Conditions Flashcards
Extraintestinal manifestations of Crohn’s
Erythema nodosum
Pyoderma gangrenosum
VTE
Primary sclerosing cholangitis
Uveitis
Anklyosing spondylitis
Induction therapy paediatric for Crohn’s
1st line
- Liquid based polymeric diet 8/52
- OR 2/12 Prednisolone 1mg/kg slow wean
Maintenance therapy paediatric Crohn’s
Azathioprine or MTX
Anti-tumour necrosis factor agents
- Infliximab
Inducing remission therapies Crohn’s
Prednisolone
5-ASA - mesalazine
antiTNF if refractory to steroids
Maintenance of remission Crohn’s
Azathioprine or MTX
Infliximab
Routine health maintenance of Crohn’s
Vaccinations
Osteoporosis prevention
Sexual health
Depression
Yearly skin check
Colon cancer screening
Wernicke encephalopathy sx + tx
Triad; ophthalmoplegia, ataxia, confusion
Tx
- Thiamine 500mg IV TDS 7/7 then 100mg IV daily for 2/52 then 100mg PO daily after
Ddx chronic diarrhoea
IBS
Functional diarrhoea
IBD
Coeliac / SIBO
C diff / Giardia
Drug - metformin, Abx, NSAID, Mg
Hyperthyroidism
Laxative abuse
Anxiety
Upper GIB hx
Reflux/epigastric pain
Weight loss
Odynophagia (oesophageal ulcer)
Alcohol intake
Retching coughing prior to haematemesis (mallory-weiss tear)
Excessive vomiting
NSAID/anticoagulants
Prev episodes of haematemsis/melaena
Cause of Upper GIB
Mallory-Weiss
Ruptured oesophageal varices
Gastritis
Bleeding ulcer
Angiodysplasia
Polyps
Malignancy
Mx Upper GIB
NBM
IV cannula x2 large bore
IV pantoprazole
Fluid resuscitation
Transfusion
Immediate gastro advice
Rome III criteria IBS
Abdo pain 3 days per month for last 3/12 with 2 of following
- Improvement after defecation
- Onset of sx assoc with change in bowel freq
- Onset of sx assoc with change in stool appearance
Mx IBS
Regular meal times + portion
Diet
- Avoid known triggers
- Fibre 25g female, 30g male
- Low FODMAP
CBT
Loperamide for diarrhoea
Pain
- Peppermint oil 0.2ml capsule 2 capsules TDS 30min prior to food
Antidepressant to reduce hypersensitivity and pain
- Amitriptyline 5mg nocte
Abx
- Rifaximin 550mg TDS for non-constipated IBS
H pylori mx
Esomeprazole 20mg BD 7/7
Amoxicillin 1g BD 7/7
Clarithromycin 500mg BD 7/7
Repeat breath test 4/52 post tx
Smoking cessation
Avoid triggering food
Stress management
DDx conjugated hyperbilirubinaemia
Intrahepatic
- ETOH liver disease
- Primary biliary cirrhosis
- Autoimmune hepatitis
- Drug induced
- Wilson’s disease
- HCC
- NALD
- Viral hepatitis
Extrahepatic
- Biliary atresia
- Gallstone
- Chronic pancreatitis
- Pancreatic cancer
Mx GB polyps
IF symptomatic or >10mm-> cholecystectomy
Surveillance
- 6-9mm size; USS 6/12 for 1 year - then annually
- <=5mm; USS annually
Acute cholangitis features
Charcot’s triad; RUQ, fever, jaundice
Reynold’s Pentad; Charcot’s triad PLUS hypotension and mental status changes
Acute pancreatitis causes
Idiopathic
Gallstones
ETOH
Trauma
Steroids
Mumps
Autoimmune
Scorpion bite
Hyperlipidaemia
ERCP
Drugs; HCTHZ
Mx pancreatitis
IV fluids
Morphine/fentanyl
Antiemetic
NBM
Risk factors pancreatic ca
Smoking
Obesity
ETOH
DM >5 years duration
FDR
BRCA1 carrier
Features of pancreatitis
> =60yo
weight loss
Back/upper abdo pain
altered bowel habit
nausea/vomiting
new onset diabetes
Ix pancreatic cancer
Urgent CT abdo + contrast
LFT
Lipase
Coag
Ca19.9, CEA
DDx splenomegaly
CML
Lymphoma
Thalassaemia
Haemolytic anaemia
Malaria
EBV
Hepatitis
Vasculitis
