatitis

multi organ immune mediated condition

281
Q

Management of haemochromatosis

A

Management

Regular (venesection)

Iron-chelating medications eg. desferrioxamine

282
Q

Which blood test suggest UGIB

A

raised urea disproportionate to creatinine

blood digested into urea as it is protein

283
Q

What 2 conditions should be considered in isolated hyperbilirubinaemia?

A

Gilbert’s and Haemolytic anaemia

284
Q

What test should be done to rule out haemolytic anaemia

285
Q

What mineral deficiency do you see dermatitis and alopecia?

A

Zinc deficiency

286
Q

What triggers Gilberts?

A

Mild jaundice from stress/infection/fasting

287
Q

What does normal LFT apart from raised bilirubin suggesT?

A

Gilbert’s

288
Q

Apart from rectal bleed, weight loss and CIBH, what other symptom should prompt you for structural cuase of bowel disease?

A

Nocturnal diarrhoea

289
Q

Where is wedged hepatic venous pressure recorded for portal hypertension?

A

hepatic sinusoids in hepatic veins

290
Q

What does isolated ALT rise suggest?

291
Q

In severe colitis with generalised abdominal tenderness, what should be ruled out?

A

Toxic megacolon

292
Q

Which hepatitis is most common cause of acute liver failure?

A

Hep A and E

293
Q

What is the investigation of choice for perianal abscess in Crohn’s?

A

MRI pelvis

294
Q

When is azathioprine used in Crohn’s?

A
  1. 2 or more exacerbations within 12 months requiring steroids
295
Q

What are the 4 pregnancy related liver disorders?

A
  1. cholestatic
  2. Acute fatty liver
  3. Hyperemesis
  4. HELLP
296
Q

Why are 2 colonscopies recommended to diagnose angiodysplasia assicated with aortic stenosis?

A

May not pick up angiodysplasia

capsule endoscopy is next step after x2 colonoscopy

297
Q

How does VIPoma cuase diarrhoea?

A

gut hormone secreting tumour in pancreas or small bowel causing watery diarrhoea and electrolyte deficienties (K+)

298
Q

How is cholera contracted?

A

Shellfish with perfuse watery diarrhoea

299
Q

Which blood test should be checked prior to starting thiopurines?

300
Q

What are the 3 complications of thiopurines

A
  1. myelosuppresion
  2. deranged LFT
  3. PANCREATITIS
301
Q

What is an example of protein losing enteropathy?

A

sarcoidosis

302
Q

Which electrolyte abnormality is seen in alcohlism and malnutrition?

A

Hypomagnesaemia

303
Q

How does hypomagnesaemia cause hypocalcaemia?

A

Mg needed for PTH release => low PTH means low Ca

304
Q

What is the management for Achalasia?

A

Dilation with balloon

305
Q

What is the analgesia of choice for chronic abdominal pain from chronic pancreatitis?

306
Q

Which GI cancer is paraprotein release seen?

A

MALT lymphoma

307
Q

What is the link between aspirin and GI cancer?

A

reduced risk

308
Q

What is the link between vitamin C and GI cancer?

A

low vitamin C increases risk of cancer

309
Q

When is erythema marginatum seen?

A

Rheumatic fever

pink red rash with pale centre

310
Q

When is the onset of Wilson’s?

A

10-25 years

311
Q

What is Hyatid disease and what is the vector?

A

cyst forming by echinococcus granulosis

farm animals (sheep)

312
Q

What is Pellagra?

A

DDD

Diarrhoea
dermatitis
dementia

nicotinic acid deficiency as carcinoid tumour uses

313
Q

What type of cell is MALT lymphoma?

314
Q

What is TIPSS and when is it used?

A

forming low resistace channel between hepatic vein and portal vein

only indicated in refractory ascites

MRCP Part 1 (17 decks)

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