extra Flashcards
what is the role loperamide
Loperamide is used to firm stool
what is the role of Ursodeoxycholic acid
Ursodeoxycholic acid disperses cholesterol and is used in the dissolution of gallstones and to treat primary biliary cirrhosis.
role of Cholestyramine
Cholestyramine is used to treat itch in patients with liver disease (and also has an effect in lowering cholesterol)
role of calprotectin
Calprotectin is a measure of gastrointestinal inflammation (think of it like CRP for the bowel)
what is the SeHCAT scan
the SeHCAT scan measures bile salt reabsorption, and is a test used to investigate chronic diarrhoea
what group is gallstone ileus common in and how does it present
Gallstone ileus is more common in the elderly and presents with evidence of small bowel obstruction (secondary to impacted calculus) –
chronic pancreatits symptoms vs acute pancreatitis
Chronic pancreatitis will have a longer history of pain, often after meals or drinking alcohol and is associated with weight loss, and malabsorption.
intestinal ischacemia differentiated from acute pancreatitis
Ischamiea pain not relieved by sitting and is often associated with rectal bleeding.
when is MRCP useful
if gallstones a likely aetiology especially if the biliary tree is dilated and stones need to be demonstrated (MRCP) and removed (ERCP).
what is malignant ascites
Malignant ascites is found in patients with malignancies in the peritoneum which lead to ascites, via increased production of peritoneal fluid and concurrent decreased resorption.
when is bowel perforation common
Bowel perforation would be more likely in a patient with a known gastrointestinal disease such as Crohn’s disease or ulcerative colitis, or as a complication of bowel surgery.
what is the presentation of Haemoperitoneum
Haemoperitoneum would be more likely following blunt or penetrating trauma, or from a ruptured blood vessel, and would unlikely be associated with a fever. Furthermore, the patient would be expected to be haemodynamically unstable.
gilbert vs NAFLD
Like non-alcoholic fatty liver disease, Gilbert syndrome can also present as jaundice following fasting. Indeed, dehydration, intercurrent disease, menstruation, and strenuous exertion can all trigger episodes in predisposed patients. In Gilbert syndrome, however, unconjugated bilirubin is typically elevated, whilst liver enzymes concentrations are normal. This is because Gilbert syndrome is caused by a mutation in the enzyme responsible of bilirubin conjugation with glucoronic acid (UGT1A1). When stressors increasing bilirubin production are present, UGT1A1 is overwhelmed and serum unconjugated bilirubin rises.
which disease is unlileky with a normal ferritin
haemochromatosis - although it should always be considered in patients with both abnormal LFTs and diabetes.
Which imaging modality for bowel obstruction
abdominal x-ray
- may present with vomiting and constipation
which imaging too for large bowel pathology?
Colonoscopy is required to assess the large bowel for signs of pathology (e.g. in the case of bleeding, diverticulum or suspicion of colorectal cancer.)
what is hepatorenal syndrome and how does it present?
a type of functional kidney impairment that occurs in patients with advanced liver disease. The key features include ascites, low urine output, and a significant increase in serum creatinine.
first line drug for hepatorenal syndrome and mechanism?
Terlipressin, a vasopressin analogue, is the recommended first-line treatment for HRS according to UK guidelines. It works by inducing splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow.
Role of ocreotide
Octreotide is primarily used to manage variceal bleeding and certain types of tumours such as somatostatinomas and carcinoid tumours.
Uses of propranolol (specifically in GI/Liver)
Propranolol typically used for primary prophylaxis against variceal bleeding in cirrhotic patients or for treating hypertension or certain arrhythmias.
role of Acetylcysteine
Acetylcysteine is an antioxidant used mainly for paracetamol overdose;
role of dopamine
Dopamine, while being a renal vasodilator that can theoretically improve renal perfusion, has not been found to be beneficial in the treatment of hepatorenal syndrome according to multiple clinical trials.
which diseases do stopping smoking have most impact on in gi/liver
primary biliary cirrhosis and alcoholic liver disease,
do statins help NAFLD
While statins can lower cholesterol levels and reduce cardiovascular risk, they have not been proven to reverse or halt the progression of NASH specifically.
role of Sulfonylureas
Sulfonylureas are a class of medications used in type 2 diabetes management
Which class of diabetic drugs can be counterproductive in NAFLD
Sulfonylureas - these medications could potentially exacerbate weight gain which would be counterproductive in managing NASH.
Why should aspirin and naproxen be avoided in cirhottic patients
due to the risk of acute renal failure and bleeding (unless in low-dosage in patients whose cardiovascular disease risk outweighs the cirrhosis disease burden).
when should
