1001. 23/09/20 Flashcards
What is meant by the truelove and Witts criteria?
Assessment of ulcerative colitis
- motions per day
- rectal bleeding
- temperature
- resting pulse
- hemoglobin
- ESR
What is the picture of bloods in UC?
CRP usually normal
Albumin low and platelets high
Fetal calprotectin= gut inflammation of unspecified region
What is the treatment line in UC?
- 5ASA- sulphasalizine, mesalazine
- Thiopurines- azathioprine, methotrexate
- Biologics- adalimumab, infliximab
How do 5 ASA’s work in UC?
Reduce inflammation
How do thiopurines work?
Deactivate a process in T lymphocytes in order to reduce inflammation
How does infliximab work?
TNF-alpha antagonist
What bloods tests are done when commencing thiopurines?
Blood test daily, weekly, then monthly
What is screened for before thiopurines are commenced?
HEP B/C, HIV, TB, TMPT (metabolic enzyme)
If they’ve not had EBV then don’t give azathioprine due to more lymphoma
What do you give for an acute flare of IBD?
Steroids
Those with IBD are at an increased risk of cancer. How are they screened?
After 8 years of diagnosis they are called back every 1-5 years (depending on severity)
What non GI and NOT Eye conditions are UC related to
Erythema nodosum- shins red and circular. relates to disease activity
Pyoderma gangrenosum- very not nice not related to disease activity
Arthritis- small joints- related to disease activity,
large joints- not related to disease activity
Ankylosing spondylitis- not related to disease activity
Primary sclerosing cholangitis
What eye conditions are related to UC?
Episcleritis- not sight threatening
Scleritis- sight threatening (steroids)
Uveitis- sight threatening (steroids)
Discuss the surgical treatments for UC and Crohn’s?
UC- usually cut out colon and leave rectal pouch. Rectum will remain inflamed. Can join up gut after 1 year.
UC- surgery usually not indicated as will need multiple surgeries and not curative. May also lead to small gut syndrome
What is common with crohn’s?
Structures and obstructions
What are the long term conditions of UC?
Toxic megacolon (3,6,9)
Deterioration
Sepsis
Everyone in UC that comes into hospital gets an abdo film
What is ALT a sign of?
Hepatocyte death
caused by viral hepatitis, hypotension, paracetamol overdose
What is AST a sign of?
Mitochondrial death (alcohol or established cirrhosis)
What is alk phos and ggt a sign of?
Biliary epithelial inflammation
obstruction (e.g. stones)
infiltration (psc)
Congestion (pregnancy)
What is high bilirubin a sign of?
Rapid RBC death or gilbert’s syndrome
What do the AST:ALT ratios show?
2: 1- indicates alcohol related liver disease
1: 1- likely ischemic
1: 2- paracetamol
How is fatty liver treated?
Diabetic control
weight loss
Vit E
What two hepatitis’ go together?
Hep B and D
What hepatitis are related to sexual and needles?
These are the only hepatitis treated with antivirals
Hep B and C
What Hepatitis can be spread through the household?
Hep B
What is the treatment for HEP A, D and E
A- self limiting, supportive care
D-peginterferon-a
?ribavirin
Why is alpha fetoprotein tested for in the liver screen?
Both HCC and metastasis cause this to be released
Pregnant women excrete it
May be elevated due to downs nd…
Why is alpha 1 antitrypsin tested for in the lvier screen?
Leads to an elastase break down in the lungs and liver
Accelerates emphysema and cirrhosis process
How is hCT treated?
Venesection
Iron chelating agents
Reduce dietary intake
Why is caeruloplasmin tested for in a liver screen?
Wilson’s disease- presents under 40 typically
Copper deposition in the liver
Low serum copper (urinary)
Low caeruloplasmin
Gold rings before the eye
How is wilson’s disease treated?
Penicillamine (copperchealation)
If patient has a raised GGt and MCV what is the likely diagnosis?
Alcohol excess
What hepatitis can be caught through pork consumption?
Hep E
What antibodies are tested for in a liver screen.
What does this show?
IgA-Alcohol
IgG-Autoimmune hepatitis (need liver biopsy to confirm)
IgM- Primary biliary cholangitis
What autoantibodies are tested for and why?
ANA/Smooth muscle- autoimmune hep
LKM- autoimmune hep
Anti-mitochondrial antibody- PBC
ANCA- PSC
