Extra GI Flashcards
Functions of vitamin A:
- retinol
- converted into retinal - visual pigment
- epithelial cell differentiation
- antioxidant
Consequences vitamin A deficiency:
night blindness
Vitamin B6 deficiency cause:
isoniazid therapy
Consequences of vitamin B6 deficiency:
- peripheral neuropathy
- sideroblastic anaemia
- anaemia, irritability, seizures
Function of vitamin B6:
- water soluble
- converted to pyridoxal phosphate
- cofactor for transamination, deamination and decarboxylation
Functions of vitamin C:
- ascorbic acid
- water soluble
- antioxidant
- collagen synthesis
- facilitates iron absorption
- cofactor for norepinephrine synthesis
Features vitamin C deficiency:
- scurvy - defective collagen synthesis and capillary fragility
- gingivitis, loose teeth
- poor wound healing
- bleeding from gums, haematuria, epistaxis
- general malaise
- follicular hyperkeratosis and perifollicular haemorrhage
- ecchymosis, easy bruising
- Sjogren’s
- arhtralgia
- oedema
Functions of vitamin B1:
- thiamine
- water soluble
- phosphate derivative - thiamine pyrophosphate
- co-enzyme in enzymatic reactions
- catabolism of sugars and amino acids
Causes of thiamine (B1) deficiency:
- alcohol excess
- malnutrition
Conditions associated with thiamine deficiency:
- Wernicke’s encephalopathy: nystagmus, ophthalmoplegia and ataxia
- Korsakoff’s syndrome: amnesia, confabulation
- dry beriberi: peripheral neuropathy
- wet beriberi: dilated cardiomyopathy
Function of vitamin B3:
- niacin
- water soluble
- precursor to NAD+ and NADP+
Consequences niacin deficiency:
pellagra: dermatitis, diarrhoea, dementia
Vitamin B7 deficiency consequences:
- biotin
- dermatitis, seborrhoea
Vitamin B9 deficiency consequences:
- folic acid
- megaloblastic anaemia
- deficiency during pregnancy: neural tube defects
Vitamin B12 deficiency consequences:
- cyanocobalamin
- megaloblastic anaemia
- peripheral anaemia
Other name for vitamin D:
- ergocalciferol
- cholecalciferol
Vitamin E deficiency:
- tocopherol
- tocotrienol
- midl haemolytic anaemia in newborn infants, ataxia, peripheral neuropathy
VItamin K deficiency:
- naphtoquinone
- haemorrhagic disease of newborn
- bleeding diathesis
First line investigation of dysphagia:
- upper GI endoscopy
- motility disorders: fluoroscopic swallowing studies
- FBC
- achalasia and GORD: oesophageal pH and manometry
What is the liver like in RHF:
firm, smooth, tender liver edge
pulsatile
What is hepatomegaly like in malignancy?
hard, irregular liver edge
What is hepatomegaly like in cirrhosis?
later disease: decreases in size
non-tender, firm liver
What causes melanosis coli and what does histology show?
- laxative abuse (anthraquinone e.g. senna)
- pigmentation of bowel wall
- pigment laden macrophages
What is the most common cause of HCC worldwide?
hepatitis B
What is the most common cause of HCC in Europe:
hepatitis C
Who should be screened for HCC?
- cirrhosis secondary to hep B and C or haemachromatosis
- secondary to alcohol
Management options HCC:
- early disease: surgical resection
- liver transplantation
- radiofrequency ablation
- transarterial chemoembolisation
- sorafenib: multikinase inhibitor
What qualifies as malnutrition:
- BMI <18.5
- unintentional weight loss greater than 10% within last 3-6months
- BMI less than 20 and unintentional weight los greater than 5% in 3-6 months
Consideration of IBS:
6 months of
- abdominal pain and/or
- bloating and/or
- change in bowel habit
Diagnosis of IBS:
-abdominal pain relieved by defecation with 2 of:
-altered stool passage
-abdominal bloating
-symptoms worse by eating
-passage of mucus
(also lethargy, nausea, backache, bladder)
Red flag symptoms when diagnosing IBS:
- rectal bleeding
- weight loss
- family history of bowel or ovarian cancer
- onset after 60
Primary care investigations IBS:
- FBC
- ESR/CRP
- coeliac disease screen (TTG)
‘urgent’ symptoms indicating oesophageal or stomach cancer:
- all dysphagia
- upper abdominal mass
- > =55yo with weight loss and any of pain, reflux or dyspepsia
‘non urgent’ symptoms suggesting oesophageal cancer or stomach cancer:
- haematemesis
- >=55yo with treatment resistant dyspepsia, or upper abdo pain with low Hb or raised platelet with symptoms etc.
How can you treat someone with dyspepsia which do not meet referral criteria?
- review medications for possible causes
- lifestyle
- trial full dose PPI for 1 month or test and treat H pylori
Underweight BMI
<18.49
Normal BMI:
18.5-25
Overweight BMI
25-30
Obese I
30-35
Obese II
35-40
Obese III
> 40
What type of tumours are most pancreatic tumours?
adenocarcinomas
Associations pancreatic cancer?
- hereditary non-polyposis colorectal carcinoma
- MEN
- BRCA 2
- KRAS
- chronic pancreatitis
- smoking
- diabetes
- age
Features of pancreatic cancer:
- painless jaundice
- pale stools, dark urine, pruritus
- cholestatic liver function tests
- steatorrhoea
- atypical back pain
- migratory thrombophlebitis (Trousseau)
Investigations pancreatic cancer:
- US
- high res CT - if diagnosis suspected
- double duct sign
Antidiarrhoeal agents:
-loperamide
-diphenoxylate
(opioid agonists)
What is metoclopramide used for?
- D2 receptor antagonist
- nausea
- GORD
- prokinetic - gastroparesis
ADR metoclopramide:
-extrapyramidal: oculogyric crisis
-hyperprolactinaemia
-tardive dyskinesia
-parkinsonism
avoid in bowel obstruction
Prophylactic ABx splenectomy:
penicillin V (500mgBD or amoxicillin 250mgBD)
Vaccination with splenectomies:
- elective: 2 weeks before
- Hib, meningitis A and C
- annual influenza
- pneumococcal
Type I herpatorenal syndrome:
- rapidly progressive
- doubling of serum creatinine to >221micromol/L or halving of creatinine clearance to less than 20ml/min over less than 2 weeks
- very poor prognosis
Type II hepatorenal syndrome:
- slowly progressive
- poor prognosis
- may live longer
Management hepatorenal syndrome:
- vasopressin analogues e.g. terlipressin
- volume expansion 20% albumin
- TIPSS
ADR PPI:
- hyponatraemia, hypomagnesaemia
- osteoporosis - increased risk of fractures
- microscopic colitis
- increased risk of C diff
What is bile acid malabsorption:
- cause of chronic diarrhoea
- excessive bile acid production or reduced absorption
- leads to steatorrhoea and vitamin ADEK malabsorption
- secondary causes: cholecystectomy, coeliac, small intestinal bacterial overgrowth
Investigation bile acid malabsorption:
SeHCAT
Management bile acid malabsorption:
bile acid sequestrates e.g. cholestyramine
Risk factors small bowel bacterial overgrowth syndrome:
- neonates with congenital GI abnormalities
- scleroderma
- diabetes mellitus
Diagnosis small bowel bacterial overgrowth syndrome:
- hydrogen breath test
- small bowel aspiration and culture
Antibiotic therapy for small bowel bacterial overgrowth syndrome:
rifaximin
co-amoxiclav or metronidazole
