Corrections 2 Flashcards
What is pseudomembranous colitis?
A severe, potentially life-threatening infection of the colon caused by C. difficile.
What is pseudomembranous colitis most commonly associated with?
Broad-spectrum antibiotics, particularly cephalosporins such as Cefaclor.
What is hepatorenal syndrome?
A type of functional kidney impairment that occurs in patients with advanced liver disease.
Key features:
1) ascites
2) low urine output
3) significant increase in serum creatinine
1st line mx of hepatorenal syndrome?
Terlipressin –> induces splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow.
What is the 1st line investigation for diagnosis of small bowel overgrowth syndrome?
Hydrogen breath test
What do all patients who have had an episode of SBP require?
Antibiotic prophylaxis –> ciprofloxacin
What is the prophylactic antibiotic of choice in SBP?
Ciprofloxacin or norfloxacin
What can the causes of ascites be grouped into?
1) Those with a SAAG <11g/L
2) Those with a SAAG >11g/L
What does a SAAG >11g/L indicate?
Portal HTN
What are the causes of an ascites with SAAG >11g/L?
1) Liver disorders are most common:
- cirrhosis/alcoholic liver disease
- acute liver failure
- liver metastases
2) Cardiac:
- RHF
- constrictive pericarditis
3) Other:
- Budd-Chiari syndrome
- portal vein thrombosis
- veno-occlusive disease
- myxoedema
What are some causes of an ascites with SAAG <11g/L?
1) Hypoalbuminaemia:
- nephrotic syndrome
- severe malnutrition (e.g. Kwashiorkor)
2) Other:
- pancreatitis
- bowel obstruction
- biliary ascites
- postoperative lymphatic leak
- serositis in connective tissue diseases
Mx of ascites?
1) Reducing dietary sodium
2) Aldosterone antagonists: e.g. spironolactone (N.B. can add loop diuretics)
3) Drainage if tense ascites (therapeutic abdominal paracentesis)
4) Prophylactic abx to reduce risk of SBP (ciprofloxacin): offer to those with cirrhosis and ascites with an ascitic protein of 15 g/litre or less
5) Can consider TIPS
What ascitic protein level should prophylactic abx be given to prevent SBP?
<15 g/L
What is required for large-volume paracentesis in the treatment of ascites?
Albumin cover –> reduces paracentesis-induced circulatory dysfunction and mortality
What 2 electrolyte disturbances can cause torsades de pointes?
1) hypokalaemia
2) hypomagnesaemia
ECG changes in hypomagnesaemia?
Same as hypokalaemia:
- U waves
- small T waves
- PR prolongation
- ST depression
- long QT
What condition is most strongly associated Helicobacter pylori infection?
Duodenal ulceration
What is carcinoid syndrome?
usually occurs when metastases are present in the liver and release serotonin into the systemic circulation
What is often the earliest feature of carcinoid syndrome?
flushing
Features of carcinoid sydnrome?
- flushing
- diarrhoea
- bronchospasm
- hypotension
- right heart valvular stenosis
- other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing’s syndrome
Mx of carcinoid syndrome?
somatostatin analogues e.g. octreotide
What can be used to help with diarrhoea in carcinoid syndrome?
cyproheptadine
What does a high SAAG gradient (>11 g/L) indicate?
Portal HTN
What is mx if a severe flare of UC has not responded to IV steroids after 72 hours?
Add IV ciclosporin, or surgery
What triad is seen in liver failure?
1) coagulopathy
2) encephalopathy
3) jaundice
What are signet ring cells?
A type of cell that can be seen in certain types of cancer, most commonly gastric adenocarcinoma
Mx of H. pylori?
PPI + amoxicillin + clarithromycin, or
PPI + metronidazole + clarithromycin
Mx of a liver abscess?
IV abx & drainage
What may be used to stop an uncontrolled variceal haemorrhage?
Insertion of a Sengstaken-Blakemore tube
What is a small hard swelling lateral to the umbilicus suggestive of?
A periumbilical lymph node (AKA a Sister Mary Joseph nodule).
What is a periumbilical lymph node (AKA a Sister Mary Joseph nodule) classically associated with?
Gastric carcinoma
Mechanism of loperamide?
Stimulation of opioid receptors in the submucosal neural plexus of the intestinal wall –> reduces gastric motility.
Mx of a mild-moderate flare of UC that does not respond to topical or oral aminosalicylates?
Add oral steroids
1st line vs gold standard investigation in diagnosis of coeliac disease?
1st line –> IgA-tTG test
Gold standard –> endoscopy and biopsy
Why should anti-motility and anti-peristaltic medications (e.g. morphine) be stopped in C. diff infection?
As these can predispose to toxic megacolon by slowing the clearance of C. diff toxin.
You wish to screen a patient for hepatitis B infection.
What is the most suitable test to perform?
HBsAg
A positive HBsAg implies either acute or chronic hepatitis B.
What doe a positive anti-HBs imply?
immunity through either previous immunisation or disease
Anti-HBs vs anti-HBc?
Anti-HBs implies immunity (either exposure or immunisation). It is negative in chronic disease.
Anti-HBc implies previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. IgG anti-HBc persists.
How long prior to an upper GI endoscopy should PPIs be stopped?
2 weeks
Mx of a severe flare of UC?
IV corticosteroids
What is cause of itching in gallstones?
Hyperbilirubinaemia
Mx of a pharyngeal pouch?
Surgical repair (myotomy) & resection
What is used to assess the severity of an UC flare?
The Truelove and Witts’ severity index
According to the Truelove and Witts’ severity index, what indicates a ‘severe’ UC flare?
When the patient has blood in their stool, or is passing more than 6 stools per day plus at least one of the following features:
1) Temperature greater than 37.8°C
2) Heart rate greater than 90 beats per minute
3) Anaemia (Hb less than 105g/ L)
4) ESR greater than 30 mm/hour
Diarrhoea, fatigue, osteomalacia →?
Coeliac disease
How can severe iron deficiency anaemia cause dysphagia?
due to post-cricoid webs (part of Plummer-Vinson syndrome)
Features of a peri-anal abscess?
Swollen, tender, fluctuant lump next to anus
Mx of a peri-anal abscess?
Incision & drainage