Sarcoidosis/amyloidosis
LFT patterns
AST:ALT >2 = ETOH
NAFLD: AST + ALT <4x upper limit
Acute viral/toxin; AST + ALT >25x upper limit
Cholestasis; ALP > 200 and >3x than ALT
History for LFT derangement
Toxin; drug, ETOH, herbal
IVDU/tattoo/sex/endemic travel
Haemochromatosis; bronze skin, DM, arthritis, hypogonadism
Obesity
Pregnancy; gallstones
IBD; primary sclerosing cholangitis
Coeliac disease
Thyroid
Raised ALP cause and work-up
DDx; #, osteomalacia, Pagets, hyperparathyroidism, hyperthyroidism, sarcoma, bony mets
Ix
- Ca, PTH, Vit amin D
- Bone scintigraphy
Raised transaminases workup
Paracetamol level
Viral hepatitis serology
bHCG
Autoimmune screen; ANA, ASMA, Anti-LMK
USS
Mx NALFD
Fibrosis staging; Fibrosis -4 score or Elastography
Avoid ETOH
Weight loss 5-7%
Hypocaloric diet 500 cal
If metabolic syndrome features -> needs specialist referral and consideration of biopsy
If nil metabolic features -> 6/12 lifestyle mx
Monitoring
- w/o fibrosis - 2 yearly liver scores/elastography
- cirrhosis; 6/112 HCC surveillance (USS + AFP)
Indications to tx chronic hep B
Immune clearance
- Lower HBV, Raised ALT, HBeAg +ve
Immune escape
- High HBV, Raised ALT, HBeAg -ve, anti-HBe +ve
Complications of decompensated cirrhosis
Variceal haemorrhage
Ascites
Spontaneous bacterial peritonitis
Hepatic encephalopathy
HCC
Hepatorenal syndrome
Hepatopulmonary syndrome
Small intestinal bacterial overgrowth
Excess/abnormal bacteria in small bowel
Bloating, distension, flatulence
Glucose breath test positive
Coeliac Ix
Coeliac serology
- Transglutaminase (tTG) antibody
- Deamidated gliadin peptide antibody
Total IgA can exclude coeliac-disease associated IgA deficiency
HLA DQ2/8 genotyping
- helps with diagnosis if unclear serology/biopsy - good for excluding
Coeliac disease mx
Education
GF diet +/- dietician
Refer coeliac support group
Screen all FDR
BMD 2 yearly
Repeat gastroscopy 2 years after GFD
Monitor serology as marker of intestinal healing
Diverticulitis mx
Mild-moderate; conservative
Diet
- Clear liquid 2/7
- Low fibre diet until pain improves
- Panadol +/- buscopan
Systemic features, fever, elevated WCC, failed conservative
- Augmentin 875/125mg BD 5/7
Prevention
- high fibre diet
- cease smoking
Eosinophilic oesophagitis
Allergic disorder
Unclear cause - milk, wheat, soy, seafood implicated
Sx; dysphagia, heart burn, dyspepsia
Minimal tx with GORD tx
Not assoc with Barrett’s or Ca
Dx biopsy
Mx
- elimination diet - allergy testing
- Topical fluticasone + budesonide
Monitoring of Barrett’s oesophagus
Short segment <3cm; 3-5 yearly
Long segment; 2-3 yearly
Indications for endoscopy
Anaemia
Dysphagia/odynophagia
Haematemesis/melaena
Weight loss
New sx in older person
Changing sx
Severe/freq sx
Inadequate response to tx
Diagnostic clarification
Distal oesophageal spasm mx
GTN 400mcg sublingual
Diltiazem 180mg daily
Haemorrhoids mx
Avoid straining
Constipation mx
Proctosedyl
Rubber-band ligation
Perianal haematoma (aka thrombosed external haemorrhoid) mx
Severe pain; excision under LA within 72hrs
Cool compress
Sitz bath BD
Donut pillow to relieve pressure
Increase fibre
Avoid exercise
Anal fissure mx
High fibre
Stool softener
Sitz bath
GTN 0.2% ointment 1.5cm into anal canal TDS
Topical diltiazem
Botox
Surgical sphincterotomy
Malnutrition workup
FBC
Blood film
Ferritin
Folate
INR
Albumin
U+E
Lipid
Vitamin D