Extras Flashcards
Test for bile acid malabsorption
SeHCAT test
done 7 days apart to see how much of the nuclear stuff you have retained
crohns
cholecystectomy
celiac disease
small intestinal bacterial overgrowth
treat with bile acid sequestrants like cholestyramine
Features of PBC
asymptomatic increase ALP middle aged women xanthelasmas, xanthomatas increase pigmentation over pressure points fatigue pruritis cholestatic jaundice
20 x increased risk gallbladder cancer
malabsorption–>osteomalacia and coagulopathy
sicca in 70%
portal hypertension
gastroparesis diagnosis
suggestive to have food undigested in stomach after ovenight fast
but gold standard is 99mtech labelled egg white meal gastric emptying scan
but opioids and functional dyspepsia false pos
prokinetics but remember tardive dyskinesia if over 3 months
Diabetics with gastroparesis what to do
amylin analogues- pramlintide and GLP1 agonists (exentaide) reduce gastric emptying so could stop
metoclopramide MOA
antag D2
antag 5HT3
Ag 5HT4
do cyclo and tac cause gastroparesis
cyclo not tac
cut off for liver tx meld
If meld under 15 then risks of transplants outweight the benefits
After bariatric surgery can get what type ofcomplication
NAFLD faler
when do you do capsule endoscopy
very clear that only indicated if replace iron but then FAIL and have RECURRENT iron der
does normal CRP rule out crohns
no
role for ERCP for cholangio screen in PSC
no
but if jump in LFTs then do
what gets lost first when clearing hep B
eAg before aAg
suspect IBD in young woman, what to do
either low fodmap
or faecal calprotectin
NASH score how useful
to predict who will go on to get cirrhosis
higher if DM2 or IGT
most important EUC abnormality in hepatic enceph
hypokalaemia
what is microscopic colitis
profuse watery diarrhoea in mid to older person
biopsy increased both in the surface epithelium (“intraepithelial lymphocytes”) and in the lamina propria
benign
budesonide
who with haemochromatosis is at risk cirrhosis
ferritin over 1000
age over 50
normal ALT
treat ileal resection diarrhoea
cholestyramine
most well studied RF for IBS
infectious diarrhea in 1/3
prominent gastric folds with a single ulcer, think
zollinger ellison
how diagnose zollinger ellison
fasting serum gastrin over 10 x ULN and pH under 4 gastric
must check gastric pH because high levels also in atrophic gastritis, renal failure, vagotomy - but ehre pH will be over 4’
if cannot make it, then secretin stimulation test will do it (should inhibit G cells but tumour cells are stimulated)
PPI false positive
when is serum chromogrannin A useful
increase in patients with gastrinomas even without liver mets
normal levels if secondary to atrophic gastritis
treat gastrinoma
mediacl therpay with high dose PPI if with MEN 1
sporadic- medical and resect
sometimes may respond to somatostatin analogue
what are the two phenotypes of H pylori infectin
antral predomonant gastritis–>predispose duodenal ulcers
pangastritis –>multifocal gastric atrophy and intestinal metaplasia–>carcinoma and gastric ulcers
